Children with complex medical problems who require anesthesia are known to be at risk for acute adverse physiologic events related to anesthesia. The risks of anesthesia include short- and long-term psychological and neurobehavioral issues. Magnetic resonance imaging (MRI) has emerged as the standard of care for diagnosis and follow-up of many conditions, and more children are being subjected to anesthesia to ensure acceptable motion-free image quality of the MRI scans. The aim of this study was to evaluate the effectiveness of an anesthesia-free patient- and family-centered intervention through an analysis of MRI quality, health-care costs, and operational efficiency as compared with other approaches. This study retrospectively reviewed patient data extracted from electronic medical records of children aged 3-17 years, who underwent outpatient MRI at an urban academic medical center from 2015 to 2016. A total matched sample size of 500 children, 125 per group, was used to investigate the outcome variables including the quality of magnetic resonance image, health-care cost, and procedural time. The groups included are as follows (1) intervention group, patient- and family-centered preparation of the child, and no anesthesia given (PFC/NA), (2) comparison group, no structured preparation, and no anesthesia given (SC/NA), (3) comparison group, certified child life specialist preparation, and anesthesia given (CCLS/A), (4) comparison group, no structured preparation, anesthesia given (SC/A). The PFC/NA intervention group was found to have significantly lower costs (p < .0001) and shorter procedure times (p < .0001), and 96.8% of the MRI images were of acceptable or better quality than those of the SC/A and CCLS/A groups. The PFC approach provides a way for children to undergo outpatient diagnostic MRI without the need for anesthesia, thus reducing risk, costs, and procedure time.