A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study

Abstract

Background A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. Objective The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. Methods A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA. Results The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. Conclusions Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process.

Effects of immersive virtual reality exposure in preparing pediatric oncology patients for radiation therapy

“…A total score of 3 or more for any category indicates the presence of simulator sickness within that category with clinical radiation therapists highly rating child compliance during RT procedures, supporting the potential clinical utility of VR exposure as a tool to support patients to prepare for RT without GA. These findings align with previous investigations on the feasibility of VR exposure in practice, with one prior study reporting VR exposure as 'easy to use', 'helpful' and 'enjoyable' in supporting extremely anxious patients as young as 4 years to undergo awake MRI scans [28], while another study found VR exposure to be associated with reduced procedure times, need for parental presence and repeat procedures in patients, aged 4 -8 years, undergoing chest radiography [29]. Taken together, these findings provide emerging evidence for the role of VR exposure in supporting young and/or anxious patients to successfully undergo potentially frightening medical treatments without sedation.…”

“…In the current study, total time in VR was limited to 4 -7 min, similar to the maximum exposure time used by previous studies [28,29,[31][32][33][34]and is in line with current recommendations that aim to protect younger children from any adverse effects [20]. Overall, only mild cases of eyestrain or dizziness and no nausea from VR use were reported by patients, consistent with the very mild or infrequent side effects observed in other VR distraction studies with pediatric hospitalized patients [26,40,[43][44][45] and VR exposure with pediatric patients [28].…”

Safety challenges related to the use of sedation and general anesthesia in pediatric patients undergoing magnetic resonance imaging examinations

“…This immersive experience will soon be leading the way in patient preparation through education and desensitization to the MRI environment, helping to alleviate anxiety related to claustrophobia, to reduce motion artifacts and potentially to avoid need for sedation and general anesthesia [ 68 ]. Ashmore et al [ 69 ] demonstrated MRI VR to benefit parents and caregivers by improving their understanding of their child’s MRI scan, thus reducing their own anxiety and facilitating patient cooperation. MRI VR simulates the child’s MRI journey by replicating the time in the scanner using visuo-spatial and auditory input (Fig.…”

“…Preliminary data and the use of MRI simulators — with complexity ranging from toys to full-scale scanners, yet all showing some benefit — suggest that both models are likely to be effective in improving patient compliance by reducing anxiety and motion, lessening the need for sedation and general anesthesia in children [ 16 , 73 , 74 ]. The optimum age range for MRI VR has not been established, although it is likely to be younger than 12 years [ 16 , 69 ].…”

Predicting multimodal MRI outcomes in children with neurodevelopmental conditions following MRI simulator training

“…Numerous studies have shown that preparation improves compliance and reduces anxiety related to the unfamiliar MRI scan environment (Gabrielsen et al 2018; Ashmore et al 2019). Preparation protocols have included showing child friendly books or videos (Barnea-Goraly et al 2014), playing with MRI toys (Cavarocchi et al 2019), immersion in virtual reality (Ashmore et al 2019; Garcia-Palacios et al 2007), or practicing in an MRI simulator ort “mock scanner”. MRI simulators are widely used and, unlike most other preparation methods, also allow direct training for motion control.…”