Published studies estimate that a significant proportion of pediatric patients have high levels of anxiety and distress before undergoing a new medical procedure, such as MRI. “Poor management of anxiety and a lack of effective preparation can result in patients moving during a medical imaging procedure,” explains John Jacob, MSc, MBA. “This can degrade the quality of the image, rendering it incomplete or inadequate for clinical use. To mitigate these situations, sedation may be used during scans, but this approach increases medical and operational complexity, requiring additional time, resources, and costs to the system.”

 

Comparing Preparation Approaches for Pediatric MRI

For a study published in the Journal of Medical Internet Research, Jacob and colleagues compared the effectiveness of a virtual reality (VR)-based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. The authors also compared caregiver anxiety, usability, procedural data, child satisfaction, and perceived fun. “We wanted to explore whether we could replicate and improve on the current best practice of a real-world preparation session through a VR experience,” Jacob says.

At a 2-hour session, study participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The trial included 84 children aged 4-13 in the final analysis, with 30 patients receiving VR-MRI, 24 receiving SPM, and 30 receiving the hospital-based CLP.

 

Success Rates Comparable Between Approaches to Pediatric MRI Head Scans

“We found no statistically significant difference in ‘success rates’ between the real-world simulation experience and our VR experience,” says Jacob. “This is the result we were hoping for, as it supports the notion that VR could be used as an alternative or supplement to the current simulation sessions, increasing access and offering a lower-cost alternative for additional preparation opportunities.” VR-MRI mitigated situational anxiety in children throughout their preparation for and completion of simulated MRI head scans.

Caregivers in the study were asked about how easy or difficult the preparation materials were to learn and use, as well as how useful and satisfied they were with using the materials to prepare children for the simulated MRI experience (Figure). Caregivers were significantly more anxious after preparing with the manual than with other interventions. On average, caregivers using CLP agreed it was useful, easy to use, and easy to learn. Caregivers reported being significantly more satisfied with the VR-MRI app and CLP than with SPM, whereas children reported the highest satisfaction with the CLP. There were no differences in how much fun caregivers perceived the preparation materials to be.

 

VR-MRI: An Affordable & Viable Alternative

The potential use for VR in healthcare is exciting and continues to advance, says Jacob. “Many researchers are already exploring use of VR in pain management and other therapeutic interventions,” he adds. “Our study demonstrated how VR can be used for orientation, exposure, and procedural training in a way that can lead to real clinical and healthcare systems outcomes. For example, safely reducing the number of kids requiring sedation for an effective procedure can increase throughput, reduce waitlists, improve time to diagnosis, and enhance clinical outcomes. The broader accessibility of the VR experience also offers an opportunity for parents to gain first-hand insight into the experience by undertaking the training themselves. We have observed that this can influence how caregivers talk to their kids, and in turn, how children perceive the overall situation. This is an area we are hoping to study further as well.”

According to the investigators, further studies are needed to confirm the findings with actual pediatric patients in a real MRI machine, as the current study was conducted using the MRI simulation suite at a hospital. “Our next step is to apply our intervention to a real-world setting and follow outcomes over a longer term,” Jacob explains. “We intend to dive deeper into the economic impact of using VR-MRI for both patients and families and for the healthcare system at large.”