Comparing a Virtual Reality–Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial

Abstract

Background The experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed. Objective This study aims to compare 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. Our secondary aim is to compare caregivers’ reported anxiety, procedural data, caregiver usability, child satisfaction, and fun. Methods This unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, 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 primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers’ reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales). Results A total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children’s reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37). Conclusions Digital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting. Trial Registration Clinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382

Efficacy and Safety of Intranasal Dexmedetomidine vs. Oral Chloral Hydrate for Sedation in Children Undergoing Computed Tomography/Magnetic Resonance Imaging: A Meta-Analysis

“…Therefore, pediatric patients are prone to uncooperative behaviors such as crying and moving during Computed tomography (CT) or Magnetic Resonance Imaging (MRI) and other examinations associated with various equipment noises as well as cold, dim and claustrophobic environments. Such adverse emotions and uncooperation will significantly affect the implementation and effect of imaging examinations ( 1 ). Anxiety and fear can lead to increasing catecholamine levels in the body, causing tachycardia, increased airway secretions, shortness of breath; furthermore, the difficulty for children to separate from their parents and complete imaging examinations is risen ( 2 ).…”

Accounting for motion in resting-state fMRI: What part of the spectrum are we characterizing in autism spectrum disorder?

“…Scanning these underrepresented populations requires thoughtful experimental accommodations. Some approaches for improving the likelihood of collecting usable data from pediatric participants focus on scan preparation: having a caregiver model scan procedures, practicing in an MRI simulator ( Horien et al, 2020 ; Nordahl et al, 2016 ; Simhal et al, 2021 ), or playing a virtual reality-based MRI game ( Pua et al, 2020 ; Stunden et al, 2021 ). Others focus on modifications during the scan: passive movie-viewing to reduce boredom ( Vanderwal et al, 2019 ), providing real-time feedback to participants using framewise integrated real-time MRI monitoring (FIRMM) software ( Dosenbach et al, 2017 ; Greene et al, 2018 ), or using personalized incentive systems to reward compliance with MRI instructions ( Pua et al, 2020 ).…”

Accounting for motion in resting-state fMRI: What part of the spectrum are we characterizing in autism spectrum disorder?

“…Scanning these underrepresented populations requires thoughtful experimental accommodations. Some approaches for improving the likelihood of collecting usable data from pediatric participants focus on scan preparation: having a caregiver model scan procedures, practicing in an MRI simulator (Nordahl et al, 2016; Horien et al, 2020; Simhal et al, 2021), or playing a virtual reality-based MRI game (Stunden et al, 2021; Pua et al, 2020). Others focus on modifications during the scan: passive movie-viewing to reduce boredom (Vanderwal et al, 2019), providing real-time feedback to participants using framewise integrated real-time MRI monitoring (FIRMM) software (Dosenbach et al, 2017; Greene et al, 2018), or using personalized incentive systems to reward compliance with MRI instructions (Pua et al, 2020).…”

“…In addition, some studies with autistic children have observed that head motion, while reduced after extensive training, is still associated with symptom severity (Simhal et al, 2021; Gabrielsen et al, 2018). Virtual reality-based games played at home may be as effective as MRI simulator training for typically developing children, (Stunden et al, 2021); however, it remains unclear if children with neurodevelopmental disorders would respond similarly. Investigating in-scanner strategies, Greene et al (2018) found that passive movie-viewing and real-time feedback both reduced head motion, but movie-viewing changed functional connectivity.…”

“…Scanning these underrepresented populations requires thoughtful experimental accommodations. Some approaches for improving the likelihood of collecting usable data from pediatric participants focus on scan preparation: having a caregiver model scan procedures, practicing in an MRI simulator (Nordahl et al, 2016;Horien et al, 2020;Simhal et al, 2021), or playing a virtual reality-based MRI game (Stunden et al, 2021;Pua et al, 2020).…”