Virtual Reality Distraction for Anxiety in Children During MRIs (VR-IMAGINE at HSJ) : A Randomized Controlled Trial

BACKGROUND

Magnetic resonance imaging (MRI) is a technique that is considered non-invasive and safe as it does not use any radiation or X-rays unlike PET (positron emission tomography) scans or CT scans. MRI technology, instead, uses a magnetic field to generate images of the tissues and organs. For MRI to work as intended, the patient must remain still while laying down within a confined space for a certain amount of time. The MRI environment may be a source of anxiety for some patients. This can be due to the claustrophobic nature of the narrow space tunnel. MRIs have been in known for almost forty years to generate fear and anxiety caused by claustrophobia. In addition, MRI scanners generate loud clicking sounds while running. These loud acoustic noises may be as loud as 100dB, the equivalent of a snowmobile next to the patient. Not surprisingly, up to 30% of patients undergoing MRIs had anxiety-related reactions of various degrees of intensity. Interviews performed with small children and their parents revealed that MRIs caused anxiety in children because of their size, design and sounds. Hence, this environment is difficult to tolerate, especially for children. Oftentimes, anxious children may become restless during the exam leading to uncontrolled movements resulting in unusable images. As a consequence, this may result in a premature termination of the procedure itself, requiring the exam to be repeated ulteriorly, thus, causing subsequent episodes of anxiety.

As a result, it is becoming common practice in many hospitals' radiology department to require conscious sedation as the frequency of repeated MRI test are higher within the pediatric population. However, sedation is not without any risks or consequences. Emerging evidence suggests that sedation in children might have long-term neurocognitive side effects, in addition to the short-term procedure-related risks.

For this reason, many efforts have been put into the development of non-pharmacological methods to reduce fear and anxiety in children requiring MRI scans. Many interventions ranging from music and artwork to videogames have been used and deemed useful to relieve anxiety in children during an MRI exam. Interventions done prior to the scan have also been investigated. Among these, preprocedural patient education has been shown to decrease anxiety and enhance comprehension of MRI exams, which in turn, can serve to increase patient collaboration. However, different educational material can have different effects on reducing anxiety levels. Mock MRI scanners, which involve using a full-size replica scanner for a 5-minute training session to lie still, have been used to help explain to children what the procedure involves and what to expect in an age appropriate manner. This preparation has been reported to reduce MRI-related procedural anxiety, rate of motion artifacts, need for sedation, overall duration of the study, as well as a decrease in heart rate during the procedure. However, a shortcoming of mock replica is that there is limited availability in hospitals, since the mock MRI machine would require a room to store, as well as additional resources, including staff and time, to organize these sessions.

Virtual reality (VR) used to replicate an MRI environment can also be used as patient preparation. Indeed, VR has been used as preparation for chest radiography, dental procedures, anesthesia and surgeries. These studies show that VR preparation helped improve procedural experience among pediatric patients by reducing anxiety, distress and procedural time while increasing parents' satisfaction. VR is a distraction method that has been proven effective in reducing pain and anxiety in children in different settings, such as phlebotomy, wound care, chemotherapy, dental procedures and bone pins removal.