Children about to undergo a magnetic resonance imaging (MRI) scan might understandably feel apprehensive, but a study suggested that their fears could be eased by giving them a 'play kit' that uses a combination of virtual and augmented reality.
A multi-centre research team, led by the University of Sheffield's Faculty of Health, said the kit, which utilises physical play and technology, successfully relieved anxiety and could help children aged 4 to 10 years old undergo MRI scanning without general anaesthesia (GA).
MRI is an important imaging modality in paediatric practice, particularly for those with long-term conditions, and involves lower radiation exposure than computed tomography scanning. However, the experience — challenging enough for adults — poses particular problems for children, who must lie still for up to 2 hours while wearing ear defenders to protect against acoustic injury from the noise in the scanner room.
Because the experience can create high levels of anxiety, children have traditionally been offered sedation and anaesthesia.
Safety concerns have been raised about possible adverse neurodevelopmental effects of GA in children. Also, anaesthesia comes with significant resource implications. The longest waiting list in radiology at the Sheffield Children's Hospital is for MRI scans under GA, and this can cause delays in diagnosis and treatment, as well as increasing scanner and anaesthetists' time.
Play Can Ease Children's Fears of Medical Procedures
The authors of the study, published in the journal BMJ Innovations, noted that play had been shown to be effective in lowering children's anxiety about medical interventions, including reducing the need for sedation or anaesthesia for certain procedures. Play in hospital settings helps children to be happier, less stressed, and less fearful, and built resilience to help them cope with medical treatment and engage with future procedures, they said.
The play kit was developed by anaesthetists, a health researcher, a children's play/storytelling expert, and a computer games producer. Their report describes the kit and the initial reactions from a small sample of child patients and parents.
The kit consisted of a flat-packed cardboard tube to be built into a small toy MRI scanner, into which children placed their own toys. As parental levels of anxiety often directly affect those of their child, the kit was "deliberately designed to be slightly too difficult for a child to be able to build alone" in order to encourage parental involvement.
The cardboard model scanner incorporates a side slot for a smartphone with an augmented reality app and a headset, through which the child could experience a virtual walkthrough of the hospital, culminating in 'entering' the MRI scanner room. The child was then able to play at being a radiographer by 'scanning' a toy, accompanied by a noisy soundscape to replicate the MRI experience.
Virtual Butterflies on Virtual Flowers Helped Children Stay Still
In addition, four interactive games help to prepare the child for aspects such as checking in, being weighed, removing ferromagnetic objects, and staying still for the scan itself. The phone's gyroscope was used for a game in which by remaining still, the child could maximise the number of virtual butterflies settling on a virtual flower.
After user-testing with nonpatients, the team conducted interviews with 13 patients and their parents before and after using the kit, which was delivered by post a week before a booked MRI scan. Both children and parents, who were recruited via Sheffield Children's Hospital, reported that they had previously felt anxiety because of the 'unknowns' involved. Feedback observations included:
- Building the kit together gave children and parents "a key moment" to discuss the upcoming scan and address together any associated worries
- Understanding what an MRI scanner would look like and the noise it would make helped to be prepared for the scan
- Remembering the scan images that the radiographers would be looking at helped to alleviate anxiety during the scan
- Recalling the butterflies landing on the virtual plant helped some children to remain still
Reducing Anaesthetic Rate for MRIs "a Clear Benefit"
The team pointed out that around one in 10 children in high-income countries are candidates for GA at some point before the age of 3 years, and that reducing the GA rate for MRIs would be "a clear benefit".
Asked to comment by Medscape News UK, Dr Katharine Halliday, president of the Royal College of Radiologists, said: "Using a virtual reality play kit as an alternative to general anaesthetic is not only much better for the health of a child, it reduces the number of staff required for an MRI, avoids the very long waits which are common in procedures involving anaesthesia, and saves the NHS a considerable amount of money."
Development of the play kit was funded by Innovate UK.