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Giving children a virtual/augmented (mixed) reality play kit to use before a magnetic resonance imaging (MRI) scan appears to reduce both them and their parents’ concerns about this procedure, preliminary findings published in the open access journal BMJ Innovations.
Reducing the need to put a child to sleep, due to the noise and time required to lie still in the MRI tunnel, could not only increase patient safety but also reduce costs and wait times decrease, the researchers suggest.
MRI has become an important diagnostic tool in pediatric healthcare due to the high-quality images produced and lower radiation exposure than computed tomography (CT) scans, which is especially important for children with long-term conditions, they explain.
But the procedure can take a long time, during which time patients must lie still. And it is very noisy (up to 80 decibels), requiring the use of protective hearing protectors, making it a challenging experience for many patients, especially children.
As a result, children are offered a general anesthetic for the scan. But recent research and safety concerns about the potential impact of anesthesia on a child’s developing brain have prompted an initiative to reduce the number of MRI scans performed under anesthesia.
It is widely accepted that play can reduce children’s anxiety about medical treatments and procedures, and with that in mind, researchers have developed a play kit to help 4-10 year olds get an MRI scan without general anesthesia.
They purposefully designed it so that an adult’s help is needed, because parental anxiety can directly affect a child’s level.
The play package consists of a flat-packed cardboard construction kit that can be converted into a small toy MRI scanner, in which the child can place his toys.
Thanks to a smartphone placed in the side of the cardboard MRI scanner, the child can take on the role of a radiographer via an augmented reality app. Augmented reality involves overlaying a computer-generated image over the user’s view of the real world.
The child can then scan their toys with the addition of scanning sounds to mimic the MRI experience. The child can then swipe through different aspects of the real MRI images that the radiographer wants to take.
The kit also includes an age-appropriate cardboard virtual reality headset, which, together with the app, allows the child to virtually walk around the hospital, culminating in him/her entering the MRI scanner itself.
The walkthrough includes four interactive games to prepare the child for different aspects of the trip, such as checking in, weighing, removing magnetic objects from clothing and standing still for the scan itself.
The development of the play kit is based on feedback from primary school children and parents, and tested on 13 patients and their parents/guardians.
This feedback showed that the playset helped some children (and their parents/carers) prepare for the MRI scan and also helped reduce anxiety during the scan.
The children said that remembering aspects of the play set during the scan helped them stay calm and quiet. Others said the playset helped prepare them for what an MRI scanner would look like and the sound it would make.
Older children seemed to prefer the virtual reality aspects of the kit, while younger children were more attracted to the physical play and augmented reality aspects.
Both children and parents/carers reported that they had previously been concerned about the prospect of an MRI scan due to the unknowns involved. And the children indicated that they would like detailed factual information about the MRI scan.
Because one child-parent pair found it difficult to build the mini cardboard scanner, the design may need to be further refined and the play kit tested on much larger numbers of children, both nationally and internationally, the researchers point out.
But they suggest the kit has the potential to be adapted for use elsewhere: for example, to prepare children coming to an inpatient unit for elective surgery; during transfer to theater; and needle procedures.
“The development of the mixed reality MRI playkit addresses a significant global problem within pediatric anesthesia and provides an opportunity for practice change to reduce the number of pediatric (general anesthesia) cases and increase efficiency and resource use within the radiology and anesthesia departments,” they write.
“The longest radiology waiting list in our hospital is for MRI scans under general anesthesia. Delays in performing scans lead to delays in the diagnosis and treatment of children and their families, as well as increased use of scanning time, which has a further impact on the MRI waiting list,” they explain.
“Additionally, a reduction in the need for (general anesthesia) for pediatric MRI reduces the need for an anesthesiologist, allowing its use elsewhere – for example, to help reduce the backlog on elective surgery waiting lists.”
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