The Development of a Virtual Reality Simulation to Reduce Anxiety in Pediatric Patients Undergoing Magnetic Resonance Imaging

Summary

Here, we present a protocol to develop a virtual reality (VR) gamified simulation to reduce anxiety in pediatric patients undergoing MRI scans. By replicating the sights and sounds of the MRI environment, the VR experience will help children become familiar with the procedure, aiming to improve comfort and cooperation.

Abstract

Magnetic Resonance Imaging (MRI) is a valuable diagnostic tool in pediatric care, offering high-resolution images without ionizing radiation; however, the unfamiliar environment, confined space, and loud noises may cause distress, claustrophobia, and anxiety. This may lead to an increased need for sedation, and longer imaging times. At Victoria Children's Hospital in London, Ontario, the Child Life program currently uses a doll and MRI model to help reduce anxiety in pediatric patients through a learning-based approach. While these methods are effective, they are limited in their ability to provide a realistic representation of the MRI experience. To address this, we developed a gamified MRI experience designed specifically for pediatric patients at Victoria Children's Hospital using virtual reality (VR), a computer-generated 3D environment experienced through a headset. The simulation replicates the sights, sounds, and spatial aspects of the MRI environment, helping children to familiarize themselves with the experience beforehand. While our VR room is a replica of the real MRI room in Victoria Children's Hospital, it could be adapted for use in other facilities by modifying the environmental details. Future work will evaluate the simulation's effectiveness in reducing anxiety through quantitative and qualitative assessments.

Introduction

Magnetic resonance imaging (MRI) is a non-invasive technique used to produce three-dimensional images of soft tissues to aid in disease diagnosis and treatment monitoring¹. MRI is considered to be one of the safest imaging modalities for children because it does not involve ionizing radiation¹; however, the procedure can be particularly challenging for young patients. Children must lie still in a confined tunnel for up to an hour while exposed to loud noises², an experience that may cause fear, anxiety, claustrophobia, or a heightened dread of the diagnosis itself^1,

Protocol

Ethical approval for this study was obtained from the Western University Health Sciences Research Ethics Board (HSREB) (Project ID: 116749). Written informed consent was obtained from the human participants. The reagents and the equipment needed are listed in the Table of Materials.

1. 3D modeling of assets

NOTE: Create a realistic, to-scale 3D model of the MRI machine and its surrounding environment using 3D modeling software.

1. Photographic documentation
   1. Capture photographic documentation of the real MRI room from multiple angles. Ensure all walls, equipme....

Results

A functional, immersive, and realistic VR MRI simulation was successfully developed to help pediatric patients at Victoria Children's Hospital prepare for MRI procedures. The simulation's supplemental features operate reliably, demonstrating its readiness for clinical testing. The first successful outcome was the accurate recreation of the MRI scanner and surrounding environment using 3D modeling techniques. Since reference photographs were used to calibrate virtual assets to match real-world spatial dimensions, the fina.......

Discussion

The development of the virtual MRI simulation was shaped by design decisions that influenced its usability in a pediatric setting. Input from Child Life Specialists and MRI technicians played an important role in replicating real-world procedures virtually. For example, the inclusion of a video MRI display above the bed, which is commonly used in actual scans as a distraction tool, was implemented into the virtual MRI based on the recommendations made by Child Life Specialists. Similarly, the addition of a "leave sim.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Advanced Sessions Plugin	Community Plugin	https://vreue4.com/generated-node-documentation?section=advanced-sessions-plugin	Enables Steam multiplayer features in Unreal Engine
Blender Software	Blender Foundation	https://www.blender.org/	Used to model 3D virtual MRI environment and assets
Fspy	Fspy Project (GitHub)	https://fspy.io/	Used for camera matching and perspective calibration
Hamachi	LogMeIn	https://vpn.net/	Used to create a virtual LAN for multiplayer sessions during development
Meta Quest 3 and 3S Headsets	Meta	https://www.meta.com/ca/quest/?srsltid=AfmBOooSwFweWKye9LY HHsSsuGhZgdZZxi-m7xAFtC ecIK2ekZnTAhGr	VR headsets used for testing and deploying the simulation
Multi User Plugin	Unreal Engine Marketplace	https://dev.epicgames.com/documentation/en-us/unreal-engine/multi-user-editing-in-unreal-engine	Enables collaborative editing in real-time within Unreal Engine
Steam	Valve Corporation	https://store.steampowered.com/	Online service platform required for multiplayer connection (via Steam Online Subsystem)
Unreal Engine	Epic Games	https://www.unrealengine.com/en-US	Game engine used for developing the VR simulation
Voice Chat Plugin / VOIP Talker	Unreal Engine	https://dev.epicgames.com/documentation/en-us/unreal-engine/voice-chat-with-epic-online-services	Enables voice chat in VR multiplayer environment
Windows PC	Microsoft	Self assembled	Development and testing platform for building the VR project. AMD Ryzen 9 5900X CPU, Nvidia RTX 3080Ti GPU, 32GB RAM, and a 2 TB SSD 4TB hard drive