Advantages of Virtual Reality for patients requiring an MRI exam

Author: Salem Hannoun, PhD – Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences

Introduction

Among medical imaging techniques, magnetic resonance imaging (MRI) has been shown to be the safest and most precise. Nonetheless, despite its non-invasive and painless nature, an MRI exam remains troublesome and unpleasant for patients and consequently for rad techs. Indeed, many individuals associate MRI tests with danger because of the small and confined tube space, loud noise, strange surroundings, length of the scan, and need for the patient to stay still for the duration of the exam [1].

Subjects undergoing an MRI examination often report moderate to severe anxiety, claustrophobia, tension, and feelings of powerlessness, imprisonment, and disorientation. The latter frequently result in a refusal to be scanned, the early termination of an MRI scan, poor quality of images, and the necessity to repeat the scan, typically under sedation this time [1, 2]. Due to claustrophobia, an estimated 2 million MRI scans cannot be conducted yearly, resulting in delayed diagnosis and treatment as well as a considerable time and financial cost to healthcare organizations [3].

Before and during the scan, a variety of measures can be carried out by the rad tech to reduce the patients’ anxiety and hence, enhance MRI image quality. These include psychological interventions such as cognitive therapy or hypnosis to reduce anxiety associated with MRI scans [4, 5], use of written educational information (brochures, posters, etc.) [6], video presentation of actual scans [2], communication of MRI-related information the day of the exam, the use of MR-compatible audiovisual systems during the scan [7], and mock MRI [8].

Sedation is also an option, but it carries significant risks and cannot be used during a functional MRI scan, which requires the patient to be awake. Unfortunately, most of these interventions, are designed for younger pediatric patients rather than adults; they are time consuming, costly, and difficult to administer solely by the rad techs; and, as a result, they are underutilized [2].

The gist: MRI early termination/cancellation due to severe anxiety, claustrophobia, fear of the loud noises has a considerable cost on healthcare organizations. Patient education prior to undergoing an MRI exam can alleviate these costs.

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Advent of Virtual Reality in MRI

An MRI scan must be experienced to be fully comprehended, as each person’s experience differs [9]. However, it appears that following a period of adaptation, individuals may grow accustomed to the scan and have a better experience [9]. Mock MRI imaging units, which are full-scale copies of MRI machines without internal magnets and equipped with speakers that play recorded sounds of genuine MR scan sequences, give a realistic experience [10]. These allow patients to experience the MRI environment prior to their actual MRI test. Despite their cost savings over general anesthetic, mock MRI scanners are costly, necessitate a specific room in a specialized unit, and require the presence of a technician, health care assistant, or therapist. The complexity of scheduling mock and actual MRI exams may necessitate repeated visits from the patient.

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The virtual surroundings are fully controllable and may be explored at the user’s leisure. In the context of MRI, VR technology allows patients to become acquainted with an unfamiliar environment and immerse themselves in a virtual MRI procedure prior to their scan. Virtual reality technology is becoming increasingly inexpensive, portable, and simple to use, with the potential to allow anyone to experience virtual MRI regardless of location or time, as many times or as often as they like. Without any organizational limitations, the simulation can be paused, resumed, or repeated [1].

Usually, MRI technologists spend a huge amount of their time educating the patients about what to expect during the MRI. They go over importance of lying still to reduce motion artefacts and avoid repeating the scan. They also explain and inform patients that the loud banging and clicking noises that the MRI scanner makes is due to the machine’s metal coils receiving electrical pulses to generate the magnetic field. The time spent educating patients is lost time and cost the institution money. Virtual reality will help radiographers manage their time more efficiently, thereby scanning more patients and increasing the machine’s productivity. Patients using virtual reality to learn about the MRI examination will have lower probability to cancel or interrupt the scan. Rad techs won’t have to reschedule the patient for another scan nor account for the time needed to the patient under anesthesia to do the scan.

The gist: The introduction of virtual reality in radiology to simulate an MRI exam has a great impact on the acceptability of patients to undergo the MRI exam.

Virtual Reality as mock MRI

A recent study evaluated virtual reality MRI simulation as a more cost-effective and accessible alternative to a mock MRI scanner for preparing people for an MRI test. They have created a virtual reality simulation to help patients prepare for their MRI scan, so they know what to anticipate before they go in. The study’s main goal was to see if virtual reality simulations of MRI procedures may be as successful as a mock MRI scanner in terms of the users’ subjective experience. Indeed, they were able to replicate patients’ experience of an MRI procedure. Following the VR experiment, patients reported feeling sleepy, tired, disorientated, annoyed by the sounds, and bored. VR provides radiographers with a new tool to use with patients who are more likely to have issues undergoing a real MRI scan, thereby reducing the number of costly canceled scans [13].

Another team even created a VR application to teach patients about MRI and recreate the experience of being scanned [11]. The application is completely immersive, incorporating both visual and auditory sensations by patients during an MRI scan. Patients are also informed about potential conditions and implanted devices that may restrict the test from being performed safely. This VR tool not only informs patients about MRI and its usefulness in their treatment, but it also allows them to visually experience what an MRI scan is like [11].

The gist: Virtual reality simulation of an MRI exam helps patients anticipate what will happen during the scan and get familiarized with it, thereby reducing the chances of opting out of doing it.

Virtual Reality during an MRI scan

Researchers at King’s College London have created an interactive virtual reality system for use in an MRI [14]. This tool will help patients struggling with an MRI exam, particularly children, and people with cognitive difficulties or those who suffer from claustrophobia or anxiety. MRI can be a rather strange experience that involves entering a narrow tunnel, with loud and often strange noises in the background, and the necessity to remain as still as possible. However, when a person is immersed in a VR environment, they completely ignore their environment. Therefore, making a system compatible with the MR environment could be an alternative way to successfully analyze these challenging populations.

To provide patients with an immersive virtual reality environment, the researchers developed a special VR headset that can be used safely inside the MR scanner. The helmet is designed in a way to make sure the user cannot see his environment at all. He is not aware of the visual reminders of his position. Once the system is correctly positioned, the system projector is immediately live. It provides immersive content. The VR experience is then continued until the patient finishes the exam. According to the researchers, this measure eliminates the feeling of being inside the MRI scanner. The frightening scene the patient lives inside the MRI is now replaced by the virtual reality environment. Vulnerable populations can now normally get an MRI without being under anesthesia. This solution will make a huge difference to daily clinical practice. It also paves the way for a dramatic new insight into how patterns of brain function, behavior and social skills develop throughout our lives [14].

The gist: The implementation of virtual reality during the MRI scan will help patients overcome the frightening scene they experience during the scan. Their senses will be immersed in a virtual reality environment, thereby not focusing on the MRI exam.

References

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