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      A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study

      research-article
      , BSc (Hons), MSc, PhD 1 , 2 , 3 , , , BA (Hons) 4 , , BSc, PGD 5 , , BSc 2 , , DipHE 2 , , BSc 2 , , DClinPsych 6 , , BSc (Hons), PhD 7
      (Reviewer), (Reviewer)
      JMIR Pediatrics and Parenting
      JMIR Publications
      virtual reality, MRI, anxiety

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          Abstract

          Background

          A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures.

          Objective

          The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure.

          Methods

          A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA.

          Results

          The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA.

          Conclusions

          Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process.

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          Most cited references21

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          The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders

          Virtual reality, or VR, allows users to experience a sense of presence in a computer-generated three-dimensional environment. Sensory information is delivered through a head mounted display and specialized interface devices. These devices track head movements so that the movements and images change in a natural way with head motion, allowing for a sense of immersion. VR allows for controlled delivery of sensory stimulation via the therapist and is a convenient and cost-effective treatment. The primary focus of this article is to review the available literature regarding the effectiveness of incorporating VR within the psychiatric treatment of a wide range of psychiatric disorders, with a specific focus on exposure-based intervention for anxiety disorders. A systematic literature search was conducted in order to identify studies implementing VR based treatment for anxiety or other psychiatric disorders. This review will provide an overview of the history of the development of VR based technology and its use within psychiatric treatment, an overview of the empirical evidence for VR based treatment, the benefits for using VR for psychiatric research and treatment, recommendations for how to incorporate VR into psychiatric care, and future directions for VR based treatment and clinical research.
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            Virtual Reality in Health System: Beyond Entertainment. A Mini-Review on the Efficacy of VR During Cancer Treatment.

            Virtual reality (VR), a computer-generated virtual environment, has been increasingly used in the entertainment world becoming a very new evolving field, but VR technology has also found a variety of applications in the biomedical field. VR can offer to subjects a safe environment within which to carry on different interventions ranging from the rehabilitation of discharged patients directly at home, to the support of hospitalized patients during different procedures and also of oncological inpatient subjects. VR appears as a promising tool for support and monitoring treatments in cancer patients influencing psychological and physiological functions. The aim of this systematic review is to provide an overview of all the studies that used VR intervention on cancer patients and analyze their main findings. Nineteen studies across nearly a thousand articles were identified that explored effects of VR interventions on cancer patients. Although these studies varied greatly in setting and design, this review identified some overarching themes. Results found that VR improved patients' emotional well-being, and diminished cancer-related psychological symptoms. The studies explored various relevant variables including different types of settings (i.e., during chemotherapy, during pain procedures, during hospitalization). Here, we point to the need of a global and multi-disciplinary approach aimed at analyzing the effects of VR taking advantage of the new technology systems like biosensors as well as electroencephalogram monitoring pre, during, and after intervention. Devoting more attention to bio-physiological variables, standardized procedures, extending duration to longitudinal studies and adjusting for motion sickness related to VR treatment need to become standard of this research field.
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              Augmented and virtual reality in surgery-the digital surgical environment: applications, limitations and legal pitfalls.

              The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena.
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                Author and article information

                Contributors
                Journal
                JMIR Pediatr Parent
                JMIR Pediatr Parent
                JPP
                JMIR Pediatrics and Parenting
                JMIR Publications (Toronto, Canada )
                2561-6722
                Jan-Jun 2019
                18 April 2019
                : 2
                : 1
                : e11684
                Affiliations
                [1 ] Department of Medical Physics and Bioengineering NHS Highland Inverness United Kingdom
                [2 ] Department of Neuroradiology King's College Hospital London United Kingdom
                [3 ] Centre for Neuroimaging Sciences King's College London London United Kingdom
                [4 ] Faculty of Life Sciences & Medicine King's College London London United Kingdom
                [5 ] King's College Hospital London United Kingdom
                [6 ] South London and the Maudsley NHS Trust London United Kingdom
                [7 ] Radiological Sciences & Imaging Regional Medical Physics Service Belfast Health and Social Care Trust Belfast United Kingdom
                Author notes
                Corresponding Author: Jonathan Ashmore jonathan.ashmore@ 123456nhs.net
                Author information
                http://orcid.org/0000-0002-5170-3772
                http://orcid.org/0000-0001-5669-4003
                http://orcid.org/0000-0003-0287-912X
                http://orcid.org/0000-0003-3798-6187
                http://orcid.org/0000-0003-1213-1924
                http://orcid.org/0000-0001-9452-390X
                http://orcid.org/0000-0002-1218-3313
                http://orcid.org/0000-0002-0356-1626
                Article
                v2i1e11684
                10.2196/11684
                6716438
                31518319
                0645bfdb-9be2-4a5e-af24-d060a0e5b8a2
                ©Jonathan Ashmore, Jerome Di Pietro, Kelly Williams, Euan Stokes, Anna Symons, Martina Smith, Louise Clegg, Cormac McGrath. Originally published in JMIR Pediatrics and Parenting (http://pediatrics.jmir.org), 18.04.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Pediatrics and Parenting, is properly cited. The complete bibliographic information, a link to the original publication on http://pediatrics.jmir.org, as well as this copyright and license information must be included.

                History
                : 11 August 2018
                : 9 October 2018
                : 31 January 2019
                : 18 February 2019
                Categories
                Original Paper
                Original Paper

                virtual reality,mri,anxiety
                virtual reality, mri, anxiety

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