Scoping review: How is virtual reality being used as a tool to support the experience of undergoing Magnetic resonance imaging?

When virtual reality becomes psychoneuroendocrine reality: A stress(or) review

This review article was awarded the Dirk Hellhammer award from ISPNE in 2023. It explores the dynamic relationship between stressors and stress from a historical view as well as a vision towards the future of stress research via virtual reality (VR). We introduce the concept of a "syncytium," a permeable boundary that blurs the distinction between stress and stressor, in order to understand why the field of stress biology continues to inadequately measure stress alone as a proxy for the force of external stressors. Using Virtual Reality (VR) as an illustrative example to explicate the black box of stressors, we examine the distinction between 'immersion' and 'presence' as analogous terms for stressor and stress, respectively. We argue that the conventional psychological approaches to stress measurement and appraisal theory unfortunately fall short in quantifying the force of the stressor, leading to reverse causality fallacies. Further, the concept of affordances is introduced as an ecological or holistic tool to measure and design a stressor's force, bridging the gap between the external environment and an individual's physiological response to stress. Affordances also serve to ameliorate shortcomings in stress appraisal by integrating ecological interdependencies. By combining VR and psychobiological measures, this paper aims to unravel the complexity of the stressor-stress syncytium, highlighting the necessity of assessing both the internal and external facets to gain a holistic understanding of stress physiology and shift away from reverse causality reasoning. We find that the utility of VR extends beyond presence to include affordance-based measures of immersion, which can effectively model stressor force. Future research should prioritize the development of tools that can measure both immersion and presence, thereby providing a more comprehensive understanding of how external stressors interact with individual psychological states.

Novel Virtual Reality App for Training Patients on MRI-guided Radiation Therapy

Purpose

Patients receiving respiratory gated magnetic resonance imaging-guided radiation therapy (MRIgRT) for abdominal targets must hold their breath for ≥25 seconds at a time. Virtual reality (VR) has shown promise for improving patient education and experience for diagnostic MRI scan acquisition. We aimed to develop and pilot-test the first VR app to educate, train, and reduce anxiety and discomfort in patients preparing to receive MRIgRT.

Methods and Materials

A multidisciplinary team iteratively developed a new VR app with patient input. The app begins with minigames to help orient patients to using the VR device and to train patients on breath-holding. Next, app users are introduced to the MRI linear accelerator vault and practice breath-holding during MRIgRT. In this quality improvement project, clinic personnel and MRIgRT-eligible patients with pancreatic cancer tested the VR app for feasibility, acceptability, and potential efficacy for training patients on using breath-holding during MRIgRT.

Results

The new VR app experience was tested by 19 patients and 67 clinic personnel. The experience was completed on average in 18.6 minutes (SD = 5.4) by patients and in 14.9 (SD = 3.5) minutes by clinic personnel. Patients reported the app was "extremely helpful" (58%) or "very helpful" (32%) for learning breath-holding used in MRIgRT and "extremely helpful" (28%) or "very helpful (50%) for reducing anxiety. Patients and clinic personnel also provided qualitative feedback on improving future versions of the VR app.

Conclusion

The VR app was feasible and acceptable for training patients on breath-holding for MRIgRT. Patients eligible for MRIgRT for pancreatic cancer and clinic personnel reported on future improvements to the app to enhance its usability and efficacy.

Supporting claustrophobic patients during Magnetic Resonance Imaging examination- the patient perspective

INTRODUCTION

Magnetic Resonance Imaging (MRI) is a common imaging modality used to diagnose disease and monitor treatment. However, some patients cannot complete their MRI examination as a result of claustrophobia. The recent developments in the MRI scanner design may have reduced the incidence of claustrophobia in MRI. This study aimed to explore the claustrophobic patients' experience to better understand how to support them.

METHODS

A qualitative descriptive approach using focus groups was deemed appropriate for the study. The research was advertised in a print newspaper and on social media platforms for eligible participants to contact the researcher. Six claustrophobic patients were recruited to the focus group meeting. The discussion was audio recorded and transcribed. Content analysis was used to analyse the data into code and categories.

RESULTS

Four themes emerged from the data analysis, which included examination preparation, information provision, coping mechanisms and MR scanner design. Participants reported that the confined space in the MRI scanner bore is responsible for their anxiety during MRI. However, the majority of the participants believe that they would be able to complete the examination if, in advance of their scan, they were shown the MRI scanner and what they would be required to do.

CONCLUSION

Several coping mechanisms were shared by the participants on how they were able to complete their MRI examination despite their claustrophobia. MRI radiographers should endeavour to use these mechanisms to support their patients in practice. Also, the findings emphasise the importance of virtual reality and clear communication with patients in preparing them for their MRI examinations.

IMPLICATIONS FOR PRACTICE

The findings of this study may be used to enhance claustrophobic patients' experience in MRI. It also identified those aspects of the MRI examination that matter most to patients with claustrophobia in order to provide a suitable intervention to support these patients.

"I think this could be a big success" - A mixed methods study on practitioner perspectives on the acceptance of a virtual reality tool for preparation in MRI

INTRODUCTION

A key part of a radiographer's role within MRI is providing the required emotional support to help patients succeed with a scan. Being informed is important; whilst information leaflets and videos are commonly used, these can be limited in their representation of the experience. Virtual reality tools are being shown to reasonably replicate a scan experience, having a positive impact on patient satisfaction and anxiety. The aim was to obtain the views of practitioners on the use and implementation of such a tool in practice.

METHODS

A mixed methods study was conducted looking at the use of a virtual scan experience for patients prior to MRI. Nine radiographers attended two focus group sessions to see the tool and undergo a virtual experience. Following this, a survey based on the technology acceptance model was completed along with a semi-structured discussion about its use.

RESULTS

Perceived usefulness, ease of use, attitude and intention to use were all positive towards the virtual scan tool. All practitioners saw value in such a tool and how it could be implemented within practice, highlighting areas for improvement and development.

CONCLUSION

The practitioner's perspective was that access to such a virtual scan experience could be of use to better prepare and support those patients needing extra support before a real scan. Acknowledgement of having time to discuss patient concerns was noted and this could provide a means of doing so away from busy scanning lists whilst not taking up additional time.

IMPLICATIONS FOR PRACTICE

Use of VR tools could be a conduit through which trust and rapport are built in advance away from busy scanning lists, thereby not impacting on operational throughput and hindering efficiency.

Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial

INTRODUCTION

This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups.

METHODS

A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination.

RESULTS

Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time.

CONCLUSION

Access to 360°VCE can reduce patients' pre-CCTA anxiety levels.

IMPLICATIONS FOR PRACTICE

The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.

Use of virtual reality for MRI preparation and technologist education: A scoping review

BACKGROUND

Virtual Reality (VR) is becoming a popular educational tool in healthcare. This scoping review aimed to (1) determine if VR can be used to reduce the anxiety a patient experiences during an MRI and (2) explore how VR is being used to train MRI technologists.

METHODS

PubMed, Web of Science, Cochrane Library, CINAHEL, and PsycINFO internet websites of VR in MRI were evaluated. Two authors independently reviewed the titles and abstracts using the inclusion and exclusion criteria. Articles chosen by both reviewers were automatically included for full text review. Articles chosen by one reviewer were audited by a third independent reviewer to determine inclusion for full text review. Descriptive analyses were conducted.

RESULTS

The initial search resulted in 357 articles. A large portion of the articles were excluded because they were either based on fMRI or training-based tools for healthcare professionals, which were not our area of focus. Eight articles were included in the final review for assessing if VR can be a useful tool to aid with patient anxiety in MRI. No articles were found that used VR in MRI technologist training.

CONCLUSIONS

This scoping review suggests there are potentially significant uses for VR in reducing anxiety in adults and children as patients. With further research and development of VR application for use with MRI testing may allow for better patient preparation and reduce scan interruptions, increase MRI operational efficiency, and improve patient outcomes.

Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia

Background: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to real images. Method: Thirty-one participants with specific phobias to small animals were included: 14 were treated with CBT + VRET (intervention group), and 17 were treated with CBT + exposure to real images (active control group). Participants’ scores in anxiety and phobia levels were measured at baseline, post-treatment, and 3-month follow-up, and brain activation was measured through functional magnetic resonance imaging (fMRI) baseline and post-treatment. Results: Both groups showed a significant decrease in anxiety and phobia scores after the therapy and were maintained until follow-up. There were no significant differences between both groups. Overall, fMRI tests showed a significant decrease in brain activity after treatment in some structures (e.g., prefrontal and frontal cortex) and other structures (e.g., precuneus) showed an increasing activity after therapy. However, structures such as the amygdala remained active in both groups. Conclusions: The efficacy of CBT + VRET was observed in the significant decrease in anxiety responses. However, the results of brain activity observed suggest that there was still a fear response in the brain, despite the significant decrease in subjective anxiety levels.