Author/Year/ Country | Aim | Study Design | Participants age & condition/s | Intervention characteristics | Intervention delivery | Data collection methods | Outcomes | Results/Findings |
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Ashmore et al. (2019) [34] UK | To gain feedback on the initial implementation of the app to help inform further enhancements of the resource | Descriptive quantitative design | 23 children (median age 9 years, range 4 to 12 years) who had never had an awake MRI (n = 19/23) or had had an MRI more than 1 year ago (n = 4/23) | An app (targeted at 4–12 year old children) to produce an immersive 360° VR experience of the entire MRI journey | The resource was developed to be used by health play specialists in hospital or at home where a disposable Google Cardboard version 2 headset was mailed to patients | Locally developed parent questionnaire Locally developed HCP questionnaire | Ease of use Helpfulness of information, Enjoyability of the resource | 23 parents/carers answered the questionnaires The parent questionnaire highlighted they felt that the resource had a positive impact on their child The feedback showed a positive impact of the app on parents, the app allowed them to better understand their child’s upcoming MRI, helping to reduce their own anxieties and enabling them to better prepare their child 10 health professionals answered the questionnaire and reported that the preparation resource was a useful tool Of the 5 patients originally booked for MRI under GA, 4 were able to tolerate an awake MRI |
Barnea-Goraly et al. (2014) [35] USA | To judge the feasibility of using a behavioural desensitisation program to yield high quality brain MRI scans in sedation-free children | Descriptive quantitative study | 222 children (4–9.9 years), 147 with type 1 diabetes and 75 age-matched non-diabetic controls | Multi-media resource and mock scanner to prepare and desensitise children prior to an MRI including preparation at home and on arrival at the hospital | One part delivered by parents at home and one part delivered by staff within the radiology centre | Each scan taken was reviewed independently by 2 staff to discern if they were useable and of good quality | Useable scan First attempt successful scan | Brief behavioural training can lead to a high rate of success for obtaining excellent-quality brain MR images without sedation from very young children |
Bharti et al. (2016) [24] India | To evaluate the effectiveness of an MRI specific play therapy intervention on the need for sedation in young children | Randomised control design | 79 children (40 intervention group, 39 control group) undergoing MRI for neurological and non-neurological conditions. Children’s mean age was 7.11 years. Children with previous experience or cognitive disabilities were excluded | Children in the intervention group received MRI customised play therapy with a doll-sized mock scanner on the day of the MRI investigation | Play therapy sessions were conducted by a paediatrician and a trained medical social worker on the day of the MRI investigation | The scan quality was rated on a five-point scale by an experienced radiologist If the child did not cooperate with the procedure within 20 min the standard protocol for sedation was used | Number of children requiring sedation Quality of the scan achieved | The study demonstrated the effectiveness of MRI customised play therapy with children prior to the scan as it significantly reduced the need for sedation and anaesthesia in a significantly greater proportion of children as compared to the control group |
Capurso et al. (2020) [36] Italy | To establish and evaluate an MRI preparation procedure | Retrospective cohort study | 66 children (3–14 years; mean 7.52 y, SD 2.55 y, 63% male) were prepared to undergo MRI scans | Play-based stimulation MRI training using a 8-step protocol including a booklet, hearing the MRI sounds and role-play activities | The training protocol is completed by two volunteers An average intervention lasted approximately 70 min | Quality was measured through a 4 point motion artefact scale at 3 points during the MRI | MRI pass rate Quality of the obtained images | All of the children succeeded in completing the preparation. Out of the 66 prepared children, 62 (93.9%) completed the MRI scan Out of 66 children who underwent the MRI preparation, 61 (92.4%) achieved clinically diagnostic scans |
de Bie et al. (2010) [37] The Netherlands | To evaluate the use of a mock scanner training protocol for preparation of children of 3 to 14 years of age for both structural and functional MRI | Descriptive quantitative design | 90 children (median age 6.5 years, range 3.7–14.5 years) 47 children (MRI group) 43 children who were recruited for a controlled study on brain development, intelligence, and cognitive outcome | Full-size mock scanner training, including verbal instruction, the various MRI sounds, role playing activities and practicing lying still | A paediatrician or experienced child-life specialist conducted the training session A training session lasted 30–60 min Delivered before the MRI | The quality of structural MRI scans was rated by a five-point rating scale by an experienced radiologist Success rate of structural scan sessions was defined as the proportion of children with structural MRI scans with score 1–3 | Pass rate of the mock scanner training sessions (ability to be still for 5 min) MRI scan quality | The overall pass rate of the mock scanner training sessions was 85/90. Structural scans of diagnostic quality were obtained in 81/90 children, and fMRI scans with sufficient quality for further analysis were obtained in 30/43 of the children |
Carter et al. (2010) [55] Australia | The aim was to determine whether the introduction of a mock MRI service assisted in reducing the number of GAs being performed on children undergoing MRI | Retrospective audit | Children aged 3- 14 years 11 months who completed an MRI 4 groups of children accessed different preparation elements | Graded exposure to the MRI process and to practice for the MRI in a 1 h pre-booked session including instruction, sounds of the MRI, role-playing and practicing lying still | Paediatric occupational therapist One hour session | Retrospective audit of the picture archiving communication system (PACS), medical charts and anaesthesia records | The need for GA Completion of the mock MRI Number of MRI scans performed Quality of the MRI scan | In the pre-mock period 756 children underwent 1,072 MRIs with a GA rate of 26.8%. In the post-mock period 875 children underwent 1,205 scans with a GA rate of 18.2%. This overall difference of 8.6% was calculated as being statistically significant |
Cavarocchi et al. (2019) [38] Italy | To evaluate the introduction of the Kitten Scanner training protocol on children undergoing an MRI | Retrospective cohort study | Children aged 4–14 years (n = 570) who underwent normal preparation and (n = 891) who underwent the MRI examination after introduction of the Kitten scanner | Play therapy training sessions. Children were engaged in a simulation of the real MRI investigation with a toy-model scanner called Kitten Scanner | Child life specialist Delivered the same day of the MRI in a quiet room in the department The duration session could last between 30 and 40 min | The quality of MRI images taken after the Kitten Scanner training was evaluated by an experienced radiologist | Number of children undergoing a brain MRI scan without sedation Quality of scans | After the introduction of the Kitten Scanner training, there was a significant increase in the number of children undergoing the brain MRI scan without sedation, both for the total group (p < .001) as well as for the 4 to 9 years of age group (p < .001) Children who received most benefit from this training were in the 4 to 9 years of age group All brain MRI examinations performed without sedation after the Kitten Scanner training were of sufficient quality to be used for diagnostic purposes |
Cedja et al. (2012) [56] USA | To examine the use of the Preparation and Support Procedures (PSP) program and its effect on the ability of young children to successfully complete brain MRI or liver R2*MRI exams | Retrospective review of medical records | 71 children with sickle cell disease (SCD) aged 5.6–12.9 years (median age 9.9 years) who underwent a conventional MRI of the brain or an R2*MRI of the liver | The play therapy session used a small model MRI machine, pictures of the MRI suite and recordings of MRI sounds to prepare the child for the procedure | Child-life therapist | The quality of images was evaluated by a neuroradiologist or paediatric radiologist | Quality of the scan Use of sedation or anaesthesia | The child life specialist offered PSP to 33 (46.5%) children; Children receiving PSP had 8.5 (95% CI 1.7, 43.3) times the odds of successfully completing an interpretable MRI exam compared to those who did not receive PSP (P = 0.0098). Of the 30 children who successfully underwent MRIs with the PSP intervention, 20 (67%) had required sedation/anaesthesia for a previous MRI |
de Amorim e Silva et al. (2006) [57] Australia | To evaluate the effectiveness of a practice magnetic resonance unit in preparing children to undergo an MRI | Retrospective review of medical notes | 134 children undertook a practice MRI (aged 4.1–16.1 years, median age 7.7 years, 47% boys) | Practice full-scale mock MRI children are shown a storybook of a child having an actual MRI with photographs and practice lying still | Most practice MR sessions take 30 min to an hour | Retrospective review of the records to assess whether the child had passed or failed the practice MRI intervention. Review of the scan quality | Ability to have an MRI without a GA Scan quality | In all, 120/134 (90%) passed the practice session; 117/120 (98%) of those subsequently had a clinical non-GA MRI and 110/117 (94%) passed |
Durand et al. (2015) [45] USA 45 | The aim of this study was to assess the impact of child life evaluation for children undergoing MRI before referral for general anaesthesia | Before and after design | Children aged 5- 18 years without severe neurodevelopmental delay Baseline (before) group (n = 47 children) Intervention group (n = 263 children) | Child life specialist preparation, information giving and coping strategies training | Child life specialist Day of the MRI scan | Data collected included whether the scan was successfully completed; and whether the scan was performed under general anaesthesia, with diazepam, or with no sedation | Successful completion of the scan Need for GA Need for sedation | The difference in the need for general anaesthesia between the time periods was highly statistically significant (p < .001) During the baseline period, 47 patients were referred for child life evaluation, all of whom eventually underwent successful scans. During the intervention period, 263 patients were referred for child life evaluation. the scan success rate in this population was 98.4%, with 2 failures due to anxiety |
Fegley (1988) [25] | The purpose of this study was to examine the effects of choice in pre-procedure instruction on: a) children’s search for information behavioural responses and self-reported distress | Randomised controlled trial | 61 children ranging in age from 4 to 12 years (M = 7.45, SD = 2.62 who were scheduled for a routine intravenous pyelograms (IVP) and/or voiding cystourethrograms (VCUG) | The child was randomly assigned to one of the following groups Contingent Instruction. Individualised education based on children’s questions and information needs Noncontingent Instruction Predetermined standard information about the radiologic procedure | Nurse Delivered on the day of the radiological procedure | Observations of the scan at three time periods during the procedure focussed on children’s information seeking, the Manifest Upset Scale, the Cooperation Scale and the self-report of distress | The type of instruction was significantly related to the search for information Older children spent more time searching for information, (pr = 0.28) were more cooperative laying on the table (pr = 0.50) and during the intrusive procedure (pr = 0.45) displayed less upset behaviour getting on the table (pr = 0.40) and reported less distress (pr = -0.40) | |
Fraser (2019) [39] USA | To examine the effects of choice of information in pre-procedural instruction on children's responses to select radiologic procedures | Electronic medical record review | 958 children aged 3 and over have participated in the programme over a 6-year period | Patient Awake While Scanned (PAWS) preparation and support program which involved phone assessment 2 weeks before MRI, images of the scanner, pre-scan CCLS meeting to provide individualised support and coaching, explanation, and support from the CCLS, MRI technologist, and caregiver during the MRI | Mostly Certified Child Life Specialists (CCLS), but also MRI technologist and caregiver | Not stated | Completion rate Cost savings | A 96% rate of successful scan completion without sedation This program has minimised health risks associated with anaesthesia use in MRI and lowered the overall cost to families and the institution. There is a cost saving of $241.82 an hour in salaries alone |
Gebarski et al. 2013 [26] USA | To assess the efficacy of a cartoon and photograph montage storybook in preparing children for VCUG | Randomised prospective study | 100 children (87 girls, 13 boys) Mean age 5.3 years 50 children received the storybook and 50 did not | A storybook with cartoon characters superimposed on photographic backgrounds of the radiology department and fluoroscopy suite. An accompanying stuffed animal was provided to enhance the parent–child interaction during reading | Delivered by the parent/carer at home | Parent questionnaire completed after the VCUG to rate their child’s tolerance, use of the book and other sources of information used VCUG technologist (blinded) rated each child’s tolerance/distress on a scale modified from the Groningen distress scale at 2 points in the procedure | Child distress | The association between experiencing the storybook and high performance scores as rated by the technologist was statistically significant (p value = 0.0092). Children prepared with the storybook were 2.7 times as likely to score high |
Hallowell et al. (2008) [54] Australia | To determine the effectiveness of a PMRI service in helping children cope with diagnostic MRI and to reduce the requirement for GA | Clinical prospective audit | 291 children (aged 3 years 7 months to 17 years, mean 7.9 years) undergoing an MRI | Play MRI process including photo story book, discussion of the steps and sensations involved, tour of the PMRI unit, choice over distraction technique and practicing lying still | Educational play therapist Session delivered on the day of the MRI | MRI scan results were reviewed by a paediatric radiologist to ascertain scan quality | MRI scan quality | Of the 291 children who underwent a PMRI, 218 (74.9%) passed, and 227 (78%) went on to clinical MRI without GA. Of these 227 children, 198 (87.2%) had passed a practice MRI, 1 (0.4%) had failed and 28 (12.3%) had been considered borderline. A diagnostic study was achieved in 218 (96%) of the 227 children who underwent a clinical MRI without GA |
Han et al. (2019) [27] Republic of Korea | To evaluate whether virtual reality education for paediatric patients before chest radiography could reduce anxiety and distress in children and improve the radiographic process | Randomised clinical trial | 99 children aged 4 to 8 years who underwent chest radiography | Virtual Reality group 3-min virtual reality education explaining chest radiography. Delivered 5 min before the procedure Control group simple verbal instruction | The VR group received a 3-min VR educational presentation regarding the radiologic process with a head-mounted VR display 5 min before entering the radiography room | Children’s stress and anxiety Amended version of an OSBD scale Parents’ Self-reported satisfaction Procedural characteristics Procedure time, number of repeated procedures, difficulty of the chest radiographic imaging | Child anxiety and distress Need for parental presence Parental satisfaction score Procedure time Number of repeated images Process difficulty score | The number of less distressed children (OSBD score, < 5) was significantly higher in the VR group (38 [77.6%]) than in the control group (26 [52.0%]) and the degree of stress and anxiety measured was significantly lower in the VR group than in the control group. The mean (SD) score for parental satisfaction (9.4 [1.4] vs 8.6 [2.0]) was higher in the virtual reality group than in the control group |
Hartman et al. (2009) [28] USA | The purpose of this study was to assess if pre-procedural education decreased pre-procedural stress and anxiety for children undergoing MRI | Randomised controlled trial | 50 children (7–12 years old, without intellectual disability) undergoing an MRI 25 in control group and 25 in education group | Education group 24- page photo diary provided for children to read describing what children can expect (sounds, sensations) | Paper implies the photo booklet was read by families | Data were collected at three points in time, enrolment, before MRI, after looking at the intervention Children completed the Children’s Stress Symptom Scale and the Revised Children’s Manifest Anxiety Scale (RCMAS) Parents completed a survey on the perception of their child’s readiness for MRI (VAS) & parental satisfaction with the education provided to their child (VAS) | Child anxiety Child stress Parental anxiety | The results of this randomised controlled study suggest that a photo diary does not reduce pre-MRI stress and anxiety in school-aged children and does not improve satisfaction with education in parents who accompanied children undergoing an MRI scan |
Hogan et al. (2018) [29] USA | To evaluate the effectiveness of an educational video vs. standard of care in improving relaxation and procedural understanding among paediatric patients undergoing a magnetic resonance imaging (MRI) procedure | Pilot randomised controlled trial | 50 children 6 to 17 years of age undergoing an MRI Half of the children had undergone a MRI previously and nearly half required an intravenous catheter for contrast dye administration | Educational group 7 min MRI educational video on a portable electronic device in the MRI waiting area including information on what a MRI is and how images are taken, the MRI noises and the healthcare team they are likely to meet during the course of their visit | Self-administered video in the MRI department | Children > 7 years were asked to circle their level of relaxation using a 10-point VAS before their scan After the scan children rated how well they understood what they were told about the MRI (VAS) and open ended questions asking what children found most helpful about the MRI education | Child self-reported relaxation Child self-reported knowledge | With regards to patient understanding of the MRI procedure, patients in the intervention group had higher levels of mean understanding scores than those in the standard care group. The educational video was associated with increased relaxation among children, with the indication that it may be the most effective among older, adolescent children A total of 26 patients, half from the control group and half from the intervention group responded that the educational video was helpful in increasing their awareness and understanding of the MRI process |
Johnson et al. (2009) [46] USA | To evaluate whether an instructional colouring book used by a parent along with the child would reduce anxiety among paediatric patients about to undergo a radiology imaging test | Before (control) and after (intervention) trial | 3- to 10-year-old children (mean age 6.1 years) who were scheduled for outpatient CT, fluoroscopic, ultrasound, or nuclear medicine Excluded MRI and brain imaging | An instructional colouring book, ‘Radiology for Kids: Take a Tour with Garfield’ included cartoon depictions of equipment and brief explanations of radiology imaging tests as explained by the Garfield character and Odie undergoes the tests | The radiology colouring book was given to parents and patients for review while in the waiting room before their radiology tests Parents and self-directed educational | Parents Parental anxiety—Modified Amsterdam Preoperative Anxiety and Information Scale (APAIS) A VAS to measure parental estimation of patient anxiety levels just before the imaging test Four specific Likert-scale questions related to the utility of the colouring book Children Modified Faces Pain Scale-Revised (FPS-R) to estimate patient anxiety | Parent reported child anxiety Child anxiety | Neither parental estimation of patient anxiety (from the VAS) nor patient anxiety score (modified FPS-R from the patient) differed significantly between the control group with no colouring book and the intervention group who reviewed the colouring book The parents and children reported that the colouring book helped them better understand the radiology imaging test and made them less worried about the test my child had |
Johnson et al. (2014) [30] USA | To examine effectiveness of the social script intervention “Going to Imaging” application (app) on anxiety, challenging behaviours, and procedure duration among children with ASD, and the anxiety of their parents | Randomised controlled trial feasibility study | 32 parents and 32 children (age 0–19 years) in the study with a mean age of 10.3 years (SD = 5.1) Children had an ASD diagnosis by parent report Children with planned sedation or anaesthesia were excluded | Four procedure specific apps for MRI, CAT scan, X- ray and nuclear medicine. Each app has 10 screens of photos. The script was based on social script formatting that prepares a child by breaking down a procedure into steps and provides a script of responses | The experience of the child using the app was estimated to be 5 min A researcher delivered the intervention | The study involved data collection immediately before and after the iPad app intervention and during imaging Parents rated their anxiety on the State-Trait Anxiety Inventory for Adults (STAI-S) Child stress was measured by HR and BP monitor Child behaviour was measured with the behavioural observation tool for children with ASD in the healthcare setting (BOT) | Stress response Observable child challenging behaviours Procedure duration | Pre and post intervention change in mean child HR and systolic BP was greater for the intervention group compared to the control group Children in the control group had higher mean number of challenging behaviours The imaging procedure's time in the imaging room was less for the intervention group compared to the control group Change in parents’ state anxiety was greater for the interventional group compared to the control group |
Karakas et al. (2015) [40] Turkey | To demonstrate whether pre-scan training and orientation affect fMRI compliance of children with ADHD and determine whether this compliance is modified by state anxiety | Part of a large-scale descriptive quantitative design | 77 boys aged 6–12 years—a subsample (53 boys with ADHD and 24 boys in the control group) of the larger study protocol (70 boys with ADHD and 38 boys in the control group) | Children were taken on a tour of the department, shown the MRI scanner, introduced to staff and technicians and watched another child being scanned. Just before the MRI, children were individually trained and practice trials were repeated until the children understood the task | Study coordinator Preparation and training were conducted on the day of the scan | State anxiety scores | Scan success (acceptable amount of head motion) Repetition rates Cancellations due to refusals Expression of distress while in the scanner | Compliance was not significantly different between ADHD and control groups based on success, failure, and repetition rates of fMRI. Compliance of ADHD patients with extreme levels of anxiety was also not significantly different |
Mastro et al. (2019) [58] | To evaluate the effectiveness of an anaesthesia-free patient- and family-centred intervention through an analysis of MRI quality, health-care costs, and operational efficiency as compared with other approaches | Retrospectivereview of electronic medical records | 500 children aged 3–17 years, who underwent outpatient MRI 125 children in each of four different intervention arms | Pre MRI preparation session included a preparation book on iPad (with sounds, pictures, and text) covering all stages of the MRI visit. A medical play session led by the child with a mock toy MRI scanner with figures and dolls. Practice of coping techniques such as keeping still, guided imagery, audio music, and movie with MRI goggles | Nurse developed CCLS supported | MRI quality on a 5 point likert scale Hospital charges Procedural time | Image Quality Hospital Cost Procedural Time | The PFC/NA intervention group was found to have statistically significant lower and shorter procedure times and 96.8% of the MRI images were of acceptable or better quality than those of the SC/A and CCLS/A groups |
McGlashan et al. (2017) [4] UK | To examine whether the animated educational video provides an internet-based tool for MRI preparation | Prospective cohort study | 6.5 to 11.5 years 9 children with A-T (neurodisability with movement disorders) and 12 undergoing a clinical research MRI scan | An internet-based educational 3 min animated video The animation used was an updated version from the Szeszak et al. (2016) study | Self-directed Participants were sent an internet link to the animation prior to the MRI scan appointment | Locally developed questionnaire with closed responses (Likert and yes/no) and some qualitative responses Children Frequency of watching video and perceptions of the video Pre-scan perceptions (worry, expectations) Post-scan perceptions (whether the animation helped them undergo the scan, whether it helped them feel less nervous) Parents Pre-scan questionnaire on whether the animation was viewed, perceived positively by their child, helped prepare their child for the scan | Understanding of MRI scan Likeability of the animation Usefulness of the animation in preparing the child for the MRI | The children rated that they liked the animation and had a good pre-scan understanding of the MRI. The impact the animation had on preparing the children for the MRI was rated good The results indicated the animation had a larger impact on younger children. Nine children across both groups commented they wanted more realistic and louder noises in the animation and six children wanted a better indication of scanner size Results from the parent/guardian questionnaire showed 100% of parents agreeing that the animated film helped prepare their child for the MRI scan 19 of 21 children completed the core MRI research protocol |
Morel (2020) [47] France | Evaluated the impact of a teddy bear-scale model of a mock MRI scanner on the anxiety experienced by parents and their children during MRI without general anaesthesia | Prospective controlled trial | 91 children (46 girls, 45 boys), aged 4 to 16 years who presented to the ambulatory tertiary centre for an MRI scan Children were excluded because of severe cerebral palsy, severe attention deficit hyperactivity disorder or a lack of communication skills | Mock scanner specially designed to look like a toy to the scale of a teddy bear | MRI technologist Duration not stated | Ambiance of the preparation room rated on a 4-point Likert scale Child Anxiety levels were rated on a VAS at three time points, in the waiting room, after the preparation and after the exam Overall appreciation of the MRI examination was collected at the end of the procedure | Ambiance of preparation room Child anxiety level | Anxiety levels before the MRI examination were lower in children after the installation of the teddy bear-scale model of an MR scanner The anxiety level estimated by children was significantly lower after the explanations in the post-mock period. a significant difference between anxiety score in the waiting room and after the exam was also observed Children and parents gave free comments: They reported that they understood the MRI device much better |
Nordahl (2016) [48] USA | To develop improved and safer methods for obtaining high-quality images in a broader spectrum of children with ASD | Cohort study | 17 children aged 9 to 13 yearswith ASD and intellectual impairment | Pre-visit preparation (Structured interview, Video Model, mock scanner room, 3 T MRI suite) Mock MRI session Full-size mock scanner practice; lying down, tolerating movement of bed into scanner, tolerating noises, staying still) | Behaviour analyst, parents, and the research team | Quality assurance procedure to meet the QA threshold | Scan success rate Scan quality | The success rate in acquiring T1-weighted images that met quality assurance for acceptable motion artifact was 100%. The success rate for acquiring high-quality diffusion-weighted images was 94% The number of mock training sessions never exceeded into two visits. All four participants with IQs in the normal range required only one mock visit |
Ong et al. (2018) [31] Singapore | To assess the effectiveness of pre-scan videos on children having an MRI examination | Prospective randomised controlled trial | 789 children (mean age 11.6 years) The children were randomly assigned into 3 groups (control, regular cartoon video and interactive video combined with regular cartoon video groups) | A 2-min regular cartoon of a potato character undergoing an MRI examination, and an interactive video where a child is able to assist a panda character undergoing an MRI examination with MRI sound included | Children were shown the videos in a separate waiting area prior to their MRI | Children were surveyed before and after the videos to assess the self-reported duration that the child believes he/she can lie still for the MRI examination | Need to anaesthetise or repeat the MRI sequence | Viewing of videos did not have a significant effect on GA requirement even after adjusting for confounding effects of age, gender and prior MRI experience The results of this prospective randomised controlled trial suggest that children benefit from the pre-MRI videos, as evidenced by the significant reduction in the requirement for repeated MRI sequences due to motion artefacts and improvement in the confidence of children in staying still for at least 30 min |
Pressdee et al. (1997) [59] | To describe the implementation of a play preparation programme | Retrospective description | 169 children aged 4–8 undergoing an MRI plus any older children who were perceived as benefitting from preparation | Play therapy and colouring book The play specialist explains the procedure to the child and parents. Photographs of children or a teddy bear undergoing MRI. A small model of the MR unit, a tape recording of the noise produced during the investigation | Play Specialist | Not stated | Completion of scan | Only 1/169 of the children required MRI under GA Parents felt that this preparation had been of considerable benefit in decreasing stress and anxiety caused by the examination |
Pua et al. (2020) [49] | To familiarise children to MRI scanner environment and improve tolerance to loud and repetitive scanner noise | Descriptive quantitative study | 12 children aged 5–18 (monozygotic twins concordant or discordant for ASD) | Parents took part in a brief clinical interview with a psychologist and provided with an MRI familiarisation package (MRI orientation video, introducing child to locations in hospital and MRI scanner, Mobile app with interactive games, on-site visit – mock MRI training session) | Psychologist interview Parent delivered video and app | Measurements from an accelerometer device MRI quality indices | Scan duration Scan completion | Only one participant failed to meet criteria for acceptable levels of head motion and image artefact control |
Rothman et al. (2016) [32] Isreal | To evaluate a program that prepares children for MRI, by means of full or partial instruction | Prospective randomised study | 64 children full instruction aged 8 years ± 2 57 children in partial instruction aged 8 years ± 3 | 64 children received full interactive instruction that included an instructional booklet, movie and simulator practice 57 children received partial instruction that consisted of only the booklet Instruction occurred while the child waited for the scan | Health professional | Spielberger state anxiety inventory. Parents were asked to rank 10 questions that referred to current feelings | Anxiety Need for anaesthesia | The frequency of anaesthesia was statistically significantly lower in children who received full as compared to partial instruction The median anxiety level prior to instruction was higher than the median level after instruction for both the partial and full instruction groups |
Szeszak et al. (2016) [50] UK | To evaluate an animation in preparing children for an MRI scan | Descriptive quantitative design | 23 children (mean age of 7.65) Children with previous experience of MRI scans, history of neurodevelopmental disorder or poor English language comprehension were excluded | The animation lasted 3 min and follows Jess as she experiences an MRI scan. The design of each scene in the animation was based on real-life MRI equipment at the particular department | Self-directed | Children rated their knowledge of MRI and anticipated anxiety on a Likert scale An interview explored children’s understanding, anxiety and opinions of the animation | Knowledge Child anticipated anxiety Opinions about the animation (usability and retained attention) | There were statistically significant improvements in children’s knowledge in 3 of the 7 knowledge questions# Questions regarding anticipated anxiety relating to MRI showed significant improvements of + 1 in median score 100% of participants responded that they liked the way the animation looked, that the people in the animation looked friendly, and that they found it easy to hear what the people were saying. 95.7% of participants reported that they liked the MRI animation overall. 87% of participants reported that they would like to see more animations of this sort for other hospital tests and treatments |
Thung (2018) [51] | To determine whether the Yale Preoperative Anxiety Scale (mYPAS) obtained before MRI simulation can effectively predict success of MRI without | Before and after cohort design | 80 participants (43 boys and 37 girls). Mean age of 8.5 SD 3 years | Simulation based training using a practice MRI scanner Practice MRI scanner | Child life specialist | Scan duration Child anxiety assessed using mYPAS | Need for sedation or anaesthesia for MRI Child anxiety | 69 from 80 did not require anaesthesia for MRI after simulation Overall study cohort mYPAS scores improved from 31 (± 11) to 27 (± 9) 11 children were unable to complete scan due to nervousness or anxiety and inability to lay still |
Tornqvist et al. (2015) [42] Sweden | To determine whether children who receive age-adjusted routines can undergo MRI without deep sedation/anaesthesia | Cohort design with two groups studied at different time period | Control group (n = 36 children) and intervention group (n = 33 children) who attended scheduled MRI scans for head or head and spine examinations | All children in the intervention group received; a booklet and a storybook sent home, a ‘doll-size’ model of an MRI scanner made with an MP3 player with the MRI sound recorded was shown to the child at the day care unit along with a DVD film while undergoing MRI | Not documented | Data collection included procedural information (sedation/anaesthesia, length of the scan, successful completion), image quality and motion and the parents recorded their satisfaction with the care of their child (Healthcare Satisfaction Module specific for Hematology/Oncology) and costs for the examination | Number of children who successfully went through MRI without deep sedation or anaesthesia Image quality concerning motion artifacts Parents’ satisfaction with the care Scan costs | In the control group, 30/36 needed sedation/anaesthesia, in the intervention group 3/33 needed sedation/anaesthesia Comparison of parents’ satisfaction showed no significant difference between the groups |
Train et al. (2006) [43] UK | The aim of this study was to evaluate a psychological intervention designed to reduce distress in children undergoing 99mTc-DMSA | Retrospective (control group) and prospective (intervention group) cohort study | 121 children in total. 81 children in the control group (mean age of 3.8 years (SD 3.2); 40 children in the intervention group (mean age 2.9 years, SD—2.4) | Intervention group families were sent a brightly coloured photo-booklet depicting a child having a scan. There was also a letter giving advice on preparing children for medical procedures and the waiting area was enhanced to be more child-friendly | Researcher | Parental satisfaction (Likert scale) completed after their child’s scan Rates of sedation and procedure failure established from the medical notes Parents completed the Spielberger Anxiety Questionnaire Child’s distress was rated by the doctor (VAS) The image quality was blind rated by a consultant radiologist | Child distress Need for sedation Parental anxiety Image quality | Sedation rates were significantly lower in the intervention group. The rates of failed procedures and use of intravenous sedation were also lower in the Intervention group Satisfaction rates were significantly higher in the intervention group The children’s distress scores before the procedure were lower in the photo-booklet group than in the standard care group but were not significantly different The qualitative comments suggest that the provision of additional information about what families should expect on the day, set out in an appealing child-centred way, increased levels of cooperation and satisfaction |
Utama et al. (2019) [33] | To investigate whether the use of an interactive educational animated video is non‐inferior to showing two videos in improving children's cooperativeness during MRI scans | Prospective, randomised, non‐inferiority trial | 558 children (aged 3 to 20 years) | Group 1 children (n = 281) watched a 2-min regular animated video of a boy undergoing an MRI scan and a 2-min animated interactive video where children help a panda through an MRI scan Group 2 children (n = 277) watched the interactive animated video only | The videos were watched in the waiting area prior to children attending their MRI scan | Children were asked to assess their confidence in staying still for at least 30 min both before and after watching the videos Recorded number of children requiring repeat MRI or GA | Repeated MRI sequences, Need for general anaesthesia (GA) Improvement in children's confidence of staying still for at least 30 min | In the interactive video group 31% (n = 86) needed repeat MRI, 0.7% needed GA and proportion of children who reported confidence to stay still increased by 22.1% In the combined video group, 36.3% (n = 102) children needed a repeat MRI, 2.1% of children needed a GA and the proportion of children who reported confidence to stay still increased by 23.2% |
Waitayawinyu (2016) [52] | To identify the success rate of MRI in 6–15-year-olds, non-sedative paediatric patients after watching MRI introductory video | Prospective interventional study | 55 children (aged 6–15 years) Children were excluded if they had neurovascular diseases | An introductory video which was presented as both cartoon animation and real MRI set up, included scanner suite introduction, how the scanner works, patient’s position in scanner and audio of the scanner. Patients would then make decision whether they needed any sedation for the scan session | 5 min | Data collection included procedure time, quality of MR imaging and anaesthetic data | Scan quality Scan completion Use of anaesthetic and/or sedation | After watching the introductory video, 37 participants (67.2%) decided to proceed with non-sedative option. Ninety-four percent of non-sedated group (35 participants) went through MRI scan course successfully while two cases were unable to complete the scan and requested sedation afterwards |
Williams & Greene (2015) [44] Australia | To examine the impact of the app on children’s anxiety when undergoing medical imaging | Prospective cohort study | 50 children in the control group 50 children in the intervention (app) group | An App for radiology procedures which includes three training games and explanatory videos. There is also information for families including tips, things to practice, wearing the right clothes and frequently asked questions | Children can access the app either before coming to hospital or when at hospital through the Play Therapists in the Medical Imaging Department | No information on the data collected | Anxiety Compliance Time taken to be ready for imaging | The average time taken for patients to be ready for imaging reduced. The average compliance issues reduced and the average anxiety rates improved. Additionally, two patients in the group who did not have the app failed to undergo imaging, while all patients who had the app were able to undergo successful imaging |
Yamada et al. (2020) [53] Japan | To explore the generalisability of preparation for functional paediatric neuroimaging to clinical simulation in nursing | Retrospective review | 241 children aged 4–17 years | A simulation protocol using a mock scanner preparation with sounds immediately before an MRI being performed | Experienced staff The average simulation time was approximately 40 to 60 min Completed just before their scheduled MRI studies | Medical case note review | Scan completion | Studies were successfully completed for 100 (98.0%) participants with TD and for 130 (93.5%) participants with NDDs, resulting in The study suggests, this device can help participants become more relaxed |