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Table 2 Data extraction of the included studies

From: Interventions and methods to prepare, educate or familiarise children and young people for radiological procedures: a scoping review

Author/Year/

Country

Aim

Study Design

Participants age & condition/s

Intervention characteristics

Intervention delivery

Data collection methods

Outcomes

Results/Findings

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