Virtual Reality MRI: Playful Reduction of Children’s Anxiety in MRI Exams Stefan Liszio University of Duisburg-Essen Entertainment Computing Group Duisburg, Germany stefan.liszio@uni-due.de Maic Masuch University of Duisburg-Essen Entertainment Computing Group Duisburg, Germany maic.masuch@uni-due.de ABSTRACT Many people, especially children, perceive MRI exams as threatening. They experience anxiety and stress during the procedure. Often this results in premature termination of the scan or low image quality. To avoid these adverse effects, it is common to sedate anxious patients. We present a playful virtual reality (VR) application for children (8 - 15 years) to counter anxiety and avoid sedation. Our approach uses a real- istic virtual MRI scanner for desensitization and habituation to the MRI exam. To compensate the limited amount of profound knowledge about the design of child-tailored VR applications, we pursued a child-centered design process. Starting with expert interviews, we iterated through several development cycles and carried out focus group testings to evaluate proto- types of the VR application. Then, we conducted a field study with 13 patients under real life clinical conditions. Although results were non-significant, tendencies indicate a drop in the anxiety level after using the application. Furthermore, the ap- plication received strong support of the participating children, and medical professionals. ACM Classification Keywords H.5.1. Information Interfaces and Presentation (e.g. HCI): Multimedia Information Systems: Artificial, augmented, and virtual realities; K.8.0. Personal Computing: General: Games Author Keywords VR gaming; stress; magnetic resonance imaging; child-centered design; sedation; patient preparation; desensitization. VIRTUAL REALITY IN HEALTHCARE Today’s VR technology is capable of presenting highly realis- tic simulated experiences while being relatively inexpensive. By providing simulated stereoscopic images and synchroniza- tion of head movements, it is possible to elicit high levels of sensory immersion [32]. The higher the level of sensory Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than the author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from permissions@acm.org. IDC ’17, June 27-30, 2017, Stanford, CA, USA © 2017 Copyright held by the owner/author(s). Publication rights licensed to ACM. ISBN 978-1-4503-4921-5/17/06. . . $15.00 DOI: http://dx.doi.org/10.1145/3078072.3079713 immersion, the more likely it is for a recipient to experience presence, that is, the feeling of actual being in the virtual world [14]. Thus, VR allows the recipient to experience virtual worlds as if they were real. These worlds represent completely controllable environments, which can be explored safely and independently of time and place. Consequently, VR has been applied in a multitude of domains related to healthcare, such as for graded exposure therapy of anxiety disorders, but also for education, and training of surgical skills [22, 1]. It has been shown that confronting patients with specific feared stimuli in immersive virtual environments is an effective way to reduce anxiety [26]. Thus, virtual reality exposure therapy (VRET) has proven to be suitable for a variety of affective (especially anxiety) disorders like specific phobias (e.g. claustrophobia, fear of heights, fear of flying, PTSD, social phobia) [43, 41]. VRET addresses some of the disadvantages of classical in vivo and imaginal exposure therapy approaches: Unlike in vivo ex- posure, VRET is independent from time and space, and can be performed in a safe environment without the risk of public embarrassment [43]. In contrast to imaginal exposure, VRET does not require imaginative abilities of the patient to visual- ize the anxiety-evoking scenario. Furthermore, a remarkable amount of research has been done in applying VR-technology to support distraction therapy in pain management [36]. Hoff- man et al. [15], the pioneers of this approach, used a VR game to distract patients from pain during woundcare. With functional magnetic resonance imaging, the authors were able to show that VR as a distraction technique is successful and ef- fective in reducing pain perception. Several follow-up studies have reinforced these findings also for chronic pain [42]. Although some authors have already anticipated the potential of VR as a method for preparing individuals for stressful situ- ations [43, 34], to our knowledge, this is the first attempt to systematically design and use a playful VR application for the reduction of children’s anxiety and stress related to magnetic resonance imaging (MRI). We present an approach which com- bines patient information, play-therapeutic elements, games, and VR exposure in one VR application for desensitization and habituation to both the MRI examination procedure and the MRI scanner itself prior to the actual scan. To design this application in accordance with the needs and preferences of the target group, we followed an iterative child-centered design process.