Examining the feasibility in reducing the need for sedating patients undergoing an MRI scan through a VR MRI experience.

MRI scans at GOS hospital are very noisy and often traumatic for young patients. Many who undergo this scan find it difficult to lay still for the duration of the procedure, so are put under general anesthetic. This can be quite costly, increase wait times, and come with medical risks. The projects main objective is to reduce the need for sedating patients before the procedure, which will save on time, money and improve the experience for the patients and radiology staff.

I hypothesised that guiding patients through the MRI experience before the scan could help reduce anxiety. The experience would explain the process e.g. how long it lasts and what the equipment does, all set within a relaxing underwater theme. The radiology department took interest in my project, including Consultant Neuroradiologist Kish Mankad and Lead Radiographe, Claire Simcock. We worked together to pursue research grants and other methods to test the project’s feasibility and accessibility. Early research questions we wanted to answer were:

• Does the VR MRI project reduce the need and cost for sedating patients before an MRI scan?
• What is the feasibility of VR during Hospital visits for patients and also for staff?
• Does VR help reduce waiting times for scans?
  

_{VR MRI project}

Early inspiration came from similar patient-focused experiences

Inspiration for the art-style came from an indie video game called That Dragon Cancer. Created by the parents of a boy who was diagnosed with terminal cancer, the game tells the story from his diagnosis to his passing. This healthcare related game offered motivation and inspiration. Development started with reference images taken of a GOSH MRI room, granted by the Lead Radiographer. A simple low poly MRI room was created in Maya, as well as a radiographer, mother and young boy.

_{GOSH MRI room with underwater theme}

As the actual GOSH MRI department is set 1 level below ground, they incorporated underwater themed wallpaper. Inspiration was taken from this by giving my VR experience an underwater theme, accompanied by sea-life. I modeled an array of fish, as well as a turtle. Equipment also created for the scene included a buzzer and helmet that is used during the actual procedure.

_{Modeled MRI room, characters and fish in Maya}

A narrative voiceover script was drafted using the current GOSH MRI video podcast. My one included important information that would be addressed to the patient during the VR experience. I ran the script by the Lead Radiographer, to make sure it was precise and understandable, something she was pleased with upon reading.

_{Narrative voiceover script of MRI procedure}

Moving from Maya to Cinema 4D

Having experimented with previous successful projects in Cinema 4D (C4D), I decided on texturing, rigging and animating the scene in this software. Basic textures were applied, along with an auto-rig for the characters. Both radiographer and mother would accompany the patient inside the VR experience, and the young boy character was used as placeholder for the animation and interaction of the two nurse characters. A camera was also placed where the boy was lying down as a POV reference.

The 2 characters were animated in conjunction to the narrative script. E.g when the voiceover says that “you are given a buzzer and a helmet,” the radiographer was animated to hold these objects up towards the camera’s POV.

_{Scene animations in Cinema4D}

To offer a calming and relaxing VR experience, the sealife would then emerge and swim around the room and patient.
Manually created rigs were applied to the animals, as well as textures. Simple yet effective animations were key framed to show them swimming serenely. To offer additional realistic movement to the sealife around the MRI room, I manually created spline paths going in a number of directions. The animals were then added onto these splines. This – combined with the animation – gave for a really nice natural swimming effect.

_{Sealife animated on spline paths}

^{Animated characters with sealife swimming about}

Setting up the scene in Unity

The animated scenes were imported into Unity and Animation systems were created to allow the models to play in-game.
A number of underwater effects were added into the scene to add immersion. E.g:

• Bubble particle effects
• Seamless water using Caustics Texture Generator
  

I then built the VR project for the Samsung Gear VR using the Oculus Mobile SDK. This was due to the fact that it was a cheap headset for the hospital to use, reducing costs. Also, it could easily be wiped down between each patient viewing, keeping to rigorous sanitation requirements.

_{Water effects using 'caustics generator' and unity particle system}

_{Animation played out in Unity}

The final design was simple yet engaging

The finished project came out great. From the realistic and captivating sea life swimming around the patient, to the informative narrative syncing with the animated characters.

_{MRI VR project}

Showcasing my project to patients and staff

During my time at GOSH, a number of departments took interest in my work. From the GOSH Data Research, Innovation and Virtual Environments (DRIVE) unit, to the Play Team, as well as the radiology department.

They invited to a number of events to showcase my project. Whether presenting to clinical staff on innovating within the hospital, to showing actual patients, feedback came from a range of participants and viewers.E.g. Patients said they felt relaxed during the experience. Parents even said they wished this project was used when their children underwent MRI scans years ago.

Some of these events included:

• ‘Care of the complex child’– Selected digital poster at the conference attended by 200 clinical and academic delegates from GOSH, UCL and wider paediatric community.
• PGME- ‘Advance in Paediatrics’– Speaker at the conference attended by GOSH + UCL clinical staff.
• Play Team’s ‘Play in Hospital Week‘– Invited by Play Team to present and show patients my project. Had my own stand and posters.
• DRIVE ‘The Big Inspiration’ event– Presented my project at GOSH’s Innovation department which showcased projects centered around Healthcare.
• Radiology Departmental meeting– Presented my project to the whole radiology department. Included consultant radiographers, sonographers and Radiographers
• ‘World Radiology Day’-Global event celebrating radiology and raising public awareness of how it plays a crucial role in healthcare.
  

_{'The Big Inspiration' event}

_{Radiology departmental meeting}

_{'Play in Hospital week'}

_{PGME certificate}

Research grant proposals for funding clinical trials

In 2020, two research grant proposals here were submitted in regards to my MRI VR project. One was for The Royal College of Radiologists Pump Priming Grant (PPG). And the other one was Patient and Public Involvement and Engagement (PPI E) Small Grants Scheme advised by Polly Livermore, NIHR Clinical Academic Programme Lead. These grants would allow us to carry out a small clinical trial in the MRI department. We wanted this grant so that we could to test the feasibility of the project in a real life setting.

For the PPG application, we asked for £2800. This would pay for things such as a Samsung VR Headset, headphones, and a Clinical Psychologist facilitator.

The disbanding of the fellowship

Due to strong competition both applications were unfortunately rejected. Reasons were given e.g. the need to: elaborate on quantitative and qualitative patient reported outcome measures + Advise for ethics committee to be involved around consent and recruitment

Research and Innovation in Healthcare is a long, slow arduous process. Where modalities could be interested one minute, caring for patients and treating them could lead innovation to the wayside.
Having left GOSH, there was no more communication from the teams.

What I learned

Realistic movement is key for VR engagement
Exploring new effects such spline paths moving was a great addition for the project. They created a really immersive experience, that allowed patients to follow the sea life around the room, feel relaxed, and sometimes reach out to the animals.

Rejections in research is normal but tough
Funding applications are popular and highly competitive in any sector. One thing I learnt from speaking to Dr Livermore is that many highly skilled clinical research staff are met with rejected applications all the time. So the need to learn from this is what hones in one’s skillset for successful future submissions.

Innovation in healthcare in not always the cure.
The strive for advancements in medicine and innovation sometimes go hand in hand. However, patient recovery is usually the more popular option for applications and interest in healthcare advancements.