A day at the beach.
While that’s clearly not the first thing that comes to mind when thinking about undergoing a magnetic resonance imaging (MRI) procedure, innovators at CHOC have created a beach-themed application designed to ease young patients’ fears about the anxiety-inducing process.
“MRI with Choco” has launched its pilot phase with the MRI department, and soon will be formally launched, providing wider access to patients and families. This is the first of many modules to be designed and implemented throughout CHOC’s health system, and was created in partnership with Eon Reality, an Irvine-based augmented and virtual reality company.
MRI with Choco is designed to not only make the process of undergoing an MRI less scary for kids, but also to educate them and their parents about this intimidating but non-invasive way for doctors to examine organs, tissues, and the skeletal system to help diagnose problems.
The team at the Sharon Disney Lund Medical Intelligence and Innovation Institute (Mi4) at CHOC, which creates, focuses and executes projects in the areas of intelligence and innovation in pediatric medicine, is overseeing the partnership with EON Reality, and selected radiology for its pilot module.
“We thought, ‘Let’s dream up something entirely new for our patients and families,’” says Debra Beauregard, part of the Mi4 leadership team. “Our MRI team shared a problem they were having, and together, we came up with an innovative solution.”
Choco is the star of show
MRI with Choco is an augmented reality app, meaning users interact with computer-generated visuals and sounds in a real-world environment. Virtual reality, on the other hand, completely replaces the user’s real-world environment with a simulated one.
Matt Taylor, project manager for EON Reality, co-designed the app along with creative consultant John Slowsky. Many members of the MRI team helped to design a unique experience for CHOC patients. In the app, Choco bear, CHOC’s beloved mascot, walks alongside patients through their MRI experience.
When a child enters the radiology lobby, they are offered an iPad, encased in a child-friendly durable case.
When the patient presses play, “Lucy,” voiced by a former CHOC patient, welcomes children, introduces them to Choco, and begins the process of relieving their anxiety about the procedure, combining distraction with practical information to help children better understand the MRI process — every step along the way.
To get children comfortable in the space, Lucy invites patients to point their iPad at a wall mural of a whale, which triggers a baby whale to come to life and swim around the lobby.
Lucy also introduces patients to the radiology staff and the roles they will play.
In search of Choco
Another mini-game in the lobby involves finding hidden Choco bears all around the room.
Before the patient leaves the lobby to move into a screening room, the patient points the tablet at a seagull marker on the wall. This activates Choco’s footprints down the hallway as the baby whale swims with the patient to the prep room.
In the prep room, an animated Choco shows off the gown the patient is going to change into.
After storing personal metal items in a locker, the patient again looks for hidden Choco bears in the prep room. In an interactive game, the patient can wave a metal detector to check if Choco has any metal items (he does, and it’s a kitchen sink).
The entrance to the MRI suite that houses two giant magnets is framed by an illustration of a sandcastle, with the sound of surf lapping at the shore. The entrance to the MRI magnet is ringed by a pink inflatable donut for swimming.
After the MRI, the patient celebrates their success with Choco.
Normalizing the environment
Ashley McGee, a child life specialist assigned full time to radiology, was a key member of the MRI with Choco team.
“We have children that come through here who are on a lot of different types of medical journeys, and oftentimes, this can be one of the more overwhelming experiences for patients and their families,” Ashley says. “This app will help reduce stress and anxiety, and also help to promote positive coping skills and help normalize the environment.”
Members of the clinical team in radiology also devoted a lot of time making the app as engaging as possible. Those members include Robert Grey, lead MRI technologist and one of the main contributors to the project; Erin Parra, an MRI technologist who assisted in the scripting and logistics; and Denise Cobian and Angela Flora, radiology RNs who assisted with scripting.
Ashley says the radiology department has high hopes for the AR app.
“We’re so excited,” she says. “This will absolutely make a difference.”
Andrew Ruiz, director of imaging services at CHOC, says MRIs can last from 30 minutes to 2 ½ hours. One child can have up to 12 orders for MRIs, and CHOC performs between 750 and 850 MRIs per month – for everything from concussions to trauma cases to patients with epilepsy and other neurological disorders.
Because patients must remain completely still inside the tube, about 60 percent of them must be sedated.
“Any kind of distraction is key,” Andrew says. “Any time you can show kids a game, their minds go away from the fear of the unknown.”
A key design factor in creating the app was to give patients more control over their physical environment – while also providing education about the process, as well as distraction, Matt notes.
Ruby Yoo, 6, recently tested the MRI with Choco app and gives it good reviews, says her father, Jeff, director of partnerships, insights, and events in CHOC’s marketing and communications department.
Ruby has undergone several MRIs since being diagnosed, at age 2, with neuroblastoma and is set to have her next scan in a year after being clear of the cancer for four years now.
“It can be an entire ordeal in terms of getting her comfortable for an MRI,” Jeff says. “The pre-process has always been tough. She knows what’s coming and it’s always a little bit of a struggle.”
Jeff says the app is a good tool to get kids more engaged on appointment day.
“Using Choco and the whale felt very integrated, and the app is a very smart and creative way to help our patients,” Jeff says.
Melissa Chambers, a tech assistant/imaging aide in radiology, saw a change in Ruby when she used the app.
“You could tell she opened up,” Melissa says. “At first she was a little apprehensive about the appointment, but then she got super excited — especially looking for Choco.”
Andrew says creating the app was a “great process with our entire team actively involved in co-creating this solution. And, in concert with the child module, we’re introducing a parent education module, answering frequently asked questions to ease the mind of parents as well.”
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