Michael Cao remembers how brave his sister was as she battled cancer, before she died at age 11 in 2009, but he also recalls the thing that scared her most: the tight confining tube of an MRI scanner.
His sister, Amy, panicked during her first scan, at age 10, and couldn't finish it. Her terror became an obstacle throughout treatment.
"That first traumatic experience set the tone for a lot of other MRIs that she had," said Cao, 17, now a senior at Mounds View High School. "They became very difficult for her."
So, in her memory, Cao sought a solution: something that would save other children from suffering the same anxiety. The result is an app that syncs with virtual reality (VR) goggles, providing children interactive simulations of MRI scans before they go through the real ones. Gillette Children's Specialty Healthcare in St. Paul now offers it to all children scheduled for the scans.
Rapid advances in VR technology have produced many new ideas for hospitals. Gillette also uses goggles loaded with imagery and games to distract children during needle pokes and drug infusions.
It made particular sense in preparing children for imaging, because it can be a noisy, disorienting and lengthy experience if they don't know what to expect, said Shannon Wier, a Gillette child life specialist.
"I had one kid who thought he was going to get sucked up in the MRI" because of tales his friends told, she said.
Studies over the past two decades have reached different estimates about the number of MRIs halted because of patients' anxiety or claustrophobia, but they generally link the problem to the tight confines of scanners and the jarring noises they make.
While sedating patients is one option, that presents costs and risks. Doctors have studied other distractions, from videos and music to foot massages and breathing exercises. Australian researchers in 2010 reported success in reducing the need for anesthesia in children by performing mock MRIs with them first in inflatable, look-alike scanners.
Cao's app takes the same approach of acclimating children. The length of MRI scans, often as much as an hour, can be one problem for squirmy children. But often they simply suffer from the fear of anticipation, said Chantel Barney, the Gillette clinical scientist who worked with Cao over the summer to get his app ready for clinical use.
"They might build it up to be this scary thing," she said.
The app gives children a digital simulation of entering an MRI, accompanied by the real whirs, beeps and buzzes that a scanner makes. Dizziness is one concern — common to all VR programs — but Cao said children are instructed to remove the goggles if they feel sick.
Ryan Ohmann, 14, approved. The high school freshman from Isanti, Minn., was more of a test case, having undergone previous scans without issue. He returned to Gillette on Tuesday for an MRI to check a tumor near his spine.
"It sounds exactly like (a real MRI) sounds like," said Ohmann, his face covered by the goggles, "which is loud."
The MRI app underwent revisions — such as adding a technician in the virtual control room to show that someone would always be there during a scan — and a review by clinical and legal officials.
Barney said VR could be expanded to preview surgeries and other procedures.
Gillette has been open to ideas from high schoolers in the past, she said, but Cao was remarkably professional in his development of the app and his presentations to leaders.
"What an incredible young man … to pull this off," she said.
Over the years, Cao looked for ways to honor his sister, such as volunteering with the Make-A-Wish Foundation or raising money on 5K runs.
He took an academic interest in 3-D printing and design, and said those skills transferred to VR development when the technology and goggles became broadly available.
Cao saw an iPad app that offered a demo of an MRI scan, but he said it lacked the immersive experience of VR that can confront kids' anxieties.
"It was still a pretty big gap between what children were told and what they expected," he said, "and what they actually experienced."
jeremy.olson@startribune.com 612-673-7744
