Augmented Reality with Choco the Bear Comforts Children During MRIs

// By Cheryl L. Serra //

Children’s Hospital of Orange County makes having an MRI feel like an adventurous day near the sea.

Imagine a child you love is not feeling well. They have seemingly ceaseless appointments at unfamiliar places — hospitals or healthcare facilities with all their starched efficiency, forms, and strangers — to be examined by yet more strangers.

Andrew Ruiz, CHOC director of imaging services

Often, it’s rinse and repeat, more tests. One of these tests, the MRI, or magnetic resonance imaging, entails the child being swallowed inside a piece of large and very noisy equipment, alone. Here, they must lie completely still for anywhere from the half hour to two-and-a-half hours necessary to perform the procedure. Some young patients may have up to a dozen MRI orders.

It would be daunting for anyone, but especially for a child.

But developers at Children’s Health of Orange County (CHOC), a pediatric healthcare system in Southern California, have used technology to make the MRI experience more comforting, engaging, and fun for children and their families.

Launched as a pilot in November 2021, the first module of an augmented reality app is the first of many modules incorporating the technology that will soon be implemented across CHOC locations, according to CHOC’s director of imaging services, Andrew Ruiz.

The first module, “MRI with Choco,” named after the beloved health system’s bear mascot, allows young users to interact with computer-generated visuals and sounds within a real-world environment to understand the MRI process.

An MRI that feels like a relaxing day at the beach with friends? Stay tuned for the full story about this reimagined patient experience.

Choco Bear Joins Children on Health Journey and Diminishes Anxiety

CHOC performs up to 850 MRIs on children each month. Innovators sought to reduce the anxiety the procedure produced in its young patients and their families and caregivers.

The team created an augmented reality application designed to mimic a day on the beach, complete with soft waves lapping the shore, seagulls chirping, and the kind of sunshine that doesn’t burn your skin. Choco Bear offers a virtual hand to help the patients along, bridging the gap between the physical and imaging worlds.

The design, originally created to guide children through the MRI process, is now underway for a complimentary MRI module for parents. This module will help answer their questions about the procedure.

Take a Walk with Lucy as She Brings Patients to Learn and Play in Preparation for MRI

Ruiz explains how the app works.

A child who is scheduled to undergo an MRI will receive an iPad wrapped in a child-friendly case when they enter the lobby of the Gregg and Celin Miller Radiology Department at CHOC Hospital, the health system’s hospital in Orange, California.

When the patient presses play, “Lucy,” voiced by a former CHOC patient, welcomes the child, introduces them to Choco, and begins the process of relieving their anxiety about the procedure by combining distraction and practical information to help children better understand the MRI process — every step along the way.

Lucy introduces patients to the radiology staff and the roles they will play during the procedure.

To get children comfortable in the space, Lucy invites patients to point the iPad at a wall mural of a whale, which triggers a baby whale to come to life and swim around the lobby. Another mini game in the lobby involves finding hidden Choco bears all around the room.

Just before the patient leaves the lobby to head to a screening room, the patient points the tablet at a seagull marker on the wall. This activates Choco’s footprints to appear down the hallway as the baby whale swims with the patient on the journey to the prep room.

In the prep room, an animated Choco shows off the gown the patient is going to wear.

After storing any personal items with metal in a locker, the patient again looks for hidden Choco bears in the prep room. Watch this video to see how it works.

In an interactive game, the patient can wave a metal detector to check if Choco has any metal items. Spoiler alert: He does, and it’s a kitchen sink!

As the patient heads to the MRI suite to begin the procedure, its entrance 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.

The iPad is put away as the procedure is underway, but the patient can choose to watch a movie or listen to music during the exam.

After the MRI, the iPad comes back out and the patient celebrates their success with Choco.

Choco Passes the Real Test

Ruby Yoo, 6 years old, was diagnosed with neuroblastoma when she was 2. She’s no stranger to scans and MRIs, says her dad, Jeff, director of partnerships, insights, and events in CHOC’s marketing and communications department.

Ruby had her last MRI last October. It was different from previous MRIs for a couple of reasons: Her improving health means this scan will be the last for a year, and Choco came along with her.

Jeff says it’s often difficult to keep children occupied when parents fill out the host of papers and talk to medical staff. For Ruby’s last scan, he says, “It was fantastic,” since the child life specialist greeted Ruby when she arrived, and Ruby and Choco went on their adventure.

AR is familiar to Ruby, Jeff says, adding, “It just made the experience a lot more smooth, it felt like a game,” rather than Ruby having to process a litany of instructions.

CHOC Facilities to Implement 30 Additional Modules Across Its Health System

Ruiz says the technology is also planned for the pediatric intensive care unit at  CHOC at Mission Hospital, the health system’s hospital in Mission Viejo, California to allow patients to find hidden Choco bears as encouragement to walk throughout the unit as part of their healing process. The Thompson Autism Center at CHOC also plans to implement the technology.

“In total, CHOC aims to implement 30 modules in three years across the health system,” says Ruiz.

Regarding the brains behind the technology, he says, “The Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3) at CHOC, the health system’s innovation powerhouse, approached the radiology team at CHOC and asked them to ideate and design a unique solution for patient anxiety around MRIs. From there, local AR and VR company EON Reality developed the modules. The Innovation Institute — MI3 — then managed every aspect of the project, from concept to storyboards, design, voice actor, 3D Choco bear images, pilot coordination, revisions, and more.”

Upcoming modules are created collaboratively between CHOC staff in various departments and EON Reality. Since Choco has such a strong emotional connection with CHOC patients, families, and staff, he’s a shoo-in for the leading role; no auditions required.

The modules also incorporate existing design elements already in place throughout the radiology department, such as whales, sandcastles, and other marine-like images. The seaside design features align with the décor throughout the floor as well.

“The goal is to provide a cohesive design and serve as wayfinding aids for patients and families. So, altogether, incorporating Choco, a whale, and other design elements provides a well-integrated experience for patients and families as they interact with the health system and move throughout the hospital,” Ruiz says. The user can spend as much or little time on each module. There is no time limit for each section.

Cheryl L. Serra is a freelance writer and marketing communications specialist. Email her at cherylserra@yahoo.com.