Animated Video Intervention Enhances Image Quality and Compliance in Pediatric Cranial MRI

Animated Video Intervention Enhances Image Quality and Compliance in Pediatric Cranial MRI | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Animated Video Intervention Enhances Image Quality and Compliance in Pediatric Cranial MRI Lizhen Liu, Zhenghua Chen, Yaru Liu, Zhongjie Zeng, Junyuan Zhong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7269642/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Pediatric MRI examinations face numerous challenges due to anxiety and motion artifacts. This study aimed to evaluate the efficacy of an animated video intervention in improving cranial magnetic resonance imaging (MRI) examination outcomes among pediatric patients aged 2 ~ 11 years. Methods: This randomized controlled trial included 207 outpatient children scheduled for cranial MRI at Ganzhou People’s Hospital, China, from January 2022 to January 2024. Participants were randomly assigned to the intervention group (n=102, watching preferred animated videos during scans) or the control group (n=105, standard procedures). Primary outcome was image quality (three-tier ordinal scale: high, moderate, low). Secondary outcomes were participants’ compliance (four-level scale: Liked to Fearful), number of repeated scans, and examination success status (five categories: Highly Successful to Unsuccessful). Multivariate ordinal logistic regression and binary logistic regression were used to assess intervention effects. Results: The intervention group achieved significantly improved image quality (aOR = 0.45, 95% CI: 0.33, 0.63, p < 0.001), higher compliance (aOR = 0.25, 95% CI: 0.18, 0.35, p < 0.001), fewer repeated scans (aOR = 0.46, 95% CI: 0.32, 0.66, p < 0.001), and greater examination success (aOR = 0.25, 95% CI: 0.18, 0.36, p < 0.001) than the control group. Sensitivity analysis excluding incomplete examinations confirmed these findings. Subgroup analysis revealed stronger benefits in boys and children under 7 years, with less consistent effects in older children. Conclusion: Animated video assistance is an effective non-pharmacological strategy to enhance pediatric MRI outcomes, particularly for younger children and boys. Pediatric MRI animated video intervention image quality pediatric compliance non-pharmacological Introduction Magnetic resonance imaging (MRI) is a cornerstone of pediatric diagnostics, valued for its safety, non-invasiveness, and advanced imaging capabilities. Unlike computed tomography (CT), MRI avoids ionizing radiation, minimizes bone artifacts, and offers multi-parametric imaging with exceptional soft-tissue contrast, making it ideal for evaluating conditions affecting the brain, chest, abdomen, pelvis, and extremities in children[1, 2]. These attributes position MRI as a globally preferred modality for accurate, non-invasive disease diagnosis[1, 3]. By leveraging magnetic fields, radiofrequency pulses, and computational algorithms, MRI produces high-resolution images that enhance clinical decision-making in pediatric care[4]. Despite its advantages, pediatric MRI poses significant challenges. The procedure’s high noise levels, confined scanning environment, and prolonged duration often provoke anxiety, particularly in young children unfamiliar with the MRI suite[5]. The intimidating equipment exacerbates fear, leading to non-compliance, crying, or agitation, which compromise image quality through motion artifacts or result in examination interruptions[6, 7]. These issues contribute to low success rates in pediatric MRI, hindering diagnostic accuracy and increasing clinical burdens[1]. Addressing these barriers is critical to optimizing imaging outcomes and patient experience. Traditional strategies to mitigate these challenges rely heavily on pharmacological sedation or waiting for natural sleep, both with notable drawbacks. Sedation entails extensive preparation, elevates costs for families, and carries medical risks, including potential adverse effects on neurodevelopment with repeated use[3, 8]. Natural sleep is unpredictable and impractical for routine clinical settings. Recent studies have explored non-pharmacological alternatives, such as mock scanners, child life specialist support, or preparatory education, which show promise but often require specialized resources or training[9, 10]. Observational evidence suggests that distraction techniques, particularly visual media, can engage school-aged children, reducing anxiety and mimicking a sedation-like state[11, 12]. Animated videos, in particular, hold potential due to their accessibility and appeal, yet their efficacy during MRI scans remains underexplored[4]. Building on this, the present study evaluates an animated video intervention to enhance cranial MRI outcomes in children aged 2 ~ 11 years. By displaying preferred videos during scans, we aim to alleviate anxiety, improve compliance, and reduce motion artifacts, thereby enhancing image quality and examination success without pharmacological agents. This approach seeks to offer a cost-effective, scalable solution to improve pediatric MRI, addressing a critical gap in non-pharmacological strategies. Materials and Methods Study Design The trial protocol was reviewed and approved by the Institutional Ethics Committee of Ganzhou People’s Hospital (Grant No.: PJB2028-128-01). This study was designed as a randomized, controlled trial conducted from January 1, 2022, to January 31, 2024, at the Medical Imaging Center, Ganzhou people’s Hospital, China. All procedures adhered to the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from the legal guardians of all participants prior to enrollment. Participants Outpatient pediatric patients tended to undergo MRI examinations were recruited. Children who 1) aged 2 ~ 11 years, 2) had experience of watching animated videos and with the ability to engage in basic verbal communication, 3) without contraindications to MRI (e.g., ferromagnetic implants, severe claustrophobia), visual or auditory impairments, or a history of severe anxiety or prior unsuccessful MRI attempts requiring sedation were enrolled in the study. Intervention Procedures Intervention Group The intervention group followed standard MRI appointment procedures. Nurses screened for contraindications, provided verbal instructions, and distributed written guidelines. On the examination day, technologists verified preparatory steps, including: (1) brief medical history collection (e.g., surgical history); (2) screening for metallic objects (e.g., phones, keys, hairpins); and (3) verbal reinforcement of examination precautions. Participants wore headphones to watch animated videos selected based on caregiver-reported preferences during the MRI scan. The detailed animated videos information are as follows (Table 1 ). Compliance was assessed post-examination. Table 1 Detailed information of animated videos in the study Animated videos Duration (min) / episode Suitable age (year) Super Wings 12 2 ~ 6 PAW Patrol 23 > 3 BabyBus 1 ~ 3 2 ~ 6 Peppa Pig 5 2 ~ 6 Control Group Patients followed identical preparatory procedures as the intervention group, including screening for contraindications, verbal instructions, and written guidelines. No additional interventions were provided during the MRI scan. Compliance was also assessed post-examination. Cranial MRI Protocol All examinations were performed using a Siemens MAGNETOM Verio 3.0T MRI system (Siemens Healthineers, Erlangen, Germany). Imaging sequences and parameters are detailed in Table 2 . Images were uploaded to the hospital’s Picture Archiving and Communication System (PACS) and independently evaluated for quality by two senior radiologists. Discrepancies were resolved through consensus. Table 2 Imaging sequences and parameters in this study Sequence Levels Thickness (mm) TR (ms) TE (ms) FOV Scan Time T2WI-TRA 27 4 5500 95 230 * 230 1:06 T1WI-TRA 27 4 2020 9 230 * 230 1:41 DWI-TRA 27 4 8000 100 230 * 230 1:28 FLAIR-TRA 27 4 8500 94 230 * 230 1:59 T2WI-SAG 20 4 2600 118 230 * 230 1:36 Note: TR: Time of Repetition; TE:Time of Echo; FOV: Field of View. Outcome Measurements Primary outcome The primary outcome in this study was quality of cranial MRI images. The quality of the images was firstly assessed by the senior radiologists, divided into three levels as follows: Grade 1: High-quality images with no motion artifacts, meeting diagnostic requirements. Grade 2: Images with mild motion artifacts, still meeting diagnostic requirements. Grade 3: Images with significant motion artifacts, unsuitable for diagnosis. Secondary outcome The secondary outcome includes number of repeated scans, compliance of the participants, and examination successful status. Number of Repeated Scans: Defined as the number of repeated sequences required per patient. We divided the participants into the 3 groups as the cut-off value of repeated scans of 0, 1, and > = 2. Patient Compliance: Assessed using a hospital-developed questionnaire administered to both groups, with responses categorized into four levels: “Liked”, “Generally Accepted”, “Reluctantly Accepted”, “Fearful.” General Acceptance Rate = [(Liked + Generally Accepted) / Total] × 100%. We further pooled the children with “liked” and “generally accepted” into “general acceptance” group, and the remained were “non-acceptance”. Examination Successful status: summarized aforementioned measurements, successful status was set as follows: Highly Successful No motion artifacts, diagnostic images, child reported liking the experience. Moderately Successful No motion artifacts, diagnostic images, child reported reluctant acceptance. Relatively Successful Mild motion artifacts, diagnostic images, child reported reluctant acceptance. Marginally Successful Mild motion artifacts, diagnostic images, child reported fear. Unsuccessful Significant motion artifacts rendering images non-diagnostic, child reported fear, or examination was aborted. General Success rate = [(Highly Successful + Moderately Successful + Relatively Successful + Marginally Successful) / Total] × 100%. Furtherly, participants were grouped into “successful” and “unsuccessful”. Statistical Analyses Sample Size Calculation The sample size was calculated based on a prior study reporting a 20% improvement in MRI image quality (Grade 1 or 2) with non-pharmacological interventions compared to 10% in standard procedures. Assuming a two-sided α of 0.05 and 80% power, a minimum of 82 participants per group was required (calculated using PASS 15.0, NCSS, Kaysville, UT, USA). Accounting for a 20% dropout rate, 100 participants per group were recruited (total n = 200). Data Analysis Statistical analyses were performed using R 4.3.1 (R Core Team, Vienna, Austria). The normality of the data distribution was assessed by Shapiro-Wilk tests. Continuous variables were summarized as medians with interquartile ranges (IQR), and categorical variables were presented as frequencies and percentages. Characteristics of the two group were compared using Wilcoxon rank-sum tests or chi-square tests (categorical variables). Multivariate ordinal logistic regression models, assuming proportional odds, were fitted to assess the effect of the intervention on image quality, compliance, number of repeated scans, and examination successful status, adjusting for age and sex. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Binary logistic regression was employed to assess the association between the intervention and general successful rate. Stratified analyses by sex (boys vs. girls) and age ( 7 years) were performed to explore effect heterogeneity. Interaction terms (e.g., group × sex, group × age) were tested to evaluate potential effect modification. Sensitivity analyses were conducted to assess the robustness of findings, including exclusion of participants with absent images. A two-sided p -value < 0.05 was considered statistically significant. Results Characteristic and examination data of the participants A total of 207 children, 149 boys and 58 girls between 24 months to 11 years-old, underwent MRI examination were enrolled and randomized to the intervention group (n = 102) and control group (n = 105). No significant differences were observed between groups regarding sex distribution ( p = 0.738) or age distribution ( p = 0.389, Table 3 ). Table 3 Characteristics and MRI Examination Outcomes in Control and Intervention Groups Variables Overall N = 207 Group p Control n = 105 Intervention n = 102 Sex, % 0.738 Boys 149 (72.0) 74 (70.5) 75 (73.5) Girls 58 (28.0) 31 (29.5) 27 (26.5) Age, % 0.389 8 years 84 (40.6) 43 (41.0) 41 (40.2) Motion artifacts, % < 0.001 Absence 88 (42.5) 32 (30.5) 56 (54.9) Presence 119 (57.5) 73 (69.5) 46 (45.1) Complete, % < 0.001 No 33 (15.9) 27 (25.7) 6 (5.9) Yes 174 (84.1) 78 (74.3) 96 (94.1) Diagnosed utility, % < 0.001 No 33 (15.9) 27 (25.7) 6 (5.9) Yes 174 (84.1) 78 (74.3) 96 (94.1) Compliance, % < 0.001 Liked 52 (25.1) 1 (1.0) 51 (50.0) Generally Accepted 99 (47.8) 63 (60.0) 36 (35.3) Reluctantly Accepted 3 (1.4) 2 (1.9) 1 (1.0) Fearful 53 (25.6) 39 (37.1) 14 (13.7) Usable Images, % < 0.001 Absence 16 (7.7) 15 (14.3) 1 (1.0) Presence 191 (92.3) 90 (85.7) 101 (99.0) Repeated scans, median (IQR) 0.0 (0.0, 1.0) 0.0 (0.0, 1.0) 0.0 (0.0, 0.0) < 0.001 Note : Data are presented as n (%) for categorical variables and median (IQR) for repeated scans. p-value s were calculated using Chi-square tests for categorical variables and Wilcoxon rank-sum tests for repeated scans. Motion artifacts: presence indicates any visible artifacts (mild or significant); Absence indicates no artifacts. Complete: Yes, indicates successful examination completion; No indicates interruption or abortion. Diagnosed utility: Yes, indicates images suitable for clinical diagnosis; No indicates non-diagnostic images. Usable images: Presence indicates images meeting quality standards (Grade 1 or 2); Absence indicates non-usable images (Grade 3). Compliance categories: Liked, Generally Accepted, Reluctantly Accepted, Fearful, assessed via a hospital-developed questionnaire. Compared with the control group, the intervention group exhibited significantly fewer motion artifacts (45.1% vs. 69.5%), higher examination completion rates (94.1% vs. 74.3%), greater diagnostic utility (94.1% vs. 74.3%), and a higher proportion of usable images (99.0% vs. 85.7%) ( p − all < 0.001). Furthermore, patient compliance was markedly improved in the intervention group, with a significantly higher percentage reporting positive experiences ("Liked": 50.0% vs. 1.0%) and a significantly lower percentage reporting negative experiences ("Fearful": 13.7% vs. 37.1%, p < 0.001). Additionally, the median number of repeated scans required was significantly lower in the intervention group than in the control group [0.0 (IQR: 0.0, 0.0) vs. 0.0 (IQR: 0.0, 1.0), p < 0.001)]. Effects of Intervention on Outcomes After animated videos involved, image quality, patient compliance, number of repeated scans, and successful status were different between the groups (Table 4 ). For image quality, the intervention group had a higher proportion of Grade 1 (high: 54.9% vs. 30.5%) and lower Grade 3 (low: 5.9% vs. 25.7%) images compared to the control group, with an adjusted odds ratio (aOR) of 0.45 (95% CI: 0.33, 0.63) from multivariate ordinal logistic regression. Compliance was markedly better in the intervention group (“Liked”: 50.0% vs. 1.0%; “Fearful”: 13.7% vs. 37.1%), with aOR = 0.25 (95% CI: 0.18, 0.35). General acceptance, evaluated using binary logistic regression models, was higher in the intervention group (85.3% vs. 61.0%; aOR = 0.21, 95% CI: 0.09, 0.44). The intervention group required fewer repeated scans (0 scans: 79.4% vs. 53.3%; >2 scans: 1.0% vs. 10.5%), with aOR of 0.46 (95% CI: 0.32, 0.66). Examination success showed greater “Highly Successful” outcomes in the intervention group (47.1% vs. 1.0%) and fewer “Unsuccessful” outcomes (5.9% vs. 25.7%), with aOR = 0.25 (95% CI: 0.18, 0.36). All the p values presented less than 0.05. Table 4 Effects of intervention on Primary and Secondary outcomes Variables Group cOR (95% CI) aOR (95% CI) Control n = 105 Intervention n = 102 Quality of Images 0.49 (0.35, 0.67) 0.45 (0.33, 0.63) Grade 1 (High) 32 (30.5) 56 (54.9) Grade 2 (moderate) 46 (43.8) 40 (39.2) Grade 3 (Low) 27 (25.7) 6 (5.9) Compliance 0.28 (0.20, 0.39) 0.25 (0.18, 0.35) Liked 1 (1.0) 51 (50.0) Generally Accepted 63 (60.0) 36 (35.3) Reluctantly Accepted 2 (1.9) 1 (1.0) Fearful 39 (37.1) 14 (13.7) General Acceptance 0.27 (0.13, 0.52) 0.21 (0.09, 0.44) No 41 (39.0) 15 (14.7) Yes 64 (61.0) 87 (85.3) Number of Repeated scans 0.46 (0.32, 0.66) 0.46 (0.32, 0.66) 0 56 (53.3) 81 (79.4) 1 38 (36.2) 20 (19.6) >2 11 (10.5) 1 (1.0) Examination Success 0.29 (0.20, 0.40) 0.25 (0.18, 0.36) Highly successful 1 (1.0) 48 (47.1) Moderately successful 63 (60.0) 39 (38.2) relatively successful 2 (1.9) 1 (1.0) marginally successful 12 (11.4) 8 (7.8) unsuccessful 27 (25.7) 6 (5.9) General success 0.18 (0.06, 0.43) 0.16 (0.05, 0.41) No 27 (25.7) 6 (5.9) Yes 78 (74.3) 96 (94.1) Note: Data are presented as n (%) for categorical variables and OR (95% CI). Crude odds ratio (cOR) and adjusted odds ratio (aOR) were derived from multivariate ordinal logistic regression for image quality, compliance, number of repeated scans, and examination success, and binary logistic regression for general acceptance and general success, adjusted for age, and sex. 95% CI: 95% confidence interval. Image quality: Grade 1 (high, no artifacts), Grade 2 (moderate, mild artifacts), Grade 3 (low, significant artifacts). Compliance: Ordinal scale (Liked > Generally Accepted > Reluctantly Accepted > Fearful). General acceptance: Binary (Yes: Liked or Generally Accepted; No: Reluctantly Accepted or Fearful). Examination success: Ordinal scale (Highly Successful > Moderately Successful > Relatively Successful > Marginally Successful > Unsuccessful). General success: Binary (Yes: Any successful outcome; No: Unsuccessful). Sensitive and Subgroup analyses Table 5 presents the sensitivity analysis results for primary and secondary outcomes after excluding 33 participants (27 control, 6 intervention) who did not complete the MRI examination, leaving 78 control and 96 intervention group participants. The findings confirmed the robustness of the intervention’s effects on both primary and secondary outcomes. After stratified by sex and age, the intervention benefits on MRI examination remained robust (Suppl.Table 1 ). For children > 7 years, general acceptance (aOR = 0.25, 95% CI: 0.01, 1.82, p > 0.05) and general success were statistically non-significant (aOR = Inf , indicating sparse data). Table 5 Sensitivity Analysis of Intervention Effects on MRI Outcomes Variables Group cOR (95% CI) aOR (95% CI) Control n = 78 Intervention n = 96 Quality of Images 0.65 (0.44, 0.95) 0.56 (0.37, 0.83) Grade 1 (High) 32 (41.0) 56 (58.3) Grade 2 (moderate) 46 (59.0) 40 (41.7) Grade 3 (Low) 0 (0.0) 0 (0.0) Compliance 0.30 (0.20, 0.44) 0.27 (0.18, 0.40) Liked 1 (1.3) 51 (53.1) Generally Accepted 63 (80.8) 36 (37.5) Reluctantly Accepted 2 (2.6) 1 (1.0) Fearful 12 (15.4) 8 (8.3) General Acceptance 0.47 (0.19, 1.15) 0.37 (0.13, 0.97) No 64 (82.1) 87 (90.6) Yes 14 (17.9) 9 (9.4) Number of Repeated scans 0.39 (0.26, 0.57) 0.35 (0.23, 0.52) 0 35 (44.9) 76 (79.2) 1 36 (46.2) 19 (19.8) >2 7 (9.0) 1 (1.0) Examination Success 0.31 (0.21, 0.46) 0.28 (0.19, 0.41) Highly successful 1 (1.3) 48 (50.0) Moderately successful 63 (80.8) 39 (40.6) relatively successful 2 (2.6) 1 (1.0) marginally successful 12 (15.4) 8 (8.3) unsuccessful 0 (0.0) 0 (0.0) General success - - No 78 (100.0) 96 (100.0) Yes 0 (0.0) 0 (0.0) Note : Data are presented as n (%) for categorical variables and OR (95% CI). Sensitivity analysis excluded 33 participants (27 control, 6 intervention) with incomplete examinations, resulting in n = 78 (control) and n = 96 (intervention). Crude odds ratio (cOR) and adjusted odds ratio (aOR) were derived from multivariate ordinal logistic regression for image quality, compliance, number of repeated scans, and examination success, and binary logistic regression for general acceptance and general success, adjusted for age, and sex. 95% CI: 95% confidence interval. General success was not estimable due to all participants completing the examination (sparse data). Variable definitions are consistent with Table 2 . Discussion This randomized controlled study aimed to investigate whether an animated video intervention could enhance cranial MRI examination outcomes in pediatric patients aged 2 ~ 11 years, focusing on image quality, patient compliance, need for repeated scans, and examination success. Our primary finding was that children watching preferred animated videos during MRI scans consistently outperformed those under standard procedures across all outcomes. This study underscores the potential of non-pharmacological interventions to reduce anxiety and motion artifacts, offering a practical alternative to sedation in pediatric imaging. By improving diagnostic efficiency and patient comfort, our findings support the integration of simple distraction strategies into clinical MRI protocols for young children. Our results revealed that the intervention group achieved notably better image quality, higher compliance, fewer repeated scans, and greater examination success compared to the control group. These outcomes resonate with recent advancements in pediatric radiology distraction techniques. L.Vieira et al. ( 2024 ) demonstrated that music-based intervention enhanced cooperation, reduced the anxiety, and Heart Rate during MRI, aligning with our findings on improved patient experience[6]. Similarly, H.L. McGlashan et al. ( 2018 ) found that internet-based educational animation played positive role on preparation for MRI among typically developing children[11]. A meta-analysis confirmed that non-pharmacological strategies reduced sedation needs across pediatric procedures, supporting our observed decrease in scan interruptions[12]. Staab et al. ( 2024 ) reported that child life specialist interventions predicted successful unsedated MRI scans, but our video-based method required less staff training, enhancing feasibility[9]. However, C. Jaimes noted that distraction efficacy varies with individual factors like attention span, suggesting that our intervention’s success may depend on video appeal[4]. These comparisons highlight the practicality of animated videos as a cost-effective, scalable solution compared to resource-intensive alternatives like mock scanners or specialized goggles, as explored by Runge et al.[13]. Sensitivity and subgroup analyses provided further insights into the intervention’s effects. The sensitivity analysis, excluding incomplete examinations, reinforced the intervention’s benefits across image quality, compliance, and examination success, affirming the consistency of our findings. Subgroup analysis revealed variations by sex and age. Boys appeared to respond more favorably than girls, possibly due to differences in engagement with animated content, a pattern hinted at in behavioral studies[7]. Younger children, especially those under 36 months, showed the most substantial improvements, consistent with the study suggested preschoolers’ strong responsiveness to visual distractions[14]. In contrast, children over 7 years exhibited less consistent responses, potentially due to reduced interest in cartoons, as suggested by Torres et al. ( 2020 ) in their review of developmental factors[7]. These findings recommend animated videos as a primary strategy for children under 7 years, particularly boys, while older children may benefit from alternative approaches, such as gamified apps or virtual reality[14–17]. The limited literature on sex-specific responses to MRI interventions underscores a research gap, warranting further investigation to optimize gender-tailored strategies. This study’s strengths include its randomized controlled design and comprehensive outcome assessment, encompassing both technical metrics (image quality, repeated scans) and patient-centered measures (compliance, success). The use of multivariate ordinal logistic regression and stratified analyses enhanced the robustness of our conclusions. The intervention’s reliance on widely accessible animated videos ensures feasibility for diverse clinical settings, addressing a practical need in pediatric radiology. However, several limitations must be acknowledged. The single-center design may restrict generalizability, as imaging protocols and patient populations differ across institutions. Smaller subgroup sizes, particularly for girls and younger children, limited precision in some analyses. The absence of long-term follow-up data, such as compliance with future MRIs, constrains our understanding of sustained effects. Additionally, unmeasured factors, such as caregiver presence during scans, may have influenced outcomes[9, 13]. Future research should address these gaps through multicenter trials and explore alternative distractions for older children to refine pediatric imaging protocols. Nonetheless, our study establishes animated video assistance as an effective non-pharmacological tool for enhancing MRI outcomes in young children, with notable benefits for boys and those under 7 years. By offering a simple, engaging strategy to improve diagnostic imaging, our findings pave the way for broader adoption in clinical practice, with future studies needed to validate efficacy across diverse populations and settings. Conclusion This study aimed to evaluate the efficacy of an animated video intervention in improving cranial MRI examination outcomes for pediatric patients aged 2 ~ 11 years. Our findings demonstrate that children watching preferred animated videos during scans achieved superior image quality, compliance, and examination success compared to those under standard procedures, with notable benefits for younger children and boys. Future research should validate these results in multicenter settings, explore tailored distraction strategies for older children, and investigate gender-specific responses to further optimize pediatric imaging protocols. Declarations Ethics declarations Conflicts of Interests The authors declare no competing financial or non-financial interests that could influence the results or interpretation of this study. Fundings This study was supported by the Clinical Research Center for Medical Imaging in Jiangxi Province [Grant number 20223BCG7400199]. Author Contribution Zhongjie ZENG and Zhenghua CHEN: Conceptualization, methodology, data curation, formal analysis, writing – original draft. Lizhen LIU, and Yaru LIU: software, validation, visualization, writing – original draft. Junyuan ZHONG: Resources, supervision, project administration, writing – review & editing. All authors have read and approved the final manuscript. Acknowledgement We express our gratitude to Medical Imaging Center and Ganzhou People’s Hospital for providing the research platform and support essential to this work. References Chang PT, Yang E, Swenson DW, et al. (2016) Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. MAGN RESON IMAGING C 24:449-480. Dillman JR, Tkach JA (2022) Neonatal body magnetic resonance imaging: preparation, performance and optimization. PEDIATR RADIOL 52:676-684. Dong SZ, Zhu M, Bulas D (2019) Techniques for minimizing sedation in pediatric MRI. J MAGN RESON IMAGING 50:1047-1054. Jaimes C, Gee MS (2016) Strategies to minimize sedation in pediatric body magnetic resonance imaging. PEDIATR RADIOL 46:916-927. Runge VM, Heverhagen JT (2024) A New Era in Magnetic Resonance Contrast Media. INVEST RADIOL 59:105-107. Vieira L, Carvalho C, Grilo A, et al. (2024) Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis. RADIOGRAPHY 30:589-604. Torres ER, Tumey TA, Dean DR, et al. (2020) Non-pharmacological strategies to obtain usable magnetic resonance images in non-sedated infants: Systematic review and meta-analysis. INT J NURS STUD 106:103551. Andropoulos DB, Greene MF (2017) Anesthesia and Developing Brains - Implications of the FDA Warning. NEW ENGL J MED 376:905-907. Staab JH, Yoder AC, Brinton JT, et al. (2024) Child life specialists predict successful MRI scanning in unsedated children 4 to 12 years old. PEDIATR RADIOL 54:1919-1927. Gabr RE, Zunta-Soares GB, Soares JC, et al. (2019) MRI acoustic noise-modulated computer animations for patient distraction and entertainment with application in pediatric psychiatric patients. MAGN RESON IMAGING 61:16-19. McGlashan HL, Dineen RA, Szeszak S, et al. (2018) Evaluation of an internet-based animated preparatory video for children undergoing non-sedated MRI. BRIT J RADIOL 91:20170719. Thestrup J, Hybschmann J, Madsen TW, et al. (2023) Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis. Hosp Pediatr 13:e301-e313. Runge SB, Christensen NL, Jensen K, et al. (2018) Children centered care: Minimizing the need for anesthesia with a multi-faceted concept for MRI in children aged 4-6. EUR J RADIOL 107:183-187. Malik A, Elshazly T, Pokuri K, et al. (2024) Virtual Reality for Postoperative Pain Management: A Review of Current Evidence. CURR PAIN HEADACHE R 28:1307-1319. Ashmore J, Di Pietro J, Williams K, et al. (2019) A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study. JMIR Pediatr Parent 2:e11684. Alotaibi NS (2024) Pediatric sedation outside the operating room integrating dexmedetomidine for MRI and CT scan procedures: A systematic review. SAUDI J ANAESTH 18:540-544. Saliba T, Boitsios G, Preziosi M, et al. (2025) Virtual reality simulations to alleviate fear and anxiety in children awaiting MRI: a small-scale randomized controlled trial. J CLIN MONIT COMPUT 39:183-192. Additional Declarations No competing interests reported. Supplementary Files Supplementarytable1.docx Supplementary table1.Subgroup Analysis of Intervention Effects on MRI Outcomes Stratified by Sex and Age. Note: non-significant results ( p >0.05). Stratification: Sex (Boys: n=149; Girls: n=58); Age (7 years: n=84). Data represent adjusted odds ratios (aOR) with 95% confidence intervals (CI) from multivariate ordinal logistic regression for image quality, compliance, number of repeated scans, and examination success, and binary logistic regression for general acceptance and general success, adjusted for age, and sex (where applicable). Inf: Infinite aOR due to sparse data (e.g., no unsuccessful outcomes in one group). Variable definitions are consistent with Table 2. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7269642","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496724217,"identity":"ef4b62bf-e299-42f4-8167-108d0218359f","order_by":0,"name":"Lizhen Liu","email":"","orcid":"","institution":"Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Lizhen","middleName":"","lastName":"Liu","suffix":""},{"id":496724218,"identity":"b0338486-1a42-4e6b-9cd6-3fb300e8d5a0","order_by":1,"name":"Zhenghua Chen","email":"","orcid":"","institution":"Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Zhenghua","middleName":"","lastName":"Chen","suffix":""},{"id":496724219,"identity":"6173ef29-5391-4c5c-b08d-ba613d63b983","order_by":2,"name":"Yaru Liu","email":"","orcid":"","institution":"Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Yaru","middleName":"","lastName":"Liu","suffix":""},{"id":496724220,"identity":"14857397-35ea-4900-b69b-f50a4c9c1c63","order_by":3,"name":"Zhongjie Zeng","email":"data:image/png;base64,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","orcid":"","institution":"Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University","correspondingAuthor":true,"prefix":"","firstName":"Zhongjie","middleName":"","lastName":"Zeng","suffix":""},{"id":496724221,"identity":"7677c0cf-90c0-40bf-9ec2-1aa39cb45492","order_by":4,"name":"Junyuan Zhong","email":"","orcid":"","institution":"Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Junyuan","middleName":"","lastName":"Zhong","suffix":""}],"badges":[],"createdAt":"2025-08-01 09:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7269642/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7269642/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89777237,"identity":"e9966d10-faf1-45e3-ae33-029bb275ebc2","added_by":"auto","created_at":"2025-08-24 23:16:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1236783,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7269642/v1/4d4b1b46-89a5-418a-98fe-d372354f5098.pdf"},{"id":88654584,"identity":"0cf626d1-fabe-4dd1-b00b-ef66edc10bdc","added_by":"auto","created_at":"2025-08-08 18:49:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13680,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary table1.\u003c/strong\u003eSubgroup Analysis of Intervention Effects on MRI Outcomes Stratified by Sex and Age.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e# non-significant results (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eStratification: Sex (Boys: n=149; Girls: n=58); Age (\u0026lt;36 months: n=33; 3–7 years: n=90; \u0026gt;7 years: n=84).\u003c/p\u003e\n\u003cp\u003eData represent adjusted odds ratios (aOR) with 95% confidence intervals (CI) from multivariate ordinal logistic regression for image quality, compliance, number of repeated scans, and examination success, and binary logistic regression for general acceptance and general success, adjusted for age, and sex (where applicable).\u003c/p\u003e\n\u003cp\u003eInf: Infinite aOR due to sparse data (e.g., no unsuccessful outcomes in one group).\u003c/p\u003e\n\u003cp\u003eVariable definitions are consistent with Table 2.\u003c/p\u003e","description":"","filename":"Supplementarytable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7269642/v1/3be8ffd35de7a2132d6aa082.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Animated Video Intervention Enhances Image Quality and Compliance in Pediatric Cranial MRI","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMagnetic resonance imaging (MRI) is a cornerstone of pediatric diagnostics, valued for its safety, non-invasiveness, and advanced imaging capabilities. Unlike computed tomography (CT), MRI avoids ionizing radiation, minimizes bone artifacts, and offers multi-parametric imaging with exceptional soft-tissue contrast, making it ideal for evaluating conditions affecting the brain, chest, abdomen, pelvis, and extremities in children[1, 2]. These attributes position MRI as a globally preferred modality for accurate, non-invasive disease diagnosis[1, 3]. By leveraging magnetic fields, radiofrequency pulses, and computational algorithms, MRI produces high-resolution images that enhance clinical decision-making in pediatric care[4].\u003c/p\u003e\u003cp\u003eDespite its advantages, pediatric MRI poses significant challenges. The procedure\u0026rsquo;s high noise levels, confined scanning environment, and prolonged duration often provoke anxiety, particularly in young children unfamiliar with the MRI suite[5]. The intimidating equipment exacerbates fear, leading to non-compliance, crying, or agitation, which compromise image quality through motion artifacts or result in examination interruptions[6, 7]. These issues contribute to low success rates in pediatric MRI, hindering diagnostic accuracy and increasing clinical burdens[1]. Addressing these barriers is critical to optimizing imaging outcomes and patient experience.\u003c/p\u003e\u003cp\u003eTraditional strategies to mitigate these challenges rely heavily on pharmacological sedation or waiting for natural sleep, both with notable drawbacks. Sedation entails extensive preparation, elevates costs for families, and carries medical risks, including potential adverse effects on neurodevelopment with repeated use[3, 8]. Natural sleep is unpredictable and impractical for routine clinical settings. Recent studies have explored non-pharmacological alternatives, such as mock scanners, child life specialist support, or preparatory education, which show promise but often require specialized resources or training[9, 10]. Observational evidence suggests that distraction techniques, particularly visual media, can engage school-aged children, reducing anxiety and mimicking a sedation-like state[11, 12]. Animated videos, in particular, hold potential due to their accessibility and appeal, yet their efficacy during MRI scans remains underexplored[4].\u003c/p\u003e\u003cp\u003eBuilding on this, the present study evaluates an animated video intervention to enhance cranial MRI outcomes in children aged 2\u0026thinsp;~\u0026thinsp;11 years. By displaying preferred videos during scans, we aim to alleviate anxiety, improve compliance, and reduce motion artifacts, thereby enhancing image quality and examination success without pharmacological agents. This approach seeks to offer a cost-effective, scalable solution to improve pediatric MRI, addressing a critical gap in non-pharmacological strategies.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe trial protocol was reviewed and approved by the Institutional Ethics Committee of Ganzhou People\u0026rsquo;s Hospital (Grant No.: PJB2028-128-01). This study was designed as a randomized, controlled trial conducted from January 1, 2022, to January 31, 2024, at the Medical Imaging Center, Ganzhou people\u0026rsquo;s Hospital, China. All procedures adhered to the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from the legal guardians of all participants prior to enrollment.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOutpatient pediatric patients tended to undergo MRI examinations were recruited. Children who 1) aged 2\u0026thinsp;~\u0026thinsp;11 years, 2) had experience of watching animated videos and with the ability to engage in basic verbal communication, 3) without contraindications to MRI (e.g., ferromagnetic implants, severe claustrophobia), visual or auditory impairments, or a history of severe anxiety or prior unsuccessful MRI attempts requiring sedation were enrolled in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention Procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention Group\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe intervention group followed standard MRI appointment procedures. Nurses screened for contraindications, provided verbal instructions, and distributed written guidelines. On the examination day, technologists verified preparatory steps, including: (1) brief medical history collection (e.g., surgical history); (2) screening for metallic objects (e.g., phones, keys, hairpins); and (3) verbal reinforcement of examination precautions. Participants wore headphones to watch animated videos selected based on caregiver-reported preferences during the MRI scan. The detailed animated videos information are as follows (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Compliance was assessed post-examination.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDetailed information of animated videos in the study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnimated videos\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDuration (min) / episode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSuitable age (year)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuper Wings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u0026thinsp;~\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePAW Patrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBabyBus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026thinsp;~\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u0026thinsp;~\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeppa Pig\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u0026thinsp;~\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eControl Group\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Patients followed identical preparatory procedures as the intervention group, including screening for contraindications, verbal instructions, and written guidelines. No additional interventions were provided during the MRI scan. Compliance was also assessed post-examination.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCranial MRI Protocol\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll examinations were performed using a Siemens MAGNETOM Verio 3.0T MRI system (Siemens Healthineers, Erlangen, Germany). Imaging sequences and parameters are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Images were uploaded to the hospital\u0026rsquo;s Picture Archiving and Communication System (PACS) and independently evaluated for quality by two senior radiologists. Discrepancies were resolved through consensus.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eImaging sequences and parameters in this study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSequence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevels\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThickness (mm)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTR (ms)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTE (ms)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFOV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eScan Time\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2WI-TRA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e230 * 230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1:06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1WI-TRA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e230 * 230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1:41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDWI-TRA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e230 * 230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1:28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFLAIR-TRA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e230 * 230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1:59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2WI-SAG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e230 * 230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1:36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eTR: Time of Repetition; TE:Time of Echo; FOV: Field of View.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome Measurements\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary outcome\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome in this study was quality of cranial MRI images. The quality of the images was firstly assessed by the senior radiologists, divided into three levels as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGrade 1: High-quality images with no motion artifacts, meeting diagnostic requirements.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 2: Images with mild motion artifacts, still meeting diagnostic requirements.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 3: Images with significant motion artifacts, unsuitable for diagnosis.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSecondary outcome\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe secondary outcome includes number of repeated scans, compliance of the participants, and examination successful status.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eNumber of Repeated Scans: Defined as the number of repeated sequences required per patient. We divided the participants into the 3 groups as the cut-off value of repeated scans of 0, 1, and \u0026gt;\u0026thinsp;=\u0026thinsp;2.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatient Compliance: Assessed using a hospital-developed questionnaire administered to both groups, with responses categorized into four levels: \u0026ldquo;Liked\u0026rdquo;, \u0026ldquo;Generally Accepted\u0026rdquo;, \u0026ldquo;Reluctantly Accepted\u0026rdquo;, \u0026ldquo;Fearful.\u0026rdquo;\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eGeneral Acceptance Rate\u003c/b\u003e = [(Liked\u0026thinsp;+\u0026thinsp;Generally Accepted) / Total] \u0026times; 100%. We further pooled the children with \u0026ldquo;liked\u0026rdquo; and \u0026ldquo;generally accepted\u0026rdquo; into \u0026ldquo;general acceptance\u0026rdquo; group, and the remained were \u0026ldquo;non-acceptance\u0026rdquo;.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExamination Successful status: summarized aforementioned measurements, successful status was set as follows:\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHighly Successful\u003c/strong\u003e\u003cp\u003eNo motion artifacts, diagnostic images, child reported liking the experience.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eModerately Successful\u003c/strong\u003e\u003cp\u003eNo motion artifacts, diagnostic images, child reported reluctant acceptance.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRelatively Successful\u003c/strong\u003e\u003cp\u003eMild motion artifacts, diagnostic images, child reported reluctant acceptance.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMarginally Successful\u003c/strong\u003e\u003cp\u003eMild motion artifacts, diagnostic images, child reported fear.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eUnsuccessful\u003c/strong\u003e\u003cp\u003eSignificant motion artifacts rendering images non-diagnostic, child reported fear, or examination was aborted.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eGeneral Success rate\u003c/b\u003e = [(Highly Successful\u0026thinsp;+\u0026thinsp;Moderately Successful\u0026thinsp;+\u0026thinsp;Relatively Successful\u0026thinsp;+\u0026thinsp;Marginally Successful) / Total] \u0026times; 100%. Furtherly, participants were grouped into \u0026ldquo;successful\u0026rdquo; and \u0026ldquo;unsuccessful\u0026rdquo;.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical Analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample Size Calculation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size was calculated based on a prior study reporting a 20% improvement in MRI image quality (Grade 1 or 2) with non-pharmacological interventions compared to 10% in standard procedures. Assuming a two-sided \u003cem\u003eα\u003c/em\u003e of 0.05 and 80% power, a minimum of 82 participants per group was required (calculated using PASS 15.0, NCSS, Kaysville, UT, USA). Accounting for a 20% dropout rate, 100 participants per group were recruited (total \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;200).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using R 4.3.1 (R Core Team, Vienna, Austria). The normality of the data distribution was assessed by Shapiro-Wilk tests. Continuous variables were summarized as medians with interquartile ranges (IQR), and categorical variables were presented as frequencies and percentages. Characteristics of the two group were compared using Wilcoxon rank-sum tests or chi-square tests (categorical variables).\u003c/p\u003e\u003cp\u003eMultivariate ordinal logistic regression models, assuming proportional odds, were fitted to assess the effect of the intervention on image quality, compliance, number of repeated scans, and examination successful status, adjusting for age and sex. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Binary logistic regression was employed to assess the association between the intervention and general successful rate. Stratified analyses by sex (boys vs. girls) and age (\u0026lt;\u0026thinsp;36 months, 3\u0026ndash;7 years, \u0026gt;\u0026thinsp;7 years) were performed to explore effect heterogeneity. Interaction terms (e.g., group \u0026times; sex, group \u0026times; age) were tested to evaluate potential effect modification.\u003c/p\u003e\u003cp\u003eSensitivity analyses were conducted to assess the robustness of findings, including exclusion of participants with absent images. A two-sided \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eCharacteristic and examination data of the participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 207 children, 149 boys and 58 girls between 24 months to 11 years-old, underwent MRI examination were enrolled and randomized to the intervention group (n\u0026thinsp;=\u0026thinsp;102) and control group (n\u0026thinsp;=\u0026thinsp;105). No significant differences were observed between groups regarding sex distribution (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.738) or age distribution (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.389, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics and MRI Examination Outcomes in Control and Intervention Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;207\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;102\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.738\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149 (72.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74 (70.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75 (73.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGirls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58 (28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31 (29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27 (26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.389\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;36 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13 (12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026thinsp;~\u0026thinsp;7 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e90 (43.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48 (47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;8 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84 (40.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43 (41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41 (40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMotion artifacts, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88 (42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (30.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56 (54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119 (57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73 (69.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46 (45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComplete, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e174 (84.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78 (74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96 (94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiagnosed utility, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e174 (84.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78 (74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96 (94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompliance, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiked\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52 (25.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGenerally Accepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e99 (47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36 (35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReluctantly Accepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFearful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53 (25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39 (37.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14 (13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUsable Images, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e191 (92.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e101 (99.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRepeated scans, median (IQR)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0 (0.0, 1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0 (0.0, 1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0 (0.0, 0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote\u003c/b\u003e:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are presented as n (%) for categorical variables and median (IQR) for repeated scans.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003ep-value\u003c/em\u003es were calculated using Chi-square tests for categorical variables and Wilcoxon rank-sum tests for repeated scans.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eMotion artifacts: presence indicates any visible artifacts (mild or significant); Absence indicates no artifacts.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eComplete: Yes, indicates successful examination completion; No indicates interruption or abortion.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eDiagnosed utility: Yes, indicates images suitable for clinical diagnosis; No indicates non-diagnostic images.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eUsable images: Presence indicates images meeting quality standards (Grade 1 or 2); Absence indicates non-usable images (Grade 3).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eCompliance categories: Liked, Generally Accepted, Reluctantly Accepted, Fearful, assessed via a hospital-developed questionnaire.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCompared with the control group, the intervention group exhibited significantly fewer motion artifacts (45.1% vs. 69.5%), higher examination completion rates (94.1% vs. 74.3%), greater diagnostic utility (94.1% vs. 74.3%), and a higher proportion of usable images (99.0% vs. 85.7%) (\u003cem\u003ep\u003c/em\u003e\u003csub\u003e\u0026minus;\u0026thinsp;all\u003c/sub\u003e \u0026lt; 0.001). Furthermore, patient compliance was markedly improved in the intervention group, with a significantly higher percentage reporting positive experiences (\"Liked\": 50.0% vs. 1.0%) and a significantly lower percentage reporting negative experiences (\"Fearful\": 13.7% vs. 37.1%, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). Additionally, the median number of repeated scans required was significantly lower in the intervention group than in the control group [0.0 (IQR: 0.0, 0.0) vs. 0.0 (IQR: 0.0, 1.0), \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001)].\u003c/p\u003e\u003cp\u003e\u003cb\u003eEffects of Intervention on Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAfter animated videos involved, image quality, patient compliance, number of repeated scans, and successful status were different between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). For image quality, the intervention group had a higher proportion of Grade 1 (high: 54.9% vs. 30.5%) and lower Grade 3 (low: 5.9% vs. 25.7%) images compared to the control group, with an adjusted odds ratio (aOR) of 0.45 (95% CI: 0.33, 0.63) from multivariate ordinal logistic regression. Compliance was markedly better in the intervention group (\u0026ldquo;Liked\u0026rdquo;: 50.0% vs. 1.0%; \u0026ldquo;Fearful\u0026rdquo;: 13.7% vs. 37.1%), with aOR\u0026thinsp;=\u0026thinsp;0.25 (95% CI: 0.18, 0.35). General acceptance, evaluated using binary logistic regression models, was higher in the intervention group (85.3% vs. 61.0%; aOR\u0026thinsp;=\u0026thinsp;0.21, 95% CI: 0.09, 0.44). The intervention group required fewer repeated scans (0 scans: 79.4% vs. 53.3%; \u0026gt;2 scans: 1.0% vs. 10.5%), with aOR of 0.46 (95% CI: 0.32, 0.66). Examination success showed greater \u0026ldquo;Highly Successful\u0026rdquo; outcomes in the intervention group (47.1% vs. 1.0%) and fewer \u0026ldquo;Unsuccessful\u0026rdquo; outcomes (5.9% vs. 25.7%), with aOR\u0026thinsp;=\u0026thinsp;0.25 (95% CI: 0.18, 0.36). All the \u003cem\u003ep\u003c/em\u003e values presented less than 0.05.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEffects of intervention on Primary and Secondary outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ecOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eaOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;102\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eQuality of Images\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.49 (0.35,\u0026nbsp;0.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.45 (0.33,\u0026nbsp;0.63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 1 (High)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32 (30.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56 (54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 2 (moderate)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46 (43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (39.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 3 (Low)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompliance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.28 (0.20, 0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.25 (0.18, 0.35)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiked\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGenerally Accepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReluctantly Accepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFearful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (37.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGeneral Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.27 (0.13, 0.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.21 (0.09, 0.44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41 (39.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64 (61.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87 (85.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of Repeated scans\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.46 (0.32, 0.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.46 (0.32, 0.66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81 (79.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (36.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExamination Success\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.29 (0.20, 0.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.25 (0.18, 0.36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighly successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerately successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39 (38.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003erelatively successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emarginally successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunsuccessful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGeneral success\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.18 (0.06, 0.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.16 (0.05, 0.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78 (74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96 (94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are presented as n (%) for categorical variables and OR (95% CI).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e Crude odds ratio (cOR) and adjusted odds ratio (aOR) were derived from multivariate ordinal logistic regression for image quality, compliance, number of repeated scans, and examination success, and binary logistic regression for general acceptance and general success, adjusted for age, and sex.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e95% CI: 95% confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eImage quality: Grade 1 (high, no artifacts), Grade 2 (moderate, mild artifacts), Grade 3 (low, significant artifacts).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eCompliance: Ordinal scale (Liked\u0026thinsp;\u0026gt;\u0026thinsp;Generally Accepted\u0026thinsp;\u0026gt;\u0026thinsp;Reluctantly Accepted\u0026thinsp;\u0026gt;\u0026thinsp;Fearful).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eGeneral acceptance: Binary (Yes: Liked or Generally Accepted; No: Reluctantly Accepted or Fearful).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eExamination success: Ordinal scale (Highly Successful\u0026thinsp;\u0026gt;\u0026thinsp;Moderately Successful\u0026thinsp;\u0026gt;\u0026thinsp;Relatively Successful\u0026thinsp;\u0026gt;\u0026thinsp;Marginally Successful\u0026thinsp;\u0026gt;\u0026thinsp;Unsuccessful).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eGeneral success: Binary (Yes: Any successful outcome; No: Unsuccessful).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSensitive and Subgroup analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the sensitivity analysis results for primary and secondary outcomes after excluding 33 participants (27 control, 6 intervention) who did not complete the MRI examination, leaving 78 control and 96 intervention group participants. The findings confirmed the robustness of the intervention\u0026rsquo;s effects on both primary and secondary outcomes. After stratified by sex and age, the intervention benefits on MRI examination remained robust (Suppl.Table\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For children\u0026thinsp;\u0026gt;\u0026thinsp;7 years, general acceptance (aOR\u0026thinsp;=\u0026thinsp;0.25, 95% CI: 0.01, 1.82, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and general success were statistically non-significant (aOR\u0026thinsp;=\u0026thinsp;\u003cem\u003eInf\u003c/em\u003e, indicating sparse data).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSensitivity Analysis of Intervention Effects on MRI Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ecOR\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eaOR\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;78\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eQuality of Images\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.65 (0.44,\u0026nbsp;0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56 (0.37,\u0026nbsp;0.83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 1 (High)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32 (41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 2 (moderate)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46 (59.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 3 (Low)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompliance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003cp\u003e(0.20, 0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003cp\u003e(0.18, 0.40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiked\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51 (53.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGenerally Accepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63 (80.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReluctantly Accepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFearful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGeneral Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003cp\u003e(0.19, 1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003cp\u003e(0.13, 0.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64 (82.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87 (90.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14 (17.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of Repeated scans\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003cp\u003e(0.26, 0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003cp\u003e(0.23, 0.52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35 (44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76 (79.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExamination Success\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003cp\u003e(0.21, 0.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003cp\u003e(0.19, 0.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighly successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerately successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63 (80.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39 (40.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003erelatively successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emarginally successful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunsuccessful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGeneral success\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote\u003c/b\u003e:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are presented as n (%) for categorical variables and OR (95% CI).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eSensitivity analysis excluded 33 participants (27 control, 6 intervention) with incomplete examinations, resulting in n\u0026thinsp;=\u0026thinsp;78 (control) and n\u0026thinsp;=\u0026thinsp;96 (intervention).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eCrude odds ratio (cOR) and adjusted odds ratio (aOR) were derived from multivariate ordinal logistic regression for image quality, compliance, number of repeated scans, and examination success, and binary logistic regression for general acceptance and general success, adjusted for age, and sex. 95% CI: 95% confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eGeneral success was not estimable due to all participants completing the examination (sparse data).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eVariable definitions are consistent with Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis randomized controlled study aimed to investigate whether an animated video intervention could enhance cranial MRI examination outcomes in pediatric patients aged 2\u0026thinsp;~\u0026thinsp;11 years, focusing on image quality, patient compliance, need for repeated scans, and examination success. Our primary finding was that children watching preferred animated videos during MRI scans consistently outperformed those under standard procedures across all outcomes. This study underscores the potential of non-pharmacological interventions to reduce anxiety and motion artifacts, offering a practical alternative to sedation in pediatric imaging. By improving diagnostic efficiency and patient comfort, our findings support the integration of simple distraction strategies into clinical MRI protocols for young children.\u003c/p\u003e\u003cp\u003eOur results revealed that the intervention group achieved notably better image quality, higher compliance, fewer repeated scans, and greater examination success compared to the control group. These outcomes resonate with recent advancements in pediatric radiology distraction techniques. L.Vieira et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) demonstrated that music-based intervention enhanced cooperation, reduced the anxiety, and Heart Rate during MRI, aligning with our findings on improved patient experience[6]. Similarly, H.L. McGlashan et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that internet-based educational animation played positive role on preparation for MRI among typically developing children[11]. A meta-analysis confirmed that non-pharmacological strategies reduced sedation needs across pediatric procedures, supporting our observed decrease in scan interruptions[12]. Staab et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) reported that child life specialist interventions predicted successful unsedated MRI scans, but our video-based method required less staff training, enhancing feasibility[9]. However, C. Jaimes noted that distraction efficacy varies with individual factors like attention span, suggesting that our intervention\u0026rsquo;s success may depend on video appeal[4]. These comparisons highlight the practicality of animated videos as a cost-effective, scalable solution compared to resource-intensive alternatives like mock scanners or specialized goggles, as explored by Runge et al.[13].\u003c/p\u003e\u003cp\u003eSensitivity and subgroup analyses provided further insights into the intervention\u0026rsquo;s effects. The sensitivity analysis, excluding incomplete examinations, reinforced the intervention\u0026rsquo;s benefits across image quality, compliance, and examination success, affirming the consistency of our findings. Subgroup analysis revealed variations by sex and age. Boys appeared to respond more favorably than girls, possibly due to differences in engagement with animated content, a pattern hinted at in behavioral studies[7]. Younger children, especially those under 36 months, showed the most substantial improvements, consistent with the study suggested preschoolers\u0026rsquo; strong responsiveness to visual distractions[14]. In contrast, children over 7 years exhibited less consistent responses, potentially due to reduced interest in cartoons, as suggested by Torres et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) in their review of developmental factors[7]. These findings recommend animated videos as a primary strategy for children under 7 years, particularly boys, while older children may benefit from alternative approaches, such as gamified apps or virtual reality[14\u0026ndash;17]. The limited literature on sex-specific responses to MRI interventions underscores a research gap, warranting further investigation to optimize gender-tailored strategies.\u003c/p\u003e\u003cp\u003e This study\u0026rsquo;s strengths include its randomized controlled design and comprehensive outcome assessment, encompassing both technical metrics (image quality, repeated scans) and patient-centered measures (compliance, success). The use of multivariate ordinal logistic regression and stratified analyses enhanced the robustness of our conclusions. The intervention\u0026rsquo;s reliance on widely accessible animated videos ensures feasibility for diverse clinical settings, addressing a practical need in pediatric radiology.\u003c/p\u003e\u003cp\u003eHowever, several limitations must be acknowledged. The single-center design may restrict generalizability, as imaging protocols and patient populations differ across institutions. Smaller subgroup sizes, particularly for girls and younger children, limited precision in some analyses. The absence of long-term follow-up data, such as compliance with future MRIs, constrains our understanding of sustained effects. Additionally, unmeasured factors, such as caregiver presence during scans, may have influenced outcomes[9, 13]. Future research should address these gaps through multicenter trials and explore alternative distractions for older children to refine pediatric imaging protocols. Nonetheless, our study establishes animated video assistance as an effective non-pharmacological tool for enhancing MRI outcomes in young children, with notable benefits for boys and those under 7 years. By offering a simple, engaging strategy to improve diagnostic imaging, our findings pave the way for broader adoption in clinical practice, with future studies needed to validate efficacy across diverse populations and settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study aimed to evaluate the efficacy of an animated video intervention in improving cranial MRI examination outcomes for pediatric patients aged 2\u0026thinsp;~\u0026thinsp;11 years. Our findings demonstrate that children watching preferred animated videos during scans achieved superior image quality, compliance, and examination success compared to those under standard procedures, with notable benefits for younger children and boys. Future research should validate these results in multicenter settings, explore tailored distraction strategies for older children, and investigate gender-specific responses to further optimize pediatric imaging protocols.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing financial or non-financial interests that could influence the results or interpretation of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Clinical Research Center for Medical Imaging in Jiangxi Province [Grant number 20223BCG7400199].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhongjie ZENG and Zhenghua CHEN: Conceptualization, methodology, data curation, formal analysis, writing \u0026ndash; original draft. Lizhen LIU, and Yaru LIU: software, validation, visualization, writing \u0026ndash; original draft. Junyuan ZHONG: Resources, supervision, project administration, writing \u0026ndash; review \u0026amp; editing. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our gratitude to Medical Imaging Center and Ganzhou People\u0026rsquo;s Hospital for providing the research platform and support essential to this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChang PT, Yang E, Swenson DW, et al. (2016) Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. MAGN RESON IMAGING C 24:449-480.\u003c/li\u003e\n\u003cli\u003eDillman JR, Tkach JA (2022) Neonatal body magnetic resonance imaging: preparation, performance and optimization. PEDIATR RADIOL 52:676-684.\u003c/li\u003e\n\u003cli\u003eDong SZ, Zhu M, Bulas D (2019) Techniques for minimizing sedation in pediatric MRI. J MAGN RESON IMAGING 50:1047-1054.\u003c/li\u003e\n\u003cli\u003eJaimes C, Gee MS (2016) Strategies to minimize sedation in pediatric body magnetic resonance imaging. PEDIATR RADIOL 46:916-927.\u003c/li\u003e\n\u003cli\u003eRunge VM, Heverhagen JT (2024) A New Era in Magnetic Resonance Contrast Media. INVEST RADIOL 59:105-107.\u003c/li\u003e\n\u003cli\u003eVieira L, Carvalho C, Grilo A, et al. (2024) Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis. RADIOGRAPHY 30:589-604.\u003c/li\u003e\n\u003cli\u003eTorres ER, Tumey TA, Dean DR, et al. (2020) Non-pharmacological strategies to obtain usable magnetic resonance images in non-sedated infants: Systematic review and meta-analysis. INT J NURS STUD 106:103551.\u003c/li\u003e\n\u003cli\u003eAndropoulos DB, Greene MF (2017) Anesthesia and Developing Brains - Implications of the FDA Warning. NEW ENGL J MED 376:905-907.\u003c/li\u003e\n\u003cli\u003eStaab JH, Yoder AC, Brinton JT, et al. (2024) Child life specialists predict successful MRI scanning in unsedated children 4 to 12 years old. PEDIATR RADIOL 54:1919-1927.\u003c/li\u003e\n\u003cli\u003eGabr RE, Zunta-Soares GB, Soares JC, et al. (2019) MRI acoustic noise-modulated computer animations for patient distraction and entertainment with application in pediatric psychiatric patients. MAGN RESON IMAGING 61:16-19.\u003c/li\u003e\n\u003cli\u003eMcGlashan HL, Dineen RA, Szeszak S, et al. (2018) Evaluation of an internet-based animated preparatory video for children undergoing non-sedated MRI. BRIT J RADIOL 91:20170719.\u003c/li\u003e\n\u003cli\u003eThestrup J, Hybschmann J, Madsen TW, et al. (2023) Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis. Hosp Pediatr 13:e301-e313.\u003c/li\u003e\n\u003cli\u003eRunge SB, Christensen NL, Jensen K, et al. (2018) Children centered care: Minimizing the need for anesthesia with a multi-faceted concept for MRI in children aged 4-6. EUR J RADIOL 107:183-187.\u003c/li\u003e\n\u003cli\u003eMalik A, Elshazly T, Pokuri K, et al. (2024) Virtual Reality for Postoperative Pain Management: A Review of Current Evidence. CURR PAIN HEADACHE R 28:1307-1319.\u003c/li\u003e\n\u003cli\u003eAshmore J, Di Pietro J, Williams K, et al. (2019) A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study. JMIR Pediatr Parent 2:e11684.\u003c/li\u003e\n\u003cli\u003eAlotaibi NS (2024) Pediatric sedation outside the operating room integrating dexmedetomidine for MRI and CT scan procedures: A systematic review. SAUDI J ANAESTH 18:540-544.\u003c/li\u003e\n\u003cli\u003eSaliba T, Boitsios G, Preziosi M, et al. (2025) Virtual reality simulations to alleviate fear and anxiety in children awaiting MRI: a small-scale randomized controlled trial. J CLIN MONIT COMPUT 39:183-192.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pediatric MRI, animated video intervention, image quality, pediatric compliance, non-pharmacological","lastPublishedDoi":"10.21203/rs.3.rs-7269642/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7269642/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Pediatric MRI examinations face numerous challenges due to anxiety and motion artifacts. This study aimed to evaluate the efficacy of an animated video intervention in improving cranial magnetic resonance imaging (MRI) examination outcomes among pediatric patients aged 2 ~ 11 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis randomized controlled trial included 207 outpatient children scheduled for cranial MRI at Ganzhou People’s Hospital, China, from January 2022 to January 2024. Participants were randomly assigned to the intervention group (n=102, watching preferred animated videos during scans) or the control group (n=105, standard procedures). Primary outcome was image quality (three-tier ordinal scale: high, moderate, low). Secondary outcomes were participants’ compliance (four-level scale: Liked to Fearful), number of repeated scans, and examination success status (five categories: Highly Successful to Unsuccessful). Multivariate ordinal logistic regression and binary logistic regression were used to assess intervention effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe intervention group achieved significantly improved image quality (aOR = 0.45, 95% CI: 0.33, 0.63, \u003cem\u003ep \u0026lt;\u003c/em\u003e0.001), higher compliance (aOR = 0.25, 95% CI: 0.18, 0.35, \u003cem\u003ep \u0026lt;\u003c/em\u003e0.001), fewer repeated scans (aOR = 0.46, 95% CI: 0.32, 0.66, \u003cem\u003ep \u0026lt;\u003c/em\u003e0.001), and greater examination success (aOR = 0.25, 95% CI: 0.18, 0.36, \u003cem\u003ep \u0026lt;\u003c/em\u003e 0.001) than the control group. Sensitivity analysis excluding incomplete examinations confirmed these findings. Subgroup analysis revealed stronger benefits in boys and children under 7 years, with less consistent effects in older children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAnimated video assistance is an effective non-pharmacological strategy to enhance pediatric MRI outcomes, particularly for younger children and boys.\u003c/p\u003e","manuscriptTitle":"Animated Video Intervention Enhances Image Quality and Compliance in Pediatric Cranial MRI","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 18:49:26","doi":"10.21203/rs.3.rs-7269642/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7148df5b-4e84-4063-8458-ca4ef7e8c8db","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-27T02:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 18:49:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7269642","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7269642","identity":"rs-7269642","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}