Virtual reality for MRI anxiety: promising but unproven

Three cardiomyopathy patients who had refused cardiac MRI scans because of claustrophobia put on VR headsets, trained inside a simulated hospital and scanner, and then, on exam day, climbed into the real machine and finished their scans without cancellations or complications, according to a case series published in PMC in 2024. It is direct, if narrow, evidence that virtual reality for MRI anxiety might help patients who otherwise cannot tolerate the scan.

The case-series authors call cardiac MRI vital for diagnosing heart disease, and note that claustrophobia affects roughly 10% of patients referred for the scan, according to the same study. That's a meaningful share of a routine diagnostic test.

The word "VR" is doing a lot of work in this research, though. It covers at least three distinct approaches: multi-session exposure therapy, a one-time virtual tour, and immersive procedural education. They are not interchangeable, and they are not equally tested for cardiac imaging, according to separate studies on MRI exposure therapy, PET-CT imaging, and pediatric cardiac procedures. This piece looks at what the cardiac-specific evidence actually shows, what related research on general MRI, PET-CT, and cardiac procedures can and can't confirm, and why lower anxiety scores and completed scans are turning out to be two different things.

Three patients, one small study

The intervention in the PMC case series was specific: three patients who had initially refused cardiac MRI trained in a metaverse-based virtual hospital, using a headset at set intervals ahead of their scheduled exam, according to the study.

On exam day, all three entered the actual scanner and completed the scan without cancellations or complications. Their anxiety levels measured lower on scan day than during the initial virtual training sessions, the researchers reported.

The authors reported successful completion in all three cases, but the design cannot establish whether VR caused the improvement. The study included no comparison group of similarly claustrophobic patients who skipped the training. Among the studies reviewed here, this is the only one that speaks directly to cardiac MRI and claustrophobia together; everything else in this piece is context for interpreting it.

Virtual reality exposure therapy for MRI: what the evidence shows

Cardiac imaging aside, the broader MRI literature offers a sharper picture, and it complicates the story rather than simplifying it.

A pilot study published three months ago tested Virtual Reality Exposure Therapy, or VRET, built around one psychoeducation session followed by four exposure sessions inside a life-sized, sound-accurate virtual scanner, according to the study. That's a structured therapy protocol, not a quick preview, and its participants were described as claustrophobic patients rather than drawn from a cardiac-specific population.

Across all participants, phobia and state-anxiety scores dropped significantly after treatment, the researchers found (p = 0.002 and p < 0.001, respectively). The study had no control group, so the drop reflects a before-and-after comparison rather than a demonstrated causal effect.

The more interesting number shows up once researchers split participants by outcome. Among patients who went on to actually complete their MRI, phobia scores were significantly lower than before treatment (p = 0.026), but state-anxiety scores were not (p = 0.888), per the same pilot. A patient can score as less phobic on a questionnaire and still walk into the scanner just as anxious. Reduced anxiety and a completed scan don't always move together.

Compare that structured protocol with a lighter-touch approach tested in PET-CT imaging. Researchers built a single virtual walkthrough, from arrival at reception to lying supine in the scanner bore, and tested it primarily for acceptability rather than clinical outcomes, according to a PET-CT pilot study published last year. Ninety percent of participants rated the experience 4 or 5 out of 5, the study found. As an exploratory add-on, researchers compared heart-rate data from the virtual tour's in-bore segment against the first eight minutes of the real scan, among 17 participants with usable comparison data, and reported a statistically significant trend toward lower heart-rate readings during the actual scan, consistent with reduced anxiety, according to the same pilot (p = 0.01).

That's a feasibility signal, not proof that anxiety scores or completion rates shift on a broader scale, and the authors say as much themselves, calling for a multicenter trial before drawing firmer conclusions.

The two approaches differ in kind, not just in scale. The VRET protocol is a structured, multi-session therapy tested against pre- and post-treatment scores. The PET-CT tour is a brief orientation tool tested mainly for acceptability, with a preliminary physiological signal attached. Neither has been tested against the other, and neither has been tested in a cardiac-MRI population specifically.

What adjacent cardiac procedures do, and don't, tell us

Cardiac MRI isn't the only place VR has shown up near a cardiac patient's chart.

A review on education for families and patients with pediatric heart disease, published in an AHA journal earlier this year, cites one study of adults undergoing cardiac catheterization. That cited study reportedly found an immersive, site-specific VR experience produced greater anxiety reduction, better procedural knowledge, and higher satisfaction than standard care, according to the AHA review. Catheterization carries a different anxiety profile than lying still inside an enclosed scanner, so the finding is secondhand and suggestive at best, not something to import directly into MRI protocols.

The most systematic evidence among the cardiac studies cited here comes from cardiac surgery, not imaging. A systematic review published last year pooled nine randomized trials covering 888 cardiac surgery patients and found only a nonsignificant trend toward lower preoperative anxiety with VR (standardized mean difference of -0.23) and a similarly nonsignificant trend toward higher satisfaction (SMD of 0.36), according to the meta-analysis.

VR was well tolerated across every trial in that review, with only mild, transient adverse events reported, the authors found. That's useful reassurance about safety, but it applies specifically to cardiac surgery patients, not to claustrophobia during MRI. The review's own conclusion is that VR is a feasible and safe perioperative adjunct in cardiac surgery, not that it reliably reduces anxiety across cardiac care in general.

Taken together, these adjacent studies show VR is tolerable and generally well received in cardiac settings. They don't show it reliably resolves claustrophobia in cardiac MRI specifically.

Why scan completion, not just anxiety scores, is the real test

Reduced anxiety and a successfully completed scan are not the same outcome, and the VRET data illustrate the gap directly. Phobia scores dropped among patients who completed their scan, but their state anxiety did not, according to the same pilot. A patient can register as less phobic by one measure and remain just as anxious by another.

The research data cited here do not report image-quality or diagnostic-usability outcomes for any of the interventions. The PET-CT researchers flag reduced anxiety-related movement as a plausible benefit for scan quality, but the pilot did not measure that directly, and the authors say a multicenter trial is needed before drawing conclusions from it, according to their study. The cardiac MRI case series reports completed scans, not measured image quality, a meaningful but narrow outcome recorded in just three patients.

What comes next

The next cardiac-MRI study needs to measure more than whether patients enter the scanner. A useful trial would need a comparison group, so researchers can separate the effect of VR training from the effect of simply being scheduled for a second attempt. It would also need to track completion and cancellation rates alongside anxiety scores, along with image quality or motion artifacts, and it would need to report adverse events and the number of training sessions required, since the case series and the VRET pilot used different protocols without testing which one performs better.

Which patients stand to benefit most, whether that's people with a formal claustrophobia diagnosis, those with a history of aborted scans, or a broader population referred for cardiac MRI, remains an open question. So does the choice between a brief virtual tour and a multi-session exposure protocol. Larger, controlled cardiac-MRI trials that track completion, cancellations, and image quality together would go a long way toward answering both, though none of the research reviewed here has done so yet.