Psychological Impact of AI-Simplified Brain MRI Reports: A Randomized Trial of Patient Understanding, Anxiety, and...

Background/Objectives: Immediate patient access to radiology reports has increased the need for communication that patients can understand, yet it remains unclear whether simplifying report language improves comprehension without worsening psychological distress. This study aimed to determine whether AI-based simplification of a brain MRI report improves patient understanding, to assess whether anxiety differs between standard and AI-simplified reports, and to examine the relationships among anxiety, report understanding, and health literacy. Methods: We conducted a minimal-risk, survey-based randomized experimental study using Qualtrics and Amazon Mechanical Turk. A total of 803 participants were randomized 1:1 to view either an original radiology report (control, n = 402) or an AI-simplified version of the same report (intervention, n = 401). The stimulus was a single de-identified brain MRI/MRV report. Primary outcomes were report understanding and post-exposure anxiety, and secondary measures included radiology literacy and general health literacy assessed with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Between-group differences were analyzed using Mann-Whitney U tests, and associations between variables were examined using correlation analyses. Results: Participants who received the AI-simplified report achieved significantly higher understanding scores than those who viewed the original report (mean 5.78 ± 1.31 vs. 5.61 ± 1.49; p = 0.007). Anxiety scores were similar between groups (mean 3.24 ± 0.84 vs. 3.23 ± 0.85; p = 0.103). A positive correlation was observed between anxiety and general health literacy (r = 0.283, p < 0.001), and report understanding was also positively correlated with anxiety (r = 0.182, p < 0.001). Age was negatively associated with anxiety, whereas income showed a weak positive association. Conclusions: AI-based simplification improved patient understanding of radiology reports but did not reduce anxiety. Greater understanding was associated with higher anxiety, suggesting that clearer language alone may be insufficient to address the emotional burden of reading radiology results without clinical context or reassurance.