Background <p>Magnetic resonance imaging (MRI) is a crucial diagnostic modality for pediatric patients because it avoids ionizing radiation. However, the confined space and loud noises inherent to MRI can trigger anxiety in children, potentially compromising their cooperation and image quality.</p> Objective <p>To evaluate the effectiveness of an audiovisual preparatory intervention in reducing anxiety and improving MRI image quality in children.</p> Materials and methods <p>In this randomized controlled trial, 48 children aged 7–11 years referred for MRI were randomly assigned to either an experimental group (<i>n</i>=24) or a control group (<i>n</i>=24). The experimental group viewed a child-friendly preparatory film prior to the MRI. Anxiety was assessed using the State-Trait Anxiety Inventory for Children before and after MRI. Image quality was evaluated independently by blinded radiologists using standardized scoring criteria.</p> Results <p>There were no significant differences in baseline state anxiety (<i>P</i>=0.790) or trait anxiety (<i>P</i>=0.414) between groups. Post-MRI state anxiety scores were significantly lower in the experimental group (31.17±8.78) compared to the control group (37.90±6.51; <i>P</i>=0.004). Post-MRI trait anxiety scores remained statistically similar (<i>P</i>=0.491). Image quality scores were significantly higher in the experimental group than in the control group (<i>P</i>=0.005).</p> Conclusion <p>Audiovisual preparatory interventions significantly reduce state anxiety and enhance image quality in pediatric MRI without affecting trait anxiety. These findings support the integration of non-pharmacological, child-centered preparatory tools into routine MRI protocols to improve patient cooperation and diagnostic outcomes.</p> Graphical Abstract <p></p>