Feature article

Easing Patients Into MRI

Thirty-six million magnetic resonance imaging (MRI) scans were performed in 2017 in the United States alone.3  MRI examinations help professionals visualize abnormalities, especially in the central nervous system of the human body2, but they can be a challenging affair for some patients. Failure to address these physical or psychological issues for patients, such as discomfort or claustrophobia, can lead to dysfunctional patient experiences and may hamper outcome measures and quality of care.5 

Most present-day MRI machines, in contrast to cramped and uncomfortable units of the past, are fairly spacious and have advanced to better cater to these patient concerns.1 In addition, open scanners have made their way into clinics and hospitals to alleviate feelings of anxiety and stress.6 Despite these devices being able to produce high-resolution images, they may not be suitable for all cases.1

Patients before and during MRI

Patient distress — defined as any unpleasant situation during MRI procedures — can range from mild to severe. A majority of individuals experience moderate distress, which includes dysphoria or unease and anxiety, during the time of imaging.5

Statistics indicate that 20 percent of patients who undergo MRI scans for the first time were unable to go through with the process due to symptoms such as claustrophobia or other similar sensations.5 However, according to a paper published in the journal Psychiatry Research: Neuroimaging, MRI-related anxiety varied, and eventually improved, with repeated sessions of scanning.7

A small population has also been observed to undergo severe psychological reactions such as chest aches, panic attacks, palpitations, nausea, vertigo and a fear of loss of control. In some situations, patients felt like they were being choked or were dying.5 

Techniques to ease patients into MRIs

Healthcare professionals — radiologists, clinicians, MRI technicians or physicians —  involved in the procedure can potentially handle tricky situations by first understanding the nature of the problem for patients. Then, appropriate action can then be taken to ease individuals into a smoother imaging practice.5 

Well-known methods that could help counteract patient duress with regard to MRIs include:

Awareness of concept & support system

In 2018, an investigation intervened 74 first-time MRI patients by subjecting them to cardiac, head or spinal scans. Results showed that prior video demonstrations of the procedure and conversations with a radiographer proved far more effective, in terms of incidence of anxiety, compared to the patients who were just routinely taken to the examination room.4

For the extremely distressed, cognitive behavior therapy (CBT) or any other form of counseling can be recommended. In this method, people are taken through the entire scenario and guided to control their minds in order to alleviate the fear of scary settings.1 

A study, conducted by researchers at the University of Adelaide, clarified that, in general, anxiety could be eased just by providing more information to the patients about MRIs and related processes. Acting Director of the Joanna Briggs Institute, Dr. Zachary Munn, reiterated, “Providing patients with quality information is a good first step towards reducing patients' fears. If medical staff are personable and talk the patient through their experience, it also helps greatly. Each patient should be treated with individual care.”9

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Ergonomics: positioning & environment

Open MRIs, where the scanners are patient-friendly and are not entirely enclosed, have been instrumental in reducing cases of apprehension in patients.8 But when that system is not available, changing the position of individuals (prone instead of supine) on the regular machines could be helpful in creating a feeling of space. But again, history and medical conditions (e.g., shortness of breath or chest tubes) need be evaluated before making alterations.6 

Another method of relieving MRI-tension could be a feet-first position into the scanner. This may enable deep breathing and eliminate the sense of being closed-in.5

Aids, such as mirrors or prism glasses, can be of assistance to patients with MRI-related fears as they permit a view outside of the scanner. Previous experiments have indicated that durable eye pillows, used a blindfold, can be a good tool to make participants unaware of their surroundings, and thus, effective for anxiety.5 

In addition, good lighting and optimization of environment can ensure the management of nerves as this may not seem as imposing to patients—more light decreases anxiety.1 Also, installation of a fan can improve circulation and, therefore, the impression of confinement.5

Difficulties that patients face during MRIs is more than a subjective issue, and, if not tended to, can become a threatening socioeconomic problem for the healthcare system as a whole. Health experts and organizations are now attempting to bridge such a gap between patients and the world of diagnostics and therapeutics through novel interventions and programs.8

References 

  1. Best ways to relieve MRI claustrophobia, 2017, Two Views, https://two-views.com/mri-imaging/claustrophobia.html, (accessed 31 May 2018)
  2. Kramer, D. B. et al., 2017, Coverage of Magnetic Resonance Imaging for Patients With Cardiac Devices, JAMA Cardiol, 2 (7), Pp 711-712
  3. Claustrophobia can turn MRI into frightening experience, 2018, The Washington Post, https://www.washingtonpost.com/national/health-science/claustrophobia-can-turn-mri-into-frightening-experience/2018/03/09/e41f50be-1bd3-11e8-ae5a-16e60e4605f3_story.html, (accessed 31 May 2018)
  4. Tugwell, J. R. et al., 2018, Alleviating anxiety in patients prior to MRI: A pilot single-centre single-blinded randomised controlled trial to compare video demonstration or telephone conversation with a radiographer versus routine intervention, International Journal of Diagnostic Imaging and Radiation Therapy, 24 (2), Pp 122-129
  5. Claustrophobia, Anxiety, and Emotional Distress, 2017, MRISafety, http://www.mrisafety.com/SafetyInfov.asp?SafetyInfoID=253, (accessed 1 June 2018)
  6. Experience Open MRI, 2018, Open Sided MRI, https://osmri.com/open-vs-closed-mri/, (accessed 1 June 2018)
  7. Chapman, H. A. et al., 2010, MRI-related anxiety levels change within and between repeated scanning sessions, Psychiatry Research: Neuroimaging, 182 (2), Pp 160-164
  8. Enders, J. et al., 2011, Reduction of claustrophobia during magnetic resonance imaging: methods and design of the "CLAUSTRO" randomized controlled trial, BMC Med Imaging, 11 (4) 
  9. HOW CAN WE HELP PATIENTS OVERCOME MRI ANXIETY?, 2014, University of Adelaide, https://www.adelaide.edu.au/news/news74922.html, (accessed 1 June 2018)