Brain MRI Examination: Managing Anxiety and Claustrophobia for Optimal Image Quality
Fear, anxiety, and phobia are common terms used to describe different emotions; they are often used interchangeably, but they have distinct meanings.
Anxiety is a future-oriented response focused on a vague threat.
Fear is a response focused on the present to an identifiable threat.
A phobia is an intense and irrational fear of one or more things or situations.
Claustrophobia is an intense and irrational fear of confined or enclosed spaces.
As we all know, the MRI environment can trigger these feelings, particularly due to the scanner gantry, the shape of the coils, scan duration, the need to remain still for the entire scan, noise, and thermal discomfort, among other factors.
Despite medical and technical advances in gantry geometry (length and size), as well as software and hardware innovations that have significantly reduced scan times and acoustic noise, patients continue to have negative experiences before and during MRI scans. Up to 35% of individuals experience anxiety during MRI scans, with a 37% incidence rate of claustrophobia [1].
In fact, based on a recent systematic review of patient responses to MRI [2], conflicting findings have been reported: some studies suggest that such technological advancements may have led to improvements in the patient experience; others, however, have continued to report high levels of distress and related procedural issues among patients undergoing MRI scans in modern MRI scanners, casting doubt on the benefits of new MRI designs. In practice, advancements in MRI technology alone may not be sufficient to eliminate anxiety in patients undergoing MRI and related unexpected behaviors.
The Impact on MRI Efficiency and Outcomes
Anxiety and discomfort in general may not only affect the patient experience, but may also affect the efficiency of healthcare providers. Anxious patients tend to move more, causing motion artifacts in the acquired images and necessitating repeat scans, which leads to longer procedure times.
In cases of severe anxiety, a scan may be terminated prematurely, leading to difficulties in patient management and rescheduling. Claustrophobia during scans is associated with early termination of scans in up to 10% of patients.
Patients who experience severe anxiety leading to premature termination will almost certainly require sedation to complete the scan.
All the concepts explained above are particularly relevant in the case of brain MRI.
Due to the “birdcage” shape of the coil and its position in the center of the scanner bore, brain MRI remains one of the most challenging MRI examinations for patients with anxiety or claustrophobia.
For this reason, every possible measure should be taken to complete the scan with the highest-quality image possible, free from motion artifacts, with sedation considered only as a last resort.
The Strategy for Managing Patients
The first step in helping patients relax and reducing their anxiety involves thorough preparation and instruction, both for patients visiting the MRI unit for the first time and for those who have had negative experiences during previous MRI exams.
The correct use of language by the MR technologist and all professionals involved in the MRI process, speaking with empathy, is a very powerful tool that should not be underestimated.
The second step is proper patient positioning that ensures patient comfort while being compatible with the anatomy being examined. Patient comfort is essential not only for reducing anxiety but also for limiting the risk of motion artifacts.
In fact, generally speaking, motion occurs in 29% of inpatient/emergency department exams and 7% of outpatient studies [3], resulting in an estimated annual loss of $115,000 per scanner due to motion artifacts [4].
To reduce motion artifacts, various approaches can be applied when discussing technical parameters at the console [5]:
Reducing scan time through techniques such as parallel imaging, compressed sensing, simultaneous multi-slice imaging, artificial intelligence, etc. With this approach, motion artifacts are less likely to occur;
Saturation bands to remove signals from moving anatomical structures;
Trigger/gating systems to synchronize the patient's physiological movements with the scanner;
Radial K-space filling to correct motion during image reconstruction through central K-space oversampling and specific algorithms;
Specific immobilization and stabilization devices, such as inflatable pads.
Regarding the last point, inflatable pads are a highly effective tool for both patient immobilization and anxiety reduction during head MRI examinations, with the goal of completing the MRI scan free of motion artifacts.
The inflatable pads allow for pressure adjustment, optimizing patient comfort and reducing the risk of movement. At the same time, the patient has an additional means of controlling their environment.
For example, when used in combination with a head coil, the MR technologist can initially inflate the pads based on the patient’s tolerance, and then give the patient control of the ball and release valve, allowing them to ease off the pressure if necessary.
This approach, combined with active communication during the scan, can help reduce anxiety levels and improve image quality.
Fig. 2: MULTIPAD ear model with inflatable pads combined with a head coil
The inflatable pads I use during MRI head scans for anxious patients are provided by Pearl Technology AG; they are the MULTIPAD Ear model.
I tested this on many patients suffering from anxiety and claustrophobia, with good results in terms of anxiety management, the ability to complete the scan, and the reduction of motion artifacts.
I compared the patients’ reactions to the external ear protection provided by the scanner manufacturer and the inflatable pads used in combination with internal ear protection. Almost all the patients I tested felt more comfortable with the inflatable pads due to the pressure equalization and the ability to control the release valve.
Fig. 3: External ear protection (left), internal ear protection with MULTIPAD Ear.
Conclusion
Ultimately, inflatable pads are a valuable tool to consider during patient positioning and instruction to help manage anxiety and prevent motion artifacts during head MRI examinations. They should be used in conjunction with other psychological and physical tools to ensure good image quality and effective anxiety management.
It is important to note that, in certain cases involving high levels of anxiety or phobia, patient sedation may be the only way to perform an MRI examination.
Source:
This article is republished from Pearl Technology with permission. Read the original article here: Brain MRI Examination: Managing Anxiety and Claustrophobia for Optimal Image Quality.[1] Advances in Magnetic Resonance Technology and Applications. Volume 6. ISSN 2666-9099. https://doi.org/10.1016/B978-0-12-824460-9.00010-8[2] Linda Becker, PhD, et al. The Psychological, Physiological, and Behavioral Responses of Patients to Magnetic Resonance Imaging (MRI): A Systematic Review and Meta-Analysis.
JMRI, Volume 59, Issue 2, February 2024, Pages 675–687
https://doi.org/10.1002/jmri.29134[3] Zaitsev M, Maclaren J, Herbst M. Motion artifacts in MRI: a complex problem with many partial solutions.
J Magn Reson Imaging 2015;42(4):887–901. https://doi.org/10.1002/jmri.24850 PMC 4517972. PMID:
25630632[4] Melendez JC, McCrank E. Anxiety-related reactions associated with magnetic resonance imaging examinations.
JAMA 1993;270:745–7. https://doi.org/10.1001/jama.1993.03510060091039[5] Artifacts and Technical Solutions in MR Diagnostic Imaging: Bartalini, Dr. Luca, Gerevini, Dr. Alan: 9781728734927: Amazon.com: Books