Patient anxiety in magnetic resonance imaging centres: Is further intervention needed?

doi:10.1016/j.radi.2007.09.007

Radiography

Volume 14, Issue 3, August 2008, Pages 265-266

https://doi.org/10.1016/j.radi.2007.09.007 Get rights and content

Abstract

Background

Anxiety is commonly reported by patients attending for Magnetic Resonance Imaging (MRI) scanning. This cross sectional postal survey sought the views of radiographers regarding: levels of patient anxiety, methods used to manage this before and during scanning, and the need for additional interventions to reduce anxiety.

Results

Participants reported that they used procedures such as information leaflets, pre-scan visits and music to inform patients about the scan procedure and to reduce anxiety. Despite this, high levels of patient anxiety were reported, leading to scan disruption in some centres. The causes of anxiety concurred with previous research findings, for example, the scan environment, noise levels and fear of what the scan may reveal. Most participants were opposed to the idea of a multi-media intervention to reduce anxiety but this was often related to resource restrictions.

Conclusions

Despite most centres using anxiety reducing techniques, many still report scan disruption suggesting there is a need to improve support for patients.

Section snippets

Background

Previous research has identified significant rates of anxiety experienced by patients attending for magnetic resonance imaging (MRI) scanning. It has been reported that 25% of patients suffer moderate to severe anxiety during scanning.¹ MRI scan-related anxiety reactions range from apprehension to severe panic and claustrophobia.² Studies indicate that the experience of being scanned can threaten an individual's sense of self-control³ and can induce levels of anxiety similar to those in

Results

One hundred and seventy-six out of 273 radiographers replied giving a response rate of 64.5%. Most (126, 71.6%) reported that anxiety was a common problem in their MRI centre, with 34 (19.3%) stating that it disrupted scanning on a regular basis. The causes of anxiety concurred with previous research findings, for example, the scan environment, noise levels and fear of what the scan may reveal.

Participants reported that they had interventions in place to inform patients about the scan

Conclusions

This study sought to survey the views of experienced radiographers about the prevalence of anxiety and current practice related to this in English MRI centres. Despite most centres using anxiety-reducing techniques, many still report scan disruption suggesting that there is a need to improve patient experience and to develop further interventions. We found the use of sedation to be not uncommon. This may be of concern given the potential risks involved, and deserves further research given that

References (10)

S. Phillips et al.
Interventions to alleviate patient anxiety during magnetic resonance imaging: a review
Radiography
(1995)
R. Mackenzie et al.
Patients' perceptions of magnetic resonance imaging
Clin Radiol
(1995)
R. Cooke et al.
The neuroimaging research process from the participants' perspective
Int J Psychophysiol
(2007)
R. Lukins et al.
A cognitive behavioural approach to preventing anxiety during magnetic resonance imaging
J Behav Ther Exp Psychiatry
(1997)
S.J. Grey et al.
Reduction of anxiety during MR imaging: a controlled trial
Magn Reson Imaging
(2000)

There are more references available in the full text version of this article.

Cited by (29)

Journey to the Center of the Bore: A Service Evaluation of the Patient Experience in Magnetic Resonance Imaging
2023, Journal of Radiology Nursing
Patient experience is an essential component of delivering person-centered care. This is particularly the case for patients referred for magnetic resonance imaging (MRI) which is a known trigger of emotional anxiety and stress.
Patients referred for MRI were invited to participate in a service evaluation via a survey. The aim was to record and report upon their experience of MRI and what mattered to them when having a scan. Insights on their use of support strategies and their considered effectiveness were also obtained.
Patients experienced the early stages of their journey as an emotional low, with greatest concern noted on entry to the scan room and during the scan. The importance of staff interaction was emphasized along with being sufficiently informed on what to expect.
The experience of MRI varies from patient to patient but understanding the potential sources and triggers of anxiety that may require additional support can help staff better deliver person-centered care.
Early MRI termination with major impact on the radiological interpretation: The experience of a large university hospital
2023, European Journal of Radiology
To report the incidence of early magnetic resonance imaging (MRI) terminations and analyse their risk factors in a large university hospital.
All consecutive patients aged > 16 years who underwent an MRI over a 14-month period were included. The following parameters were collected: demographics, in- or outpatient, history of claustrophobia, anatomical region investigated, and early MRI termination along with its cause. The potential link between these parameters and early MRI termination was statistically analysed.
Overall, 22,566 MRIs were performed (10,792 [48%] men and 11,774 [52%] women, mean age: 57 [range: 16–103] years). Early MRI termination was reported in 183 (0.8%) patients (99 men and 84 women, mean age: 63 years). Of these early terminations, 103 (56%) were due to claustrophobia and 80 (44%) to other causes. Early terminations were more common in inpatients than outpatients (1.2% vs. 0.6%, p < 0.001), for both claustrophobia- and non-claustrophobia-related reasons. A prior history of claustrophobia was strongly associated with claustrophobia-related early termination (6.6% vs. 0.2%, p = 0.0001). Non-claustrophobia-related early terminations were significantly more common (0.6% vs. 0.2%) in elderly patients (>65 years old) than in younger ones. No other parameter was significantly associated with early termination.
Early MRI termination is currently rare. The main risk factors for claustrophobia-related terminations comprised a prior history of claustrophobia, and examinations in inpatients. Non-claustrophobia-related early terminations were more common in both elderly patients and inpatients.
Radiographer Perspectives on current occurrence and management of claustrophobia in MRI
2022, Radiography
Citation Excerpt :
One manifestation may be claustrophobia, either to enclosed spaces or of being trapped.7–9 Whilst this anxiety and phobia may result from the physical nature of the scanner design, it can also be due to the noise related to the imaging process, having to lie flat for extended periods of time, or simply the fear of the unknown or what the results may show.10–13 Whatever the cause, the outcome for the patient can be one of reduced diagnostic quality or failure to successfully complete a scan which impacts on their clinical management, as well as operational and financial impact on scanning units.14–16
Magnetic Resonance Imaging (MRI) is well known to be a source of anxiety for patients, commonly appearing as claustrophobia. One of the main reasons for this is due to the physical nature of the scanner itself. Despite technological improvements, there is lacking evidence on whether these improvements have resulted in a reduction in claustrophobia and anxiety in the clinical setting. Background anxiety associated with the current COVID-19 pandemic may also have shown an increase in prevalence. Therefore, the aim of this study was to survey MRI radiographers on their perspectives on the occurrence and management of claustrophobia in modern day clinical practice.
Following ethical approval, an online survey was used to gather the opinions of MRI radiographers. This used closed ranking questions as well as open responses to gain insight into how this issue may be presenting in practice, preferences in management, and barriers to providing support.
Responses provide an up-to-date view on how radiographers perceive both displays of anxiety and associated impacts on patient outcome, the considered sources of anxiety, the use and effectiveness of support strategies, barriers to providing this support, and views on how COVID-19 has impacted on practice.
The study provides a current view from radiographers on their experience of claustrophobia in practice. It shows that this remains a regular part of practice within the modality. Therefore, for MRI radiographers managing this is an essential component of their role. Communication and interaction with the patient are recognised as important, although time is a barrier to always being able to provide patient centred care.
Ongoing support is needed for both patients and radiographers to improve experience within MRI.
The luminous environment and patient anxiety in MRI service
2021, Psychologie Francaise
L’objectif principal de cette étude est de comparer l’anxiété des patients réalisant une IRM.
Deux cent huit patients ont participé à cette étude. Quatre groupes ont été formés en fonction de la présence vs absence d’environnement lumineux, d’écran et de musique. Un questionnaire a été distribué aux patients afin d’analyser leur anxiété par rapport à l’examen et dans la vie de tous les jours et des questions ouvertes leur ont été posées afin de recueillir le vécu de l’examen (points positifs et axes d’amélioration).
Les participants qui ont passé leur examen dans une salle contenant un environnement lumineux équipé d’un écran avec une musique à tempo lent ont un score d’anxiété significativement moins élevé, rapportent davantage de satisfaction et proposent moins d’axes d’amélioration par rapport aux trois autres groupes.
Les résultats de cette étude devraient encourager les centres à se doter de ces nouvelles installations. L’atmosphère relaxante — sensations visuelles et sonores apaisantes — agit positivement sur l’anxiété des patients. Bien que ce travail témoigne de l’intérêt d’un environnement lumineux avec écran sur l’anxiété des patients, celui-ci ne remplacera jamais la prise en charge des manipulateurs en électroradiologie médicale et des radiologues, et notamment toutes les informations transmises et le soutien proposé en amont de l’examen.
Magnetic Resonance Imaging (MRI) is a medical imagery exam, which is considered stressful/worrying for patients. This anxiety is related to several factors: negative beliefs linked to the lack of knowledge about the procedure of the exam, duration, noise of the MRI, etc. Several interventions, before and during the MRI were proposed and evaluated with the aim of reducing anxiety for patients (information given to patients, psychological preparation before the exam and hypnosis, aromatherapy, sedation, environment and positioning of the patient). While the health service is more and more centered on cost-efficiency and pressure for greater patient throughput, it is important to find appropriate interventions to improve patient tolerance of MRIs.
The objective of this study was to compare anxiety of patients based on the MRI luminous environment.
208 patients aged 18–70 years participated in the study. Four subgroups were created according to the presence or absence of luminous environment, screen and music: G1 (60 participants, with luminous environment, without screen, music with fast tempo); G2 (60 participants, with luminous environment, with screen, music with slow tempo); G3 (27 participants, without luminous environment, without music); G4 (61 participants, without luminous environment, music with fast tempo). All participants completed a questionnaire to evaluate their anxiety regarding the exam (anxiety-state, AE) and in everyday life (anxiety-trait, AT): STAI-Y. Open questions were also asked to participants in order to gain an understanding of their experience of the exam (positive points and suggestions for improvements).
The results showed a significant difference between the groups of the AE: patients of group G1 showed more AE than patients in group G2 (p = 0.037), patients of group G2 showed less AE than those of group G3 (p = 0.001), and patients of group G3 showed more AE than patients in group G4 (p = 0.019). No significative difference was found between the 3 groups in the AT. The participants who underwent exams in a room with a luminous environment equipped with a screen with slow tempo music reported more satisfaction and offered fewer suggestions for improvement compared with the two other groups.
This study has revealed that the environment in which patients undergo their exam affects their level of anxiety during the exam. A luminous environment equipped with a screen led to a considerable decrease in patient anxiety during the MRI exam. Technological innovations are allowing the patient to be the center of radiographers focus more and more. Trying to priorities improvement of patient well-being consequently facilitates their work. Taking into account the cost and increasing number of medical imagery exams, prevention of anxiety and its undesirable side-effects is not only important for patients, but also avoids wastage of staff and of time. The results of this study should encourage health centers to invest in these new installations, keeping in mind that new technologies can never replace information and support offered before the exam by radiologists and radiographers.
Anxiety during magnetic resonance imaging of the spine in relation to scanner design and size
2020, Radiography
Magnetic resonance imaging in closed-bore scanners sometimes provokes anxiety but closed-bore designs have gradually become wider and shorter. Open scanners may be easier to tolerate. The aim was to compare patient anxiety during MRI between bore diameters of 60 cm and 70 cm, and to determine the current level of patient anxiety and experience in open scanners in a clinical setrting.
Consecutive patients referred for examination of the spine in 60 cm and 70 cm bores and one open scanner participated. Four established/validated questionnaires, answered before, directly after (N = 155) and one week after (N = 109) the MRI-examination were used, measuring anxiety, fear and depression.
No difference was found in the patient scores of anxiety between the 60 cm and the 70 cm scanners on the examination day. At follow-up, patients in the 70 cm bore rated their examination experience better (p < 0.025), compared to patients in the 60 cm bore. Patients in the open scanner rated higher levels of anxiety (p < 0.001) before, directly after and one week after the examination, compared to the closed bore scanners.
Scanners with a 70 cm diameter bore seem more tolerable than those with a 60 cm bore. Patients referred to the open scanner had on average a higher tendency to express anxiety. Still, patient anxiety in MRI is challenging and further research required.
Patients prefer to be examined in 70 cm bore scanners compared with 60 cm. If open scanners aren't available extended support may be necessary for the most anxious patients.
Heart rate variability as a biomarker in health and affective disorders: A perspective on neuroimaging studies
2019, NeuroImage
The dynamic embodiment of psychological processes is evident in the association of health outcomes, behavioural traits and psychological functioning with Heart Rate Variability (HRV). The dominant high-frequency component of HRV is an index of the central neural control of heart rhythm, mediated via the parasympathetic vagus nerve. HRV provides a potential objective measure of action policies for the adaptive and predictive allostatic regulation of homeostasis within the cardiovascular system. In its support, a network of brain regions (referred to as the ‘central autonomic network’) maps internal state, and controls autonomic responses. This network includes regions of prefrontal cortex, anterior cingulate cortex, insula, amygdala, periaqueductal grey, pons and medulla. Human neuroimaging studies of neural activation and functional connectivity broadly endorse this architecture, and its link with cardiac regulation at rest and dysregulation in clinical states that include affective disorders. In this review, we appraise neuroimaging research and related evidence for HRV as an informative marker of autonomic integration with affect and cognition, taking a perspective on function and organisation. We consider evidence for the utility of HRV as a metric to inform targeted interventions to improve autonomic and affective dysregulation, and suggest research questions for further investigation.

View all citing articles on Scopus

View full text

Technical notePatient anxiety in magnetic resonance imaging centres: Is further intervention needed?

Abstract

Background

Results

Conclusions

Section snippets

Background

Results

Conclusions

Radiography

Clin Radiol

Int J Psychophysiol

J Behav Ther Exp Psychiatry

Magn Reson Imaging

Technical note
Patient anxiety in magnetic resonance imaging centres: Is further intervention needed?