Nerves before an MRI are normal—up to 37 percent of patients report either moderate or high levels of anxiety leading up to an exam—and this apprehension can have physical consequences that render an entire scanning experience useless, first author J.R. Tugwell colleagues wrote in Radiography this month.
“Patients undergoing MRI often experience fear and anxiety prior to and during scanning,” the authors said. “This could result in early termination of scan and indirectly affect image quality of motion artifacts. In addition, anxiety is known to increase respiratory rate, peristalsis and fluid flow, all potentially having detrimental effects on image quality.”
Clinicians have struggled in the past to find solutions for the problem after attempting to implement psychological interventions like cognitive behavioral therapy, sedation and mock MRIs, the researchers said. And those methods weren’t just too pricey or difficult to integrate into clinical work—they also focused on a largely pediatric population, “are very protocol-driven and do not consider the individual needs of each patient.”
For their research, Tugwell and the team conducted a randomized, single-center controlled trial of 74 first-time MRI patients. Individuals were either attending for a head, spine or cardiac scan, and each patient was randomized to traditional MRI prep with a mailed appointment letter, a video demo or a scheduled phone conversation with a radiographer. The State-Trait Anxiety Inventory questionnaire was used to assess nerve levels before and after exams, and two observers were recruited to scan images for anxiety-induced artefacts.
Patients selected for video preparation were granted access to a four-minute online clip made specifically for Tugwell et al.’s study, according to the research. Actors in the film demonstrated what MRI machines look like, how they work, what they sound like and what patients needed to do to prep for the experience. Though it’s short, the authors said, the video is comprehensive and guides a patient from checking in with reception to obtaining imaging results after the fact.
Slightly more time-consuming was the phone call approach, in which patients scheduled a brief call with an attending radiographer to answer any outstanding questions and be guided through the MRI process.
Both avenues were similarly successful in significantly reducing patient anxiety levels compared to traditional prep, Tugwell and colleagues reported, and motion artefact levels remained unchanged regardless of the cohort. Of the more than half of patients who admitted to anxiety before the exam, 18.9 percent said their nerves stemmed from the possible outcomes of the MRI.
Though both methods saw success, the authors said they’d probably favor the video approach, since phone calls take extra time and coordination. Granting patients access to a short film could answer questions and concerns without eating up any additional time, and supplementary phone calls could be set up as needed.
“It may be beneficial to make both interventions available to patients in conjunction with each other, whereby the extra information from the video may reduce the need of patients to speak to a radiographer, but the option would still be available,” Tugwell and co-authors said.