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Impact of Sensory design interventions on image quality, patient anxiety and overall patient experience at MRI
Abstract
Objectives:
This study aims to assess the effect of sensory stimulation on patient MRI experience, and to assess whether sensory stimulation has a significant effect on MR image quality.
Methods:
Case-control study conducted over 4 months, involving patients undergoing MRI brain, cervical spine, breast and prostate. N=106 patients, 64 cases and 42 controls. Cases underwent sensory stimulation during the scan in the form of a scented cotton pad placed in the scanner near their head and/or calming bird noises played over headphones. Post scan, participants completed a questionnaire regarding their experience of MRI. Scanning radiographers completed a questionnaire regarding patient tolerance of the scan. All studies were evaluated by 2 radiologists for the presence of movement artefact.
Results:
39% of cases and 38% of controls reported anxiety in the days preceding MRI. 6.2% of cases required coaching during image acquisition, while 9.7% of controls required coaching.4.7% of cases and 4.8% controls required sequence repetition due to movement artefact. Mean patient experience score (as graded by the patient) for controls was 1.74 +/-0.63 SD and for cases was 1.67 +/-0.60 SD. (Lower assigned scores equated to a better experience.) Mean patient experience score based on comments on a 5 point scale as graded by two observers was 2.81 +/- 0.70 SD for controls, 2.42+ 0.94 SD for sound intervention and 2.46 +/- 1.01 SD for scent intervention. Mean motion artefact score graded by the two radiologists was 1.13 +/-0.53 SD for controls and 1.08 +/-0.36 SD for cases. (A lower score equated to less movement artefact). We demonstrated a trend towards a relaxing experience in those patients undergoing MRI for the first time who underwent sensory intervention. Participants positive ratings of the smell pleasantness were associated with a reduced likelihood of experiencing anxiety (p=0.13). Results were not statistically significant Conclusion: This study demonstrated a subjectively improved experience of MRI for some patients with the intervention of sound and smell. The study failed to show a significant decrease in patient movement during MRI investigations. This may relate to the small study size and a low level of patient movement in the case group.
Advances in knowledge:
Sound and olfactory sensory environment interventions at MRI can improve the patient experience. These low cost interventions are well tolerated, may improve acceptance of MRI in patients with anxiety, and offer a competitive advantage to imaging centres.
... Desain MRI mulai dikembangkan ke arah patient-friendly, desain bore lebih luas dan pendek, scanner terbuka, dan menurunkan tingkat kebisingan (Mubarak et al., 2015). Walaupun demikian, perkembangan teknologi tersebut tidak sepenuhnya dapat menurunkan Claustrophobia dan kecemasan pada pasien (Stanley et al., 2016). ...
... Sensory Intervention merupakan suatu pendekatan dengan konsep dasar ditujukan pada indra manusia sebagai penentu persepsi dan perilaku (Mostafa, 2014). Konsep sensory intervention dilakukan dengan memberikan rangsangan indrawi (sensory stimulation) pada individu yang diharapkan dapat memberikan efek pada individu tersebut (Stanley et al., 2016). Penelitian ini berfokus pada indra pembau dengan pemanfaatan intervention scent, yaitu pemberian rangsangan berupa aromaterapi secara inhalasi, serta indra pendengar dengan pemanfaatan intervention sound, berupa pemberian musik yang diperdengarkan. ...
Background: The use of MRI as a non-invasive diagnostic radiological examination modality is painless. However, patients may experience claustrophobia and anxiety. Sensory intervention is a method of providing sensory stimulation to an individual, which is expected to reduce the anxiety. Purpose: To determine the effect of the sensory intervention on the anxiety level of patients using an intervention scent by inhalation and intervention sound based on heart rate and MRI-AQ in patients with MRI lumbal examination. Method: 24 samples were divided into three groups: intervention scent, combination intervention scent-sound, and control, with eight samples each. Intervention scent is given using lavender essential oil as aromatherapy, drop three drops on the mask, then put the mask on for 5 minutes before the examination until the examination is completed. Intervention sound is given by playing music (nature-sound) during the examination. Result: Sensory intervention, specifically the use of combination intervention scent-sound, significantly reduces anxiety in patients during MRI lumbal examination significantly p = 0.004 (p<0.05). Conclusion: The use of a combination between lavender and nature-sound as media for sensory intervention has a positive effect on reducing anxiety during MRI lumbal examination based on heart rate. Due to the easy administration of this aromatherapy and the minimal risk for this treatment, it is recommended that it is applied to reduce anxiety during MRI.
... The majority of responding MR radiographers working in Kuwait (97.9%) acknowledged the use of anxiety reduction methods to support patients with claustrophobia. Based on literature evidence, interventional approaches employed to support claustrophobic patients within MRI departments include sedation, 24 musical therapy, 15,25 and, more recently, virtual reality (VR). 14,26 The single most striking observation to emerge from this study ( Table 2) was the high ranking assigned by MR radiographers to 'providing supportive instructions' as a method to support claustrophobic patients during their MRI scan. ...
... 15 This research highlighted the importance of music therapy in reducing anxiety, resulting in decreased individual examination times by reducing the likelihood of having to repeat sequences because of degradation due to motion artefact. The effect of music therapy on improving the patient experience in MRI was also affirmed by Stanley et al. 25 Based on radiographer rating, the current study has shown that the use of music was a practical and effective method of supporting patients with claustrophobia, enabling many to complete their MRI scans. Therefore, the results support established evidence that music therapy improves the MRI experience for claustrophobic patients. ...
Introduction
Claustrophobia is a major problem experienced by some patients referred for magnetic resonance imaging (MRI). This results in significant costs and delays to healthcare service provision due to appointment cancellations or patients' inability to complete MRI examinations. Radiographers may use several strategies to effectively manage patients with claustrophobia during MRI. This study aimed to determine radiographer's confidence in managing patients with claustrophobia and evaluate the perceived effectiveness of the intervention approaches employed.
Methods
With institutional ethical approval, an online survey was conducted (15th September to 9th November 2020) among Kuwaiti MRI radiographers. The survey was designed to obtain information relating to participant demographics and the perceived confidence of radiographers in their use of interventions to manage claustrophobia during MRI procedures. Data obtained were analysed using the Statistical Package for the Social Sciences (v.26).
Results
A total of 144 valid responses were obtained. Of the respondents, 82% (n = 118) were confident that they could support claustrophobic patients during MRI examinations. Almost all respondents (97.9%, n = 141) employed various claustrophobia reduction and relaxation techniques to improve patient experience and increase scan completion rates. There was a significant association between radiographer’s level of education (rs = +0.18, p = 0.028) and experience (rs = +0.33, p < 0.001) with their confidence managing claustrophobic patients. While participating radiographers considered lectures and training the most effective methods to improve their skills in managing such patients, educating claustrophobic patients prior to their MRI scan was the most effective technique for facilitating scan completion.
Conclusion
Kuwaiti MRI radiographers are confident in applying different claustrophobic management techniques to improve patient compliance. Patient education, through supportive discussion, prior to their MRI examination was identified as the most effective intervention for managing claustrophobia.
Implications for practice
Patient education before MRI examination is necessary to enhance their experience and optimise scan completion rates. In addition, it is essential that MR radiographers develop their practical competence in supporting patients with claustrophobia during their scans.
... To address these issues, it is recommended to use non-magnetic materials for metal implants in the body. For patients with claustrophobia, large aperture MRI equipment and fast scanning sequences can help complete the examination [14,15]. ...
Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis with clinical symptoms of obstructive jaundice and abdominal discomfort; this condition is caused by autoimmunity and marked by pancreatic fibrosis and dysfunction. Previous studies have revealed a close relationship between early pancreatic atrophy and the incidence rate of diabetes in type 1 AIP patients receiving steroid treatment. Shimada et al performed a long-term follow-up study and reported that the pancreatic volume (PV) of these patients initially exponentially decreased but then slowly decreased, which was considered to be an important factor related to diabetes; moreover, serum IgG4 levels were positively correlated with PV during follow-up. In this letter, regarding the original study presented by Shimada et al , we present our insights and discuss how multimodal medical imaging and artificial intelligence can be used to better assess the relationship between pancreatic morphological changes and diabetes in patients with AIP.
... Therefore, different cognitive and behavioral interventions have been developed and tested to reduce anxiety and improve the experience of patients undergoing MRI scans [21][22][23]. These interventions included procedural education, prior MRI-simulator rehearsal, relaxation exercises, noise reduction, ambient lighting, aromatherapy, a phone call with the radiographer, and an information booklet on MRI [21,22,[24][25][26]. Many of these interventions have proven effective in reducing anxiety and improving the experience of the patients, and their satisfaction. ...
Background
Magnetic resonance imaging (MRI) is a noninvasive diagnostic tool that is commonly used to visualize soft tissues and anatomical structures. Many patients who undergo MRI scans experience anxiety. This multicenter study was conducted to assess anxiety levels experienced by patients who underwent MRI scans in the Palestinian radiology departments and identify the risk factors associated with higher levels of anxiety experienced by the patients.
Methods
This multicenter cross-sectional study was conducted in the radiology departments of different hospitals in the West Bank of Palestine using a questionnaire. The questionnaire collected different demographic data of the patients. A 100-mm visual analog scale (VAS) was used to assess the level of anxiety experienced by the patients who received MRI scans. The data were analyzed using SPSS version 28.
Results
A total of 383 patients participated in this study. Of the patients, 255 (66.6%) reported experiencing low, moderate, or high anxiety levels during the MRI scan. The median anxiety was 20.0 with an interquartile range (IQR) of 0.0–50.0 as measured using the 100-mm VAS. Higher anxiety levels were reported by the patients who were female (p-value < 0.001), unemployed (p-value = 0.009), and did not receive an MRI scan before (p-value = 0.001). In addition, the patients who received pelvis scans reported higher levels of anxiety compared to those who received scans for upper extremities (p-value = 0.031), abdomen (p-value = 0.033), pelvis (p-value = 0.043), and lower extremities (p-value = 0.016). In addition, the patients who received scans for the head/neck reported higher levels of anxiety compared to the patients who received scans for the lower extremities (p-value = 0.021).
Conclusion
The findings of this study showed that a considerable proportion of the patients who received MRI scans in Palestinian hospitals experience anxiety. Radiologists and other decision-makers in the healthcare system should design effective measures to reduce anxiety and improve the experiences of patients who are female, unemployed, and those who are scheduled to receive MRI scans for the first time. Moreover, these interventions should particularly focus on the patients who are scheduled to receive scans for the pelvis and head/neck.
... 99,100 The identified studies on distraction seem to show either a positive or an absence of effect on perceived pain, anxiety, or satisfaction. Nevertheless, these distraction strategies are also used in other contexts such as improving the experience of patients undergoing MRI 101,102 or radiotherapy. 103 This review revealed that the vast majority of studies focused on women, and none mentioned the inclusion of men or transgender people. ...
Introduction: A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening purposes. Mam-mograms indeed facilitate early disease detection, enhance the potential for cure, and consequently reduce breast cancer mortality. The main objective of this review was to identify and map the strategies aiming to improve the patient experience in diagnostic and screening mammography. Methods: This scoping review was performed following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed through databases of MEDLINE, Embase.com, CINAHL, APA PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest Dissertation and Theses, and three clinical trial registries. This review considered studies evaluating the effect of interventions, occurring within the mammography department, on the patient experience. Results: The literature search yielded 8113 citations of which 60, matching the inclusion criteria, were included. The strategies were classified into eight categories. The most represented one was breast compression and positioning, followed by relaxation techniques and analgesic care, communication and information, screening equipment, examination procedures, patient-related factors, physical environment , and finally staff characteristics. The studied outcomes related to patient experience were mainly pain, anxiety, comfort, and satisfaction. Other types of outcomes were also considered in the studies such as image quality, technical parameters, or radiation dose. Most studies were conducted by radiographers, on female patients, and none mentioned the inclusion of male or transgender patients. Conclusion: This review outlined a diversity of strategies to improve patient experience, although technique-based interventions were predominant. Further research is warranted, notably on psychological strategies, and on men and transgender people. Implications for practice: This scoping review provides guidance to healthcare providers and services for better patient/client-centered care. Introduction Mammography is routinely used to detect changes in breast tissue that may be indicative of early-stage breast cancer (BC), which is the most frequently diagnosed malignancy and the main cause of cancer death in women in a vast majority of the world's regions. 1 With a 20 % risk of BC before the age of 75, 1 preventive measures are of paramount importance and mammography is the gold standard for BC screening. Indeed, early detection allows the management of potentially curable diseases and therefore a reduction in the mortality associated with this malignancy. 2e4 Mammography examination may however lead to several psychological phenomena to patients, such as anxiety, fear of the diagnostic result, uncomfortable experience, and pain related to breast compression. 5,6 During mammography, the breast must be compressed, to be as thin as possible for each of the four projections performed, two views per breast namely a craniocaudal and a mediolateral oblique views. Breast compression is pivotal for dose reduction and image quality, to avoid additional views or
... 23 A group of subjects whose sensory stimulation was evaluated during an MRI scan using olfactory stimuli intended to have a sedative effect reported an improvement in their subjective experience scores even though it did not affect their movement during an MRI. 25 Anxiety helps keep the patient still throughout the examination process. Another common problem with MRI is claustrophobia, which is the excessive fear of tight spaces. ...
Ali Alghamdi,1 Maaidah Algamdi,2 Khaledah Alatawi,2 Basmah Alghamdi,2 Hana Alanazi,2 Shumukh Alamri,2 Somiah Alamri,2 Zahra Albishi2 1Department of Radiological Sciences, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia; 2Department of Nursing, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi ArabiaCorrespondence: Ali Alghamdi, Department of Radiological Science, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, 47512, Saudi Arabia, Tel +966561587982, Email ah.alghamdi@ut.edu.saBackground: Magnetic resonance imaging (MRI) has become one of the most essential diagnostic medical imaging techniques. The most common disadvantage of MRI is that patients may feel anxious before the examination, which can negatively affect them, prevent them from attending or completing the examinations, and cause patient movement during the examination, which accordingly results in misinterpretation issues. Recently, several methods have been suggested to reduce MRI anxiety. Our study aimed to examine nurses’ roles in reducing the levels of patient anxiety during pre-MRI scans by using informative video.Methods: A cross-sectional and interventional study was conducted among MRI patients in Tabuk City. A convenience sample of 16 patients as the case group and 28 patients as the control group was included. A 2-minute informative video clip containing comprehensive instructions about MRI was recorded by the research team in the MRI room and introduced to patients 30 minutes before the scan in the waiting area. An Arabic version questionnaire (State-Trait Anxiety Inventory) was used to measure the pre-MRI-related anxiety of patients in the case and control groups. State-trait anxiety scores were analyzed and compared between groups. Median pulse, oxygen saturation, and blood pressure were also compared between the cases and control groups using a p-value of 0.05.Results: The state anxiety score was significantly higher in cases compared to controls. However, the trait anxiety score was not significantly different between cases and controls. Females showed significantly higher state anxiety scores in the cases than in the controls. Based on the previous MRI experience, the cases group who had undergone a previous MRI had significantly higher state anxiety scores than those in the control group. Based on the educational degree, cases with bachelor’s degree had higher state anxiety scores than their counterparts in the control group.Conclusion: The present study showed that the self-made visual tool used by nurses 30 minutes before MRI scan did not reduce the level of anxiety significantly in patients. However, state anxiety scores increased in females, patients with previous MRI experience, and patients with a higher educational degree. Healthcare professionals may need to consider the negative effect of informative video before MRI.Keywords: magnetic resonance imaging, MRI, anxiety, nurses’ role, informative video, patient, interventions, STAI-Y
... If this device proves to be beneficial for patients undergoing radiotherapy, it may have the potential to be used in other clinical settings to alleviate anxiety. MRI scans are known to cause anxiety, 37 and there have been investigations into interventions prior to the procedure to alleviate anxiety. Interventions have included phone calls to patients or videos for patients to watch which explain the procedure. ...
Objective
The aim of this study was to elicit the views of relevant stakeholders on the design of a device using simulated affective touch to reduce procedural anxiety surrounding radiotherapy and imaging.
Design
This qualitative study collected data from focus groups which were then analysed using inductive thematic analysis in line with Braun and Clarke’s methods.
Participants and setting
Twenty patients and carers were recruited, as well as 10 healthcare practitioners involved in either delivering radiotherapy or imaging procedures.
Results
Patients, carers and healthcare practitioners agreed on some aspects of the device design, such as ensuring the device is warm and flexible in where it can be used on the body. However, patient and healthcare practitioner cohorts had at times differing viewpoints. For example, healthcare practitioners provided professional perspectives and required easy cleaning of the device. Meanwhile patients focused on anxiety-relieving factors, such as the tactile sensation of the device being either a vibration or pulsation. There was no consensus on who should control the device.
Conclusions
The desired features of a simulated affective touch device have been investigated. Different priorities of patients and their carers and healthcare practitioners were evident. Any design must incorporate such features as to appease both groups. Areas where no consensus was reached could be further explored, alongside including further patient and public involvement in the form of a project advisory group.
... Mental effects cause problems such as motion artifact [7], longer examination times or patients may not adherence with the examination, making the doctor unable to diagnose the disease and the treatment of the disease and the disease may get worse [4]. In addition, the increased anxiety may lead to the need for anesthesia to calm the patient [8], thus affecting costs and lengthening hospital stays and unsuccessful or lengthy scans affect the expenses of the organization [9]. ...
objective: To study the effects of Preparatory Information via Line application on anxiety and adherence in patients undergoing Magnetic Resonance Imaging (MRI). Methodology: A quasi-experimental pilot study using a one-group pretest-posttest design with 8 outpatients undergoing MRI of the head or spine for the first time who were selected by simple random sampling from the diagnostic radiology department in a tertiary care hospital. The participants were required to use the Line Application for patients undergoing magnetic resonance imaging to prepare before the examination. The research instruments consisted of 1) Demographic Data Collection Questionnaire, 2) Anxiety Assessment Form in MRI, and 3) Adherence Assessment Form in MRI. Results: It was found that after providing information to prepare through the Line Application the participants had the median scores of anxiety lower than before, comparing the median scores of 33 (IQR = 29.5-40) and 21.50 (IQR = 19.5-23.5), respectively. The difference in the score of anxiety was statistically significant p < 0.05. Moreover, the participants were highly adherence with a percentage of 100. Conclusion: The results showed that providing Preparatory Information via Line Application for patients undergoing magnetic resonance imaging reduced anxiety and increased adherence in the examination. However, this is a pilot study. Therefore, a further experimental study using a larger sample size should be implemented.
... The findings are consistent with the study which showed that mean patient experience score for the control group was 1.74 ± 0.63, and for cases, it was 1.67 ± 0.60 where lower scores are assigned to better experience, which suggest that cases who received music interventions had better experience as compared to the control group. [16] In the current study, opinions were taken from patients about use of VBE which revealed suggestions regarding the use of VBE during waiting time for all patients who are undergoing MRI procedure as they believed that it improved overall experience. These findings were similar with a study by Narender Kumar et al., where it was found that total 85.5% had an opinion regarding utilization of waiting time by providing information regarding MRI and 87.5% subjects wished to know the procedure beforehand. ...
Background
With the increasing use of magnetic resonance imaging (MRI) in diagnostic radiology, the problem of anxiety is also encountered more often in patients undergoing MRI. Anxious patients may not co-operate well with the procedure resulting in poor image quality. Repetition of sequences to acquire the images of better quality prolongs the total scan time and precludes optimal patient experience. For satisfactory completion and clinical usefulness of the scan, patient compliance is vital.
Aim
The aim of this study is to assess the effectiveness of video-based education (VBE) versus music therapy (MT) on anxiety, experience, and co-operation among patients undergoing MRI.
Materials and Methods
Randomized controlled trial pre- and posttest-based study was carried out among 90 patients undergoing MRI who were randomly allocated to VBE group (30), MT group (30), and control group (30). The data on anxiety, experience, and cooperation were collected using the appropriate tools. Patients in VBE group were provided with VBE, patients in MT group received MT and control group received routine procedural instructions.
Results
No significant differences were found in VBE group, MT group, and control group in terms of posttest anxiety scores. With regard to mean experience scores, the VBE group had better experience (81.70 ± 3.153) as compared to the control group (77.27 ± 6.817). A significant strong positive correlation was found between experience and co-operation of patients in VBE group ( r = 0.860, P < 0.001) and MT group ( r = 0.640). All of the patients (100%) agreed that VBE was easy to understand and also suggested to use VBE for all patients undergoing MRI procedure. Most of the patients (96.7%) found MT effective during the waiting time of MRI procedure and useful for diverting the mind.
Conclusions
Both VBE and MT were effective in improving the experience and co-operation of patients undergoing MRI as compared to routine procedural instructions in the control group.
... We are planning to take the unification approach even further by using projection mapping technology, which makes the real MRI device look like the spaceship from the outside. Some radiological facilities already apply such solutions and it has been shown that the design of the MRI environment can have a significant impact on the patient experience [40]. ...
The feeling of lying in the restricted bore of an MRI scanner, surrounded by loud noises and not allowed to move, is a psychological burden for patients. Children especially have problems to lie still during the examination and sometimes exhibit intense fear reactions. Therefore, children are frequently sedated before the examination. We introduce the concept and implementation of a virtual reality (VR) game as a medication-free alternative for children , aiming to reduce anxiety, stress, and boredom during MRI examinations. Playing or just watching an animated space story in VR provides distraction and relaxation to the patients. We pursued a child-centered, participatory design process and derived design requirements from the results of two workshops with children in a hospital school (N = 15) and a primary school (N = 14), as well as a focus group test with a prototype. We propose VR games as a solution to enhance the well-being of children during medical interventions and show a way to approach a user-centered and targeted game design.
... 31 One study evaluated sensory stimulation during MRI using olfactory and auditory stimuli intended to have a calmative effect and reported a trend toward improved subjective patient experience scores, albeit without significant change in patient movement during MRI. 32 ...
Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients' motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.
... In addition to music, listening to relaxing sounds may also have a calming effect as demonstrated by Stanley et al, 50 who found that patients reported a subjectively improved experience when they listened to bird noises. Patient motion was, however, not significantly decreased. ...
For many patients, numerous unpleasant features of the magnetic resonance imaging (MRI) experience such as scan duration, auditory noise, spatial confinement, and motion restrictions can lead to premature termination or low diagnostic quality of imaging studies. This article discusses practical, patient-oriented considerations that are helpful for radiologists contemplating ways to improve the MRI experience for patients. Patient friendly scanner properties are discussed, with an emphasis on literature findings of effectiveness in mitigating patient claustrophobia, other anxiety, or motion and on reducing scan incompletion rates or need for sedation. As shorter scanning protocols designed to answer specific diagnostic questions may be more practical and tolerable to the patient than a full-length standard-of-care examination, a few select protocol adjustments potentially useful for specific clinical settings are discussed. In addition, adjunctive devices such as audiovisual or other sensory aides that can be useful distractive approaches to reduce patient discomfort are considered. These modifications to the MRI scanning process not only allow for a more pleasant experience for patients, but they may also increase patient compliance and decrease patient movement to allow more efficient acquisition of diagnostic-quality images.
... Moreover, the literature shows that using audio-visual systems reduces patient motion and leads to a quality diagnostic MRI without the use of sedation 29 . Other authors confirm this thesis in their study on auditory and olfactory stimulation during MRI scanning 30,31 . Sensory stimulation in the form of calming bird noises played over headphones and a scented cotton pad placed in the scanner near the patients' heads has improved the overall subjective experience of MRI in the patients. ...
Magnetic resonance imaging (MRI) patients often experience anxiety-related respiratory disorders, including hyperventilation, but their respiratory indicators are not routinely monitored during scanning. Free from metal parts and immune to electromagnetic radiation, fibre-optic sensors have the potential to better control the patient’s condition by providing continuous non-invasive monitoring of the respiratory rate (RR). The study was purposed to assess the relationship between anxiety in MRI patients and their RR acquired by a fibre-optic sensor system. Forty-four subjects were involved in the study. The mean RR values recorded for 2 minutes immediately after the beginning and immediately before the end of the scanning were assessed relative to the State-Trait Anxiety Inventory (STAI) X-1 scores obtained immediately before and immediately after the scanning, respectively. A growth mixture model analysis was performed to statistically differentiate two groups of subjects according to the trends in repeated measures of RR. A significant lowering of the anxiety state was observed in the group characterised by a decrease in RR, whereas essentially no change in anxiety level was observed in the group with a stable RR. The t-test showed significant differences in changes in anxiety between these groups (t(39) = −2.349, p = 0.012, Cohen’s d = 2.13).
Background:
Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for clinical concerns or research. Increased sensory stimulation, lack of appropriate environmental adjustments, or lack of streamlined communication in the MRI suite may pose challenges to autistic patients and render MRI scans inaccessible. This study aimed at (i) exploring the MRI scan experiences of autistic adults in the United Kingdom; (ii) identifying barriers and enablers toward successful and safe MRI examinations; (iii) assessing autistic individuals' satisfaction with MRI service; and (iv) informing future recommendations for practice improvement.
Methods:
We distributed an online survey to the autistic community on social media, using snowball sampling. Inclusion criteria were: being older than 16, have an autism diagnosis or self-diagnosis, self-reported capacity to consent, and having had an MRI scan in the United Kingdom. We used descriptive statistics for demographics, inferential statistics for group comparisons/correlations, and content analysis for qualitative data.
Results:
We received 112 responses. A total of 29.6% of the respondents reported not being sent any information before the scan. Most participants (68%) confirmed that radiographers provided detailed information on the day of the examination, but only 17.1% reported that radiographers offered some reasonable environmental adjustments. Only 23.2% of them confirmed they disclosed their autistic identity when booking MRI scanning. We found that quality of communication, physical environment, patient emotions, staff training, and confounding societal factors impacted their MRI experiences. Autistic individuals rated their overall MRI experience as neutral and reported high levels of claustrophobia (44.8%).
Conclusion:
This study highlighted a lack of effective communication and coordination of care, either between health care services or between patients and radiographers, and lack of reasonable adjustments as vital for more accessible and person-centered MRI scanning for autistic individuals. Enablers of successful scans included effective communication, adjusted MRI environment, scans tailored to individuals' needs/preferences, and well-trained staff.
Introduction
This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups.
Methods
A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination.
Results
Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time.
Conclusion
Access to 360°VCE can reduce patients’ pre-CCTA anxiety levels.
Implications for practice
The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.
Introduction
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.
Methods
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.
Results
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.
Conclusion
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.
Implications for practice
Ongoing support is needed for both patients and radiographers to improve experience within MRI.
Objectives
Undergoing a Magnetic Resonance Imaging (MRI) scan continues to be a source of anxiety and concern for many patients. Various interventions have been developed and are used in regular clinical practice to support patients through the procedure. A novel approach which is gaining traction is that of virtual reality (VR) as a tool to support patient experience in MRI. This scoping review considers how it is currently being used and developed and discusses how effective it may be.
Key Findings
The eight papers found show a range of approaches being used; as a preparatory tool, exposure therapy or distraction technique. All of which show general positive influence on patient anxiety, compliance, and acceptability. The more recent, but limited number of papers, show this to be a developing field.
Conclusion
The potential for the use of VR lies in its ability to closely replicate the real world as a preparatory and exposure technique for those likely to experience concerns over the MRI procedure itself. The reality of the virtual environment also provides opportunity to spend time coaching patients in advance without the need to take up actual scanner time, thereby providing a safe space in which preparation and support can be given.
Implications for practice
It is argued that a better understanding of the theoretical basis on which VR may be working would further help development and implementation in clinical practice. This could then support a truly patient-centred approach to management of claustrophobia and associated anxieties related to MRI.
Objective:
To identify and characterize patient-centered outcomes (PCOs) relating to multiparametric MRI (mpMRI) and MRI-guided biopsy as diagnostic tests for possible prostate cancer.
Methods:
Medline via OVID, EMBASE, PsycInfo, and the Cochrane Central register of Controlled Trials (CENTRAL) were searched for relevant articles. Hand searching of reference lists and snowballing techniques were performed. Studies of mpMRI and MRI-guided biopsy that measured any PCO were included. There were no restrictions placed on year of publication, language, or country for study inclusion. All database search hits were screened independently by two reviewers, and data were extracted using a pro forma.
Results:
Overall, 2,762 database search hits were screened based on title and abstract. Of these, 222 full-text articles were assessed, and 10 studies met the inclusion criteria. There were 2,192 participants featured in the included studies, all of which were conducted in high-income countries. Nineteen different PCOs were measured, with a median of four PCOs per study (range 1-11). Urethral bleeding, pain, and urinary tract infection were the most common outcomes measured. In the four studies that compared mpMRI or MRI-guided biopsy to transrectal ultrasound biopsy, most adverse outcomes occurred less frequently in MRI-related tests. These four studies were assessed as having a low risk of bias.
Discussion:
PCOs measured in studies of mpMRI or MRI-guided biopsy thus far have mostly been physical outcomes, with some evidence that MRI tests are associated with less frequent adverse outcomes compared with transrectal ultrasound biopsy. There was very little evidence for the effect of mpMRI and MRI-guided biopsy on emotional, cognitive, social, or behavioral outcomes.
Artifacts in magnetic resonance imaging and foreign bodies within the patient's body may be confused with a pathology or may reduce the quality of examinations. Radiologists are frequently not informed about the medical history of patients and face postoperative/other images they are not familiar with. A gallery of such images was presented in this manuscript. A truncation artifact in the spinal cord could be misinterpreted as a syrinx. Motion artifacts caused by breathing, cardiac movement, CSF pulsation/blood flow create a ghost artifact which can be reduced by patient immobilization, or cardiac/respiratory gating. Aliasing artifacts can be eliminated by increasing the field of view. An artificially hyperintense signal on FLAIR images can result from magnetic susceptibility artifacts, CSF/vascular pulsation, motion, but can also be found in patients undergoing MRI examinations while receiving supplemental oxygen. Metallic and other foreign bodies which may be found on and in patients' bodies are the main group of artifacts and these are the focus of this study: e.g. make-up, tattoos, hairbands, clothes, endovascular embolization, prostheses, surgical clips, intraorbital and other medical implants, etc. Knowledge of different types of artifacts and their origin, and of possible foreign bodies is necessary to eliminate them or to reduce their negative influence on MR images by adjusting acquisition parameters. It is also necessary to take them into consideration when interpreting the images. Some proposals of reducing artifacts have been mentioned. Describing in detail the procedures to avoid or limit the artifacts would go beyond the scope of this paper but technical ways to reduce them can be found in the cited literature.
Magnetic resonance (MR) imaging has been described as the most important medical innovation in the last 25 years. Over 80 million MR procedures are now performed each year and on average 2.3% (95% confidence interval: 2.0 to 2.5%) of all patients scheduled for MR imaging suffer from claustrophobia. Thus, prevention of MR imaging by claustrophobia is a common problem and approximately 2,000,000 MR procedures worldwide cannot be completed due to this situation. Patients with claustrophobic anxiety are more likely to be frightened and experience a feeling of confinement or being closed in during MR imaging. In these patients, conscious sedation and additional sequences (after sedation) may be necessary to complete the examinations. Further improvements in MR design appear to be essential to alleviate this situation and broaden the applicability of MR imaging. A more open scanner configuration might help reduce claustrophobic reactions while maintaining image quality and diagnostic accuracy.
We propose to analyze the rate of claustrophobic reactions, clinical utility, image quality, patient acceptance, and cost-effectiveness of an open MR scanner in a randomized comparison with a recently designed short-bore but closed scanner with 97% noise reduction. The primary aim of this study is thus to determine whether an open MR scanner can reduce claustrophobic reactions, thereby enabling more examinations of claustrophobic patients without incurring the safety issues associated with conscious sedation. In this manuscript we detail the methods and design of the prospective "CLAUSTRO" trial.
This randomized controlled trial will be the first direct comparison of open vertical and closed short-bore MR systems in regards to claustrophobia and image quality as well as diagnostic utility.
ClinicalTrials.gov: NCT00715806.
The purpose of this study was to identify the proportion of adult patients at our institution who require sedation to tolerate MR imaging. We also wished to identify whether the type of study and patient age or sex was associated with a variation in the use of sedation. A total of 939 patients, 18 years of age or older, underwent MR imaging at a large university hospital during a randomly selected 7-week period. Age, sex, type of study, number of prior MRI's, and use of sedation were identified in this group. Patients requiring sedation were compared by these criteria to all non-sedated members over 18 years of age in the cohort who acted as a control. Of the 939 patients 134 (14.3%) required oral sedation, i.v. sedation, or general anesthesia to tolerate MRI. This group was 35.8% male, 64.1% female (control group 48.1% male, 51.9% female). Of those requiring sedation, 89 patients (66.4%) were having brain MRI (male n = 29 or 32.6%, female n = 60 or 67.4%). In the control group 461 patients (57.3%) were having brain MRI (male n = 209 or 45.3%, female n = 252 or 54.6%). The mean age of the sedated group was 60.75 (range 19-91). The non-sedated group had a mean age of 67.3 (range 28-93). The sedated group had undergone a mean of 1.56 prior MR studies (range 0-16); the control group had a mean of 0.9 prior studies (range 0-7). Sedation was more commonly utilized in women than men, in patients having brain MRI, and in patients who had undergone prior MRI procedures. The identification of a population having the greatest need for sedation may aid in the development and selection of methods of stress reduction which will result in greater patient comfort, reduction in motion artifact, and fewer prematurely terminated studies.
Previous research suggests that while subjective anxiety is reduced by relaxing music, the effect of music on physiological stress indices is less consistent. In the current study, the effect of relaxing music on participants' subjective and physiological response to stress was explored, with attention paid to methodological factors and mediating variables that might have contributed to inconsistencies in previous studies. Undergraduate students (43 females & 44 males) were exposed to a cognitive stressor task involving preparation for an oral presentation either in the presence of Pachelbel's Canon in D major, or in silence. Measures of subjective anxiety, heart rate, blood pressure, cortisol, and salivary IgA were obtained during rest and after presentation of the stressor. The stressor caused significant increases in subjective anxiety, heart rate, and systolic blood pressure in male and female controls. These stress-induced increases were each prevented by exposure to music, and this effect was independent of gender. Music also enhanced baseline salivary IgA levels in the absence of any stress-induced effects. These findings provide experimental support for claims that music is an effective anxiolytic treatment, the robustness of which is demonstrated by retention of the effect in the presence of a range of potentially mediating variables.
To evaluate whether increased written information to patients prior to magnetic resonance imaging (MRI) decreases patient anxiety and image motion artifacts.
A two-group controlled experimental design was used. Of 242 patients, 118 received routinely given basic written information (control group) while 124 were given increased written information (intervention group). To measure patient anxiety before and during scanning, the self-report psychometric test State-Trait Anxiety Inventory (STAI) was used. After MR examination, the patients answered a questionnaire on satisfaction with the written information. The images were assessed with regard to motion artifacts.
Motion artifacts were present in fewer patient images in the intervention group than in the control group (4.0% versus 15.4%,; P=0.003). There was no significant difference between the control and the intervention group regarding patient anxiety and satisfaction with the information. Women in both groups showed a higher level of anxiety than the men did.
Increased information about the MRI scanning procedure and expected experiences during the scan may help patients to lie still during the sequences, with a decrease in motion artifacts. However, further research is needed to evaluate the effect of other interventions on patient anxiety during MRI scanning.
MUSICAL INTERVENTIONS have been used in health care settings to reduce patient pain, anxiety, and stress, although the exact mechanism of these therapies is not well understood.
THIS ARTICLE PROVIDES A SYSTEMATIC review of 42 randomized controlled trials of the effects of music interventions in perioperative settings.
MUSIC INTERVENTION HAD POSITIVE effects on reducing patients' anxiety and pain in approximately half of the reviewed studies.
FURTHER RESEARCH into music therapy is warranted in light of the low cost of implementation and the potential ability of music to reduce perioperative patient distress. AORN J 87 (April 2008) 780–807. © AORN, Inc, 2008.
Objective.
—To review the epidemiology of anxiety-related reactions during magnetic resonance imaging (MRI) examinations, the feasibility of identifying patients at risk, and the management strategies that have been applied.Data Sources.
—Published original articles were retrieved using computerized MEDLINE searches encompassing 1980 through April 1993. Further references were obtained from the primary sources.Study Selection and Data Extraction.
—All studies obtained through the data search were chosen for review. All data relevant to anxiety-related reactions were analyzed.Data Synthesis.
—Anxiety-related reactions occur in approximately 4% to 30% of patients undergoing MRI, ranging from apprehension to severe reactions that interfere with the performance of the test. Criteria for diagnosis or categorization of the reactions and identification of patients at risk are scanty. Several management strategies have been proposed, including patient education, drug therapy, and cognitive-behavioral intervention.Conclusions.
—While a more precise characterization of the nature and incidence of anxiety-related reactions during MRI examinations and better methods of recognizing patients at risk are desirable, a strategy for general and individual prophylaxis, identification of patients at risk, and individual patient management can be developed on the basis of current knowledge.(JAMA. 1993;270:745-747)
Purpose:
To evaluate the effectivity of a combined intervention of information and communication to reduce magnetic resonance imaging (MRI) anxiety using prolactin and cortisol as biochemical markers and State Trait Anxiety Inventory (STAI).
Materials and methods:
This study is a randomized prospective research. Sample size was 33 patients. Fourteen patients were enrolled as study group, compared to 19 patients as control group. Blood samples were collected by venous sampling, and STAI was filled before and after scan. State anxiety inventory was used twice. Study group received a standard information about MRI scans and were communicated with 2 minute intervals via intercom; control group had no intervention. Blood samples were carried in ice to be centrifuged and stored as soon as they were taken to study prolactin and cortisol. Data were stored and analyzed by SPSS 17.0. P value for significance was accepted as 0.05.
Results:
Prolactin-pre, prolactin-post, cortisol-pre, cortisol-post, cortisol percent increase, Trait Anxiety Inventory (TAI), SAI (State Anxiety Inventory) pre-scan and post-scan levels were similar between demographic groups. Cortisol-pre levels were similar between study and control, however prolactin-pre levels were significantly higher in control group. Study group had 6% lower cortisol level post-scan, whereas control group had 18% increase. Study and control groups had similar Trait Anxiety and SAI-pre scores. SAI-post scores were lower in study group when compared with control group. Study group also had lower SAI-post scores than SAI-pre, whereas control group had higher.
Conclusion:
MRI anxiety can be reduced by information and communication. This combined method is shown to be effective and should be used during daily radiology routine.
The purpose of this study was to investigate whether lavender oil aromatherapy can reduce the bispectral index (BIS) values and stress and decrease the pain of needle insertion in 30 volunteers.
Thirty (30) healthy volunteers were randomly allocated to 2 groups: the experimental group received oxygen with a face mask coated with lavender oil for 5 minutes, and the control group received oxygen through a face mask with no lavender oil for 5 minutes. The stress level (0=no stress, 10=maximum stress), BIS value, and pain intensity of needle insertion (0=no pain, 10=worst pain imaginable) were measured.
There were no significant differences in age, sex, height, and weight between the two groups. Stress level, BIS value, and pain intensity of needle insertion before aromatherapy were similar between the two groups. However, the stress values (p<0.001) and BIS value (p<0.001) after aromatherapy were significantly reduced compared with the control. In addition, the pain intensity of needle insertion was significantly decreased after aromatherapy compared with the control (p<0.001).
Lavender aromatherapy in volunteers provided a significant decrease in the stress levels and in the BIS values. In addition, it significantly reduced the pain intensity of needle insertion.
Preoperative anxiety is prevalent in surgical patients who may require anxiety medications, thus impacting preoperative teaching and patient satisfaction. No studies were found in a comprehensive search on the effect of essential oils on anxiety in the preoperative setting. The purpose of this experimental study was to investigate whether the essential oil lavandin is more effective than standard care in reducing preoperative anxiety. A convenience sample of 150 adult patients were randomly assigned to either control (standard care), experimental (standard care plus essential oil lavandin), or sham (standard care plus jojoba oil) groups. Visual analog scales were used to assess anxiety on admission and OR transfer. Controlling for baseline anxiety and pain, the lavandin group had significantly lower anxiety on OR transfer, suggesting that lavandin is a simple, low-risk, cost-effective intervention with the potential to improve preoperative outcomes and increase patient satisfaction. Future studies should test the effects of lavandin in the postoperative phase and in specific populations with documented high anxiety.
There are several anxiety-related reactions associated with magnetic resonance imaging (MRI). Patients who experience such reactions may disrupt the examination or move so much that images are degraded. These experiences may also influence patients' perceptions of the quality of their care. The objective of this study was to further assess the subjective experiences of patients undergoing MRI in an attempt to identify those patients likely to have problems and factors affecting their experiences. Five hundred consecutive patients undergoing MRI were surveyed using questionnaires before and immediately after imaging. Anxiety was measured using the state anxiety component of the state-trait anxiety inventory. All patients exhibited some degree of pre-imaging anxiety. This was particularly associated with a previous 'unpleasant' imaging experience. Patients who experienced problems during MRI had pre-imaging anxiety levels equivalent to patients about to undergo surgery, were more likely to react badly when first seeing the scanner and were more likely to leave the MRI unit with even greater feelings of anxiety than when they arrived. In contrast to previous studies, anxiety was not associated with either the patient's understanding of the procedure or the duration of the examination. Several features have been identified which could improve the patient's experience (e.g. better information sheet). Awareness of MRI-related anxiety should also be considered when assessing the impact of MRI on outcome for the patient.
To review the epidemiology of anxiety-related reactions during magnetic resonance imaging (MRI) examinations, the feasibility of identifying patients at risk, and the management strategies that have been applied.
Published original articles were retrieved using computerized MEDLINE searches encompassing 1980 through April 1993. Further references were obtained from the primary sources.
All studies obtained through the data search were chosen for review. All data relevant to anxiety-related reactions were analyzed.
Anxiety-related reactions occur in approximately 4% to 30% of patients undergoing MRI, ranging from apprehension to severe reactions that interfere with the performance of the test. Criteria for diagnosis or categorization of the reactions and identification of patients at risk are scanty. Several management strategies have been proposed, including patient education, drug therapy, and cognitive-behavioral intervention.
While a more precise characterization of the nature and incidence of anxiety-related reactions during MRI examinations and better methods of recognizing patients at risk are desirable, a strategy for general and individual prophylaxis, identification of patients at risk, and individual patient management can be developed on the basis of current knowledge.
In response to a mail survey, 225 leading general internists provided their opinions of the relative importance to patients of thirty medical innovations. They also provided information about themselves and their practices. Their responses yielded a mean score and a variability score for each innovation. Mean scores were significantly higher for innovations in procedures than in medications and for innovations to treat cardiovascular disease than for those to treat other diseases. The rankings were similar across subgroups of respondents, but the evaluations of a few innovations were significantly related to physicians' age. The greatest variability in response was usually related to the physician's patient mix.
Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest-posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P< or =0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001-0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001-0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.
To evaluate whether MR scanners with acoustic noise reduction and a short magnetic bore reduce the rate of claustrophobic reactions.
We performed a cohort study in an outpatient setting, enrolling a total of 55,734 consecutive patients referred for MRI of any part of the body based on a clinical indication. Imaging was performed using a conventional MR scanner (42,998 patients) and a recently developed MR scanner (12,736 patients) with 97% acoustic noise reduction and a short bore. Multiple logistic regression analysis was used to adjust for the nonrandomized design.
In addition to those undergoing head-first examinations, female and middle-aged patients were significantly more likely to develop claustrophobia in the logistic regression analysis (P < 0.001). The rate of claustrophobic reactions was significantly lower with the recent MR scanner (0.7%; 95% confidence interval [CI]: 0.6-0.9%) than with the conventional scanner (2.1%; 95% CI, 2.0-2.3%; P < 0.001) with an adjusted odds ratio (OR) of 3.1 (95% CI, 2.5-3.9) and a number needed to treat of 72 (95% CI, 63-85).
The incidence of claustrophobia may be reduced by a factor of 3 when recently-developed MR scanners are used.