Eleven steps to alleviate Claustrophobia in the MRI scanner

Claustrophobia ~an anxiety disorder that one experiences when they fear the inability to escape, which sometimes results in a panic attack of what “could” happen to them.  The “fear” is based on a fear of restriction or fear of suffocation. Claustrophobia is a direct result of the “fight or flight” response stimulated by the amygdala in the brain, which has evolved for human survival.   Humans are genetically predisposed to imagining what “could happen” to them, so during an MRI exam, a very small part of the fear experienced could be from the possible negative results of the MRI exam results, almost as much as from being inside the MRI scanner bore itself.  Large bore MRI  and open MRI scanners alleviate some of this anxiety, merely from the fact that the bore is a larger diameter, or the open line of sight which allows for the patient to visualize one’s escape from it.

Claustrophobia in MRI also has a great deal to do with the actual position of the patient for the exam ordered. For instance, it is unlikely a patient will experience claustrophobia for an MRI knee, ankle or foot exam when most of the body is outside the bore of the scanner, however, we have seen this happen.

Most exams such as MRI lumbar spines, MRI brains, MRI cervical spines, MRI shoulders, MRI abdomen or pelvis exams, and MRI chest exams require the patient being centered in the middle of the MRI scanner bore.  It is often these exams when the patient is further inside the MRI gantry, that they feel confined, experience claustrophobia, and are stricken with panic believing they cannot escape and help is far away.

Eleven steps to help patients avoid Claustrophobia in the MRI scanner

Below is a list of Eleven steps to alleviate claustrophobia in the MRI scanner:

1) Many MRI pre-screen appointment calls ask the question directly about patient claustrophobia. If you have a patient who might be claustrophobic, call those people ahead of their appointment date, and discuss their MRI exam explaining what will happen during the MRI exam.  Politely discuss the series of events, expectations, answer questions and let them know how they will get their results. Speak patiently and calmly to help alleviate some of the anxiety patients may experience prior to and during the exam.  Do not rush when talking with the patients. Through your conversation, allow them to feel that your attention is all about their comfort and well being. This will help build trust, which is an important part of a patient’s success.

2) Request that your patient avoid all stimulants prior to their scheduled exam, such as coffee, teas and high sugar items. Some sites request this up to 24 hours prior to the exam.

3)  If your patient’s appointment is within the next few days, ask them to perform a personal test for a claustrophobic exercise lying in the comfort of their bed at home.   Request they put a dry washcloth over their eyes, and lie there for a few minutes, imagining they are inside the MRI scanner.   Ask them to think about how they “feel” when they have this experience in the comfort of their own home.  Ask them to think about being in control of the situation, and through positive reinforcement, while visualizing that they can lie still inside an MRI scanner with a washcloth over their eyes, they can also remain in control of their body and mind.

4) If the exam allows the patient to wear headphones during the MRI exam, ask the patient to bring some of their favorite quiet music so they can listen to something familiar while inside the MRI scanner.  Most sites have MRI compatible headphones for music, along with CD and music systems. (Confirm ahead of time the MRI study hardware will allow for use of the headphones during the MRI scan, as some cervical spine MRI hardware, and even some brain MRI hardware will not allow room for headphones to be worn during the exam. This will depend upon your MRI system and the hardware coils used for the patient study.) If headphones are not allowed, reassure the patient they will be given earplugs to wear during the exam.

5) Discuss with the patient that the MRI is much like a tanning bed, in which many clients actually pay to lie in and tan their skin. Discuss also that first time airline flying can also be like a claustrophobic environmental experience, that many frequent flyers overcome with practice. Reassure the patient that all possible will be done to create successful outcome.  If sedation is needed, then this will have to be arranged using the site’s policy and procedure guidelines.

a) If sedation is needed based on this conversation, then arrangements should be made to get the sedation orders from the referring physician so the patient can pick it up at a pharmacy prior to their exam.  Be sure to explain the necessity of a driver to take the patient home after their exam. Cabs can be used as well. Do not request the patient take the sedative until requested at the site, just in case the MRI schedule is running behind.

6) Invite the patient in for a table test run, prior to their scheduled time if tensions run extremely high.  Remind them that they will need to pass all MRI safety screening requirements prior to admittance into the MRI scan room.  Be patient and work with empathy toward the patient, understanding that claustrophobia is an uncontrollable anxiety condition that creates a flight or fight condition.

Very often, even when patients have never had an MRI experience before, they may experience claustrophobia for the first time going into the MRI scanner.  An experienced technologist will understand this and can adapt the situation to help a patient through this experience.  Some techs can sense which patients will experience an immediate claustrophobic reaction from their first MRI scanner entry based on the MRI screening discussion.

In order to get through the study completely, it is sometimes in the best interest of the patient that the technologist coach the patient through a series of “dry runs” going into the scanner, and immediately bringing them back out to discuss how they feel.

Here’s an example we found that works:

First -After the patient has passed MRI screening process and is compatible and prepared for the MRI exam, help the patient onto the MRI table, and turn on the internal MRI bore fan and lights.  Explain to the patient that you are going to do a “test run” going into the scanner bore, and then bring them immediately back out.  Discuss how they felt in that short “test run” experience. If there is any hesitancy on the patient’s behalf, or they express to you any tension or troubling dialogue, either try the dry run again, or make a decision with the patient to discuss further sedation options with the ordering physician or healthcare provider.

Secondly- If the patient expresses some concern about their comfort with the first dry run, discuss further what they experienced.  Talk calmly to the patient, letting them know many others experience that first feeling of anxiety, but just as many absolve it each time they go into the scanner.  Like anything, it becomes easier with practice.  Likening the experience of going into an MRI bore for the first time to flying on an airplane for the first time.  Let them know that very often, people fall asleep inside the bore from the vibrations.   After more verbal exchange and discussion, ask the patient again, if they will let you try another dry run.  The approval from the patient is a direct response from the patient trusting and feeling comfortable with the individual technologist.  Remind the patient “they are in charge.” Do not start moving them into the bore until after you get their permission.  If they agree, do so again without hardware, blankets, or any immobilization implements, and while explaining to the patient what you are doing, insert them into the position again with the promise of immediately bringing them back out.  Once you’ve placed them in the center location, then immediately bring them out again. (If they disagree, then you may need to defer them back to the ordering healthcare provider for alternatives with sedation. )

Third – If necessary, take the time to work with the patient, moving them into and out of the MRI gantry bore sweet spot on the table several times. If things seem to be getting easier for them, next explain to them you would like  to give them a washcloth over their eyes, which psychologically fools the brain, but they still know they are inside the scanner.  Do this without hardware, or immobilization.  If you get agreement from the patient, try this with a washcloth, and then using a calm collected voice, coach the patient while touching their hand or skin on their arm, letting them know you are immediately available.

Fourth – At some point of this experience, you will know whether your personal coaching is making a successful difference in getting the patient through their MRI exam.

7) If things get tougher for that patient, encourage a friend or family member to accompany the patient. The friend or family member accompanying the patient should also be thoroughly screened for MRI safety, just as one would the patient, and wear MRI compatible clothing. It would be ideal if this friend or family member could accompany the patient into the MRI exam room and hold the hand (or the leg) of the patient while they are inside the MRI bore of the magnet.  It is also in the best interest of your images, that you coach the friend or family member to hold perfectly still and not move or change positions once the scanner has shimmed, and after the start of each sequence.

8) Always, always give the “call button” to the patient before and during the exam. Inform them that you are nearby at the operator’s console and immediately available should they squeeze the “call button”. (Never use the term “Panic ball” or “panic button” in referring to the call button when discussing this with the patient. The power of suggestion is strong, especially when emotions are heightened.)

9) Inform the patient that you will be talking to them between the sequences, or each series of pictures, and ask them how they are doing between each set of images. Inform them of the time frame for next set of images, and remind them to hold as still as possible for the best in image quality. Ask them for permission to begin the next sequence, and when you get approval, do so. Often, patients just want to be left alone to sleep inside the bore. Through dialogue, a proficient MRI technologist will find the comfort level of each patient, and abide by it for a speedy and well procured MRI study.

10) Remind your patient when you give them the call button, that they are the one, always in control.  If they squeeze the call button, then tell them you will immediately remove them from inside the MRI scanner. And if they squeeze it, do as you promised!  (Never, ever leave the operators’ console to deal with changing the next patient or getting a cup of coffee from the break room with a patient inside the scanner. Your responsibility should be to the immediate patient at hand, and not to the next three on deck.)

11) If the above steps seem too difficult, tedious or elaborate for you to perform in helping a claustrophobic patient through what they perceive as a difficult and trying exam, then it is suggested you change your field of employment.  These steps we’ve shared have worked in many circumstances when patients with Claustrophobic find an MRI exam difficult.

Building respect and trust between the technologist and the patient is paramount for any radiology study, and even more important when you want to help patients alleviate claustrophobia in the MRI scanner.  These will not eliminate the ultimate fear experienced by those who are completely claustrophobic, but these are a series of suggested actions which may help minimize the fear of claustrophobia that many patients experience.

These kind actions could also allow for many opportunities to create a better level of patient care than what your competitors are doing, which in turn will help build brand loyalty through your clientele, improve your reputation for having kinder, more thoughtful clinical staff, and ultimately improve your business through word of mouth.

What do you want your MRI patients saying about you when they are finished with the MRI exam?

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