Claustrophobic Patients Research Articles

What factors affect a patient’s subjective perception of MRI examination

MRI is becoming increasingly available and more common. However, it is a long examination, within a limited space, and making strong demands on the patient for proper co-operation. Using survey data collected by prospective questionnaire, this work examines the influence of patient preparation and type of MRI device on patients’ subjective perception of the examination. The work analysed 800 patient questionnaires from 7 radiology centres, 12 MRI machines from 3 manufacturers. It was shown that 20% of patients were not informed at all or only insufficiently about the MRI examination by the referring physician, and this had a statistically significant effect on subjective perception as to the length of the examination. In claustrophobic patients, there was no significant difference in the perception of MRI examination between machine types (open vs. closed) or between bore size. This work demonstrated the influence of technical parameters of MRI devices on some other evaluated aspects in terms of patients’ perception of MRI examinations (such as noise perception or peripheral nerves irritation) and that the preparation prior to the examination itself plays also an important role. Sufficient explanation from the referring physician, good workplace time management, and sufficient communication with the patient influence the subjective perception of the examination and thus indirectly its diagnostic benefit.

Role of MRI in classification and preoperative evaluation of perianal fistula

BackgroundA fistula is an unusual communication between the skin and an inward organ or between the organs. The current study aimed to determine the role of magnetic resonance imaging (MRI) in the diagnosis, description, and classification of fistula-in-ano. Additionally, the study aimed to compare the MRI findings with the operative findings, which is considered the gold standard in our study.MethodsThe present study is a prospective study and was carried out on a group of 61 patients: 52 males and 9 females with a mean age of 41 years, who were suspected to have perianal fistulae presented clinically with discharge or localized pain or were asymptomatic. A preoperative MRI was conducted for fistula-in-ano evaluation in these patients from October 2019 till the end of October 2021. A surgeon conducted a physical examination of all patients to document the number and location of cutaneous openings following a full medical history. The MRI images were evaluated and interpreted by multiple expert radiologists who had more than 5 years of experience in analyzing MRI. In the cases (in 3 cases, 4.92%) where there were discrepancies in their interpretations, a senior radiologist’s evaluation was considered the final result and was confirmed surgically. Subsequently, the MRI findings were correlated with surgical findings to indicate the specificity, sensitivity, and accuracy of such MRI findings.ResultsThe MRI technique was the routine (i.e., without contrast administration) technique in 36 (59.02%) patients, with contrast administration in 21 (34.43%) patients and with anesthesia/sedation (uncomfortable, anxious, and claustrophobic patients need to minimize their motion artifact to improve the quality and obtain more detailed images) in 4 (6.56%) patients. The MRI pathology of the studied patients revealed normal findings in 1 (1.64%) patient, anal fissure/early developing tract in 6 (9.84%) patients, and established tract (sinus/fistula) in 54 (88.52%) patients. Park’s and St. James's University Hospital classifications were utilized to categorize the patients, with the most common fistula types based on the Park’s classification: intersphincteric (44.3%) and transsphincteric (29.5%). Based on the St. James’s classification, grade 1 (intersphincteric (34.4%)) and grade 4 (transsphincteric with abscess/side branch (16.4%)) were the most prevalent. A substantial consensus was reached between MRI and surgery findings for classifying tracts, side branches, and abscesses formation with sensitivity, specificity, and accuracy of 100%, 85.71%, and 98.36%, respectively.ConclusionsMRI is a valuable tool in managing patients with perianal fistulas due to its ability to detect hidden areas of infection (such as abscesses) and secondary extensions. These factors contribute to the high recurrence rate after surgery. Additionally, MR imaging can define the anatomical relationships between the fistula and anal sphincters, helping to predict the likelihood of fecal incontinence following surgery.

Patient-centric comparative analysis of experiences in open upright and conventional closed MRI scanners

IntroductionMRI often induces anxiety, leading to incomplete scans and claustrophobia-related distress. Open MRI systems aim to enhance patient comfort. This study examines how prior MRI experiences impact subsequent encounters in an open upright MRI scanner. MethodsIn this cross-sectional study, 118 adult patients completed a self-administered questionnaire from August 2022 to October 2023. It covered previous MRI experiences, including questions about claustrophobia, premature scan terminations, sedative medication usage, general MRI experiences, and interactions with radiology technologists. ResultsPatients in open upright MRI reported less claustrophobia compared to closed MRI systems (18.4% vs. 58.3%), fewer premature scan terminations (5.3% vs. 31.0%), and less sedative use (5.3% vs. 46.9%). Moderate positive correlations were found between past and current claustrophobic events and premature scan terminations. Effective communication with radiology technologists was essential for patient comfort and reduced claustrophobia. Scan duration and noise triggered discomfort in 26.1% and 21.6% of study participants respectively. Persons without prior MRI experience were more satisfied with the examination and expressed no clear preference for future MRI settings, contrasting those with previous exposure favoring the open MRI setup. ConclusionThe study emphasizes the benefits of open upright MRI for high-risk claustrophobic patients. It identifies the lasting impact of negative MRI experience on future examinations and highlights the crucial role of radiology technologists. Implications for practiceIntegrating open MRI scanners in medical facilities and prioritizing effective communication with radiology technologists enhances patient comfort. Positive experiences with open MRI may improve patient compliance and offer greater flexibility for future examinations.

Metaverse-based cardiac magnetic resonance imagingsimulation application for overcoming claustrophobia: a preliminary feasibility trial.

Introduction: Cardiac magnetic resonance imaging (CMR) is vital, but claustrophobia affects 10% of patients. The metaverse, an immersivevirtual and augmented reality environment, has healthcare potential. We present a metaverse-based CMR simulation for claustrophobic patients. Methods: Three cardiomyopathy patients, initially CMR-refusing due to claustrophobia, received training via a virtual reality headset in a metaverse-based virtual hospital. Training efficacy was assessed through questionnaires and anxiety scales. Results: The patients successfully completed metaverse-based training, adapting to the CMR simulation. On CMR day, all entered the machine without issues and with reduced anxiety. Patients found the training useful, suggesting platform familiarization. Discussion: Our study demonstrates the metaverse's potential in alleviating CMR-related claustrophobia. The immersive nature enhances patient preparation, although usability improvements are needed. Further research should compare this approach with alternatives.

ECMR 1-19 - Use of a 0.55T 80cm-wide Bore Scanner for Cardiac Imaging in Bariatric and Claustrophobic Patients: A Preliminary Single Centre Experience

ECMR 1-19 - Use of a 0.55T 80cm-wide Bore Scanner for Cardiac Imaging in Bariatric and Claustrophobic Patients: A Preliminary Single Centre Experience

CT-based generation of synthetic-pseudo MR images with different weightings for human knee

Synthetic MR images are generated for their high soft-tissue contrast avoiding the discomfort by the long acquisition time and placing claustrophobic patients in the MR scanner's confined space. The aim of this study is to generate synthetic pseudo-MR images from a real CT image for the knee region in vivo. 19 healthy subjects were scanned for model training, while 13 other healthy subjects were imaged for testing. The approach used in this work is novel such that the registration was performed between the MR and CT images, and the femur bone, patella, and the surrounding soft tissue were segmented on the CT image. The tissue type was mapped to its corresponding mean and standard deviation values of the CT# of a window moving on each pixel in the reconstructed CT images, which enabled the remapping of the tissue to its MRI intrinsic parameters: T1, T2, and proton density (ρ). To generate the synthetic MR image of a knee slice, a classic spin-echo sequence was simulated using proper intrinsic and contrast parameters. Results showed that the synthetic MR images were comparable to the real images acquired with the same TE and TR values, and the average slope between them (for all knee segments) was 0.98, while the average percentage root mean square difference (PRD) was 25.7%. In conclusion, this study has shown the feasibility and validity of accurately generating synthetic MR images of the knee region in vivo with different weightings from a single real CT image.

Head-centric computing for vestibular stimulation under head-free conditions.

Background: The vestibular end organs (semicircular canals, saccule and utricle) monitor head orientation and motion. Vestibular stimulation by means of controlled translations, rotations or tilts of the head represents a routine manoeuvre to test the vestibular apparatus in a laboratory or clinical setting. In diagnostics, it is used to assess oculomotor postural or perceptual responses, whose abnormalities can reveal subclinical vestibular dysfunctions due to pathology, aging or drugs. Objective: The assessment of the vestibular function requires the alignment of the motion stimuli as close as possible with reference axes of the head, for instance the cardinal axes naso-occipital, interaural, cranio-caudal. This is often achieved by using a head restraint, such as a helmet or strap holding the head tightly in a predefined posture that guarantees the alignment described above. However, such restraints may be quite uncomfortable, especially for elderly or claustrophobic patients. Moreover, it might be desirable to test the vestibular function under the more natural conditions in which the head is free to move, as when subjects are tracking a visual target or they are standing erect on the moving platform. Here, we document algorithms that allow delivering motion stimuli aligned with head-fixed axes under head-free conditions. Methods: We implemented and validated these algorithms using a MOOG-6DOF motion platform in two different conditions. 1) The participant kept the head in a resting, fully unrestrained posture, while inter-aural, naso-occipital or cranio-caudal translations were applied. 2) The participant moved the head continuously while a naso-occipital translation was applied. Head and platform motion were monitored in real-time using Vicon. Results: The results for both conditions showed excellent agreement between the theoretical spatio-temporal profile of the motion stimuli and the corresponding profile of actual motion as measured in real-time. Conclusion: We propose our approach as a safe, non-intrusive method to test the vestibular system under the natural head-free conditions required by the experiential perspective of the patients.

Randomized controlled trial on the effects of mindfulness-based respiratory decompression therapy in claustrophobic patients undergoing MRI inspection

BackgroundClaustrophobia is a psychological disease. It is estimated to occur in 2.1–14.3% of all magnetic resonance imaging (MRI) examinations. Mindfulness decompression is an effective means to treat and reduce fear and anxiety. There is a rare report on the application of mindfulness-based stress reduction therapy in the magnetic resonance examinations of patients with claustrophobia to date.PurposeThe purpose of this study is to explore the intervention effect of mindfulness respiratory decompression therapy on the MRI inspection of patients with claustrophobia.MethodsA total of 86 patients with claustrophobia requiring MRI in our hospital from January 2018 to December 2020 were divided into two groups. The control group was given routine psychological nursing, and the observation group was given a mindfulness breathing technique on the basis of the control group. Before and after the intervention, we compared the intervention effect, satisfaction with nurses’ psychological intervention technique, severe autonomic nervous symptoms during the examination, self-rating anxiety scale (SAS) scores, and profile of mood states revised (POMS-R) scores.ResultsThe total effective rate of intervention in the observation group was 90.90%, which was significantly higher (χ2 = 6.857, p = 0.00004) than that in the control group (26.19%). Severe autonomic nervous symptoms in the observation group were significantly lower than those in the control group (p < 0.05). After the intervention, SAS scores and POMS-R scores in the observation group decreased with statistical significance (p < 0.05).ConclusionMindfulness respiratory decompression therapy can effectively help claustrophobic patients complete an MRI examination, which may be worthy of wide promotion and application in the clinic.

Supporting claustrophobic patients during magnetic resonance imaging examination– the radiographer perspective

IntroductionSome patients cannot complete their magnetic resonance imaging (MRI) examinations because of claustrophobia. Evidence showed that supportive instruction is an effective intervention used to assist claustrophobic patients in MRI. However, the effectiveness of this intervention depends on the experience and education level of the MRI radiographer. This study aimed to understand the views of MRI radiographers on supporting claustrophobic patients and develop a guide to improve the effectiveness of the intervention. MethodsA qualitative descriptive approach utilising focus group discussion was considered suitable. A purposive sampling method was used to enrol eligible participants into the study. The study was advertised in print newspapers and on social media platforms. There were seven MRI radiographers in the focus group discussion. The conversation was recorded and transcribed for analysis, with content analysis employed to group the data into relevant codes and categories. ResultsThe radiographer's understanding of claustrophobia and knowledge of the interventions used to support claustrophobic patients were the key elements that influenced claustrophobic patients' experience in MRI. However, there were some factors inhibiting the radiographer's ability to support these patients. These factors include insufficient appointment slots, availability of supportive tools and support with developing communication skills. ConclusionCommunication and identifying anxiety signs are essential for MRI radiographers to address patient anxiety during examinations. This might increase the MRI examination completion rate and give the patient a positive experience in the department. Implications for practiceMRI radiographers can better understand how to support claustrophobic patients. Also, the guide developed from the data could help improve consistency in the use of supportive instruction in clinical practice.

Supporting claustrophobic patients during Magnetic Resonance Imaging examination– the patient perspective

IntroductionMagnetic Resonance Imaging (MRI) is a common imaging modality used to diagnose disease and monitor treatment. However, some patients cannot complete their MRI examination as a result of claustrophobia. The recent developments in the MRI scanner design may have reduced the incidence of claustrophobia in MRI. This study aimed to explore the claustrophobic patients’ experience to better understand how to support them. MethodsA qualitative descriptive approach using focus groups was deemed appropriate for the study. The research was advertised in a print newspaper and on social media platforms for eligible participants to contact the researcher. Six claustrophobic patients were recruited to the focus group meeting. The discussion was audio recorded and transcribed. Content analysis was used to analyse the data into code and categories. ResultsFour themes emerged from the data analysis, which included examination preparation, information provision, coping mechanisms and MR scanner design. Participants reported that the confined space in the MRI scanner bore is responsible for their anxiety during MRI. However, the majority of the participants believe that they would be able to complete the examination if, in advance of their scan, they were shown the MRI scanner and what they would be required to do. ConclusionSeveral coping mechanisms were shared by the participants on how they were able to complete their MRI examination despite their claustrophobia. MRI radiographers should endeavour to use these mechanisms to support their patients in practice. Also, the findings emphasise the importance of virtual reality and clear communication with patients in preparing them for their MRI examinations. Implications for practiceThe findings of this study may be used to enhance claustrophobic patients’ experience in MRI. It also identified those aspects of the MRI examination that matter most to patients with claustrophobia in order to provide a suitable intervention to support these patients.

The Rise and Efficiency of Low Field Portable MRI Scanners

AbstractSince the discovery of magnetic resonance imaging (MRI) as an imaging modality, it has evolved immensely and is still doing so. Most imaging modalities have made bedside or emergency imaging possible due to their portability. This aspect is yet to be fully evaluated and established in the case of MRI as its high-field strength requires specialized infrastructure and its time-consuming nature makes its portability questionable. The goal of this review is to access the efficiency and feasibility of low-field portable MRI (pMRI) systems in a wide array of health care applications. Articles from indexed journals, on PubMed, Springer, Elsevier, etc. databases, relevant to this study were searched and reviewed. This review provides an atypical design that could be used in making a pMRI unit that could find its potential in diagnosing a wide variety of pathologies with an added advantage of imaging critical patients in the intensive care unit or patients in isolation due to its portability, imaging patients with implants or prosthesis effectively due to its low field, pediatric imaging due to its high speed, for guided interventions, imaging obese and claustrophobic patients due to its open nature, in dental imaging, extremity scanning, etc. With its vast spectrum of applications in the health care system, the future of low-field pMRI units seems to be bright.

Diagnostic Accuracy of MRI in Delineation of Ultrasonographically Indeterminate Female Adnexal Lesions keeping Histopathology as Gold Standard

Objective: This study was performed to check the diagnostic accuracy of MRI in the detection and delineationof sonologically indeterminate adnexal masses as benign or malignant, keeping histopathology as goldstandard.Study Design: Cross-sectional study.Place and Duration of Study: This cross-sectional study was conducted at the Department of Diagnosticst st Radiology of POF Hospital, Wah Cantt, Pakistan, from 1 December 2018 to 31 May 2019.Materials and Methods: All female patients (15-80 years) with sonographically diagnosed indeterminateadnexal masses, both symptomatic and incidental, were included in the study. Patients who were unfit forsurgery and those for whom MRI is contraindicated (cardiac pacemakers, intracranial metal clips,claustrophobic patients, hypersensitivity to contrast) were excluded. Total of 115 patients meeting theinclusion criterion underwent an MRI examination. All patients had undergone surgery in the concerned ward,and a histopathology report was followed. MRI findings were compared with histopathological findings. Datawas entered and analysed via SPSS version 26.Results: Mean age of the patients was 48.22±10.5. Out of 115 patients, there were 74 (64.3%) cases related tothe uterine mass category, 35 (30.4%) were related to ovarian mass category, and 6 (5.2%) fell in theExtraovarian/Extrauterine mass category. Out of 115 patients, 74 (64.3%) patients had a mass size <3cm, 35 hadthe size of 3-5 cm (5.2%), and 6 had size >5 cm (5.2%). The sensitivity of MRI was calculated to be 77.14%,specificity was 87.5%, positive predictive value was 72.9 %, and negative predictive value was 89.7 %.Conclusion: MRI has high sensitivity and specificity in diagnosing adnexal masses and therefore, can serve as agood choice in the delineation of sonographically indeterminate adnexal masses.

Orthograde nonsurgical endodontic therapy of a molar with periapical radiolucency by employing the rotary files and adjunctive laser-assisted disinfection in a claustrophobic pediatric patient: A rare case report with literature review

Orthograde nonsurgical endodontic therapy of a molar with periapical radiolucency by employing the rotary files and adjunctive laser-assisted disinfection in a claustrophobic pediatric patient: A rare case report with literature review

Diagnostic Accuracy of Multislice CT Scan in the Detection of Cervical Lymph Node Metastasis in Head and Neck Cancers

Objectives: To determine the diagnostic accuracy of multislice CT scan in the detection of cervical lymph node metastasis in head and neck cancers, taking histopathology as gold standard. Study design: Descriptive, cross-sectional study. Settings: Department of Radiology, Jinnah Hospital, Lahore Study duration: 8th January 2018 to 7th July 2018 Materials & Methods: Total 95patients with squamous cell carcinoma of head and neck, 15-55 years of age of both genders were selected. All the patients with prior radiation to head and neck, already proven histopathology, CRF and claustrophobic patients were excluded. Multislice computed tomography of neck was performed on Toshiba Aquilion Multislice CT scanner before and after intravenous contrast administration. Each multislice CT scan findings were looked for malignant cervical lymph nodes. Multislice CT scan findings were compared with histopathology findings. Results: Mean age was 43.21 ± 8.16 years. Out of these 95 patients, 54 (56.84%) were males and 41 (43.16%) were females with ratio of 1.3:1.All the patients were subjected to CT of neck and found that 48 were True Positive and 04 were False Positive. Among 43, CT negative patients, 04 (False Negative) had malignant cervical nodes on histopathology whereas 39 (True Negative) had benign cervical nodes on histopathology (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of multislice CT scan in the detection of cervical lymph node metastasis in head and neck cancers, taking histopathology as gold standard was 92.31%, 90.70%, 92.31%, 90.70% and 91.58% respectively. Conclusion: This study concluded that multislice CT scan is a highly sensitive and accurate non-invasive modality for detecting cervical lymph node metastasis in head and neck cancers. Keywords: Head and Neck Cancers, Cervical Lymph Node Metastasis, Computed Tomography.

Fast high-resolution late gadolinium enhancement magnetic resonance imaging for an accurate detection of myocardial radiofrequency catheter ablation lesions

Abstract Funding Acknowledgements Type of funding sources: None. Background Whole- heart high-resolution free-breathing late gadolinium enhancement (HR-LGE) is a key sequence for detecting radiofrequency catheter ablation (RFCA) lesions. However, long acquisition time is the main limitation especially for dyspneic and claustrophobic patients. Purpose We aimed to introduce an accelerated HR-LGE technique for the detection of myocardial RFCA lesions. Method An under sampled (3-fold) navigator-gated whole- heart HR-LGE (acquired resolution of 1.25 mm3) sequence combined with advanced patch-based low-rank reconstruction was implemented on a 1.5 CMR scanner. Three sheep prospectively underwent radiofrequency ablation at multiple endocardial and epicardial sites. The animals were imaged 3 months later using conventional post-contrast LGE (PSIR, voxel size 1.8x1.4x6mm) and the proposed sequence. A reader graded image quality and diagnostic value of both LGE imaging. Results The acceleration allowed for acquisition times of 3 min 22s ± 20 s at 1.25 mm resolution. Compared with 2D PSIR, HR-LGE showed comparable image quality (P= 0.03). All LGE- positive segments on 2D PSIR in LV myocardium were also detected on HR-LGE (6 segments). Two additional enhanced segments were only visible on HR-LGE (8 segments). LGE-positive segments in RV myocardium were detected on HR-LGE (4 segments) while 2D PSIR was either definitely negative (2 segments) or uncertain (2 segments). Conclusion Accelerated whole-heart HR- LGE allows an accurate detection of left and right myocardial RFCA lesions.

Radiographer's confidence in managing patients with claustrophobia during magnetic resonance imaging

IntroductionClaustrophobia 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. MethodsWith 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). ResultsA 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. ConclusionKuwaiti 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 practicePatient 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.

Noninvasive measurement of cerebral cortex hemoglobin oxygenation with Near-Infrared spectroscopy

Near-Infrared (NIR) is the region of light with wavelength from 650 nm to 1100 nm. In this region light can penetrate into higher depth compared to visible light in biological tissues. In NIR region there is a special optical window from 700 nm to 900 nm in which dominant absorber chromophores inside the brain are oxy-hemoglobin and deoxy-hemoglobin. non-invasive Functional Near-Infrared Spectroscopy (fNIRS) is a portable low-cost efficient method for monitoring hemodynamic change in cerebral cortex. Since fNIRS and Functional Magnetic Resonance Imaging (fMRI) both measure hemoglobin oxygenation, it is acceptable to compare these two methods for cortex related cognitive task studies and drug addiction studies. in cases that other diagnostic techniques like fMRI are not applicable and might be harmful for example in case of a patient with cardiac pacemaker, or when fMRI is not available or for claustrophobic patient an alternative method should be available. in many studies for specific tasks because of subject’s positioning limits inside fMRI, an inexpensive method that allows data acquisition from a sitting or standing subject fNIRS is a reliable alternative. When it’s about cerebral cortex fNIRS can be an alternative for fMRI considering that fNIRS price is much lower and for many cognitive task designs subject’s mobility and position are important factors and with fNIRS we do not have to be that concerned about these issues. In this article Principles and equations for this technology will be described and as an example we designed a cognitive task and used fNIRS device to measure cerebral activity in left prefrontal cortex of healthy male adult to show accuracy and efficiency of this device for cerebral cortex activity monitoring. Also, Value of this method in attention & cognitive disorders specially in children thanks to higher depth of light penetration in their brain compared to adults will briefly be discussed.

Overcoming claustrophobia in cardiovascular magnetic resonance with medical hypnosis

Abstract Funding Acknowledgements Type of funding sources: None. Background the role of Cardiovascular Magnetic Resonance has gained the more and more importance in the field of cardiovascular disease. Claustrophobia remains a frequent cause of failure to complete a CMR. It is estimated that 2 million scans worldwide cannot be performed annually either due to premature termination or refusal of the patient to be scanned due to claustrophobia. In this setting, medical hypnosis may prove useful to overcome this main limitation. Methods we propose an observational study of consecutive patients referred to CMR and known for severe claustrophobia. Patients were proposed to undergo CMR examination with the help of medical hypnosis according to Milton H. Erickson’s method or with administration of mild sedation (lorazepam 2.5 mg). Results 20 severe claustrophobic patients were considered in the study. 1 patient was excluded due to psychiatric condition, 1 patient undergo to general anesthesia, 5 patients refused the examination. Among the 13 patients, 10 underwent medical hypnosis while 3 patients accepted to undergo to CMR examination with the administration of lorazepam 2.5 mg. All patients treated with medical hypnosis were able to complete the examination with a great tolerance and no sign of stress or anxiety were reported. CMR protocol was performed according to clinical request and was not different form non-claustrophobic patients. None of the patients treated with lorazepam 2.5mg was able to complete the exam. Conclusion we prove medical hypnosis to be safe and effective in controlling patients’ anxiety, allowing optimal diagnostic imaging quality without the need to adapt the examination. Further studies in larger populations are needed to confirm our results.

Is hypnosis a valid alternative to spontaneous breathing general anesthesia for claustrophobic patients undergoing MR exams? A preliminary retrospective study

BackgroundThe purpose of our retrospective study was to assess the termination rate and the image quality of MR exams performed in claustrophobic patients under medical hypnosis, as compared to patients undergoing MR under spontaneous breathing general anesthesia.MethodsOur study was approved by the ethics committee. The “hypnosis group” included consecutive patients that had previously interrupted an MR exam because of claustrophobia. The “control group” included patients undergoing MR under pharmacologic sedation. Two experienced radiologists assessed, randomly, independently and blinded the image quality of the two groups using a symmetrical Likert scale: 0 = non-diagnostic images; 1 = bad image quality; 2 = fair image quality; 3 = good image quality; 4 = very good image quality. Descriptive statistics was performed.ResultsEighty patients were included, equally distributed between the two groups. Every patient was able to complete the MR exam. Ratings 3 and 4 represented the majority of ratings. Both readers rated the MR exams with score 3 or 4 in 66.25% (53/80) of MR exams. Only 5% (4/80) of MR exams were rated below score 2. The majority of the MR exams showed good or very good image quality. No significant difference was found in image quality between the two (p = 0.06) groups. The agreement between the two readers according to the k score was 0.105.ConclusionsMedical hypnosis is a valid alternative to spontaneous breathing general anesthesia in patients unable to undergo MR due to claustrophobia, allowing good quality images.

Determining the efficacy of low-dose oral benzodiazepine administration and use of wide-bore magnet in assisting claustrophobic patients to undergo MRI brain examination

PurposeClaustrophobia remains a challenging barrier for a significant number of patients to successfully complete a Magnetic Resonance Imaging (MRI) examination. While use of wide-bore machines and pre-exam administration of a low-dose benzodiazepine are commonly employed, there is little published research to determine which modality is the most efficacious based on the patient's specific degree of claustrophobia. This retrospective case-control study examines the efficacy of using a low-dose oral benzodiazepine and wide-bore magnet to successfully aid the claustrophobic patient in completing an MRI Brain examination. Methods3966 non-contrast MRI brain examinations were considered for this study. The sample was filtered to include only patients who were older than 18 years of age, not currently experiencing symptoms which may hinder MRI examination, and did not undergo any additional MR studies at the time of their exam, resulting in a final sample of 2358 examinations for analysis. Patients were then sub-divided based on severity of claustrophobia and analyzed using logistic regression analysis. ResultsUse of wide-bore magnet increased odds of successfully completing the MRI Brain examination in mild, moderately, and severely claustrophobic patients (OR: 1.79, 95% CI: 1.17–2.75). The administration of pre-examination low-dose oral benzodiazepine increased odds of successfully completing the MRI Brain examination in severely claustrophobic patients (OR: 6.21, 95% CI: 1.63–19.28). ConclusionUse of a wide-bore magnet is effective in assisting mild, moderately, and severely claustrophobic patients in completing an MRI Brain exam. However, the efficacy of low-dose oral benzodiazepine is limited to severely claustrophobic patients.