MRI scanxiety - can technology beat the innate fear?

MRI scanxiety - can technology beat the innate fear?
Photo by Tonik / Unsplash

In my personal opinion MRI is one of the greatest technological achievements of all time and definitely one of the methodologies in radiology that most fascinate me. We can really look into bodies and analyze the consistency of tissue! We can even tell if there is inflammation or not or if there are areas in your brain that lack oxygen (or to be more exact and really nerd it out: have lacked oxygen for too long time). So basically from a physicians point of view this machine is just perfect.

There should be consensus about this, right? If you agree you have probably never had an MRI scan. The patient perspective on an MRI is often slightly different.

But let's start with the basics: What impact has (the rise of) MRI on healthcare:

  1. It's a first-class method for both patient and physicians in diagnosis and treatment.
  2. It incurs costs for the healthcare system and generates revenue for healthcare providers.

Considering these aspects, research and development have been focused on enhancing MRI by shortening scan times, improving image quality, and enhancing patient experience. From my experience, we've achieved our goals in scan time and image quality. So now let's get back to the patient experience. What is the status quo here? A group among Janika Madl from Erlangen university has conducted a systematic review and meta-analysis on this topic. And they got some really interesting results. In my personal opinion these results really call for action.

✏️The facts:

  • In Germany, 145 in every 1000 inhabitants underwent an MRI scan in 2018.
  • Despite the introduction of new technologies like open MRI and MRIs with shorter or larger bores, it's unclear if these advancements truly enhance patient experience.
  • Unexpected patient-related events (UPEs), including failed scans, no-shows, sedation, and motion artifacts, contribute to revenue loss.
  • The review analyzed 44 studies in total.

🎯The results:

  • Anxiety is common among MRI patients, peaking right before the scan and often reaching clinically relevant levels.
  • Anxiety does not significantly decrease post-scan.
  • Nearly 4% of patients would choose not to undergo an MRI again.
  • UPEs occur in 10% of cases.
  • Levels of anxiety, reluctance for repeat MRI, and UPEs have remained stable over time.

💡The conclusion:

  • Technological advancements haven't improved the patient experience during MRI scans.
  • Proposed solutions are more thorough patient information, relaxation techniques, and targeted staff training to improve communication.
  • Future MRI development should consider patient insights and involve patients in the process, perhaps through co-creation sessions.

✌️What do I learn from this study:

To me this review highlights something we should have considered earlier: A patient-first approach to improving MRI experiences.

How could we do this:

  1. Patients should routinely provide feedback after a scan, covering the entire procedure from arrival to departure.
  2. Analyze this feedback and see where you can make small and thus very cost-effective changes.

I am also astonished by this approach: Hayley Homewood and Jonathan Hewis from Charles Sturt University in Australia made a study where they looked at instagram posts before and after an MRI scan with a focus on anxiety and distress. So this could be another very effective way to gather a lot of information.

What I would suggest:

So I do not think we need to invent another short and large bore MRI that can give you a massage and has free wifi. Looking at the data we could acquire from the patients we could do some really great improvments:

  • I envision tailored infographics for different patient types (anxious, ignorant, interested, informed)
  • pre-scan educational podcasts
  • relaxation exercise tutorials before the exam
  • find the optimal way to communicate with different patient types and train our technicians how to do this
  • creating a calming ambiance in MRI rooms with low lights and soothing colors.

Sources:

Madl JEM, Nieto Alvarez I, Amft O, Rohleder N, Becker L. The Psychological, Physiological, and Behavioral Responses of Patients to Magnetic Resonance Imaging (MRI): A Systematic Review and Meta-Analysis. J Magn Reson Imaging. 2024 Feb;59(2):675-687. doi: 10.1002/jmri.29134. Epub 2023 Nov 21. PMID: 37990634.

Homewood H, Hewis J. 'Scanxiety': Content analysis of pre-MRI patient experience on Instagram. Radiography (Lond). 2023 May;29 Suppl 1:S68-S73. doi: 10.1016/j.radi.2023.01.017. Epub 2023 Feb 8. PMID: 36759225.