Technical note
Can MRI related patient anxiety be prevented?

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Abstract

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.

Introduction

Magnetic resonance imaging (MRI) is a painless radiological tool that does not use ionizing radiation. Although MRI is considered as biologically safe and painless, patients experience claustrophobia and anxiety due to the nature of the procedure. Brennan et al. showed that 35% of patients experience some degree of anxiety during MRI scans [1]. Quirk et al. showed 37% incidence of intermediate level claustrophobia during MRI scans [2].

Anxiety is a feeling experienced by nearly everyone, which can be subjectively explained as worry or fear [3]. Anxiety is as defined by Barlow as “a future oriented mood state, in which one is ready or prepared to attempt to cope with upcoming negative events” [4]. Anxiety causes many hormonal response systems to be activated; such as sympatho–adrenomedullary axis (SAM) and hypophysis–pituitary–adrenal axis (HPA). These pathways release catecholamines and glucocorticoids as effector hormones [5]. Effector hormones in blood increase in concentration in a matter of seconds to minutes [6].

Prolactin is one of the novel stress markers. Its blood level increases in anxiety, particularly in response to acute psychosocial stressors [7]. However, prolactin and cortisol levels peak in different situations. Sobinho et al showed prolactin peaks as a result of humiliation and rage, whereas cortisol peaks due to fear and confusion [8].

During MRI, the patient lies in a narrow closed cylinder, which causes discomfort and anxiety particularly in patients with claustrophobia. It is also known that the sound of MRI and the loss of control over procedure contributes to the anxiety [9]. Katz et al pointed out that fear of pain and the expectation of test result also contributes to anxiety [10]. These contributors are sometimes so severe that patients experience their first claustrophobia attack during MRI, even without a previous condition [11].

Patients often describe their MRI experiences as “being buried alive”, “being deserted” or “left to death”. These thoughts may cause premature endings to MRI sessions or session skips by patients; causing clinical problems in short-term and economical loss in long-term [10].

MRI anxiety and its negative effects are both well known. A study published in 2007 shows that this is a current problem: Seventy-one percent of the participants reported that anxiety was a common problem at their MRI center, and 19% stated that it disrupted scanning on a regular basis [12]. A study conducted by Dantendorfer et al. showed that 12.8% of scans had motion artifacts and 6.4% had impaired diagnostic quality [13].

A variety of preventive methods have been tried to reduce MRI anxiety such as information and relaxation exercises [14], communication during procedure [15], prone positioning [16], systemic desensitization [17], music [18], anxiolytics [19] and imaginative visualization [20]. The primary focus of this study is to show the effectiveness of a combined method of information and communication to reduce anxiety by using biophyschometric scales and biochemical markers.

Section snippets

Methods

This study is a randomized prospective research and was performed according to the World Medical Association Declaration of Helsinki, and an informed consent was obtained from all participants. The sample size was limited to 33, patient selection was limited with 5 weekdays (between 7th and 11th of February, 2011) and randomization was conducted day-wise i.e. patients undergoing MRI on odd numbered days were accepted as control group, and patients on even numbered days were accepted as study

Demographics

There were 33 patients enrolled in the study. Fourteen of them were study patients; 19 were control patients. Demographic variables include age, sex, marital status and educational level (Table 1). Since the sample size was small for multiple subgroups analysis, demographic data were analyzed by grouping. Age was grouped into 2 categories as “above 30” or “30 or below”, and educational level was grouped into 2 categories as “high school or lower” and “higher education”. Prolactin-pre,

Discussion

This is a randomized controlled trial of a combined method of information and communication to reduce MRI anxiety. Anxiety levels were measured by both (a) plasma levels prolactin and cortisol before and after scan as biochemical markers (b) STAI as a biophyschometric scale. Information was given to the study group patients as standard messages. Study group patients were communicated between each sequence by the built-in intercom. Control group patients had neither information nor communication.

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