Pre-screening questionnaires and optimized acquisition techniques are among the measures shown to reduce or eliminate the need for sedation in patients with MRI-related anxiety — including in the pediatric population — according to leading experts in the field.
A pre-examination questionnaire on claustrophobia proved to be an effective tool for screening patients before MRI, according to a study published in the Nov. 25, 2016, online issue of Radiology.
Patients with claustrophobic anxiety are more likely to experience a feeling of confinement inside the scanner’s narrow bore. For these patients, completing the examination may require conscious sedation and additional sequences, adding cost, risk and time to the procedure.
“The workflow may be interrupted if additional staff are needed to cope with the patient’s claustrophobic event and/or because of the delay for the next examination,” said study last author Marc Dewey, MD, vice chair and Heisenberg Professor in the Department of Radiology at Charité University Hospital in Berlin.
Previous research by Dr. Dewey and colleagues determined that, on average, 2.3 percent of all patients scheduled for MRI suffer from claustrophobia. With more than 80 million MRI procedures performed every year worldwide, this means that approximately 2 million MRI procedures may be affected.
Added costs associated with claustrophobic events per procedure can range from 100 €, or slightly more than $100, for additional staff and slight delays, to about 400 €, or almost $420, in cases where the examination needs to be prematurely terminated, Dr. Dewey said.
In his Radiology research, Dr. Dewey and colleagues explored the potential of a 26-item claustrophobia questionnaire (CLQ) as a screening tool in hospitalized patients scheduled for an MRI exam. Before undergoing MRI, patients were questioned on their fear of restriction and suffocation and were asked to rank their responses on a scale of 0 to 4.
“A question for restriction is, for example, how afraid patients would feel in a small dark room,” said first author Adriane E. Napp, MSC, biologist and project manager in the Department of Radiology at Charité. “For suffocation, a typical question asks how afraid patients would be in a crowded cinema.”
Out of 6,520 patients in the study group, 4,288 patients completed the CLQ before MRI, while 2,232 patients underwent imaging without having completed the questionnaire. Staff members recorded the number of claustrophobic events and compared them between the two groups.
Claustrophobic events occurred in 640 of the patients in both groups, or 9.8 percent. The CLQ mean score in patients with claustrophobic events was 1.48 — significantly higher than the 0.6 average for the group without claustrophobic events.
The results suggest that the CLQ is a suitable screening tool for the absence of a subsequent claustrophobic event. In addition, not all patients at risk for claustrophobic events need or request sedation, the results show.
“Half of the patients said they prefer non-sedation coping methods like prism glasses, music or an escort into the scanner room,” Dr. Dewey said. “This is a very interesting and unexpected finding of our study.”
Patients in the study who suffered from claustrophobia were thankful for the questionnaire, saying they appreciated being offered help and having their concerns taken seriously, Dr. Napp added.
“This is why we were able to include so many patients in the study since the patients were so appreciative,” she said.
In addition, radiologists and staff who may have been skeptical of the process at first were convinced of its effectiveness, Dr. Dewey said.
“Initially they thought that filling out the questionnaire would take too much time and might upset some of the patients,” he said. “Yet, the patients filled the surveys out in 10 minutes and were glad to participate.”
Dr. Dewey concluded that further funding is needed to better understand which interventions might reduce claustrophobic events.
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