According to the NHS, claustrophobia (an irrational fear of confined spaces), affects between 10% and 30% of the population and whilst the signs of claustrophobia are easy to identify, pinning down the exact cause is not so simple. As the definition suggests, the fear is usually irrational and can often take an individual by surprise in the most unexpected situations. In fact, it is a common misconception that the fear pertains only to the fear of being physically confined in an enclosed space. Claustrophobia sufferers may find themselves feeling equally anxious in a traffic jam or a crowded shopping centre, as in a broken lift or MRI scanner. Unfortunately, for the majority of sufferers, claustrophobia will dictate many aspects of their day to day lives.
MRI and Claustrophobia
For most claustrophobes, the idea of having an MRI scan will not be a pleasant one. If you ask the general public what an MRI scan may entail, then the majority of responders will provide an explanation which includes at least one descriptive from the following list – ‘tunnel’, ‘dark’, ‘enclosed’ and ‘claustrophobic’. However, it is worth noting that the way people speak about MRI is often not based upon what they have experienced themselves but have more commonly heard from others. Everyone has a story about a ‘friend of a friend’ and subsequently, MRI scans do have a certain reputation. Indeed, if there were a PR agency for medical procedures, then MRI would surely be its best customer!
The fact is that many people’s perception of MRI is based upon the very early days of the technique which, surprisingly, were not that long ago. In its infancy, MRI scans were very much the realm of scientists, where patients did perhaps have to cope with less than comfortable surroundings in order to get the best possible scan. Technology was such that the desire for high diagnostic quality superseded patient comfort and speed. However, as the technique has developed over time, comfort has increased and modern day scanners are now more welcoming and fully kitted out with a number of aides which are designed specifically to make the experience more comfortable.
Now…….not wanting to contradict what I have said above, MRI is still a ‘unique’ experience. MRI is not something that most people undergo very often and therefore, feelings of apprehension and perhaps even nerves should be expected. Even the hardiest of submariners (or even MRI radiographers) would lay down on an MRI scanner and find it a little unusual (believe me, I can talk from experience having been a guinea pig for countless new scans over the years.) This is not because MRI scans are dangerous, or even particularly scary. It is just an unusual experience in which our natural and normal reaction is to be at least a little cautious of what is happening around us.
So what can I expect?
As I mentioned previously, MRI scanners such as the ones we use in our imaging units, are now more comfortable and designed specifically to make the task of getting through an MRI scan more manageable for the patient. Modern scanners such as ours are much wider, fully lit, ventilated and open at both ends (we have all heard from a next door neighbour who went into a ‘tunnel’ which was closed at one end!) In fact, scanners have always been open at both ends. It is just that older scanners were deeper than they are now so the end of the bore was not so visible from the patient’s perspective.
For many scans (depending on the area being imaged), a patient can now be positioned in a ‘feet first’ position, so that the patient’s head doesn’t have to enter the scanner. This can often make a big difference to patients with feelings of claustrophobia and it is always worth asking the radiographer if this might be possible for your scan. If it is technically possible, then the radiographer can do this easily.
MRI scanners do also have the reputation for being noisy machines, and this is something which unfortunately hasn’t changed a great deal. Whilst manufacturers are currently developing ‘silent’ scanners, these are a way off from being commonplace and there are some drawbacks. However, it is worth remembering that the clicking and buzzing that is produced during an MRI is perfectly normal and nothing to worry about (in fact, the noise means that the scanner is working perfectly and doing exactly what it should be doing in order to produce the best possible scan.) To put the noise into perspective, the noise level for a routine scan is a similar level to what you would expect standing beside a busy road. The noise can also produce some subtle (and not entirely unpleasant) vibrations in the bed. This is again, perfectly normal. To protect your ears during the scan and to make it more comfortable for you, you will always be given ear protection for your scan and it is important that this is worn. We routinely use foam earplugs in our departments, which reduce the noise to a limit which is well within safe and comfortable margins.
In many cases, patients can also use special headphones to listen to music during their scan which can help pass the time. This does depend on the type of scan being performed but it is always worth asking the radiographer for it, if this is something which you feel might help. The radiographer will talk to you continuously during the scan via a two way intercom and will keep you fully informed of the scan’s progress from start to finish. You may even find that you want to have a snooze in which case you may be want the radiographer to be quiet! An emergency buzzer also acts as a backup should you want to stop the scan at any time when it is not possible to speak with the radiographer. The patient is always in control of their scan!
Most importantly, our staff understand exactly what we are asking of our patients and therefore, we treat each individual with respect and use an unhurried approach so that every patient, including those who identify as having claustrophobia, can be at ease and comfortable enough to successfully complete their MRI scan.
What if that is not enough?
A small number of patients will still find that their anxiety levels are too high to cope with an MRI scan. If this is you, then you are not alone and the radiographers will have seen many patients before you who have had similar problems. However, all is not lost and there are things which can help further:
Familiarise yourself with the department
Whether you have claustrophobia or not, we would always recommend that you familiarise yourself with the scanning process and with our department by reading our ‘Patient Journey’ guide here. You are also welcome to come in and visit so that we can show you the scanner and answer any questions you may have in person. If you would like to arrange a pre-scan visit, just give the imaging centre a call and we will welcome you at any time that suits you. The more familiar you are with the environment and the team, the more relaxed you will feel.
Bring a friend or relative
Sometimes, it can also help to have some company in the scanner room and it is perfectly OK for you to bring a trusted someone with you to hold your hand during your scan. It is important that this person is safe to enter the scan room and the radiographer will need to go through a strict safety checklist with both of you before taking you into the scanning room. You may not be able to talk to each other during the scan, but often just knowing someone else is there is all that is needed to help you relax.
It is reasonably common for some people to require a light sedative to help them relax during their MRI scan. This medicine will not put you to sleep. Instead, it will just relax you enough to control your nerves and be comfortable enough to tolerate the scan. This medicine is often very effective and we find that the majority of patients who do this will be successful. If you feel that this would help you, then you must obtain a prescription for the sedative from your doctor and bring the tablet with you on the day of the scan to take here in the department. We cannot give you sedation as this is something your doctor must be aware of and help you organise. We will give you more instructions when you book your appointment.
In essence, if you have been referred for an MRI scan by your specialist, there is likely to be good clinical justification for it. It is important that we work with you to do all we can to make you sufficiently relaxed and comfortable that you are able to tolerate the scan and keep sufficiently still, enabling us to obtain the best imaging possible. Trust me when I say that we have encountered every possible scenario and are able to adapt what we do to suit your needs. However, by taking into account the simple actions outlined above and trying to keep an open mind, chances are that the experience will not be nearly as bad that ‘friend of a friend’ had said!