Introduction
Magnetic resonance imaging (MRI) is an important modality in diagnostics
and treatment follow-up. A common non-open MRI camera consists of a
tunnel approximately 1.6 m long and 0.6 m in diameter surrounded by the
magnet 1-2. The patient lies isolated in the camera
during the examination which lasts for approximately 30-60 minutes. The
noise level during the examination is high, between 65 and 95 decibels
depending on the MRI equipment and procedure, thus ear protection is
used during the examination. Although noninvasive, MRI may therefore be
perceived as unpleasant and stressful 3. For example,
experiences of fear and a threat of losing self-control have been
described during MRI 4-5, and 14% of patients
experience severe anxiety and fear in MRI 6. Several
studies reported that up to 15% of patients terminate their MRI due to
anxiety and feelings of claustrophobia during the examination7-10. Features of MRI equipment and its strange
environment have been described as sources of distress4-6.
Various measures aiming to alleviate patient discomfort have been
investigated 11; for example, premedication9, relaxation exercises 12-14,
hypnosis 15, a visit prior to MRI16, extensive oral information and counselling14, 17, and a telephone contact or a video
demonstration of the procedure prior to the examination18-19. Most of these interventions are time consuming
and rather complex to provide in clinical practice. Using a
questionnaire to identify whether a person has claustrophobia has been
suggested 20-21, and persons with claustrophobia may
then be examined in an open magnet 22-24 or receive
premedication 9. However, open magnets have
limitations 25 and using sedatives may be inconvenient
for outpatients due to side effects, and if sedatives are given
intravenously, monitoring of the patient also needs to be considered26.
Lack of information can worsen anxiety at MRI 27-28.
However, patients’ knowledge of how MRI is conducted is usually scarce
and the source of information is often relatives 29,
which points to the need for accurate and standardized pre-scanning
information. For example, written information before an MRI has been
found needed and welcomed by patients 3, 30, and an
information booklet would be a simple and inexpensive means to
ameliorate the discomfort that might be experienced. It has been
stressed that such written patient information should contain several
types of information, i.e., procedural (how the examination/treatment is
carried out), behavioral (how the patient can cooperate), and sensory
(what the patient may experience) information 31.
However, the evidence regarding the potential effects of a simple
intervention such as an information booklet delivered to the patient
prior to the MRI examination is scarce. One non-randomized study used
written information but in combination with other measures16 and found reduced anxiety levels during scanning.
Another non-randomized study failed to demonstrate any differences in
anxiety or satisfaction with the information between groups receiving
standard vs. extended pre-scan written information, although motion
artefacts in the MRI images were fewer in the latter group32.
The aim of this randomized single-blind placebo-controlled trial was to
investigate the effects of a standardized information booklet on patient
anxiety and satisfaction with information in connection with MRI.
Specifically, the following hypotheses were investigated.
- A standardized information booklet on MRI decreases patient anxiety
prior to and during MRI scanning.
- A standardized information booklet on MRI increases patient
satisfaction with information about the procedure.