As a Director of Imaging, I have seen my share of canceled MRI exams due to patients’ inability to complete an MRI study.
There are many reasons why an MRI exam may not be completed.
- Claustrophobia is the #1 issue leading to incomplete exams
- Inability to remain motionless for long periods of time
- The annoyance of loud sounds the MRI machine makes
- Too uncomfortable to remain laying on the back for the duration of the exam
- Pain from undisclosed metal on or in the patient
Claustrophobia inside the MRI magnet
Claustrophobia is the inability to remain in a perceived tight space which leads to varying degrees of panic.
There are several things that a patient who is concerned with claustrophobia can do to mitigate this issue. Perhaps not completely but enough to get the MRI exam completed.
Sedative medications can be prescribed in order to calm the patient immediately prior to the examination.
Calming music is often played through MRI safe earphones that are offered to the patient when getting onto the MRI bed or couch.
Most recently, the invention of MRI movie goggles have been developed which allow the patient to literally watch a video during the examination. Coupled with the audio mechanisms, this experience can be truly enjoyable and successfully distracting.
Restless Leg Syndrome and MRI
An MRI exam demands that the patient remain completely motionless during the entire duration of the study.
Breathing can not be stopped and, for the most part, is mitigated during image acquisition. But there are times when even simple breathing can be seen in the images.
Think about when you tried to take a photograph of a person running. The image probably came out somewhat blurred. This is the same thing that can happen during an imaging exam of any type, not just MRI.
Therefore, it is crucial that a patient be as motionless as possible during the exam. If an exam is not acquired with enough diagnostic quality, it will have to be completely repeated.
Patients with tremors of any type like Restless Leg Syndrome, Parkinson’s, or other neurological disorders will need to speak to their ordering physician. Together you should be able to figure out the best scenario to obtain a diagnostic study.
Chronic Back Pain
Back pain when laying in the supine position (on the back, face up) is a condition some patients have in their daily lives.
Attempting to lay down for an MRI exam is simply too painful for these patients. Medication may not be enough to ease the pain but could be worth a try.
Medical necessity is what will be determined for these patients.
Tick Tick Knock Knock Rim Rim Rim
The sounds of an MRI magnet during examination is unmistakable. There is no other sound like it.
One MRI study may contain 4-7 series and each series is a separate exam. Each exam contains 30-100 slices of anatomy that are combined together to make one exam.
Each of these exams within the series requires the MRI magnet to do different things during magnetic resonance operation. These operations create vastly different sounds which will be heard by everyone in the room.
This is one of the reasons music headphones are offered to every MRI patient. The noise cannot be stopped but can be dampened by the headphones and music.
The big winner in the field of MRI will be the vendor who creates a soundless machine. We are far from that at this point but they are getting quieter over the years.
Metallic Implants Can Cause Skin Burning
All patients are asked several times if they have anything in their body that may contain metal. This includes replacement surgeries like knee, shoulder, or hip. It includes dental partials, metal hair clips, and some pacemakers.
Even though MRI Technologists relentlessly ask patients questionnaires full of probing questions regarding implants and metal objects, there are still some who get through.
The problem arises when a patient may not know there is a metal foreign object inside of their body. This can happen, for example, when a person has received a gunshot wound and some of the buckshot or bullets remain in the body.
There is also a new emergence of ultraviolet tattos, or tattoos that are only seen under a black light, which unknowingly to the owner, contains microfragments of metal in the tattoo ink.
This metallic ink can lead to a warming or light burning sensation on the skin where the UV tattoo is imprinted.
Talk to Your Ordering Physician Before Your MRI
In the end, it is up to the patient to fully disclose any objections or obstacles that may preclude performing an MRI study.
The MRI Technologists are trained in asking the proper questions but they don’t have xray vision.
The best way to obtain a diagnostically viable imaging study with little to no discomfort is to be completely forthcoming with your physician and the technologists.