As a doctor who has monitored MRIs for the past 25 years I would like to say a few words about this very misunderstood topic.
First of all I want to reiterate that it is a real phenomenon which prevents some patients from even thinking about the possibility of having an MRI. Second I want to mention that most claustrophobic patients have never met a physician who really wants to help them, let alone a facility that is specifically designed to reduce their anxiety. And lastly I realize that just talking about it makes some patients want to change the conversation but it must be discussed and there are so many solutions that can help patients that we must find what is best for each patient.
MRI technology advances at a similar pace as computer technology. We have new software and hardware which can help patients. Even though they can be proven to be helpful there are always obstacles. The major obstacle is that you must choose very carefully the array of new technology that is available. And most doctors are not very knowledgeable about all the different scanners and the options that are available. Having 25 years experience in MRI, I believe that I am a reasonable judge of these new technologies and I have to admit that I have guided my many MRI cneters over the past years and bought the correct technologies that have changed MRI. It is important to note that many of them are very technical but lets try to cover them in a simple and hopefully layman friendly way. When I started MRIs were done at 0.6T on a machine made by Johnson and Johnson called a Teslacon. It was the first MRI scanner widely deployed but there were many competitors. Some were at 0.3T and 0.4T – all different magnet strengths but when the first 1.5T (tesla) scanner was invented by GE – it took over the market and the other manufacturers had to follow GE.
Back then each series we would scan would take 12-15 minutes each. Most of the patients held still for the 15 minutes sequences because MRI was so remarkable and rare that every patient scanned was desperate to have the scan which might show their abnormality and used ot have to wait a month or more for the scan. Back then the bore opening was 55 cm – which is about 22 inches wide. New technology has allowed us to have 60cm and now 70 cm bores which are as wide as 30 inches now. It is very unfortunate that most doctors are not as knowledgeable about these advanced scanners.
My recommendation for ALL patients is to have a scan on the newest 70 cm scanner. This is 30 inches wide and a completely different experience than on older scanner. So called OPEN MRI scanners – such as the workhorse Aeris II from Hitachi and the upright FONAR scanner have weaker magnets and much narrower widths – as little as 45 cm or 18 inches and a maximum of 49 cm or 19 inches. Most patients have no idea that most OPEN MRI scanners actually narrower than closed magnets – which by the way are open at both ends but are a narrow tunnel.
With the 70 cm technology an MRI is no longer that claustrophobic. According to Siemens which is the manufacturer of these advanced scanners if you are taller than 5’2″ your head is outside the scanner if we scan your lumbar spine or any location in your body lower than this – such as the pelvis, hip, thigh, femur, knee, ankle, calf, leg or foot. The more important thing is that the 70 cm technology is actually a revolutionary new superconducting magnet which is the widest in the world. Most patients who are scanned on the OPEN BORE technology are not claustrophobic. We do many patients every day who are claustrophobic on other OPEN or closed MRI scanners but are not claustrophobic on our 70 cm OPEN BORE scanner. We show our scan room to our patients and even have a TV you can watch – so you can bring your favorite bluray or DVD to watch during your 12-20 minute scan. At 1.5T which is the lowest field strength of the 70 cm OPEN BORE magnets the scans are done is 1-5 minutes of scan time. At 3T (the 3T OPEN BORE magnet called the Verio) the scans can be as little as 30 seconds to 3 minutes.
State of the art new scanners also have advanced software which can freeze motion called BLADE. This is a remarkable new MRI sequence that completely changes MRI. I was at a dinner with 10 radiologists from another group and they were totally unaware of the new technology and how this helped their patients. BLADE imroves all scans because motions such as swallowing, breathing or even peristalsis – the motion of your bowel can cause blurring and the scan might miss a subtle finding. You need the most dedicated radiologists with the newest technology to possible find your tumor or lesion when it is the smallest possible. With these new tools we can often find lesions smaller than 1/4 of an inch. 1.5T (tesla) and 3.0T (tesla) scanners are the best we can use today. If you scanner is less than 1.5T is is likely your results can be compromised by the age and strength of the scanner. If you have a 3T scanner it is likely to be good as they are the most expensive on the market today. You should always ask for 70 cm OPEN BORE technology and do a web search to find the closest provider in your state. Most states will have several providers who care enough about their patients to have this available.
The second important thing is the facility has to be sympathetic to claustrophobic or larger patients. We feel that the facility itself – the staff, the equipment, even the waiting rooms and changing rooms should be designed to soothe the patient. Our facility has large waiting rooms with sky lenses in the ceiling and a massage chair in the waiting room to reduce anxiety. For children we can put on their favorite movie or cartoon on a huge theatre with dolby AC-3 surround sound. If the child might need sedation that can be given chloral hydrate (a mickey) while watching their favorite movie and then when the child falls asleep we gently left them into the scanner and can scan them in a few minutes. We also offer conscious Valium sedation in case you are a serious case of claustrophobia which can not be alleviated by all these methods already mentioned. We have never had a failure if you allow us to administer conscious sedation.
There are patients who refuse sedation and of course then they cannot have the benefit of MRI. MRI has no ionzing radiation and in many cases is the ONLY way a doctor can find your problem. What patients do not realize is that if the scanner is old or they use the wrong software your lesion or abnormality might not show up clearly. You need a dedicated MRI physician with the finest equipment to ensure we can properly diagnose your problem. The system is broken. In many cases when your doctor orders an MRI you might end up at a facility with an old scanner or an outdated OPEN MRI which simply cannot make the proper diagnosis. The patient must beware and ask questions. This is the only way the system can be corrected. You cannot assume your doctor is knowledgeable about MRI technology. Even radiologists might not know about the latest technology.
For instance we have a sequence called diffusion weighted imaging which we use in the brain to find early strokes. It can be used in the body to find early cancer in the breast, liver,pancreas, kidneys and bowel. It has detected cancer filled lymph nodes in my experience. However even with all these advantages you have to have a radiologist who will add these extra 1 to 4 minutes to your scan. All of our abdomen scans include this remarkable new sequence. At most university hospitals they also do this. However none of the other 30 scanners uses this sequence. They might be missed cancers and their patients and doctors are not aware of the deficiency of not adding this. It is true that insurance and medicare do not pay extra for the extra time. But I feel that the patient and their well being is worth it.
Another way MRI facilities cut corners is the choice of contrast material. MR contrast is much safer than CT contrast but it has a rare complication called NSF (nephrogenic system sclerosis) which occurs largely in patients with renal disease. One thing that many patients do now know is that CT contrast causes temporary loss in renal function. It has not been shown yet but it is theoretically possible that you could have multiple CT scans in a week which reduces your renal function and then you get an unsafe MR contrast which might actually give a normal kidney functioning patient NSF because of the multiple CT scans which reduced their kidney function. Many patient do not realize there are 6 different MR contrasts. Three of them have never been associated with NSF. In my facility we only use the safe MR contrasts. They are called Multihance, Prohance and Eovist. Please do your homework and ask for them by name.
Another way to reduce claustrophobia is to distract the patient. We have a TV in our scan room which the patient can watch in about 60% of the scans. This really helps. We also have the shortest least claustrophobic MR magnet. A patients friend or spouse can actually hold the patients hands or feet during the scan. A parent can hold their child because the bore is so short. No other magnet can offer this comforting gesture for all their patients. The larger opening also allows us to scan patients as large as 650 lbs. We have done many patients who simply did not fit on any other OPEN or closed MRI scanner. For all of the rest of us the extra room in the scanner is much appreciated.
Another important thing is to limit the time of the patient inside the magnet. Our 1.5T Espree and 3.0T Verio magnets are the fastest scanenrs in their class. They have 18 channels of signal to improve the picture quality and make the scans as little as 1 minute in length. If you doctor orders the test without a contrast injection – that cuts the scan time in half as well. Our cervical spine studies can be done in as little as 5 minutes. Our shoulder studies take 12 minutes with BLADE motion correction making them sharper and more diagnostic than any other scanner. You really need to find a sympathetic facility to make your MRI the least claustrophobic and anxiety provoking experience. I say that caring really does help. We get MRI studies on patient s that simply have failed at every other MRI facility in our state. There is a difference.
Choose the newest MR scanners if possible. Choose an 18 channel Espree – the worlds most spacious and least claustrophobic scanner and if you are lucky enough try to find a 3T Verio. This 3T OPEN MRI is the world’s finest scanner. Giving the doctor the flexibility of speed an advanced technology to help the patients find the smallest possible strokes or cancer. For instance 3T MRI is 100% sensitive for breast cancer. We cannot say that about lower field strength scanners. Please ask questions. Do not get a breast MRI study on a scanner less than 1.5T in field strength.
Have a happy new year!