What we can do to make MRIs less stressful

I have some ideas, from a layman’s perspective, on how to make MRIs less stressful for patients. I had two MRIs taken this year, and the way they were administered, and how that differed between the two clinics, made me reflect on why they’re stressful. I’m pretty sure that many stressful aspects don’t have to be that way. So I’m writing this to fix & publish some naïve ideas for what could be done better.

Importantly, these are rough ideas, and not demands. I’m not a doctor, and I haven’t done any research on how MRIs work or how they’re administered. For all I know, all of these ideas could be ridiculous and harmful, entirely impractical, or already well-known.

Basic suggestions

The first MRI I got was for a study on magnetic resonance elastography, where an MRI of my liver was compared with the results from a previous liver biopsy. Liver biopsies are not fun, and I very much hope MRE can replace it.

This was a very relaxed affair. I had lots of time to ask questions beforehand. For instance: Not only did I get a “stress ball” to communicate that I was uncomfortable and wanted the MRI to stop, but I also got to test that beforehand to convince me it did in fact work.

Openness and taking your time for each patient is generally important. Here, seeing the stress ball work let me have more intuitive trust that this unfamiliar setting would help me.

Suggestion 0. A general caring attitude, being open to the patient’s questions, and taking your time, are needed.

Knowing that everything’s working correctly is also important for the machine itself. Since I’m alone when the MRI is running, and I don’t know anything about MRIs, I need to judge for myself if the machine is working correctly. The machine is big and heavy, and unfamiliar, so if I have the faintest suspicion something’s not working properly, it makes me nervous.

Unfortunately that is an area where I didn’t get much reassurance. I didn’t know what sounds I should expect. It doesn’t help that MRI sounds are usually in my view inaccurately described as “knocking” or “very loud”. I also didn’t know how long everything went precisely. When the machine pauses, I can’t tell if we’re at the end, or if something’s gone wrong, or if this is just a regular pause.

I actually made use of the stress ball once. That was because I felt a repeated strange senation in one part of my body. They couldn’t tell what it was either, and it was probably harmless, so we continued afterwards. In general, even though MRI is non-invasive, you do feel some strange things. I don’t know if these are actually the result of the magnetic field, or just because the device is vibrating, but it’s an interesting sensation, and I think it should be stated upfront.

Suggestion 1. I should be given an understanding of what I should expect. First, I need to be given a sample of the sounds I should expect. Ideally every kind of sound that will happen. Secondly, I want to know what passes the MRI does, and why it changes its sound patterns, and how long they’ll be.

This also applies massively to my position in the machine. I had my head near the end of the tube and could look out the back, and in my second MRI the head was fully outside of the tube, but it’s still unexpected just how cramped it feels in there. This is especially the case because the bed you lie on rises so far up before going into the tube that the space in the tube is basically cut in half. When I first looked at it, I thought there was plenty of space, because I was imagining myself lying in the bottom of the tube. I think I should be given more opportunities to familiarise myself with the space. For instance, you could be shown how high the bed goes, or be moved into the MRI for a short moment and taken back out.

Suggestion 1½: Give me an understanding of how tight the space will be by demonstrating it or showing how the bed is positioned inside the machine.

In this MRI, I got noise-cancelling headphones that the test taker could communicate via. There were also pre-recorded voices that instructed me to hold my breath for some phases of the scan.

This had two important effects: I got a feeling of being connected to the outside world, even being able to ask questions when the headphones were connected, and I got reassured that everything was working correctly and moving along when I got instructions.

Suggestion 2. During the test, I should be given updates on how the test is going. Ideally I should also be told how long it will probably take, or how much of it is already done.

I think the messages were under-utilised. They could’ve been used to inform me of the specific sound patterns I should expect, such as by playing a sample, and why they would happen, by explaining the specific scan passes.

The second scan I got

The second MRI I got was a lot more rushed. It was at a clinic that specialises in imaging people, and they clearly process a lot of people and operate on a tight schedule. I had to rush in my question about whether my head would be inside or outside the tube while I was being moved into it. I also didn’t get any voice updated through the noise-cancelling headphones.

This wasn’t as big a deal, as I was already somewhat familiar with MRI, now. Since I was asked if I had an MRI taken of me before, and I told them, I hope they are a bit more accomodating with those that take their first MRI at this clinic. But since the MRI wasn’t exactly the same, I still had some questions, and I still felt uncomfortable because of this unwillingness to take questions.

However, one thing I do applaud them for is giving me access to the MRI scan in a web-based viewer. I could even download the scan as a file. I think this is very neat, though I understand not everyone will take advantage of it. It also seems like this isn’t done for transparency or the curious patient, but so that the referring doctor can view the scan in this tool. It’s just also coincidentally available to the patient.

Broader context

I said in the opening that I haven’t done any research—that’s a bit of a lie. I did search once for “MRI stress” (or something), and I found an article about how to cope with MRI, and a paper that discussed the issue. I didn’t read either—I was just trying to confirm my assumption that MRIs were commonly seen as stressful. Before, the best evidence I had of that was that my mother warned me intently about the MRI before I got it. My mother is claustrophobic, and I believed I wouldn’t have as much of an issue with it as she seemed to have had. I still had more stress than I expected.

But I did read a bit of the abstract of the paper I found (Madl et al. 2022, see bibliography entry 1). It says Despite being noninvasive and painless, MRI is recurrently associated with stress and anxiety in patients. (emphasis added). ^{Footnote 1}

I think this sentence is arrogant and disregards the patients. Even though the article is about how to accomodate patients more, it still carries the assumption that our fears are unfounded—we fear “despite” MRI being safe. The patient can’t know that as well as the study authors do. And e.g. considering what you would do if the machine malfunctioned, and how you can tell if it does, is still a rational thought, that nonetheless induces stress.

It also says “painless”. But I did experience unusual sensations when inside. Not only did I experience the psychological stress of being confined in a tight space and isolated from other people while loud noises came from a huge machine close to my body, but I also experienced physical sensations. If I read “painless”, what I imagine is something like an infrared thermometer, or a fingertip pulse oximeter.

While these were harmless here, I was explicitly informed that it’s possible some metal objects a patient might have could vibrate or heat up during the procedure, which is why you have to tell the staff about those. I have braces, and while I was told that it probably wasn’t a problem at the first MRI, I was told an equivalent of “whatever, if it heats up you’ll push the stress ball and we’ll figure it out” from staff at the second MRI.

All of this is, in my view, part of a broader pattern of discounting the patients’ experience when doing medicine. As another example, when I got the biopsy I mentioned earlier, I wasn’t informed that I’d be cut with a scalpel. That was a really stressful moment, since I have a light fear of knives. When I saw the scalpel I recoiled instinctively and was effectively pressured to “get over”, so to say, my fear, in the moment. This sort of thing probably happens routinely in the medical system. And publishing studies on how it should be done better won’t fix it on its own. (Neither will this article.)

Bibliography

1. The abstract of Madl, J., Janka, R., Bay, S., & Rohleder, N. (2022). MRI as a Stressor: The Psychological and Physiological Response of Patients to MRI, Influencing Factors, and Consequences. Journal of the American College of Radiology : JACR, 19(3), 423–432. https://doi.org/10.1016/j.jacr.2021.11.020