Anxiety of patients undergoing CT imaging-an underestimated problem?

A comprehensive analysis of metastatic disease following surgery for clinically localized cutaneous melanoma

BACKGROUND

The National Comprehensive Cancer Network considers "baseline staging" (whole body computed tomography or positron emission tomography scans with or without brain magnetic resonance imaging scans) for all patients with asymptomatic melanoma who had a positive sentinel lymph node biopsy result. The true yield of these workups is unknown.

METHODS

We created cohorts of adult patients with malignant melanoma using the National Cancer Database (2012-2020) to mimic 3 common scenarios: 1) clinically node-negative disease, with positive sentinel lymph node biopsy results; 2) clinically node-negative disease, with negative sentinel lymph node biopsy results; and 3) clinically node-positive disease, with confirmed lymph node metastases. Multivariable regression, supervised decision trees, and nomograms were constructed to assess the risk of metastases based on key features.

RESULTS

In total, 10 371 patients were in scenario 1, 55 172 were in scenario 2, and 4012 were in scenario 3. The proportion of patients with any metastatic disease (brain metastases) were as follows: 1.4% (0.3%) in scenario 1, 0.3% (<0.1%) in scenario 2, and 11.6% (1.6%) in scenario 3. On multivariable regression, Breslow depth greater than 4, ulceration, and lymphovascular invasion were associated with greater risk of metastatic disease. A supervised decision tree for patients in scenarios 1 and 2 found that the only groups with more than 2% risk of metastases were groups with T4 tumors or T2/T3 tumors with ulceration and lymphovascular invasion. Most groups had a negligible risk (<0.1%) of brain metastases.

CONCLUSION

This study is the first large analysis to guide the use of imaging for cutaneous melanoma. Among patients with clinically node negative disease, metastatic disease is uncommon, and brain metastases are exceedingly rare. Further investigation could promote a tailored approach to metastatic workups guided by individual risk factors.

Exploring communication gaps and parental needs during paediatric CT scan risk-benefit dialogue in resource-constrained facilities

BACKGROUND

Clear communication during informed consent is crucial in paediatric computed tomography (CT) procedures, particularly in resource-constrained settings. CT offers valuable diagnostic information but carries potential radiation risks, especially for paediatric patients. Parents play a critical role in decision-making, necessitating thorough risk-benefit discussions. This study aimed to explore parental experiences regarding risk-benefit communication during their children's CT scans in under-resourced healthcare facilities.

METHODS

A qualitative approach with a descriptive design was employed. Semi-structured interviews were conducted with 13 purposefully selected and consenting parents accompanying paediatric patients for CT scans at two public hospitals. Data were analysed using Tesch's eight-step method and ATLAS.ti software.

RESULTS

Participants were parents of children aged 0-10 years (8 males, 5 females), with 11 making their first visit to the CT department. Three main themes emerged: (1) Compromised consenting process, characterised by inadequate explanation of consent and limited risk-benefit communication; (2) Procedural information deficiency, including minimal communication about the procedure and lack of information on examination results; and (3) Preference for improved communication, with parents expressing a desire for comprehensive information and varied opinions on who should disseminate this information. Parents reported feeling uninformed, anxious, and unable to make well-informed decisions due to communication gaps.

CONCLUSIONS

Significant improvements are needed in risk-benefit communication during paediatric CT scans. Healthcare providers should use simplified language, visual aids, and patient-centred discussions to enhance understanding and reduce parental anxiety. Radiographers should allocate sufficient time for discussions, involve referring physicians when necessary, and document the informed consent process thoroughly. Addressing these issues can improve patient experiences and contribute to positive health outcomes in resource-constrained settings.

Minimum Fascia-Tumour Distance for Differentiating Deep Lobe From Superficial Lobe Benign Parotid Tumours: A Retrospective Study and Meta-Analysis

BACKGROUND

This study was designed to evaluate the diagnostic efficacy of the minimum fascia-tumour distance (MFTD) in distinguishing deep-lobe benign parotid tumours from superficial-lobe tumours through both an original study and a meta-analysis.

METHODS

In this study, we performed a retrospective analysis of data from 91 patients who had been diagnosed with benign parotid tumours. The MFTD values were sourced from preoperative ultrasound examinations. The locations of these tumours were confirmed through surgical findings. We assessed the diagnostic accuracy of MFTD by utilising receiver operating characteristic (ROC) curves. Additionally, we conducted a systematic review of the pertinent literature and performed a diagnostic meta-analysis to ascertain the overall diagnostic efficacy of MFTD in identifying benign parotid tumours.

RESULTS

Patients with tumours in the deep lobe had a significantly greater MFTD than patients with tumours in the superficial lobe. Using a cutoff value of 3.50 mm for MFTD, we found an AUC of 0.93, a sensitivity of 81.8%, and a specificity of 98.8%. Our meta-analysis included seven studies covering a total of 1689 tumours. The pooled values for sensitivity, specificity, and diagnostic odds ratio (OR) of MFTD were 81.0%, 89.0%, and 32.2, respectively. The AUC of the summarised ROC curve of MFTD was 0.90.

CONCLUSION

The MFTD demonstrated reliable diagnostic accuracy in identifying deep-lobe benign parotid tumours and may be incorporated into standard evaluations before parotidectomy.

Effect of information delivery techniques in reducing pre-procedural anxiety in computed tomography

OBJECTIVES

Patients undergoing medical procedures often experience heightened anxiety, which can affect their experience and overall health. The current study aimed at looking at a quality improvement initiative to compare written and audiovisual information delivery methods to reduce anxiety prior to Computed Tomography (CT).

METHODS

In this prospective interventional study, we assessed state and trait anxiety in patients scheduled for their first CT scan. Three PDSA cycles were carried out over six months, with each cycle lasting for two months each. The participants were divided into three groups, the baseline, written, and audiovisual intervention groups. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire. State anxiety is a temporary emotional response, while trait anxiety reflects enduring personality characteristics.

RESULTS

The mean age of participants was 43.26 years (SD 15.07) in the baseline group, 39.9 years (SD 14.72) in the written group, and 48.59 years (SD 13.54) in the audiovisual group. For state anxiety, the baseline mean was 58.4 (SD 6.9), notably reduced to 43.2 (SD 5.5) with written intervention and to 38.6 (SD 7.7) with audiovisual intervention (p < 0.001). Trait anxiety scores remained relatively stable in all groups (p = 0.31).

CONCLUSION

Both written and audiovisual interventions successfully alleviate pre-imaging anxiety in patients undergoing CT scans. The findings underscore the superior efficacy of audiovisual materials in achieving a more substantial reduction in state anxiety compared to written information. These findings are particularly relevant in resource limited settings where simple interventions show significant improvements.

Reduction of metal artefacts from bilateral hip prostheses during lower extremity computed tomography angiography: an experimental phantom study

INTRODUCTION

Image quality reduction due to metallic artefacts is a significant challenge during vascular computed tomography (CT) imaging of the lower extremities in patients with hip prostheses. This study aims to analyse various reconstruction algorithms' ability to reduce metal artefacts due to two types of hip prostheses during lower extremity CT angiography examinations.

METHODS

A pelvis phantom was fabricated with the insertion of a tube filled with contrast media to simulate the femoral artery, and the phantom was then CT scanned with and without hip prostheses. Multimodal images were acquired using different kilovoltage peak (kVp) settings and reconstructed with different algorithms, such as filtered back projection (FBP), iterative reconstruction (iDose4), iterative model-based reconstruction (IMR) and orthopaedic metal artefact reduction (O-MAR). Image quality was assessed based on image noise, signal-to-noise ratio (SNR) and Hounsfield unit (HU) deviation.

RESULTS

The IMR approach significantly improved image quality compared to iDose4 and FBP. For the vascular region, O-MAR improves SNR by 5 ± 1, 23 ± 5 and 42 ± 9 for FBP, iDose4 and IMR respectively, and improves HU precision towards the baseline values by 49% and 83% for FBP and IMR, respectively. The noise reduction was 71% and 89% for FBP and IMR, and 57% for iDose4. O-MAR greatly enhances SNR corrections among the most severe artefacts, with 29 ± 1 and 43 ± 4 for FBP and IMR, compared to iDose4 by 37 ± 7.

CONCLUSION

IMR combined with O-MAR could improve the CT angiography of the lower extremities of patients with a hip prosthesis.

Survey of maternal anxiety and perceptions towards foetal MRI and pre-scan education

INTRODUCTION

Foetal MRI scans can induce feelings of fear, concern and anxiety in pregnant patients. The aim of this research was to determine if providing patients with an information leaflet reduced maternal anxiety regarding foetal MRI.

METHODS

A prospective, three-arm comparative pilot study was performed in the MRI department of a quaternary public hospital in Brisbane, Australia. Three groups of 30 participants (total 90 participants) received differing levels of information about foetal MRI: Group A - no foetal-MRI specific information (current practice at the site); Group B - a basic information leaflet; Group C - a comprehensive information leaflet. All participants completed a survey that explored their pre-scan anxiety immediately after their MRI scan.

RESULTS

Over 50% of participants in each group felt anxious before the MRI. Participants expressed anxiety towards the general process of the MRI, the outcome or results of the scan, and the safety of the modality. The basic and comprehensive leaflets were both efficacious in reducing anxiety for the majority of participants.

CONCLUSIONS

Whilst not all patients express anxiety regarding MRI scans, emotional distress surrounding the entire process is prevalent. Providing patients with comprehensive information about what the MRI scan entails (including the scan environment and duration, positioning, breath-holding requirements, and foetal safety) reduces anxiety for most patients. These findings can be used to determine ways in which reduction of anxiety improves the patient experience.

Trajectories and Predictors of Raised State Anxiety Among Outpatients Who Have Undergone Medical Imaging Procedures

PURPOSE

The aim of this study was to examine the prevalence of raised state anxiety before and after medical imaging procedures, the prevalence of state anxiety trajectories, and factors associated with postprocedural raised state anxiety.

METHODS

A prospective survey was administered to outpatients undergoing elective medical imaging procedures (CT, radiography, MRI, ultrasound, angiography, or fluoroscopy) recruited from one center. Participants completed a self-report survey preprocedure (time 1) and postprocedure (time 2). State anxiety was measured using the six-item State-Trait Anxiety Inventory. The point prevalence of raised state anxiety (State-Trait Anxiety Inventory score ≥33.16) at time 1 and time 2 was calculated, as was the prevalence of four state anxiety trajectories over time: persistent low anxiety, decreasing anxiety, increasing anxiety, and persistent raised anxiety. Factors predictive of raised state anxiety at time 2 were examined using logistic regression analysis.

RESULTS

Three hundred fifteen participants completed both surveys. The prevalence of raised state anxiety at time 1 (50%) and time 2 (51%) was similar. Most patients reported persistent raised anxiety (36%) and persistent low anxiety (34%) over time. Fewer patients reported increasing anxiety (15%) and decreasing anxiety (14%). Raised state anxiety (odds ratio, 4.84; 95% confidence interval, 2.48-9.48) and lower reported health status (odds ratio, 2.48; 95% confidence interval, 1.11-5.51) at time 1 were significantly associated with greater odds of raised anxiety at time 2.

CONCLUSIONS

Raised state anxiety related to medical imaging procedures is common among outpatients. Half of patients either developed or continued to experience raised anxiety after their procedures. Outpatients may benefit from evidence-based methods of alleviating anxiety before their procedures.

Individual and Contextual Variables as Predictors of MRI-Related Perceived Anxiety

BACKGROUND

Magnetic resonance imaging (MRI) generates patient anxiety (PA) and, therefore, it is important to understand individual and contextual variables that may cause it. In study one, we explored those anxiety predictors. In study two, we examined the effect of the experience of MRI on PA comparing anxiety pre- to post-MRI.

METHODS

PA was measured with an anxiety and stress scale in an interview format. Data collection occurred at a public hospital with MRI outpatients aged 18 or older. In study one (n = 204), participants answered the questionnaire immediately after experiencing the MRI and the data were analyzed through structural equation modeling. In study two (n = 242), participants answered the questionnaire before and after the examination and the data were analyzed through Bayesian statistics.

RESULTS

Being female, having a higher education level (EL), and not receiving information about the examination predicts higher PA after MRI. Patients with prior information have a decrease in PA from pre- to post-MRI. Those who do not have no change in PA. In low-educated patients, PA also decreases and no changes occur in highly educated patients.

CONCLUSION

This study provides health professionals with valuable indicators about patients who are more likely to perceive and express anxiety during MRI.

Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial

INTRODUCTION

This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups.

METHODS

A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination.

RESULTS

Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time.

CONCLUSION

Access to 360°VCE can reduce patients' pre-CCTA anxiety levels.

IMPLICATIONS FOR PRACTICE

The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.

Audiovisual intervention alleviates anxiety of patients during PET/CT imaging

AIM

to assess if the use of an audiovisual intervention in the uptake room and/or in the scanning room, could help to reduce anxiety during [18F]FDG PET/CT imaging.

METHODS

We prospectively studied 120 patients referred for [18F]FDG PET/CT imaging. Patients were allocated in 4 groups of 30 patients depending on the use of the audiovisual intervention: (1) no audiovisual intervention; (2) audiovisual intervention only in the uptake room; (3) audiovisual intervention only in the scanning room; (4) audiovisual intervention in the uptake and the scanning rooms. In order to measure the anxiety levels of the patients before and after the scan, all patients answered the State-Trait Anxiety Inventory (STAI).

RESULTS

The anxiety status across typical situations on a daily basis (STAI-T) of the 4 groups of patients was comparable with no significant differences. The mean State Anxiety (STAI-S) sum-score at prescan and postscan among groups was: (1) 17.5±8.7 vs. 17.3±8.6, p=0.834; (2) 17.4±10.5 vs. 15.8±9.6, p=0.110; (3) 17.5±11.7 vs. 15.1±9.8, p= 0.013; (4) 17.4±9.7 vs. 14.9±8.1, p= 0.009. The percentage of patients with reduction of the STAI-S score among groups 1-4 was 17%, 47%, 50%, and 66%, respectively. The variation of the percentage of patients with lower scores after intervention among groups was statistically significant (p<0.001).

CONCLUSION

Audiovisual intervention decreases anxiety levels of patients referred for PET/CT imaging. The results of our study support a beneficial effect of the audiovisual intervention and its potential to alleviate the anxiety of oncological patients who undergo a PET/CT scan.

A survey study investigating perceptions and acceptance of the whole-body imaging techniques used for the diagnosis of myeloma

INTRODUCTION

The purpose of this study was to investigate patient perceptions and acceptance of the three whole-body imaging (WBI) modalities used for diagnosing myeloma; radiographic skeletal survey (RSS), low-dose whole-body computed tomography (LD-WBCT) and whole-body magnetic resonance imaging (WB-MRI). The secondary aim was to explore the factors affecting the acceptance of whole-body imaging for myeloma.

METHODS

60 participants (median age = 58.5 years old) recruited from three NHS trusts and social media completed a survey in which they scored their experiences of each WBI modality on nine 5-point rating scales. Spearman's correlation coefficient, Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were used to compare scores between different WBI techniques. Participants were invited to provide additional open text responses for interpretation using thematic analysis.

RESULTS

All modalities demonstrated high levels of acceptability (median score = 4). WB-MRI was perceived as more stressful (p=<0.01) and claustrophobic (p=<0.01) than RSS and LD-WBCT. Thematic analysis showed patients understood the importance of imaging but had concerns about exacerbated pain and the results. WB-MRI was difficult to tolerate due to its duration. Respondents were averse to the physical manipulation required for RSS while remaining stationary was perceived as a benefit of LD-WBCT and WB-MRI. Staff interactions had both positive and negative effects on acceptance.

CONCLUSIONS

Despite the psychological and physical burdens of WBI, patients accepted its role in facilitating diagnosis. Staff support is vital for facilitating a positive whole-body imaging experience. Healthcare practitioners can improve WBI acceptance by understanding the burdens imposed by WBI and adopting the personalised care model.

IMPLICATIONS FOR PRACTICE

Patient experience can be improved by tailoring examinations to individual needs. RSS can be as burdensome as other WBI techniques and could be superseded by LD-WBCT or WB-MRI.

Patients', radiographers' and radiography students' experiences of 360° virtual counselling environment for the coronary computed tomography angiography: A qualitative study

INTRODUCTION

The aim of this study was to describe patients', radiographers' and radiography students' experiences of the developed 360° virtual counselling environment (360°VCE) for the coronary computed tomography angiography (cCTA).

METHODS

A descriptive qualitative approach was used. The participants were cCTA patients (n = 10), radiographers (n = 10) and radiography students (n = 10) who used the 360°VCE and visited or worked at a university hospital in Finland. The 360°VCE, resembling the authentic environments of a CT imaging unit, included digital counselling materials in text, image, animation and video formats. Data were gathered through thematic interviews individually to obtain an understanding of participants' perspectives and analyzed by inductive content analysis.

RESULTS

Five main categories and 15 categories were identified. Identified benefits of the 360°VCE for patients included improvements in knowledge, spatial and environmental orientation, and senses of security and self-efficacy, with reductions in fear and nervousness. Patients found the counselling materials engaging, and that the 360° technology conveniently provided reassuring familiarity with the environment before their visit. Identified benefits for radiographers and radiography students included improvements in patients' mental preparedness, knowledge, spatial and environmental orientation, and reductions in patients' fear, which eased procedures and enhanced diagnostic success. The 360°VCE also provided useful information and familiarization with the cCTA unit for students during clinical practice and staff of referring units.  CONCLUSION: It seems that patients', radiographers' and radiography students' experiences of 360°VCE respond to patients' needs by improved knowledge and reduced fears. Thus, current counselling practices can be usefully complemented with spherical panoramic imaging technology and online information delivery.

IMPLICATIONS FOR PRACTICE

The results may be used to improve patient counselling and care, thereby optimizing the cCTA examination procedure and reducing fear. However, further research is needed to characterize experiences of the 360° VCE more comprehensively.

A systematic review of non-pharmacologic interventions to reduce anxiety in adults in advance of diagnostic imaging procedures

OBJECTIVES

Anticipation of a diagnostic imaging (DI) procedure, particularly one involving advanced technology, can provoke feelings of anxiety in patients. Anxiolytics (anxiety reducing drugs) can be used to reduce pre-procedural anxiety in patients, however there are several known disadvantages to this approach. The aim of this systematic review was to identify and evaluate any preparatory non-pharmacological interventions used to reduce patient anxiety in advance of DI procedures.

KEY FINDINGS

Database searches revealed twelve studies met the eligibility criteria and were included in the review. A narrative synthesis identified three intervention categories: patient information/education, cognitive strategies (i.e. guided imagery, breathing techniques, imaginative visualisation) and music therapy.

CONCLUSION

The current review demonstrates that despite the existence of a number of studies providing some evidence for the effectiveness of a range of anxiety reducing interventions for patients prior to DI, the small number and overall low quality of studies identified makes it difficult to draw firm conclusions regarding the application of a specific intervention in clinical practice.

IMPLICATIONS FOR PRACTICE

The majority of interventions included in this review were shown to be practical for inclusion in the clinical setting and did have some positive effect on patient anxiety levels. As a result those professionals working with adults undergoing advanced technology DI procedures may consider implementing some of the strategies that have been discussed within their practice.

Use of video-based multimedia information to reduce anxiety before office hysteroscopy

Introduction

Use of multimedia tools has been shown to improve patient comprehension, reduce pre-procedural anxiety, and increase patient satisfaction in various surgical settings.

Aim

To investigate the impact of video-based multimedia information (MMI) on the anxiety levels of patients undergoing office hysteroscopy (OH).

Material and methods

All consecutive women aged 18–65 years and scheduled for diagnostic OH were enrolled in this prospective randomized study. Subjects were assigned to receive video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after application of the MMI or written information. All patients underwent a standardized transvaginal hysteroscopy procedure by the same gynecologist. Following the hysteroscopy, patient satisfaction and procedural pain were ranked using a Likert scale and visual analogue scale.

Results

Fifty-two patients were randomized to receive a video-based MMI, and 52 patients were randomized to receive written information. Post-information STAI-S score was significantly lower in the MMI group than that of the written information group (45.0 ±8.0 vs. 49.4 ±8.4, p < 0.001, 95% CI for the difference: 1.36–7.79). Moreover, the satisfaction rate of the video group was significantly higher than the satisfaction rate of the controls (92.3% vs. 63.5%, p < 0.001). VAS score of procedural pain was similar for the two groups.

Conclusions

A video-based MMI before OH might be preferred to conventional information methods in order to reduce the pre-procedural anxiety and to increase patients’ satisfaction.

Mitigating clinical waste in the trauma intensive care unit: Limited clinical utility of cardiac troponin testing for trauma patients with atrial fibrillation

BACKGROUND

The clinical significance of obtaining cardiac troponin (cTn) levels among trauma patients with new onset arrhythmias is unknown. We aimed to assess whether cTn levels actually influence clinical decision making or represent an inappropriate use of resources.

METHODS

Trauma patients admitted from 2013 to 2014 diagnosed with atrial fibrillation (AF) were retrospectively reviewed using the institutional trauma database. Demographics, cTn levels, and myocardial infarction (MI) diagnosis data were recorded. Standard univariate tests were used to compare data between patients with and without cTn.

RESULTS

There were 258 patients included of which 126 patients had cTn levels obtained (48.8%, TEST group). The remaining 132 patients (51.2%) were untested (noTEST group). Among TEST patients, use of echocardiography nearly doubled and cardiology consultations increased (all p < 0.05). No TEST patients suffered MI or PE.

CONCLUSIONS

Obtaining cTn values in trauma patients with new-onset AF resulted in increased resource utilization without clinical utility.

Medical Imaging Outpatients' Experiences With Receiving Information Required for Informed Consent and Preparation: A Cross-Sectional Study

BACKGROUND

Medical imaging outpatients often experience inadequate information provision and report high levels of anxiety. However, no studies have assessed patients' receipt of preparatory information in this setting.

OBJECTIVE

To examine medical imaging outpatients' perceived receipt or non-receipt of preparatory information from health professionals and imaging department staff prior to their procedure.

METHOD

Computed tomography and magnetic resonance imaging outpatients at one Australian hospital self-completed a touchscreen computer survey assessing their perceived receipt of 33 guideline-recommended preparatory information items.

RESULTS

Of 317 eligible patients, 280 (88%) consented to participate. Eight percent (95% confidence interval: 5%-12%) of participants reported receiving all information items. The median number of information items not received was 18 (interquartile range: 8-25). Items most frequently endorsed as "not received" were: how to manage anxiety after (74%) and during the scan (69%). Items most commonly endorsed as "received" were: reason for referral (85%) and how to find the imaging department (74%).

CONCLUSION

Few medical imaging outpatients recalled receiving recommended preparatory information. Preparatory communication needs to be improved to better meet patient-centered service imperatives.

Prevalence and correlates of patient-centred preparatory information provision to computed tomography and magnetic resonance imaging outpatients: A cross-sectional study

OBJECTIVE

Responsiveness to information preferences is key to high-quality, patient-centred care. This study examined the top ten preparatory information items not delivered in accordance with medical imaging outpatients' preferences, and patient characteristics associated with reporting a greater number of unmet information preferences.

METHODS

Magnetic resonance imaging and computed tomography outpatients were recruited consecutively in one major public hospital waiting room. Participants self-administered a touchscreen computer questionnaire assessing their sociodemographic and scan characteristics, and unmet preferences for 33 guideline-endorsed preparatory information items.

RESULTS

Of 317 eligible patients, 280 (88%) consented to participate. Given equal rankings, the top ten unmet information preferences included 13 items which were endorsed by at least 25% of participants, and commonly related to receiving 'too little' information. One item related to the pre-scan period, seven items to the scan period and five items to the post-scan period. None of the patient characteristics examined were significantly associated with reporting a greater number of unmet information preferences.

CONCLUSION

There is room to improve responsiveness to medical imaging outpatients' preparatory information preferences. Improvements should be targeted at individuals, rather than groups defined by sociodemographic or scan characteristics.

PRACTICE IMPLICATIONS

A standardised approach to addressing individual patient's information preferences is needed.

Managing discomfort and developing participation in non-emergency MRI: Children's coping strategies during their first procedure

INTRODUCTION

Building on existing work, this paper aims to develop a detailed analysis of the practical coping strategies developed by children who had not previously experienced an MRI, regarding a non-emergency examination of the brain.

METHODS

Semi-structured interviews with 22 children, aged between eight and sixteen years, were conducted immediately post-procedure. Emergent data were thematically analysed in line with the core precepts of Grounded Theory, and triangulated against interview data with their parents where pertinent.

RESULTS

The primary concern among interviewees related to how they had coped with the discomfort of an unfamiliar medical procedure; this was recurrently managed through a process herein termed Participation Development. This comprised three phases. The first, preparative participation, describes the children's reported attempts to ready themselves for the examination (with parents) ahead of arriving in hospital. The second, enabling participation, describes how the children (with input from parents and radiographers) endeavoured to understand what was to come, and select viable distraction techniques. Finally, sustaining participation describes the children's reports of actualizing their preparations during the examination itself. Where the overall process of participation development was successful, the children reported a sense of mastery, growth and even joy.

CONCLUSION

While much work in the domain portrays children as relatively 'passive' agents during an MRI procedure, the findings herein point to how they can (with varying degrees of success) actively and constructively work with others. This, it is contended, has direct import for the improvement of support, both prior to and within a procedure itself.

Perceived patient burden and acceptability of whole body MRI for staging lung and colorectal cancer; comparison with standard staging investigations

Objective:

To evaluate perceived patient burden and acceptability of whole body MRI (WB-MRI) compared to standard staging investigations, and identify predictors of reduced tolerance.

Methods:

Patients recruited to multicentre trials comparing WB-MRI with standard staging scans for lung and colorectal cancer were invited to complete two questionnaires: a baseline questionnaire at recruitment, measuring demographics, comorbidities, and distress; and a follow-up questionnaire after staging, measuring recovery time, comparative acceptability/satisfaction between WB-MRI and CT (colorectal cancer) and PET-CT (lung cancer), and perceived scan burden (scored 1, low; 7, high). 

Results:

115 patients (median age 66.3 years; 67 males) completed follow up and 103 baseline questionnaires. 69 (63.9%) reported “immediate” recovery from WB-MRI and 73 (65.2%) judged it “very acceptable”. Perceived WB-MRI burden was greater than for CT (p < 0.001) and PET-CT (p < 0.001). High distress and comorbidities were associated with greater WB-MRI burden in adjusted analyses, with deprivation only approaching significance (adjusted regression β = 0.223, p = 0.025; β = 0.191, p = 0.048; β = −0.186, p = 0.059 respectively). Age (p = 0.535), gender (p = 0.389), ethnicity (p = 0.081) and cancer type (p = 0.201) were not predictive of WB-MRI burden.

Conclusion:

 WB-MRI is marginally less acceptable and more burdensome than standard scans, particularly for patients with pre-existing distress and comorbidities. 

Advances in knowledge:

This research shows that WB-MRI scan burden, although low, is higher than for current staging modalities among patients with suspected colorectal or lung cancer. Psychological and physical comorbidities adversely impact on patient experience of WB-MRI. Patients with high distress or comorbid illness may need additional support to undergo a WB-MRI.

General anaesthesia for patients with a history of a contrast medium-induced anaphylaxis: a useful prophylaxis?

Contrast-enhanced radiological examinations are important diagnostic tools in modern medicine. Currently, all approved and available iodinated and gadolinium-based contrast agents are safe and well-tolerated by most patients. However, approximately 2% of patients receiving iodinated contrast media exhibit hypersensitivity reactions. Patients with a history of such a reaction are at increased risk upon reexposure. Therefore, they are subjected to a prophylaxis such as injection of antiallergy drugs or general anaesthesia. The latter procedure is expensive, can burden the patients organism, and besides lacks objective verification. Therefore, the purpose of our review paper is to present and discuss the background and the previous practice, as well as to provide a proposal for a safe individual patient management.

Effect of patient anxiety on image motion artefacts in CBCT

BACKGROUND

Artefacts in images related to patient movement decrease image quality, potentially necessitating re-scanning, which leads to an extra radiation dose for the patient. Thus, avoiding patient motion reduces patient exposure to radiation. The aim of this study was to analyse image motion artefacts (MAs) and how they are affected by patient anxiety during cone beam computed tomography (CBCT) examination.

METHODS

A total of 100 patients undergoing CBCT examination were investigated. The State Trait Anxiety Inventory (STAI-S and STAI-T) form was used to measure patient anxiety. Patient's age, gender, dental anxiety score, diagnostic reason for CBCT examination, field of view (FOV), acquisition time, anatomical area, and presence of motion artefacts on images were recorded. Comparisons of the parameters were evaluated using Pearson's correlation, the chi-square test, the Mann-Whitney U test, the Kruskal-Wallis test and t-tests. The significance level was set at 0.05.

RESULTS

The mean values of the scores for the total population were 37.2 for the STAI-S and 41.6 for the STAI-T. Women exhibited higher anxiety levels than men. The patients' anxiety scores were significantly correlated with dental fear. The prevalence of patients showing motion artefacts was 6%. The mean age of patients with motion artefacts on their images (56.83) was higher than that of patients without (39.14). There was no relationship between motion artefact presence and patient gender, anxiety score, diagnostic reason for CBCT examination, FOV, acquisition time, or anatomical area. Patients showing motion artefacts on their images had higher STAI scores than those with no motion artefacts (non-significant).

CONCLUSIONS

The population in this study experienced anxiety before CBCT scanning. Excessive anxiety did not clearly affect whether image motion artefacts were generated during CBCT examination, although a non-significant increase in STAI scores was noticed in patients with motion artefacts on their images.

Developing and testing an electronic literacy resource for Arab patients before experiencing radiology procedures

BACKGROUND

Radiological examinations require prior preparation that patients should be informed about. Radiologists and radiologic technologists have limited time and resources to do so. Therefore, the internet is a valuable and accessible resource for patient education, but the information may not be reliable, especially that in Arabic language. This study aimed to develop online patient education resources about imaging procedures in Arabic. It also evaluated the understandability and actionability of the source materials.

MATERIALS AND METHODS

The study was conducted at the University of Sharjah between October 2014 and July 2015. A website containing texts and audiovisuals for 21 medical imaging procedures was created. Bilingual (Arabic and English) radiology experts evaluated the materials with automatic score calculation using the Patient Education Materials Assessment Tool. Two procedures were pilot tested by one evaluator, followed by completion of 28 evaluations by 15 selected experts.

RESULTS

Nineteen of 21 procedures were randomly evaluated. For printable materials, the mean understandability score was 92.37 (SD=8.355) and actionability score was 92.11 (SD=13.157). For audiovisual materials, the mean understandability score was 97.63 (SD=13.157) and the percentage for all actionability scores was 100%. The minimum acceptable percentage is 70%.

CONCLUSION

The high percentages scored for the online materials indicate that the evaluators were satisfied with the materials included and that the information would be easy for patients to understand and follow. The higher scores for the audiovisual materials indicate that they were considered more effective for improving patient knowledge patient knowledge.

Clinical Efficacy, Safety, and Feasibility of Using Video Glasses during Interventional Radiologic Procedures: A Randomized Trial

PURPOSE

To evaluate the clinical efficacy, safety, and feasibility of implementing video glasses in a variety of interventional radiologic (IR) procedures.

MATERIALS AND METHODS

Between August 2012 and August 2013, 83 patients undergoing outpatient IR procedures were randomized to a control group (n = 44) or an experimental group outfitted with video glasses (n = 39). State-Trait Anxiety Inventory (STAI) scores, sedation and analgesia doses, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pain scores, and procedure times were obtained. Complications and adverse events related to the use of video glasses were recorded. Postprocedural staff surveys and patient satisfaction surveys were completed.

RESULTS

Women had greater preprocedural anxiety than men (P = .0056), and patients undergoing vascular interventions had greater preprocedural anxiety than those undergoing nonvascular interventions (P = .0396). When assessed after the procedure, patients who wore video glasses had significantly reduced levels of anxiety (-7.7 vs -4.4, respectively; P = .0335) and average MAP (-6.3 vs 2.1, respectively; P = .0486) compared with control patients. There was no significant difference in amount of sedation and analgesia, HR, RR, pain score, or procedure time between groups. No significant adverse events related to the use of video glasses were observed. Postprocedural surveys showed that video glasses were not distracting and did not interfere or pose a safety issue during procedures. Patients enjoyed using the video glasses and would use them again for a future procedure.

CONCLUSIONS

Video glasses can be safely implemented during IR procedures to reduce anxiety and improve a patient's overall experience.

Anxiety at outpatient hysteroscopy

This review summarises current understanding and research on the association between anxiety and outpatient hysteroscopy. Women undergoing hysteroscopy suffer from significant levels of anxiety, with repercussions on pain perception, success rates and satisfaction. Using validated tools such as the Spielberger State-Trait Anxiety Index (STAI) or the Hospital Anxiety and Depression Scale (HADS) in the outpatient hysteroscopy setting, average state anxiety scores similar or greater than those measured before more invasive procedures under general anaesthesia have been consistently reported. This clearly suggests a significant gap between our clinical viewpoint of what is "minimally invasive" and patients' expectations. In spite of its potential role of confounder in studies on pain-reduction interventions, we found that patient anxiety was evaluated in only 9 (13 %) out of a sample of 70 randomised controlled trials on outpatient hysteroscopy published since 1992. Factors such as trait anxiety, age, indication and the efficiency of the clinic can be correlated to state anxiety before hysteroscopy, but more robust data are needed. Promising non-pharmacological interventions to reduce anxiety at hysteroscopy include patient education, communication through traditional or multimedia approaches, interaction and support during the procedure and music listening.