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Sutherland R, Gross CP, Ma X, Jeong F, Seibert TM, Cooperberg MR, Catalona WJ, Ellis SD, Loeb S, Schulman‐Green D, Leapman MS. 'It Just Makes Sense to Me': A qualitative study exploring patient decision-making and experiences with prostate MRI during active surveillance for prostate cancer. BJUI COMPASS 2024; 5:593-601. [PMID: 38873351 PMCID: PMC11168777 DOI: 10.1002/bco2.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Although prostate magnetic resonance imaging (MRI) is commonly used in the diagnosis, staging and active surveillance of prostate cancer, little is known about patient perspectives on MRI. Methods We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- and intermediate-risk prostate cancer managed with active surveillance. Interviews focused on experiences with and knowledge of prostate MRI and MRI-ultrasound fusion biopsy during active surveillance. We purposively sampled patients who received prostate MRI as part of their clinical care, conducted interviews until reaching thematic saturation and performed conventional content analysis to analyse data. Results Twenty patients aged 51-79 years (mean = 68 years) participated in the study. At diagnosis, 17 (85%) had a Gleason grade group 1, and three (15%) had a grade group 2 tumour. Overall, participants viewed prostate MRI as a valuable tool that accurately localizes and monitors prostate cancer over time, and they considered prostate MRI central to active surveillance monitoring. We identified five thematic categories related to MRI use: (1) the experiential aspects of undergoing an MRI scan; (2) the experience of visualizing one's own prostate and prostate cancer; (3) adequacy of provider explanations of MRI results; (4) confidence in prostate MRI in decision-making; and (5) the role of prostate MRI in longitudinal follow-up, including an interest in using MRI to modify the timing of, or replace, prostate biopsy. Conclusion Patients value prostate MRI as a tool that enhances their confidence in the initial diagnosis and monitoring of prostate cancer. This work can inform future studies to optimize patient experience, education and counselling during active surveillance for prostate cancer.
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Affiliation(s)
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Farah Jeong
- Yale School of Public HealthNew HavenConnecticutUSA
| | - Tyler M. Seibert
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of BioengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Matthew R. Cooperberg
- Department of UrologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - William J. Catalona
- Department of UrologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Shellie D. Ellis
- Department of Population Health Kansas University Medical CenterKansas CityKansasUSA
| | - Stacy Loeb
- Departments of Urology and Population HealthNew York University Langone HealthNew YorkUSA
- Manhattan Veterans Affairs Medical CenterNew YorkNew YorkUSA
| | | | - Michael S. Leapman
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Department of UrologyYale School of MedicineNew HavenConnecticutUSA
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2
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Nohava L, Czerny R, Tik M, Wurzer D, Laistler E, Frass-Kriegl R. Citizen science approach to assessing patient perception of MRI with flexible radiofrequency coils. Sci Rep 2024; 14:2811. [PMID: 38307928 PMCID: PMC10837436 DOI: 10.1038/s41598-024-53364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Abstract
Magnetic Resonance Imaging (MRI) is a major medical imaging modality, which is non-invasive and provides unique soft tissue contrast without ionizing radiation. The successful completion of MRI exams critically depends on patient compliance, and, thus patient comfort. The design, appearance and usability of local MRI radiofrequency (RF) coils potentially influences the patients' perception of the exam. However, systematic investigations and empirical evidence for these aspects are missing. A questionnaire specifically evaluating the impact of RF coils on patient comfort in MRI would be a valuable addition to clinical studies comparing the performance of novel flexible RF coils with standard rigid coils. This paper describes the development of such a questionnaire in the scope of a citizen science (CS) initiative conducted with a group of students at the upper secondary school level. In this work, the CS initiative is presented in the format of a case report and its impact on scientific projects and the students' education is outlined. The resulting questionnaire is made available in German and English so as to be directly applicable by researchers working on the clinical evaluation of novel RF coils or the comfort evaluation of specific hardware setups in general.
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Affiliation(s)
- Lena Nohava
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Raphaela Czerny
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Martin Tik
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Dagmar Wurzer
- Bundes(real)gymnasium BG/BRG Keimgasse, Mödling, Austria
| | - Elmar Laistler
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Roberta Frass-Kriegl
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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Madl JEM, Nieto Alvarez I, Amft O, Rohleder N, Becker L. The Psychological, Physiological, and Behavioral Responses of Patients to Magnetic Resonance Imaging (MRI): A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2024; 59:675-687. [PMID: 37990634 DOI: 10.1002/jmri.29134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND MRI is generally well-tolerated although it may induce physiological stress responses and anxiety in patients. PURPOSE Investigate the psychological, physiological, and behavioral responses of patients to MRI, their evolution over time, and influencing factors. STUDY TYPE Systematic review with meta-analysis. POPULATION 181,371 adult patients from 44 studies undergoing clinical MRI. ASSESSMENT Pubmed, PsycInfo, Web of Science, and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality appraisal was conducted with the Joanna Briggs Institute critical appraisal tools. Meta-analysis was conducted via Meta-Essentials workbooks when five studies were available for an outcome. Psychological and behavioral outcomes could be analyzed. Psychological outcomes were anxiety (State-Trait-Anxiety Inventory, STAI-S; 37) and willingness to undergo MRI again. Behavioral outcomes included unexpected behaviors: No shows, sedation, failed scans, and motion artifacts. Year of publication, sex, age, and positioning were examined as moderators. STATISTICAL TESTS Meta-analysis, Hedge's g. A P value <0.05 was considered to indicate statistical significance. RESULTS Of 12,755 initial studies, 104 studies were included in methodological review and 44 (181,371 patients) in meta-analysis. Anxiety did not significantly reduce from pre- to post-MRI (Hedge's g = -0.20, P = 0.051). Pooled values of STAI-S (37) were 44.93 (pre-MRI) and 40.36 (post-MRI). Of all patients, 3.9% reported unwillingness to undergo MRI again. Pooled prevalence of unexpected patient behavior was 11.4%; rates for singular behaviors were: Failed scans, 2.1%; no-shows, 11.5%; sedation, 3.3%; motion artifacts, 12.2%. Year of publication was not a significant moderator (all P > 0.169); that is, the patients' response was not improved in recent vs. older studies. Meta-analysis of physiological responses was not feasible since preconditions were not met for any outcome. DATA CONCLUSION Advancements of MRI technology alone may not be sufficient to eliminate anxiety in patients undergoing MRI and related unexpected behaviors. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Janika E M Madl
- Chair of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Siemens Healthcare GmbH, Erlangen, Germany
| | - Isabel Nieto Alvarez
- Siemens Healthcare GmbH, Erlangen, Germany
- Chair of Digital Health, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Intelligent Embedded Systems Lab, University of Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Amft
- Chair of Digital Health, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Intelligent Embedded Systems Lab, University of Freiburg, Freiburg im Breisgau, Germany
- Hahn-Schickard, Freiburg im Breisgau, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Linda Becker
- Chair of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Humanwissenschaftliche Fakultät, Vinzenz Pallotti University, Vallendar, Germany
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Fraga Rivas P, de Miguel Criado J, García Del Salto Lorente L, Gutiérrez Velasco L, Quintana Valcarcel P. Patient safety in magnetic resonance imaging. RADIOLOGIA 2023; 65:447-457. [PMID: 37758335 DOI: 10.1016/j.rxeng.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/29/2023] [Indexed: 10/03/2023]
Abstract
Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.
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Affiliation(s)
- P Fraga Rivas
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain.
| | - J de Miguel Criado
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L García Del Salto Lorente
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L Gutiérrez Velasco
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - P Quintana Valcarcel
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
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Platon A, Constantin C, Zamorani Bianchi MP, Becker M, Vallée JP, Challande P, Rubbia-Brandt L, Poletti PA. Early MRI termination with major impact on the radiological interpretation: The experience of a large university hospital. Eur J Radiol 2023; 161:110751. [PMID: 36893680 DOI: 10.1016/j.ejrad.2023.110751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To report the incidence of early magnetic resonance imaging (MRI) terminations and analyse their risk factors in a large university hospital. METHOD All consecutive patients aged > 16 years who underwent an MRI over a 14-month period were included. The following parameters were collected: demographics, in- or outpatient, history of claustrophobia, anatomical region investigated, and early MRI termination along with its cause. The potential link between these parameters and early MRI termination was statistically analysed. RESULTS Overall, 22,566MRIs were performed (10,792 [48%] men and 11,774[52%] women, mean age: 57 [range: 16-103] years). Early MRI termination was reported in 183 (0.8%) patients (99 men and 84 women, mean age: 63 years). Of these early terminations, 103 (56%) were due to claustrophobia and 80 (44%) to other causes. Early terminations were more common in inpatients than outpatients (1.2% vs. 0.6%, p < 0.001), for both claustrophobia- and non-claustrophobia-related reasons. A prior history of claustrophobia was strongly associated with claustrophobia-related early termination (6.6% vs. 0.2%, p = 0.0001). Non-claustrophobia-related early terminations were significantly more common (0.6% vs. 0.2%) in elderly patients (>65 years old) than in younger ones. No other parameter was significantly associated with early termination. CONCLUSIONS Early MRI termination is currently rare. The main risk factors for claustrophobia-related terminations comprised a prior history of claustrophobia, and examinations in inpatients. Non-claustrophobia-related early terminations were more common in both elderly patients and inpatients.
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Affiliation(s)
- Alexandra Platon
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Constantin
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | | | - Minerva Becker
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Vallée
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Pascal Challande
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
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Greenberg JK, Frumkin MR, Javeed S, Zhang JK, Dai R, Molina CA, Pennicooke BH, Agarwal N, Santiago P, Goodwin ML, Jain D, Pallotta N, Gupta MC, Buchowski JM, Leuthardt EC, Ghogawala Z, Kelly MP, Hall BL, Piccirillo JF, Lu C, Rodebaugh TL, Ray WZ. Feasibility and Acceptability of a Preoperative Multimodal Mobile Health Assessment in Spine Surgery Candidates. Neurosurgery 2023; 92:538-546. [PMID: 36700710 PMCID: PMC10158869 DOI: 10.1227/neu.0000000000002245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Rapid growth in smartphone use has expanded opportunities to use mobile health (mHealth) technology to collect real-time patient-reported and objective biometric data. These data may have important implication for personalized treatments of degenerative spine disease. However, no large-scale study has examined the feasibility and acceptability of these methods in spine surgery patients. OBJECTIVE To evaluate the feasibility and acceptability of a multimodal preoperative mHealth assessment in patients with degenerative spine disease. METHODS Adults undergoing elective spine surgery were provided with Fitbit trackers and sent preoperative ecological momentary assessments (EMAs) assessing pain, disability, mood, and catastrophizing 5 times daily for 3 weeks. Objective adherence rates and a subjective acceptability survey were used to evaluate feasibility of these methods. RESULTS The 77 included participants completed an average of 82 EMAs each, with an average completion rate of 86%. Younger age and chronic pulmonary disease were significantly associated with lower EMA adherence. Seventy-two (93%) participants completed Fitbit monitoring and wore the Fitbits for an average of 247 hours each. On average, participants wore the Fitbits for at least 12 hours per day for 15 days. Only worse mood scores were independently associated with lower Fitbit adherence. Most participants endorsed positive experiences with the study protocol, including 91% who said they would be willing to complete EMAs to improve their preoperative surgical guidance. CONCLUSION Spine fusion candidates successfully completed a preoperative multimodal mHealth assessment with high acceptability. The intensive longitudinal data collected may provide new insights that improve patient selection and treatment guidance.
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Affiliation(s)
- Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Madelyn R. Frumkin
- Department of Psychology and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Justin K. Zhang
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ruixuan Dai
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Camilo A. Molina
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Brenton H. Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Paul Santiago
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Matthew L. Goodwin
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Deeptee Jain
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Nicholas Pallotta
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Munish C. Gupta
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jacob M. Buchowski
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Eric C. Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Zoher Ghogawala
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Michael P. Kelly
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Bruce L. Hall
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jay F. Piccirillo
- Department of Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Chenyang Lu
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Thomas L. Rodebaugh
- Department of Psychology and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Shimokawa K, Matsumoto K, Yokota H, Kobayashi E, Hirano Y, Masuda Y, Uno T. Anxiety relaxation during MRI with a patient-friendly audiovisual system. Radiography (Lond) 2022; 28:725-731. [PMID: 35428571 DOI: 10.1016/j.radi.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Many patients experience anxiety, not limited to claustrophobia, before magnetic resonance imaging (MRI) examination. We performed a non-randomized controlled trial to evaluate whether a patient-friendly audiovisual (AV) system in the MR scanner room reduces patient anxiety. METHODS We randomly selected 61 participants from outpatients who required brain MRI examination. Patients were informed that they could choose to undergo an MRI examination with a patient-friendly AV system (Ambient Experience, Philips Healthcare, Best, The Netherlands) or the standard system. To complete the MRI examination without affecting clinical practice, all patients who preferred the patient-friendly AV system were assigned to the preferring AV group. Patients who indicated that either system was acceptable were randomly assigned to the no preference but allocated AV group or control (using the standard system) groups. In both groups, state anxiety using the State-Trait Anxiety Inventory (STAI) was assessed before and after the MRI examination (A-State-before and A-State-after MRI, respectively). The changes in A-State-before and A-State-after MRI were categorized as follows: relieved high-state anxiety, no change in high-state anxiety, stable easiness, and intensified anxiety. RESULTS Among the 61 included patients, 19 were assigned to the preferring AV group, 20 to the no preference but allocated AV group, and 22 to the control group. There were no significant differences between the group. However, in patients with high-state anxiety before MRI, the preferring AV group and the no preference but allocated AV group, which used the patient-friendly AV system, relieved high-state anxiety by 63.6% (7 of 11 patients) and 81.8% (9 of 11 patients), respectively. In contrast, the control group using the standard system relieved high-level anxiety by only 42.9% (three out of seven patients). CONCLUSION The patient-friendly AV system may reduce anxiety in patients undergoing MRI examinations. IMPLICATIONS FOR PRACTICE The patient-friendly AV system may reduce anxiety in patients undergoing MRI examination by providing a more patient-centered MRI examination environment. These findings may help ameliorate negative perceptions associated with MRI examination.
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Affiliation(s)
- K Shimokawa
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan.
| | - K Matsumoto
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan.
| | - H Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.
| | - E Kobayashi
- Department of Neurosurgery, National Hospital Organization Chiba Medical Center, 4-1-2 Tsubakihara, Chuo-ku, Chiba-shi, Chiba 260-8606, Japan.
| | - Y Hirano
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-0856, Japan.
| | - Y Masuda
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan.
| | - T Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.
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Multiparametric ultrasound versus multiparametric MRI to diagnose prostate cancer (CADMUS): a prospective, multicentre, paired-cohort, confirmatory study. Lancet Oncol 2022; 23:428-438. [DOI: 10.1016/s1470-2045(22)00016-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
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9
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Madl J, Janka R, Bay S, Rohleder N. MRI as a Stressor: The Psychological and Physiological Response of Patients to MRI, Influencing Factors, and Consequences. J Am Coll Radiol 2022; 19:423-432. [DOI: 10.1016/j.jacr.2021.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022]
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10
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Environnement lumineux et anxiété des patients en service d’IRM. PSYCHOLOGIE FRANCAISE 2021. [DOI: 10.1016/j.psfr.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Nadar SK, Daar S, Abdelmottaleb WA, Shaikh MM, Al Mahrouqi H, Al-Raiisi M, Hassan M, Al Rawahi B, Al Rahbi S. Abnormal diastolic function and Global longitudinal strain in patients with Thalassemia Major on long term chelation therapy. Int J Cardiovasc Imaging 2020; 37:643-649. [PMID: 32965605 DOI: 10.1007/s10554-020-02036-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
Cardiac complications are the major cause of mortality in patients with Thalassemia major (TM). Cardiac T2* MRI is currently the gold standard for assessing myocardial iron concentration. The aim of our study was to assess whether any echocardiographic parameter would correlate with these findings in patients well established on chelation therapy. This was a prospective study on patients with TM who are regularly followed in our clinic. Patients had a cardiac MRI and echocardiogram within 2 months of each other. Echo parameters included global longitudinal strain and diastolic function. We also compared these findings with those from a cohort of thalassemia intermedia (TI) and normal controls. A total of 84 patients (mean age 26.3 ± 6.1 years, 42.8% male) with TM were enrolled. All had normal left ventricular ejection fraction and only 8 patients had MRI T2* < 10. As compared to 17 patients with TI and 53 controls, these patients had significantly higher E/E' and lower pulmonary vein s/dd ratio suggesting early diastolic dysfunction. 28 patients fulfilled criteria for diastolic dysfunction even in the presence of normal MRI T2*. Global longitudinal strain (GLS) was significantly lower in the TM group as compared to the TI and controls. We found no correlation between any of the echo findings and the MRI T2*in TM patients. In patients with thalassemia and MRI T2* > 20 ms features of diastolic dysfunction persist even in the presence of normal LV function and normal GLS. This suggests that diastolic function remains abnormal even when myocardial iron concentrations are normal and follow up therefore is essential.
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Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman.
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre At Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Wael A Abdelmottaleb
- Department of Medicine, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Muhammad M Shaikh
- Department of Medicine, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Hafsa Al Mahrouqi
- Department of Clinical Physiology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Majida Al-Raiisi
- Department of Clinical Physiology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Moez Hassan
- Department of Hematology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Badar Al Rawahi
- Department of Hematology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Sarah Al Rahbi
- Department of Hematology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
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Bellhouse S, Brown S, Dubec M, Taylor S, Hales R, Whiteside L, Yorke J, Faivre-Finn C. Introducing magnetic resonance imaging into the lung cancer radiotherapy workflow - An assessment of patient experience. Radiography (Lond) 2020; 27:14-23. [PMID: 32451307 DOI: 10.1016/j.radi.2020.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/17/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) offers superior soft tissue contrast to computed tomography (CT), the current standard imaging modality for planning radiotherapy treatment. Improved soft tissue contrast could reduce uncertainties in identifying tumour and surrounding healthy tissues, potentially leading to improved outcomes in patients with lung cancer. This study explored patient experience of MR treatment planning scans in addition to a CT scan. METHODS Participants were recruited to the 'Magnetic Resonance Imaging for the Delineation of Organs At Risk and Target Volumes in Lung Cancer Patients (MR-Lung)' study at a UK specialist cancer centre. Participants completed their standard of care radiotherapy planning CT scan and two additional MRI scans. Baseline and post-scan questionnaires were completed assessing anxiety and claustrophobia. Motion artefact during MRI was assessed by a modified visual grading analysis. Sixteen participants completed semi-structured interviews; transcripts were analysed thematically. RESULTS 29 people (66% female; aged 54-89 years) participated. Nineteen participants completed all imaging and 10 participants withdrew before completion. There was minimal adverse impact on state and scan-specific anxiety levels from completing the MRI scans. Completers experienced significantly less scan-specific anxiety during MRI 1 compared to non-completers (U = 33, z = -1.98, p < 0.05). 78% of those who withdrew during or post MRI 1 were positioned 'arms up'. Motion artefact negatively impacted image quality in 34% of scans. Participants commonly reported concerns during MRI; noise, claustrophobia and pain in upper limbs. CONCLUSION Two thirds of participants tolerated two additional MR scans with minimal adverse impact on anxiety levels. IMPLICATIONS FOR PRACTICE Patient arm positioning and comfort ought to be considered when introducing MR-Linac systems. A screening tool to identify those at high risk of non-completion should be developed.
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Affiliation(s)
- S Bellhouse
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, UK.
| | - S Brown
- Department of Radiation Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, UK
| | - M Dubec
- Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - S Taylor
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, UK
| | - R Hales
- Radiotherapy Related Research, The Christie NHS Foundation Trust, UK
| | - L Whiteside
- Radiotherapy Related Research, The Christie NHS Foundation Trust, UK
| | - J Yorke
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, UK; Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, UK
| | - C Faivre-Finn
- Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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Is there a relationship between oxygen saturation and MRI-induced anxiety? A prospective study. Clin Imaging 2020; 60:147-152. [DOI: 10.1016/j.clinimag.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 01/10/2023]
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15
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Ahlander BM, Engvall J, Ericsson E. Anxiety during magnetic resonance imaging of the spine in relation to scanner design and size. Radiography (Lond) 2020; 26:110-116. [PMID: 32052788 DOI: 10.1016/j.radi.2019.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Magnetic resonance imaging in closed-bore scanners sometimes provokes anxiety but closed-bore designs have gradually become wider and shorter. Open scanners may be easier to tolerate. The aim was to compare patient anxiety during MRI between bore diameters of 60 cm and 70 cm, and to determine the current level of patient anxiety and experience in open scanners in a clinical setrting. METHODS Consecutive patients referred for examination of the spine in 60 cm and 70 cm bores and one open scanner participated. Four established/validated questionnaires, answered before, directly after (N = 155) and one week after (N = 109) the MRI-examination were used, measuring anxiety, fear and depression. RESULTS No difference was found in the patient scores of anxiety between the 60 cm and the 70 cm scanners on the examination day. At follow-up, patients in the 70 cm bore rated their examination experience better (p < 0.025), compared to patients in the 60 cm bore. Patients in the open scanner rated higher levels of anxiety (p < 0.001) before, directly after and one week after the examination, compared to the closed bore scanners. CONCLUSION Scanners with a 70 cm diameter bore seem more tolerable than those with a 60 cm bore. Patients referred to the open scanner had on average a higher tendency to express anxiety. Still, patient anxiety in MRI is challenging and further research required. IMPLICATIONS FOR PRACTICE Patients prefer to be examined in 70 cm bore scanners compared with 60 cm. If open scanners aren't available extended support may be necessary for the most anxious patients.
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Affiliation(s)
- B M Ahlander
- Ryhov County Hospital, SE-551 85 Jönköping, Sweden.
| | - J Engvall
- Department of Clinical Physiology, Linköping University, SE-581 83 Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, SE-581 83 Linköping, Sweden.
| | - E Ericsson
- Faculty of Medicine and Health, School of Health Science, Örebro University, SE-701 82 Örebro, Sweden.
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Taylor SA, Mallett S, Miles A, Morris S, Quinn L, Clarke CS, Beare S, Bridgewater J, Goh V, Janes S, Koh DM, Morton A, Navani N, Oliver A, Padhani A, Punwani S, Rockall A, Halligan S. Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health Technol Assess 2019; 23:1-270. [PMID: 31855148 PMCID: PMC6936168 DOI: 10.3310/hta23660] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN The design was a prospective multicentre cohort study. SETTING The setting was 16 NHS hospitals. PARTICIPANTS Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. LIMITATIONS Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. CONCLUSIONS In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment. TRIAL REGISTRATION Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Susan Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, and Priment Clinical Trials Unit, University College London, London, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Sutton, UK
| | - Alison Morton
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Alfred Oliver
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Anwar Padhani
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Andrea Rockall
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
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Can virtual reality simulation prepare patients for an MRI experience? Radiography (Lond) 2019; 26:205-213. [PMID: 32052767 DOI: 10.1016/j.radi.2019.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A Magnetic Resonance Imaging (MRI) examination is often described by patients as frightening and uncomfortable. To prepare patients for an MRI examination, this study explored the use of virtual reality (VR) simulation compared to a mock MRI scan (full-scale MRI machine replica, without internal magnets). METHODS Twenty participants underwent a VR and a mock MRI scan. Ratings of anxiety and how comfortable and relaxed the participants felt were recorded at five touchpoints during and after each simulation. Post-simulation questionnaires were used to gather responses on the experience and preferences. RESULTS No significant differences were found in participants' ratings of how anxious they felt during or between the two simulations (χ2 (9) = 27.269, p = .126), or how relaxed they felt (χ2 (9) = 14.664, p = .101). There were also no significant differences in the reported levels of comfort between the two types of simulation (χ2 (9) = 20.864, p = .013, post hoc tests for all VR versus mock scan rankings p > .05). There were no significant differences in how real the participants thought each simulation felt, or how anxious, relaxed, and comfortable they felt following each type of simulation (p > .05). Although 65% of participants thought the mock simulation felt more real than the VR, 86% found VR simulation to be a helpful way to prepare for a real MRI exam. CONCLUSION VR could be a feasible and accessible alternative to mock scanning. It has the potential to improve patient experiences of potentially stressful MRI examinations. IMPLICATIONS FOR PRACTICE VR offers clinicians a new cost-effective tool to prepare patients for an MRI examination. VR technology could be used at home, as a training tool, to familiarise clinicians and clinical trainees with the MRI procedure and better understand patients' experiences.
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Buckley JG, Rai R, Liney GP, Dowling JA, Holloway LC, Metcalfe PE, Keall PJ. Anatomical deformation due to horizontal rotation: towards gantry-free radiation therapy. ACTA ACUST UNITED AC 2019; 64:175014. [DOI: 10.1088/1361-6560/ab324c] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Phexell E, Åkesson A, Söderberg M, Bolejko A. Intra- and inter-rater reliability in a comparative study of cross-sectional and spiral computed tomography pelvimetry methods. Acta Radiol Open 2019; 8:2058460119855187. [PMID: 31218082 PMCID: PMC6560807 DOI: 10.1177/2058460119855187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022] Open
Abstract
Background Different low-dose computed tomography (CT) pelvimetry methods can be used to evaluate the size of birth canal before delivery. CT pelvimetry might generate an acceptable low fetal radiation dose but its measurement accuracy is unknown. Purpose To investigate intra- and inter-rater measurement reliability of cross-sectional and two spiral CT pelvimetry methods: standard spiral and short spiral. Material and Methods Ten individuals (age ≥60 years, body mass index ≥30 kg/m2) having a CT scan of the abdomen also had CT pelvimetry scans. Three radiologists made independent measurements of each pelvimetry method on two occasions and also in consensus for a reference pelvimetry computed from the standard-dose CT scan of the abdomen. Inter- and intra-rater reliability was analyzed by intraclass correlation coefficient. Results Measurements in the short spiral pelvimetry demonstrated excellent intra- and inter-rater reliability, intraclass correlation coefficient ≥0.93, and good to excellent 95% confidence interval 0.87–0.99. Corresponding results of the standard spiral and cross-sectional pelvimetry showed good to excellent intraclass correlation coefficient ≥0.85 and ≥0.76, and 95% confidence interval was least good and moderate 0.73–0.98 and 0.59–0.97, respectively. Intraclass correlation coefficient between reference pelvimetry and other CT methods showed analogous results. Conclusion The short spiral pelvimetry demonstrated high and best reliability in comparison to other methods. Standard spiral method showed also good measurement reliability but the short spiral pelvimetry generates lower fetal radiation dose. This method might be suitable for measurements at narrow pelvis. Patient acceptance and attitude to CT pelvimetry should be investigated.
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Affiliation(s)
- Erika Phexell
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Anna Åkesson
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Marcus Söderberg
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden.,Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Anetta Bolejko
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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House AV, Muthurangu V, Spanel AJ, Danford DA, Mir B, Schuster A, Hsu H, Kutty S. Can Abbreviated Cardiac Magnetic Resonance Imaging Adequately Support Clinical Decision Making After Repair of Tetralogy of Fallot? Pediatr Cardiol 2019; 40:616-622. [PMID: 30539240 DOI: 10.1007/s00246-018-2035-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/05/2018] [Indexed: 01/03/2023]
Abstract
Quantification of pulmonary regurgitation (PR), pulmonary flow distribution, and ventricular function is important for clinical surveillance in repaired Tetralogy of Fallot (TOF). Cardiovascular magnetic resonance (CMR) is the established reference, but cost, test duration, and patient discomfort are potential limitations to its serial use. We investigated whether an Abbreviated CMR protocol would alter clinical decisions in TOF from those that would have been made using a full protocol. Patients > 7 years with repaired TOF were identified. CMR was performed according to standard complete imaging protocol. CMRs were prepared in two ways, Full and Abbreviated and submitted for review by two imaging specialists. In conjunction with clinical information and case-specific quantitative CMR data (PR fraction, ventricular volumes, ejection fraction, branch pulmonary artery flow), Full and Abbreviated image sets were anonymized and uploaded for review. For the first half, Imager 1 received Abbreviated, and Imager 2 Full and for the remaining, Imager 1 received Full and Imager 2 received Abbreviated. Blinded to the other's choices, Imagers provided clinical decisions. Inter-rater agreement for each decision was measured. In all, 124 studies from 80 patients (mean 17.8 years) were analyzed. For 'intervention versus no-intervention' decision, the inter-rater agreement was strong [κ 0.75, p < 0.0001, 95% CI (0.630, 0.869)]. Agreement for recommended timing of follow-up imaging was good (κ 0.64, p < 0.0001, 95% CI (0.474, 0.811)] in the 'no-intervention' group. When raters were asked whether or not further imaging was necessary, agreement was modest [κ 0.363 (p < 0.0001), 95% CI (0.038, 0.687)]. In conclusion, Abbreviated CMR yield decisions for clinical care similar to those made using the standard full protocol. These results suggest a potential enhancement of clinical practice in which efficiency and cost saving might be achieved using Abbreviated CMR for routine follow-up surveillance of TOF.
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Affiliation(s)
- Aswathy Vaikom House
- Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, 8200 Dodge St, Omaha, NE, 68114, USA
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK
| | - Alan J Spanel
- Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, 8200 Dodge St, Omaha, NE, 68114, USA
| | - David A Danford
- Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, 8200 Dodge St, Omaha, NE, 68114, USA
| | - Bilal Mir
- Heart Imaging Technologies, Durham, NC, USA
| | | | - Hao Hsu
- Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, 8200 Dodge St, Omaha, NE, 68114, USA
| | - Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, 8200 Dodge St, Omaha, NE, 68114, USA.
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Capurso M, Rossetti C, Mutti L, Ciani A, Santangelo V. A low cost, volunteer-based program to prepare children to undergo magnetic resonance imaging without sedation. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1545581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michele Capurso
- Department of Philosophy, Social Sciences & Education, University of Perugia, Perugia, Italy
| | | | - Luca Mutti
- Department of Radiology, Città di Castello Hospital, Città di Castello (PG), Italy
| | | | - Valerio Santangelo
- Department of Philosophy, Social Sciences & Education, University of Perugia, Perugia, Italy
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
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22
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Evans RE, Taylor SA, Beare S, Halligan S, Morton A, Oliver A, Rockall A, Miles A. Perceived patient burden and acceptability of whole body MRI for staging lung and colorectal cancer; comparison with standard staging investigations. Br J Radiol 2018. [PMID: 29528257 PMCID: PMC6223281 DOI: 10.1259/bjr.20170731] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Ruth Ec Evans
- 1 Deparment of Psychological Sciences, Birkbeck, University of London , London , UK
| | - Stuart A Taylor
- 2 Division of Medicine, Centre for Medical Imaging, University College London , London , UK
| | - Sandra Beare
- 3 Cancer Research UK and UCL Cancer Trials Centre , London , UK
| | - Steve Halligan
- 2 Division of Medicine, Centre for Medical Imaging, University College London , London , UK
| | - Alison Morton
- 4 C/O National Cancer Research Institute, Angel Building , London , UK
| | - Alf Oliver
- 4 C/O National Cancer Research Institute, Angel Building , London , UK
| | - Andrea Rockall
- 5 Department of Surgery and Cancer, Imperial College London, Kensington , London , UK.,6 Department of Radiology, Royal Marsden NHS Foundation Hospital Trust , London , UK
| | - Anne Miles
- 1 Deparment of Psychological Sciences, Birkbeck, University of London , London , UK
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Parmar R, Brewer BB, Szalacha LA. Foot Massage, Touch, and Presence in Decreasing Anxiety during a Magnetic Resonance Imaging: A Feasibility Study. J Altern Complement Med 2018; 24:268-275. [DOI: 10.1089/acm.2016.0274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rajni Parmar
- College of Nursing, University of Arizona, Tucson, AZ
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ
| | | | - Laura A. Szalacha
- Research Methods and Statistics, College of Nursing, University of Arizona, Tucson, AZ
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Gossett EW, Wheelock MD, Goodman AM, Orem TR, Harnett NG, Wood KH, Mrug S, Granger DA, Knight DC. Anticipatory stress associated with functional magnetic resonance imaging: Implications for psychosocial stress research. Int J Psychophysiol 2018; 125:35-41. [PMID: 29454000 DOI: 10.1016/j.ijpsycho.2018.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/02/2017] [Accepted: 02/11/2018] [Indexed: 12/01/2022]
Abstract
Stress tasks performed during functional magnetic resonance imaging (fMRI) elicit a relatively small cortisol response compared to stress tasks completed in a traditional behavioral laboratory, which may be due to apprehension of fMRI that elicits an anticipatory stress response. The present study investigated whether anticipatory stress is greater prior to research completed in an MRI environment than in a traditional behavioral laboratory. Anticipatory stress (indexed by cortisol) was greater prior to testing in the MRI environment than traditional behavioral laboratory. Furthermore, anticipation of fMRI elicited a cortisol response commensurate with the response to the stress task in the behavioral laboratory. However, in the MRI environment, post-stress cortisol was significantly lower than baseline cortisol. Taken together, these findings suggest the stress elicited by anticipation of fMRI may lead to acute elevations in cortisol prior to scanning, which may in turn disrupt the cortisol response to stress tasks performed during scanning.
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Affiliation(s)
- Ethan W Gossett
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States
| | - Muriah D Wheelock
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States
| | - Adam M Goodman
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States
| | - Tyler R Orem
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States
| | - Nathaniel G Harnett
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States
| | - Kimberly H Wood
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California Irvine, United States; Johns Hopkins University School of Nursing, United States; Johns Hopkins University Bloomberg School of Public Health, United States; Johns Hopkins University School of Medicine, United States
| | - David C Knight
- Department of Psychology, University of Alabama at Birmingham, CIRC 235H, 1720 2nd Avenue South Birmingham, AL 35294, United States.
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Park YB, Ha CW, Jang JW, Kim M, Lee HJ, Park YG. Prediction Models to Improve the Diagnostic Value of Plain Radiographs in Children With Complete Discoid Lateral Meniscus. Arthroscopy 2018; 34:479-489.e3. [PMID: 29305289 DOI: 10.1016/j.arthro.2017.08.252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To develop prediction models to improve the diagnostic utility of plain radiographs for the diagnosis of complete discoid lateral meniscus by combining previously reported radiographic findings. METHODS Patients ages 5 to 16 years with complete discoid lateral meniscus confirmed by arthroscopy or magnetic resonance imaging were included. Patients with insufficient radiographs were excluded. Normal control subjects were randomly sampled by age and sex matching. Subjects were divided into 2 groups considering skeletal maturation (5-9 and 10-16 years). Radiographic variables included were lateral joint space, height of the fibular head, height of the lateral tibial spine, obliquity and cupping of the lateral tibial plateau, condylar cutoff sign, and squaring and notching of the lateral femoral condyle. Prediction models were developed by regression analyses. The cutoff value (COV) for best accuracy was determined with its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS A total of 162 knees (126 patients) with complete discoid lateral meniscus and 151 age- and sex-matched knees (151 subjects) with normal meniscus were included. In subjects 5 to 9 years old, the prediction model was risk score = [-20.08 * height of the fibular head/femoral interepicondylar distance (FIED)] + [-42.26 * height of the lateral tibial spine/FIED]. The COV of -8.47 showed the best accuracy (74.4%), with sensitivity of 85.9%; specificity, 60.4%; PPV, 72.4%; and NPV, 78.0%. In subjects 10 to 16 years old, the prediction model was risk score = [77.04 * lateral joint space/FIED] + [-34.55 * height of the fibular head/FIED] + [-56.58 * height of the lateral tibial spine/FIED] + [-16.44 * condylar cutoff sign]. The COV of -18.03 showed the best accuracy (85.4%), with sensitivity of 79.6%; specificity, 90.4%; PPV, 87.6%; and NPV, 83.9%. CONCLUSIONS The prediction models combining the plain radiographic findings showed higher diagnostic values than the diagnostic values of the individual radiographic findings. The results of this study provide improved diagnostic utility of plain radiography for the detection of completed discoid lateral meniscus in children. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Chul-Won Ha
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Jae Won Jang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Manyoung Kim
- Department of Orthopedic Surgery, Nanoori Seoul Hospital, Seoul, Republic of Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
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Koh SAS, Lee W, Rahmat R, Salkade PR, Li H. Interethnic variation in the prevalence of claustrophobia during MRI at Singapore General Hospital: does a wider bore MR scanner help? PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817695819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and objectives: It is estimated that 60 million magnetic resonance imaging (MRI) scans are performed annually around the world. Of these, 25% of patients experienced moderate to severe claustrophobia during the procedure. The aim of this study was to determine the prevalence and interethnic variations of patients requiring sedation due to claustrophobia. Another aim was to determine if a wider bore MR scanner was helpful in reducing the incidence of claustrophobia. Methodology: This was an institutional review board-approved study. We retrieved records for 11,813 adult outpatients from the hospital radiological system from 1 January 2012 to 31 December 2012. The data collected included patients’ gender, age, ethnicity, body region scanned, body orientation with respect to the scanner, the types of scanners used, and the need for sedation. Statistical analysis was performed using R 3.0.1. Results: The prevalence of claustrophobic patients requiring sedation was 0.45%, i.e. 53. Of these, 55% were females and 45% males. Among these, 64% were Chinese, 15% Malays, 15% Indians, and 6% were other races. 74% experienced claustrophobia at the 60 cm-wide bore scanners and 26% at 70 cm-wider bore scanners. Referring to Chinese, multivariable regression showed Malays and the Indians were six times and other ethnic groups were 12 times more likely to develop claustrophobia. The incidence of claustrophobia could be reduced by a factor of 2.95 with wider bore scanners. Conclusions: The MR environment is still disturbing to some patients. Feet-in positioning does not significantly minimize claustrophobia. Gender and age had no bearing on claustrophobia. Wider bore MR scanners with a bore size of 70 cm are an obvious choice toward more patient-friendly MR scanners.
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Affiliation(s)
- Salem Ah Sing Koh
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Weiling Lee
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Rosherinna Rahmat
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Huihua Li
- Department of Clinical Research, Singapore General Hospital, Singapore
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Evans R, Taylor S, Janes S, Halligan S, Morton A, Navani N, Oliver A, Rockall A, Teague J, Miles A. Patient experience and perceived acceptability of whole-body magnetic resonance imaging for staging colorectal and lung cancer compared with current staging scans: a qualitative study. BMJ Open 2017; 7:e016391. [PMID: 28882915 PMCID: PMC5588966 DOI: 10.1136/bmjopen-2017-016391] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To describe the experience and acceptability of whole-body magnetic resonance imaging (WB-MRI) staging compared with standard scans among patients with highly suspected or known colorectal or lung cancer. DESIGN Qualitative study using one-to-one interviews with thematic analysis. SETTING Patients recruited from 10 hospitals in London, East and South East England between March 2013 and July 2014. PARTICIPANTS 51 patients (31 male, age range 40-89 years), with varying levels of social deprivation, were recruited consecutively from two parallel clinical trials comparing the diagnostic accuracy and cost-effectiveness of WB-MRI with standard scans for staging colorectal and lung cancer ('Streamline-C' and 'Streamline-L'). WB-MRI was offered as an additional scan as part of the trials. RESULTS In general WB-MRI presented a greater challenge than standard scans, although all but four patients completed the WB-MRI. Key challenges were enclosed space, noise and scan duration; reduced patient tolerance was associated with claustrophobia, pulmonary symptoms and existing comorbidities. Coping strategies facilitated scan tolerance and were grouped into (1) those intended to help with physical and emotional challenges, and (2) those focused on motivation to complete the scan, for example focusing on health benefit. Our study suggests that good staff communication could reduce anxiety and boost coping strategies. CONCLUSIONS Although WB-MRI was perceived as more challenging than standard scans, it was sufficiently acceptable and tolerated by most patients to potentially replace them if appropriate. TRIAL REGISTRATION NUMBER ISRCTN43958015 and ISRCTN50436483.
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Affiliation(s)
- Ruth Evans
- Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
| | - Stuart Taylor
- Division of Medicine, Centre for Medical Imaging, University College London, London, United Kingdom
| | - Sam Janes
- Division of Medicine, Lungs for Living Research Centre, University College London, London, United Kingdom
| | - Steve Halligan
- Division of Medicine, Centre for Medical Imaging, University College London, London, United Kingdom
| | - Alison Morton
- C/O National Cancer Research Institute, London, United Kingdom
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, University College London, London, United Kingdom
| | - Alf Oliver
- C/O National Cancer Research Institute, London, United Kingdom
| | - Andrea Rockall
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jonathan Teague
- Cancer Research UK & UCL Clinical Trials Centre, London, United Kingdom
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
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Napp AE, Enders J, Roehle R, Diederichs G, Rief M, Zimmermann E, Martus P, Dewey M. Analysis and Prediction of Claustrophobia during MR Imaging with the Claustrophobia Questionnaire: An Observational Prospective 18-month Single-Center Study of 6500 Patients. Radiology 2017; 283:148-157. [DOI: 10.1148/radiol.2016160476] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adriane E. Napp
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Judith Enders
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Robert Roehle
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerd Diederichs
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Rief
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Elke Zimmermann
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Martus
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Marc Dewey
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Accelerated Brain Atrophy on Serial Computed Tomography: Potential Marker of the Progression of Alzheimer Disease. J Comput Assist Tomogr 2017; 40:827-32. [PMID: 27224227 DOI: 10.1097/rct.0000000000000435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of this study was to validate computed tomography (CT)-based longitudinal markers of the progression of Alzheimer disease (AD). MATERIALS AND METHODS We retrospectively studied 33 AD patients and 39 nondemented patients with other neurological illnesses (non-AD) having 4 to 12 CT examinations of the head, with over a mean (SD) of 3.9 (1.7) years. At each time point, we applied an automatic software to measure whole brain, cerebrospinal fluid, and intracranial space volumes. Longitudinal measures were then related to disease status and time since the first scan using hierarchical models. RESULTS Absolute brain volume loss accelerated for non-AD patients by 0.86 mL/y (95% confidence interval [CI], 0.64-1.08 mL/y) and 1.5× faster, that is, 1.32 mL/y (95% CI, 1.09-1.56 mL/y) for AD patients (P = 0.006). In terms of brain volume normalized to intracranial space, the acceleration in atrophy rate for non-AD patients was 0.0578%/y (95% CI, 0.0389%/y to 0.0767%/y), again 1.5× faster, that is, 0.0919%/y (95% CI, 0.0716%/y to 0.1122%/y) for AD patients (P = 0.017). This translates to an increase in atrophy rate from 0.5% to 1.4% in AD versus to 1.1% in non-AD group after 10 years. CONCLUSIONS Brain volumetry on CT reliably detected accelerated volume loss in AD and significantly lower acceleration factor in age-matched non-AD patients, leading to the possibility of its use to monitor the progression of cognitive decline and dementia.
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Cox AD, Virues-Ortega J, Julio F, Martin TL. Establishing motion control in children with autism and intellectual disability: Applications for anatomical and functional MRI. J Appl Behav Anal 2016; 50:8-26. [DOI: 10.1002/jaba.351] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 04/20/2016] [Indexed: 11/09/2022]
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Ellerbrock I, May A. MRI scanner environment increases pain perception in a standardized nociceptive paradigm. Brain Imaging Behav 2016; 9:848-53. [PMID: 25527478 DOI: 10.1007/s11682-014-9345-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Functional magnetic resonance imaging (MRI) has been widely used in neuroscientific studies to investigate neural correlates of perception and higher cognitive functions. Early on, the MR-scanning procedure itself has been identified to create discomfort and anxiety in some individuals, which may influence task performance and perception. The present study analyzed behavioral differences in pain intensity ratings obtained in two distinct situations: MR environment and laboratory setting. Within our longitudinal study design twenty healthy volunteers were exposed daily to an identical paradigm consisting of 60 repeated noxious heat stimuli (46 °C) on 21 consecutive days. After each block of ten stimuli, participants were prompted to rate pain intensity on a visual analog scale (VAS). On days 1, 8, 14, and 21 ratings scores were obtained during a functional imaging scan, whereas on the remaining days the sessions were conducted in a laboratory. It has come to our attention that pain intensity ratings acquired in MR environment were significantly higher than behavioral data collected in the lab setting. Given that the stimuli were standardized and no task or distraction confounded the ratings, it is likely that the attentional focus on noxious stimulation was identical in both conditions. It seems that the highly artificial scanner environment as such is sufficient to increase awareness/alertness. Given that salience rather than pure nociceptive input has been suggested to explain functional imaging results in painful conditions, these findings highlight concerns regarding the comparability of behavioral data assembled across inconsistent settings.
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Affiliation(s)
- Isabel Ellerbrock
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 22046, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 22046, Hamburg, Germany.
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Ahlander BM, Årestedt K, Engvall J, Maret E, Ericsson E. Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ). J Adv Nurs 2016; 72:1368-80. [PMID: 26893007 DOI: 10.1111/jan.12917] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/30/2022]
Abstract
AIM To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging- Anxiety Questionnaire. BACKGROUND Questionnaires measuring patients' anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients' experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. DESIGN Psychometric cross-sectional study with test-retest design. METHODS A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbach's alpha. Criterion-related validity, known-group validity and test-retest was calculated. RESULTS Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbach's alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. CONCLUSION Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.
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Affiliation(s)
| | - Kristofer Årestedt
- Department of Medical and Health Sciences, Division of Nursing Science, Linkoping University, Sweden.,Center for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Linkoping University, Sweden.,Center of Medical Image Science and Visualization, Linkoping University, Sweden
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Ericsson
- Faculty of Medicine and Health, School of Health and Medical Sciences, Orebro University, Sweden
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Klaming L, van Minde D, Weda H, Nielsen T, Duijm LEM. The Relation Between Anticipatory Anxiety and Movement During an MR Examination. Acad Radiol 2015; 22:1571-8. [PMID: 26410806 DOI: 10.1016/j.acra.2015.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/31/2015] [Accepted: 08/23/2015] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES During a magnetic resonance imaging (MRI) examination, patients are required to remain still to minimize motion that may compromise image quality and may make rescanning necessary. It is often assumed that anxiety, which is experienced by a considerable number of patients undergoing an MR examination, increases motion and decreases image quality. The present study explores the relationship between anxiety and movement of patients during an MR examination. MATERIALS AND METHODS Anxiety was measured subjectively by means of the State Anxiety Inventory and a visual analogue scale for claustrophobia. Motion and image quality were measured in three different ways. First, software was used that allows an estimation of motion based on tracker scans between the clinical scans. Second, the MRI technician who performed the MR examination was asked to indicate the degree of motion artifacts and image quality for each patient. Third, after all scans had been collected, two radiologists evaluated each clinical scan. RESULTS No or low correlations between anxiety and the distinct measures of motion and image quality were found for all three measures. CONCLUSIONS This finding shows that there is little evidence for the assumption that anxiety increases motion and decreases image quality during an MR examination.
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Affiliation(s)
- Laura Klaming
- Philips Research Laboratories Europe High Tech Campus 34 5656 AE Eindhoven, The Netherlands.
| | - Daisy van Minde
- Philips Research Laboratories Europe High Tech Campus 34 5656 AE Eindhoven, The Netherlands
| | - Hans Weda
- Philips Research Laboratories Europe High Tech Campus 34 5656 AE Eindhoven, The Netherlands
| | - Tim Nielsen
- Philips Technologie GmbH Innovative Technologies Research Laboratories Röntgenstrasse 24-26 22335 Hamburg, Germany
| | - Lucien E M Duijm
- Canisius Wilhelmina Hospital Department of Radiology Weg door Jonkerbos 100 6532 SZ Nijmegen PO Box 9015 6500 GS Nijmegen, The Netherlands
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Bali A, Jaggi AS. Clinical experimental stress studies: methods and assessment. Rev Neurosci 2015; 26:555-79. [DOI: 10.1515/revneuro-2015-0004] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/06/2015] [Indexed: 11/15/2022]
Abstract
AbstractStress is a state of threatened homeostasis during which a variety of adaptive processes are activated to produce physiological and behavioral changes. Stress induction methods are pivotal for understanding these physiological or pathophysiological changes in the body in response to stress. Furthermore, these methods are also important for the development of novel pharmacological agents for stress management. The well-described methods to induce stress in humans include the cold pressor test, Trier Social Stress Test, Montreal Imaging Stress Task, Maastricht Acute Stress Test, CO2 challenge test, Stroop test, Paced Auditory Serial Addition Task, noise stress, and Mannheim Multicomponent Stress Test. Stress assessment in humans is done by measuring biochemical markers such as cortisol, cortisol awakening response, dexamethasone suppression test, salivary α-amylase, plasma/urinary norepinephrine, norepinephrine spillover rate, and interleukins. Physiological and behavioral changes such as galvanic skin response, heart rate variability, pupil size, and muscle and/or skin sympathetic nerve activity (microneurography) and cardiovascular parameters such as heart rate, blood pressure, and self-reported anxiety are also monitored to assess stress response. This present review describes these commonly employed methods to induce stress in humans along with stress assessment methods.
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Affiliation(s)
- Anjana Bali
- 1Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002 India
| | - Amteshwar Singh Jaggi
- 1Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002 India
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Munn Z, Moola S, Lisy K, Riitano D, Murphy F. Claustrophobia in magnetic resonance imaging: A systematic review and meta-analysis. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Günay E, Baki ED, Kokulu S, Ulaşlı SS, Öz G, Akar O, Bağcıoğlu E, Ünlü M. Impact of multimedia information on bronchoscopy procedure: is it really helpful? Ann Thorac Med 2015; 10:34-7. [PMID: 25593605 PMCID: PMC4286843 DOI: 10.4103/1817-1737.146862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/26/2014] [Indexed: 12/23/2022] Open
Abstract
AIM: In this study, we aimed to investigate the effect of written informed consent and comprehensive multimedia information on the anxiety level of patients, consumption of sedatives, difficulties during bronchoscopy, complications and duration of procedure. METHODS: 150 patients undergoing bronchoscopy were included to this study. They were randomized into two groups Multimedia information group (MIG, n = 75) and written-informed consent group (WICG, n = 75)). Signed written informed consent was obtained from all patients. Patients in MIG group watched comprehensive multimedia presentation. State anxiety scores of all patients were evaluated with State and Trait anxiety inventory (STAI-S). RESULTS: STAI-S score of patients in MIG (40.31 ± 8.08) was lower than patients in WICG (44.29 ± 9.62) (P = 0.007). Satisfaction level was higher in MIG (P = 0.001). Statistically higher difficulties during passage through vocal cords and interventions during bronchoscopy were present in WICG group (P = 0.013 and P = 0.043, respectively). Total midazolam dose during bronchoscopy, and duration of bronchoscopy were statistically lower in MIG patients (P < 0.001 and P = 0.045, respectively). Difficulties during waiting period, passage through nasal/oral route, applications of local anesthesia and complication frequency were similar in both groups. CONCLUSION: Besides reducing the state anxiety, multimedia information can reduce the dose of sedation, shorten the processing duration and reduce the difficulties during bronchoscopy.
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Affiliation(s)
- Ersin Günay
- Department of Pulmonary Diseases, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Elif Doğan Baki
- Department of Anesthesiology and Reanimation, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Serdar Kokulu
- Department of Anesthesiology and Reanimation, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Sevinç Sarınç Ulaşlı
- Department of Pulmonary Diseases, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Gürhan Öz
- Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Olcay Akar
- Department of Pulmonary Diseases, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Erman Bağcıoğlu
- Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Mehmet Ünlü
- Department of Pulmonary Diseases, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
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Heyer CM, Thüring J, Lemburg SP, Kreddig N, Hasenbring M, Dohna M, Nicolas V. Anxiety of patients undergoing CT imaging-an underestimated problem? Acad Radiol 2015; 22:105-12. [PMID: 25239843 DOI: 10.1016/j.acra.2014.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES Prospective evaluation of anxiety in patients undergoing computed tomography (CT) imaging using a standardized state-trait anxiety inventory (STAI-S) and identification of possible risk factors. MATERIAL AND METHODS During a 9-month interval, patients undergoing CT were questioned using STAI-S. Additionally, 10 questions concerning specific procedure-related features (claustrophobia, radiation, administration of contrast, and so forth) were added. Moreover, sex, age, admitting subspecialty, organ region, reason for imaging, and prior imaging studies were recorded. Statistical analysis was performed using the Student t test and linear regression analysis; significance level was set to 5%. RESULTS Of 6122 patients, 825 patients undergoing CT (14%) were included (67% men; average age, 54 ± 17 years). Average STAI was 42 ± 10 with women (45 ± 11 vs. 41 ± 10; P < .001) and patients who received intravenous contrast (43 ± 10 vs. 42 ± 11; P = .021) showing significantly higher anxiety levels compared to those without contrast. Patients with investigations of their extremities (41 ± 11 vs. 43 ± 10; P = .020) and trauma patients (41 ± 11 vs. 43 ± 10; P = .006) revealed significantly lower STAI results. Patients who had never received a CT scan before showed significantly greater STAI-S values than those with repeat studies (42 ± 10 vs. 41 ± 11; P = .036). Females had greater fears concerning examination results (P < .001), radiation exposure (P = .032), administration of contrast (P = .014), and claustrophobia (P < .001). Patients with known malignancies had a significantly higher level of anxiety concerning their CT results (P = .002). CONCLUSIONS Anxiety does not only occur before MRI but also occur before CT. Its sources are manifold and include communication of CT results, administration of contrast agents, radiation exposure, and claustrophobia. In this setting, women seemed to be more receptive than men.
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Affiliation(s)
- Christoph M Heyer
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil, Ruhr-University of Bochum, Bürkle-de-la-Camp Platz 1, D-44789 Bochum, Germany.
| | - Johannes Thüring
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil, Ruhr-University of Bochum, Bürkle-de-la-Camp Platz 1, D-44789 Bochum, Germany
| | - Stefan P Lemburg
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil, Ruhr-University of Bochum, Bürkle-de-la-Camp Platz 1, D-44789 Bochum, Germany
| | - Nina Kreddig
- Department of Medical Psychology and Medical Sociology, Ruhr-University of Bochum, Bochum, Germany
| | - Monika Hasenbring
- Department of Medical Psychology and Medical Sociology, Ruhr-University of Bochum, Bochum, Germany
| | - Martha Dohna
- Institute of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Volkmar Nicolas
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil, Ruhr-University of Bochum, Bürkle-de-la-Camp Platz 1, D-44789 Bochum, Germany
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Karakaş S, Doğutepe Dinçer E, Özkan Ceylan A, Tileylioğlu E, Karakaş HM, Talı ET. Functional MRI compliance in children with attention deficit hyperactivity disorder. Diagn Interv Radiol 2015; 21:85-92. [PMID: 25519454 DOI: 10.5152/dir.2014.14006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to test the effect of prescan training and orientation in functional magnetic resonance imaging (fMRI) in children with attention deficit hyperactivity disorder (ADHD) and to investigate whether fMRI compliance was modified by state anxiety. METHODS Subjects included 77 males aged 6-12 years; there were 53 patients in the ADHD group and 24 participants in the healthy control group. Exclusion criteria included neurological and/or psychiatric comorbidities (other than ADHD), the use of psychoactive drugs, and an intelligence quotient outside the normal range. Children were individually subjected to prescan orientation and training. Data were acquired using a 1.5 Tesla scanner and an 8-channel head coil. Functional scans were performed using a standard neurocognitive task. RESULTS The neurocognitive task led to reliable fMRI maps. Compliance was not significantly different between ADHD and control groups based on success, failure, and repetition rates of fMRI. Compliance of ADHD patients with extreme levels of anxiety was also not significantly different. CONCLUSION The fMRI compliance of ADHD children is typically lower than that of healthy children. However, compliance can be increased to the level of age-matched healthy control children by addressing concerns about the technical and procedural aspects of fMRI, providing orientation programs, and performing on-task training. In patients thus trained, compliance does not change with the level of state anxiety suggesting that the anxiety hypothesis of fMRI compliance is not supported.
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Affiliation(s)
- Sirel Karakaş
- Department of Psychology, Cyprus International University, Nicosia, Turkish Republic of Northern Cyprus.
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Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) is associated with high levels of anxiety in many patients which may interfere with image quality and increase examination time. In order to develop effective intervention strategies that decrease anxiety, more insights into moments of high anxiety during a MRI examination are necessary. PURPOSE The present study aimed at obtaining insights into anxiety levels and moments of high anxiety during a Magnetic Resonance Imaging examination. METHOD The study included 67 patients, of whom 52 (77.6 %) were categorized as highly anxious. Stress and anxiety were measured continuously throughout the entire duration of the MRI examination by monitoring the heart rate. An increase in heart rate during the scan was taken as an indication for higher stress and anxiety. In addition to measuring stress and anxiety objectively, anxiety was assessed subjectively before and after the procedure by means of self-report questionnaires. RESULTS The self-report data indicate that patients were highly anxious before the MRI examination. Moreover, the electrophysiological data clearly show that anxiety levels were highest at the beginning of the procedure, i.e., when the MRI table moved into the scanner, and then decreased over the course of the examination. Furthermore, the findings show that while subjectively measured anxiety was higher in patients who had taken anxiolytics prior to the MRI examination than in patients who had not taken any anxiolytics, objectively measured anxiety during the scan was equally high in both groups. CONCLUSION The present study provides detailed insights into the anxiety levels during an MRI examination, which may aid in developing effective anxiety-reduction strategies. Additionally, the findings show that measuring anxiety continuously throughout the entire examination using electrophysiology in combination with measuring anxiety subjectively prior to and after the scan provides a more complete assessment of MRI-related anxiety.
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Affiliation(s)
- Daisy van Minde
- Philips Research Laboratories Europe, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands,
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Funk E, Thunberg P, Anderzen-Carlsson A. Patients' experiences in magnetic resonance imaging (MRI) and their experiences of breath holding techniques. J Adv Nurs 2014; 70:1880-90. [DOI: 10.1111/jan.12351] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Funk
- School of Health and Medical Sciences; Örebro University; Sweden
| | - Per Thunberg
- Department of Medical Physics; Örebro University Hospital; Sweden
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Carlsson S, Carlsson E. ‘The situation and the uncertainty about the coming result scared me but interaction with the radiographers helped me through’: a qualitative study on patients' experiences of magnetic resonance imaging examinations. J Clin Nurs 2013; 22:3225-34. [DOI: 10.1111/jocn.12416] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Sofia Carlsson
- Department of Radiology Lindesberg Hospital Lindesberg Sweden
| | - Eva Carlsson
- Centre for Health Care Sciences Örebro University Hospital Örebro Sweden
- School of Health and Medical Sciences Örebro University Örebro Sweden
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Schellhammer F, Ostermann T, Krüger G, Berger B, Heusser P. Good scent in MRI: can scent management optimize patient tolerance? Acta Radiol 2013; 54:795-9. [PMID: 23535184 DOI: 10.1177/0284185113482606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychological distress for patients undergoing magnetic resonance imaging (MRI) may range from mild anxiety to serious panic attacks. Scents associated with a sense of wellbeing have been used to diminish psychological stress in various clinical conditions. PURPOSE To evaluate the influence of inhalation aromatherapy in the reduction of artifacts in patients undergoing MRI. MATERIAL AND METHODS Based on the assumption aromatherapy will lead to significant reduction of patient-related motion artifacts (PRMA) in MRI, a randomized controlled trial with two groups of 54 patients was enrolled. The primary endpoint was the number of sequences with PRMAs. Secondary outcomes were improvements of mood measured with the ASTS questionnaire as well as patient's recommendation to fellow patients tested by a visual analogue scale. Incidence and intensity of adverse events were documented. RESULTS Ninety-five patients were included in the statistical analysis. We were not able to detect a significant reduction of PRMAs. There were also no significant differences in mood or in relation to the feeling before and after examination. The only differences that neared significance were "positive mood" and "recommendation". No adverse reaction was observed. CONCLUSION Although aromatherapy has been effective in enhancing patient's mood or wellbeing in a variety of stressful clinical settings, we were not able to find a similar effect. Neither the primary nor the secondary endpoints reached a clinical meaningful magnitude.
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Affiliation(s)
- Frank Schellhammer
- Department of Radiology, Krankenhaus der Augustinerinnen, Cologne
- Gemeinschaftskrankenhaus Herdecke, Herdecke
| | - Thomas Ostermann
- Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Herdecke, Germany
| | | | - Bettina Berger
- Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Herdecke, Germany
| | - Peter Heusser
- Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Herdecke, Germany
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Shechner T, Wakschlag N, Britton JC, Jarcho J, Ernst M, Pine DS. Empirical examination of the potential adverse psychological effects associated with pediatric FMRI scanning. J Child Adolesc Psychopharmacol 2013; 23:357-62. [PMID: 23738869 PMCID: PMC3689936 DOI: 10.1089/cap.2012.0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Over the past decade, the number of functional magnetic resonance imaging (fMRI) studies has increased dramatically. As MRI scans may be anxiety provoking, performing them in a research setting, particularly with children already prone to anxiety, raises questions about ethics as well as methodological feasibility. It is essential to address these questions before expanding the use of this technique to clinical settings, or more widely in the context of pediatric psychopharmacology and biological psychiatry research. The current study investigates the psychological reactions of anxious and non-anxious children and non-anxious adults to an fMRI scan. METHODS Eighty-seven anxious children, 140 non-anxious children, and 98 non-anxious adults rated their emotional reactions to an fMRI scan. RESULTS Results indicated that anxious and non-anxious children reported no greater anxiety after fMRI scanning than did adults. In addition, no age-related differences in distress were observed. These data demonstrate that anxious children, healthy children, and healthy adults have similar emotional reactions to fMRI scanning. CONCLUSIONS The observed findings suggest that the potential for fMRI to produce anxiety should not impede its widespread use in clinical research, psychopharmacology, and biological psychiatry.
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Affiliation(s)
- Tomer Shechner
- Section on Developmental Affective Neuroscience, The National Institute of Mental Health, Bethesda, MD 20892, USA.
| | | | | | - Johanna Jarcho
- The National Institute of Mental Health, Bethesda, Maryland
| | - Monique Ernst
- The National Institute of Mental Health, Bethesda, Maryland
| | - Daniel S. Pine
- The National Institute of Mental Health, Bethesda, Maryland
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El-Kordi A, Kästner A, Grube S, Klugmann M, Begemann M, Sperling S, Hammerschmidt K, Hammer C, Stepniak B, Patzig J, de Monasterio-Schrader P, Strenzke N, Flügge G, Werner HB, Pawlak R, Nave KA, Ehrenreich H. A single gene defect causing claustrophobia. Transl Psychiatry 2013; 3:e254. [PMID: 23632458 PMCID: PMC3641414 DOI: 10.1038/tp.2013.28] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Claustrophobia, the well-known fear of being trapped in narrow/closed spaces, is often considered a conditioned response to traumatic experience. Surprisingly, we found that mutations affecting a single gene, encoding a stress-regulated neuronal protein, can cause claustrophobia. Gpm6a-deficient mice develop normally and lack obvious behavioral abnormalities. However, when mildly stressed by single-housing, these mice develop a striking claustrophobia-like phenotype, which is not inducible in wild-type controls, even by severe stress. The human GPM6A gene is located on chromosome 4q32-q34, a region linked to panic disorder. Sequence analysis of 115 claustrophobic and non-claustrophobic subjects identified nine variants in the noncoding region of the gene that are more frequent in affected individuals (P=0.028). One variant in the 3'untranslated region was linked to claustrophobia in two small pedigrees. This mutant mRNA is functional but cannot be silenced by neuronal miR124 derived itself from a stress-regulated transcript. We suggest that loosing dynamic regulation of neuronal GPM6A expression poses a genetic risk for claustrophobia.
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Affiliation(s)
- A El-Kordi
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Göttingen, Germany
| | - A Kästner
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - S Grube
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - M Klugmann
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - M Begemann
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Göttingen, Germany
| | - S Sperling
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - K Hammerschmidt
- Cognitive Ethology Laboratory, German Primate Center, Göttingen, Germany
| | - C Hammer
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - B Stepniak
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - J Patzig
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | | | - N Strenzke
- Department of Otolaryngology, Georg-August-University, Göttingen, Germany
| | - G Flügge
- DFG Research Center for Molecular Physiology of the Brain (CMPB), Göttingen, Germany,Department of Clinical Neurobiology, German Primate Center, Göttingen, Germany
| | - H B Werner
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - R Pawlak
- Laboratory of Neuronal Plasticity and Behaviour, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - K-A Nave
- DFG Research Center for Molecular Physiology of the Brain (CMPB), Göttingen, Germany,Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany,Max Planck Institute of Experimental Medicine, Hermann-Rein Street 3, 37075 Göttingen, Germany. E-mail: (HE) or (K-AN)
| | - H Ehrenreich
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Göttingen, Germany,Max Planck Institute of Experimental Medicine, Hermann-Rein Street 3, 37075 Göttingen, Germany. E-mail: (HE) or (K-AN)
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Lima MS, Shigueoka DC, Salvador ME, da Silva Canteras LM, Carmagnani MIS, Ajzen SA. Assessment of nurses' knowledge about magnetic resonance imaging in a university hospital in Sao Paulo. Int J Nurs Pract 2012. [PMID: 23181959 DOI: 10.1111/ijn.12011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aims of this descriptive study were to determine the academic profile of nurses in a university hospital, assess their level of knowledge about magnetic resonance imaging (MRI) and verify whether this knowledge was acquired during their undergraduate or graduate education. Ninety randomly selected nurses working in inpatient wards and outpatient units of a university hospital participated in the study. Data were collected through a questionnaire completed by the participants between August and October 2009. Most nurses were females who have received specialized education. The participants had a limited knowledge about MRI, which was restricted to the procedures to prepare patients for MRI examination and MRI contraindications. Most of the nurses acquired information about MRI during the professional practice. The majority of nurses showed interest to know more about the MRI examination, especially regarding the exam environment, conditions and contraindications, in order to prevent accidents.
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Affiliation(s)
- Marcos Souza Lima
- Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Tamam MO, Bagcioglu E, Mulazimoglu M, Tamam L, Ozpacaci T. Evaluation of anxiety and depression in patients prior to myocardial perfusion scintigraphy. Int J Psychiatry Clin Pract 2012; 16:93-7. [PMID: 22136214 DOI: 10.3109/13651501.2011.631017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In myocardial perfusion scintigraphy (MPS) negative results indicate coronary artery diseases which might cause prominent anxiety and other psychological reactions. The aim of this study was to determine anxiety and depression levels of patients prior to MPS procedures. METHODS The Hospital Anxiety Depression Scale(HADS) and the State and Trait Anxiety Inventory I and II were used to evaluate the anxiety and depression levels of the patients. Descriptive analyses and independent sample t-test were used for statistical assessment. RESULTS The mean score of HADS-anxiety score prior to MPS was 8.1 ± 4.2, whereas the mean HADS depression score was 6.1 ± 3.7. The mean state anxiety score prior to MPS was 39.7 ± 10.6 and the mean trait anxiety score was 45.02 ± 9.1. HAD and state and trait anxiety scores were found to be significantly higher in female patients than male patients and non-smoker patients than smoker patients. Other risk factors such as having bypass operation, myocardial infarction, hypercholesterolemia, diabetes and hypertension were not related to depression and anxiety scores. CONCLUSION The results in this study suggest a role for MPS as a risk factor for higher state anxiety. The MPS procedures might lead to an increase in anxiety levels of patients which is possibly associated with anticipation anxiety felt during waiting period and expectation life-threatening.
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Affiliation(s)
- Muge Oner Tamam
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey.
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Enders J, Zimmermann E, Rief M, Martus P, Klingebiel R, Asbach P, Klessen C, Diederichs G, Wagner M, Teichgräber U, Bengner T, Hamm B, Dewey M. Reduction of claustrophobia with short-bore versus open magnetic resonance imaging: a randomized controlled trial. PLoS One 2011; 6:e23494. [PMID: 21887259 PMCID: PMC3161742 DOI: 10.1371/journal.pone.0023494] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/18/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Claustrophobia is a common problem precluding MR imaging. The purpose of the present study was to assess whether a short-bore or an open magnetic resonance (MR) scanner is superior in alleviating claustrophobia. METHODS Institutional review board approval and patient informed consent were obtained to compare short-bore versus open MR. From June 2008 to August 2009, 174 patients (139 women; mean age = 53.1 [SD 12.8]) with an overall mean score of 2.4 (SD 0.7, range 0 to 4) on the Claustrophobia Questionnaire (CLQ) and a clinical indication for imaging, were randomly assigned to receive evaluation by open or by short-bore MR. The primary outcomes were incomplete MR examinations due to a claustrophobic event. Follow-up was conducted 7 months after MR imaging. The primary analysis was performed according to the intention-to-treat strategy. RESULTS With 33 claustrophobic events in the short-bore group (39% [95% confidence interval [CI] 28% to 50%) versus 23 in the open scanner group (26% [95% CI 18% to 37%]; P = 0.08) the difference was not significant. Patients with an event were in the examination room for 3.8 min (SD 4.4) in the short-bore and for 8.5 min (SD 7) in the open group (P = 0.004). This was due to an earlier occurrence of events in the short-bore group. The CLQ suffocation subscale was significantly associated with the occurrence of claustrophobic events (P = 0.003). New findings that explained symptoms were found in 69% of MR examinations and led to changes in medical treatment in 47% and surgery in 10% of patients. After 7 months, perceived claustrophobia increased in 32% of patients with events versus in only 11% of patients without events (P = 0.004). CONCLUSIONS Even recent MR cannot prevent claustrophobia suggesting that further developments to create a more patient-centered MR scanner environment are needed. TRIAL REGISTRATION ClinicalTrials.gov NCT00715806.
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Affiliation(s)
- Judith Enders
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Elke Zimmermann
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Peter Martus
- Department of Biostatistics and Clinical Epidemiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Randolf Klingebiel
- Division of Neuroradiology, Department of Radiology, Charité, Medical School, Humboldt-Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Christian Klessen
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Gerd Diederichs
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Ulf Teichgräber
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Thomas Bengner
- Department of Clinical Psychology, Charité, Medical School, Humboldt-Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité, Medical School, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
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Lueken U, Muehlhan M, Wittchen HU, Kellermann T, Reinhardt I, Konrad C, Lang T, Wittmann A, Ströhle A, Gerlach AL, Ewert A, Kircher T. (Don't) panic in the scanner! How panic patients with agoraphobia experience a functional magnetic resonance imaging session. Eur Neuropsychopharmacol 2011; 21:516-25. [PMID: 21269812 DOI: 10.1016/j.euroneuro.2010.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 08/26/2010] [Accepted: 12/09/2010] [Indexed: 12/01/2022]
Abstract
Although functional magnetic resonance imaging (fMRI) has gained increasing importance in investigating neural substrates of anxiety disorders, less is known about the stress eliciting properties of the scanner environment itself. The aim of the study was to investigate feasibility, self-reported distress and anxiety management strategies during an fMRI experiment in a comprehensive sample of patients with panic disorder and agoraphobia (PD/AG). Within the national research network PANIC-NET, n=89 patients and n=90 controls participated in a multicenter fMRI study. Subjects completed a retrospective questionnaire on self-reported distress, including a habituation profile and exploratory questions about helpful strategies. Drop-out rates and fMRI quality parameters were employed as markers of study feasibility. Different anxiety measures were used to identify patients particularly vulnerable to increased scanner anxiety and impaired data quality. Three (3.5%) patients terminated the session prematurely. While drop-out rates were comparable for patients and controls, data quality was moderately impaired in patients. Distress was significantly elevated in patients compared to controls; claustrophobic anxiety was furthermore associated with pronounced distress and lower fMRI data quality in patients. Patients reported helpful strategies, including motivational factors and cognitive coping strategies. The feasibility of large-scale fMRI studies on PD/AG patients could be proved. Study designs should nevertheless acknowledge that the MRI setting may enhance stress reactions. Future studies are needed to investigate the relationship between self-reported distress and fMRI data in patient groups that are subject to neuroimaging research.
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Affiliation(s)
- Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany.
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Lourenco SF, Longo MR, Pathman T. Near space and its relation to claustrophobic fear. Cognition 2011; 119:448-53. [DOI: 10.1016/j.cognition.2011.02.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/07/2011] [Accepted: 02/11/2011] [Indexed: 11/16/2022]
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