RESEARCH FINDINGS USING GUIDED IMAGERY FOR
MRI

August, 2006

The Value of MRI
Magnetic Resonance Imaging (MRI) is among the safest and most valuable procedures in all of medicine. Over 24.2 million MRI procedures were performed in the United States in 2003 (Prochaska, 2005), many of them to diagnose and evaluate injury, tumor growth, structural abnormalities and various disease processes.

MRI has several advantages over X-ray and computerized tomography (CT). Cross-sectional views can be taken from any angle, while CTs can view from only one direction at a time. By using different scanning parameters, MRI operators can highlight different aspects of the tissues they investigate, yielding more complete information.


Problems with MRI
Because patients must remain still in the tight space of the MRI scanner for up to two hours or more, MRIs frequently create anxiety and panic. This can cause significant harm to patients and greatly increasing costs. Five to ten percent of patients undergoing MRI experience severe claustrophobia or panic attacks, and 30% report milder distress (Melendez and McCrank, 1993).

Severe anxiety can require the procedure to be canceled and rescheduled, increasing costs and delaying medical evaluation (Koechling, Spevack, et al, 1996; Quirk, Letendre, et al, 1989a). Over 14% of patients require sedation to complete the examination, adding new costs and risks to the procedure (Murphy and Brunberg, 1997).

Many patients report that their MRI continued for several months after the exam (McIsaac, 1996; Quirk, Letendre, et al, 1989a). Patient anxiety can lead to patient movement during the test, leading to poor quality images (Melendez and McCrank; Thompson and Coppens, 1994).


The Role of Relaxation and Imagery
Many studies have shown that relaxation with guided imagery or hypnosis can reduce patient anxiety and movement, even in children (Smart, 1997), increase patient tolerance of and satisfaction with the procedure, and reduce need for sedation in MRI (Friday and Kubal, 1990; Lukins, Davan, and Drummond, 1997; Quirk, Letendre, et al, 1989b; Smart; Thompson and Coppens, 1994).

Similar benefits have been found in other medical procedures (Cataldo, 1996; Lang, Joyce, et al, 1996). Reduced sedation decreases complications and cuts the need for expensive monitoring, as well as allowing patients and caregivers a more rapid return to their daily lives (Cataldo, 1996). Increased satisfaction improves willingness to have future procedures, if necessary.


Conclusion
Guided imagery can reduce patient anxiety and movement during MRI, improving quality of images. The use of guided imagery can save money by reducing need for sedation and/or cancellation of procedures, and increase patient satisfaction with the procedure.


References
Cataldo PA. Colonoscopy without sedation. Diseases of the Colon and Rectum. 1996; 3:257-61.

Friday PJ, Kubal WS. Magnetic resonance imaging: improved patient tolerance utilizing medical hypnosis. Am J Clin Hypn. 1990;33:80-84.

Koechling UM, Spevack MG, Gerstein S, Del Vasco R, Del Carpio R. Panic attacks while undergoing the magnetic resonance imaging scan (MRI). Presentation to the American Psychological Association (APA) 104th Annual Convention 1996, Toronto, Canada.

Lang E, Joyce J, Spiegel D, Hamilton D, Lee K. Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use. The International Journal of Clinical and Experimental Hypnosis. 1996; Apr;44(2):106-19.

Lukins R, Davan IG, Drummond PD. A cognitive behavioural approach to preventing anxiety during magnetic resonance imaging. J Behav Ther Exp Psychiatry. 1997 Jun;28(2):97-104.

McIsaac H. Claustrophobic fear and the magnetic resonance imaging procedure. Presentation to the American Psychological Association's (APA) 104th Annual Convention, 1996, Toronto, Canada.

Melendez C, McCrank E. Anxiety-related reactions associated with magnetic resonance imaging examinations. Journal of the American Medical Association. 1993;270: 745-747.

Murphy KJ, Brunberg JA. Adult claustrophobia, anxiety and sedation in MRI. Magn Reson Imaging.1997;15(1):51-4.

Prochaska G. Latest IMV study shows MRI clinical utilization expanding. IMV, Ltd., Medical Information Division. 2005, Apr 19.
http://www.imvlimited.com/PDF/2005/MID/Press%20Release/MRI04%20Release%20April05.pdf
Accessed August, 2005.

Quirk ME, Letendre AJ, Ciottone RA, Lingley JF. Anxiety in patients undergoing MR imaging. Radiology. 1989a Feb;170(2):463-6.

Quirk ME, Letendre AJ, Ciottone RA, Lingley JF. Evaluation of three psychologic interventions to reduce anxiety during MR imaging. Radiology. 1989b Dec;173(3):759-62.

Smart G. Helping children relax during magnetic resonance imaging. MCN Am J Matern Child Nurs. 1977 Sep-Oct;22(5):236-41.

Thompson MB, Coppens NM. The effects of guided imagery on anxiety levels and movement of clients undergoing magnetic resonance imaging. Holist Nurs Pract. 1994 Jan;8(2):59-69.