Review of claustrophobia incidence in MRI: A service evaluation of current rates across a multi-centre service

Abstract

Patient anxiety related to undergoing medical imaging procedures is common, with reported incidence varying from 49-95% (1,2). The source of this may be related to particular aspects of the procedure itself or anticipation of the significance of results (1–7). For Magnetic Resonance Imaging (MRI) the most notable response is one of claustrophobia due to the enclosing nature of the scanning equipment, along with scanning noise, duration and lying flat(8–10). A range of responses are reported, from awareness of discomfort to extreme panic(11), with heightened anxiety reported in 29-56% of patients (1,2,12) and up to 3.4 times more likely when compared to undergoing an ultrasound scan(1). This impacts patient outcomes; movement or reduced scan times may reduce scan quality (13–16) through to inability to tolerate or even attempt a scan(15,17–19). This then has financial and operational impacts on scanning units(13,19–21). Meta-analysis has shown an incidence of 0.46-5.29% premature termination rate in MRI (summed effect 1.8%) with the potential for this to drop below 1% as scanner design improves (22). Indeed, it has been argued that as new designs and technological enhancements become commonplace, the need to consider claustrophobia related anxiety in MRI will be removed(23). Scanners are becoming more patient friendly by design, coupled with developments that reduce scan acquisition times(21,24–26). However, studies have shown that as of 2017 in the UK over 50% of scanners were still traditional narrow bore (60cm) systems(27) and there has been no change in the percentage of scanners in practice over 10years old since 2015(28). As a consequence, it seems improbable that incidence of premature scan termination due to claustrophobia will show significant reduction whilst provision across the UK is not currently making available the benefits of newer technology to improve patient experience. As well as the influence of scanning equipment, it would be advantageous to understand whether any specific patient groups may be more prone to an anxious response to their scan experience. This would enable services to tailor emotional support provided, an important element of personcentred care(29). Being able to offer reasonable adjustment for patients goes some way to addressing potential inequalities, where all patients should be appropriately supported to achieve the scan and diagnosis needed to inform their care. Therefore, the aim of this evaluation was to provide a current view on the incidence of scan related anxiety, defined as failure to scan due to claustrophobia, drawing on operational data alone.