Alleviating MRI anxieties

James Tytko spoke with the University of Cambridge's Stephanie Brown to learn about magnetic resonance imaging (MRI) and how professionals are helping children deal with the anxiety of a scan...

Stephanie - MRI stands for Magnetic Resonance Imaging and an MRI scanner contains a strong magnet, basically. MRI scanners come in different strengths of magnet and stronger magnets give us higher resolution in the images. So the way this works technically is that protons within bodily water molecules act like very small magnets, which we can manipulate with the strong magnet inside the scanner and radio waves to form images.

James - When it comes to why someone might be asked to have an MRI, specifically of their brain this is, what's going to have caused that?

Stephanie - There's a variety of reasons. It could be for research purposes or it could be because it is suspected by a clinician that there may be something abnormal in the brain. In research, a commonly used technique is functional MRI or fMRI for short. Functional MRI is different to a structural MRI, which is commonly used in the clinic, as it uses blood oxygenation which has different magnetic properties to deoxygenated blood - if we remember, that is, the iron in our blood cells that is important for carrying oxygen. This tells us about the activity in the brain and the idea behind this is that active neurons use more oxygen for energy. So, using this information, we can create maps of the brain for which regions are using higher levels of energy when people are, for instance, resting or doing a very specific task.

James - We know that the brain is very complicated and there's lots about it we still don't know. So what is it that an MRI or an fMRI can actually tell us?

Stephanie - Brain MRIs, both functional and structural, can tell us really quite a lot about healthy psychological processes and also what might be happening when people might be suffering from diseases or disorders. This can include things like memory, language, pain, or the physical processes that happen for instance during Alzheimer's disease or Parkinson's. Technology is always improving. This allows us to get further information about how the brain works in healthy and diseased states. Importantly, these changes that we might be able to detect on an MRI scan can be used for better and more effective diagnoses. Often, having or not having a biologically based diagnosis can really stand in the way of effective treatments.

James - And so far we've focused quite a lot on the technical side of things which is great. But someone who's actually had an MRI scan will be the first to tell you, especially of their brain, it's something of an anxiety inducing experience, isn't it, given the sounds this machinery makes and the way you are sort of engulfed in it?

Stephanie - Yes, so it definitely can be. So, to have an MRI, you would usually be asked to lie down on a table and go into a tube in an MRI scanner, this is where the magnet is located. Then you're just asked to lie very still for the duration of the scan, which can vary according to what doctors or researchers might be interested in looking at. Most people actually don't mind having an MRI scan and some people find it quite comfortable or even fall asleep. However, some people may really struggle to stay still. This is especially true for children who might find the environment a bit claustrophobic or find it too noisy. But we can often find solutions to these problems. Some people may find the scanner less claustrophobic, for instance, if they've seen the scanner before and had some time to mentally prepare. You will also usually wear earplugs to minimise the noise and sometimes there can be a helpful distraction provided such as listening to music or watching something when you're in the scanner, which can be really beneficial for reducing anxiety.

James - Because what we want to avoid as much as possible is putting people under anaesthetic while they're undergoing these scans. Because there's some research that suggests that especially, as you mentioned, for young children, there's developmental concerns of putting them under anaesthetic too frequently.

Stephanie - Yes, that's exactly right. So this brings us onto a very interesting recent article published in the BMJ and what they found in this research was that giving children a virtual augmented reality play kit to use ahead of an MRI really seemed to ease both that and their parents' anxieties about the procedure. So MRI, as we've mentioned, is a really important diagnostic tool in children's healthcare because of the high quality images, but also the lower radiation exposure compared with something like a CT scan, which is particularly important for children with long-term conditions. But many children really do find this a challenging experience. As you mentioned, recent research has really brought up some safety concerns about the potential impact of anaesthesia on a child's developing brain and this has really pushed forward an initiative to reduce the number of MRI scans done under sedation.

James - The BMJ's 'Augmented Reality Innovation.' What's that? What does that even mean?

Stephanie - They've developed a play kit which consists of a flat packed cardboard kit for building into a small toy MRI scanner into which the child can place their toy. A smartphone is slotted into the side of the cardboard MRI scanner, which enables the child to take on essentially the role of a radiographer via an augmented reality app. And augmented reality superposes a computer generated image on a user's view of the real world so the child can then essentially scan their toy with the addition of scanning noises to replicate the MRI experience. The feedback from this study indicated that the play kit really helps some children and their parents and carers to prepare for the MRI scan and helps to relieve anxiety as well. The children themselves said that recalling aspects of the play kit during their scan helped them remain calm and still, which is obviously really beneficial and a positive step.