The Doctor's Visit
You've had a nagging headache, off and on, for the last several months. You've seen your family physician several times since it started and, despite the medications he's put you on, it hasn't gotten any better. So here you sit in his office, yet again, wondering what he'll want to do next. In the exam room he talks to you a bit and asks the same questions he has asked before. Then, out of the blue he says, "I think you should have an MRI of your head. It will rule out any major problems." The gray haze of fear envelopes you and all you can think of is how claustrophobic you are. He talks a little more, but you aren't listening. You can't stop thinking about how horrible this is going to be.
The Worrying Time
The doctor's office scheduled the MRI for you as you checked out. They wrote the name of the medical imaging facility, the date, and the time of your MRI test on the back of a doctor's order. It's not until you get home that you realize it's not scheduled for another week, great more time to worry!
Does this scenario sound a little bit familiar? Take heart in knowing that you're not alone. Most people experience some level of anxiety over an MRI exam. As a medical imaging technologist I've spent the better part of my life performing various medical imaging tests on patients. MRIs are some of the more difficult tests for most patients. In fact, as a technologist, often times the most difficult part of performing an MRI exam is helping the patient tolerate the study. It doesn't have to be a daunting or scary experience though. Let's take some time to demystify the machine and discuss what you can do to make your MRI experience easier and less stressful.
What is an MRI?
MRI stands for Magnetic Resonance Imaging. It is a medical imaging study that uses magnetism to create pictures of the inside of the body. Your doctor has ordered an MRI for a reason. Each medical imaging modality (CT, Nuclear Medicine, X-ray, Ultrasound, PET, and MRI) is used to look at specific anatomy and/or for a specific pathology or disease. MRIs are good at visualizing soft tissue (tissue not made of bone). The MRI of your head will allow him to see your brain, eyes, and ears (internally), sinuses, and even part of your spinal cord. Diseases or disorders in these organs may be causing the pain and discomfort you're experiencing. Your doctor can't treat the issue until he has a diagnosis and that diagnosis may be obtained through an MRI.
How Does the MRI Machine Work?
An MRI machine is an amazing and intricate marvel of technology. Initially invented in the 1970s, the first medically operational units were FDA approved in the 1980s. Since then their use has steadily grown.
The machines consist of a series of very, very powerful magnets. Anyone who has had an MRI will tell you that they are very loud. This noise, usually rhythmic in nature, is caused by the magnets turning off and on. As they do so they either attract or repel to and from one another, causing them to bang against their housings and mounts.
The fluctuation and manipulation of the magnetic field in the area of the body being scanned, along with the application of radio frequencies makes certain atoms in the body move in specific ways. This movement causes the atoms to give off a radio frequency that is picked up or received by a "coil" or antenna which has been placed around the part of the body being scanned. That radio frequency is eventually turned into a shade of grey in the scanner's computer. When you look at an MRI image you're not really looking at tissue; instead, you are looking at a representation of the amount of water or other substance in the part being scanned. Interesting stuff, right? Now that you have a basic understanding of how the machine works, let’s go through some information you can put into practice that will make the whole experience easier for you.
The Day Before Your MRI
1. Know where your testing facility is located. This sounds so simple, but you would be surprised how many patients go to the wrong facility to have their test performed. If you've never been there before, and you have the time to do so, you may want to travel to where your MRI is scheduled. See what the commute is like, how long it takes you to get there, what the parking is like or how far the walk is from the nearest metro station.
If you don't have the time to take a trip there, you can also call the facility's main number. They're used to getting calls from patients with all sorts of questions. Rest assured that you will not be the only person calling that day to ask how long it takes to get to their facility from a given part of town.
2. Preregister your information if possible. If you are told that you can register or preregister prior to your test, try to do it. It will be one less thing you'll have to worry about the day of your MRI.
3. Make sure to follow the instructions on the doctor's order regarding whether or not you can eat the morning of your test. A few MRI tests require that you don't eat or drink anything for a specific amount of time prior to the test. If you are unsure if you have to abstain from eating, or you have medicine that you normally take with food, call your physician's office and ask them for guidance.
The Day Of
There are some things you can do prior to arriving at the testing facility for your MRI that will help make the whole experience a little less stressful.
1. Dress appropriately. You'll want to wear comfortable clothing without metal components attached (i.e. zippers, metal buttons, ringlets etc.) Don't wear jewelry, they'll just make you take it off. Some types of metal jewelry can cause "image artifacts" and distort the images making them difficult for the doctors to read. Metal jewelry can also pull, vibrate and even heat up in the MRI machine, in rare circumstances.
2. Bring your doctor's order with you. The testing facility may or may not have a copy of the order, and in most cases you must have this to have the test. Even if your doctor's office says they sent it to the testing facility, you still want to bring the doctor's order with you. If you weren't given an order, call the testing facility the morning of, or the day before your test and make sure they have the order. Some facilities are going "paperless" and their doctor's orders are sent electronically.
3. Arrive a little early. If possible, try to arrive 15 to 30 minutes early to the testing facility. You may have to complete some paperwork when you get there, typically some type of MRI screening form with questions regarding your prior medical and surgical history. In some cases this is completed during the scheduling or registration process. You may be asked the same questions more than once so be prepared for a little bit of redundancy. We often get different answers to the same questions that patients have been asked multiple times, and it's imperative that we have the correct answers.
The screening form is very important so be sure to answer the questions honestly. The MRI technologists must make sure that you don't have any implants that may be affected by the MRI machine's magnetic environment.
Typically a member of the MRI team will come to the waiting room and call your name. They'll walk you back to an area where you can change into a gown if applicable. This is usually where you will also leave or lock up your belongings and use the restroom if needed. They"ll go over your screening form with you and answer any questions you may have. It's usually around this time that you glimpse the MRI machine for the first time. At first glance it looks like a huge machine with a tiny tube in the center. Some patients ask whether or not they're going to fit into such a small space, that probably won't be an issue, but depending on your size, you may touch the sides while inside of the machine. We do occasionally encounter patients that don't fit into the scanner. If you're worried about this, call the testing facility as soon as you know you are scheduled to have an MRI and ask them if they have a weight limit for their machine. If you are over their weight limit they will tell you what your other options are. Many facilities have multiple scanners with at least one that can handle larger patients.
The technologist will walk you into the room and help you get onto the padded table. She will get you into position and give you ear plugs or headphones with music. She'll make you as comfortable as she can and give you a call button. (The more comfortable we can make you, the easier the test will be for you. Don't hesitate to tell the technologist if you want a blanket to cover up with or a pillow under your knees.) She will probably explain that you must hold still during the MRI since movement will make the pictures blurry. She will pull what looks like a helmet down over your head. Remember, in this scenario you're having an MRI of your head. As mentioned before, in most cases, the part being scanned has to have an antenna put around it. The helmet is essentially that antenna. She may or may not ask you to close your eyes as she putting you into the scanner. Some scanners have a laser light that is used to center the patient to the scanner. We will have patients close their eyes to avoid looking this laser light.
The MRI test is actually a series of sequences comprised of different types of scans. The protocol, or specific sequences, is set by a radiologist (the physician trained to read the images created during the MRI exam) and is typically determined by the age of the patient and the pathology the ordering physician is looking for. Usually the first few scans are pretty fast, 15 seconds to a minute long. They tend to get longer after that. MRI tests can last from 10 minutes to over an hour for some really long and in depth studies. If your physician orders multiple MRI exams on you, your total scan time could be even longer.
As the machine begins to scan, the first thing you will notice is how loud it is, with sounds raging from banging and clanging to buzzing and beeping. At first, the noise level can be frightening and disorientating for some patients, however, most soon realize that the noises are rhythmic and vary in volume. Each sequence sounds different and in between the sequences the technologist may talk to you through the scanner. You should be able to respond to her through the scanner as well. Be honest, if you're afraid or need a break, let her know. She is there to help you get through this.
Breathe, Just Breathe
So you are now in the machine, and it's making a veritable cacophony of sounds. You're trying really hard not to concentrate on how loud it is or that you are in a tube, but it's not easy. It is at this point that you have to take control of your mind and it's not as hard as it may seem.
I like to have my patients use a technique called Guided Imagery. At its most basic, guided imagery is just was it sounds like. You think about something that has images associated with it. I like to have patients think about a vacation or holiday gathering that was really special and memorable to them. We tend to recall more vivid images from experiences in our lives that engaged all of our senses.
Think back to that cruise you took, that trip to the beach or mountains last year or the Christmas or Hanukkah gathering you reminisce about from your childhood. Really put yourself there. Smell the smells, the salty air, the food. Hear the sounds of the people around you, the revelry of the party or the sounds of nature. Think back to what the specific environment was like, how hot or cold it was, what the wind and the sun felt like or the tactile sensation of the paper as you unwrapped your presents. Really put yourself back into that particular moment and relive the experience, concentrating on the sensory details.
You can practice guided imagery at home, before your MRI exam. Lie on the sofa or in your bed and concentrate on your favorite experience. The more you practice the better you'll get at it. I know it sounds very new-age but it really does work.
A Word on MRI Contrast Media
Some MRI exams require the intravenous injection of a contrast media or "dye" to help the radiologist tell the difference between normal and abnormal tissue. If your MRI has been ordered with contrast, ask your physician for more information. He can provide you with as much as you need to know to be able to have an informed discussion with him about the contrast.
Before you know it, you will be finished. I find that the majority of patients start to relax after the first three or four scans. Some patients need to come out half way through for a little break. This usually isn't a problem, however, it may add time and additional scans to the exam if you move or sit up while outside of the scanner.
Through my years working in an MRI department the most repeated patient sentiment has to be, "That wasn't nearly as bad as I thought it would be." For many, the IDEA of having an MRI is much worse than actually going through the study.
A Few More Tips That May Help You Get Through your MRI
~ Research and do your homework. The testing facility probably has a brochure explaining the specific MRI procedure you are supposed to have. Knowledge is power.
~Get to know your way around the testing facility. I know I've mentioned this before, but it is a big stressor for many people. Some facilities publish maps of their campuses online.
~ The staff is there to help you, be honest and tell them if you’re anxious and afraid. The more they know about how you're feeling the easier it is to make you comfortable and relaxed.
~ Ask the staff for a blindfold before you go into the scanner. Something as simple as a small washcloth folded and put over your eyes (not covering your nose or mouth) can really help you to tolerate the study.
~If you know you are extremely claustrophobic ask your doctor if you can have your MRI exam performed on an "open" or "extremity" scanner. The scanner described in the scenario you just read is a tube-like scanner. Open scanners are open on the sides and although the distance between the table and the roof of the inside of the scanner may be similar to the tube-like scanner, the extra room you have on the sides may help you feel less closed in. Extremity scanners are used to scan wrists, knees, ankles etc. They are much smaller versions of the MRI machine and typically only the extremity that needs scanned goes into the scanner. Not all facilities have an extremity scanner since they are so limited in what they can scan; however, it doesn't hurt to ask if this is an option your testing facility can offer.
~If your physician prescribes you medicine to help you relax during the MRI exam, make sure you follow the prescription instructions. You may not be able to drive after taking the medicine so you might need to have someone drive you and pick you up from your appointment.
Remember, this is your body, and you are in control. The better you know and understand the test you are having, the easier it will be to tolerate. MRIs aren't always comfortable or pleasant but the results they yield may actually save your life.
This article is not meant to diagnose, treat, prevent, or cure any disease. All medical facilities are different. Some of the information contained in this article may not pertain to your testing situation. All medical facilities want you to be informed and empowered. Don't be afraid to call the facility where you are scheduled to have your MRI exam (or any test for that matter) if you have questions.
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