MRTs help to minimize and alleviate patient anxiety due to claustrophobia through education and the use of other available measures
Claustrophobia in diagnostic imaging and radiation therapy
- Claustrophobia is defined as a ‘fear of enclosed spaces’1,2.
- Some recent studies suggest it may be comprised of two separate fears: a fear of restriction and a fear of suffocation1,3
- Claustrophobia is common, with an estimated incidence of 4% in the general population1,4.
- It is an important issue to consider for diagnostic imaging and radiation therapy since many modalities and the immobilization used can create a feeling of confinement.
- Claustrophobia can be a barrier to patient compliance and completion of examinations/treatment.
Identifying patients with claustrophobia
- Identification prior to the time of examination/treatment helps MRTs make appropriate preparations for patients with claustrophobia1.
- All patients are educated on the nature of the examination or treatment prior to undergoing the procedure
- An opportunity to discuss and ask questions about the procedure or treatment allows patients to bring up their apprehensions beforehand
- MRTs are sensitive to cues that claustrophobia could present an issue for a given patient
- Identification can be facilitated through the use of screening methods or questionnaires
- Patients at high risk for severe distress can be identified as such by their referring physician or by the scheduling staff person5.
Managing claustrophobia and anxiety
- Education about the procedure, how long it will last and how it will feel can help alleviate anxious feelings for the patient
- A dry run (walk through) of the procedure can also help
- Communication throughout the procedure or treatment can be an effective method to reassure and distract an anxious patient1,5.
- MRTs maintain contact with patients throughout examinations and treatment
- A familiar person in the room, where safe and appropriate, will often help an anxious patient develop an increased sense of security
- Modifications to, and advances in, technology have led to developments that help alleviate patient claustrophobia:
- Newer open bore machines have been shown to decrease the incidence of claustrophobia among patients
- Modified radiation therapy masks have been shown to decrease claustrophobia
- Aural and visual stimulation during scanning are also common methods to reduce anxiety1,5-7.
- Reports indicate that systems which transmit music or audio communication in scanners successfully reduce symptoms of anxiety in patient5
- Modifications that address elements of the fear and anxiety (e.g., darkness, closed space, etc.) may also be helpful methods to reduce distress and feelings of claustrophobia5.
- Modified positioning (e.g., prone or feet-first position) can alleviate the “closed-in” feelings frequently associated with being supine – this may not be practical for all patients
- Mirrors or prism glasses can be used to permit the patient to maintain a view of the surrounding environment
- Bright lights can produce a less imposing environment for the patient
- A fan to increase airflow can also help reduce the sensation of confinement
- Relaxation techniques (e.g., controlled breathing, mental imagery, aroma therapy) or medical hypnosis may also be helpful5.
- Patients that are severely affected by claustrophobia, anxiety or panic attacks usually need sedation when non-medical interventions to counteract their distress fail5.
- The use of sedation requires special preparation, involving several important patient management considerations (please refer to the Patient sedation guideline https://ww2.camrt.ca/bpgbroken/patientmanagement/patientcare/patientsedation/)
Booth L, Bell L. Screening for claustrophobia in MRI – a pilot study. Eur Sci J 2013; 9(18):20-31.
Harris L, Robinson J, Menzies RG. Evidence for fear of restriction and fear of suffocation as components of claustrophobia. Behav Res Ther 1999;37:155-159.
Radomsky AS. Rachman S. Thordarson DS. McIsaac HK. Teachman BA. The Claustrophobia Questionnaire. J Anxiety Disord 2001;15:287-297.
Thorpe S. Salkovskis PM. Dittner A. Claustrophobia in MRI: The Role of Cognitions. Magn Reson Imaging 2008;26:1081-1088.
Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices. 2013 ed. Los Angeles, CA: Biomedical Research Publishing Group; 2013.
Phillips S, Deary IJ. Interventions to Alleviate Patient Anxiety During Magnetic Resonance Imaging: A Review. Radiography 1995; 1:29-34.
Tischler V. Calton T. Williams M. Cheetham A. Patient Anxiety in Magnetic Resonance Imaging Centres: Is Further Intervention Needed? Radiography 2008;14:265-266.