MRTs ensure patient positioning and comfort are addressed in order to provide a safe and successful outcome for diagnostic and therapeutic procedures
- Many diagnostic and therapeutic procedures require patients to remain immobilized for significant lengths of time.1,2
- Patient comfort is important for the successful delivery of diagnostic examinations and radiation therapy.3
- Generally, the position assumed by the patient should be one that can be maintained for the duration of the procedure
- The ability to maintain a certain position for a period of time is affected by a patient’s level of comfort4,5
- Patient comfort includes both physical and psychological aspects, such as claustrophobia, for some exams and procedures
- Patient motion is a common impediment to diagnostic imaging and radiation therapy6,7, which may result in poor image quality which can lead to repeat procedures, inaccurate treatments, and/or increased exposure to radiation.2,8,9,10
- Continual communication with the patient throughout the procedure is essential.11
- A discussion of the communication (e.g., monitoring system, intercom, call-button, etc.) should take place before the procedure
- Other communication tools such as a verbal countdown can be useful when interacting with patients
- Time taken to assess the patient and ensure their comfort will lead to greater patient compliance with the procedure.3,11
- Continual patient collaboration and reassurance from the MRT throughout the procedure or treatment is an essential way to ensure comfort
- Determine what the limitations of the patient are (e.g., breathing restrictions, other injuries etc.) in order to make modifications if possible
- Patient education and preparation is an important element in gaining patient cooperation and compliance.12
- Patients must be provided the opportunity to ask questions prior to and throughout the procedure or treatment which can alleviate anxiety and provide a rationale behind the required position
- Providing reassurance that the patient can be removed from the equipment at any time, if necessary, may provide some comfort to the patient2
- A combination of different strategies, techniques and aids can be provided to enhance comfort throughout the procedure12,13:
- Ear protection must be provided to reduce the loud noise during MRI procedures4
- An in-bore fan may be used to increase airflow and help regulate temperature (MRI specific)
- Positioning aids, such as straps, pillows, foot holders and foam pads may help the patient remain still and comfortable3,14
- Modified positioning (if appropriate for the study and safe for the patient) can help improve patient comfort and immobility
- Mirrors or prism glasses may be offered to help view surroundings (MRI specific)
- Patients are encouraged to relax during procedures/treatments and music or other narratives may be made available to patients
- Breathing techniques prior to the procedure may help calm the claustrophobic patient
- A familiar person in the room, where safe and appropriate, will often help an anxious patient develop an increased sense of security
- Once immobilized, ensure the patient is ready to proceed. If patient effort is required to maintain the position, movement is more likely.4,5
- Patients may require some form of sedation by the appropriate healthcare provider (e.g., usually physician’s orders) when other techniques and modifications are not successful.7,11,13
Radiological Society of North America, Inc. Magnetic Resonance Imaging (MRI) – Body. RadiologyInfo.org. May 2016. Available from: https://www.radiologyinfo.org/en/info.cfm?pg=bodymr. [Accessed 11 Dec 2017]
Carlsson S, Carlsson E. The situation and the uncertainty about the coming result scared me but interaction with the radiographers helped me through: a qualitative study on patients’ experiences of magnetic resonance imaging examinations. J Clin Nurs. 2013 Nov;22(21-22):3225-34. DOI: 10.1111/jocn.12416
Ehrlich RA, Coakes DM. Patient Care in Radiography with an Introduction to Medical Imaging. 9th ed. Elsevier; 2017.
Potters L, Kavanagh B, Galvin JM, et al. ASTRO and ACR practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2010 Feb;76(2):326-332.
Sahgal A, Roberge D, Schellenberg D, et al. The Canadian Association of Radiation Oncology scope of practice guidelines for lung, liver and spine stereotactic body radiotherapy. Clin Oncol. 2012 Nov;24(9):629-639. Epub 24 May 2012. DOI: 10.1016/j.clon.2012.04.006.
Munn Z, Jordan Z. Interventions to reduce anxiety, distress and the need for sedation in adult patients undergoing magnetic resonance imaging: a systematic review. Int J Evid Based Healthc. 2013 Dec;11(4):265-274. DOI: 10.1111/1744-1609.12045
ClinicalTrials.gov. Reduction of Claustrophobia and Patient Motion After Training of MRI Personnel in Comfort Talk. April 2017. Available from: https://clinicaltrials.gov/ct2/show/NCT01563198. [Accessed 16 Apr 2018]
Radiological Society of North America, Inc. Computed Tomography (CT) – Body. RadiologyInfo.org. March 2016. Available from: https://www.radiologyinfo.org/en/info.cfm?pg=bodyct. [Accessed 11 Dec 2017]
Lampignano JP, Kendrick LE. Bontrager’s Textbook of Radiographic Positioning and Related Anatomy. 9th ed. Elsevier (Mosby); March 2017.
Howlin C, O’Shea E, Dunne M, et al. A randomized controlled trial comparing customized versus standard headrests for head and neck radiotherapy immobilization in terms of set-up errors, patient comfort and staff satisfaction (ICORG 08-09). Radiography. 2015 Feb;21(1):74-83.
Medicines and Healthcare Products Regulatory Agency (MHRA). Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use. GOV.UK. March 2015. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/476931/MRI_guidance_2015_-_4-02d1.pdf. [Accessed 15 Dec 2017]
Munn Z, Jordan Z. The Effectiveness of Nonpharmacologic Interventions to Reduce Anxiety and Increase Patient Satisfaction and Comfort during Nuclear Medicine Imaging. JMIRS. 2014 Jan;45(1):47-54.
Canadian Association of Medical Radiation Technologists. Claustrophobia. CAMRT, Best Practice Guidelines. Feb 2016. Available from: https://camrt-bpg.ca/patient-management/patient-care/claustrophobia/. [Accessed 19 Apr 2018]
Machado JM, Monteiro MS, Vieira VF, et al. Value of a lower-limb immobilization device for optimization of SPECT/CT image fusion. J Nucl Med Technol. 2015 June;43(2):98-102. DOI: 10.2967/jnmt.114.145771.