ANYONE who has had a Magnetic Resonance Imaging (MRI) scan will know that although they are painless in themselves, they can be an unpleasant examination. Having had around eight MRI scans, all in various hospitals in Jeddah, I speak from personal experience. Unfortunately, many staff working in hospitals become blasé and lose their “bedside manner”; what is a routine part of their day is a worrying event in the day of their patient who is possibly anxious, upset, or in pain, and needs reassurance. The best scan I have experienced had Filipino technicians who regularly communicated with me during the procedure, asked me if I was okay and made comments like “Not long to go now”, and “Only a few minutes more.” This communication was very comforting, especially being told about the amount of time left, as you lose all track of time during the scan. My husband also spoke to me from time to time, and I could ask questions if I wanted to. The worst situation was when the scanning technician, on two occasions, flatly refused to activate the voice intercom and didn't give me the hand-held alarm “bubble”. I had two scans following an accident and was in extreme pain inside the scanner but had no way of communicating with either the technician or my husband. After what seemed like an age, my husband said to the technician: “I am sure I can hear my wife calling.” It is a momentarily terrifying experience to find that you are in a sound proofed room, encased within a narrow tube from which there is no escape, with no way of communicating to anyone – a surreal, nightmarish feeling of being the victim in a TV murder thriller! Before having such a scan, it therefore helps to be well informed, know what to expect, and the questions to ask. What are MRI scans? MRI scans are used to assist in the diagnosing of numerous conditions in the soft tissues of the body, from torn ligaments to malignant tumors. They are especially useful for diagnosing and monitoring disorders of the brain and the spinal cord, so patients with conditions like Multiple Sclerosis and Spinal Cord Injury have regular scans. Unlike X-Rays, which are a form of ionizing radiation, the MRI uses large magnet and radio waves which are harmless. The human body has millions of hydrogen nuclei (protons) in water molecules which align with the strong magnetic field in the scanner. The radio waves push these protons out of alignment; as they snap back into place, they produce a detectable rotating magnetic field. The protons in different tissues of the body realign at different speeds, thereby revealing the different structures. The collected signals are interpreted by a computer to produce images that are clear, detailed three dimensional representations of your body. About the machine The MRI scanner is a futuristic looking machine positioned in the center of a virtually soundproofed room. It has a narrow, circular tunnel going through the middle, like a giant donut; you lie on a flat, padded stretcher that then slides into the tunnel. You are usually told how long your scan will take – usually between 15 and 45 minutes, but complicated scans can take up to two hours, or more – and are told to lie very still. After a while, you get used to the loud, intermittent thumping and knocking noises made by the scanner. You may have to have an intravenous injection of a contrast agent to help obtain a clearer picture of the area being examined. The technician operates and monitors the scan from a station outside the room and has a large window through which he can observe his patient. Some conditions preclude patients from having MRI scans: for example, if you have an implantable cardioverter defibrillator, or a pacemaker, as the strong magnetic field may interfere with their function. Other items that could cause problems are metal implants in your body – these could be accidental, for example from a shrapnel or bullet injury. Even tattoos with a metallic content in the dye, or medication patches that contain metal foil, can cause problems. It is also imperative to tell your doctor or technician if you are pregnant, or think you might be. Preparing yourself First of all, make sure that a member of your family or a close friend is available to come with you. Before the scan, you can usually eat normally and continue with any medication. You will have to remove any metal objects which will include jewelry, watches and hairpins. Wigs, dentures and hearing aids should also be removed, and if in doubt about anything, ask the technologist. In the scanner, you have to wear clothing without metal fasteners, so cotton trainer trousers and a t-shirt are fine. Women will be asked to remove their bras. Alternatively, you can wear a hospital gown. What to ask for Before you go into the scanner, ask the technician about communication between you inside the scanner and those outside – i.e. with the technician and whoever has accompanied you. There should be a voice intercom between the two, and you should insist that this is switched on and test it once you are inside the scanner. They can also give you a hand held “bubble” that you squeeze if you need attention and it gives a signal to the technician. In some hospitals, they give you headphones to reduce the noise and play soothing music. If you suffer from lower back pain, ask for a foam cushion to be placed under your knees so that they are bent and supported throughout the scan. This will relieve the pressure on your back. It can also be cold in the scanner, so if you aren't given a blanket, ask for one. If you have ever learnt any relaxation techniques, now is the time to use them: deep breathing, visualization and concentrating on things that distract your mind from the moment. If you are in a lot of pain, or suffer from claustrophobia, you can ask for sedation. Nonetheless, insist on some method of communication with whoever is outside. Although the technicians always ask everyone to leave the scanning room during the procedure, you can ask if someone can stay with you. The “head” end of the scanner is open, and they can sit at that end and talk to you, or at the foot end they can keep a comforting hand on one of your feet. They will also be asked to remove any metal objects on them. What the doctors forget As your scan is revealed on the screen, the technician may be answering questions that your accompanying relative asks. However, he is not the one who will interpret the scan and write the report. This is done by a doctor who will usually do this after you have left; you will then return to collect the report later. What can be scary is when you see a cluster of doctors all looking at your scan with furrowed brows before you have even left. Doctors forget the effect that this has on the patient: it usually causes anxiety, because the patient assumes they are doing this because there is something serious being revealed on the scan. If you ask them about the scan, the chances are they will say: “Oh, it is nothing to worry about. Your doctor will explain to you later.” And finally … If you have to have a scan, be prepared and think positive: when something is wrong, it is a wonderful diagnostic device. __
