Magnetic resonance imaging Life with Disease

Outlook and expectations for magnetic resonance imaging

An MRI scan is a completely safe, non-invasive diagnostic technique that has no lasting negative effects on the health of the people who undergo it. Unlike X-rays or computed tomography (CT), MRI does not use ionising radiation, which makes it the preferred imaging test when frequent scans are needed for diagnosis or for monitoring treatment, especially of the brain.1

The procedure is completely painless and most people tolerate it well without the need for additional medication. However, a significant proportion of patients experience anxiety before or during the scan, mainly related to the enclosed space of traditional scanners or the characteristic noise of the machine.2 This anxiety does not harm the patient’s physical health, although it can make the experience less comfortable than desired.

Modern MRI scanners have improved considerably in recent years, offering wider tunnels, better lighting and better ventilation. Open MRI machines have two flat magnets positioned above and below the patient, with a large space between them, leaving two sides open and relieving much of the claustrophobia that many people experience with closed-bore machines.1 Although these open machines do not produce images as sharp as closed-bore scanners, they remain a valuable option for patients with severe anxiety.

For the vast majority of people, an MRI scan is completed without complications and provides valuable information that helps doctors diagnose or rule out a wide range of medical conditions. The scan usually takes between 15 and 90 minutes, depending on the part of the body being examined.3 Once it is over, the patient can return to their normal activities immediately without restrictions.

How the procedure normally unfolds

Having an MRI scan follows an orderly and predictable sequence. Before the appointment, many medical centres send an information video by email so that the patient can understand what to expect and feel more comfortable about the upcoming procedure.4 This advance preparation helps to reduce any anxiety that might arise from not knowing what will happen.

Before the scan, the patient must complete a specific MRI safety screening questionnaire. This form is essential because it gives the medical staff, the MRI radiographer and the radiologist key information about any implant or other conditions they need to know about. The questionnaire is usually available on the patient portal before the appointment and also at registration on the day of the scan.4 This screening stage is crucial for patient safety, as MRI uses very powerful magnetic fields that can interact with certain metals or medical devices in the body.

During the procedure, the patient lies on a table that slides into a large tunnel formed by magnets. The magnets create a powerful magnetic field around the body that aligns the positively charged particles within atoms, known as protons. More specifically, it aligns the protons in the body’s water molecules.5 These protons are constantly spinning, but the magnets stop their spin and align them so that they all point in the same direction. The radio waves knock the protons out of alignment, and when the radio waves are switched off, the protons return to their normal spinning patterns and give off signals. The computer in the MRI scanner uses these signals to create images.

During the scan, the patient will hear noises that can be described as a cross between a building site and an electronic music concert. This noise is electricity being switched on and off through large coils of wire inside the machine.3 The medical staff usually provide earplugs or headphones to make the experience more comfortable. It is essential that the patient stays completely still throughout the process so that the images are sharp and useful for diagnosis.

Once the scan is over, the table slides out of the tunnel and the patient can get up and go home straight away. No recovery period is needed unless sedation has been given for anxiety, in which case the patient will need someone to accompany them home.4

Possible complications

MRI is generally very safe, but there are some situations that require special attention. The most common complication is not physical but psychological: anxiety and claustrophobia. Many people feel nervous at the idea of being in an enclosed space for a long time, and this fear can be intense enough to prevent some patients from completing the scan.2

If the patient cannot stay completely still during the procedure, whether because of anxiety, pain or any other reason, the images may be blurred and not usable for diagnosis. In these cases, the scan may need to be repeated, sometimes with mild sedation to help the patient relax. If the doctor has prescribed medication to prevent claustrophobia, or if anaesthesia will be needed to help the patient tolerate the MRI, the patient will need extra time to prepare for the scan.4

Another important safety aspect relates to metal objects and implanted medical devices. The powerful magnetic field can attract certain ferrous metals with great force, turning them into dangerous projectiles. For this reason, it is strictly forbidden to take metal objects into the MRI room. Patients must remove jewellery, body piercings, hairpins, watches, hearing aids and any clothing containing metal.3

For people with metal implants in their body, the situation can be more complex. Dental braces, retainers and fillings are generally not a problem for MRI. However, other implants such as orthopaedic pins, bone plates, metal joints, embedded bullet fragments, shrapnel or metal shavings require careful assessment.6 In some cases, these objects can heat up during the scan or move slightly, although this is uncommon with modern implants designed to be MRI-compatible.

Medical devices containing magnets, such as cochlear implants or breast tissue expanders, may malfunction in the presence of the MRI magnetic field. Surgical clips, including aneurysm clips, and stents also require special assessment before the scan is performed.6

People with tattoos may feel a sensation of warmth or irritation in the tattooed area during the MRI scan, especially if the ink contains metal particles. Although this is uncommon with modern tattoos, the medical staff should be told about it in advance.6

In some MRI scans, a contrast agent is used, which is injected into a vein. This contrast, usually gadolinium-based, helps certain structures or abnormal tissues show up more clearly in the images. Although allergic reactions to gadolinium contrast are rare, they can occur. Patients with severe kidney disease have a slightly higher risk of developing a rare but serious condition called nephrogenic systemic fibrosis when exposed to certain types of gadolinium contrast.7

Impact on daily life

For the vast majority of people, having an MRI scan has minimal impact on daily life. The procedure requires no recovery, and the patient can resume all their normal activities immediately after leaving the medical centre, including driving, working and exercising.1 There are no lasting side effects on the body from exposure to the magnetic field or the radio waves used during the scan.

However, the emotional side can have some impact. Many people experience anxiety in the days before the MRI scan, worrying about the enclosed space, the loud noises or simply the unfamiliarity of the procedure. This anticipatory anxiety can affect sleep, appetite and concentration at work or in other everyday activities.2

For people with significant claustrophobia, worry about the scan can begin weeks before the scheduled appointment. This can cause additional stress and lead the person to avoid or postpone the scan, which could delay important diagnoses. In these cases, talking openly with the doctor about the available options, such as open MRI or mild sedation, can greatly help to reduce anxiety.1

There are several strategies that can help people feel more comfortable during the procedure. Many medical centres allow the patient to listen to relaxing music through headphones during the scan. Some even offer virtual reality goggles that can help take the mind off the enclosed space.3 Practising deep breathing techniques before and during the scan can also be very helpful for staying calm.

On the day of the scan, it is advisable to wear comfortable, loose-fitting clothing without zips, metal buttons or embellishments. Many centres provide hospital gowns to change into, but wearing suitable clothing can save time. It is important not to wear make-up, as some cosmetics contain metal particles that can interfere with the images or irritate the skin.3

For people who need frequent MRI scans as part of the monitoring of a chronic medical condition, developing effective coping strategies becomes particularly important. Each successful experience can help reduce anxiety about future scans, as the person gains confidence and familiarity with the process.

At work, the impact is usually minimal. Most MRI scans can be scheduled early in the morning or late in the afternoon to minimise disruption to the working day. As the procedure requires no recovery, the patient can return to work the same day if they wish.

Support for the family

Family members play an important role in helping to make the MRI experience easier for the patient. Understanding exactly what the procedure involves and what to expect can help relatives provide more effective emotional support and reduce the patient’s anxiety.

It is helpful for family members to know that MRI is completely safe and non-invasive. It involves no radiation, no needles (unless contrast is needed) and no pain. This information can help them reassure the patient if they express worries or fears about the procedure. Sometimes a calm conversation with a trusted relative who understands the facts can be more effective in reducing anxiety than formal medical explanations.

Family members can help with practical preparation for the scan. They can go through the MRI safety screening questionnaire together, helping to recall important details about previous operations, medical implants or past jobs that may have involved exposure to metal particles. Going through it together can ensure that no important information the medical staff need to know is forgotten.4

If the patient needs sedation for the procedure because of severe anxiety or claustrophobia, a family member must be available to accompany them home after the scan. Sedative medicines can temporarily affect judgement, reflexes and the ability to drive, so the patient should not drive or make important decisions that day.4

For children who need MRI scans, family support is especially crucial. Interestingly, recent research suggests that children are less anxious about MRI scans than adults, showing that much of the fear comes from overthinking rather than from the reality of the procedure.3 Parents can help by explaining the process in simple, positive terms, describing it as a machine that takes special pictures of the inside of the body without hurting.

In some medical centres, a family member is allowed to wait in the MRI room during the procedure, provided they have no medical contraindications. Simply knowing that a loved one is nearby can be a great comfort to the patient, especially if they suffer from anxiety. However, the family member must also go through the safety screening process and remove all metal objects before entering the room.

Family members can also help by looking into medical centres that have open MRI scanners if the patient has significant claustrophobia. Although these scanners do not produce images of the same quality as closed-bore machines, in many cases they are perfectly adequate for diagnostic purposes and can make the experience much more bearable.1

After the procedure, family members can help by making sure the patient understands how and when they will receive the results. A specialist radiologist will analyse the images and send a report to the doctor who requested the scan. This process can take anything from a few hours to several days, depending on the urgency of the case and the medical centre. Family members can help manage anxiety during this waiting period by reminding the patient that a delay in the results does not necessarily mean that something is wrong.

In the context of clinical trials, family members can play an even more active role. MRI scans are key diagnostic and monitoring tools in many clinical trials, especially those relating to neurological diseases, cancer and cardiovascular disorders. If a patient is considering taking part in a clinical trial that requires frequent MRI scans, family members can help by finding out what equipment the research centres use, whether they offer flexible appointment times and what comfort measures are available to participants.

Family members can also accompany the patient to appointments with the research team to ask questions about the clinical trial protocol, including those relating to imaging procedures. Understanding exactly how often MRI scans will be needed, which parts of the body will be examined and whether contrast will be used can help both the patient and the family make informed decisions about taking part in the trial.

Registered medicines used for this procedure

• Gadolinium contrast – Intravenous contrast agent used in some MRI scans to improve the visibility of certain structures or abnormal tissues in the images
• Sedatives – Prescription medicines used to help prevent claustrophobia and allow patients with severe anxiety to tolerate the MRI procedure better