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Reduction of Claustrophobia during Magnetic Resonance Imaging: Prospective Cohort Study in over 55,000 Patients |
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Marc Dewey, M.D., Tania Schink, M.S., and Charles F. Dewey, M.D., Ph.D.
From the Departments of Radiology (M.D.) and Medical Biometry (T.S.), Charité, Medical School, Humboldt-Universität zu Berlin, and the Radiology Outpatient Center Löbau (C.F.D.), Germany.
Address reprint requests to Dr. Marc Dewey at the Charité, Department of Radiology, Schumannstr. 20/21, 10117 Berlin, Germany; or at marc.dewey@charite.de
2000 words, 28 references, 2 tables, 3 figures
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Dr. M. Dewey and Dr. C.F. Dewey designed the study. A technical assistant gathered the data, which were checked by Dr. C.F. Dewey. Dr. M. Dewey and Ms. T. Schink performed the statistical analysis. All authors vouch for the data and participated in the interpretation of the data and approved the final version of the manuscript. Dr. M. Dewey drafted the manuscript.
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PURPOSE
Claustrophobia is a common problem during magnetic resonance (MR) examinations that requires anxiolytic sedation of the patient, reduces work-flow, and elevates costs. We compared the rate of claustrophobic reactions on a conventional and a newly-designed MR scanner.
Methods
Between 1997 and 2005 a total of 55,734 consecutive patients were included in this study analyzing the rate of claustrophobic reactions on a conventional MR scanner (42,998 patients) and a modern MR scanner (12,736 patients). The modern MR scanner produces 30 dB(A) less acoustic noise (97%) and has a patient-centered design (short (1.6 m) and wide (0.6 m) conical-shaped magnetic bore). Claustrophobia was defined as an anxious or panic reaction preventing MR imaging or requiring intravenous sedation with benzodiazepines. Multiple logistic regression analysis was used to adjust for the non-randomized design and to calculate adjusted odds ratios. The study was approved by the State Ethics Committee.
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Results
In addition to those undergoing head-first examinations, female and middle-aged patients were significantly more likely to develop claustrophobia in the logistic regression analysis (P < .001). The rate of claustrophobic reactions was significantly lower with the recent MR scanner (0.7%; 95% confidence interval: 0.6, 0.9%) than with the conventional scanner (2.1%; 95% confidence interval: 2.0, 2.3%; P < .001) with an adjusted odds ratio of 3.1 (95% confidence interval: 2.5, 3.9) and a number needed to treat of 72 (95% confidence interval: 63, 85). MR imaging was less frequently prevented by claustrophobia with the recent scanner than with the conventional MR scanner (P < .001). Also there was less need for intravenous sedation with the recent MR scanner (P < .001).
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Conclusions
Claustrophobia may be reduced by a factor of three from 2.1% to 0.7% when newly designed MR scanners are used.
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Clinical Relevance
Magnetic resonance scanners with 97% acoustic noise reduction and a short and wide magnetic bore significantly reduces the rate of claustrophobic reactions by a factor of three.
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