Training health professionals in patient-centered communication during magnetic resonance imaging to reduce patients’ perceived anxiety

Objective: We examined how a patient-centered communication training program for magnetic resonance imaging (MRI) affected health professional (HP) practice and patients’ perceived anxiety (PA). Methods: We implemented an intervention program. Six of the 17 eligible HPs completed the study. The proportion of observed desired behaviors (PODBs), including MRI procedure explanation (MRI-PE), communication, and MRI checking procedures was measured using an observation grid. We tested 182 patients (85 pre-, 58 post-, and 39 at follow-up) for PA pre- and post-MRI. Results: The Bayesian ANOVA effect size suggested moderate evidence of improvement in HP PODBs, preto post-intervention. Use of MRI-PE declined between post-intervention and follow-up (6 months later). Observed changes in PA, pre- to post-MRI, could be related to time constraints and perceived pressure to explain the exam in detail once institutional routines are reestablished. Conclusion: In MRI units, time constraints condition the performance of HPs who address patients’ PA. Practice implications: “Real workplace” interventions that promote better patient-centered communication and provide each patient with a comprehensive explanation of MRI procedures also appear to improve HP PODBs

Individual and Contextual Variables as Predictors of MRI-Related Perceived Anxiety

Background: Magnetic resonance imaging (MRI) generates patient anxiety (PA) and, therefore, it is important to understand individual and contextual variables that may cause it. In study one, we explored those anxiety predictors. In study two, we examined the effect of the experience of MRI on PA comparing anxiety pre- to post-MRI. Methods: PA was measured with an anxiety and stress scale in an interview format. Data collection occurred at a public hospital with MRI outpatients aged 18 or older. In study one (n = 204), participants answered the questionnaire immediately after experiencing the MRI and the data were analyzed through structural equation modeling. In study two (n = 242), participants answered the questionnaire before and after the examination and the data were analyzed through Bayesian statistics. Results: Being female, having a higher education level (EL), and not receiving information about the examination predicts higher PA after MRI. Patients with prior information have a decrease in PA from pre- to post-MRI. Those who do not have no change in PA. In low-educated patients, PA also decreases and no changes occur in highly educated patients. Conclusion: This study provides health professionals with valuable indicators about patients who are more likely to perceive and express anxiety during MRI.Centro de Investigação em Educação e Psicologia (CIEP

Colangiopancreatografia por Ressonância Magnética

A colangiopancreatografia por ressonância magnética (CPRM) pode constituir uma alternativa à colangiopancreatografia retrógrada endoscópica (CPRE) no estudo da maioria das patologias das vias biliares e do pâncreas. Esta técnica é considerada o exame diagnóstico de escolha após uma CPRE inconclusiva, sendo igualmente útil no planeamento pré-cirúrgico e acompanhamento pós-cirúrgico. O artigo descreve os protocolos adequados à realização do exame com e sem uso de secretina, demonstra as características da anatomia normal e possíveis alterações congénitas (pâncreas divisum, quistos do colédoco, Santorinicelo e Wirsungocelo) e faz uma revisão das principais patologias benignas (coledocolitíase, síndrome de Mirizzi, colecistolitíase, estenoses ductais, pancreatite aguda e crónica) e malignas (colangiocarcinoma, carcinoma da vesícula biliar, tumores pancreáticos e ampuloma) que podem ser ilustradas na CPRM. São ainda descritas algumas limitações e potenciais artefactos desta técnica

MRI of pregnant patients for suspected pulmonary embolism: steady-state free precession vs postgadolinium 3D-GRE

INTRODUCTION: Pulmonary embolism is a leading cause of maternal mortality in the developed world. Ventilation-perfusion scintigraphy and Computer tomography cause ionizing radiation exposure. Gadolinium-enhanced magnetic resonance imaging is generally not indicated in pregnant patients. MRI using motion resistant techniques that do not use intravenous contrast material, such as balanced steady-state free precession may be a better approach in pregnant patients. PURPOSE: To describe the preliminary findings of the use of SSFP for the evaluation of pregnant patients with suspected PE, and to compare with a young women population evaluated with postgadolinium 3D-gradient echo sequences for the same intention. MATERIALS AND METHODS: Radiology database was searched for two groups of subjects who underwent chest MRI at 1.5T for suspected PE, between January, 2007 and June, 2010: pregnant patients with MRI including balanced SSFP (group A) and females younger than 45 years old including a T1-weighted postgadolinium 3D-GRE (group B) sequence. The final study population consisted of 21 subjects. Blind and independent evaluation of MR images was performed for image quality of the pulmonary arterial system, PE and other chest findings. Data was subject to statistical analysis. RESULTS: Good image quality was observed in all central and lobar arteries on both groups and in 90% (group A) and at least 83.3% (group B) of the segmental arteries. There was no significant difference between groups A and B for image quality of central and lobar pulmonary arteries (p > 0.05). CONCLUSION: SSFP can visualize central, lobar and segmental pulmonary arteries with sufficient image quality in pregnant patients, comparable to 3D-GRE

Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall

Individual and Contextual Variables as Predictors of MRI-Related Perceived Anxiety

Background: Magnetic resonance imaging (MRI) generates patient anxiety (PA) and, therefore, it is important to understand individual and contextual variables that may cause it. In study one, we explored those anxiety predictors. In study two, we examined the effect of the experience of MRI on PA comparing anxiety pre- to post-MRI. Methods: PA was measured with an anxiety and stress scale in an interview format. Data collection occurred at a public hospital with MRI outpatients aged 18 or older. In study one (n = 204), participants answered the questionnaire immediately after experiencing the MRI and the data were analyzed through structural equation modeling. In study two (n = 242), participants answered the questionnaire before and after the examination and the data were analyzed through Bayesian statistics. Results: Being female, having a higher education level (EL), and not receiving information about the examination predicts higher PA after MRI. Patients with prior information have a decrease in PA from pre- to post-MRI. Those who do not have no change in PA. In low-educated patients, PA also decreases and no changes occur in highly educated patients. Conclusion: This study provides health professionals with valuable indicators about patients who are more likely to perceive and express anxiety during MRI