The lights are low, the music is soothing, and the views are of a tropical garden and blue sky. This is the perfect setting for … magnetic resonance imaging? Nowadays, yes. With the advancements in MRI technology and various accessories and equipment features now available, an MRI suite can be almost as inviting as an upscale hotel room.

It wasn’t long ago that most patients who needed to undergo this type of imaging procedure anticipated it with apprehension and dread. The thought of being enclosed and having to remain still in the tunnel-like equipment for a long period of time was enough to incite claustrophobia. Add to that the anxiety associated with the possible diagnosis of a life-threatening condition, and even the most courageous patients would wither.

Art Research Institute provides MRI patients with an “escape” during procedures.

Taking in the Scenery
“It used to be that facilities would just throw a piece of equipment in a room and that was it,” says Joey Fischer, president of Art Research Institute (Atlanta), which installs nature imagery to transform clinical environments into more inviting spaces. “It’s not that there wasn’t caring, but now it is becoming much clearer how crucial the environment is to patients’ well-being. Even though MRI is not invasive or painful, it can be very unnerving, and our goal is to create a more relaxing, uplifting environment for the patient.”

Fischer’s ever-expanding library of images features his own photographs of nature, which can be installed on walls or ceilings as back-lit transparencies or mural prints. He says that technologists find the images to be useful focal points for sustaining patients’ interest, distracting them from their fears during imaging, and offering comfort—in essence, visual therapy. Fischer reports that many MRI equipment manufacturers are now aware of the healing and stress-reducing power inherent in patient-oriented environmental design and are actually funding the installation of ceiling and wall transparencies for facilities that purchase their equipment.

Another company offering “healing imagery” is the Sky Factory (Fairfield, Iowa). With its Sky Ceilings and Sky Tiles, the company transforms interior spaces with photographic images of skies and clouds, providing a highly realistic experience of nature. The goal is for a patient on an imaging table to recall looking up into the sky and to feel the sense of well-being and comfort that those images can bring.

Patients undergoing MRI procedures can relax with serene views from The Sky Factory  while listening to their favorite CDs on the multidisc changer from Newmatic Sound Systems.

“Nature is a powerful healer,” explains Bill Witherspoon, creator of the Sky Factory. “We choose to recreate the sky because it is universal, the one thing that every person can experience with a sense of joy and freedom. [The sky] is huge and perhaps our most significant and direct experience of nature. We are creating an illusion that will have a soothing psychological and physiological effect, to counteract the anxiety and stress that patients naturally experience when they need to undergo imaging. We’re like magicians: We go to great lengths—with the use of space, orientation, light, and color—to ensure that our creations are convincing to the eye and mind of the observer as authentic images.” Witherspoon enjoys sharing a story from a client, who reported that a 7-year-old patient looked up at the Sky Ceiling and asked, “What do you do when it rains?”

The Sky Factory offers geographically specific skies for every season and time of day as well as custom designs. The installations often include overhanging tree branches, flowers, or architectural elements, all designed from the exact perspective of the observer to create an authentic image. “Ultimately,” Witherspoon explains, “we want to engage the patient in a quiet, meditative sense rather than distract them with something overly stimulating.”

Soothing Sounds
Manufacturers of imaging products have been coming up with some creative solutions to the noise produced during imaging procedures, which can be harmful as well as frightening to patients.

For very young patients, Neonatal Noise Guards from Newmatic Sound Systems (Petaluma, Calif) protect the sensitive ears of infants without the need for cumbersome earphones or uncomfortable earplugs. The disposable padded shields slip easily over the ears and reduce the noise level in the MRI environment by at least 7 decibels, while reducing sound pressure by more than 50%.

The company also produces a full sound system that features a multidisc CD changer, AM/FM tuner, cassette deck, and four different headsets. The MRI patient can simply relax with music of his choice during imaging, and the technologist can listen to different music at the same time.

With the Genesis IV system from Magnacoustics (Atlantic Beach, NY), hand-held controls enable patients to select and change the music and volume. A volume-compensation feature automatically adjusts the music level according to the gradient sound pressure level. In addition, a built-in intercom allows the patient to communicate with the technologist (and vice versa) during the scanning process. These features give the patient some sense of control over the imaging environment, which can be daunting.

Avotec’s Real Friend audio headset (right) lets a friend communicate with the patient and vice versa.

Similarly, Avotec (Stuart, Fla) offers the Silent Scan Hearing Protection and Communication systems, which integrate music, communication, and hearing protection components in specially designed headsets that make yelling or repetition unnecessary, regardless of the patient’s location within the bore. Other Avotec products include the Real Friend Video system and the Real Friend audio headset; the latter allows the patient to communicate with a friend in the room as well as with the technologist. The friend also can listen to the same music as the patient during the scanning process.

Relief in Sight
MRI product engineers have found that the relaxing effect of music enables the patient to remain still, thus reducing motion artifacts and improving image quality. Resonance Technology Inc (Northridge, Calif) produces audio as well as video equipment for this purpose.

With its MRVision2000, which integrates 3-D video with a quality audio system, the company believes it offers not just a solution to patients’ anxiety and claustrophobia but also a tool with which imaging centers can decrease the need for sedation, increase throughput, and attract a higher volume of patients. The head-mounted visor system enables patients to enjoy soothing images and sounds of nature or watch a favorite movie or television program. Technologists have found that such a device is especially popular with children undergoing imaging.

High Tech, Yet Patient Friendly
All of the major MRI equipment manufacturers have turned toward enhancing patients’ comfort as they upgrade the technology.

Acoustic noise is reduced by about 90% with the Toshiba Vantage MR System.

“Toshiba’s strategy, in addition to developing systems that provide high utility, productivity, and efficiency, is to achieve clinical excellence through the development of patient-focused technology,” reports Anita Bowler, MR product manager for Toshiba America Medical Systems (TAMS of Tustin, Calif). With its Vantage System and Ultra System, “[TAMS has] addressed the closed nature of the systems, the loud noise related to the gradients, and the compromise in image quality previously caused by any attempt to improve on the first two issues.” The Ultra System’s four-post open architecture allows easy access and helps accommodate large, pediatric, or claustrophobic patients; yet, the system produces high-resolution images. Another patient-friendly feature is the Pianisimo noise-reduction technology of the Vantage System, which reduces acoustic noise by as much as 90%.

GE Medical Systems (GEMS of Waukesha, Wis) has answered the call for patient comfort by reducing examination times and opening the magnet environment. “The Signa EXCITE platform changes everything in MRI,” says Vicki Hanson, MR market segment manager for GEMS Americas. “Signa EXCITE not only enables new applications that improve the diagnosis and staging of disease, but it also reduces examination times. Less time in the magnet means greater comfort for the patient.”

Signa EXCITE from GEMS reduces examination times on the OpenSpeed scanners, a feature welcomed by patients large and small.

Signa EXCITE is available on GEMS’ 3.0T, 1.5T, and OpenSpeed scanners. In addition, the new OpenSpeed scanner provides an open environment that allows accessibility for interventional procedures and joint studies. Its integrated body coil even allows large patients to be scanned without the use of surface coils and makes the procedure more tolerable for many patients, while delivering high-quality images in a range of clinical applications.

The Panorama series from Philips offers 270^o patient access.

Likewise, Philips Medical Systems (Andover, Mass) has introduced the Panorama series of MR scanners, which are open systems designed to optimize comfort while increasing throughput. The 0.6T and 0.23T feature true C-arm design, offering convenience to technologists and greater comfort to patients. Also, the 0.23T offers 270° patient access, which allows for a family member or support person to accompany the patient.

Siemens’ MAGNATOM Avanto features a table weight limit of 440 pounds, ideal for heavier patients.

At Siemens Medical Solutions (Malvern, Pa), engineers have been especially cognizant of patient comfort in the basic design as well as hardware and software features of the company’s new products, says Laurie Fisher, product manager for high-field MRI. “In the MAGNETOM Avanto system, the main

feature is comfort,” she explains. “The free-floating table can be lowered to 19 inches from the floor so that elderly and pediatric patients, for example, can be eased on and off. Positioning is feet first, which lessens claustrophobia, and the technologist can position up to 76 coil elements at one time for multiple scans.”

The MAGNETOM Avanto has an Audio Comfort feature that reduces acoustic noise by 97%, which eliminates the need for ear protection; such protection is mandatory for equipment with less effective noise dampening. In addition, at 440 pounds, the table weight limit is the largest in the industry—

an advantage for heavier patients. The lighter coil design also enhances patients’ comfort during imaging.

Auto-align software allows the MAGNETOM Avanto to recognize the slice location from a previous examination and automatically set the alignment for follow-up imaging. “This [feature] eliminates a great deal of positioning time and, thus, increases throughput,” Fisher notes. “And conceivably, patients no longer have to wait anxiously for results, because the integrated report function allows a report and images to be sent directly to the referring physician.”

Those Little Extras
Newly introduced MRI accessories might be smaller than complete systems but just as important to patients’ comfort. For instance, Medrad Inc (Indianola, Pa) manufactures the Spectrus Solaris MR injection system, which has large, 115-mL syringes that allow technologists to continue scanning instead of needing to stop for refilling. The compact injector head can be positioned on either side of the patient for maximum versatility. Several timing features allow for synchronization and precise time-injection phases with the scanning, which simplifies the procedure for both the technologist and the patient.

In addition, a convenient feature that is becoming common in MRI systems is a mirror with which the patient can see the room or a companion during the imaging procedure, which eases anxiety as well as claustrophobia.

Bremen Corp’s patient positioners offer soft comfort during a harsh procedure.

Even the simplest products can have special features, explains Ryan McCartney, sales manager for Bremen Corp (Bremen, Ind). The company supplies patient positioners and table pads for most major MRI equipment manufacturers. “The Polyscan vinyl coating on our foam resists fluids rather than absorbing them, and it is seamless, so it cannot cause imaging artifacts or harbor bacteria,” he explains. “Some patients are so anxious that they are sweating. But with a quick wipe-down, the pads are ready for the next patient.” Another important factor is that the pads can be easily repaired, right in the field, if they are punctured. And because the padding is firm and dense, it remains comfortable throughout the examination instead of sinking down to the table from the patient’s weight.

Total Comfort
A new facility in Fort Worth, Texas, serves as an example of how every detail of a practice can be enhanced with a patient comfort-based philosophy.

“When we train our staff, we ask, ‘How would you treat your mother if she were the patient?’” says Neil Lucera, chief technologist at Monticello Diagnostic Imaging, which opened in 2002. “We wanted to offer the community something new, and we wanted to focus on the patient’s comfort. This is a very competitive service, and we knew we had to do things differently. Ours is more of a boutique MRI center. In fact, part of our mission statement is to redefine open MRI.”

When patients enter the imaging facility, they find a waiting area decorated more like a home than a medical office. Paintings on the walls are accented with spotlights, and oriental rugs highlight the hardwood floors. Patients are offered a beverage as they complete paperwork and then are brought into a sub-waiting room for the interview. This room is smaller and furnished with a bureau and cozy leather chairs, one of which is a recliner for IV administration. Two large dressing rooms flank this area, and beyond that is the imaging room, where hardwood—rather than metal—is the predominant surface material.

“We really toned down the lighting so that it wouldn’t be harsh or glaring. We do have some fluorescent fixtures, but mostly we have spotlights and sconces, to enhance the relaxing atmosphere,” Lucera reports. “We also used blues and yellows, colors that are subconsciously soothing, and there is a bank of windows in the examination room that lets in natural light and opens up the view.” As an extra demonstration of care, patients are covered with two blankets.

Monticello Diagnostic Imaging also incorporates technological devices that have proved helpful for ensuring patients’ comfort. “We use headphones with virtually every scan. They are so thin that they actually serve as a stabilizing and positioning aid,” Lucera says. These are more comfortable than the earplugs that were routinely used in the past, he notes, and seem to be the device most preferred by claustrophobic patients for distraction. “Newmatic [Sound Systems] really came through for us. One time, a patient began screaming during the scanning, and we could barely hear her through the microphone; she had dropped the call button. We knew we needed to make a change right away, and [the company] engineered a microphone in a flexible tube that we could position easily next to any patient.”

Representatives of all successful MRI equipment manufacturers have similar stories to share from their clients, who appreciate the customer service offered by companies that set out to build a market for their products one customer at a time. The newest facet to their customer service now appears to be helping imaging facilities build their practices one patient at a time, with systems that produce quality images while enhancing the comfort and confidence of patients.

Aubrey C. Patrick is a contributing writer for Medical Imaging.