By John R. Fischer

Linda Pacheco was worried about her son Paul’s next MR scan. The seven-year-old, who was diagnosed at two with a brain tumor, experienced bad reactions when sedated during his last two visits, and doctors said he could not be put under again. Pacheco worried her claustrophobic son would not be able to lie still and would become anxious during the scan.

But months before Paul’s appointment, The Hospital for Sick Children in Toronto began using Resonance Technology’s CinemaVision, an integrated audio-video headset that allows children to watch movies and TV shows or listen to music during MR exams. When Paul slipped on the device, he was immediately entranced by his favorite video and forgot all about the scan.

“My son was not afraid, and he was very comfortable during his one-hour scan. I can’t tell you how grateful my husband and I are to you,” wrote Pacheco in a testimonial to Resonance Technology, located in Los Angeles.

Today, hospitals worldwide employ solutions like this to calm patients before and during their scans, making them more adherent and cooperative so that providers can obtain quality images without having to stop or repeat exams. Additionally, patient experience technologies save on costs and prevent disruptions in hospital workflow.

HCB News sat down with designers who make these solutions to discuss the various types available, their benefits, and how they are making the imaging process more efficient, simpler, and personal and inviting for patients.

Finding the right solution
Visual solutions like CinemaVision A/V are growing in demand because of their ability to immerse patients in virtual worlds of movies and TV shows. The aim is to distract and make them forget they are undergoing an MR scan all together. CinemaVision A/V does this with the use of 3D goggles and has noise-attenuating headphones to block out the gradient sounds of the MR scanner.

Mokhtar Ziarati, president of Resonance Technology, says these elements relax the patient before they get into the scanner, reducing the risk of cancellations, and allow them to stay still, preventing the need for repeat scans.

“The image quality of the patient actually improves if they watch the movies, because they are just fixating on what’s in the movie and don’t move around,” he told HCB News.

Some organizations resort to turning the whole MR suite into another world, incorporating solutions that decorate and transform the cold and sterile environment into a fun and relaxing setting. PDC Facilities does this with its Caring MR Suite, which hides scanning equipment behind customized cabinetry, and uses colored LED lighting and natured themed images to make patients feel like they are somewhere else, like the beach, outer space, or the jungle.

The patient simply chooses which setting they would like, and the Caring MR Suite customizes it by adjusting video, lighting, and music. Additionally, they can sit back in the scanner and watch a movie or TV show on PDC Facilities’ wireless version of its In-Bore Viewing Video Display.

“The personalized experience provides patients with both a sense of wonder and control. For busy MR techs, all suite controls are a tap or two away, and the Caring MR Suite is designed to ensure techs can always quickly deliver a great patient experience,” said Jessica Maslowski, marketing and customer support for Caring Suite Applications at PDC Facilities, located in Hartland, Wisconsin.

Comfort Health Solutions, in Fletcher, North Carolina, has a similar approach. Using 12 projectors, the company’s Enspirations 360 interactive system bathes the walls and gantry in ambient lighting and designs that create a full 360-degree personalized experience to make them feel more at ease. “It really immerses the patient when they come through," said David Mathieu, chief creative officer for Comfort Health Solutions.

While a good distraction visually, video has its limitations, according to John Hornbrook, chief operating officer at MRIaudio, located in Carlsbad, California. He says that audio-only solutions may allow patients to imagine themselves in any place that makes them feel at ease by listening to their favorite music or podcast. They also may be able to converse more easily with personnel in the control room.

"With audio alone, the patient has music and their imagination, and you can go anywhere, whereas with visuals, you only have the options available to you. If you only have one or two scenes or a scary movie to offer, it can be a little stress inducing," said Hornbrook.

Relaxing the patient at the best cost
Movement alone can cost as much as $115,000 per scanner each year, according to a 2015 study by Harborview Medical Center in Seattle, published in the Journal of the American College of Radiology. The researchers found that across 192 completed clinical exams, roughly 20% had to be repeated. This is because anxiety among patients causes them to move, distorting scans and creating the need to reschedule them. This, in turn, delays diagnosis and care, and creates longer waiting times for other patients.

Sedation and anesthesia services can prevent patients from moving but are costly and time consuming. They require additional specialized staff to put the patient under, and make the scan more complex, raising the risk associated with it.

A study published in Radiology in 2011 found that an outpatient MR scan costs $902 with sedation, compared to $665 without it. This indicates that pediatric MR costs for sedated and anesthetized patients are, respectively, 3.24 and 9.56 times higher than MR costs for patients who stay awake.

"After a patient is sedated for a scan, they need to be placed in a recovery room until the sedation medication is worn off. This takes up valuable nurse's time, as well as hospital space, which increases costs. If hospitals can eliminate this, it's a major savings for both the patient and hospital," said Mathieu.

Utilizing MR patient experience solutions reduces the need for anesthesia and sedation, making scans easier, as well as less costly and time-consuming. Hornbrook recommends that providers invest in a solution that is simple and easy to use.

He also says it should be one that has undergone extensive testing, is certified to meet specific requirements, and has been refined based on feedback from technicians. MRIaudio's headphones, for instance, are certified with a noise reduction rating of 29 decibels, which is the highest quality sound standard for hearing protection in MR. This reduces the chances of a patient developing tinnitus or experiencing hearing damage.

"A lot of those things go into the design of the system to make it something that a technologist would want to use, that they're happy to use and that doesn't interrupt their workflow. The most important thing is that we don't interrupt the day and cause a scan to take longer," said Hornbrook.

Communicating effectively is also vital, as radiologists and technicians must be able to relay instructions to patients such as “please hold still” and “you’re doing great” to keep them informed. The CinemaVision A/V headset contains a microphone that allows staff to communicate with patients and monitor their breathing. And PDC Facilities’ Caring MR Suite utilizes custom patient scrolling text that runs across the bottom of its In-Bore Viewing Video Display.

“This is also helpful for anyone who may have trouble hearing, or speaks other languages. We can also tie messages to countdown timers, which has been particularly helpful for ViewRay's MRIdian breath holds,” said Maslowski.

Enhancing future patient experiences
In some cases, patient experience solutions can mean the difference between patients completing an MR scan or not, because patients may be too anxious or might not respond well to anesthesia or sedation. The best approach is to create an environment that is personalized and gives them a sense of familiarity, according to Maslowski.

“If you imagine a traditional MR suite without patient experience design, it's usually cluttered, cold and clinical-feeling, which can increase anxiety in an already intimidating situation for many,” she said. “In contrast, our Caring MR Suite solutions take into consideration the entire MR suite experience to positively engage the patient's senses in a soothing, personalized experience of their choice from the moment they enter the suite.”

Hornbrook says he expects in the next few years to see this experience begin even sooner, with patients able to start watching movies or listen to music from small devices the moment they check in at the front desk.

He also says that these experiences may eventually be accessible in one’s home. "Scanners are getting smaller, one company has portable scanners that will fit in an elevator. You're going to be able to stay in your hospital room. Eventually, we might be able to bring a portable MR scanner to your house, scan you there, put it back in a van and drive away. Patient satisfaction and patient comfort are going to be the way things are done, going forward.”

Manufacturers are also working to create new solutions to add to their existing portfolios. MRIaudio is developing an in-bore video entertainment system, as well as an MR alert system with a squeezable alarm that patients can use to get the technologist’s attention.

And Resonance Technology is in the midst of creating a curved flat screen that will stretch across the entire tunnel of the MR scanner and not require the patient to wear goggles. “The patient will no longer feel like they are in a tunnel because they are watching a movie. It will look like they are outside the tunnel. It depends on what you show them. It’s going to be more relaxing,” said Ziarati.

These changes in process and technology are already affecting providers and making them more aware of the significant role that patient experience plays in the MR imaging experience, says Mathieu. "Hospitals are now putting CXO's (chief experience officers) in place to focus on enhancing the patient experience across the entire facility to help increase their HCAHPS scores, which, in turn, means higher reimbursement dollars.”