Imaging adventures: MRI for beginners

Brain Scans: the truth in black and white. The NHS provides prospective scanees with an information sheet “Magnetics Resonance Imaging Investigations”. It’s designed to answer questions and alleviate any anxiety associated with the procedure. Here, I provide the NHS questions and answers, annotated with my own more individual and expressive insight and experiences.

Q. What does MRI do?

A. MRI provides very detailed pictures of the body which are useful for diagnosis and basic medical research into the human body functions.

Vix’s A. Simple really, it provides you, the patient, with a chance to see if you still fit in the machine, and if your claustrophobia, that you never knew you suffered from, has gotten any better or worse. It tests your hearing, and your ability to tolerate the very unpleasant. Plus, it provides a nice picture of your brain for your oncologist to see if your brain cancer is stable, or not. Perhaps a PhD using nuclear magnetic resonance spectroscopy was taking it a bit too seriously, to understand the science behind my future medical treatment and investigations.

Q. How does it work?

A. The human body is largely made up of water which contains hydrogen. Hydrogen atoms act like tiny magnets and it is information from these that are used to produce images. Information is obtained using a combination of external magnetic fields and radio waves (at a similar frequency to radio stations).

Vix’s A. It’s clever physics stuff in a nutshell. You probably shouldn’t be worrying about things at an atomic level, but believe me, it does work. Those who need to see inside my head, will get a good look. All my little protons get excited, and line themselves up with the big magnet I am put inside, and then the protons relax, and the clever physics chaps are able to build the picture of my brain as the protons behave differently depending on what kind of environment they are in.  So normal brain tissue, cerebrospinal fluid, scar tissue, tumour tissue will look different. Nuff said.

Q. Does it involve X-rays?

A. No. Neither does it involve any other form of ionising radiation such as alpha, beta or gamma rays.

Vix’s A. No, you Silly Billy, it’s not radiation at all, it’s relaxation of excited protons. It’s not going to fry you like X-rays, it’s much less harmful than CT scans. There are no X-rays, nothing X-rated and no X-Factor either.

Q. Will it hurt?

A. No. The scanning process itself is totally painless. For some investigations a single injection may be necessary but if so, it will be discussed with you beforehand.  The scanning process can be noisy, but ear defenders or ear plugs will be supplied is necessary.

Vix’s A. Well, this all depends on what you understand by the word “hurt”. It’s not like boot camp, or the last few uphill miles of a marathon that you should have trained more for, it’s not like a match in the front row against the Western Samoans, or even like falling off your bike, or out of a tree. It’s not like a headache, a stinking hang-over, or a dead arm, or even a broken heart. It’s a special kind of pain, restricted to the confines of the MRI Suite: You may well be scarred, for life. I got to wear ear plugs, sponges over my ears and a bandana before the Hannibal Lechter-like mask, the former to prevent ocular damage, and the later to hold me in, tight. The “sharp scratch” hurts in a more traditional pure-and-simple pain way, when they insert a needle in a vein to add the Gallidium contrast at scanning half-time. That made me feel pretty nauseous, not the needle and sharp scratch, the contrast agent, to the extent that I had to come out of the tube and be stroked a bit and sip some water before more light saber wooshes and fog horn blasts. The highlight was that I was told that I should eat after my scan was finished, and you really can’t grumble at that kind of medical advice can you?

Q. What happens if I change my mind about being scanned?

A. Scanning is certainly not compulsory but it is usually the most accurate and least painful way of obtaining important medical information about you. For your sake you should allow the scan to proceed. However, even if you change your mind during the scanning you can simply signal the staff using the “sqeezeball” device which will be provided. The staff will stop the scan and remove you from the imager.

Vix’s A. Scanning is certainly not compulsory, but I have no choice, really.  Squeeze the ball if I must, but that really means that I have to start all over again, so the whole thing takes even longer. Grin and bare it. Man up. Visualise…

“Changing my mind”, is an interesting thought in itself though, perhaps a good idea to go into the scanner with my brain, and come out, with it changed, morphed, substituted into a fully healthy hybrid of Stephen Fry’s intellect, and some of David Attenborough, plus Judi Dench’s charisma, control and style, Dawn French’s fun and wit, Nigella Lawson’s kitchen flair, and a dollop of calming Zen: my Grand Design Mind. Perhaps Kevin Macleod could help me.

Q. How long will scanning take?

A.  You will spend typically 45 minutes in the imaging suite, of which about 30 minutes will actually be spent in the imager.

Vix’s A. Well in reality, it took few months to get the letter inviting me for the scanning appointment, and it took a good few weeks to work myself into a frenzied state, not just about the scan procedure itself, but, more importantly, about the results that the scan will provide, and what they mean for the next chapter of my life. In total, I lost several good nights of sleep, and uncountable daylight hours of productive time as I wondered and pondered about the “what if” outcomes, and the gravity and reality of the scan, life and everything: the Big Stuff that hangs on the result of the scan. Back to the question, and my answer… the duration including travel time from home to Glasgow and back is about two days, and the reality of the amount of time spent in hospital is that it’s less than two hours, and that includes the relaxing pre-scan cuppa, the waiting room stint, the undressing room, and scan itself, and the redressing room. The time actually spent in the scanner was about forty minutes, a piece of cake? That’s two thousand four hundred seconds, have you tried to lie really still for sixty seconds when you are feeling somewhat anxious? I can promise you, that the forty minutes of scanner time, feel like the longest minutes you ever have experienced, I am sure that time slowed whilst I was in there.

Q. What should I do whilst I am in the imager?

A. Relax, that is the most important thing. The second most important thing is to keep absolutely still as any movement can cause bad blurring in the final images.

Vix’s A. A silly thing to suggest would be to say “relax”. Your protons may be exciting and relaxing, but it’s not like you are horizontal on a sun lounger on the beach, or even on your back on a hillside on a summer’s day, though you do get a blanket for warmth. I suggest that you try and maintain control of your anal sphincter, bowels and bladder, and try and combat any waves of nausea. Knitting, crochet, cross-stitch, cross-words probably won’t be allowed in with you, nor a hard copy book, or a Kindle, not even a newspaper or a magazine.  What you’ll be needing is a good imagination so that you can try and forget your wearing a pair of surgical pyjamas, in a long noisy tube, which makes all kinds of very loud fog-horn noises, interspersed with alarms, sirens and light saber whooshing noises. You’ll need to bring your imagination that allows you to escape from this skinny tube, onto a hillside, or a beach, where you might actually be able to relax. You’ll need to forget that if you keep comfort eating that this confined space it going to be even more confined. You’ll need to forget that you have a stress-ball panic alarm squeezey thing in your hands. So, ideas for things to do include visualisation, extreme visualisation and escapism, whilst keeping very, very still. Play Musical Statues (the extended play version), or Sleeping Lions with your friend. Think about fluffy bunny rabbits, kittens, puppies, sunny days, a days, snow on mittens, frosted window panes, heavy rain, thunder and lightning. Think about logs fires, hot chocolate with marshmallows…. must I go on and on? Think about my positional alignment, and I don’t just mean my protons, keep still, dead still. So, it was no surpize when I was asked “Are you OK in there?” on a few occasions during the forty minutes, I answered flippantly “Living the Dream”, “Loving it” and “Happy Days”. Indeed, if you ask a silly question, expect a silly answer.

Q. Are there any reasons why I should not be scanned?

A. If you have any metal in your body the magnetic fields used in MRI can affect it. For example, if you have a cardiac pacemaker or a cerebral aneurysm clip or you know or suspect you may have metal fragments in your eye then you should inform the MRI staff. Even if you don’t have metal in your body you will be required to remove all metal form your person before entering the imaging suite, except dental fillings and bridge work which don’t affect scans. You will also be required to remove all cards with magnetic strips (cash-point and credit cards) and lock away all your property, and it’ll be returned to you before you leave. You’ll be asked a series of questions to make absolutely sure you do not have any metal on your person.

Vix’s A. Well, a good reason for not being scanned is that it’s not a fun or nice in there. I am sure it smelt of sick in there last time. If, like my paternal grandmother you believe in the philosophy of “sic non amat, fecit” translated from Latin this means “if you don’t like it, don’t do it”. If you know what’s best for you, you’ll get in there, lie still and hold on to your breakfast. If you do not want realigning and an ordered mind, in a purely physical non-orthopaedic or organisational way, this could be your get out clause.

Q. Is there anything I should do before I attend the Unit?

A. Yes. You should wear light clothing under your outdoor attire as the temperature in the MR imager can get pleasantly warm. Women should not wear any makeup or at least should bring a cleansing cream to remove it before the scan. Hairspray, hair gel or mouse should not be applied on the day of the scan. You may eat normally before the scan.

Vix’s A. Wear decent knickers and socks. It doesn’t matter about your bra as you have to take that off. Moisturise well. I cursed myself as I realised that the “sculpting mud” I’d put in my hair, probably should be there. Eat breakfast, after all it’s the most important meal of the day, and you’ll need something to throw-up. Drink water, as you’ll need lots of protons to get excited and relax. Do your normal morning ablutions. Ask all those who care about you to beam positive energies, of the magnetic resonance kind, to your location, at the specific time on the specific date of your scan. Whilst in the scanner I have five missed calls, seven text messages and a dozen messages on Facebook about my “status update”. Fortunately my phone was turned off while I lay horizontal in my metal-free tube, ears plugged, muffed, bandana and mask on. I recommend that you take a friend who can make you laugh, even in tough times. Get there in plenty of time so that your anxiety levels can be modestly reduced, but be prepared to wait, as it seems the scheduling of scans never fits quite with the conventional clocks. Smile at your scanner siblings. Expect to feel a bit anxious. Prepare for your Pre-scan Interview: Do I have a cardiac pacemaker or an artificial heart valve? No; have I had an aneurysm in my brain clipped or treated? Not as far as I’m aware; Have I, at any time in my life, had metal fragments or filings enter my eyes? No, not unless someone did it while I was sleeping; Do I have any implants, stents or shunts in my body? Nope, my breasts are all home-grown and I have no stenty shunty things. Am I pregnant? Chance would be a fine thing, stupid question. Have I had any surgery within six weeks of the scan date? Nope, I’ve just had my 1 year anniversary since my last surgery thanks. Do I suffer or have I suffered from kidney failure? Blimey, I thought my brain was the problem, my kidneys are doing just fine thanks. Do you suffer from anxiety, fits or epilepsy? I had been pretty anxious about this scan. The interviewer asked my if I had had an MRI scan of my head before, and as I nodded she said “so you’ll remember the noise then”. My silent reply was that it wasn’t quite the highlight of 2010 for me. This is an interview that I was successful in. I got my scan.

Vicky’s supplementary Questions:

Who will be present while I am being scanned?

Vix’s A. Imaging Team members, will be doing their jobs with a modest scrape of compassion and empathy of what they are putting you through.

Can I bring my friend with me? I mean, can they really come with me into the scanner, to hold my hand? We could surely fit in, we’re good mates, we could go head to tail, or do spoons, or the press-up plank. It would be like two for the price of one, BOGOF?

Insert pics

Do I get a prize if I’m not sick inside the machine?

 

Imaging adventures: MRI for beginners

 Vicky Galbraith, 14 November 2011

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