What happens if you are too claustrophic to have a normal MRI scan? Health Editor Barry Nelson discovers an alternative.

IT is becoming increasingly common for patients undergoing investigation to be referred for a MRI scan. Since it was developed in the Eighties, magnetic resonance imaging has come on in leaps and bounds and has become an essential tool for diagnosis.

Scanners pulse radio waves up to 30,000 times stronger than the magnetic field of the earth through the patient’s body and use a computer to analyse changes to hydrogen atoms in the body.

This produces highly detailed black and white images of the body’s internal organs, ranging from dark grey where there are bones to off-white where there is fatty tissue. Skilled interpretation of these images can help doctors decide if there are abnormalities present and work out the best form of treatment.

MRI scanners are particularly good at scanning soft tissue and are very useful in finding benign or malignant tumours in the brain.

So far, so good, but to have a scan, patients have to lie perfectly still for half an hour or so within a large cylinder. For some, particularly those who are claustrophic, this is a major problem. Very anxious patients may need to be given a general anaesthetic, but doctors try to avoid this because there is always a small risk.

Patients in the North-East had the option of being referred to an open-sided NHS MRI scanner at Bishop Auckland General Hospital, in South West Durham. Constructed so that claustrophic patients do not feel so restricted, the scanner was taken out of commission recently.

NHS bosses plan to replace the ten-year-old open-sided scanner with a modern, but conventional, “tunnel” model. This means the only alternative for doctors who want to refer patients to an open-sided scanner is to send them to the private Newcastle Clinic, in Jesmond.

Shaun Fryer, managing director of the Newcastle Clinic, says the decommissioning of the Bishop Auckland scanner means that his clinic’s machine is now the only one in the UK north of Cheltenham. “We have been operating an open-sided MRI since 1999 and last year we replaced the old scanner with this newer and better scanner,” he says.

About 80 per cent of patients referred to the Newcastle Clinic for an open-sided scan are actually NHS patients and Mr Fryer is expecting the number of referrals to increase because of the closure of the County Durham scanner and its replacement by a conventional MRI.

Dr Danny Birchall, a consultant neuroradiologist, from the Royal Victoria Infirmary in Newcastle, often refers his NHS patients to the Newcastle Clinic for an open-sided MRI scan.

“We had a woman patient not long ago who needed an open-sided MRI scan. She got very claustrophobic after falling down an old shaft and getting trapped. We also get people who have a variety of traumatic memories who are very uncomfortable in a conventional scanner.”

DR Birchall says having the option of referring to an open-sided scanner was essential.

“Realistically, the only other option we have is to do the scan under general anaesthetic, which is very slow and involves an element of risk.”

Dr Birchall says MRI scans are “vastly superior”

to conventional CT x-rays for soft tissue and are “essential for diagnosing many conditions”.

MRI “is probably the fundamental way of imaging in my field and for a number of other fields it is absolutely essential”, he says.

“Spine and neural surgeons who work with me usually have specific clinical questions they want answering. For the vast majority of questions I am faced with, this machine will give me the answers. I am often looking for stroke damage, evidence of multiple sclerosis, signs of tumours, ear, nose and throat problems, as well as problems affecing the neck and lower spine.”

Sitting at a screen, Dr Birchall comments on what he can see. “The detail is incredible. You can see the inner ear structure, you can even see the nerve going into the cochlear. The black lines are blood vessels, which means you can see excellent vascular detail,” he says.

“The MRI is vastly superior to CT for the purpose of locating abnormalities, partly because we are looking at images in three different planes. CT has only one plane,” he says Dr Birchall described the Newcastle Clinic scanner as “a hugely important resource for the North-East NHS. In 20 years it has gone from a novelty to being fundamental. If we didn’t have this, we would be anaesthetising them or sending them to Cheltenham.”

Liz Storey, the imaging manager who has been a radiographer for 40 years, does her best to help patients relax.

One of the tricks is to get them to wear special glasses which mean when they are lying on their backs looking up, all they can see is a soothing pastoral scene of woodland.

“It works really well,” she says.

The only challenge is when the patient is all skin and bone.

“If they are a fit athletic type, it can be difficult.

Having some fatty tissue is good for imaging,”

she says.