Claustrophobia and MRI: What Can Help?

Why does MRI cause claustrophobia?

An MRI scanner is a large cylindrical magnet with a tunnel through the centre. You lie on a table that moves into the scanner. Depending on the body part being examined, your head, chest or abdomen may be within the scanner bore. For some people this creates a feeling of being trapped, enclosed, unable to escape or short of breath. MRI also produces loud knocking and buzzing noises and requires you to remain relatively still.

Systematic reviews of patient experience identify several recurring contributors to MRI anxiety, including confined space, scanner noise, loss of control, uncertainty and physical discomfort.^[1,2]

Is MRI claustrophobia common?

Yes. The exact frequency varies according to how claustrophobia is defined, scanner design, patient population and body part being scanned. Claustrophobia is a recognised reason for anxiety, movement during the scan, delayed examinations and incomplete examinations.^[2] So if you feel worried about MRI, you are not unusual.

What does claustrophobia feel like?

Claustrophobia can cause both emotional and physical symptoms. These may include:

• —overwhelming anxiety or fear
• —rapid heartbeat, sweating or trembling
• —dizziness, nausea or chest tightness
• —feeling short of breath
• —feeling that you need to escape.

These symptoms can feel intense even when you are physically safe.

Should I tell the hospital before my appointment?

Yes. This is probably the most useful practical advice on this page. Current NHS guidance advises people who are anxious about MRI or afraid of small spaces to contact the hospital before their appointment.^[3,4] Do not wait until you are already lying on the scanner table if you know that you have significant claustrophobia.

Giving the department advance warning allows staff to consider whether:

• —extra time may help
• —a wider scanner is available
• —you can bring somebody for support
• —particular positioning may be possible
• —additional reassurance or visual aids can be arranged.

What if I have tried an MRI before and couldn't finish it?

Tell the department. Explain what happened, what part of the experience was hardest, whether you entered the scanner, whether you became anxious after several minutes, and what helped or did not help last time. A previous unsuccessful scan does not mean a second attempt will necessarily fail. Recent research suggests that person-centred approaches and environmental modifications can help some people who have previously struggled to complete MRI.^[5]

Can I look at the scanner before starting?

Often, yes. Ask the radiographer if they can show you the scanner, the table, how far you will move inside, where your head will be, and how you communicate with them. Seeing the equipment before lying down can reduce uncertainty.

Will my whole body be inside the scanner?

Not necessarily. It depends on what is being scanned. For example, during some knee, ankle or lower-leg MRI examinations, your head may remain outside or closer to the end of the scanner. For brain, neck, shoulder or upper spine MRI, your head will usually be within the bore. Ask the radiographer what position will be required for your specific scan.

Can I go into the scanner feet-first?

Sometimes. The direction you enter depends on the body part being examined, the coil being used, scanner design and technical requirements. For certain examinations, a feet-first position may be possible and can feel less enclosed. For others, head-first positioning is necessary. You can always ask whether feet-first positioning is possible for your examination.

What is a wide-bore MRI scanner?

MRI scanners vary in design. Many newer systems have a wider and sometimes shorter bore than older scanners. The additional space can make a meaningful difference for people who experience claustrophobia. Research has shown improved completion rates in some claustrophobic patients using wider, shorter scanner designs.^[6] However, no scanner design completely eliminates claustrophobia. A randomised study comparing open and short-bore MRI found claustrophobic events in both groups.^[7] Scanner design is therefore only one part of making MRI easier to tolerate.

What is an open MRI?

Open MRI scanners have a more open physical design than conventional cylindrical scanners. Some people find this easier. However, depending on the scanner, image quality may differ, some specialised examinations may not be possible, scan times may vary, and availability can be limited. An open scanner is therefore not automatically better for every medical question. The ideal examination is one that you can tolerate and that provides the images your clinical team needs.

Can I keep my eyes closed?

Yes. Many people find this very helpful. A simple strategy is to close your eyes before the table moves into the scanner and keep them closed until you come back out. This prevents you from focusing visually on the inside of the scanner. Some people also prefer an eye mask where permitted by the department.

Do mirrors help?

Some MRI setups include a mirror attached to the head coil. This can allow you to see outside the scanner, the room, or occasionally a visual display, rather than looking directly at the inside of the bore. For some people this creates a greater sense of space. Availability depends on the equipment being used.

Will the radiographer be able to hear me?

Yes. The MRI radiographer operates the scanner from a nearby control room but can see you, hear you and communicate with you. You are not simply left alone inside the scanner. There is normally an intercom system between you and the radiographer.

What is the call bell?

You will normally be given a call bell or squeeze alarm to hold. If you become unable to tolerate the examination, you can alert the radiographer. Knowing that you retain the ability to communicate can itself reduce the feeling of being trapped.

Can the radiographer talk to me between sequences?

Yes. This can be extremely helpful. Ask whether they can tell you when each sequence starts, tell you approximately how long it lasts, update you on your progress, tell you when you are halfway through, and reassure you between sequences. For some people, "This next scan lasts three minutes" feels much more manageable than "Stay still until we're finished." Patient-centred communication is an important part of improving the MRI experience.^[1,2,5]

How long will I be inside?

MRI examinations often take approximately 15 minutes to 1 hour, and occasionally longer depending on the scan.^[4] However, MRI is usually made up of several individual sequences rather than one continuous hour-long scan. A sequence may last a few minutes, followed by a brief pause. It can help to think about the scan as one sequence at a time.

What breathing technique can I use?

Slow, controlled breathing can help reduce the physical symptoms of anxiety. One simple approach is to breathe in gently through your nose, breathe out slowly, and make the out-breath slightly longer than the in-breath. For example, inhale for 4 seconds and exhale for 6 seconds. Do not force yourself to breathe extremely deeply because this can sometimes cause light-headedness. The aim is simply to slow your breathing and shift your attention away from the scanner. A randomised study in claustrophobic MRI patients found that mindfulness-based breathing was associated with reduced anxiety and improved scan completion.^[8]

What can I focus on mentally?

Some people find visualisation useful. You might imagine lying on a beach, being outdoors, walking somewhere familiar, being in a favourite room, planning a holiday, or mentally counting backwards. The aim is to give your attention somewhere else to go.

Does music help?

Many MRI departments provide headphones or ear protection because the scanner is noisy. Some allow you to listen to music. Systematic-review evidence suggests music may reduce anxiety during MRI and CT, although the size of the effect varies between studies.^[9] Music is therefore best thought of as a simple comfort strategy rather than a guaranteed treatment for claustrophobia.

What about video or audiovisual systems?

Some newer MRI systems provide video goggles, projected images or immersive audiovisual displays. Early research suggests these approaches may help some anxious or claustrophobic patients tolerate MRI.^[5] They are not available in every hospital.

Can someone come into the room with me?

Sometimes. You can ask whether somebody can accompany you for support. Anyone entering the MRI room must undergo the same strict MRI safety screening. Whether another person can remain in the scanner room depends on local policy, the examination and MRI safety requirements. If having somebody there would help, ask the department in advance.

Could I have CT instead?

Sometimes another type of imaging can answer the question. But CT and MRI are not interchangeable. MRI provides particular advantages for imaging structures including the brain, spinal cord, joints, bone marrow, muscles and soft tissues, pelvic organs and heart. If claustrophobia is preventing you from completing MRI, discuss this with the radiology team and the healthcare professional who referred you rather than simply cancelling the scan.

Should I practise beforehand?

It may help. If you know you are anxious, you could practise lying still with your eyes closed, practise slow breathing, listen to MRI scanner noises beforehand if that makes you feel better prepared, practise visualisation, and identify exactly which part of MRI worries you most. The aim is not to force yourself to "get over" claustrophobia. It is to make the experience more predictable.

Should I avoid caffeine?

There is no universal rule requiring people to avoid caffeine before MRI. However, caffeine can make some people feel shaky, more aware of their heartbeat, restless or more anxious. If caffeine reliably makes your anxiety worse and your scan preparation allows it, you may prefer to reduce it beforehand. Always follow the specific instructions for your examination.

What should I say when I call the MRI department?

You can simply say: "I have significant claustrophobia and I'm worried I may not manage the MRI. What options do you have to make the scan easier for me?" Tell them if you have previously been unable to complete MRI, you experience panic attacks, you know that a wider scanner helped previously, or having somebody nearby would help.

A practical plan

Before the appointment

• —Tell the MRI department that you are claustrophobic.
• —Ask what support and scanner options are available.

When you arrive

Tell the radiographer again.

Before entering the scanner

• —Ask where your head will be.
• —Ask how long the scan should take.
• —Ask whether a mirror is available.
• —Ask whether music is available.
• —Ask how the call bell works.

During the scan

• —Try closing your eyes.
• —Use slow breathing.
• —Listen to music.
• —Visualise somewhere else.
• —Take the examination one sequence at a time.

Five things to remember

• —Tell the MRI department before your appointment if you are claustrophobic.
• —Claustrophobia during MRI is common.
• —Wider scanners, mirrors, communication, breathing techniques and music can help some people.
• —Breaking the scan into individual sequences can make it feel more manageable.
• —A previous failed MRI does not mean you will never be able to complete one.

The key message

The best approach to MRI claustrophobia is preparation. There is no single strategy that works for everyone. But combining information, communication, a sense of control, scanner modifications and anxiety-reduction techniques can make a significant difference.