What an MRI is actually like

An MRI scanner is a tube open at both ends, brightly lit, with fresh air blowing through it. You lie on a padded table that slides in. The scanner never touches you, nothing hurts, and there is no radiation. It is noisy — loud knocking, buzzing and beeping — which is completely normal, and you’ll be given hearing protection. Most scans take 15–45 minutes.

Things you can do in advance

• Tell the department when you book if you’re claustrophobic or anxious. They can plan extra time, choose the widest scanner available, and discuss options like medication. Research consistently shows that good information beforehand lowers anxiety.^4,5
• Ask what will happen step by step. Knowing what to expect — the noise, the length, how far in you’ll go — reduces fear of the unknown, which studies show is a major driver of MRI anxiety.⁶
• Ask whether your body part allows feet-first entry (e.g. knee, ankle, hip, prostate, and often spine). For many scans your head can stay near or outside the opening.
• Ask about music — most departments can play music through the headphones during many scan types.⁴
• Consider bringing a support person. A screened friend or family member can often sit in the room and touch your leg or hold your ankle.
• If your anxiety is severe, ask your referring doctor about a one-off dose of a mild sedative (see the Claustrophobia tab). You’ll need someone to drive you home.
• Practise a relaxation technique beforehand — slow breathing (in for 4, out for 6), muscle relaxation, or imagining a favourite place. Rehearsing at home makes it easier to use in the scanner.

Staying comfortable in the scanner

• You are never alone. The radiographer watches you the whole time, can see and hear you, and talks to you between sequences.
• You hold a squeeze-ball alarm. Squeezing it stops the scan and brings the team in immediately. Most people relax once they know they can stop at any moment — control reduces panic.⁶
• Keep your eyes closed before the table moves in and keep them closed. Many claustrophobic patients complete scans this way. An eye mask or folded cloth over the eyes helps.
• Use the airflow. Ask for the bore fan turned up — feeling moving air counters the sense of being enclosed.
• Breathe slowly: in through the nose for 4 counts, out through the mouth for 6. Long exhalations activate the body’s calming response.
• Anchor your mind: count backwards from 300 by 3s, name songs by your favourite artist, mentally walk through your house, or “reframe” the scanner noise as a rhythm or beat.
• Take it one sequence at a time. Scans are broken into blocks of 2–5 minutes. Ask the radiographer to tell you how long each one is and how many are left — patients rate this ongoing communication as one of the most helpful things staff do.^5,6

If you’re claustrophobic

About 1–2 people in every 100 have a claustrophobic reaction in MRI, and departments deal with this every week.^1,2 A stepwise plan usually works:

Step 1 — Preparation

• Visit the department beforehand and look at the scanner, or watch a video of a scan. Familiarisation reduces fear — this is why hospitals use “mock scanners” and, increasingly, virtual-reality practice runs.^7,8
• Ask whether a wide-bore (70 cm) or open scanner is available. Newer short, wide scanners roughly tripled completion odds compared with older narrow ones in a study of 55,000 patients.¹ Note: in a head-to-head trial, even open scanners didn’t abolish claustrophobia — preparation and support still matter most.³

Step 2 — Comfort measures on the day

• Eye mask or eyes closed from before entering the bore; prism glasses (which let you see out of the scanner) if available; mirror on the head coil.
• Feet-first positioning where possible; fan on; music on; support person’s hand on your leg; regular voice contact.

Step 3 — Extra help if needed

• Mild oral sedation (e.g. a small dose of lorazepam or diazepam prescribed by your doctor, taken 30–60 minutes before). You must not drive afterwards and need an escort home.⁹
• Guided relaxation or medical hypnosis — studies show audio-guided self-hypnosis and hypnosis-trained staff reduce claustrophobic events and can replace sedation for some patients.^10,11
• A few sessions of cognitive-behavioural therapy (CBT) for severe claustrophobia — brief exposure-based CBT has strong evidence for claustrophobia generally and helps future scans too, not just this one.⁴
• As a last resort, scans can be done under deeper sedation or general anaesthesia — your care team will weigh this up with you.

Children

• Preparation works. Play-based preparation, practice (“mock”) scanners, videos and apps, and child life specialists substantially increase the number of children who scan awake, avoiding anaesthesia.^12,13
• Parents help. A randomized study found that having a parent present in the scan room improved children’s success rates without sedation.¹⁴
• Babies can often be scanned during natural sleep using “feed-and-wrap”: feed, swaddle, settle, then scan — no anaesthetic needed.¹²
• Many centres offer movie goggles so children watch a film during the scan.

Other situations

• Pain lying flat: tell the team — pads, knee bolsters, and taking pain relief an hour before the scan (as advised by your doctor) make a big difference. An uncomfortable patient moves, and movement blurs images.
• Large body habitus: ask about wide-bore (70 cm) scanners and table weight limits when booking.
• Hearing impairment: agree on visual signals beforehand; written step-by-step cards help.
• Previous trauma or PTSD: you can ask for a same-gender radiographer, explain what makes you feel unsafe, and agree a stop signal. Feeling in control is protective.⁶

Identify at-risk patients before the appointment

Claustrophobic events cluster: prior failed MRI, self-reported claustrophobia, female sex, middle age, head/cervical coil examinations, and high scores on the suffocation subscale of the Claustrophobia Questionnaire (CLQ) all predict events.^1,2,3 Screening at booking lets you act before the patient is on the table.

• Add two questions to booking scripts: “Have you had an MRI before — how did it go?” and “Are you uncomfortable in confined spaces?”
• Flag positive responders for: longest-available appointment slot, widest-bore scanner, first-of-day or quiet-list slot, pre-visit information pack, and possible anxiolysis discussion with the referrer.
• Send preparation material with the appointment letter: what MRI is, the noise, duration, the squeeze ball, a photo of the scanner. Pre-procedural education measurably reduces anxiety and improves cooperation.^4,5
• Offer a familiarisation visit for high-risk patients; consider VR or video familiarisation where available.^7,8
• Match preparation to coping style where possible — “monitors” (information-seekers) benefit from detail; “blunters” prefer brief instruction plus distraction. Tailored preparation improved patient experience in a controlled study.¹⁵

Communication is the highest-yield intervention

Qualitative syntheses of patient experience consistently identify three anxiety drivers: fear of the result, fear of the procedure (enclosure/noise), and loss of control. Information and continuous contact address the last two directly.^5,6,16

Scripted structure that works

• Greet and assess (2 min): introduce yourself by name, ask about previous scans and specific fears. Let the patient name their worst-case (“What worries you most about this?”).
• Explain with sensory detail: what they’ll hear, feel (vibration, warmth, cool air), how long, and exactly what you’ll do. Sensory-procedural information beats procedural information alone.
• Hand over control explicitly: squeeze ball demonstration (“the scan stops the moment you squeeze”), agree a rest-break plan, promise talk-through between every sequence — and keep the promise.
• During the scan: before each sequence give its length (“next one is 4 minutes”); count down the remaining sequences; praise stillness. Silence is the enemy — unexplained gaps are when panic starts.
• Coach breathing: demonstrate slow exhalation-weighted breathing before the scan and cue it over the intercom if the patient becomes distressed.

Training staff in patient-centred communication reduces patients’ perceived anxiety — this is a teachable department-level skill, not just individual bedside manner.^17,16

Positioning, hardware and protocol tricks

Graded claustrophobia pathway

Escalate stepwise; document what worked for next time.

Tier 1 — Universal (every anxious patient)

• Full explanation + squeeze ball + talk-through between sequences + fan + eye mask offered + music + support person in room where screening allows.

Tier 2 — Behavioural add-ons

• Familiarisation visit / mock experience / VR preparation.^7,8
• Guided relaxation or audio self-hypnosis during the scan — an observational two-group study found fewer claustrophobic events and fewer premature terminations with audio-guided self-hypnosis.¹⁰ Hypnosis-based care has been reported as a viable alternative to sedation/GA in claustrophobic patients.¹¹
• Graded entry: table in halfway → out → fully in; or “trial run” with coil off.
• Refer for brief exposure-based CBT for severe claustrophobia if imaging is non-urgent (also fixes the problem for all future scans).⁴

Tier 3 — Pharmacological (see sedation tab)

Tier 4 — Alternative solutions

• Open/upright scanner referral (accepting possible SNR/field-strength trade-offs).
• Alternative modality discussion with the radiologist (CT, US) where it can answer the clinical question.
• GA list as final option — cost, risk and access make this a genuine last resort.

Anxiolysis and sedation pathway (adults)

Local policy and prescriber judgement always govern — the below reflects commonly published practice.

• Screen for contraindications: respiratory compromise, OSA, hepatic impairment, pregnancy, interacting CNS depressants, and lack of escort.
• Timing matters: oral benzodiazepines given too early wear off mid-scan; too late and the patient enters the bore un-anxiolysed. Aim for peak effect at table time.
• Monitoring: any sedated patient needs monitoring appropriate to depth of sedation with MR-conditional devices, and staff able to rescue one level deeper than intended.¹⁸
• Document response: record dose, tolerance and completion in the RIS so the next appointment starts from knowledge, not scratch.

Paediatrics: scan awake where possible

• 0–6 months — feed-and-wrap: feed, swaddle, ear protection, vacuum immobiliser/padding, dim lights, scan in natural sleep. High success without anaesthesia.¹²
• ~3–7 years — preparation ecosystem: mock scanner sessions, play therapy, preparation videos/apps and child life specialists reliably increase awake-scan success and reduce GA lists.^12,13
• School age/adolescents — distraction + agency: movie goggles/audiovisual systems (an RCT-style study showed audiovisual intervention reduced anxiety and improved image quality¹³), music, choosing their film, and a practice “still like a statue” game.
• Parental presence in the scan room improved non-sedated completion in a prospective randomized study — screen the parent and give them a job (hand on leg, voice reassurance).¹⁴
• Protocol design: shortest diagnostic protocol first; motion-robust sequences (radial/PROPELLER-type) as backup.

Other special groups

• Dementia/cognitive impairment: carer present, simple one-step instructions, scan early in the day, minimise waiting, expect to prioritise the critical sequence first.
• Chronic pain / cannot lie flat: analgesia timed pre-scan, knee bolster, positioning aids, offer breaks; consider splitting long protocols across visits.
• Bariatric patients: check table limit and bore diameter at booking; wide-bore allocation; larger coils; honest, respectful communication about fit before the appointment day, not on it.
• PTSD/trauma history: trauma-informed approach — explain before touching, same-gender staff on request, explicit consent for each step, agreed stop signal.
• Non-English speakers: interpreter for the safety screen and instructions; agree hand signals; translated preparation sheets.