Rationale and Objectives
Prospective evaluation of anxiety in patients undergoing computed tomography (CT) imaging using a standardized state-trait anxiety inventory (STAI-S) and identification of possible risk factors.
Material and Methods
During a 9-month interval, patients undergoing CT were questioned using STAI-S. Additionally, 10 questions concerning specific procedure-related features (claustrophobia, radiation, administration of contrast, and so forth) were added. Moreover, sex, age, admitting subspecialty, organ region, reason for imaging, and prior imaging studies were recorded. Statistical analysis was performed using the Student t test and linear regression analysis; significance level was set to 5%.
Results
Of 6122 patients, 825 patients undergoing CT (14%) were included (67% men; average age, 54 ± 17 years). Average STAI was 42 ± 10 with women (45 ± 11 vs. 41 ± 10; P < .001) and patients who received intravenous contrast (43 ± 10 vs. 42 ± 11; P = .021) showing significantly higher anxiety levels compared to those without contrast. Patients with investigations of their extremities (41 ± 11 vs. 43 ± 10; P = .020) and trauma patients (41 ± 11 vs. 43 ± 10; P = .006) revealed significantly lower STAI results. Patients who had never received a CT scan before showed significantly greater STAI-S values than those with repeat studies (42 ± 10 vs. 41 ± 11; P = .036). Females had greater fears concerning examination results ( P < .001), radiation exposure ( P = .032), administration of contrast ( P = .014), and claustrophobia ( P < .001). Patients with known malignancies had a significantly higher level of anxiety concerning their CT results ( P = .002).
Conclusions
Anxiety does not only occur before MRI but also occur before CT. Its sources are manifold and include communication of CT results, administration of contrast agents, radiation exposure, and claustrophobia. In this setting, women seemed to be more receptive than men.
For decades, magnetic resonance imaging (MRI) and computed tomography (CT) have been among the most common imaging methods broadly accepted by users worldwide. Although MRI is noninvasive and painless, it is subjectively perceived as strain by many patients. Reasons for this include long examination time, loud noises, the narrow tunnel and herewith linked claustrophobia, and the technical necessity to lie motionless during the scanning procedure. A number of publications analyzed MRI-associated anxiety of patients showing that claustrophobia is a key concern with incidences of up to 65% . Such anxieties can become a major problem in some patients thus making repetition of MRI sequences; pharmacologic sedation ; or other calming measures including musical entertainment , psychological preparation , and hypnosis necessary. Furthermore, in a substantial number of patients, poor imaging quality due to movement artifacts , premature termination of scanning , or complete refusal of the patient to carry out MRI must be expected. Worldwide, more than 80 billion MRI examinations are carried out per year with an estimated loss of productivity of approximately 1 billion Euros caused by anxiety-associated canceling of MRI . This problem has thus reached relevant socioeconomic and health political dimensions.
During the past years, CT scanning has highly improved in imaging quality and scanning speed. Modern CT scanners allow dynamic high-resolution and noise-reduced imaging of large body volumes within seconds. Although the length of CT gantries has increased because of growing detector sizes, they are substantially shorter compared to those of MRI. Thus, CT-related claustrophobia should only be a minor problem. Nevertheless, we also experienced extreme claustrophobia reactions in single patients during CT scanning. Although this has rarely lead to premature termination of scanning, acceptance of the examination and the will to undergo future examinations can be negatively influenced. Furthermore, many patients reported a number of additional anxiety triggers including poor information, possibility of tumor diagnosis, radiation exposure, and application of contrast media. Interestingly, research of the literature revealed that the phenomenon of patient anxiety during CT scanning with all its facets has never been systematically evaluated. As CT examinations rapidly rise in number and spread worldwide , patient anxiety might be a yet-underestimated phenomenon.
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Material and methods
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Study Group
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Testing Procedure
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Statistical Evaluation
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Results
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State-Trait Anxiety Inventory
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Additional Questions No. 1–10
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Table 1
Detailed Answers to Additional Questions No. 1–10
No. Additional Question “not at all,” % “somewhat,” % “moderately so,” % “very much so,” % 1 I am afraid of the narrowness of the scanner. 52.8 ( n = 450) 32.0 ( n = 273) 8.5 ( n = 72) 6.7 ( n = 57) 2 I trust in the technology. 6.8 ( n = 58) 8.5 ( n = 72) 48.9 ( n = 417) 35.8 ( n = 305) 3 I know why the examination is carried out. 3.5 ( n = 30) 6.5 ( n = 55) 26.1 ( n = 222) 64.0 ( n = 545) 4 I have already heard or read a lot about the examination. 9.5 ( n = 81) 27.2 ( n = 232) 35.6 ( n = 303) 27.7 ( n = 236) 5 I am worried about the examination results. 18.4 ( n = 157) 36.2 ( n = 308) 31.6 ( n = 269) 13.8 ( n = 118) 6 I am convinced that the examination is best for me. 4.5 ( n = 38) 9.7 ( n = 83) 43.5 ( n = 371) 42.3 ( n = 360) 7 I am afraid of the radiation. 41.5 ( n = 354) 39.0 ( n = 332) 13.3 ( n = 113) 6.2 ( n = 53) 8 I am proud to have the examination carried out on me. 36.4 ( n = 310) 26.3 ( n = 224) 24.9 ( n = 212) 12.4 ( n = 106) 9 I think the examination results are important for me. 3.6 ( n = 31) 4.6 ( n = 39) 35.3 ( n = 301) 56.5 ( n = 481) 10 I am afraid of contrast medium application. ( n = 260) 36.9 ( n = 96) 38.5 ( n = 100) 16.2 ( n = 42) 8.5 ( n = 22)
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Discussion
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