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Human Touch for High-Tech Imaging and Imaging-Guided Procedures: Integrative Medicine Strategies for Patient-Centered Nonpharmacologic Approaches

Part 1: Challenges for High-Tech Imaging and Procedures: How Can Integrative Medicine Impact Quality and Operations?

Mayr, Nina A. MD; Yuh, William T. C. MD, MSEE; Oztek, Murat A. MD; Nguyen, Xuan V. MD, PhD

Author Information
Topics in Magnetic Resonance Imaging: June 2020 - Volume 29 - Issue 3 - p 123-124
doi: 10.1097/RMR.0000000000000240
  • Open

The central theme of this Special Edition is to address and manage patients’ anxiety with nonpharmacologic and noninvasive approaches during imaging studies and imaging-guided procedures. These procedures are commonly viewed as “high-tech” because of their advanced, complex technologies that in turn can be intimidating uncomfortable and unfamiliar to many patients. Advanced procedures often demand a high degree of patient cooperation to achieve their intended objective of delivering high-quality care. Not infrequently invasive and pharmacologic means are required to ensure patients’ cooperation during the imaging and imaging-guided procedures.

In this Special Edition, we provide a succinct overview of the experience using various integrative medicine strategies of noninvasive and nonpharmacologic approaches for diagnostic imaging and imaging-guided therapy, and their efficacy and mode of action, including psychology and neuroscience perspective.1–11 We envision the Special Edition's focus on integrative medicine approaches to bring together, in an “integrative” and multidisciplinary way, both advanced technologies and patient-centered integrative health and psychology concepts to optimize the success of advanced diagnostic imaging and imaging-guided therapies. This is relevant and innovative and may offer insights beyond conventional wisdom and beyond the scope of many current scientific and medical journals.

This Special Edition consists of 2 parts that both support its central theme with slightly different focus in the relative emphasis of their constituent articles. Part 1 discusses the challenges for high-tech imaging and related procedures, and how integrative medicine concepts and approaches can impact quality of care and operations.1,3,5,7,9 Part 2, forthcoming later this year,12 will discuss the applications of MR physics, technology, and multidisciplinary patient-centered strategies in a variety of clinical settings to overcome patients’ anxiety, pain, and related challenges.2,4,6,8,10,11

BACKGROUND

Rapid progress in technology has contributed to remarkable advances in many aspects of medical care that have become increasingly technology dependent. This is particularly true in imaging, such as MRI and imaging-guided therapy, which includes interventional radiology (IR) procedures and radiation therapy. In these areas we can often achieve up to submillimeter precision in imaging spatial resolution and targeted therapy delivery. Meanwhile, there is constant pressure for efficient utilization of the typically costly “high-tech” equipment, and increasing levels of patient cooperation and active patient participation become necessary for these expensive patient care efforts.9

The critical dependence of imaging or procedural success on patients’ ability to cooperate has, however, been underemphasized. Patients are required to either remain motionless for long time periods or to follow complex instructions (such as extended deep breath holds at various time points) for the imaging process or procedures to make these highly sophisticated diagnostic and interventional processes effective and safe. To ensure patients’ cooperation, invasive and pharmacologic means are often required in patients with anxiety, claustrophobia, pain or other challenges. Such pharmacologic approaches may be effective in keeping patients still but do not necessarily promote patients’ cooperation, such as actively following specific instructions during imaging-guided therapy. Sedative medications may also contribute to additional difficulties, including prolonged procedure time, quality and safety concerns related to hemodynamic or respiratory instability, recovery time, and finally increased cost. Currently, evidence-based methods to incorporate various noninvasive and non-pharmacologic approaches, aiming to reduce patients’ anxiety, pain and suffering and improve patient experience, cooperation, quality of care and safety, have been largely lacking. The benefits of these approaches are not well-recognized, and their mechanisms are poorly understood, particularly from the psychology perspective and accumulating neurosciences data.

Integrative medicine refers to a broad spectrum of medical care approaches, with noninvasive and nonpharmacologic strategies, which emphasize patient-centered care, effective patient-practitioner partnership and attention to emotional and mental well-being. This Special Edition leverages Dr. Elvira Lang's extensive work on calmative techniques that were initially developed for IR procedures,13 and her experience was showcased on national TV in an interview by Good Morning America. Many of us have been applying the same or similar calmative techniques or principles routinely and with positive results in imaging studies and imaging-guided procedures, including MRI, IR, lumbar puncture, intrathecal chemotherapy, and computed tomography/MRI-guided biopsy. For radiation therapy, similarly successful results have been observed in improving patients’ ability to cooperate, relax, and improve deep breath-holding through training approaches.14 There is an extensive body of literature on various aspects of integrative medicine, spanning multiple areas of radiology including pediatric radiology. Based on the emerging experience such nonpharmacologic approaches likely have the potential to complement and/or facilitate the “high-tech” components of imaging-based patient care and ultimately impact the quality, safety, patient experience, and health care costs.

PART 1 OF THIS SPECIAL EDITION

All invited authors present their experience applying various nonpharmacologic and noninvasive approaches for their respective patients’ imaging-based diagnostic and/or treatment procedures.1–11 Part 1 consists of 5 articles1,3,5,7,9 on MRI and radiation therapy and includes a discussion of psychology and neuroscience perspectives.

The remaining 6 articles2,4,6,8,10,11 will be published later in a separate issue as Part 212 of the Special Edition and will cover applications in MRI, pediatric radiology, and IR, including discussions of how patient-centered technology innovations could augment the role of the integrative medicine approaches that are described in Part 1.

For Part 1, this introduction serves as the opening statement and provides the background, rationale and purpose for different integrative medicine approaches discussed in the following contributions.1,3,5,7,9 The article by Nguyen et al9 discusses the incidence and potentially detrimental impact of poor patient cooperation and/or anxiety or claustrophobia, and provides a discussion of financial implications that may help justify consideration of the various integrative medicine approaches1,3,5,7 described in Part 1 in terms of potential cost savings. To reduce patients’ anxiety and stress, the contribution by Ajam et al.1 summarizes MRI experiences using human interactions and communication skills, including calmative cognitive behavioral techniques, whereas the article by Mayr et al7 shares experiences with both communication and pretreatment training to reduce unintended radiation dose to the heart to decrease long-term cardiac complications in patients with breast cancer treated with radiation therapy. Borm et al3 discusses the relevance of complementary and alternative medicine in cancer patients undergoing radiation therapy and its potential to improve patients’ wellness and decrease toxicity and anxiety. Finally Chadderdon et al5 provide a comprehensive review of the possible mechanisms underpinning the effects of integrative medicine approaches, along with a discussion of their potential benefits and limitations.

While we worked to assemble this Special Edition with the commitment and help of our contributors, the COVID-19 crisis is evolving worldwide and all around us. In the confusion, stress, and formidable adjustments our patients and we now have to make, we have come to recognize that—beyond the technology, physiology, and biology—the psychological and mental aspects of health care are equally important to the physical focus. This permeates all fields, whether general medicine, imaging, or procedural fields. With patients in greater anguish and fear and more isolated than ever in recent history, and health care workers redeployed to give care beyond their chosen medical fields, the borders between specialties blur. So do the borders between “high-tech” medicine and the art of communication, caring, and healing as stress, anxiety, depression, and failing mental health are expected to greatly increase in the course of this crisis. That medicine in all its aspects is both a science and a healing art becomes clear in a most amplified way in this current crisis. Foremost, with our roles and tasks bound to cross medical specialties in the surge planning, we are “all in this together” to embrace both the highest technical advances and the emotional and mental wellbeing of our patients, which are illustrated in this Special Edition in the example of imaging and imaging-guided procedures.

In conclusion, we have selected a unique combination of topics that are of practical relevance to our readers and readily applicable for clinical translation to many areas of patient care. These articles have been assembled into a comprehensive and succinct edition covering a variety of integrative medicine strategies for patient-centered diagnosis and treatment across specialties. We hope that considering and perhaps integrating some of these concepts into your practice will prove useful to you.

REFERENCES

1. Ajam AA, Tahir S, Makary MS, et al. Communication and team interactions to improve patient experiences, quality of care, and throughput in MRI. Top Magn Reson Imaging 2020; 29:131–134.
2. Bermo MS, Patterson D, Sharar SR, et al. Virtual reality to relieve pain in burn patients undergoing imaging and treatment. Top Magn Reson Imaging 2020; [Epub ahead of print].
3. Borm KJ, Schiller K, Asadpour R, et al. Complementary and alternative medicine in radiotherapy: a comprehensive review. Top Magn Reson Imaging 2020; 29:149–156s.
4. Brunnquell CL, Hoff MN, Balu N, et al. Making magnets more attractive: physics and engineering contributions to patient comfort in MRI. Top Magn Reson Imaging 2020; [Epub ahead of print].
5. Chadderdon AL, Carns DR, Pudalov LR, et al. Underlying mechanisms of psychological interventions in magnetic resonance imaging and image-guided radiology procedures. Top Magn Reson Imaging 2020; 29:157–163.
6. Makary MS, Da Silva A, Kingsbury J, et al. Non-invasive approaches for anxiety reduction during interventional radiology procedures. Top Magn Reson Imaging 2020; [Epub ahead of print].
7. Mayr NA, Borm KJ, Kalet AM, et al. Reducing cardiac radiation dose from breast cancer radiation therapy with breath hold training and cognitive behavioral therapy. Top Magn Reson Imaging 2020; 29:135–148.
8. Nguyen XV, Oztek MA, Nelakurti DD, et al. Applying artificial intelligence to mitigate effects of patient motion or other complicating factors on image quality. Top Magn Reson Imaging 2020; [Epub ahead of print].
9. Nguyen XV, Tahir S, Bresnahan BW, et al. Prevalence and financial impact of claustrophobia, anxiety, patient motion, and other patient events in magnetic resonance imaging. Top Magn Reson Imaging 2020; 29:125–130.
10. Oztek MA, Brunnquell CL, Hoff MN, et al. Practical considerations for radiologists in implementing a patient-friendly MRI experience. Top Magn Reson Imaging 2020; [Epub ahead of print].
11. Oztek MA, Noda S, Beauchemin E, et al. Gentle touch: non-invasive approaches to improve patient comfort and cooperation for pediatric imaging. Top Magn Reson Imaging 2020; [Epub ahead of print].
12. Yuh WTC, Mayr NA, Oztek MA, et al. Part 2: overcoming anxiety in imaging and invasive procedures: what can physics, technology and integrative medicine do for us? Top Magn Reson Imaging 2020; [Epub ahead of print].
13. Lang EV, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet (London, England) 2000; 355:1486–1490.
14. Kim A, Kalet AM, Cao N, et al. Effects of preparatory coaching and home practice for deep inspiration breath hold on cardiac dose for left breast radiation therapy. Clin Oncol (R Coll Radiol) 2018; 30:571–577.
Keywords:

advanced technology; anxiety; artificial intelligence; claustrophobia; cognitive behavioral therapy; imaging-guided procedures; magnetic resonance imaging; patient satisfaction; psychotherapy; virtual reality

Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.