The UK Autism-Friendly MRI Project

Background

From the recent post by Dr Christina Malamateniou, Reader/Associate Professor - "It only took 7 long years from idea, to funding by?Society and College of Radiographers (SCoR), to overcoming obstacles, to ethics, to team building, to learning the language, to understanding the needs, to getting a brilliant, big, multidisciplinary team of healthcare professionals together, including?#autistic?#coresearchers."

Thank you Dr Christina Malamateniou, Reader/Associate Professor and Nikolaos Stogiannos for being at the helm of this important project. You brought together many researchers and practising radiographers to explore the quality of the MRI service currently provided to autistic service users.

To recap, our first paper, Autism-friendly MRI: Improving radiography practice in the UK, a survey of radiographer practitioners, asked those involved in delivering the service, MR radiographers, about their experiences and views regarding the scanning of autistic patients. Responses indicated that for successful scanning, customisation in service delivery is essential with nuanced practices required,?in some instances, as per each patient's preferences and condition. This research revealed a need for specific guidelines and formal training to be established for MRI staff to improve clinical practice by MRI teams when preparing and scanning autistic people for their scan. Radiographers recognised this and suggested the required adjustments which were consistent with the interventions proposed in a review of the literature.

The second paper, A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia, reviewed the range of reasonable radiographic adjustments offered to autistic adults and children when undergoing an MRI scan. A literature search was performed of topics relating to MRI practice for autistic people who underwent a scan without sedation or anaesthesia. The aim was to find out what appropriate modifications could be made and how to improve the patient's experience. The overall quality of the scan experience from the point of view of the patient, family/carer, and radiographers and the implications for scan quality were considered. From the pre-appointment information required to the different approaches that need to be taken in the unit, all stages formed part of the investigation to see how a consistently satisfactory scan experience could be reached. Customising communication was found to be crucial, as well as optimisation of the scan, in terms of noise, comfort and speed. Necessary environmental adaptations were proposed too, such as reducing general noise. It is evident that autistic service users can face more challenges regarding both general and loud noises, as they can suffer hyperacusis and certain sounds may cause significant distress. Autistic patients may experience a feeling of 'sensory overload' by the sights and sounds in a busy MRI unit, hindering any feeling of potential ease with the process and any desire to comply. The importance of distraction techniques and the skills of specialised nurses, trained in autism to aid scan compliance, was also highlighted. The results of this study may help to develop recommendations to improve both MRI practice and the patient experience, and to reduce the need for some autistic people to require sedation or anaesthesia to have their scan.

The third and latest paper, just published, Toward Autism-Friendly Magnetic Resonance Imaging: Exploring Autistic Individuals' Experiences of Magnetic Resonance Imaging Scans in the United Kingdom, a Cross-Sectional Survey, asked autistic service users including carers how satisfied they were with their MRI experience. The aim was to try to identify what, or if, there were any issues preventing autistic patients from achieving a successful and safe MRI exam. This revealed a lack of effective communication and coordination of care, either between health care services or between autistic service users and the radiographers. The results of this paper may inform future recommendations for improvement in practice. It is hoped that as well as those delivering the service, researchers and scanner manufacturers can also be helped to realise the issues faced by this patient group and as a consequence become enabled to make the necessary changes to overcome the problems.

Where do we go from here?

These are my thoughts on what we should do next.

There is a need to standardise the delivery of the MRI service in the UK for this vulnerable patient group. Introducing formal training and more guidance for MRI staff on how best to prepare and scan an autistic patient is overdue. Any training, though, must include an understanding of the vast range of autistic people and explain that there is no one-type-fits-all solution. This must be reflected in the service on offer with an individualised care experience for all. It is acknowledged that there will always be a need for some autistic patients to require sedation or anaesthesia for their MRI scan if their condition is too severe. However, for others with this condition, as this research has shown, by introducing feasible adjustments such medical interventions may be avoided.

It has been indicated that further guidance would be appreciated by the workforce. Changing practice in some units might reap dividends for the service by providing a safe environment for patients and staff alike, with the ultimate goal of a quality scan. By learning how best to interact with autistic patients and how to improve the overall experience of such patients in their care, MRI staff will benefit too. Radiographers are thoughtful, compassionate individuals who go into radiography to care for people. Shining a light on which aspects of service delivery could be improved for autistic service users and making the required steps to increase patient compliance and ease could provide better job satisfaction. It is hoped that sharing autistic persons’ experiences of undergoing an MRI scan will facilitate improvements in the scan service, providing dividends for both providers of the service and users. Having the necessary skill mix, such as specialised nurses to help to assist in creating the appropriate environment, may help in creating a more accessible and person-centred service.

Integrating autism training into the radiography schools is recommended but, in addition, an educational resource for qualified radiographers is required too.

The Future

The overall results of this project may have positive implications for future MRI practice. By sharing these views and suggested recommendations for best practice, guidance could be produced and followed to ensure that, for any autistic person, their experience of undergoing an MRI scan is always satisfactory and accessible for them as an individual.

The challenge now is to ensure that the best practice recommendations for 'autism-friendly MRI scans' are followed. Professional bodies should develop and introduce the necessary standardised guidance. This will enable the required adjustments to be made. Improving communication within hospital interdisciplinary teams and between the workforce and autistic patients and their kin and carers will result in a truly person-centred MRI service for this patient group.

The need for a person/condition-centred approach to scanning for every patient group is also recognised. Adjusting techniques, methods and environments is necessary for dealing with all patient types. Whether it’s for infants, children, the elderly, those with infirmities, those in pain or those who feel anxious or claustrophobic, any patient experience can be improved if we find out about that experience and share the learning.

Autistic patients deserve better, and we now have some more information to ensure this vulnerable patient group have sufficient and specific adjustments made to the benefit of their comfort and compliance.

For more information on this project please see Christina’s lab on ResearchGate.

#mrisafety, #mricompliance, #autism