2356. Technical and Safety Challenges Unique to Breast MRI with Sedation and General Anesthesia
Authors* Denotes Presenting Author
Huong Le-Petross *;
University of Texas MD Anderson Cancer Center
Shreyas Bhavsar;
University of Texas MD Anderson Cancer Center
Marion Scoggins;
University of Texas MD Anderson Cancer Center
Thao Bui;
University of Texas MD Anderson Cancer Center
Jia Sun;
University of Texas MD Anderson Cancer Center
Kyungmin Shin;
University of Texas MD Anderson Cancer Center
Beatriz Adrada;
University of Texas MD Anderson Cancer Center
Objective:
Breast MRI (bMRI) has become a standard of care (SOC) modality for both screening and diagnostic work-up of breast disease (1-2). Despite availability of larger bores, claustrophobia remains the most common reason for patients declining MRI (3). Anesthesia service can offer sedation during MRI improving patients’ acceptance. However, unlike routine MRI, bMRI is performed with patient positioned prone. Our anesthesiologists observed patients’ expectation of receiving general anesthesia, without understanding the risks associated with sedation/anesthesia in this particular setting and no prior trials of oral anxiolysis. This objective of this retrospective quality assurance study is to review the image quality of bMRI performed under general anesthesia and to identify potential complications associated with prone positioning in the MRI environment.
Materials and Methods:
Patients receiving bMRI exams with sedation/anesthesia at a large academic cancer center were identified from the existing institutionally approved Report Imaging Quality Issue database after receiving institutional approval for this quality improvement project with waiver for consent, obtained from Institution Review Board. Patient demographics, imaging data, and clinical notes were reviewed by two board certified breast radiologists with over 15-20 years of experience in MRI interpretation. Safety reports were reviewed in consensus between two radiologists and lead anesthesiologist for MRI department.
Results:
Of 4844 bMRI exams, 33 were performed with sedation/anesthesia. Mean age was 60 years (range 37-77), with mean body mass index of 34 (range 21-45). Reason for anesthesia included claustrophobia in 13 (40%) patients, pain in 6 (18%), and 14 not clearly documented (42%). Eighteen of 33 (55%) exams were rated as poor quality, 7 (21%) as average, and 8 (24%) good or diagnostic. Most common reasons for poor quality included motion from snoring or pain and poor fat suppression due to body habitus. In 11/33 (33%), repeat imaging with still poor quality was documented in technologists’ comments. Length of exam appointment ranged from 52 – 155, average 90 minutes. Only one case documented facial bruising due to prone positioning and one case of positioning requiring up to 7 staff.
Conclusion:
Availability of on-site anesthesia has enabled a small population of patients with severe claustrophobia to have a bMRI examination. However, the exam quality was rated as poor in over half of the patients due to snoring and breathing. These patients present to MRI with the expectation of sedation/anesthesia without realizing the reduced image quality outcome nor understand the risks associated with anesthesia and prone positioning while under sedation. Most have a challenging body habitus contributing to difficulty in prone positioning. Patient and provider education and development of an oral patient anxiolysis program is needed to improve image quality and reduce utilization of general anesthesia.
