What are the preparations and protocols for a functional Magnetic Resonance Imaging (fMRI) procedure?

From the Guidelines

Functional Magnetic Resonance Imaging (fMRI) procedures require patients to be prescreened for MRI contraindications, remove metallic items, and lie still for the duration of the scan, which can last between 30-90 minutes, to ensure accurate results and patient safety. To prepare for an fMRI procedure, patients should:

• Be prescreened for potentially relevant MRI contraindications using a standardized checklist, as recommended by the joint eanm/eano/rano/snmmi practice guideline 1
• Remove any metallic items, such as dental prostheses, jewelry, and clothing with zippers or buttons, to prevent interference with the magnetic field 1
• Empty their bladder before the scan for maximum comfort and to reduce absorbed dose to the bladder 1
• Be able to lie still for at least 5 to 20 minutes, depending on the sensitivity of the PET scan, if PET imaging is performed with PET/MRI 1 Some key considerations for the fMRI procedure include:
• The use of a standardized checklist to identify contraindications, such as previous contrast agent reactions, implants, ports, catheters, metallic implants, vascular stents, coils, active implants, cardiac pacemakers, bullets, and claustrophobia 1
• The importance of knowing the specific type, location, and material of any implants before scheduling an MRI examination, and checking the implant's safety level with the manufacturer 1
• The need for patients to follow specific instructions during task-based fMRI, and for technicians to monitor patients throughout the procedure via intercom systems and provide emergency buttons for patient use if needed, as discussed in the context of acquisition reporting and preliminary quality control 1

From the Research

Preparations for fMRI Procedure

• Preparation for an fMRI procedure involves several steps to ensure the patient's safety and comfort during the scan 2, 3.
• Patients with claustrophobia may require additional support and preparation, such as being shown the MRI scanner and what they will be required to do during the scan 2.
• Providing clear information and using coping mechanisms, such as virtual reality and clear communication, can help reduce anxiety and claustrophobia in patients 2, 3.

Protocols for fMRI Procedure

• The fMRI procedure typically involves the use of a MRI scanner to measure blood flow and metabolism in the brain 4.
• The scanner may use specialized sequences, such as VAT, OMAR, WARP, SEMAC, and MAVRIC, to reduce artifacts and improve image quality 5.
• The patient will be required to remain still and follow instructions during the scan, which may involve tasks such as language, sensory, and motor functions 4.
• The use of fMRI in conjunction with other imaging modalities, such as PET and MRS, can provide a more comprehensive understanding of brain function and pathology 4.

Reducing Anxiety and Claustrophobia

• Several interventions have been found to be effective in reducing anxiety and claustrophobia in patients undergoing fMRI, including:
  • Open MRI scanners or newer MRI scanners with reduced acoustic noise 6.
  • Quieter machines or audiovisual systems 3.
  • Information provision and psychological support 2, 3.
  • Mock MRI scans or team training 3.
  • Prone scanning or patient positioning devices 3.
  • Cognitive behavioral therapies or guided imagery 3.
  • Fragrance administration or pediatric preparation booklets 3.