Researchers at City, University of London have devised a set of guidelines for performing MR scans on patients with autism, a condition that affects how people communicate and interact with the world.

Around 1%–2% of the general population is autistic, with the condition more prevalent in males. Autistic individuals may need to undergo MR scans for common clinical concerns, such as recurring lower back pain, persistent headaches, injury or trauma. Certain medical conditions also may be more common in autistic adults, including immune conditions, gastrointestinal and sleep disorders, epilepsy, obesity, dyslipidemia, hypertension and diabetes, along with psychological and mental health issues.

Due to their sensory sensitivities and communication preferences, scanning autistic people can be challenging due to long scanning times and narrow bores. Noise, table movements and vibrations from the machine in action can also be difficult for autistic people to process calmly and can make MR scans a daunting experience. At times, sedation may be needed.

In a systematic review, the researchers emphasize the need for reasonable adjustments when performing MR brain scans on an autistic person to make the scan more friendly for them. These include efficient communication, simulation for familiarization with the environment, distraction techniques, and scan-based optimization.

Lead author Dr. Christina Malamateniou, postgraduate programme director for radiography at City, University of London told the European Society for Magnetic Resonance in Medicine and Biology that the study is the first to discuss reasonable radiographic adjustments for autistic adults and children in MR suites, and emphasizes the need for ensuring communication with them is clear. "It’s less distressing to the autistic individuals, in terms of the sensory sensitivities and the anxieties they may have about the scan, which is heightened and also after the scan, the aftercare and the results."

She and her colleagues suggest the following:

• Communication: Contact autistic individuals and their parents or carers prior to exams to customize a game plan. Use letters and visual flow charts and pre-scan interviews to explain the procedure to autistic children and their patents. Allocate extra time to explain and answer questions. Have staff wear ID cards during the exam to help with face/name associations and give instructions in a calm and reassuring tone. Include parents and caregivers in the procedure to help alleviate anxiety.



• Psychology-based interventions: Use applied behavioral analysis (ABA) with autistic children and positive reinforcement learning strategies. Visually demonstrate exam processes using mock scanners and create individual anxiety reduction plans.



• Sensory-easing adjustments: Optimize schedules, reduce staff in suite and conduct exams in quiet places to reduce anxiety. Use visit maps and visual timers to guide children; and weighted blankets, headphones and ear plugs to make them more comfortable.



• Simulation for familiarization: Use mock scanners, live modeling, mobile and iPad applications, audiovisuals, and illustrated story books to explain the procedure.



• Distraction techniques: Utilize audiovisuals such as music, videos or movies during scans to keep children and adults calm. Coping kits such as video games, stress balls, music devices or sound-producing toys can also be used before exams to relax them.



• Scan-based optimisation: Fast acquisition protocols to speed up scans are recommended, along with "soft tone" sequences to reduce acoustic noise and prospective motion correction approaches. Use video in the MR room that freezes when patients move to get real-time feedback and help them stay still for longer durations.

The adjustments were derived from a survey of 130 responses from U.K. radiographers. Included in it were open-ended and closed type questions to determine their understanding of and experience with autism, as well as their ability to recognize autistic patients.

Many lacked general knowledge and training required for working with autistic patients. The researchers also said the lack of formal guidelines in the radiography workforce for dealing with such patients and limited standardization of practices created challenging conditions for radiographers to care for autistic patients properly. “Facilitating MR scan access means autistic people need not live with undiagnosed conditions or chronic pain, and they can get the treatment they need at the time they need it,” said Malamateniou. “This is vital for their well-being and quality of life, as it is for every person.”

The survey was published in Radiography.

The systematic review was published in Autism.