Overcoming Cancer Scan-xiety - I Got A Full Body MRI Scan
‘’You’re all clear!’’ - three of the best words a doctor can ever give you. It’s right up there with “it’s a girl/boy”. After our article on if and when to consider a full body MRI scanning, I wanted to share my personal experience of recently having had a whole body MRI for the first time.
What was it like?
It was surprising actually. Although I know the preferred imaging center in London very well, and have met the very radiologist scientists who pioneered the research on whole body MRI scanning several times, the experience was still surprising. It put me into the shoes of probably hundreds or so of my ‘healthy’ patients and friends that I have counseled as to when to have such a scan.
I was just shy of 60 minutes in the scanner, but I needed to book out a couple of hours from my day for the full process. I took the opportunity to eat at my favorite French restaurant just half an hour before the scan, although eating fish probably wasn’t the wisest choice since I had to carry around that lingering smell throughout my scan. Anyway, the point is - you do not need to fast before getting a scan. There’s no injection of contrast needed either. Consuming too much coffee or water is unwise too if you want an uninterrupted scan!
At the center, I was asked to change into my underwear and they gave me a nice warm dressing gown. I had to ensure that I was completely metal free - rings (including oura rings), watch, chains etc. The M in MRI stands for Magnetic and is the reason why metals are such a strict no-go. The most daunting part about being in that machine for an hour was probably being away from my phone. We rely so heavily on our phones to organize, schedule and manage our lives that it’s easy for the brain to feel chaotic without being able to reach it for a whole hour.
The room itself was at a nice cool temperature with good airflow - something that I valued, knowing that I was going to be in a machine for an hour. Upon entering the MRI machine, I was asked to lie on a padded ‘bed’, with my feet propped up by a comfortable cushion. Claustrophobic folks might get worried at this point; in our practice we prepare our patients and even prescribe for this in advance. I certainly am claustrophobic after having had a spinal scan 10 years ago in a very tight and poorly ventilated scanner, but technology has come a long way and this experience was mostly fine for me.
After lying on the bed that slid in and out of the scanner tunnel to scan different bits of me, I popped in some ear plugs. I would suggest bringing your own, since the generic ones provided are a hit and miss if they don’t fit you. They can also pop headphones on you, in case you want to catch up on some music streaming or play your favorite podcast. In my case, this feature was not working so I had to spend an hour doing nothing - which can be a pretty difficult thing to do for most people today.
Inside the machine, I lay flat with my arms by my side and then they wrapped me in quite a heavy blanket like meshes called coils. I found these quite comforting actually, but again for those that are claustrophobic, it’s certainly worth flagging and preparing adequately by taking a light prescription anxiolytic beforehand. The coil for the head scan is a mesh that does not sit on your skin but is more like an open cage which has a prism of angled mirror above your eyes so you can see over your body out of the opening of the tunnel and see your feet wiggling which relieves the claustrophobic worries greatly. Some scanning centers put an MRI compatible screen on the wall past you, where you can see your toes wiggling. Some have goggles or a screen built into the head coils, so you can watch some TV or a movie. Frankly, I think the best thing to do is to just relax and to shut your eyes intermittently.
The whole body MRI process is in 3 main passes. Each starts with your head then the bed moves through your chest and abdomen and finally your pelvis, at which point your head is just out the other end of the MRI. Each pass takes about 20 minutes each.
The first scan looked at my spine and bones. In this bit, I was able to lie comfortably and fell fast asleep. The scanner even with the earplugs and headphones is not very quiet though, as all the electrons in the magnet are charged and released. Personally, I still found it kind of relaxing.
During the second pass, I got instructed to breathe in and out, and hold my breath for about 10-15 seconds. I was asked to repeat this a couple of times and then I got shifted along to the next segment of my body where I had to do the same thing for another 15-20 minutes. I am pretty sure my oxygen statistics improved throughout with all those good quality deep diaphragmatic breaths. This second pass looked at the soft tissues and organs of the body, and so my body needed to be as still as possible as the breathing could blur the images. The sounds were different too as the magnets aligned and relaxed the water molecules everywhere in a different way. Here it was obvious that I had to pay full attention to what was going on, so there was no sleeping, but the breathing exercises felt quite relaxing to me. The final pass - the diffusion scan - was also surprising for me. Diffusion MRI is still mostly used in research, although some highly advanced cancer imaging providers like Ezra and Prenuvo, and HLI provide it in their MRI scans.
All such services cite the work of our two radiology-scientist friends, Prof Anwar Padhani and Prof Mu Ko who showed that Diffusion imaging laid on top of regular structural MRI imaging can help see if normal lumps and cysts are suspicious, or if things that might otherwise falsely alarm a radiologist are in fact less active and suspicious. Nothing is perfect but it may help avoid the big issue for large scale health systems and national screening programmes where false alarms cause more lives to be hurt and lost from unnecessary investigations gone wrong than the lives helped and saved. Such cases are irreverently, and quite insensitively labeled VOMITs (victims of medical imaging technology). So Diffusion MRI with the right eyes like our colleagues (who both report on every scan) or their AIs in future will help make this a rational, radiation free and less nauseating part of catching cancer early. Already in small cell lung cancer it is positioning itself as a replacement to the highly radiation heavy PET CT scan.
Why have a full body MRI?
A good question, although perhaps the wrong question. Probably the wiser question to ask is when to have one, and what’s the cost vs benefit. Why try to catch a cancer before it has spread seems to have an intuitively obvious answer: if you can catch a tumor at stage 1, before it has become malignant then it is more easily removable, with clear margins. This makes it possible to have a surgical cure without the need for chemotherapy, radiation or immunotherapy.
Monty Python star, Eric Idle recently revealed that he survived lethal pancreatic cancer because his friend - a doctor practicing preventative medicine encouraged him to have scans that helped him have a rare early diagnosis.
Three weeks ago a close member of my family went to their local emergency department with nausea and constipation, experiencing some new acute abdominal pain. A few days ago he passed away (very peacefully, in the care of a brilliant, compassionate local hospice). It turns out that he had end-stage small bowel cancer. As doctors we are constantly thinking if we could have avoided a premature death had the patient gotten an early diagnosis. The answer isn’t always clear. Sometimes an early diagnosis simply means more time spent treating the patient and not necessarily a better quality of life, but as I said, it does make us wonder if more could be done if only we had caught the disease in its primary stage.
My professional responsibility is not to shock, or spread concern, nor is it to convince you to be top to tail investigated for cancer at a private scanning center. There is always going to be anxiety associated with getting a full body scan, however, as long as you’re making an informed decision after speaking to your doctors, chances are you’re making the right call. I certainly felt like I did!