Abstract P2-05-04: Safety of Breast MRI under General Anesthesia

Abstract INTRODUCTION: 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. OBJECTIVE: This project retrospectively reviewed bMRI exams with sedation for image quality and potential complication to identify areas for intervention such as provider education on anesthesiology risks in the bMRI environment and the implementation of an institution-approved oral anxiolysis program. 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 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. DISCUSSION: Availability of on-site anesthesia has enabled some patients to receive bMRI. These patients present to MRI with expectation of sedation/anesthesia without understanding risks or prior trial of anxiolysis and most have a challenging body habitus contributing to difficulty in prone positioning and decreased image quality while under sedation/anesthesia. Development of an oral patient anxiolysis program and provider education may improve image quality and reduce utilization of anesthesia. Citation Format: H. T. Carisa Le-Petross, Shreyas Bhavsar, Marion E. Scoggins, Jia Sun, Thao Bui, Kyungmin Shin, Jason Stafford, Richard Carlson III, Beatriz Adrada. Safety of Breast MRI under General Anesthesia [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-05-04.