Claustrophobia and a PET/CT Appointment
A 45-year-old man with newly diagnosed lymphoma is scheduled for an FDG PET/CT staging study. He has no prior imaging history. On arrival he tells the technologist he is very claustrophobic and became panicky during a previous MRI, though he completed it. The scanner bore is 70 cm; the planned acquisition is from skull base to mid-thigh, approximately 20 minutes of imaging after a 60-minute uptake period. His blood glucose is 6.1 mmol/L. He has not eaten for 6 hours and has been resting. He asks whether he can "just take a pill" to relax, and whether he can have his wife in the room. The department policy permits oral anxiolytics only with a physician order and does not permit family members in the scan room during acquisition.
1. What should the technologist do to manage this patient's claustrophobia while preserving image quality and safety?
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The technologist should first acknowledge the concern and use non-pharmacologic measures: explain the procedure step by step, show the patient the scanner and the camera/bore, confirm the intercom and call bell, offer a headset/music, provide a washcloth or eye mask, position him comfortably with arms supported, and offer a short break or a brief test position in the bore before the full acquisition. Explaining that the camera does not enclose him and that he can communicate at all times reduces anxiety.
If these measures are insufficient, the technologist should contact the supervising physician/nuclear medicine physician to discuss whether an oral anxiolytic is appropriate, since policy requires a physician order. Timing matters: an anxiolytic given after FDG administration could alter uptake or sedation safety, so the decision must be physician-led. The technologist should not promise medication or administer anything without an order, and should not allow the wife into the scan room, per policy, but can explain that she may wait nearby and be present before and after scanning. If the patient cannot tolerate the study, the physician and referring team should be informed so the study can be rescheduled with appropriate premedication and support.
2. If the patient ultimately cannot complete the full skull-base-to-mid-thigh acquisition, what are the implications and how should the study be handled?
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An incomplete acquisition limits staging accuracy. For lymphoma, the extent of disease (nodal and extranodal sites, above and below the diaphragm) determines stage and treatment. Missing coverage could miss disease and lead to under-staging. The technologist should document exactly which bed positions were acquired, why the study was truncated, and how much time the patient tolerated. The interpreting physician must be told so the report states the limitation explicitly and recommends completion or an alternative (e.g., rescheduling with premedication, or supplementing with another modality if clinically urgent).
The technologist should not fabricate or infer missing coverage, and should not simply cancel without notifying the physician and referring team. If partial images are of diagnostic quality, they may still be reported with a clear caveat. The priority is patient safety and honest documentation, with a plan for completing staging.