If you’re claustrophobic and need to get an MRI, can you get one in an open MRI? How do radiologists decide which type of MRI you need? I discuss the concept in my latest Ask Dr. Geier column.

Gwen in South Carolina asks:

I have a question regarding MRI’s. I need to have one on my shoulder, but I am claustrophobic. Can I get an open MRI, or do I need to have a regular one?

This is an excellent question, and it is one that I’m not sure I can completely explain. I asked William F. Conway, MD, PhD and Thomas L. Pope, Jr., MD, musculoskeletal radiologists, to help me understand and explain the “open” versus “closed” MRI debate.

What is an open MRI?

First of all, the terms “open” and “closed” MRIs refer to the size of the hole, or tube, in which the patient lies. The two main advantages of an open MRI compared to a close one are their ability to be used by very large patients and by patients who are claustrophobic. Unfortunately up to 10% of patients who undergo MRIs do get claustrophobic. “It’s always nice to have an open magnet alternative to closed magnets to avoid having to give a patient sedation, which is well known to have risks,” Dr. Pope points out.

Is an open MRI appropriate for some patients?

Quality of the MRI images

The main question with open MRIs has always been the quality of the images and studies. I personally have always worried about ordering a study on an open magnet and finding out after it has been performed that the study is not a high quality one. Dr. Pope notes, “The newer open magnets out there have strength up to 0.7 Tesla, which produce very reasonable images.” Dr. Conway agrees and points out, “The protocols set up by the radiologists, including the specific sequences used, often matter much more than the signal strength of the magnet.”

Closed MRIs do have advantages. According to Dr. Pope, “Closed magnets have higher field strengths, which in theory can produce better images. Also, their data acquisition is faster, which can potentially lead to shorter procedure times for the patients.”

Also read:
Common questions patients have about MRI tests
Reasons an MRI can be important to evaluate an injury

Take home points about closed and open MRI

In summary, how do you know which type of MRI is best for you? If you’re not grossly overweight or claustrophobic, it still seems that a closed MRI study on a 1.5 or 3 Tesla magnet, especially if the musculoskeletal radiologists optimize the protocols, is a worthy option. For the larger or claustrophobic patients, though, current open MRIs done with appropriate protocols can be a reasonable alternative. If you’re not sure about the quality of the studies done where you are scheduled to have an MRI, call the facility. “Patients can always call the hospital or radiology facility and ask whether there is an open magnet and the strength of the magnet,” Conway emphasizes.