Advertisement

Do MRI Patients Tweet? Thematic Analysis of Patient Tweets About Their MRI Experience

Published:October 28, 2015DOI:https://doi.org/10.1016/j.jmir.2015.08.003

      Abstract

      Background

      Twitter is an online, multimedia microblogging tool used actively by millions across the world. Twitter may provide a unique insight into the magnetic resonance imaging (MRI) patient experience.

      Methods

      In-depth, qualitative content analysis of MRI patient tweets during one calendar month.

      Results

      Overall, 464 tweets were categorized into three themes: MRI appointment, scan experience, and diagnosis.

      Conclusions

      This study demonstrates that MRI patients do tweet about their experiences and that Twitter is a viable platform to conduct research into patient experience within the medical radiation sciences.

      Résumé

      Contexte

      Twitter est une plateforme de microblogage multimédia en ligne utilisée activement par des millions de personnes dans le monde. Twitter pourrait offrir un coup d’œil intérieur unique sur l'expérience des patients en IRM.

      Méthodologie

      Analyse qualitative approfondie du contenu des gazouillis des patients en IRM sur une période d'un mois.

      Résultats

      464 gazouillis ont été catégorisés sous trois thèmes: rendez-vous d’IRM, expérience de l'examen et diagnostic.

      Conclusions

      L’étude a permis de démontrer que les patients en IRM utilisent Twitter pour parler de leur expérience et que Twitter est une plateforme viable de recherche sur l'expérience des patients dans le domaine des sciences de la radiation médicale.

      Keywords

      Introduction

      There has been exponential growth in the clinical use of magnetic resonance imaging (MRI) over the last 2 decades [
      • Mitchell J.M.
      • LaGalia R.R.
      Controlling the escalating use of advanced imaging: the role of radiology benefit management programs.
      ]. From the patient's perspective, attending for an MRI examination can often be psychologically distressing [
      • Hewis J.
      Magnetic resonance imaging.
      ]. Many patients experience anxiety or claustrophobia immediately before or during an MRI examination [
      • Munn Z.
      • Jordan Z.
      The patient experience of high technology medical imaging: a systematic review of the qualitative evidence.
      ]. Causes of patient anxiety are multifaceted but can include feeling enclosed or restricted, acoustic noise, fear of the MRI results, pain, discomfort, and keeping still for long periods of time [
      • Dewey M.
      • Schink T.
      • Dewey C.
      Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients.
      ,
      • Thorpe S.
      • Salkovskis P.
      • Dittner A.
      Claustrophobia in MRI: the role of cognitions.
      ,
      • Munn Z.
      • Pearson A.
      • Jordan Z.
      • Murphy F.
      • Pilkington D.
      • Anderson A.
      Patient anxiety and satisfaction in a magnetic resonance imaging department: initial results from an Action Research Study.
      ]. In 2014, 19% of the entire adult population of the United States used Twitter, with nearly 90% accessing the application through their mobile devices [
      Pew Research Center
      Demographics of key social networking platforms—January 2015.
      ]. It is estimated that one in four adults worldwide with a cell phone are regularly accessing a social media site, with emerging nations rapidly embracing cell phone technology [
      Pew Research Center
      Emerging Nations Embrace Internet–February 2014.
      ].
      Twitter is a free microblogging, social networking tool that enables millions of users worldwide to share short messages or “tweets” limited to 140 characters. Textual-based content can be complemented with an icon or “emoji” used to express an emotion and/or idea and attached photographs or images [
      • Takhteyev Y.
      • Gruzd A.
      • Wellman B.
      Geography of Twitter networks.
      ]. Users also frequently link to other online social networking sites [
      • Takhteyev Y.
      • Gruzd A.
      • Wellman B.
      Geography of Twitter networks.
      ]. Research on Twitter is growing rapidly due primarily to the public nature of the data, enabling easy access and collection. Health research conducted on Twitter is diverse and ranges from providing online support to mental health service users [
      • Shepherd A.
      • Sanders C.
      • Doyle M.
      • Shaw J.
      Using social media for support and feedback by mental health service users: thematic analysis of twitter conversation.
      ] through to predicting flu pandemics [
      • Signorina A.
      • Segre A.M.
      • Polgreen P.M.
      The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. during the Influenza A H1N1 Pandemic.
      ,
      • Gesualdo F.
      • Stilo G.
      • Agricola E.
      • et al.
      Influenza-like illness surveillance on Twitter through automated learning of naïve language.
      ]. Little or no Twitter-based research exists with a medical radiation science focus, and no study could be identified that explored patient experience within MRI.
      This study aims to determine if, what and when patients tweet during their MRI experience. A secondary aim is to analyze whether Twitter poses a viable research environment to evaluate patient MRI experience.

      Methods

      An in-depth qualitative content analysis of individual patient tweets was conducted. Content analysis is an established method to review patient experience [
      • Hsieh H.
      • Shannon S.
      Three approaches to qualitative content analysis.
      ]. Content analysis is one of many research methods frequently used to analyze text data. Other qualitative methods include grounded theory, phenomenology, and ethnography. In conventional content analysis, the coding categories are derived directly from the text data [
      • Hsieh H.
      • Shannon S.
      Three approaches to qualitative content analysis.
      ]. Computational approaches are increasingly used within content analysis when performing big data research on social media platforms [
      • Lewis S.C.
      • Zamith R.
      • Hermida A.
      Content analysis in an era of big data: a hybrid approach to computational and manual methods.
      ,
      • Kim A.E.
      • Hansen H.M.
      • Murphy J.
      • Richards A.K.
      • Duke J.
      • Allen J.A.
      Methodological considerations in analyzing Twitter data.
      ]. Limitations with these methods include potential coding inaccuracies and the application of a “broad brush” approach that can fail to identify subtle or complex issues [
      • Lewis S.C.
      • Zamith R.
      • Hermida A.
      Content analysis in an era of big data: a hybrid approach to computational and manual methods.
      ]. Although labour intensive, a manual conventional content analysis approach was adopted.

       Ethics

      Seeking informed consent is a challenge for social media–based research. When creating an account, Twitter users agree to the terms and conditions of www.twitter.com allowing their profile demographics and tweets to be freely available within the public domain unless restricted by the user; the role of research is not precluded under these terms. Many researchers argue this validates access to freely use these data [
      • Kim A.E.
      • Hansen H.M.
      • Murphy J.
      • Richards A.K.
      • Duke J.
      • Allen J.A.
      Methodological considerations in analyzing Twitter data.
      ]. For the purpose of this study, it has been established that MRI patients may undergo psychological distress and could therefore be perceived as vulnerable research participants. To reduce potential risk, all user demographics and metadata were excluded from the content analysis to ensure anonymity and privacy of each participant in accordance with the Association of Internet Researchers guidance [
      • Markham A.
      • Buchanan E.
      Ethical decision-making and Internet research. Recommendations from the AoIR Working Committee (Version 2.0).
      ]. Ethical approval for the study was sought and approved by the Charles Sturt University, Faculty of Science Research Committee.

       Search Strategy

      The native Twitter search engine was employed using the advanced search functions. All tweets containing the phrase “MRI” or “magnetic resonance imaging” on and between the 1st and the 31st May, 2015, were exported within one encrypted and password-protected portable document format (pdf) to include text, attached images, and links.

       Content Analysis

       Stage One

      Tabled 1
      CategoriesInclusionExclusion
      Tweeted in English?YesNo
      Type of twitter userIndividualGroup or organization
      Role in the MRI experience?PatientPartner, family, friend of a patient, undetermined
      Pertains to a specific MRI episodeYesNo, undetermined
      Participated recently in an MRI episode (before, during, or after)?YesNo, undetermined
      MRI, magnetic resonance imaging.
      A manual review of the user Twitter feed both preceding and subsequent to the original tweet was also conducted to aid application of the criteria. Tweets meeting the criteria were manually transcribed to an Excel spreadsheet. Multiple entries by the same individual pertaining to a single MRI episode were aggregated to form one entry. All attached images were reviewed, and a brief description formulated. No further Twitter user demographics, images, links, or metadata were transferred to the Excel spreadsheet.

       Stage Two

      Manual coding of each tweet was performed. Attached photographs and images were coded separately.

       Stage Three

      Emergent themes were identified from the coded tweets. The coding and thematic analysis was an iterative process, and a symbiotic relationship existed between the writing and data analysis that occurred concurrently. Representative quotes were then identified to illustrate the emerging themes.

      Results

      A total of 6,471 tweets were extracted from www.twitter.com; 464 tweets met the inclusion and/or exclusion criteria and were categorized into three emergent themes (n = 464). Table 1 provides a succinct overview of each theme, the descriptive subcodes used, and the number of tweet counts. A small number of tweets were coded into multiple categories (a total of 16 tweet counts highlighted in red). Photography and/or image coding and themes are summarized in Table 2. The results are presented chronologically along the MRI journey from referral to results.
      Table 1Themes, Coding, and Tweet Text Count (n = 464)
      ThemeDescriptive CodingCount
      Being scheduled for an MRI examination as an important milestone in the patient journey94
      Health update36
      Prayer or support26
      Cost, funding, and insurance14
      Scan date11
      Scheduled appointment time5
      Trivialisation2
      The MRI examination patient experience208 (16)
      Pre-examination advice4
      Waiting2
      Pre-examination anxiety46
      Claustrophobia and confinement20 (3)
      Coping strategies11 (3)
      Time to self8
      Examination preparation19
      MR contrast administration8 (3)
      Communication5 (1)
      Keeping still, sleeping, and sound62 (6)
      Postexamination thanks5
      Postexamination update10
      Unspecified negative experience8
      The relationship between MRI as a diagnostic tool and patient expectation and/or perception178
      Anticipation60
      Outcome117
      Advice1
      MRI, magnetic resonance imaging.
      Table 2Themes, Coding, and Tweet Photo Count (n = 96)
      ThemeDescriptive CodingCount
      Before MRI41
      Picture of comfort/coping aides; eg, sedation pills4
      “Selfie” or picture en route or outside imaging facility6
      “Selfie” or picture at facility on bed/trolley or in MR waiting area23
      Picture of MR waiting area or scan door before MRI waiting5
      Picture of MRI safety questionnaire3
      During MRI30
      “MRI gown selfie”15
      “Selfie” undergoing sedation1
      “Selfie” or picture in/of MR scan room or on MR scan couch8
      “Post-MRI selfie”6
      After MRI25
      Picture of injection site/dressing2
      Picture of post-MRI reward (food or drink)2
      Photo of MR payment request1
      Photo/copy of MR scan image(s)7
      MR scan image(s) made into art2
      MR scan report2
      Collecting results (inside referring Doctor's office)1
      Injured/abnormal anatomic region8
      MRI, magnetic resonance imaging.

       Being Scheduled for an MRI Examination as an Important Milestone in the Patient Journey

      Tweets coded within this theme focused on the impact of receiving a scheduled MRI appointment. Gaining an appointment appeared to be a significant or noteworthy event that stimulated a health update tweet (n = 36). All tweets included information about the MRI appointment within the context of a broader health update, along with underlying symptoms or clinical history. Frequently, the scheduled MRI appointment or scan date was included or was the sole focus for a tweet (n = 11).“Knee still hurt from the accident. Probably shouldn't of ran routes & played catch yesterday. Getting an MRI next week:(“ [sic]
      The scheduled appointment often followed other diagnostics tests with a small number of individuals expressing a feeling of being “overwhelmed” by the volume and array of diagnostic testing undertaken.“…getting old is a pain in the ass. Today was a pulmonary test. Tomorrow's a cardiac stress test. Sunday's an MRI. Arghhh too much!!”
      Several practical issues emerged associated with gaining a scheduled MRI appointment. Challenges related to cost, funding, and insurance evoked strong emotional tweets (n = 14). Some identified MRI as a significant personal cost concern, whereas others expressed anger or frustration in regard to delayed MRI examinations or delayed processing of repayment claims caused by their insurance company.“Just paid $1662.48 for an MRI, entirely out of pocket! And they say the American medical system is broken!”“I want my MRI. Stop taking away my Constitutional rights you facist insurance companies. I want my MRI!”
      Many tweets provide a commentary on contemporary sociopolitical issues or concerns regarding health care policy, waiting times, and funding.
      Prayer or support in relation to scheduled MRI appointment (n = 26) was the second major issue within this theme. Requests or thanks for prayers, luck, or “thoughts” may indicate some level of anxiety or negative connotation associated with or toward the MRI procedure. The prayer or praying emoji was frequently used throughout this theme.“I have a Mri on my shoulder tomorrow afternoon. Everyone send a prayer my way! Thankss” [sic]“MRI on Monday “I have an MRI of my brain Wednesday for a check up, please keep me on your thoughts. #Neurofibromatosis”

       The MRI Examination Patient Experience

      This theme incorporated the most diverse range of issues. Tweets within this theme focus on first-hand patient experience immediately prior, during, and after the MRI examination. Several patients displayed pre-examination anxiety (n = 46) immediately before or travelling to their MRI examination, with descriptions of emotional state ranging from “anxious” to “terrified.” Causes of anxiety included but were not limited to: concerns about keeping still, pain, ongoing anticipation of results, having an injection, and concerns about claustrophobia.“I can barely stand still for 5 min idk how I'll be able to be still for 45 min for MRI…” [sic]
      Having to wait for the procedure or unexpected delays further added to anxiety levels. For some individuals, being surrounded by “sick” people while waiting was also highlighted as a cause of anxiety and/or concern.“The MRI machine broke on a patient right before I went in. So now I have to wait another 45 minutes. Noooo…”“Now in MRI waiting room… It's just me, a lot of sick people… help me”
      Waiting for the imminent procedure allowed time for a small number of patients to reflect on previous negative scan experiences.“First #MRI since D/X in 2000, the memories I thought I had banished came flooding back!..” [sic] + picture of MRI waiting area
      Many individuals directed their negative emotion directly toward the MRI scan room and its contents.“hating this room” + picture of MRI scan room door
      The length of the MRI procedure and the associated waiting period appears to provide a catalyst for patients to document their MRI experience through the medium of photography. More photographs were tweeted during the pre-MRI waiting period than at any other point in the MRI journey. Photographs taken during this phase were often attached to pre-examination anxiety tweets.
      A small number of patients tweeted about claustrophobia and confinement-related issues immediately before and during their MRI examination (n = 20). These were coded separately to reflect that claustrophobia is often considered a potential contraindication for MRI and a regular cause for incomplete or failed examinations [
      • Dewey M.
      • Schink T.
      • Dewey C.
      Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients.
      ]. A reduced ability to comply with keeping still was a common cause of anxiety. The use of sedation was inferred in several tweets but could not be quantified.“I'm having an mri scan on my heart done soon Wish me luck bc this is my only fear in the hospital i am so claustrophobic, I freak out ” [sic]“some big padding was put across my chest and I was strapped onto the table (which I hated)”“Worse experience of my life going into that MRI, I told them I was claustrophobic and they still put me into the closed MRI machine…”
      One patient was rescheduled for an MRI under general anesthetic as a result of an incomplete examination attributed to “extreme claustrophobia.” This was the only “failed” examination that could be identified during the entire study.
      The “scan experience” theme also provided some insight into personal coping strategies used by MRI patients with procedural-related anxiety (n = 11). These included mental distraction, gaining “strength” through support from others, use of rewards and/or bribes, and music.“during my MRI today I kept calm by thinking up ways to legally frustrate & shame the stomp on the flag challengers…” [sic]
      Continuing with the music theme, more tweets pertained to keeping still, sleeping, and sound than any other aspect of the “scan experience” (n = 62). Scanner noise was frequently discussed and many imaginative analogies given.“Ugh having an MRI is like being inside of a pissed of fax machine” [sic]
      Not all tweets were negative regarding scan sounds and many often featured humour.“I laughed through the whole MRI bc I was makin beats out of the noise it was making…” [sic]
      Music was an emotive topic. A lack of control over, not liking or not having any music at all, were all tweeted as negative aspects of the scan experience.“At least the loud machine gun noise of the MRI machine drowned out the terrible music on the headphones”
      For others, music provided a positive element of the MRI experience worthy of tweeting, typically when individuals appreciated the music choice. Music “drowned out” the gradient noise and as identified earlier, served as a coping strategy.“When you're getting an MRI and you have to be still and Uptown Funk comes on the radio…”
      Keeping still during image acquisition proved challenging for some individuals. Concerns related either to an inability to keep still due to an underlying condition, claustrophobia, pain, and twitching while sleeping or the enforced nature of having to remain motionless. An unrequited desire to scratch an itch was articulated in a few tweets. Fourteen patients reported napping or sleeping during the entire examination, indicating some level of comfort and relaxation within the MRI environment. Noise cancelling headphones were mentioned as an enabling factor. Sleeping was often an unexpected outcome expressed using amusement or astonishment.“Had a lovely nap in the MRI machine (very awkward)”
      Interestingly, some individuals found the enforced time to self a beneficial experience.“Turns out a 30-minute stint in the MRI machine is the perfect way to spend #NationalDayofPrayer. #TrulyCaptiveAudience”“…another MRI of my brain tonight and I'm no joke looking forward to the time to relax” [sic]
      The time to self and sleeping subthemes provide an alternative and perhaps undocumented perspective and/or aspect of the patient experience within the MRI environment.
      An unexpected discovery of the examination preparation process was the MRI gown selfie. Fifteen patients tweeted a self-portrait photograph taken inside the changing cubicle while posing in their MRI gown and/or scrubs. Anecdotally, the “MRI gown selfie” seemed to transcend age.“The MRI tech caught me taking a selfie #ManCardRevoked” + self-portrait photograph wearing MRI gown

       The Relationship Between MRI as a Diagnostic Tool and Patient Expectation and/or Perception

      Tweets coded within this theme focused primarily on the role of MRI as a diagnostic tool with two major issues identified. Anticipation of the outcome of pending MRI results was a frequent focus for a large number of patients (n = 60). Several of the tweets demonstrated explicit anticipation that MRI may provide an answer to or identify a cause for hitherto unexplained symptoms.“…MRI on Friday will give us some miraculous answer to why I've had recurring numbness for the past year” [sic]
      The unknown outcome and implications of pending results was a common source of anticipatory anxiety that often manifested in an expression of hope or prayers for a positive outcome.“Breast MRI to make sure the cancer hasn't returned. Positive thoughts, prayers, lighting a candle, and goat sacrifice are appreciated.”“I know the good Lord is with me in times like this. I hope and pray for good news in my MRI…”
      Tweets commonly focused on the implications for management or change in prognosis, rather than the diagnosis itself. This was particularly common for individuals with chronic health conditions.“Brain MRI finished. Hopefully no new MS lesions…”
      Emoji were used frequently as either a supplementary or complementary method of expressing anxiety and other negative emotions in relation to anticipated results.“Having MRI scan on my back tomorrow, an hour and a half long, hope the results come back positive“Terrified of the possible outcomes from this MRI
      A strong desire to return to normalcy was demonstrated, particularly by previously active individuals and those with athletic-related injuries.“MRI this morning I hope everything is ok and I can play again. It's been too long…”
      Anticipatory anxiety was the predominant emotion portrayed within tweets regarding anticipated results.
      The final aspect of the “diagnosis” theme considers patient reaction to the outcome of their MRI results via Twitter (n = 117) and was the most prolific subject matter tweeted within this study. On receiving a positive outcome, individuals regularly posted messages of celebration or thanks. Celebration was not only just confined to the scan results but also the potential return to normalcy or termination of current medical intervention.“MRI clear as and I'm the happiest…” [sic]“my mri and blood tests were perfect im so beyond happy to be okay for three months and possibly knowing ill be getting off meds…” [sic]
      Many individuals' directed thanks toward their health care team as well as family and friends who provided “support.” Introspectively, tweeters also gave thanks for their own health after a positive scan outcome. Some tweeters displayed an assumption that symptoms should now diminish after a normal MRI result.“…thank you to everyone else who has supported me this far…”“So much to be thankful for. No more MRI's until 2016. All clear…”“My MRI came back normal…hopefully all of the dizziness and headaches go away”
      Unsurprisingly, on receiving a negative outcome, individuals routinely displayed a negative emotional response both within the textual and emoji component of the tweet.“Bad news after all, found and ACL tear in my MRI. Surgery in two weeks ” [sic]
      There appears to be a shift of focus away from the MRI results toward potential or pending intervention with many patients sharing their upcoming surgery dates. The intervention now becomes the new source of anxiety.“Left knee MRI wasn't good. I guess I knew that. Ligament tears. Surgery scheduled. Besos in advance for your prayers” [sic]
      Not all tweets elicited a completely negative reaction, for some individuals, the negative outcome provided validation of symptoms or the individual displayed tenacity and courage to beat and/or defy the diagnosis and/or prognosis.“Biopsies/MRI scans suggested the cancer was not contained within the breast. Unfortunately, it's spread. The real fight starts now, let's do it!”
      Perception of MRI as a gateway to further intervention was a frequent feature within the “diagnosis” theme. Sharing of their health journey and the role of MRI was common for individuals with chronic illness. Many individuals also displayed genuine interest and intrigue toward their MR images irrespective of the nature of the results. Tweeters described the images as “cool” and seven posts included pictures of their actual scan images. Two further tweeters created and shared personalized art that incorporated their own MR images.“Some rad pics from my MRI. This is the coolest thing ever!”

      Discussion

      There is a large volume of literature published on patient experience within MRI. However, limited literature explores the entirety of the MRI journey. This study provides a novel and alternative insight into patient experience from referral to results. A variety of factors were identified that contributed to anxiety or a negative scan experience.
      Patient anxiety in MRI is an extensively documented phenomenon [
      • Munn Z.
      • Pearson A.
      • Jordan Z.
      • Murphy F.
      • Pilkington D.
      • Anderson A.
      Patient anxiety and satisfaction in a magnetic resonance imaging department: initial results from an Action Research Study.
      ,
      • Lukins R.
      • Davan I.
      • Drummond D.
      A cognitive behavior approach to preventing anxiety during magnetic resonance imaging.
      ,
      • Tischler V.
      • Calton T.
      • Williams M.
      • Cheetham A.
      Patient anxiety in magnetic resonance imaging centres: is further intervention needed?.
      ]. In this study, anxiety affected a large proportion of patients and presented throughout the MRI journey. Anticipatory anxiety about the procedure and future results was frequently reported at the point of receiving a scheduled MRI appointment, when travelling to an appointment and while waiting at the imaging facility. This supports findings by Van Minde et al [
      • Van Mind D.
      • Klaming L.
      • Weda H.
      Pinpointing moments of high anxiety during an MRI examination.
      ] that procedural anxiety is often at its highest immediately before the MRI examination. Anticipation or fear of the MRI results was an underlying anxiety throughout the MRI journey. The findings of this study indicate that anticipatory anxiety can manifest over an extended period and that the focus can shift and change along the MRI journey. An appreciation of anxiety relating to results is an important clinical consideration for MRI facilities and referrers.
      A perceived “lack of control” has previously been reported as a key component of anxiety and claustrophobia [
      • Thorpe S.
      • Salkovskis P.
      • Dittner A.
      Claustrophobia in MRI: the role of cognitions.
      ]. Similarly within this study, a lack of control over music was the most frequent source of negative scan experience. Music was also highlighted as a coping strategy. Music choice is a simple intervention that can provide familiarity within a “terrifying” environment. The findings of this study reinforce the “good practice” of enabling patient choice of music, which may help alleviate procedural anxiety. This supports similar findings by Funk el al [
      • Funk E.
      • Thunberg P.
      • Anderzen-Carlsson A.
      Patients’ experiences in magnetic resonance imaging (MRI) and their experiences of breath holding techniques.
      ] in relation to patient-initiated breath control.
      In contrast to previous studies [
      • Dewey M.
      • Schink T.
      • Dewey C.
      Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients.
      ], only a small proportion of participants reported claustrophobia. This may indicate that many individuals who experienced claustrophobia and or a failed examination do not frequently tweet or were not captured within the search parameters.
      This study demonstrates that patients are regularly using Twitter and social media to dynamically capture and share their MRI experiences. What is not clear is the motive, particularly as many of the tweets elicited limited or no response. For some individuals, support from family and friends appeared to be the key motivation for tweeting about their MRI experience. Prayers, support, and “thoughts” from others were a key coping strategy identified by several patients that enabled them to complete their examination. Similarly, sophisticated and unique coping strategies have been identified in other studies [
      • Murphy F.
      Act, scene, agency: the drama of medical imaging.
      ]. Determining patient demographic and motivation for using Twitter and the resulting twitter community response are all areas for further investigation.
      Several limitations of this study should be noted. Social media and Twitter lend itself to selection bias [
      • Kim A.E.
      • Hansen H.M.
      • Murphy J.
      • Richards A.K.
      • Duke J.
      • Allen J.A.
      Methodological considerations in analyzing Twitter data.
      ]. Sampling tweets over a full calendar month minimized geographic bias caused by time zones, although no attempt was made to identify the location or demographics of tweeters within this study. Twitter demographics can provide location indicators to enable infodemiological analysis [
      • Signorini A.
      • Segre A.M.
      • Polgreen P.M.
      The use of twitter to track levels of disease activity and public concern in the U.S. during the influenza A H1N1 pandemic.
      ]; however, this was not an aim of this study. The restriction of a tweet to 140 characters presented challenges with depth and the potential misinterpretation of the role of the user and/or the intended message. Reviewing the user's Twitter feed enabled some clarification but many tweets were excluded because of undetermined context or role. Only Twitter users who met the inclusion and/or exclusion criteria could potentially be identified as a service user, this may have unintentionally excluded a number of MRI patients who tweet. The motivation for sharing Twitter experiences is also undetermined and may be biased toward a particular demographic or experience. Finally, the use of a solitary researcher may contribute further selection and interpretation bias; however, coding consistency was easy to achieve.

      Conclusion

      Through content analysis of one calendar month of tweets, it was possible to identify individual users undergoing MRI examinations as well as friends, family, and parents of MRI patients. This study demonstrates that MRI patients do tweet about their experiences and that these correlate with published findings using more traditional participant recruitment methods. This study demonstrates the potential use of Twitter as a viable platform to conduct research into patient experience within the medical radiation sciences.

      References

        • Mitchell J.M.
        • LaGalia R.R.
        Controlling the escalating use of advanced imaging: the role of radiology benefit management programs.
        Medical Care Research and Review. 2009; 66: 339-351
        • Hewis J.
        Magnetic resonance imaging.
        in: Ramlaul A. Vosper M. Patient centred care in medical imaging & radiotherapy. 1st ed. Churchill Livingstone, London2013: 197-204 (ISBN 9780702046131)
        • Munn Z.
        • Jordan Z.
        The patient experience of high technology medical imaging: a systematic review of the qualitative evidence.
        Radiography. 2011; 17: 323-331
        • Dewey M.
        • Schink T.
        • Dewey C.
        Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients.
        Journal of Magnetic Resonance Imaging. 2007; 26: 1322-1327
        • Thorpe S.
        • Salkovskis P.
        • Dittner A.
        Claustrophobia in MRI: the role of cognitions.
        Magnetic Resonance Imaging. 2008; 26: 1081-1088
        • Munn Z.
        • Pearson A.
        • Jordan Z.
        • Murphy F.
        • Pilkington D.
        • Anderson A.
        Patient anxiety and satisfaction in a magnetic resonance imaging department: initial results from an Action Research Study.
        Journal of Medical Imaging and Radiation Sciences. 2015; 46: 23-29
        • Pew Research Center
        Demographics of key social networking platforms—January 2015.
        2015 (Available at:)
        • Pew Research Center
        Emerging Nations Embrace Internet–February 2014.
        2014 (Available at:)
        • Takhteyev Y.
        • Gruzd A.
        • Wellman B.
        Geography of Twitter networks.
        Social Networks. 2012; 34: 73-81
        • Shepherd A.
        • Sanders C.
        • Doyle M.
        • Shaw J.
        Using social media for support and feedback by mental health service users: thematic analysis of twitter conversation.
        BMC Psychiatry. 2015; 15: 29
        • Signorina A.
        • Segre A.M.
        • Polgreen P.M.
        The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. during the Influenza A H1N1 Pandemic.
        PLoS ONE. 2011; 6: e19467
        • Gesualdo F.
        • Stilo G.
        • Agricola E.
        • et al.
        Influenza-like illness surveillance on Twitter through automated learning of naïve language.
        PLoS ONE. 2013; 8: e82489
        • Hsieh H.
        • Shannon S.
        Three approaches to qualitative content analysis.
        Qualitative Health Research. 2005; 15: 1277-1288
        • Lewis S.C.
        • Zamith R.
        • Hermida A.
        Content analysis in an era of big data: a hybrid approach to computational and manual methods.
        Journal of Broadcasting & Electronic Media. 2013; 57: 34-52
        • Kim A.E.
        • Hansen H.M.
        • Murphy J.
        • Richards A.K.
        • Duke J.
        • Allen J.A.
        Methodological considerations in analyzing Twitter data.
        Journal of the National Cancer Institute. Monograph. 2013; 47: 140-146
        • Markham A.
        • Buchanan E.
        Ethical decision-making and Internet research. Recommendations from the AoIR Working Committee (Version 2.0).
        Association of Internet Researchers – Ethics Working Committee, 2012 (Available at:)
        • Lukins R.
        • Davan I.
        • Drummond D.
        A cognitive behavior approach to preventing anxiety during magnetic resonance imaging.
        Journal of Behaviour Therapy and Experimental Psychiatry. 1997; 28: 97-104
        • Tischler V.
        • Calton T.
        • Williams M.
        • Cheetham A.
        Patient anxiety in magnetic resonance imaging centres: is further intervention needed?.
        Radiography. 2008; 14: 265-266
        • Van Mind D.
        • Klaming L.
        • Weda H.
        Pinpointing moments of high anxiety during an MRI examination.
        International Journal of Behavioral Medicine. 2013; 21: 487-495
        • Funk E.
        • Thunberg P.
        • Anderzen-Carlsson A.
        Patients’ experiences in magnetic resonance imaging (MRI) and their experiences of breath holding techniques.
        Journal of Advanced Nursing. 2014; 708: 1880-1890
        • Murphy F.
        Act, scene, agency: the drama of medical imaging.
        Radiography. 2009; 15: 34-39
        • Signorini A.
        • Segre A.M.
        • Polgreen P.M.
        The use of twitter to track levels of disease activity and public concern in the U.S. during the influenza A H1N1 pandemic.
        PLoS ONE. 2011; 6: e19467