Magnetic resonance imaging is widely used for different diagnostic examinations involving autistic patients. The noisy, narrow, isolating magnetic resonance imaging environment and long scan times may not be suitable for autistic individuals, given their communication challenges, sensory sensitivities and often heightened anxiety. This systematic review aims to reveal any reasonable and feasible radiography-based adjustments to facilitate magnetic resonance imaging scanning without the use of sedation or general anaesthesia. Nine electronic databases were systematically searched. Out of 4442 articles screened, 53 were deemed directly relevant; when assessed against eligibility criteria, only 21 were finally included in this systematic review. Customising communication was found to be a key adjustment, as well as scan-based optimisation and environmental adaptations. The importance of distraction techniques and use of technology for familiarisation with the processes was also highlighted. The results of this study can inform recommendations to improve magnetic resonance imaging practice and patient experience, without the use of sedation or anaesthesia, where feasible. They can also inform the basis of dedicated training for magnetic resonance imaging radiographers. Lay abstract Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.

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A case study approach was used that included data collection from a wide range of sources, e.g., a stakeholder conference, audit, questionnaires, and evaluative feedback from carers, families, staff, and Autism Champions. Integrated pathways for patient care improvement were developed. Families and carers were involved in raising awareness of the needs of children with autism and policy development to meet these needs. Increased involvement from interdisciplinary working strengthened the work of the Recognising Autism Management Programme (RAMP) and improved patient care outcomes. The interventions undertaken by the RAMP resulted in improved patient /carer satisfaction, the reduction of challenging behaviour, complaints, and treatment refusal. The Autism Champions played a significant role in signposting resources and the cascading of education and practice development. All children and young people (0-25 years) on the Autism Spectrum and their families benefit from safe, individualised, high quality care in a supportive environment. Education of staff and families and targeted actions in adapting attitudes and behaviours in communication and care management will result in positive experiences for staff, children and families and financial benefit to the NHS Trust by reducing cancellation of appointments and operating theatre slots. ARTICLE HISTORY

Background: Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for clinical concerns or research. Increased sensory stimulation, lack of appropriate environmental adjustments or lack of streamlined communication in the MRI suite may pose challenges to autistic patients and render MRI scans inaccessible. This study aimed to i) explore the MRI scan experiences of autistic adults in the UK, ii) identify barriers and enablers towards successful and safe MRI examinations, iii) assess autistic individuals' satisfaction with MRI service, and iv) inform future recommendations for practice improvement. Methods:We distributed an online survey to the autistic community on social media, using snowball sampling. Inclusion criteria were: being older than 16, have an autism diagnosis or self-diagnosis, self-reported capacity to consent and having had an MRI scan in the UK. We used descriptive statistics for demographics, inferential statistics for group comparisons/correlations, and content analysis for qualitative data. Results:We received 112 responses. A total of 29.6% of the respondents reported not being sent any information before the scan. Most participants (68%) confirmed that radiographers provided detailed information on the day of the examination but only 17.1% reported that radiographers offered some reasonable environmental adjustments. Only 23.2% of them confirmed they disclosed their autistic identity when booking MRI scanning. We found that quality of communication, physical environment, patient emotions, staff training and confounding societal factors impacted autistic people's experiences. Autistic individuals rated their overall MRI experience as neutral and reported high levels of claustrophobia (44.8%). Conclusion:The study highlighted a lack of effective communication and coordination of care, either between healthcare services or between patients and radiographers, and lack of reasonable adjustments as vital for more accessible and person-centred MRI scanning for autistic individuals. Enablers of successful scans included effective communication, adjusted MRI environment, scans tailored to individuals' needs/preferences, and well-trained staff.'' Request a private waiting room, if possible. Use any relaxation aids that they can provide. Make sure staff know of any autism-related factors you have, e.g. hyperacusis; it's LOUD in there''. Table 3. Key recommendations for practice. Challenge Implication Recommendations • Poor communication and lack of adequate information provided to service user by radiology prior to scanning. • Adjust communication style to the individual. 10,21 • Ensure communication and coordination of services between GPs/referring consultants and Radiology. 24 • Implement tailored pre-scan communication COMFORT

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