Few words strike fear into a person like the words, “You have
cancer.” An estimated 1.64 million people will hear those words this
year as they receive a diagnosis of breast cancer, prostate cancer,
head/neck cancer, or any one of the many other forms of the
second-leading cause of death in the United States.1
As part of
their treatment, many of these patients will undergo positron emission
tomography and computed tomography (PET/CT) scanning, one of the most
powerful and effective imaging technologies available to help radiation
oncologists diagnose, stage, and monitor cancerous lesions and their
response to treatment.
“PET scanning has revolutionized scanning
for treatment of cancer,” said Bruce Cross, MD, citing head/neck cancer
as just one example. “Before, we had assumed that if you had a large
lymph node, you had to treat the entire lymph node. With PET scanning,
you can distinguish which lymph nodes are involved and which ones are
not. We have been able to tailor our treatment fields to [target] only
the areas involved and to protect, for example, the salivary glands.”
a radiation oncologist in the Sparks Health System in Fort Smith, AR,
Dr. Cross said he uses PET/CT to help treat adults with “the whole gamut
of cancers,” including lymphomas and cancers of the head and neck,
lung, and breast.
Patient anxiety: A PET/CT imaging challenge
Yet getting patients’ anxiety under control is crucial to the success of PET/CT scanning, which requires injections of 18F
fluorodeoxyglucose (18F-FDG) and relies heavily on the patient to
remain quiet and still for up to 90 minutes or more. That’s a
challenging task for anyone, much less a patient dealing with the
emotional turmoil accompanying a cancer diagnosis, said Dr. Cross.
are asking [patients] to wait while you inject them with radioactive
material, and they are already pretty nervous to start with because they
have cancer, and on top of that they have to be quiet. That is
incredibly difficult for people to do,” he said.
“When you inject
the patient with FDG, you want patients to be relaxed so they don’t
produce false positives in the images, which may be caused by motion,
either from humming, talking or just moving about,” he said, explaining
that such motion can cause extra dye uptake and metabolization by the
muscles, leading to false positive results.
Administering sedatives like diazepam to help patients relax is an
option, but various studies have produced mixed results on their
effectiveness, in addition to other drawbacks, such as the inability of
outpatients to drive home and potential interactions with other drugs.2 Radiation oncologists like Dr. Cross use a variety of techniques to relax patients and enhance the clinical process.
The Ambient Experience solution
Ambient Experience is Philips’ strategy for creating a
patient-friendly, soothing environment for those undergoing PET/CT
imaging procedures. To calm nervous patients during radiopharmaceutical
injection, the walls of the uptake room are bathed in a warm-colored
glow, and patients are provided with a comfortable chair. Patients
entering the exam room, meanwhile, can select from several different
room themes by using a touchscreen tablet PC. The selected theme is
reflected in immediate changes to the room environment, including
colored lighting from a skylight and animated projected images
accompanied by soothing music and other sounds.
Experience suite is also designed to promote operational efficiency
that, combined with more relaxed patients, helps improve patient
compliance and streamlines PET/CT examinations by reducing patient
Audiovisual intervention: A sound solution
A recent study concluded that “audiovisual intervention” can help to
reduce patient anxiety in the PET uptake room and reduce false positive
18F-FDG uptake in brown adipose tissue (BAT) “without the disadvantages
associated with pharmacologic interventions.”2
the stay in the uptake room, a significant decrease in overall anxiety
was found, together with several other significant changes in patient
physiology. In the cohort with audiovisual intervention, however, the
decrease in patient anxiety was significantly larger. The cohort with
intervention also showed significantly lower 18F-FDG uptake in BAT, but
not in muscles,” the researchers reported.2
The results of the study of 101 patients were published in the June 2012 issue of the Journal of Nuclear Medicine Technology.*
The study results are no surprise to Medhat M. Osman, MD, ScM, PhD,
Associate Professor and Medical Director of the Division of Nuclear
Medicine and PET/CT, Saint Louis University School of Medicine, St.
Louis, Mo. “Strategies such as Ambient Experience can lead to improved
patient management because calmer patients are better able to cooperate,
which can impact many aspects of the clinical process,” Dr. Osman said.
“And that means happier referring physicians.”
In the opinion of
Dr. Cross, the value of Ambient Experience lies in delivering a more
successful PET/CT examination because you have a calm, relaxed, and
“The fact that we have provided [patients]
with a distraction or entertainment … to take their mind off the
radioactive agent is a really positive thing,” he said. “It gives them
something else to focus on.”
He also said the tropical beach
scenes are especially popular with his adult patients. “The beach, with
palm trees and the ocean, is a classic mental getaway for adults. If the
only thing available were cartoon characters, not many adults would
want to see them. That’s why the choice [that the Ambient Experience]
offers makes them very happy,” he said.
Dr. Cross said he is “convinced that we do a better job here” at Sparks in part because of Ambient Experience.
been very impressed that Sparks went all out on with the Ambient
Experience. I am convinced, from my 25 years of experience reading PET
scans, that we do a better job here. How much of that is patient
cooperation or the excellent algorithms in the technology is hard to
tell, but I feel very secure that we’re doing a better job.”
is important to note that this study was performed with a prototype
configuration that is not commercially available. Ambient Experience as a
product/service has not been designed nor has it been approved by
Philips to have capability to provide the effect described in the study.
- American Cancer
Society. Cancer facts and figures 2012: Leading new cancer cases and
Last accessed Aug. 28, 2012.
- Vogel, Wouter V, Valdes Olmos
Renato A, Tijs Tim JW, et al. “Intervention to lower anxiety of 18F-FDG
PET/CT patients by use of audiovisual imagery during the uptake phase
before imaging.” J Nucl Med Technol. 2012:40;1-7.
Website. Ambient Experience. PET/CT.
Accessed Aug. 28, 2012.