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Effectiveness of a Virtual Reality-Based Intervention to Reduce Anxiety and Pain in Pediatric Nuclear Medicine: A Randomized Clinical Trial

This randomized clinical trial demonstrates that a virtual reality-based intervention significantly reduces anxiety in pediatric patients undergoing nuclear medicine procedures, offering a safe, non-pharmacological alternative to sedation, although it did not significantly impact perceived pain or caregiver satisfaction.

Original authors: Marta FERRAZ-TORRES, Arantxa BUJANDA-SAINZ DE MURIETA, Cristina GARCÍA-VIVAR, Paula ESCALADA-HERNÁNDEZ, Nuria LASSA-TODA, Nelia SOTO-RUIZ

Published 2026-07-10

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Original authors: Marta FERRAZ-TORRES, Arantxa BUJANDA-SAINZ DE MURIETA, Cristina GARCÍA-VIVAR, Paula ESCALADA-HERNÁNDEZ, Nuria LASSA-TODA, Nelia SOTO-RUIZ

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a pediatric nuclear medicine test as a long, boring, and slightly scary movie where the main character (the child) has to lie perfectly still on a cold table for over 10 minutes. For many kids, this feels like being trapped in a tiny, humming box, leading to a panic that can ruin the movie (the scan) or require heavy sedation (a chemical "sleep" button) to finish.

This study asked a simple question: What if we could swap that scary movie for a magical, immersive adventure?

The researchers tested a "magic helmet" called Virtual Reality (VR) on 78 kids aged 2 to 16. The kids in the "magic" group (36 children) wore a headset that showed them 360-degree videos of peaceful places like oceans, valleys, and mountains, complete with relaxing sounds. The kids in the "normal" group (42 children) just got the usual care.

The Big Win: Anxiety Vanishes
The results were like a magic trick. The VR group didn't just feel a little better; their anxiety dropped by a massive 42.6%.

The Numbers: The kids without the magic helmet had an average anxiety score of 48.31. The kids with the helmet had a score of 27.72.
The "Who": This worked especially well for the younger kids. In fact, the study found that the VR helmet was so good at calming things down that it helped the youngest, most anxious kids catch up to the older, calmer ones. It's like the helmet gave the little ones a "superpower" to handle the scary machine.
The "Who Else": It even helped kids who were terrified of small spaces (claustrophobia). While these kids usually have the highest anxiety, the VR group managed to finish their tests without needing to quit, proving the helmet can turn a scary box into a safe space.

What the Magic Helmet Did NOT Do
Here is where we have to be careful not to overhype the magic. The paper is very clear about what the helmet didn't fix:

Pain: The helmet did not make the tests hurt less. The pain scores were almost identical for both groups (around 2.1 out of 10 on average). The authors suggest this is because the "ouch" part of these tests usually happens before the scan starts (when they put in the IV needle), and the helmet was only used during the scan. So, while the helmet stopped the fear, it didn't stop the hurt.
Caregiver Satisfaction: The parents and guardians didn't rate the experience significantly differently whether their child wore the helmet or not. They were happy either way.
Finishing the Test: The helmet didn't magically make more kids finish the test. The completion rate was 87.2% for everyone, and the difference between the two groups wasn't statistically significant.

The "Age" Twist
Usually, older kids are naturally less anxious than younger ones. But the study found something interesting: the VR helmet changed the rules. In the normal group, anxiety dropped as kids got older. In the VR group, the helmet was so effective that it didn't matter as much how old the child was; the anxiety stayed low for everyone. It seems the helmet is a great equalizer, helping the little ones just as much as the big ones.

The Bottom Line
This study suggests that putting a VR helmet on a child during a nuclear medicine scan is a safe, non-drug way to slash anxiety by nearly half. It doesn't cure pain, and it doesn't guarantee a parent's satisfaction will skyrocket, but it does offer a powerful tool to keep kids calm and still without needing to put them to sleep with medicine. It turns a scary, long wait into a journey through a virtual ocean or mountain, making the hospital feel a little less like a hospital and a little more like an adventure.

Technical Summary: Effectiveness of a Virtual Reality-Based Intervention to Reduce Anxiety and Pain in Pediatric Nuclear Medicine

1. Problem Statement

Pediatric nuclear medicine procedures, such as PET/CT and various scintigraphies, present significant challenges due to the requirement for prolonged immobility in a clinical environment. These factors frequently induce high levels of anxiety and distress in children, which can compromise study quality through motion artifacts, prolong examination times, and necessitate pharmacological sedation. While sedation ensures procedural completion, it carries risks of adverse effects, requires additional monitoring time, and is not always clinically indicated. Although non-pharmacological distraction strategies exist, the specific efficacy of immersive Virtual Reality (VR) in the context of pediatric nuclear medicine—a setting characterized by long durations and potential claustrophobia—remains under-explored.

2. Methodology

Study Design:
The study was a randomized clinical trial (RCT) conducted at the Hospital Universitario de Navarra (HUN) between September 2024 and December 2025. It utilized a 1:1 parallel group design with blinded allocation via the Random Allocation Rule (RAR).

Participants:
The sample consisted of 78 pediatric patients (aged 2–16 years) undergoing diagnostic imaging tests lasting more than 10 minutes.

Intervention Group (IG/REVIMED): $N=36$ .
Control Group (CG): $N=42$ .
Note: Three patients initially allocated to the IG refused the VR device due to fear of loss of control, resulting in a slight imbalance in sample size.

Intervention (REVIMED):
The IG utilized a Meta Quest VR headset displaying a custom 360° monoscopic video (4K resolution, 30 fps) created using Unreal Engine. The content consisted of three 5-minute nature scenes (ocean, valley, mountain) designed for supine viewing, accompanied by relaxing audio. The videos looped continuously during the procedure. The CG received standard care without VR.

Variables and Instruments:

Primary Outcome: Anxiety levels measured via the abbreviated modified Yale Preoperative Anxiety Scale (m-YPAS), a validated 18-item tool yielding a score of 0–100.
Secondary Outcomes:
- Pain: Measured using the Wong-Baker Faces Visual Analog Scale (FVAS), scored 0–10.
- Caregiver Satisfaction: Assessed via a 10-item ad-hoc Likert scale (1–10) covering waiting time, environment, communication, and overall satisfaction.
- Procedural Success: Binary variable for test completion vs. non-completion.
Covariates: Age, sex, claustrophobia status, test type, and procedure duration.

Statistical Analysis:
Data were analyzed using R software (v4.5.2). Non-parametric tests (Wilcoxon rank-sum, Kruskal–Wallis, Spearman correlation) were used for bivariate analysis due to sample size and distribution. Multivariable linear and logistic regression models were fitted to assess the intervention's effect on anxiety, pain, and test completion, adjusting for covariates including age, sex, and claustrophobia.

3. Key Results

Demographics and Baseline:
The groups were comparable regarding sex distribution, test type, and duration. However, the CG was significantly older (mean 11.17 years) than the IG (mean 8.94 years, $p=0.008$ ). Notably, 25% of the IG reported claustrophobia, whereas 0% of the CG did ( $p<0.001$ ).

Primary Outcome (Anxiety):
The VR intervention demonstrated a statistically significant reduction in anxiety.

IG Mean Score: $27.72 \pm 6.58$
CG Mean Score: $48.31 \pm 15.06$
Reduction: A 42.6% reduction in anxiety levels ( $p < 0.001$ ).
Multivariable Analysis: The adjusted linear regression model confirmed that the VR intervention was strongly associated with lower anxiety scores ( $\beta = -58.71$ , $p < 0.001$ ). A significant interaction was found between the intervention and age ( $p=0.003$ ), indicating that the anxiety-reducing effect of VR was particularly pronounced in younger children, effectively "leveling" the emotional experience across age groups.

Secondary Outcomes:

Pain: No significant difference was observed between groups ( $p=0.8$ ). Pain scores were significantly higher in females ( $p=0.037$ ) and varied by test type (highest in gastroenterology).
Caregiver Satisfaction: No significant difference was found between groups ( $p=0.8$ ). However, patients with claustrophobia reported significantly lower satisfaction scores compared to non-claustrophobic patients.
Test Completion: The overall completion rate was 87.2%. There was no statistically significant difference in completion rates between the VR and control groups ( $p=0.500$ ), despite the VR group being younger and containing all claustrophobic cases. Non-completion was associated with younger age and longer procedure durations.

4. Significance and Claims

The authors claim that the REVIMED intervention offers a safe, non-pharmacological alternative to sedation for managing anxiety in pediatric nuclear medicine. The study highlights several specific contributions:

Anxiolytic Efficacy: VR significantly reduces procedural anxiety, with a 42.6% reduction observed. This is particularly impactful for younger children, a demographic traditionally prone to higher cooperation difficulties and fear.
Management of Claustrophobia: The intervention successfully facilitated the completion of tests in patients with claustrophobia without technical incidents, suggesting VR acts as a tool for habituation and desensitization to enclosed spaces.
Institutional Efficiency: By reducing the need for pharmacological sedation, the intervention potentially enhances institutional efficiency and patient safety.
Differentiated Management: The study concludes that while VR is superior for managing the psychological component (anxiety), it does not replace the need for specific analgesic protocols for physical pain, which appears linked to biological factors (sex) and technical factors (test type). Therefore, a multimodal approach combining immersive distraction with exam-specific analgesia is recommended.

The authors maintain modesty regarding generalizability, noting limitations such as the single-center design, the specific VR protocol used, and the age imbalance between groups. They suggest that while the results are promising, further studies are needed to isolate the effect of VR across specific age ranges and to validate the protocol in diverse settings.

Technical Summary: Effectiveness of a Virtual Reality-Based Intervention to Reduce Anxiety and Pain in Pediatric Nuclear Medicine

1. Problem Statement

2. Methodology

3. Key Results

4. Significance and Claims

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