For a patient facing radiation therapy for cancer, the process is filled with unknowns. They might wonder about the radiation itself—will it burn? Then there’s the face mask for head and neck cancer patients—will it be tolerable? And those radiation placement tattoos— will they hurt? The uncertainty can be overwhelming for someone already dealing with fear, anxiety, or anger related to their diagnosis and other treatments.
Ibefore their first dose of radiation—in addition to talking with their care team and reading about what to expect during treatment—they could personally shadow another patient’s treatment and get a private behind the scenes tour with the team members involved in every step of their care.
This type of experience is now possible in virtual reality, thanks to a pair of videos produced by a virtual reality film class at the University of Pennsylvania, in partnership with Penn Medicine Radiation Oncology. They went live in the fall of 2024 with lung patients at the Perelman Center for Advanced Medicine; the department plans for other disease teams to slowly integrate them into their practices and eventually to share the videos with other Penn Medicine radiation therapy sites.
Besides creating an innovative educational tool to alleviate patients’ fears, the project yielded benefits for both the film students and the Radiation Oncology staff, said Peter Decherney, professor of Cinema & Media studies in the School of Arts & Sciences, and the instructor of the undergraduate Virtual Reality Lab spring course.
“The students were exposed to cutting-edge research and real patient experiences, and they were very excited by that,” Decherney said. “And on the other hand, the doctors and nurses and everyone else were genuinely excited to be working with undergraduates, who they don't always have access to.”
A stage pass to the radiation process
In one video, viewers are transported into the treatment rooms and workspaces of team members who see patients every day and those who work behind the scenes. They meet medical dosimetrist Gabrielle Collinsworth, who creates patients’ treatment plans, and medical physicist Austin Kassaee, who makes sure is delivered in the right place. Radiation therapist Angela Natale explains the how and why behind radiation masks and tattoos, while radiation oncologist William P. Levin, MD, reflects on the grounding power of mindfulness.
Besides explaining the treatment process, the staff convey their love for their work and empathy for patients.
“I could just tell when they were talking about their areas of expertise, all their passion was coming through,” said Fern Nibauer-Cohen, senior director of Patient Engagement for Radiation Oncology. “Everyone had their part to share … and they really got into it.”
In the second video, patient Cindy Olson guides viewers from the moment she takes the elevator to the concourse level of the Perelman Center for Advanced Medicine, home to the Roberts Proton Center, with her sister, and receives a buzzer. She explains she’ll first be called back to the gowned waiting area, and then to treatment room #5.
The viewer is in the room as Olson talks with her radiation oncologist, Michelle Alonso-Basanta, MD, PhD, and then later, Olson describes how she found comfort in the radiation mask, designed for patients receiving radiation to the head and neck to keep still. She talks about the sense of community she felt with the other patients she encountered in the waiting room five days a week for the seven weeks she received proton therapy.
While watching the videos, viewers can move their heads from side to side to explore the spaces on their own.
A Penn collaboration is born
It was a 2023 Penn Today article about the virtual reality course that gave Nibauer-Cohen the idea to email Decherney about working together.
“There’s this whole wealth of knowledge on our campus—wouldn’t it be amazing to see how we could collaborate?” Nibauer-Cohen remembers wondering. “There’s so much opportunity to tap into the expertise of the university.”
Every Thursday for eight weeks, in the Spring of 2024, about 12 film students—mostly undergraduates, pursuing all sorts of majors—learned from the department staff and used remotely operated 360-degree cameras to capture the process from literally every angle. supported by Penn’s Stavros Niarchos Foundation Paideia Program.
Biophysics major Amalya Knapp said the experience showed her “how collaborative medicine can be and how it’s such a team effort.”
Knapp was the lead interviewer for Olson’s video. She was especially moved by the patient’s sense of gratitude for the Radiation Oncology team, even “in the thick of her treatment.”
“She was able to recognize how lucky she was to be in such an incredible place, and she was so grateful for this experience while she was going through it. I think it’s very easy to say that after the fact, but she was saying that very much in the middle of it,” Knapp said. “It speaks to how incredible the Roberts Proton Therapy Center and Penn Radiation Oncology team are. They really put the patient first.”
The medium fit the message
The Radiation Oncology department, under the leadership of Levin, Nibauer-Cohen, and department chair James Metz, MD, has embraced virtual reality as a tool to enhance patient care as well as patient education and clinical training. Levin is currently leading a study looking at patients’ stress levels before and after watching a meditative, virtual reality-based guided breathing exercise. He has also incorporated VR into an anatomy course he teaches for medical physics master's degree students, using software to go “inside” an organ and “take it apart” to better understand it.
From a filmmaker’s perspective, Decherney agreed that the immersive medium of virtual reality nicely fits the mission of assuaging patients’ anxieties about the radiation process.
“New patients who are diagnosed with cancer and then trying to understand radiation therapy want to know, what's the experience going to be like? You can tell them about it, you can show them photos, or even a flat video, but we put people into the experience,” Decherney said. “Hopefully that alleviates patients’ anxiety and helps them be less worried.”