Ultrasound in psycho-oncology: Early detection, patient anxiety, and the role of radiologists in psychological support
Abstract
Ultrasound plays an essential role in cancer detection and follow up, yet the psychological experience surrounding this procedure has received limited attention. This review explores the intersection between diagnostic imaging and patient psychology within the context of psycho oncology, focusing on how communication and environmental factors influence anxiety and trust. Evidence from recent studies shows that patients often experience significant emotional tension before and during ultrasound examinations, driven by uncertainty, prior medical experiences, and perceived risk of recurrence. However, anxiety can be effectively reduced through empathetic communication, clear explanations, and supportive interaction by radiologists and sonographers. The review also highlights that a calm physical environment, pre scan orientation, and post scan reassurance contribute to a more positive patient experience. Integrating psychological awareness into routine radiology practice requires no major workflow changes but consistent efforts in communication, training, and empathy. By viewing the ultrasound encounter as both a diagnostic and psychological process, radiology departments can promote emotional comfort, trust, and resilience among patients. The review concludes that radiologists who combine technical expertise with compassion can transform ultrasound from a source of anxiety into an opportunity for psychological support and healing.
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References
1. Perna G, Pinto E, Spiti A, et al. Foundations for a personalized psycho-oncology: The state of the art. Journal of Personalized Medicine. 2024; 14(9): 892. doi: 10.3390/jpm14090892
2. Caruso R, Breitbart W. Mental health care in oncology. Contemporary perspective on the psychosocial burden of cancer and evidence-based interventions. Epidemiology and Psychiatric Sciences. 2020; 29: e86. doi: 10.1017/S2045796019000866
3. D’Abramo F, Goerling U, Guastadisegni C. Targeted drugs and psycho-oncological intervention for breast cancer patients. Journal of Negative Results in Biomedicine. 2016; 15(1): 6. doi: 10.1186/s12952-016-0049-9
4. Fugmann D, Holsteg S, Schäfer R, et al. Use of follow-up psycho-oncology consultations in urological cancer after transition from inpatient to outpatient care. Oncology Research and Treatment. 2025; 48 (1–2): 4–13. doi:10.1159/000542458
5. Valentine A, Brown J, Lacourt T, et al. Frequency of anxiety and depression and screening performance of the Edmonton Symptom Assessment Scale in a psycho‐oncology clinic. Psychooncology. 2022; 31(2): 290–297. doi:10.1002/pon.5813
6. Brandão T, Schulz MS, Matos PM. Psychological adjustment after breast cancer: A systematic review of longitudinal studies. Psychooncology. 2017; 26(7): 917–926. doi: 10.1002/pon.4230
7. Bagha SM, Macedo A, Jacks LM, et al. The utility of the Edmonton Symptom Assessment System in screening for anxiety and depression. European Journal of Cancer Care (Engl). 2013; 22(1): 60–69. doi: 10.1111/j.1365-2354.2012.01369.x
8. Kuhnt S, Brähler E, Faller H, et al. Twelve-month and lifetime prevalence of mental disorders in cancer patients. Psychotherapy and Psychosomatics. 2016; 85(5): 289–296. doi: 10.1159/000446991
9. Anderson D, Vlachostergios PJ, Simpson L, et al. A feasibility study of distress screening with psychometric evaluation and referral of cancer patients. Scientific Reports. 2025; 15(1): 10397. doi: 10.1038/s41598-025-94538-5
10. Valdes-Stauber J, Vietz E, Kilian R. The impact of clinical conditions and social factors on the psychological distress of cancer patients: An explorative study at a consultation and liaison service in a rural general hospital. BMC Psychiatry. 2013; 13(1): 226. doi: 10.1186/1471-244X-13-226
11. Lo Re G, De Luca R, Muscarneri F, et al. Relationship between anxiety level and radiological investigation: Comparison among different diagnostic imaging exams in a prospective single-center study. Radiologia Medica. 2016; 121(10): 763–768. doi: 10.1007/s11547-016-0664-z
12. Raaschou H, Pilegaard M, Klausen L, et al. Oncology patients’ experience of a routine surveillance CT examination: Relationships and communication. Radiography. 2019; 25(4): 308–313. doi: 10.1016/j.radi.2019.02.009
13. Hoffstädt H, Stouthard J, Meijers MC, et al. Patients’ and clinicians’ perceptions of clinician-expressed empathy in advanced cancer consultations and associations with patient outcomes. Palliative Medicine Reports. 2020; 1(1): 76–83. doi: 10.1089/pmr.2020.0052
14. Reese JB, Beach MC, Smith KC, et al. Effective patient-provider communication about sexual concerns in breast cancer: A qualitative study. Supportive Care in Cancer. 2017; 25(10): 3199–3207. doi: 10.1007/s00520-017-3729-1
15. Madhuripan N, Cheung HMC, Alicia Cheong LH, et al. Variables influencing radiology volume recovery during the next phase of the coronavirus disease 2019 (COVID-19) pandemic. Journal of the American College of Radiology. 2020; 17(7): 855–864. doi: 10.1016/j.jacr.2020.05.026
16. Sulzer SH, Feinstein NW, Wendland CL. Assessing empathy development in medical education: A systematic review. Medical Educucation. 2016; 50(3): 300–310. doi: 10.1111/medu.12806
17. Banning M, Gumley VA. Clinical nurses’ expressions of the emotions related to caring and coping with cancer patients in Pakistan: A qualitative study. European Journal of Cancer Care (Engl). 2012; 21(6): 800–808. doi: 10.1111/j.1365-2354.2012.01364.x
18. Lima T, Torres A, Carvalho P, et al. Defining and assessing distress in oncology patients: A systematic review of the literature. Healthcare. 2025; 13(16): 1976. doi: 10.3390/healthcare13161976
19. Neamţiu L, Deandrea S, Pylkkänen L, et al. Psycho-oncological support for breast cancer patients: A brief overview of breast cancer services certification schemes and national health policies in Europe. The Breast. 2016; 29: 178–180. doi: 10.1016/j.breast.2016.07.002
20. Meoded MD, Tănase M, Mehedințu C, et al. Psycho-oncology in breast cancer: Supporting women through distress, treatment, and recovery—three arguments—rapid narrative review. Medicina (B Aires). 2025; 61(6): 1008. doi: 10.3390/medicina61061008
21. Faller H, Weis J, Koch U, et al. Utilization of professional psychological care in a large German sample of cancer patients. Psychooncology. 2017; 26(4): 537–543. doi: 10.1002/pon.4197
22. Dunn J, Adams C, Holland J, et al. Reinforcing the role of psycho‐social oncology in global cancer prevention: Applying psycho‐oncology research in programmes and practice. Psychooncology. 2015; 24(10): 1217–1221. doi: 10.1002/pon.3923
23. Parris T, Wakefield D, Frimmer H. Real World performance of screening breast ultrasound following enactment of Connecticut Bill 458. Breast Journal. 2013; 19(1): 64–70. doi: 10.1111/tbj.12053
24. Zwahlen D, Tondorf T, Rothschild S, et al. Understanding why cancer patients accept or turn down psycho-oncological support: A prospective observational study including patients’ and clinicians’ perspectives on communication about distress. BMC Cancer. 2017; 17(1): 385. doi: 10.1186/s12885-017-3362-x
25. Broadbridge EA, Venetis MK. Examining the role of pre‐visit anxiety on patient uncertainty and breast cancer patient–provider communication. Cancer Medicine. 2024; 13(14). doi: 10.1002/cam4.70003
26. Laughey WF, Brown MEL, Dueñas AN, et al. How medical school alters empathy: Student love and break up letters to empathy for patients. Medical Education. 2021; 55(3): 394–403. doi: 10.1111/medu.14403
27. Öztürk A, Kaçan H. Compassionate communication levels of nursing students: Predictive role of empathic skills and nursing communication course. Perspectives in Psychiatric Care. 2022; 58(1): 248–255. doi: 10.1111/ppc.12954
28. Webster SN, Biggs EE, Simons LE, et al. Bracing for the worst? Real-time scanxiety and uncertainty management during cancer surveillance. Health Psychology 2025; in press. doi: 10.1037/hea0001540
29. Kaplan R, Adams S. Incidental fetal ultrasound findings: Interpretation and management. Journal of Midwifery & Women’s Health. 2018; 63(3): 323–329. doi:10.1111/jmwh.12754
30. Derry-Vick HM, Heathcote LC, Glesby N, et al. Scanxiety among adults with cancer: A scoping review to guide research and interventions. Cancers (Basel). 2023; 15(5): 1381. doi: 10.3390/cancers15051381
31. Ritter A, Sabev M, Bonny O, et al. Incidental findings on non-contrast abdominal computed tomography in an asymptomatic population: Prevalence, economic and health implications. PLoS One. 2025; 20(8): e0328049. doi: 10.1371/journal.pone.0328049
32. Nieto Alvarez I, Madl J, Becker L, et al. Patients’ experience to MRI examinations—A systematic qualitative review with meta‐synthesis. Journal of Magnetic Resonance Imaging. 2025, 61(1): 480–493. doi: 10.1002/jmri.29365
33. Mariano L, Nicosia L, Sorce A, et al. Radiologists’ communicative role in breast cancer patient management: Beyond diagnosis. Healthcare. 2024; 12(11): 1145. doi: 10.3390/healthcare12111145
34. Milch HS, Grimm LJ, Plimpton SR, et al. Communicating with breast imaging patients during the COVID-19 pandemic: Impact on patient care and physician wellness. Journal of Breast Imaging. 2022; 4(2): 144–152. doi: 10.1093/jbi/wbac005
35. Brocken P, Prins JB, Dekhuijzen PNR, et al. The faster the better?—A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psychooncology. 2012; 21(1): 1–10. doi: 10.1002/pon.1929
36. Sprague BL, Ichikawa L, Eavey J, et al. Breast cancer risk characteristics of women undergoing whole‐breast ultrasound screening versus mammography alone. Cancer. 2023; 129(16): 2456–2468. doi: 10.1002/cncr.34768
37. Starcevich A, Lombardo P, Schneider M. Patient understanding of diagnostic ultrasound examinations in an Australian private radiology clinic. Australasian Journal of Ultrasound in Medicine. 2021; 24(2): 82–88. doi: 10.1002/ajum.12237
38. Mannion S, Martin NA, O’Connor J, et al. In their own words, “Waiting Sucks”: A qualitative study of medical testing-related anxiety in patients with cancer. American Journal of Hospice and Palliative Medicine. 2023; 40(5): 468–474. doi: 10.1177/10499091221105502
39. Bui KT, Liang R, Kiely BE, et al. Scanxiety: A scoping review about scan-associated anxiety. BMJ Open. 2021; 11(5): e043215. doi: 10.1136/bmjopen-2020-043215
40. Patel DS, Webster SN, Dowling EJ, et al. Scanxiety and fear of recurrence in young adult female breast and gynaecological cancer survivors: Investigating shared mechanisms. Psychooncology. 2024; 33(12). doi: 10.1002/pon.70050
41. Brédart A, Kop J, Fall M, et al. Anxiety and specific distress in women at intermediate and high risk of breast cancer before and after surveillance by magnetic resonance imaging and mammography versus standard mammography. Psychooncology. 2012; 21(11): 1185–1194. doi: 10.1002/pon.2025
42. Fonseca AMA, Silvestre AJD, Rocha SM. From physicochemical characteristics variability to purple passion fruit (Passiflora edulis f. edulis) powders nutritional value: On the path of zero‐waste. Journal of the Science of Food and Agriculture. 2025; 105(6): 3306–3316. doi: 10.1002/jsfa.14087
43. Harinck F, Nagtegaal T, Kluijt I, et al. Feasibility of a pancreatic cancer surveillance program from a psychological point of view. Genetics in Medicine. 2011; 13(12): 1015–1024. doi: 10.1097/GIM.0b013e31822934f5
44. Remonti LR, Kramer CK, Leitão CB, et al. Thyroid ultrasound features and risk of carcinoma: A systematic review and meta-analysis of observational studies. Thyroid. 2015; 25(5): 538–550. doi: 10.1089/thy.2014.0353
45. Lei Z, He Z, Mei Y, et al. Associations of psychological status and ultrasonic characteristics of thyroid nodules in adults during the COVID-19 pandemic. Frontiers in Psychology. 2023; 14. doi: 10.3389/fpsyg.2023.1202122
46. Katz ML, Donohue KA, Alfano CM, et al. Cancer surveillance behaviors and psychosocial factors among long‐term survivors of breast cancer. Cancer. 2009; 115(3): 480–488. doi: 10.1002/cncr.24063
47. Frank RC, Lo T, Jin D, et al. A pancreatic cancer screening study in individuals with new-onset or deteriorating diabetes mellitus (PANDOME study). Journal of Clinical Oncology. 2021; 39(15_suppl): TPS10607-TPS10607. doi: 10.1200/JCO.2021.39.15_suppl.TPS10607
48. Plantinga M, Zwienenberg L, van Dijk E, et al. Parental experiences of rapid exome sequencing in cases with major ultrasound anomalies during pregnancy. Prenatal Diagnosis. 2022; 42(6): 762–774. doi: 10.1002/pd.6056
49. Kim H, Cho IK, Lee D, et al. Effect of cancer-related dysfunctional beliefs about sleep on fear of cancer progression in the coronavirus pandemic. Journal of Korean Medical Science. 2022; 37(36). doi: 10.3346/jkms.2022.37.e272
50. Pahade J, Couto C, Davis RB, et al. Reviewing imaging examination results with a radiologist immediately after study completion: Patient preferences and assessment of feasibility in an academic Department. American Journal of Roentgenology. 2012; 199(4): 844–851. doi: 10.2214/AJR.11.8064
51. Miller LS, Shelby RA, Balmadrid MH, et al. Patient anxiety before and immediately after imaging-guided breast biopsy procedures: Impact of radiologist-patient communication. Journal of the American College of Radiology. 2016; 13(11): e62–e71. doi: 10.1016/j.jacr.2016.09.034
52. Koech B, Sikolia G, Macharia N. Doctor patient nonverbal communication and tuberculosis treatment adherence in Kibera informal settlement in Nairobi County, Kenya. International Journal of Communication and Public Relation. 2023; 8(4): 28–41. doi: 10.47604/ijcpr.2166
53. Adams SJ, Burbridge B, Chatterson L, et al. Telerobotic ultrasound to provide obstetrical ultrasound services remotely during the COVID-19 pandemic. Journal of Telemedicine and Telecare. 2022; 28(8): 568–576. doi: 10.1177/1357633X20965422
54. Fakes K. Patient experiences and anxiety related to medical imaging: Challenges and potential solutions. Journal of Medical Radiation Sciences. 2024; 71(1): 3–6. doi: 10.1002/jmrs.748
55. Rockall AG, Justich C, Helbich T, et al. Patient communication in radiology: Moving up the agenda. European Journal of Radiology. 2022; 155: 110464. doi: 10.1016/j.ejrad.2022.110464
56. Meira M, Bitencourt AGV, Travesso DJ, et al. Relationship between anxiety and internet searches before percutaneous ultrasound-guided diagnostic procedures: A prospective cohort study. PLoS One. 2022; 17(10): e0275200. doi: 10.1371/journal.pone.0275200
57. Kasalak Ö, Yakar D, Dierckx RAJO, et al. Radiologist-patient consultation of imaging findings after neck ultrasonography: An opportunity to practice value-based radiology. Clinical Imaging. 2022; 81: 87–91. doi: 10.1016/j.clinimag.2021.09.022
58. Zigman Suchsland M, Cruz MJ, Hardy V, et al. Qualitative study to explore radiologist and radiologic technologist perceptions of outcomes patients experience during imaging in the USA. BMJ Open. 2020; 10(7): e033961. doi: 10.1136/bmjopen-2019-033961
59. Zhou F, Du K, Dong Y. Qualitative research on the psychological experience of female patients undergoing in vitro fertilization and embryo transfer. 2020; preprint. doi: 10.21203/rs.3.rs-24233/v1
60. Kaur E, Arezina J, Bryant L, et al. ‘More like a partnership’: A qualitative evaluation of communication coaching for sonographers (CCS) in obstetric ultrasound. Ultrasound. 2025; 33(2): 112–122. doi: 10.1177/1742271X241277127
61. Yu LS, Chojniak R, Borba MA, et al. Prevalence of anxiety in patients awaiting diagnostic procedures in an oncology center in Brazil. Psychooncology. 2011; 20(11): 1242–1245. doi: 10.1002/pon.1842
62. Puri PR, Dimsdale JE. Health care utilization and poor reassurance: Potential predictors of somatoform disorders. Psychiatric Clinics of North America. 2011; 34(3): 525–544. doi: 10.1016/j.psc.2011.05.011
63. Van Tuyl R, Berry-Einarson K. Conveying missed miscarriage information at obstetric ultrasounds: Patient experiences and trauma-informed considerations. Journal of Patient Experience. 2025; 12. doi: 10.1177/23743735251343497
64. Isabirye N, Kisa R, Santos N, et al. Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience. PLoS One. 2021; 16(11): e0259770. doi: 10.1371/journal.pone.0259770
65. Adamson HK, Chaka B, Hizzett K, et al. An exploration of communication skills development for student diagnostic radiographers using simulation-based training with a standardised patient: UK-based focus-group study. Journal of Medical Imaging and Radiation Sciences. 2023; 54(3): 465–472. doi: 10.1016/j.jmir.2023.06.004
66. Alamanioti K, Lambrou GI. Communication of patients and healthcare personnel during the diagnostic radiological process. Journal of Research and Practice on the Musculoskeletal System. 2022; 6(2): 55–64. doi: 10.22540/JRPMS-06-055
67. van Vliet LM, Stouthard J, Gröschel LC, et al. Effect of clinician-expressed empathy in advanced cancer on different ethnic groups: Results from an experimental video-vignette study. Journal of Palliative Medicine. 2023; 26(8): 1109–1114. doi: 10.1089/jpm.2022.0602
68. Abdallah HMM, Amin SM, Hammouda EY, et al. Family intensive care unit syndrome: Investigating the mediating role of healthcare communication in psychological well‐being among family members. Nursing in Critical Care. 2025, 30(4). doi: 10.1111/nicc.70119
69. Hamouda N, Ibrahim MK, Jabal MS. Research design protocol: Assessing the impact of using ChatGPT in radiology reporting in an emergency setting in Egypt. 2023; preprint. doi: 10.1101/2023.06.28.23291928
70. Brito SF, Galiassi GER, Biasi IF, et al. The importance of doctor-patient communication in clinical practice. International Journal of Health Science. 2023; 3(83): 2–4. doi: 10.22533/at.ed.15938323091010
71. Vetter D, Barth J, Uyulmaz S, et al. Effects of art on surgical patients. Annals of Surgery. 2015; 262(5): 704–713. doi: 10.1097/SLA.0000000000001480
72. Sarkar M, Rock P, Rowen L, et al. Increased patient satisfaction in the postanesthesia care unit with the implementation of a controlled noise reduction program. Journal of PeriAnesthesia Nursing. 2021; 36(1): 3–7. doi: 10.1016/j.jopan.2020.05.001
73. Lu Y, Ma L, Chen Z, et al. Effect of noise management in interventional radiology suites on patients undergoing transarterial chemoembolization: A retrospective study. Noise Health. 2024; 26(122): 325–331. doi: 10.4103/nah.nah_53_24
74. Hamd ZY, Alorainy AI, Alrujaee LA, et al. How different preparation techniques affect MRI-induced anxiety of MRI patients: A preliminary study. Brain Sciences. 2023; 13(3): 416. doi: 10.3390/brainsci13030416
75. Monteiro Grilo A, Ferreira AC, Pedro Ramos M, et al. Effectiveness of educational videos on patient’s preparation for diagnostic procedures: Systematic review and meta-analysis. Preventive Medicine Reports. 2022; 28: 101895. doi: 10.1016/j.pmedr.2022.101895
76. Brown RKJ, Petty S, O’Malley S, et al. Virtual reality tool simulates MRI experience. Tomography. 2018; 4(3): 95–98. doi: 10.18383/j.tom.2018.00023
77. Khazen M, Mirica M, Carlile N, et al. Developing a framework and electronic tool for communicating diagnostic uncertainty in primary care. JAMA Network Open. 2023; 6(3): e232218. doi: 10.1001/jamanetworkopen.2023.2218
78. Zhang R, Xu X, Luo X, et al. Building bridges—communication education for residents in radiology: A scoping review. BMC Medical Education. 2024; 24(1): 662. doi: 10.1186/s12909-024-05660-3
79. Pacheco FA, Felix MM dos S, Pires P da S, et al. Validation of a patient safety checklist for radiological procedures in hemodynamics. Revista Brasileira de Enfermagem-REBEn. 2022; 75(6). doi: 10.1590/0034-7167-2021-0011
80. Dilworth S, Higgins I, Parker V, et al. Patient and health professional’s perceived barriers to the delivery of psychosocial care to adults with cancer: A systematic review. Psychooncology. 2014; 23(6): 601–612. doi: 10.1002/pon.3474
81. Senf B, Fettel J, Demmerle C, et al. Physicians’ attitudes towards psycho‐oncology, perceived barriers, and psychosocial competencies: Indicators of successful implementation of adjunctive psycho‐oncological care? Psychooncology. 2019; 28(2): 415–422. doi: 10.1002/pon.4962
82. Mascarella MA, Morand GB, Hier MP, et al. Dealing with the vicissitudes and abject consequences of head and neck cancer: A vital role for psycho-oncology. Current Oncology. 2022; 29(9): 6714–6723. doi: 10.3390/curroncol29090527
83. Bergerot CD, Dizon DS, Ilbawi AM, et al. Global breast cancer initiative: A platform to address the psycho‐oncology of cancer in low‐ and middle‐income countries for improving global breast cancer outcomes. Psychooncology. 2023; 32(1): 6–9. doi: 10.1002/pon.5969
