Even though the positive impacts of natural elements are well established, a significant gap remains in understanding how their effects can be enhanced through design. This gap is especially evident with respect to natural blue elements, represented by sky and water. To address this, the present study explores how natural blue elements can be implemented into the built environment of healthcare settings in order to enhance their effects on patients. Medical imaging environments, specifically Positron Emission Tomography/Computed Tomography (PET/CT) rooms, were selected as the research setting. Employing a mixed-methods research approach allowed for measuring subjective and physiological responses, as well as the duration of head orientation during four virtual scenarios associated with natural blue elements. The findings indicate that the design strategies which incorporate motion, strategic spatial placement, and adjustments to the amount of sky and water resulted in more positive responses, consequently enhancing the effects of natural blue elements in medical imaging environments. Furthermore, adaptable design strategies that consider individual preferences, particularly regarding the sound of water, are needed to further improve the benefits of natural blue elements.