The biggest development in obstetric ultrasound since it was first developed 40 years ago means that physicians and expectant parents can now see 3D images of foetuses moving in real-time in the womb. Mike McGrath examines how 4D ultrasound technology is bringing a new dimension to prenatal care.

Ultrasound is already recognised as being the best method of assessing foetal health during pregnancy, but new developments allowing practitioners to see video footage of foetuses moving in the womb, make it an even more effective tool for prenatal diagnosis. The latest generation of ultrasound machines such as the GE Voluson 730 show moving images of the foetus in real time and in three dimensions.

Dr Hisham Youssef, General Manager, GE Ultrasound, Middle East and Africa, says that the introduction of 4D ultrasound enables sonographers to see images that were only imaginable before. “Exclusive live action technology brings the fourth dimension - time - to ultrasound,” he said.

“For the first time it is now possible to display an infinite number of images using novel planes distinct from those used to acquire the original image. This allows doctors to observe anatomy in motion and enables patients to recognise what is being viewed inside their body,” Dr Youssef says.

Ultrasound specialists have always needed to visualise anatomy in three dimensions in order to acquire a diagnosis. With traditional machines technicians use a two-dimensional device to acquire images and then use their skill and training to interpret them. Three-dimensional ultrasound, which has been available for the past few years, does this by using a powerful computer to layer two-dimensional images on top of each other to form a 3D image.

Revolutionary technology used in the new 4D machines allows the image of the foetus to be continuously updated providing a live action view. The technology has evolved so much that the new machines can bring an exceptional level of accuracy to diagnostic imaging. Four-dimensional ultrasound enables the pinpointing of problems that traditional ultrasounds cannot achieve.

“In obstetrics the role of 4D ultrasound is evolving at an exceptional rate. For example in foetal mor-phology the 4D ultrasound’s multi-planar display and surface rendering capabilities lead to a clearer and more comprehensive understanding of foetal abnormalities,” Dr Youssef explains.

Nearly all pregnant women in developed countries undergo at least one ultrasound scan during the course of their pregnancy, but the cost and expertise required to use 4D ultrasound means that at present the technique will in most cases only be used where examination with traditional ultrasound indicates further investigation is required.

The images are most valuable when a problem with the foetus is detected with two-dimensional ultrasound and the physician needs to make a specific diagnosis. This is particularly valuable when dealing with abnormalities of the brain, spina bifida, heart, or cleft lips.

The ability to see movements of the foetal head, body and limbs and also facial expressions such as yawning, smiling and crying allows physicians to assess foetal motor activity and behaviour which provides an important milestone for foetal physiology research, Dr Youssef says.

Ultrasound technology has evolved so much in the past few years that new machines can bring an exceptional level of accuracy to diagnostic imaging, allowing the early detection of tumours and giving physicians much greater potential to save lives. Four-dimensional ultrasound also offers huge benefits in allowing physicians to measure volume, an important tool in follow up treatment.

In breast scanning, it is possible to detect the pattern of tissue in small breast masses, helping one to identify malignant masses using ultrasound which was not possible before.

Dr Ulrich Honemeyer, Specialist Obstetrician and Gynecologist at the Welcare Hospital in Dubai has worked with ultrasound since 1986. He says that the main advantage of 4D imaging is that the rapid sequence of images of the area of interest and the fantastic memory of the machine, enables the physician to quickly and more easily make a diagnosis than with the static conventional 3D with its long “blind” intervals. “The value of a 3D picture or 4D film sequence showing the child’s face, spine, feet and hands, and thus ruling out cleft lip, spina bifida aperta, club foot and more, cannot be over estimated,” Dr Honemeyer says.

The physician who witnessed the beginnings of ultrasound in Obstetrics in the days when physicians had to use a fair amount of physical strength to move the machine’s “probe” says that another important benefit of 4D ultrasound is in reassuring parents who may be worried about the health of their child.

Parents may fear for the health of their child due to past experience or problem pregnancies among friends or family, especially since many abnormalities include a risk of reoccurrence.

“The strongest argument against such fears is to show a normal 3D picture of the baby including the region of special interest and to let the parents have the visual experience of the child’s movements in utero,” Dr Honemeyer says.
In the unfortunate case that problems are identified the images can help expectant families understand the abnormality and the options available for their foetus.

Four-dimensional documentary machines have also proven very successful in engendering parental bonding.
“The parents experience their child in a much more complete way by seeing it move! The face with its changing expressions gives the child’s emotional message to the parents and ultrasound appointments have become more exciting events for the parents,” Dr Honemeyer says.

Four-dimensional systems and technology are the fastest growing developments in ultrasound in the world. Future advances in 4D ultrasound will include lighter probes, the introduction of more user-friendly options and the release of faster machines. GE has already introduced the next generation of 4D probes which are approximately 35 per cent smaller and lighter than all other equipment available on the market.

Physicians in the Middle East have been quick to take advantage of the new technology and GE Ultrasound has sold approximately 140 systems to hospitals and healthcare clinics in the region in the past two years.

Dr Honeymeyer says that expectations of the highest standards in medical imaging are common among today’s patients.

“Patients will always find their way to clinics and hospitals not only equipped with illustrious names but also the most advanced medical technology. In regards to 4D ultrasound this means not just following the latest fashion, but continuing to push prenatal screening and diagnostics to a higher level,” Dr Honeymeyer says.
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