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.
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,”
“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
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
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
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.
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 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