2).
4D: What the medical literature says
Journal
of Ultrasound in Medicine. 24(12):1599-624, 2005
Dec.
The article published in this prestigious journal looked at over
500 scientific articles on this subject. The results of the various
studies reported in those articles clearly showed that Three-dimensional
ultrasound provides additional diagnostic information for the diagnosis
of facial anomalies, especially facial clefts. There was also evidence
that 3D
ultrasound provides additional diagnostic information in neural
tube defects and skeletal malformations.
2005
Journal of Ultrasound
in Medicine. 24(12):1599-624, 2005
Dec.
The article published in this prestigious journal looked at over
500 scientific articles on this subject. The results of the various
studies reported in those articles clearly showed that Three-dimensional
ultrasound provides additional diagnostic information for the
diagnosis of facial anomalies, especially facial clefts. There was
also evidence that 3D baby ultrasound provides additional diagnostic
information in neural tube defects and skeletal malformations. It
was also concluded that additional research was needed to determine
the clinical role of 3D/4D ultrasound for the diagnosis of congenital
heart disease and central nervous system anomalies.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Journal:
Ultrasound in Obstetrics & Gynecology.
25(5):473-7, 2005 May.
Authors E K Ji and others from the Department
of Radiology, CHA General Hospital, Pochon
CHA University, Seoul, Republic of Korea published an article titled
‘Effects of ultrasound on maternal-fetal bonding: a comparison of
two- and three-dimensional imaging’ in May 2005. Their study had
shown that ‘Patients having a 3D ultrasound examination consistently
scored higher than those having a 2D ultrasound examination alone
for all categories of maternal-fetal bonding’.
Ultrasound in
obstetrics & gynecology is the official
journal of the International Society of Ultrasound in Obstetrics
and Gynecology.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
2004
Journal: Current Opinion
in Obstetrics & Gynecology. 16(2):123-8,
2004 Apr.
P Malcus in the publication Current Opinion
in Obstetrics & Gynecology wrote a
review article titled ‘Antenatal fetal surveillance’. The thrust
of the article was that modern obsterics
has moved on from waiting for problems to arise in pregnancy to
targeted active surveillance of fetal wellbeing. In this area 3D
baby ultrasound could play a crucial role in fetal biometry with
potentially more accurate (and quicker) measurements of fetal size
(growth), amniotic fluid volumes etc.
2004
Writing in this
publication in October 2004, Christina Poon and Philippe
Zimmern explained that
the technique of three-dimensional ultrasound imaging has been developing
over the past 15 years, and has been particularly embraced by the
field of obstetrics. Application in other areas such as gynaecology
especially in examining the urinary tract and pelvic floor continue
to advance. This is particularly useful and promising considering
the enormity of the problem of urinary incontinence among women.
In this area, it is already proving useful by providing reproducible,
affordable and clinically relevant information in the assessment
of urethral bulking agent therapy with collagen.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
2002
Journal: Current Opinion
in Obstetrics & Gynecology. 14(6):569-75,
2002 Dec.
I.E. Timor-Tritsch and L.D.Platt
wrote an article in this publication in December 2002 titled ‘Three-dimensional
ultrasound experience in obstetrics’.
It was a review article of over 60 published scientific papers on
the subject of 3D ultrasound. in the article,
these authors said: The advantages of 3D and 4D baby ultrasound
in certain clinical areas are unequivocal. Its use in the workup
of fetal anomalies involving the face, limbs, thorax, spine and
the central nervous system are already applied by most centers.
The use of this technology in applying colour Doppler, in guiding
needles for different puncture procedures as well as in the evaluation
of the fetal heart are under close research scrutiny. The bonding
effect between the parents and their future offspring is becoming
more and more evident as 3D ultrasound is used.
+++++++++++++++++++++++++++++++++++++++++++
2001
Journal: Obstetrics &
Gynecology. 98(6):1099-103, 2001 Dec.
In December 2001,researchers B Woelfer
and others from the Early Pregnancy and Gynaecology Assessment Unit
at King’s College, London published results of their study under
an article titled ‘Reproductive outcomes in women with congenital
uterine anomalies detected by three-dimensional ultrasound screening’.
In this, they had looked at reproductive outcomes in women with
congenital uterine anomalies detected incidentally by 3D scanning.
The conclusion was that these women were more likely to have adverse
pregnancy outcomes than women with a normal uterus. This is an unexpected
‘benefit’ of this technology as it will allow the mother with this
risk factor to be identified and therefore allow optimal measures
to be put in place to maximize the chances of a favourable pregnancy
outcome.
2000
Journal: Annual Review
of Biomedical Engineering Vol. 2: 457-475, Aug.
In August 2000, this publication carried a highly detailed article
by Aaron Fenster and Donal
Downey of The John P. Robarts Research
Institute and Department of Diagnostic Radiology & Nuclear Medicine,
The University of Western Ontario, Canada. It was titled simply:
Three-dimensional Ultrasound imaging.
The article was mainly directed at professionals in the field and
largely technical. However it dissected the reasons for the increased
quest for using 3D ultrasound. They said that the increase in the
use of 3D ultrasound is related to the limitations of 2D viewing
of 3D anatomy, using conventional ultrasound. This, they said, occurs
because conventional ultrasound images are two-dimensional, yet
the anatomy is three dimensional, hence the doctor/technician must
integrate multiple images in his/her mind. This practice is clearly
inefficient, and may lead to variability and even incorrect diagnoses.
Moreover, the 2-dimensional ultrasound image represents a thin plane
at some arbitrary angle in the body. It is, in practice, difficult
to localize the image plane and reproduce it at a later time for
follow-up studies.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
1999
From 9th
World Congress On Ultrasound in Obstetrics & Gynecology,
November - Buenos Aires, Argentina.
Many experts from across the world met at the congress and 3D ultrasound
was a major topic covered. It was acknowledged by various speakers
that this was a major advance in medical diagnostics. There was
excitement that a very important addition in our armamentarium was
steadily coming into mainstream medical practice. As always, there
was a fair dose of caution that many tough challenges lay ahead
and as one speaker, Andrew Hull, from San Diego, USA, put it succinctly in his lecture, 3D
ultrasound, like any new technology, had potential pitfalls and
therefore misdiagnosis. Some of these are observed in conventional
2D ultrasound and others are unique to
3D. Today, more than five years since that talk, many of these have
been overcome and many others are still to be resolved. However,
the place of 3D/4D ultrasound, as an extremely beneficial technology,
is no longer in doubt.
Limitations
of 3D/4D scans
Limitations of three-dimensional
ultrasound of the fetus are as follows:
Suboptimal volume-rendered images are obtained if there is inadequate
amniotic fluid surrounding the structure of interest. This is a
major limitation with reduced liquor volume and as the fetus
progresses towards term. The adjacent structures cannot be excluded
from the rendered volume in these cases and this interferes with
surface rendering. In other words, when there is little water or
when the baby is relatively large (as in the final weeks and days
of pregnancy), images can be poor and unclear.
Unacceptable
surface rendering occurs with unfavorable
fetal position and with adjacent or superimposed structures (e.g.,
limbs, umbilical cord)
Image processing of the volume data may take additional time on
the part of the examiner
Real-time capacity is not generally available with three-dimensional
ultrasound. (Real time three-dimensional ultrasound is also known
as 4D ultrasound.) Whereas 3D ultrasound is a static display of
the various reformatting techniques based on the acquisition of
a static volume, 4D ultrasound displays a continuously updated and
newly acquired volume in any rendering modality creating the impression
of a moving structure. The time vector (the fourth dimension) makes
it possible to perceive a rapid update of the successive individual
images displayed on the monitor at very short intervals which creates
the impression of a real time measurement, and enables the user
to see fetal motion in almost real-time.
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