3D & 4D in obstetrics

Mohammed Abdou
Fetal ABC
 Probe

Mechanical Electronic (Matrix)

 Principles

• 3D
• 4D
• 5D

• In volume sonography, the concept of the “voxel”

replaces the “pixel,”
• where you now have three intersecting orthogonal or
perpendicular planes with which you are working the X,
Y, and Z planes
3D tools (Applications)
 3D Step by step

1. Orientation in 2D
2. Select 3D or 4D
3. Correct preset for 3D and 4D
4. Hit freeze / update
5. Correct post- acquisition 3D and 4D
 3D Step by step
1. Orientation in 2D
The basic principle for generating a good 3D image is a
good underlying 2D image.

Suboptimal 2D image = suboptimal 3D image

1. Gain
Too bright AF appears black
2. Depth
3. Focus
4. Zoom
5. Region of acquisition

Part of the head will be absent Well centered

 3D Step by step
1. Orientation in 2D

1. The 2D imagine is the basis of 3D & 4D

2. To have a good image for fetal face  Try to have
fetal profile in 2D parrel to the probe ( Horizontal)
3. A good fluid interface is necessary to optimize the
image.
 3D Step by step
2. Select 3D&4D

Select 3D & 4D Volume box will appear

 3D Step by step
2. Select 3D&4D
• You can change and
adjust the position
and size of the box
and the camera line

Volume box = Acquisition box = ROI box

Green line = Camera line
 3D Step by step
3. Correct pre-set for 3D and 4D
1. Volume angle

Width
 ‫‪3D Step by step‬‬
‫‪3. Correct preset for 3D and 4D‬‬
‫‪1. Volume angle‬‬
‫يعني ايه تظبيط ال ‪angle‬؟‬
‫• انت بتقول للجهاز ‪ < --‬بص يا جهاز‬
‫• هيرد يقولك أأمر يا دكتره ؟‬
‫• انا عاوزك تاخد الصوره ال ‪ 2D‬دي و تحطها في النص و‬
‫تاخد ال ‪ volume‬بتاعك دا بزوايه كام درجه ) أنا اللي‬
‫هحددهالك( علي يمين الصوره و زاويه كام درجه علي‬
‫شمال الصوره‬
‫• تأمر يا دكتره‬
 3D Step by step
3. Correct pre-set for 3D and 4D
1. Volume angle

25O 0 25O
Width

Volume angle = 50
 3D Step by step
3. Correct pre-set for 3D and 4D
1. Volume angle
No gold standard for the best angle of acquisition
Our rule
As small as possible, as big as necessary
• Face : 50 -65
• STIC : 30
• Gyn : 120
 3D Step by step
3. Correct pre-set for 3D and 4D
2. Quality

Quality : high Quality : low

Higher Quality = more images better resolution
Lower quality = fewer images  reduced resolution
 2. Quality

Quality : low Quality : high

 3D Step by step
3. Correct pre-set for 3D and 4D
2. Quality
• However , Higher quality  longer
acquisition time  possible movement
artifact
 3D Step by step
3. Correct pre-set for 3D and 4D Higher Quality = more
images better
2. Quality resolution

‫حلو هختار دا‬

Movements artifacts

However, Higher quality  longer acquisition time

 possible movement artifact

‫يالهوي عليا و علي‬

‫سنيني السودا‬
 3D Step by step
3. Correct pre-set for 3D and 4D
2. Quality

• Static = Highest quality

• Movable = Mid quality
 3D Step by step

1. Orientation in 2D
2. Select 3D or 4D
3. Correct preset for 3D and 4D
4. Select Mode
 3D Step by step

1. Orientation in 2D
2. Select 3D or 4D
3. Correct preset for 3D and 4D
4. Select Mode
5. Hit Freeze / update

To 3D World
1. Multiplanar (orthogonal ) Mode
 1. Multiplanar

• After a volume acquisition, in most

cases the 3D-display on the screen
is presented in a multiplanar mode,
mostly in the three orthogonal
planes
 Visualization
1. Multiplanar
Plane A Plane B

Plane C
• Plane A is the reference plane during volume acquisition
• Plane B is the 90O rotation
• Plane C corresponds to the horizontal plane.
 Visualization
1. Multiplanar

• Plane A is the reference plane

• Plane B is the 90O rotation
• Plane C corresponds to the horizontal plane.
 Visualization
1. Multiplanar
A.The Orientation point = Reference point
• The 3 planes intersect at a point called the
Orientation point .
• This dot, represents the same location within
the Volume in all 3 planes.
 Visualization
1. Multiplanar
A. The Orientation point = Reference point
 Visualization
1. Multiplanar
The Orientation point = Reference point
A. The Orientation point = Reference point
 Visualization
1. Multiplanar
The Orientation point = Reference point
A. The Orientation point = Reference point
 Visualization
1. Multiplanar
B. ROTATION ALONG THE X, Y, AND Z AXES
1. X axis rotation is similar to the motion of a ‘rotisserie’
2. Y axis rotation is similar to the motion of a ‘drill’
3. Z axis rotation is similar to a clockwise

X axis rotation Y axis rotation Z axis rotation

2. Render Mode
 Rendering
Plane A Plane B

Plane C 3D
 Rendering mode
Surface modes Transparency modes

• Surface smooth • Maximum mode

• Surface texture • Minimum mode
• HD-live surface • Inversion mode
• HD-live smooth • X-ray mode
• HD-live silhouette
• Glass body mode
 Rendering mode
Surface modes

• Surface smooth
• Surface texture
• HD-live surface
• HD-live smooth
 Render mode
That moment when mother says I feel like

‫ﷲ صوره البيبي حلوه‬

‫أووووووي‬ ‫فلتر يا عسل‬
 Surface Rendering

The green line is your

camera
 Surface Rendering
Correct post- acquisition

What is the wrong here ?

 Surface Rendering
Correct post- acquisition

What is the wrong here ?

How to Correct?
Option 1 : Adjust camera line
 Surface Rendering
Correct post- acquisition
What is the wrong here ?

How to Correct?
Option 2 : Use sonorender
 Surface Rendering
Correct post- acquisition

Option2 : Use sonorender

 Surface Rendering
Correct post- acquisition

Option2 : Use sonorender

 Surface Rendering
Correct post- acquisition The same volume information with varying threshold parameters
Threshold
a kind of Filter which will remove those Artifacts.
Threshold Low-level echoes or noise are removed in
order to achieve a clear view from the border of the
render box to the structure of interest.
 Surface Rendering
2. Surface Rendering
Threshold
a kind of Filter which will remove those Artifacts.
Threshold Low-level echoes or noise are removed in
order to achieve a clear view from the border of the
render box to the structure of interest.
 Surface Rendering
2. Rendering : threshold , transparency , brightness and colour scale
Threshold
This knob can be used mainly to eliminate weak artifacts
and speckles to highlight structures with true signals.
• A very low threshold (< 20) :
visualize fine structures such as the amniotic membrane or the
umbilical cord.

• A middle threshold (25—40) :

display a wide range of gray scale information such as in the fetal
shin

• High threshold (>50)

can be applied to highlight bones in maximum mode or other
structures in the inversion mode.
 Surface Rendering
Correct post- acquisition
Threshold
 Surface Rendering
Correct post- acquisition
Magicut- electronic scalpel
• After a volume data set is frozen,
• the volume can be rotated in all
directions and undesired
information can be removed
 Surface Rendering
Correct post- acquisition
Magicut- electronic scalpel
• After a volume data set is frozen,
• the volume can be rotated in all
directions and undesired
information can be removed
 Surface Rendering
Special effects
3D dynamic depth rendering
•This software displays structures that are deep in the volume visualized with colors blue, gray or black,
and with the color switch between sepia and blue a depth rendering can be appreciated.
•Often this is amniotic fluid that appears nicely blue
 Surface Rendering
Special effects
Light source function = HD live = 5D
 Surface Rendering
HD live
Special effects
Light source function = HD live = 5D
 Surface Rendering
Special effects
Light source function = HD live = 5D
• Enables the illumination of the 3D image with a light source.
• The 3D image usually appears as if light is projected directly
from the front onto the image.
• The new software allows the user to move a light source
around a sphere so as to illuminate the image from different
perspectives, even from behind
 Surface Rendering
Special effects
Light source function = HD live = 5D
 Rendering mode
Surface modes Transparency modes

• Surface smooth • Maximum mode

• Surface texture • Minimum mode
• HD-live surface • Inversion mode
• HD-live smooth • X-ray mode
• HD-live silhouette
• Glass body mode
 Transparency render modes
Transparency modes

• Maximum mode
• Minimum mode
• Inversion mode
• X-ray mode
• HD-live silhouette
• Glass body mode
 Transparency render modes
1. Maximum mode
Maximum mode :
• all hyperechoic information in the render box is projected .
• This render mode is used to visualize bones and is ideal in
the examination of the fetal skeletal system

Surface Mode

Maximum Mode
 Transparency render modes
1. Maximum mode
Maximum mode :
• all hyperechoic information in the render box is projected .
• This render mode is used to visualize bones and is ideal in
the examination of the fetal skeletal system

Surface Mode

Maximum Mode
 Transparency render modes
1. Maximum mode
Maximum mode :
• all hyperechoic information in the render box is projected .
• This render mode is used to visualize bones and is ideal in
the examination of the fetal skeletal system

Maximum Mode
 Transparency render modes
2. Minimum mode
Minimum mode
• all anechoic information in the
entire volume is projected . This
approach is ideal to visualize fluid-
filled organs as well as the heart
and large vessels.
 Transparency render modes
3. Inversion mode
Inversion mode
Presenting the hypoechoic structures as
echogenic solid structures. It blackens most of
the surrounding tissue information

Stomach with the double bubble sign

Similar to negative/positive film
 Transparency render modes
3. Inversion mode
Inversion mode
Presenting the hypoechoic structures as
echogenic solid structures. It blackens most of
the surrounding tissue information

Hydronephrosis in a fetus with vesico-ureteral reflux

Similar to negative/positive film
 Transparency render modes
4. X-Ray mode

X-Ray mode
• used for the visualization of
hypoechoic tissue and is calculated as a
mixture of minimum and maximum
transparency modes.
• The ideal regions of interest for the use
of this mode are the lungs, abdominal
organs, brain. The X-Ray mode is most
often combined with a thin slice such
as that used in volume contrast
imaging (VCI)
 Transparency render modes
5. Silhouette mode

Silhouette mode
demonstration of contours of the structures
present in the volume

Surface Mode Silhouette Mode

 Transparency render modes
5. Silhouette mode

Silhouette mode
demonstration of contours of the structures
present in the volume

Surface Mode Silhouette Mode

 Transparency render modes
5. Silhouette mode

Silhouette mode
Demonstration of contours of the structures
present in the volume

Silhouette Mode
 Transparency render modes
6. Glass-body mode

Glass-body mode
visualize blood flow either separately in
3D or together with the surrounding
structures

Glass-body mode
 Transparency render modes
6. Glass-body mode

Glass-body mode
visualize blood flow either separately in
3D or together with the surrounding
structures

Glass-body mode
 Transparency render modes
6. Glass-body mode

Glass-body mode
visualize blood flow either separately in
3D or together with the surrounding
structures

Glass-body mode
 Visualization
2. Rendering modes
3. Tomographic ultrasound imaging (TUI)
 Tomographic ultrasound imaging (TUI)

• Tomographic ultrasound imaging (TUI) is

a multi- planar mode display of the
volume as parallel planes similar to
tomographic images obtained from CT and
MR workstations.
• You can change :
• Number of slice
• The interslice distance
• Number of image display
 Steps in TUI

Select which image you want to apply Press TUI

TUI from multiplanar mode (A,B,C)
 Let’s select Plane A

Axial

From Axial Sagittal & Parasagittal

 Let’s select Plane A again ;)

Axial

From Axial Coronal

Let’s select Plane B again ;)

Sagittal

From Sagittal  Axial

 Let’s have more fun

Here the number of displayed slices is 3 x3. Here the number of displayed slices is 4 x4.
The interslice distance is now 2.5 mm. The interslice distance is now 2.5 mm.
 Let’s be practical

Fetus with multicystic renal dysplasia displayed in Tomography mode of the abdomen in a fetus with
tomography mode. ileus and bowel perforation.
The stomach (*) can be seen in the lower planes
4. Volume Contrast Imaging (VCI)
 Volume Contrast Imaging (VCI)

• VCI is reconstructed from several adjacent images (two in

that case).
• Signals from true tissue information are high and present
at the same place, while signals from noise and speckles
are weak and present at different places.
• The sum-up of two adjacent images (VCI) increases the
intensity from true signals and information from noise
and speckle is too low and almost eliminated.
 Volume Contrast Imaging (VCI)

• VCI is reconstructed from several adjacent images (two in

that case).
• Signals from true tissue information are high and present
at the same place, while signals from noise and speckles
are weak and present at different places.
• The sum-up of two adjacent images (VCI) increases the
intensity from true signals and information from noise
and speckle is too low and almost eliminated.
Volume Contrast Imaging (VCI)
 Volume Contrast Imaging (VCI)

Without VCI With VCI

Volume Contrast Imaging (VCI)

Without VCI With VCI

5. Omni view
 Omni view

• Visualisation up to 3 planes
1. Line
2. Curved
3. Polyline
4. Trace
• + /- VCI
 Omni view

• Visualisation up to 3 planes
1. Line
2. Curved
3. Polyline
4. Trace
• + /- VCI
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