Ideal Positions: 3D Sonography, Medical Visuality, Popular Culture

As digital technologies are integrated into medical environments, they continue to transform the experience of contemporary health care. Importantly, medicine is increasingly visual. In the history of sonography, visibility has played an important role in accessing fetal bodies for diagnostic and entertainment purposes. With the advent of three-dimensional (3D) rendering, sonography presents the fetus visually as already a child. The aesthetics of this process and the resulting imagery, made possible in digital networks, discloses important changes in the relationship between technology and biology, reproductive health and political debates, and biotechnology and culture.

Investigation into the fusion of multiple 4-D fetal echocardiography images to improve image quality

Recent advances in four-dimensional (4-D) ultrasound enable the acquisition and visualisation of the entire fetal heart. However, getting consistent, shadow free, data remains problematic due to the uncontrollable nature of fetal orientation. This article presents the first investigation into the utility of image fusion to improve the quality of volumetric fetal cardiac imaging. Multiple volume scans are registered using a semiautomatic approach and five fusion methods are assessed for their ability to remove artefacts and improve image quality. Image quality is assessed in terms of signal-to-noise ratio, contrast and contrast-to-noise ratio. Qualitative results are presented for the ability to remove artefacts. The fusion methods assessed were found to be divided into those that reduce noise and those that increase contrast. The effect of fusion on left ventricle segmentation using commercial state-of-the-art software is also considered. The use of image fusion is shown to reduce the variability of volume estimates by about 50% relative to measurement on a single scan.

Improving Detection of Transposition of the Great Arteries in Routine Obstetric Sonographic Screening

Transposition of the great arteries (TGA) is a congenital malformation in which the pulmonary artery arises from the left ventricle and the aorta arises from the right ventricle. At birth, when the ductus arteriosus and foramen ovale close, severe hypoxemia results, and intervention is necessary. Prenatal diagnosis of TGA is associated with a significant decrease in mortality and morbidity. Currently, detection of TGA is low. This literature review explores techniques for detecting TGA, the importance of prenatal diagnosis, scanning techniques, new technologies, and possible maternal risk factors.

Prenatal detection of congenital heart disease in southern Nevada: the need for universal fetal cardiac evaluation

OBJECTIVE

Congenital cardiac malformations are common developmental anomalies. In the United States, congenital heart disease is the number one cause of infant mortality from congenital malformations. Prenatal diagnosis of congenital heart defects aids treatment coordination. Our aim was to evaluate prenatal detection of serious congenital heart malformations in Clark County, Nevada.

METHODS

We electronically searched our research department-maintained computer database for patients with serious congenital heart disease born in Clark County between May 2003 and April 2006. We excluded patients that did not have at least 1 local prenatal ultrasound examination. All pre-natal ultrasound studies were performed in obstetric offices, radiology imaging centers, or maternal-fetal medicine specialty practices. Fetal echocardiography was performed in maternal-fetal medicine specialists' offices under the supervision of a fetal cardiologist. Pediatric cardiologists performed all postnatal echocardiographic examinations.

RESULTS

During the study period, we diagnosed serious congenital heart malformations in 161 patients among a total estimated 77,000 births (2/1000). Of the 161 patients, 58 (36%) had a prenatal diagnosis, and 103 (64%) had an exclusively postnatal diagnosis.

CONCLUSIONS

Standard prenatal ultrasound fails to show congenital heart disease in most fetuses.