3D/4D Imaging in the Pregnancy Medical Clinic (PMC) Setting

Ultrasound images can be impressive to look at. The ultrasound technology in the contemporary setting where 2D or 3D are available, are beyond what we would have considered in the early days of sonography.  I’d like provide information on 3D image rendering specifically and provide some insight into its use in the PMC.  To ensure that we…

Ultrasound images can be impressive to look at. The ultrasound technology in the contemporary setting where 2D or 3D are available, are beyond what we would have considered in the early days of sonography.  I’d like provide information on 3D image rendering specifically and provide some insight into its use in the PMC.  To ensure that we are using the same terms, let me define what a PMC is by the Sonography Now definition. The PMC, as we have experienced them, exists to engage, educate, and empower the patient by providing the following: pregnancy confirmation through imaging, information and resources related to her greatest need(s) impacted by the pregnancy, and build a solution based on what she has shared.  All of this is done in a faith based setting that strives to be accurate, unbiased and truthful in all patient encounters, and is typically complimentary.

Pregnancy confirmation is done through 2D imaging.  This type of imaging has become common practice in OB offices including PMC’s.  While that is nothing new, the frequency of the scanning may be new to you.  Many offices provide imaging each time a woman is seen, “just to take a look”.  This is told to us by patients who have seen their pregnancy’s progress monthly and share with us the peace of mind it brings with it.  This can be a complimentary service of the physician, and may not be a medically indicated exam.  It’s quick; it enhances maternal fetal bonding and may even be cost effective for the doctor in doing his/her physical exam.  In the PMC, we use sonography to offer the patient confirmation of pregnancy after a positive pregnancy test is obtained and we too experience it being a quick exam, enhancing maternal fetal bonding and optimizing the early pregnancy confirmation as the earliest dating is most accurate.

As far back as 2005, the AIUM stated that there are three settings in which 3D imaging takes place.  http://www.aium.org/resources/viewStatement.aspx?id=31. We are going to focus on number 1: Images or video clips given to parents during the course of a medically indicated ultrasound examination.  In the PMC, the ultrasound ordered should always have a medical indication.  According to the AIUM list of medical indications for an ultrasound, a “Limited” exam can be performed to gather specific information.  The specific information needed ot confirm pregnancy would include but is not limited to the following:  determine location of the pregnancy, visualize presence or absence of a fetal heartbeat, and determine the gestational age.  The key being that the sonographer is able to provide the ordering physician with the information requested in order that he/she can make a diagnosis of pregnancy.

In confirming that the ultrasound exam in the PMC is medically indicated, it is easy to see that it can be appropriate for the sonographer to add 3D imaging to the exam.  This is valuable information for me as the sonographer performing the exam, as I do not want to exceed the ALARA principle.  As a training company, we don’t want to encourage misuse of a value medical tool by promoting unnecessary imaging.  In considering the information we know and have experienced, we feel it is certainly within our bounds to allow 3D image renderings in the PMC setting just as in the Obstetrical office setting.   As educators, we would recommend that you have training in such a modality before using it.   While we strive to educate our patients, we also need to ensure that we are responsible to them by having foundational training in any patient care services we provide, 3D imaging is no exception.

The second question we’re addressing in this article is, “how are patients affected?”  At a recent 3D/4D training we gathered some anecdotal data to share with those who are considering the benefits of 3D/4D imaging.  We asked a number of questions with responses on a simple 1 to 5 scale.

The one day training revealed the following from patient interviews:

  • 10 out of 10 could identify fetal anatomy with 2D imaging
  • 7 out of 10 could identify fetal anatomy with 3D imaging
  • 5 out of 10 scored a 5 for WOW factor for 3D images


Before we look at verbal responses, let’s consider a few things that affect the results of 2D or 3D imaging.

  • 2D imaging is established in the medical arena, so familiar to the patient
  • 2D images are well recognized by those of childbearing age
  • 2D imaging provides fetal heartbeat visualization
  • 3D imaging is a relatively new modality when compared to 2D imaging
  • 3D imaging is dependent upon cooperation of the baby
  • 3D imaging requires increased operator skill
  • 3D imaging obtains images with a visible skin surface
  • 3D image optimization occurs at 28 weeks gestation

What do patients say?

  • “Adorable”
  • “Pretty real looking”
  • “Very cool”
  • “There’s the face”
  • “Now I see it”

What else have patients shared?

  • “It is clearer sometimes with 2D”
  • “What’s going on in there?”
  • ”Too early can look creepy”

The WOW factor was powerful when the baby was positioned just right.  If we could just make him or her move to help us!

Our third question is, “Is it practical?”  Considering that many of the ultrasound units available have affordable 3D capabilities, we would feel it could serve a good purpose in a life-affirming setting.  How practical is it?  Remember that you will be doing 2D imaging to obtain your routine images for documentation.  You will need additional training in order to optimize 3D image gathering.  It’s more than twisting here and a turn there.

The basic requirements for the sonographer who has decided to learn 3D imaging are as follows:

  • Skilled in hands-on scanning as documented through competency testing
  • Proven understanding of basic ultrasound principles to be translated to 3D
  • Proven commitment to life-long learning
  • Willingness to be critiqued in current imaging methods
  • And finally, a teachable spirit

While this specialized imaging is not required, it can be beneficial for pregnancy confirmation related to informed consent.  You will likely see an increase in patient bonding as 3D images can be used with favorable responses as early as 10-11 weeks. Sonography Now does not feel that it is a necessity to have 3D imaging capabilities in your PMC, but we do want you to have the understanding of how it can fit into your clinical setting.  We know that there is increased interest in 3D/4D ultrasound and we know that those skilled in the art of hands-on scanning in the Pregnancy Medical Clinic can offer such imaging.  To quote a nurse sonographer recently visiting a clinic with 3D capabilities, “It’s techie, patients expect it, and it’s very cool.”

Together we work to image optimally, provide accurate information and offer services that are above reproach.  Positioning you to have a good understanding of the standard of care as it relates to 3D/4D imaging is imperative for the PMC.  Thank you for serving your community for life.

If you have any questions please call and find out how this might fit in your clinic, Connie can be reached at 702-556-1101 or via email.