- The Washington Times - Monday, July 28, 2003

Stacii Bryson of Laurel is collecting pictures of her son for a scrapbook. One day, she hopes to impress him with the memento. However, because he hasn’t left his mother’s womb yet, it will be a while before he fully understands the significance of the album.

Mrs. Bryson, whose baby is due Oct. 3, is one of a growing number of women who have been examined with a four-dimensional (4-D) ultrasound machine. The technology, which has been highly advertised for the past year, provides a flesh-toned, three-dimensional picture of a baby moving in real time in the mother’s womb. The 4-D ultrasound machine provides a moving image of the 3-D image.

“It’s nice to be able to put the picture with the movements,” Mrs. Bryson says. “He moves around so much it’s hard to tell if it’s a foot or a hand. He’s never in the same position.”

The 4-D depictions give Mrs. Bryson and her husband, Kelvin, something to appreciate until they meet their son face to face. Among other things, the technology portrays their baby’s eye sockets, chubby cheeks and the outline of his chin. The couple feel the ultrasound images have helped them form a relationship with their son even before his birth.

“It makes me anxious to see him for real,” Mrs. Bryson says. “This gives me an idea of how he will look, but to actually see him will be better than all the photographs.”

Although the clinical benefits of the technology are still being researched, the pictures far exceed the surface detail of the traditional grainy, black-and-white, two-dimensional ultrasound images. Technically, the 4-D equipment provides a three-dimensional photograph. However, as a marketing gimmick, the fourth dimension is referred to as “time.”

It should be made clear that the new 4-D ultrasound does not replace the two-dimensional technology, says Dr. Kerry Lewis, director of the prenatal diagnostic and ultrasound center at Georgetown University Hospital in Northwest.

Two-dimensional ultrasound machines still are necessary for the proper medical evaluation of pregnant women. For instance, 2-D images give a better perception of the internal organs. However, some physicians have opted to use the 4-D technology as well in hopes that it will provide added information. Since the beginning of July, Dr. Lewis’ department has been using the new technology in addition to the old.

The department purchased a Voluson 730, marketed by GE Medical Systems. Right now, it is the only company with a four-dimensional ultrasound machine on the market. The machine also has 2-D capabilities. Competitors such as Siemens Medical Solutions and Phillips International Inc. have developed ultrasound machines that provide three-dimensional images, without real-time features.

Already, Dr. Lewis is certain the 4-D equipment helps to better describe cleft lips, cleft palates and club feet in babies in the womb. It also can highlight skin lesions. He anticipates that additional benefits of the technology will be revealed in the future. In fact, the new technology might be useful for women who aren’t pregnant when physicians are trying to characterize fibroids in the uterus.

“Its main advantage is that it gives nice pictures,” he says, “but just because there is a nice picture doesn’t mean there is a healthy baby. … We’re trying to determine whether it gives a significant clinical advantage.”

Anencephaly, a medical condition occurring when the upper section of the brain is missing, has been better understood using the new technology, says Dr. David Downing, attending physician in the department of obstetrics and gynecology at the Washington Hospital Center in Northwest.

His department is in the process of testing 3-D and 4-D ultrasound equipment and hopes to purchase a machine soon. Dr. Downing says the unknown nature of some of the machines’ capabilities doesn’t concern him. Every time a new technology is created there usually is ambiguity about its full potential, he says.

For instance, Wilhelm Rontgen, a German scientist, discovered X-rays by chance in 1895, and a year later, the machines were being installed in hospitals. It took years before the devices were understood completely, however.

“Like some things in medicine, the physical ability to perform a specific evaluation has outpaced the interpretation of the evaluation,” Dr. Downing says. “It would be great to have 3-D pictures become the standard care if you can see more detail and pick up more things than you can with a 2-D machine.”

Unfortunately, because the four-dimensional equipment is a novelty, a number of shopping malls across the country have obtained the ultrasound systems and have been charging hundreds of dollars for pictures of babies in pregnant women, says Paul Weinbaum, director of maternal and fetal medicine at Prince George’s Hospital Center in Cheverly.

His department has used a four-dimensional machine for about a year. He uses the machine strictly for medical purposes and encourages patients to steer clear of fetal photography services outside the medical community.

“A 4-D ultrasound machine, like any other medical device, is not a toy,” he says. “The examination of a fetus should be reserved for a medical indication.”

In most instances, hospitals bill the cost of an examination with the new technology the same as any regular procedure. However, some physicians have been known to charge patients large amounts of money for the service when it is not related to a medical diagnosis.

Dr. William Sweeney, director of maternal and fetal medicine at Anne Arundel Medical Center in Annapolis, finds that practice unethical. Because the two-dimensional and four-dimensional capabilities come together in the Voluson 730, he says it’s simple to flip a switch and show the patient her baby in real time.

Because the clarity of the photograph is dependent upon the position of the baby and the size of the mother, he says, the 4-D pictures sometimes are not as clear as the ones in General Electric’s commercials. Skinnier women usually produce clearer four-dimensional ultrasound photos because there is less tissue for the sound waves to penetrate. Therefore, Dr. Sweeney says, he can’t justify manipulating people for money.

“As long as the 2-D ultrasound did the job I needed to be done, I was happy to get the 4-D as well,” he says. “The couple extra minutes it takes for me to give them a 3-D photo is meaningful. You are tugging at people’s heartstrings.”

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