title: Feasibility of performing a virtual patient examination using three-dimensional ultrasonographic data acquired at remote locations.
abstract: OBJECTIVE
  To evaluate the feasibility of performing three-dimensional ultrasonographic studies that meet American Institute of Ultrasound in Medicine and American College of Radiology ultrasonographic examination guidelines with review off-line and at remote locations.
  
  
  METHODS
  One hundred patients were studied at 2 institutions using high-end two-dimensional clinical ultrasonographic scanners and commercially available three-dimensional ultrasonography for a variety of organ systems (first- and second-trimester fetus, abdomen, and female pelvis). We evaluated several parameters, including measurements, completeness of organ visualization, abnormalities identified, image quality, number of volumes required, and discrepancies between interpretations.
  
  
  RESULTS
  Overall, three-dimensional ultrasonography could produce diagnostic-quality results comparable with those of two-dimensional ultrasonography. Three-dimensional ultrasonographic image quality was lower than that of two-dimensional ultrasonography. Two- and three-dimensional ultrasonographic measurements were comparable (<5% difference), as was the extent of organ visualization, although some structures were challenging for both two- and three-dimensional ultrasonography. In general, organs completely imaged in the scanner field of view required 1 to 1.5 volumes, whereas larger organs required between 3 and 6 volumes. Differences among reviewers' interpretations highlighted the need for standardization of acquisition and reviewing protocols for sonographers and physicians.
  
  
  CONCLUSIONS
  Our results show that it is clinically feasible to acquire three-dimensional ultrasonographic data at one site and to obtain accurate interpretation by off-line review at another within the context of providing high-quality clinical diagnostic studies.
authors.affiliation: Department of Radiology, University of California, San Diego, La Jolla 92014, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Nelson
authors.forename: D H
authors.initials: DH
authors.lastname: Pretorius
authors.forename: A
authors.initials: A
authors.lastname: Lev-Toaff
authors.forename: G
authors.initials: G
authors.lastname: Bega
authors.forename: N E
authors.initials: NE
authors.lastname: Budorick
authors.forename: K A
authors.initials: KA
authors.lastname: Hollenbach
authors.forename: L
authors.initials: L
authors.lastname: Needleman
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D020407:Internet; D008297:Male; D015588:Observer Variation; D010388:Pelvis / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D019114:Remote Consultation; D016216:Ultrasonography, Prenatal / Q000379:methods*