title: Using virtual reality for evaluation of fetal ambiguous genitalia.
abstract: OBJECTIVE
  The utility of a virtual reality system was examined in the visualization of three-dimensional (3D) ultrasound images of fetal ambiguous genitalia.
  
  
  METHODS
  In 2005, fetal ambiguous genitalia were diagnosed in four patients referred to our department for prenatal ultrasound assessment. The patients were examined by two-dimensional (2D) and 3D ultrasound and, subsequently, the volumes obtained on 3D ultrasound were visualized in the BARCO I-Space virtual reality system. This system projects stereoscopic images on three walls and the floor of a small 'room', allowing several viewers to see a 3D 'hologram' of the data being visualized. The results of 2D and 3D ultrasound examination and the virtual reality images of the I-Space were compared with diagnoses made postpartum.
  
  
  RESULTS
  In all cases, prenatal diagnosis was unclear based on 2D ultrasound alone. Surface rendering of 3D data provided an impression of ambiguity, but diagnosis based on these data proved incorrect at birth in three cases. Conclusions based on the evaluation of 3D volumes in virtual reality best fitted the postpartum diagnosis in all cases.
  
  
  CONCLUSIONS
  This study suggests that by evaluation of the genitals in the I-Space, a better impression of genital ambiguity can be established. Binocular depth perception appeared particularly useful in distinguishing either a micropenis or enlarged clitoris from labia minora, since it helps in the estimation of size and position. Therefore, we see potential for the application of virtual reality not only for the evaluation of fetal ambiguous genitalia, but in all those cases where depth perception would improve the visualization of anatomical structures.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, University Medical Center, Rotterdam, The Netherlands. c.verwoerd@erasmusmc.nl
authors.forename: C M
authors.initials: CM
authors.lastname: Verwoerd-Dikkeboom
authors.forename: A H J
authors.initials: AH
authors.lastname: Koning
authors.forename: I A L
authors.initials: IA
authors.lastname: Groenenberg
authors.forename: B J
authors.initials: BJ
authors.lastname: Smit
authors.forename: C
authors.initials: C
authors.lastname: Brezinka
authors.forename: P J
authors.initials: PJ
authors.lastname: Van Der Spek
authors.forename: E A P
authors.initials: EA
authors.lastname: Steegers
mesh_terms: D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005835:Genitalia / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006696:Holography / Q000379:methods; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014584:User-Computer Interface; D055815:Young Adult