At Erasmus MC's Fetal Medicine outpatient clinic, parents can see their unborn child as a hologram in pictures thanks to the new I-Wall. The virtual reality wall system, 3 meters wide and 2 meters high, clearly shows every detail of the developing child. It helps health care providers determine if there are congenital defects and what this means for the child and for the parents-to-be.
Until now, health care providers assessed the unborn child primarily through 2D images. Thanks to developments in ultrasound techniques, research was conducted in recent years to improve imaging in early pregnancy. And with success because the 3D ultrasound technique with virtual reality on the big screen is now being introduced in the outpatient clinic. “A world first,” states doctor of fetal medicine, Carsten Pietersma, who hopes to receive his doctorate on the research this year. The I-Wall is the hub of the world's first outpatient center for innovative prenatal imaging.
With the I-Wall, parents and caregivers stand together in a dark room in front of a kind of cinema screen. Through 3D glasses, a giant hologram one square meter in size appears in the room. In reality, the unborn child is only 6.6 centimeters tall. Unlike during an ultrasound, the baby lies still on the screen because it is a recording of the earlier ultrasound. “Thus, the baby's movements do not hinder the study of the images in the I-Wall,” says doctor of fetal medicine and PhD student Kristel Zandbergen.
Growth differences
The hologram of the unborn child can be rotated and viewed via the computer's joystick. Organs can be scrolled through for detection of any congenital abnormalities. Possible growth differences come into clear view. A volume measurement of the bladder can also be taken. “I take these measurements after the ultrasound is done. That way I can take time to view the images calmly without it being a burden on the pregnant woman,” Zandbergen adds.
The position of a foot or an extra finger can usually be seen better in 3D than with 2D images. An abnormality does not always have to be serious but it does mean an alarm bell for doctors to look further. Doctors ask themselves each time: what can we expect? With multiple abnormalities, a genetic disorder more often plays a role, the doctors know. For example, gynecologist Melek Rousian explains that not all congenital anomalies are equally serious. You can live to be 100 with an extra finger, of course. And an opening in the abdominal wall can be surgically closed. But there are also abnormalities that will make the quality of life a lot less. “The severity of the abnormality, whether caused by a genetic disorder or not, generally determines the child's prognosis,” says Rousian.
Looking early in pregnancy allows parents to know what is going on in a timely manner, prepare and make informed choices. Congenital defects involve many emotions. “Guilt, questions and doubt. We hope that with the images we can better support parents in this,” says gynecologist Annemarie Mulders. If it turns out that a child cannot live independently outside its mother's womb, the parents decide whether to continue the pregnancy.
I-Wall
The I-Wall at the Fetal Medicine outpatient clinic is the result of years of research at Erasmus MC. In 2005, researchers used the I-Space. That was a room with 3D technology on three walls and floor. Bioinformatician Anton Koning of Erasmus MC then developed the V-Scope application specifically to better analyze 3D scans, such as ultrasounds. This VR technique has been in miniature use on a 3D TV at the Obstetrics and Fetal Medicine outpatient clinic since 2012. Research cohort Generation R is also using an I-Wall.
When it comes to home monitoring of the unborn child, the introduction of the so-called NemoRemote at Bravis Hospital is a godsend. Pregnant women undergoing treatment at the Bravis can monitor their unborn baby at home. With the NemoRemote, for example, a cardiotocogram (CTG) can be made at home.
