Our offices are equipped with the most advanced ultrasound machines that deliver 2D, 3D, and 4D sonography. The standard of care in the evaluation of the fetus, placenta, umbilical cord and the uterus/ovaries during pregnancy is 2D sonography, i.e. single planar evaluation either in the X-, Y-, or Z-axis, and any of the oblique axes. 2D sonography in experienced hands allows for the detection of the large majority of abnormalities seen during pregnancy.

3D and 4 D ultrasound are performed by a specially designed ultrasound probe. The probe takes a volume sweep, of any fetal or maternal structure, which basically is comprised of many parallel planes (2D) of that structure. The ultrasound machine then allows the operator to evaluate the complete volume of data in each of the X-, Y-, and Z-axis, as well as all oblique axes. The ultrasound machine also has software that permits evaluation of the 3D and 4D acquired volumes in a variety of modalities: surface (e.g. fetal face image), skeletal (e.g. fetal vertebral discs), and other tissues (e.g. fetal brain or heart), among many other modalities. The ultrasound machines also permit the use of a variety of background colors, from skin tone to rainbow (in other words, the color you see is not actually real)!

3D ultrasound allows for an improvement in imaging, when used in conjunction with 2D, of several key fetal structures such as the fetal hard palate (roof of the mouth), fetal ribs and vertebrae, fetal skin masses (skin tags), fetal face (front and profile views) and fetal brain (especially cerebellar vermis). Furthermore, the acquired volume of planes remains accessible to the operator, and to other consultant as needed, indefinitely for comparison with future imaging studies of the fetus or newborn.

4D imaging is real time 3D, i.e. acquired volumes over several seconds, thus time is the fourth dimension. This modality of sonography is also helpful in conjunction with 2D for evaluation of several fetal organs, such as the fetal heart (including the valves) and fetal movements.

To perform 3D and 4D ultrasound during pregnancy, in conjunction with the 2D standard of care, requires additional time and effort from the ultrasound technologists and physicians acquiring and interpreting the information. This additional acquisition time (along with its consequent risk to the operator of more injury to the right arm and shoulder) and interpretation time, as well as the additional expense of the ultrasound machines equipped for 3D and 4D imaging, and the expensive ultrasound probes designed for such imaging (on average $10,000, ten thousand dollars) are the reasons why our office currently applies a nominal surcharge of $50.00 (fifty dollars) at each of the visits during pregnancy when the fetus is being evaluated in maximal detail (usually once in each pregnancy trimester: 11-13 weeks, 16-22 week and 28-34 weeks). When insurance companies used to cover 3D and 4D ultrasound billing codes, the insurance reimbursement from those codes averaged $150.00 (One hundred and fifty dollars), i.e. is in addition to the other billing codes used for 2D imaging, and for color and Doppler flow. However, over the past recent years, most insurance carriers have declined covering 3D or 4D ultrasound imaging during pregnancy, deeming the procedure experimental, even though the medical literature shows otherwise.
We believe that the use of 3D and 4D ultrasound in conjunction with 2D is helpful in maintaining a high rate of prenatal diagnosis of fetal congenital abnormalities (birth defects). Since insurance carriers disagree, our office’s policy therefore is for you, the patient, to determine whether you wish to incur this additional expense for having 3D and 4D imaging in conjunction with 2D sonography.

Please be advised that our current office policy is that all patients who present for 2D sonography during pregnancy will receive a courtesy 3D fetal face image (a picture of the fetal face in color), if the fetal position permits during the allotted time for the 2D ultrasound. Please understand that 3D and 4D ultrasounds as applied in the evaluation of fetal structure, as explained above, has nothing to do with giving you such a courtesy 3D picture (in color) of your fetus.

Also, please be advised that the courtesy fetal face or fetal body pictures are not always what you or your family expects: in the first and second trimesters, the fetus appears “alien” which at times distresses the family; and in the third trimester, the fetus, during the ultrasound allotted time, may be curled up and facing the patient’s back, or will have hands, feet or placenta in front of the face, thus completing limiting any type of quality picture, if any, of the fetus.

If you, the patient, wish to have medical 3D and 4D imaging, as described above, in conjunction with 2D ultrasound, and you agree to incur the surcharge noted above, the operator performing the ultrasound will make every effort to obtain images of the fetal hard palate, as well as the fetal face and profile, fetal vertebrae and ribs, fetal brain, etc. during your visits for detailed evaluation of the fetal structures. Should the fetal position not allow for such assessment, you will be asked to return to our office at no further expense to you or to your insurance carrier, within 10 days of that visit, to have another attempt at completing the assessment. Please note that if the operator is unable to complete all the 3D or 4D imaging due to fetal position after one, or two attempts should you opt to return at no further expense, the primary surcharge of $50.00 (fifty dollars), not covered by insurance, will be applied to your bill.

If you have any questions regarding our office’s 3D and 4D ultrasound policies, please do not hesitate to ask any of our ultrasound operators or physicians. Please be advised that our front office staff, receptionists and billers, as well as our back office staff, ultrasound technologists and medical assistants, are following instructions from the administrator physician(s), so we firmly request that all patients and family members treat our staff with the utmost respect and not challenge them regarding our policies. Our staff as well is required and expected to treat all patients and their families with the utmost respect and to provide you with the aforementioned policy. Should any of our staff treat you with disrespect, or should you have any questions regarding our policies, please advise our office manager Anu Jairam (Anu@hiriskob.com), or our current physician administrator Waleed Doany, M.D. (drdoany@hiriskob.com).