A 28-mm crown-rump length embryo.

Abstract

UOG likes artistic or eye-catching cover images, usually of novel techniques or highly characteristic or surprising findings. Many diagnostic ultrasound images have artistic qualities and, in the quest for the ‘best’ diagnostic image, esthetics are always considered. This is also particularly true for teaching ultrasound imaging. The ultrasound image presented here (Figure 1) is a (fun) by-product of a larger diagnostic and educational project involving volume ultrasound data from early pregnancies. The figure shows a diagnostic image of an embryo, presented in a different but familiar style. It is not ‘l'art pour l'art’, but alerts ultrasound users to relevant details and may aid in the development of diagnostic skills. Andy Warhol's iconic colorful images, produced in the 1960s using the silkscreen technique, are known universally and are instantly recognizable. They are a major contribution to what is referred to as Pop Art, which uses images of popular, as opposed to elitist, culture, often employing irony, and applies reproduction and rendering techniques1. Warhol's art generates the same effect on its viewers as does an abstract expressionistic painting; the latter uses line and color to evoke feelings whereas the former creates the same effect by manipulating photographic reality2. Today, three-dimensional (3D) imaging and rendering has been fully integrated into diagnostic ultrasound in obstetrics and gynecology. In a sense, prenatal 3D surface rendering has also become a ‘popular art’. On the one hand, it improves parental bonding and provides parents with a more realistic perception of their unborn child3, 4, and on the other hand, 3D rendering is a popular technique to present interesting or surprising findings, especially in obstetric journals. On the cover of UOG over the last 24 months, for example, 3D imaging has been the dominant and colorful form of imagery. Cross-sectional and purely grayscale imaging might have provided the same clinical information in most cases, however, the use of 3D, and with the addition of color, enhances both recognition and esthetic appeal. Figure 1, showing 3D surface rendering of a normal 28-mm crown–rump length embryo, was prepared by digitally reducing the number of colors in the image, from thousands, present in the initial image, to only a handful, for each reproduction. The different colorizations of an otherwise identical object emphasize the easily recognizable anatomical shape of the embryo. Repetition maximizes the viewer's attention. When presented with this abstracted image, an experienced sonoembryologist can estimate precisely gestational age and developmental stage. Reduction, abstraction and repetition contribute to pattern recognition and are important in diagnostic ultrasound. The proper selection of a region of interest, the optimization of an image and skillful repetition (i.e. being able to obtain certain diagnostic views time after time) are key elements of successful diagnostic work.