3D echocardiography (3DE) will gain increasing acceptance as a routine clinical tool as the technology evolves due to advances in technology and computer processing power. Images obtained from 3DE provide more accurate assessment of complex cardiac anatomy and sophisticated functional mechanisms compared with conventional 2D echocardiography (2DE), and are comparable to those achieved with magnetic resonance imaging. Many of the limitations associated with the early iterations of 3DE prevented their widespread clinical application. However, recent significant improvements in transducer and post-processing software technologies have addressed many of these issues. Furthermore, the most recent advances in the ability to image the entire heart in realtime and fully automated quantification have poised 3DE to become more ubiquitous in clinical routine. Realtime 3DE (RT3DE) systems offer further improvements in the diagnostic and treatment planning capabilities of cardiac ultrasound. Innovations such as the ability to acquire non-stitched, realtime, full-volume 3D images of the heart in a single heart cycle promise to overcome some of the current limitations of current RT3DE systems, which acquire images over four to seven cardiac cycles, with the need for gating and the potential for stitch artefacts.
