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This review is about the development of three-dimensional (3D) ultrasonic medical imaging, how it works, and where its future lies. It assumes knowledge of two-dimensional (2D) ultrasound, which is covered elsewhere in this issue. The three main ways in which 3D ultrasound may be acquired are described: the mechanically swept 3D probe, the 2D transducer array that can acquire intrinsically 3D data, and the freehand 3D ultrasound. This provides an appreciation of the constraints implicit in each of these approaches together with their strengths and weaknesses. Then some of the techniques that are used for processing the 3D data and the way this can lead to information of clinical value are discussed. A table is provided to show the range of clinical applications reported in the literature. Finally, the discussion relating to the technology and its clinical applications to explain why 3D ultrasound has been relatively slow to be adopted in routine clinics is drawn together and the issues that will govern its development in the future explored.

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Displacement estimation is a key step in the evaluation of tissue elasticity by quasistatic strain imaging. An efficient approach may incorporate a tracking strategy whereby each estimate is initially obtained from its neighbours’ displacements and then refined through a localized search. This increases the accuracy and reduces the computational expense compared with exhaustive search. However, simple tracking strategies fail when the target displacement map exhibits complex structure. For example, there may be discontinuities and regions of indeterminate displacement caused by decorrelation between the pre- and post-deformation radio frequency (RF) echo signals. This paper introduces a novel displacement tracking algorithm, with a search strategy guided by a data quality indicator. Comparisons with existing methods show that the proposed algorithm is more robust when the displacement distribution is challenging.