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European Radiology

, Volume 29, Issue 3, pp 1489–1495 | Cite as

Reliability of 2D and 3D ultrasound for infant hip dysplasia in the hands of novice users

  • Emanuel Mostofi
  • Baljot Chahal
  • Dornoosh Zonoobi
  • Abhilash Hareendranathan
  • Koosha P. Roshandeh
  • Sukhdeep K. Dulai
  • Jacob L. JaremkoEmail author
Ultrasound
  • 121 Downloads

Abstract

Purpose

Developmental dysplasia of the hip (DDH) diagnosis by two-dimensional ultrasound (2DUS) can have poor inter-rater reliability. 3D ultrasound (3DUS) may be more reliably performed, particularly by novice users. We compared intra- and inter-rater reliability between expert and novice operators performing 2DUS and 3DUS for DDH.

Materials and methods

Infants with suspected DDH were assessed with 2DUS and 3DUS. Novice operators had 1.5 h of training and Experts had 5–15 years’ experience. Images included two 2DUS static and two 3DUS sweep images per operator. Image quality was assessed by 5-point system (yes/no: full femoral head; full acetabular roof; horizontal iliac wing; os ischium; absent motion/artifact). 2DUS indices (alpha angle, coverage) were measured centrally by a blinded reader with 2 years DDH US experience. 3DUS was post-processed by semi-automated custom software generating acetabular surface models, indices and estimated probability of DDH. Gold-standard diagnosis of each hip as normal, borderline or dysplastic was based on radiologist review of expert 2DUS.

Results

Thirty infants, mean age 10.8 weeks were enrolled. Quality scores were 2.7±1.2 Novice versus 4.9±0.3 Expert for 2DUS (p = 0.04), and 4.2±1.0 Novice versus 4.9±0.3 Expert for 3DUS (p = 0.99). Inter-rater reliability was poor for 2DUS (ICC=0.10 for alpha angle, 0.04 for acetabular coverage) and moderate to high for 3DUS (ICC=0.73-0.83 for alpha angle, 0.55 for acetabular coverage). Intra-rater reliability and diagnostic accuracy was higher for 3DUS than 2DUS.

Conclusion

Novice operators can perform 3DUS for DDH with reliability and accuracy approaching expert sonographers. Novices perform 2DUS with poor reliability and accuracy.

Key Points

• Novice/expert inter-rater reliability improved from poor with 2DUS to moderate/high with 3DUS.

• Novice operators using 3DUS correctly classified 57/58 (98%) of infant hips.

• DDH can be reliably assessed by novice operators using 3DUS.

Keywords

Diagnostic imaging Hip dislocation, congenital Observer variation Reproducibility of results Ultrasonography 

Abbreviations and Acronyms

2DUS

Two-dimensional ultrasound

2Dα

2D Alpha Angle

3DUS

Three-dimensional ultrasound

ACR

American College of Radiology

DDH

Developmental dysplasia of the hip

ICC

Intraclass correlation coefficients

POCUS

Point-of-care ultrasound

Notes

Funding

This study has received funding by: Capital Health Endowed Chair in Diagnostic Imaging; CIHR-IHDCYH New Investigator Research Grant; RSNA Research Seed Grant; AI-HS Postdoctoral Fellowship Award; CMA Joule Innovation Grant. Dr. Jaremko is supported by Medical Imaging Consultants. Mr. Mostofi was partly supported by the M.E. Ledingham Memorial Award.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Jacob Jaremko, M.D., Ph.D, FRCPC.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

References

  1. 1.
    Shorter D, Hong T, Osborn DA (2013) Cochrane review: screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 8:11–54.  https://doi.org/10.1002/ebch.1891 CrossRefGoogle Scholar
  2. 2.
    Ömeroğlu H, Köse N, Akceylan A (2015) Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip. Clin Orthop Relat Res 474(5):1146–1152.  https://doi.org/10.1007/s11999-015-4388-5 CrossRefGoogle Scholar
  3. 3.
    Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI (2001) Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the norwegian arthroplasty register 1987-99. J Bone Joint Surg Br 83(4):579–586.  https://doi.org/10.1302/0301-620x.83b4.0830579 CrossRefGoogle Scholar
  4. 4.
    Paton RW (2017) Screening in Developmental Dysplasia of the Hip (DDH). Surgeon 15(5):290–296.  https://doi.org/10.1016/j.surge.2017.05.002 CrossRefGoogle Scholar
  5. 5.
    Pollet V, Percy V, Prior HJ (2017) Relative Risk and Incidence for Developmental Dysplasia of the Hip. J Pediatr 181:202–207.  https://doi.org/10.1016/j.jpeds.2016.10.017 CrossRefGoogle Scholar
  6. 6.
    Mostert AK, Tulp NJ, Castelein RM (2000) Results of pavlik harness treatment for neonatal hip dislocation as related to graf's sonographic classification. J Pediatr Orthop 20(3):306–310.  https://doi.org/10.1097/01241398-200005000-00007 Google Scholar
  7. 7.
    Orak M, Onay T, Çağırmaz T, Elibol C, Elibol F, Centel T (2015) The reliability of ultrasonography in developmental dysplasia of the hip: How reliable is it in different hands? Indian J Orthop 49(6):610.  https://doi.org/10.4103/0019-5413.168753 CrossRefGoogle Scholar
  8. 8.
    Jaremko JL, Mabee M, Swami VG, Jamieson L, Chow K, Thompson RB (2014) Potential for Change in US Diagnosis of Hip Dysplasia Solely Caused by Changes in Probe Orientation: Patterns of Alpha-angle Variation Revealed by Using Three-dimensional US. Radiology 273(3):870–878.  https://doi.org/10.1148/radiol.14140451 CrossRefGoogle Scholar
  9. 9.
    Hünerbein M, Raschke M, Khodadadyan C, Hohenberger P, Haas NP, Schlag PM (2001) Three-dimensional ultrasonography of bone and soft tissue lesions. Eur J Ultrasound 13(1):17–23.  https://doi.org/10.1016/s0929-8266(01)00117-3 CrossRefGoogle Scholar
  10. 10.
    American Institute of Ultrasound in Medicine (2013) AIUM practice guideline for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip. J Ultrasound Med 32(7), 1307–1317.  https://doi.org/10.7863/ultra.32.7.1307
  11. 11.
    Zonoobi D, Hareendranathan A, Mostofi E et al (2018). Developmental Hip Dysplasia Diagnosis at Three-dimensional US: A Multicenter Study. Radiology 287(3):1003–1015.  https://doi.org/10.1148/radiol.2018172592
  12. 12.
    Noordin S, Umer M, Hafeez K, Nawaz H (2010) Developmental dysplasia of the hip. Orthop Rev (Pavia) 2(2):e19.  https://doi.org/10.4081/or.2010.e19 CrossRefGoogle Scholar
  13. 13.
    Mahan ST, Katz JN, Kim YJ (2009) To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip. J Bone Joint Surg Am 91(7):1705–1719.  https://doi.org/10.2106/JBJS.H.00122 CrossRefGoogle Scholar
  14. 14.
    Patel H, Canadian Task Force on Preventive Health Care (2001) Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ 164(12):1669–1677Google Scholar
  15. 15.
    Shipman SA, Helfand M, Moyer VA, Yawn BP (2006) Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force. Pediatrics, 117(3).  https://doi.org/10.1542/peds.2005-1597
  16. 16.
    Buerger AM, Clark KR (2017) Point-of-Care Ultrasound: A Trend in Health Care. Radiol Technol 89(2):127–138Google Scholar
  17. 17.
    Waterbrook AL, Adhikari S, Stolz U, Adrion C (2013) The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med 31(9):1352–1356.  https://doi.org/10.1016/j.ajem.2013.06.006 CrossRefGoogle Scholar
  18. 18.
    Sippel S, Muruganandan K, Levine A, Shah S (2011) Review article: Use of ultrasound in the developing world. Int J Emerg Med 4:72.  https://doi.org/10.1186/1865-1380-4-72 CrossRefGoogle Scholar
  19. 19.
    Papali A (2015) Providing health care in rural and remote areas: Lessons from the international space station. Bull World Health Organ 94(1):73–74.  https://doi.org/10.2471/blt.15.162628 CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Emanuel Mostofi
    • 1
  • Baljot Chahal
    • 1
  • Dornoosh Zonoobi
    • 1
  • Abhilash Hareendranathan
    • 1
  • Koosha P. Roshandeh
    • 1
  • Sukhdeep K. Dulai
    • 1
  • Jacob L. Jaremko
    • 1
    Email author
  1. 1.Department of Radiology and Diagnostic Imaging, 2A2.41 WC Mackenzie Health Sciences CentreUniversity of AlbertaEdmontonCanada

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