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



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.


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.


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.


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

Abbreviations and Acronyms


Two-dimensional ultrasound


2D Alpha Angle


Three-dimensional ultrasound


American College of Radiology


Developmental dysplasia of the hip


Intraclass correlation coefficients


Point-of-care ultrasound



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


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.


• Retrospective

• Cross-sectional study

• Performed at one institution


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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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