Reliability of 2D and 3D ultrasound for infant hip dysplasia in the hands of novice users
- 121 Downloads
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.
• 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.
KeywordsDiagnostic imaging Hip dislocation, congenital Observer variation Reproducibility of results Ultrasonography
Abbreviations and Acronyms
2D Alpha Angle
American College of Radiology
Developmental dysplasia of the hip
Intraclass correlation coefficients
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Cross-sectional study
• Performed at one institution
- 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
- 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
- 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.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
- 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.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.Buerger AM, Clark KR (2017) Point-of-Care Ultrasound: A Trend in Health Care. Radiol Technol 89(2):127–138Google Scholar