Automated Dynamic 3D Ultrasound Assessment of Developmental Dysplasia of the Infant Hip

  • Olivia Paserin
  • Kishore Mulpuri
  • Anthony Cooper
  • Antony J. Hodgson
  • Rafeef Garbi
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 11404)


Dynamic two-dimensional sonography of the infant hip is a commonly used procedure for developmental dysplasia of the hip (DDH) screening by many clinicians. It however has been found to be unreliable with some studies reporting associated misdiagnosis rates of up to \(29\%\). Aiming to improve reliability of diagnosis and to help in standardizing diagnosis across different raters and health-centers, we present a preliminary automated method for assessing hip instability using three-dimensional (3D) dynamic ultrasound (US). To quantify hip assessment, we propose the use of femoral head coverage variability (\(\varDelta FHC_{3D}\)) within US volumes collected during a dynamic scan which uses phase symmetry features to approximate the vertical cortex of the ilium and a random forest classifier to identify the approximate location of the femoral head. We measure the change in \(FHC_{3D}\) across US scans of the hip acquired under posterior stress vs. rest as maneuvered during a 3D dynamic assessment. Our findings on 38 hips from 19 infants scanned by one orthopedic surgeon and two radiology technicians suggests the proposed \(\varDelta FHC_{3D}\) may provide a good degree of repeatability with an average test-retest intraclass correlation measure of 0.70 (\(95\%\) confidence interval: 0.35 to 0.87, \(F(21,21)\,{=}\,7.738\), \(p\,{<}\,0.001\)). This suggests that our 3D dynamic dysplasia metric may prove valuable in improving reliability in diagnosing hip laxity due to DDH, which may lead to a more standardized DDH assessment with better diagnostic accuracy. The long-term significance of this approach to evaluating dynamic assessments may lie in increasing early diagnostic sensitivity in order to prevent dysplasia remaining undetected prior to manifesting itself in early adulthood joint disease.


Pediatric Ultrasound Hip Bone imaging Developmental dysplasia of the hip DDH Dynamic assessment Repeatability 



We gratefully acknowledge the support of NVIDIA Corporation with the donation of the Titan X GPU used for this research.


  1. 1.
    Bracken, J., Ditchfield, M.: Ultrasonography in developmental dysplasia of the hip: what have we learned? Pediatr. Radiol. 42(12), 1418–1431 (2012). Scholar
  2. 2.
    Imrie, M., Scott, V., Stearns, P., Bastrom, T., Mubarak, S.: Is ultrasound screening for DDH in babies born breech sufficient? J. Child. Orthop. 4(1), 3–8 (2010). Scholar
  3. 3.
    Harcke, H., Grissom, L.: Performing dynamic sonography of the infant hip. AJR Am. J. Roentgenol. 155(4), 837–844 (1990). Scholar
  4. 4.
    Gomes, H., Ouedraogo, T., Avisse, C., Lallemand, A., Bakhache, P.: Neonatal hip: from anatomy to cost-effective sonography. Eur. Radiol. 8(6), 1030–1039 (1998). Scholar
  5. 5.
    Graf, R.: New possibilities for the diagnosis of congenital hip joint dislocation by ultrasonography. J. Pediatr. Orthop. 3(3), 354–359 (1983)CrossRefGoogle Scholar
  6. 6.
    Alamdaran, S., Kazemi, S., Parsa, A., Moghadam, M., Feyzi, A., Mardani, R.: Assessment of diagnostic value of single view dynamic technique in diagnosis of developmental dysplasia of hip: a comparison with static and dynamic ultrasound techniques. Arch. Bone Joint Surg. 4(4), 371–375 (2016)Google Scholar
  7. 7.
    Koşar, P., Ergun, E., Unlübay, D., Koşar, U.: Comparison of morphologic and dynamic US methods in examination of the newborn hip. Diagn. Interv. Radiol. 15(4), 284–289 (2009). Scholar
  8. 8.
    Charlton, S., Schoo, A., Walters, L.: Early dynamic ultrasound for neonatal hip instability: implications for rural Australia. BMC Pediatr. 17, 82 (2017). Scholar
  9. 9.
    Quader, N., Hodgson, A., Mulpuri, K., Cooper, A., Abugharbieh, R.: Towards reliable automatic characterization of neonatal hip dysplasia from 3D ultrasound images. In: Ourselin, S., Joskowicz, L., Sabuncu, M.R., Unal, G., Wells, W. (eds.) MICCAI 2016. LNCS, vol. 9900, pp. 602–609. Springer, Cham (2016). Scholar
  10. 10.
    Jaremko, J., Mabee, M., Swami, V., Jamieson, L., Chow, K., Thompson, R.: 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 (2014). Scholar
  11. 11.
    Quader, N., Hodgson, A.J., Mulpuri, K., Cooper, A., Abugharbieh, R.: A 3D femoral head coverage metric for enhanced reliability in diagnosing hip dysplasia. In: Descoteaux, M., Maier-Hein, L., Franz, A., Jannin, P., Collins, D.L., Duchesne, S. (eds.) MICCAI 2017. LNCS, vol. 10433, pp. 100–107. Springer, Cham (2017). Scholar
  12. 12.
    Paserin, O., Mulpuri, K., Cooper, A., Abugharbieh, R., Hodgson, A.: Improving 3D ultrasound scan adequacy classification using a three-slice convolutional neural network architecture. In: Zhan, W., Rodriguez Y Baena, F. (eds.) Proceedings of Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery - CAOS 2018, EPiC Series in Health Sciences, vol. 2, pp. 152–156 (2018).
  13. 13.
    Paserin, O., Mulpuri, K., Cooper, A., Hodgson, A.J., Garbi, R.: Real time RNN based 3D ultrasound scan adequacy for developmental dysplasia of the hip. In: Frangi, A.F., Schnabel, J.A., Davatzikos, C., Alberola-López, C., Fichtinger, G. (eds.) MICCAI 2018. LNCS, vol. 11070, pp. 365–373. Springer, Cham (2018). Scholar
  14. 14.
    Quader, N., Hodgson, A., Abugharbieh, R.: Confidence weighted local phase features for robust bone surface segmentation in ultrasound. In: Linguraru, M.G., et al. (eds.) CLIP 2014. LNCS, vol. 8680, pp. 76–83. Springer, Cham (2014). Scholar
  15. 15.
    Torr, P., Zisserman, A.: MLESAC: a new robust estimator with application to estimating image geometry. Comput. Vis. Image Underst. 78(1), 138–156 (2000). Scholar
  16. 16.
    McGraw, K., Wong, S.: Forming inferences about some intraclass correlation coefficients. Psychol. Methods 1(1), 30–46 (1996). Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Olivia Paserin
    • 1
  • Kishore Mulpuri
    • 2
  • Anthony Cooper
    • 2
  • Antony J. Hodgson
    • 3
  • Rafeef Garbi
    • 1
  1. 1.Department of Electrical and Computer EngineeringUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Orthopaedic SurgeryBritish Columbia Children’s HospitalVancouverCanada
  3. 3.Department of Mechanical EngineeringUniversity of British ColumbiaVancouverCanada

Personalised recommendations