Feasibility study: Detection of developmental dysplasia of the hip using ultrasound performed by a novice user

Abstract

Developmental hip dysplasia (DDH) affects 1 %–4 % of infants globally, and ultrasound is the standard method to diagnose using Graf's method. However, ultrasound is not commonly used in primary care tool due to the required extensive training. Instead, physicians rely on physical examinations and risk stratification, resulting in a significant number of infants without DDH being referred. This study aimed to investigate if a novice user could be trained within 1 h to use an AI-assisted handheld ultrasound device to diagnose DDH.

The novice user conducted hip ultrasounds on 31 infants at the Radboud UMC. Trained radiologists performed ultrasounds on the same infants, serving as the ground truth. The ultrasound acquisitions by the novice user were evaluated by a pediatric radiologist to determine if they adhered to the standard plane of Graf. When deemed sufficient, the pediatric radiologist assessed if DDH could be excluded, and subsequently, it was compared to the ground truth diagnosis.

The ground truth identified 28 infants as no DDH, of which 23 (82 %) had AI-assisted ultrasounds in line with the standard plane of Graf, so DDH could be excluded. Additionally, all three infants with DDH (100 %) were correctly identified by the AI-assisted ultrasounds as ‘not excluding DDH’. This study demonstrates that it is possible for a novice user to acquire ultrasound images that satisfy the Graf criteria in 82 % of infants with 1 h of training. Such an approach could reduce the barrier of introducing ultrasound in the first-line of care and decrease the number of referred infants without DDH.