Abstract
Hip joint ultrasonographic (US) imaging is the golden standard for developmental dysplasia of the hip (DDH) screening. However, the effectiveness of this technique is subject to interoperator and intraobserver variability. Thus, a multi-detection deep learning artificial intelligence (AI)-based computer-aided diagnosis (CAD) system was developed and evaluated. The deep learning model used a two-stage training process to segment the four key anatomical structures and extract their respective key points. In addition, the check angle of the ilium body balancing level was set to evaluate the system’s cognitive ability. Hence, only images with visible key anatomical points and a check angle within ±5° were used in the analysis. Of the original 921 images, 320 (34.7%) were deemed appropriate for screening by both the system and human observer. Moderate agreement (80.9%) was seen in the check angles of the appropriate group (Cohen’s κ = 0.525). Similarly, there was excellent agreement in the intraclass correlation coefficient (ICC) value between the measurers of the alpha angle (ICC = 0.764) and a good agreement in beta angle (ICC = 0.743). The developed system performed similarly to experienced medical experts; thus, it could further aid the effectiveness and speed of DDH diagnosis.
Highlights
Developmental dysplasia of the hip (DDH) is a hip joint disease with various possible causes, including genetics, intrauterine factors, and cultural practices
If the diagnosis is further delayed or DDH is not diagnosed, osteoarthritis of the hip joint may occur at an early age, requiring major surgical treatment [7]
Check angle values measured within ± 5◦ by both a pediatric orthopedic surgeon and the artificial intelligence (AI) system were classified as the “appropriate image”
Summary
Developmental dysplasia of the hip (DDH) is a hip joint disease with various possible causes, including genetics, intrauterine factors, and cultural practices. DDH causes multiple spectrum disorders, such as mild capsular laxity, acetabular deficiency, subluxation, and hip dislocation. This spectrum gradually progresses in severity, with treatment becoming more difficult as the patient ages and grows. Secondary anatomical changes caused by delayed diagnosis could require surgical treatment [5,6]. If the diagnosis is further delayed or DDH is not diagnosed, osteoarthritis of the hip joint may occur at an early age, requiring major surgical treatment (e.g., hip replacement) [7]. Many countries (e.g., Germany, Israel, Korea) have conducted DDH screening tests on newborns at about six weeks of age because of the advantages of early diagnosis [8,9,10]
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