Early Diagnosis Of Developmental Dysplasia Research Articles

Breaking barriers: A Pediatrician's perspective on enhancing early diagnosis of developmental dysplasia of the hip

Breaking barriers: A Pediatrician's perspective on enhancing early diagnosis of developmental dysplasia of the hip

The reality of sonography of the infant hip in Brazil: results and recommendations

Since 1980, when Professor Reinhard Graf developed a novel technique, sonography of the infant hip has played a prominent role in the early diagnosis of developmental dysplasia of the hip (DDH). Brazil is a vast country, and disparities exist among regions and between the public and private health systems. In addition, healthcare professionals often have limited knowledge of DDH, and patients need to be referred to larger urban centers for definitive diagnosis and appropriate treatment. These reasons, and more, may hinder the early diagnosis of DDH. Following the successful implementation of similar neonatal screening programs for other conditions in Brazil, developing a screening program for DDH in Brazil is imperative. Such a program should consider training professionals to use Graf’s technique as a diagnostic procedure. It is recommended that more studies be conducted in every region of the country to provide a broader understanding of the current role of sonography in the screening and diagnosis of DDH in infants in Brazil.

The Diagnosis of Developmental Dysplasia of the Hip From Hip Ultrasonography Images With Deep Learning Methods.

Hip ultrasonography is very important in the early diagnosis of developmental dysplasia of the hip. The application of deep learning-based medical image analysis to computer-aided diagnosis has the potential to provide decision-making support to clinicians and improve the accuracy and efficiency of various diagnostic and treatment processes. This has encouraged new research and development efforts in computer-aided diagnosis. The aim of this study was to evaluate hip sonograms using computer-assisted deep-learning methods. The study included 376 sonograms evaluated as normal according to the Graf method, 541 images with dysplasia and 365 images with incorrect probe position. To classify the developmental hip dysplasia ultrasound images, transfer learning was applied with pretrained VGG-16, ResNet-101, MobileNetV2 and GoogLeNet networks. The performances of the networks were evaluated with the performance parameters of accuracy, sensitivity, specificity, precision, F1 score, and AUC (area under the ROC curve). The accuracy, sensitivity, specificity, precision, F1 score, and AUC results obtained by testing the VGG-16, ResNet-101, MobileNetV2, and GoogLeNet models showed performance >80%. With the pretrained VGG-19 model, 93%, 93.5%, 96.7%, 92.3%, 92.6%, and 0.99 accuracy, sensitivity, specificity, precision, F1 score, and AUC results were obtained, respectively. In this study, in addition to the ultrasonography images of dysplastic and healthy hips, images were also included of probe malpositioning, and these images were able to be successfully evaluated with deep learning methods. On the sonograms, which provided criteria appropriate for evaluation, successful differentiation could be made of healthy hips and dysplastic hips. Level-IV; diagnostic studies.

Domain-aware contrastive learning for ultrasound hip image analysis

Early diagnosis of Developmental Dysplasia of Hip (DDH) using ultrasound can result in simpler and more effective treatment options. Handheld ultrasound probes are ideally suited for such screening due to their low cost and portability. However, images from the pocket-sized probes are of lower quality than conventional probes. Image quality can be enhanced by image translation techniques that generate a pseudo-image mimicking the image quality of conventional probes. This can also help in generalizing the performance of AI-based automatic interpretation techniques to multiple probes. We develop a new domain-aware contrastive unpaired translation (D-CUT) technique for translating between images acquired from different ultrasound probes. Our approach embeds a Bone Probability Map (BPM) as part of the loss function which enforces higher structural similarity around bony regions in the image. Using the D-CUT model we translated 575 images acquired from a Philips Lumify handheld probe to generate pseudo-3D ultrasound (3DUS) images similar (Fréchet Inception Distance = 92) to those acquired from a conventional ultrasound probe (Philips iU22). The pseudo-3DUS images showed high structural similarity (SSIM = 0.68, Cosine Similarity = 0.65) with the original images and improved the contrast around the bony regions. This study establishes the feasibility of using D-CUT to improve the quality of data acquired from handheld ultrasound probes. Among other potential applications, clinical use of this tool could result in wider use of ultrasound for DDH screening programs.

Joint Landmark and Structure Learning for Automatic Evaluation of Developmental Dysplasia of the Hip.

The ultrasound (US) screening of the infant hip is vital for the early diagnosis of developmental dysplasia of the hip (DDH). The US diagnosis of DDH refers to measuring alpha and beta angles that quantify hip joint development. These two angles are calculated from key anatomical landmarks and structures of the hip. However, this measurement process is not trivial for sonographers and usually requires a thorough understanding of complex anatomical structures. In this study, we propose a multi-task framework to learn the relationships among landmarks and structures jointly and automatically evaluate DDH. Our multi-task networks are equipped with three novel modules. Firstly, we adopt Mask R-CNN as the basic framework to detect and segment key anatomical structures and add one landmark detection branch to form a new multi-task framework. Secondly, we propose a novel shape similarity loss to refine the incomplete anatomical structure prediction robustly and accurately. Thirdly, we further incorporate the landmark-structure consistent prior to ensure the consistency of the bony rim estimated from the segmented structure and the detected landmark. In our experiments, 1231 US images of the infant hip from 632 patients are collected, of which 247 images from 126 patients are tested. The average errors in alpha and beta angles are 2.221 ° and 2.899 °. About 93% and 85% estimates of alpha and beta angles have errors less than 5 degrees, respectively. Experimental results demonstrate that the proposed method can accurately and robustly realize the automatic evaluation of DDH, showing great potential for clinical application.

"Video Technique on Clinical Tests for DDH": New-Born to Walking Age.

The early diagnosis of developmental Dysplasia of Hip (DDH) remains elusive. In the absence of symptoms, early signs need heightened awareness and an astute clinical examination. Every newborn child must be examined for hip instability by the Barlow and Ortolani tests. Periodic examination of the lower limbs for limb length discrepancy, restricted hip abduction, thigh or gluteal crease asymmetry must alert the examiner to rule out hip dysplasia. In a walking child with unilateral DDH the limp is obvious, and the Trendelenburg sign is positive. In bilateral DDH, limitation of hip abduction and waddling gait with increased lumbar lordosis are the only early discernible signs. Often the care-giver or parents notice the subtle changes of limb asymmetry and bring to the notice of the primary care doctors. These early signs must not be ignored to prevent late presenting DDH. This article highlights the signs of DDH that every clinician dealing with children must be well-versed. The online version contains supplementary material available at 10.1007/s43465-021-00528-w.

Implementation of Screening Program for Early Diagnosis of Developmental Dysplasia of Hip Joint in Kirkuk City

Back ground: screening program is vital for the early diagnosis and treatment of developmental dysplasia of the hip (DDH) in infants to avoid disability. The aim of the current study is to audit the implementation of the program after setting up the program. Material and method: In between 2010-2012; a questionnaires was distributed to 280 mothers, and 120 health professionals, in order to obtain feedback about the effectiveness and the existence of preventive program for early detection of DDH in Kirkuk. During the same period, two workshops were organized for the health professionals about the screening program for DDH, the data were collected during the workshop. Also the medical notes of 200 new born baby delivered in Azadi hospital were also reviewed to determine the existence of the screening program. In order to check the effectiveness of the screening program, an audit on 32 children was performed, looking through medical files of children with DDH managed by the pediatric unit in the rehabilitation unit of Azadi teaching hospital. Result: The incidence of awareness of the DDH screening program was (21%) among health professional, and was (14%) among the mother. In the neonatal care unit, none of 200 newborn babies was screened for DDH. The DDH screening program was better implemented by the vaccinators. Conclusion: It is better to rely on vaccinators to lead the program rather than medical doctors. Referring children with risk factors to a pediatric unit, is more practical than relying on the performance of Ortolani and Barlow test, in the health centers. Yearly workshops and media awareness of DDH prevention is useful.

Impact of scan quality on AI assessment of hip dysplasia ultrasound.

Early diagnosis of developmental dysplasia of the hip (DDH) using ultrasound (US) is safe, effective and inexpensive, but requires high-quality scans. The effect of scan quality on diagnostic accuracy is not well understood, especially as artificial intelligence (AI) begins to automate such diagnosis. In this paper, we developed a 10-point scoring system for reporting DDH US scan quality, evaluated its inter-rater agreement and examined its effect on automated assessment by an AI system-MEDO-Hip. Scoring was based on iliac wing straightness and angulation; visibility of labrum, os ischium and femoral head; motion; and other artifacts. Four readers from novice to expert separately scored the quality of 107 scans with this 10-point scale and with holistic grading on a scale of 1-5. MEDO-Hip interpreted the same scans, providing a diagnostic category or identifying the scan as uninterpretable. Inter-rater agreement for the 10-point scale was significantly higher than holistic scoring ICC 0.68 vs 0.93, p < 0.05. Inter-rater agreement on the categorisation of individual features, by Cohen's kappa, was highest for os ischium (0.67 ± 0.06), femoral head (0.65 ± 0.07) and iliac wing (0.49 ± 0.12) indices, and lower for the presence of labrum (0.21 ± 0.19). MEDO-Hip interpreted all images of a quality > 7 and flagged 13/107 as uninterpretable. These were low-quality images (3 ± 1.2 vs. 7 ± 1.8 in others, p < 0.05), with poor visualization of the os ischium and noticeable motion. AI accuracy in cases with quality scores < = 7 was 57% vs. 89% on other cases, p < 0.01. This study validates that our scoring system reliably characterises scan quality, and identifies cases likely to be misinterpreted by AI. This could lead to more accurate use of AI in DDH diagnosis by flagging low-quality scans likely to provide poor diagnosis up front.

Problems encountered in screening study with ultrasound for early diagnosis of developmental dysplasia of hip in eastern region of Turkey

Problems encountered in screening study with ultrasound for early diagnosis of developmental dysplasia of hip in eastern region of Turkey

ACR Appropriateness Criteria® on Developmental Dysplasia of the Hip—Child

Developmental dysplasia of the hip (DDH) affects 1.5 of every 1,000 caucasian Americans and less frequently affects African Americans. Developmental dysplasia of the hip comprises a spectrum of abnormalities, ranging from laxity of the joint and mild subluxation to fixed dislocation. Early diagnosis of DDH usually leads to low-risk treatment with a harness. Late diagnosis of DDH in children may lead to increased surgical intervention and complications. Late diagnosis of DDH in adults can result in debilitating end-stage degenerative hip joint disease. Screening decreases the incidence of late diagnosis of DDH. Clinical evaluation for DDH should be performed periodically at each well-baby visit until the age of 12 months. There is no consensus on imaging screening for DDH. Consideration for screening with ultrasound is balanced between the benefits of early detection of DDH and the increased treatment and cost factors. In addition, randomized trials evaluating primary ultrasound screening did not find significant decrease in late diagnosis of DDH. In the United States, hip ultrasound is selectively performed in infants with risk factors, such as family history of DDH, breech presentation, and inconclusive findings on physical examination. Ultrasound for DDH should be performed after 2 weeks of age because laxity is common after birth and often resolves itself. A pelvic radiograph can optimally be performed after the age of 4 months, when most infants will have ossification centers of the femoral heads.

Diagnosis of Developmental Dislocation of the Hip by Sonospectrography

Because not all infants can be screened for DDH by experts, early diagnosis of developmental dysplasia of the hip (DDH) by primary health care professionals is important. We developed a broadband electroacoustic sound transmission-detection (sonospectrography) system and explored its utility in 22 patients (average age, 5.9 years; range, 0.3-14 years) with unilateral DDH in this preliminary study. Distinct from ultrasonography, the sonospectrography system functions by sound transmission and recording through tissues to differentiate between normal and abnormal hips. All hips were examined at four different hip and knee positions. The normal hip served as the control. The sonospectrography system was able to detect unilateral DDH. Dysplastic hips had lower sound transmission values when compared to normal hips in all patients and all four positions; however, the highest (X = 88.8 +/- 30.2 Hz) and lowest (X = 8.3 +/- 5.4 Hz) sound transmission mean values were obtained at different positions in the normal hips and those with DDH. Sound transmission values of dysplastic hips were always lower than that of normal hips when the hip and knee was flexed during measurements. Sound transmission values decreased with age. The sonospectrography system may offer a new noninvasive method in the diagnosis of unilateral DDH but requires further study of sensitivity and specificity of detecting dysplastic hips without subluxation in newborn infants. Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip

Although hip ultrasonography is gaining acceptance as the most effective method for the early diagnosis of developmental dysplasia of the hip, there is still some controversy regarding the use of ultrasonography as a screening method. The purpose of this study was to investigate prospectively the capacity of clinical examination findings and associated risk factors to detect developmental dysplasia of the hip defined ultrasonographically in infants. A total of 3,541 infants underwent clinical examination and hip ultrasonography. Measured against ultrasonography as a standard, the sensitivity and specificity of clinical examination were 97% and 13.68%, respectively. Graf type IIb or more severe developmental dysplasia was found in 167 infants (208 hips), at an overall frequency of 4.71%. Graf type IIa physiological immaturity was encountered in 838 hips, and of these, 15 hips (1.78%) developed Graf type IIb dysplasia and underwent treatment. Patient characteristics that were found to be significant risk factors were swaddling use, female gender, breech delivery and positive family history. Given its low specificity, our findings suggest that clinical examination does not reliably detect ultrasonographically defined developmental dysplasia of the hip in infants being screened for this disease.

Sonography of Hip Dysplasia

Early diagnosis of developmental dysplasia of the hip (DDH) is important to institute appropriate treatment and reduce the incidence of long-term complications. Risk factors for DDH include genetic, developmental, mechanical, and physiologic factors. Physical examination using Ortolani and Barlow maneuvers is standard for early detection. Plain film radiography is limited for the diagnosis of DDH even when applying several classic landmarks, lines, and measurements, due to the lack of visualization of the cartilaginous components of the infant's hip. Ultrasound arose as a tool for evaluation of the cartilaginous structures of the hip in the early 1980s. Graf's method of examination by ultrasound stresses morphology, whereas dynamic examination uses physical maneuvers to elicit laxity of the hip. The Pavlik harness is the mainstay of treatment of DDH in the young infant, and ultrasound examination in the harness is useful to monitor progress. Closed or open surgical reduction is reserved for unresponsive or advanced cases. Universal ultrasound screening of newborns is not deemed cost effective by most North American authors, although in Europe non-selective screening has been more widely used.