Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 2;10(1):16407.
doi: 10.1038/s41598-020-73536-9.

Development of an electronic navigation system for elimination of examiner-dependent factors in the ultrasound screening for developmental dysplasia of the hip in newborns

Alexander Kolb  1 , Catharina Chiari  2 , Markus Schreiner  2 , Stephan Heisinger  2 , Madeleine Willegger  2 , Gregor Rettl  2 , Reinhard Windhager  2
Affiliations

Development of an electronic navigation system for elimination of examiner-dependent factors in the ultrasound screening for developmental dysplasia of the hip in newborns

Alexander Kolb et al. Sci Rep. .

Abstract

To develop an electronic navigation system to increase reliability and comparability in the ultrasound screening of developmental dysplasia of the hip (DDH). The impact of the navigation system on transducer positioning and on sonographic measurements according to Graf was analyzed. Twenty hips in newborns were examined sonographically using a new navigation system capable of detecting the transducer and pelvis position in order to calculate the relative tilt in the frontal, axial, and sagittal-plane. In each newborn an ultrasound image was obtained conventionally according to Graf and a second image using the sonographic navigation system. Relative roll and pitch angles and sonographic measurements were analyzed using paired T-tests and Levene-tests. Relative tilt angles in the conventional group ranged from - 8.9° to 14.3° (frontal-plane) and - 23.8° to 14.2° (axial-plane). In the navigation-assisted group ranges from - 3.0° to 3.5° and - 2.8° to 4.5° were observed. Variances were significantly lower in the navigation-assisted group (p < 0.001 and p = 0.004 respectively). The navigation system allowed for a significant reduction of relative tilt angles between the transducer and the newborn pelvis, thus supporting an optimal transducer positioning. This is a promising approach to improve reproducibility and reliability in the ultrasound screening for DDH.

PubMed Disclaimer

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest. One of the authors (RW) has received institutional funding from Stryker, DePuy Synthes Austria, Johnson & Johnson Medical Limited, Medacta, Zimmer Biomet Gmbh.

Figures

Figure 1
Figure 1
Systematic setup of the electronic navigation system: The 3D-orientation-sensors communicate the data to a microcomputer, which further processes the data and transfers them to a PC-based output software, which stores the data and depicts the relative angles to assist the navigation.
Figure 2
Figure 2
Illustration of the positioning of 3D-orientation-sensors: (a) epicutaneous fixation of the pelvic sensor (arrow head) dorsal above the sacral bone to detect the pelvis position, (b) fixation of the second sensor (thin arrow) to the transducer using a 3D printed adapter in a typical situation prior to adjustment of the transducer position.
Figure 3
Figure 3
Illustration of tilt and rotational movements: roll-angle in the frontal plane (green double arrow), pitch-angle in the axial plane (blue double arrow), and yaw-angle in the sagittal plane (orange double arrow).
Figure 4
Figure 4
XY-plot of relative roll and pitch angles: (a) conventional group with adjustment of the transducer according to Graf’s sonographic criteria, (b) navigation-assisted group using the navigation system in addition to Graf’s criteria to optimize the transducer position.
See this image and copyright information in PMC

References

    1. Graf R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J. Pediatr. Orthop. 1984;4:735–740. doi: 10.1097/01241398-198411000-00015. - DOI - PubMed
    1. Graf R. New possibilities for the diagnosis of congenital hip joint dislocation by ultrasonography. J. Pediatr. Orthop. 1983;3:354–359. doi: 10.1097/01241398-198307000-00015. - DOI - PubMed
    1. Simon EA, et al. Inter-observer agreement of ultrasonographic measurement of alpha and beta angles and the final type classification based on the Graf method. Swiss Med. Wkly. 2004;134:671–677. - PubMed
    1. Roposch A, Graf R, Wright JG. Determining the reliability of the Graf classification for hip dysplasia. Clin. Orthop. Relat. Res. 2006;447:119–124. doi: 10.1097/01.blo.0000203475.73678.be. - DOI - PubMed
    1. Kolb A, et al. Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int. Orthop. 2015 doi: 10.1007/s00264-015-2799-2. - DOI - PubMed

Publication types