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Ghasseminia S, Lim AKS, Concepcion NDP, Kirschner D, Teo YM, Dulai S, Mabee M, Kernick S, Brockley C, Muljadi S, Singh P, Rakkunedeth Hareendranathan A, Kapur J, Zonoobi D, Punithakumar K, Jaremko JL. Interobserver Variability of Hip Dysplasia Indices on Sweep Ultrasound for Novices, Experts, and Artificial Intelligence. J Pediatr Orthop 2022; 42:e315-e323. [PMID: 35125417 DOI: 10.1097/bpo.0000000000002065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ultrasound for developmental dysplasia of the hip (DDH) is challenging for nonexperts to perform and interpret. Recording "sweep" images allows more complete hip assessment, suitable for automation by artificial intelligence (AI), but reliability has not been established. We assessed agreement between readers of varying experience and a commercial AI algorithm, in DDH detection from infant hip ultrasound sweeps. METHODS We selected a full spectrum of poor-to-excellent quality images and normal to severe dysplasia, in 240 hips (120 single 2-dimensional images, 120 sweeps). For 12 readers (radiologists, sonographers, clinicians and researchers; 3 were DDH subspecialists), and a ultrasound-FDA-cleared AI software package (Medo Hip), we calculated interobserver reliability for alpha angle measurements by intraclass correlation coefficient (ICC2,1) and for DDH classification by Randolph Kappa. RESULTS Alpha angle reliability was high for AI versus subspecialists (ICC=0.87 for sweeps, 0.90 for single images). For DDH diagnosis from sweeps, agreement was high between subspecialists (kappa=0.72), and moderate for nonsubspecialists (0.54) and AI (0.47). Agreement was higher for single images (kappa=0.80, 0.66, 0.49). AI reliability deteriorated more than human readers for the poorest-quality images. The agreement of radiologists and clinicians with the accepted standard, while still high, was significantly poorer for sweeps than 2D images (P<0.05). CONCLUSIONS In a challenging exercise representing the wide spectrum of image quality and reader experience seen in real-world hip ultrasound, agreement on DDH diagnosis from easily obtained sweeps was only slightly lower than from single images, likely because of the additional step of selecting the best image. AI performed similarly to a nonsubspecialist human reader but was more affected by low-quality images.
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Affiliation(s)
| | - Andrew Kean Seng Lim
- Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System
| | | | | | - Yi Ming Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Sukhdeep Dulai
- Surgery, Faculty of Medicine and Dentistry, University of Alberta
| | - Myles Mabee
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sara Kernick
- Department of Medical Imaging, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Cain Brockley
- Department of Medical Imaging, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Siska Muljadi
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Pavel Singh
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | | | - Jeevesh Kapur
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
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Lalzad A, Wong FY, Singh N, Coombs P, Brockley C, Brennan S, Ditchfield M, Rao P, Watkins A, Saxton V, Schneider M. Surveillance Practice for Sonographic Detection of Intracranial Abnormalities in Premature Neonates: A Snapshot of Current Neonatal Cranial Ultrasound Practice in Australia. Ultrasound Med Biol 2020; 46:2303-2310. [PMID: 32616429 DOI: 10.1016/j.ultrasmedbio.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
There are no publications reporting on scan duration and Doppler use during neonatal cranial ultrasound scans. We investigated current practice of neonatal cranial ultrasound at four large tertiary neonatal intensive care units in Australia. Cranial scans were prospectively recorded between March 2015 and November 2016. Variables, including total number of scans, scan duration and frequency and duration of colour and spectral Doppler mode, were extracted. A total of 196 scans formed the final cohort. The median (range) number of scans for each neonate was 1 (1-12). The median (range) overall total scan duration was 309 (119-801) s. Colour mode with or without spectral Doppler mode was used in approximately half of the cohort (106/196, 54%). Our findings comport with our hypotheses. Operators performing neonatal cranial scans in Australia have low overall scan durations. Although the use of Doppler mode during neonatal cranial scans is not standard practice in all neonatal intensive care units, it is used widely irrespective of the degree of prematurity or the presence of brain pathology. Further efforts are required to incorporate recommendations on scan duration and the routine use of Doppler mode during neonatal cranial scans. This is especially imperative given that the most vulnerable neonates with the greater neural tissue sensitivity are likely to be scanned more often.
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Affiliation(s)
- Assema Lalzad
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Medical Imaging, St. Francis Xavier Cabrini Hospital, Malvern, Victoria, Australia; Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Flora Y Wong
- Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia; The Ritchie Centre, Hudson's Institute of Medical Research, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter Coombs
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Medical Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - Cain Brockley
- Department of Medical Imaging, Royal Childrens Hospital, Parkville, Victoria, Australia
| | - Sonja Brennan
- Department of Medical Imaging, Townsville General Hospital, Douglas, Queensland, Australia
| | | | - Padma Rao
- Department of Medical Imaging, Royal Childrens Hospital, Parkville, Victoria, Australia
| | - Andrew Watkins
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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Lalzad A, Wong F, Singh N, Coombs P, Brockley C, Brennan S, Ditchfield M, Rao P, Watkins A, Saxton V, Schneider M. Knowledge of Safety, Training, and Practice of Neonatal Cranial Ultrasound: A Survey of Operators. J Ultrasound Med 2018; 37:1411-1421. [PMID: 29152774 DOI: 10.1002/jum.14481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasound can lead to thermal and mechanical effects in interrogated tissues. This possibility suggests a potential risk during neonatal cranial ultrasound examinations. The aim of this study was to explore safety knowledge and training of neonatal cranial ultrasound among Australian operators who routinely perform these scans. METHODS An online survey was administered on biosafety and training in neonatal cranial ultrasound, targeting all relevant professionals who can perform neonatal cranial ultrasound examinations in Australia: namely, radiologists, neonatologists, sonographers, and pediatricians. The survey was conducted between November 2013 and May 2014. RESULTS A total of 282 responses were received. Twenty of 208 (10%) answered all ultrasound biosafety questions correctly, and 49 of 169 (29%) correctly defined the thermal index. Two-thirds (134 of 214 [63%]) of respondents failed to recognize that reducing the overall scanning time is the most effective method of reducing the total power exposure. Only 13% (31 of 237) indicated that a predetermined fixed period of training or that a specified minimum number of supervised scans was used during training. The reported number of supervised scans during training was highly variable. Almost half of the participants (82 of 181 [45%]) stated that they had received supervision for 10 to 50 scans (median, 20 scans). CONCLUSIONS There is a need to educate operators on biosafety issues and approaches to minimize power outputs and reduce the overall duration of cranial ultrasound scans. Development of standardized training requirements may be warranted.
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Affiliation(s)
- Assema Lalzad
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
- Department of Medical Imaging, St Francis Xavier Cabrini Hospital, Malvern, Victoria, Australia
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Flora Wong
- Department of Pediatrics, Monash University, Clayton, Victoria, Australia
- Monash Newborn, Monash Medical Center, Clayton, Victoria, Australia
- Ritchie Center, Hudson's Institute of Medical Research, Melbourne, Victoria, Australia
| | - Nabita Singh
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter Coombs
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Cain Brockley
- Department of Medical Imaging, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sonja Brennan
- Department of Medical Imaging, Townsville General Hospital, Douglas, Queensland, Australia
| | | | - Padma Rao
- Department of Medical Imaging, Monash Medical Center, Clayton, Victoria, Australia
- Department of Medical Imaging, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Andrew Watkins
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Michal Schneider
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
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Affiliation(s)
- Simone Alyson Mandelstam
- Department of Medical Imaging, Royal Children's Hospital, Flemington Road, Parkville Melbourne, Victoria 3052, Australia.
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