Clinical thought-based software for diagnosing developmental dysplasia of the hip on pediatric pelvic radiographs

Figures

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  Figure 1. Diagnostic references of developmental dysplasia of the hip (relies on the midpoint of the proximal femoral metaphysis, H-point). Hilgenreiner’s line is a basal line connecting the top of bilateral triradiate cartilages. Perkin’s line is perpendicular to Hilgenreiner's line, passing through the lateral acetabular edge. The diagonal line is drawn 45 degrees from the junction of Perkin's line and Hilgenreiner's line. The acetabular index is the angle between Hilgenreiner's line and the line from the top of the triradiate cartilage to the lateral acetabular edge. Lateral center-edge angle is the angle between a vertical line through the center of the femoral head and a line connecting that center and the lateral acetabular edge.

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  Figure 2. Detailed workflow of the proposed software for developmental dysplasia of the hip.

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  Figure 3. Examples of radiographic diagnosis of developmental dysplasia of the hip on pelvic radiographs by the software. The left images represent the evaluation results of the standard, while the middle and right images represent those of the software by Junior orthopedist and Intermediate orthopedist, respectively. (A) the pelvic radiograph of a 2.3-year-old girl; (B) the pelvic radiograph of a 1.4-year-old girl.

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  Figure 4. ROC analysis showing that the diagnostic performance of the software (green line) was better than that of the conventional method (blue line) in both the (A) junior and (B) intermediate orthopedists.

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  Figure 5. Confusion matrix of the specific classification in two orthopedists. (A) The confusion matrix of the conventional method by Junior orthopedist. (B) The confusion matrix of the conventional method by Intermediate orthopedist. (C) The confusion matrix of the software by Junior orthopedist. (D) The confusion matrix of the software by Intermediate orthopedist.

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  Figure 6. Diagnostic performance of two methods for parametric measurements using Bland-Altman plots. Two images on the left represent the diagnoses of the conventional group (for junior and intermediate orthopedists, respectively), whereas two images on the right represent the diagnoses of the software group (for junior and intermediate orthopedists, respectively). (A) acetabular index. (B) lateral center-edge angle.