{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:51:55Z","timestamp":1775868715555,"version":"3.50.1"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2002Sonographic diagnosis of developmental dysplasia of the hip allows treatment with a flexion-abduction orthosis preventing hip luxation. Accurate determination of alpha and beta angles according to Graf is crucial for correct diagnosis. It is unclear if algorithms could predict the angles. We aimed to compare the accuracy for users and automation reporting root mean squared errors (RMSE).<\/jats:p><jats:p>\n          Materials and Methods\u2002We used 303\u200a306 ultrasound images of newborn hips collected between 2009 and 2016 in screening consultations. Trained physicians labelled every second image with alpha and beta angles during the consultations. A random subset of images was labeled with time and precision under lab conditions as ground truth. Automation predicted the two angles using a convolutional neural network (CNN). The analysis was focused on the alpha angle.<\/jats:p><jats:p>\n          Results\u2002Three methods were implemented, each with a different abstraction of the problem: (1) CNNs that directly learn the angles without any post-processing steps; (2) CNNs that return the relevant landmarks in the image to identify the angles; (3) CNNs that return the base line, bony roof line, and the cartilage roof line which are necessary to calculate the angles. The RMSE between physicians and ground truth were found to be 7.1\u00b0 for alpha. The best CNN architecture was (2) landmark detection. The RMSE between landmark detection and ground truth was 3.9\u00b0 for alpha.<\/jats:p><jats:p>\n          Conclusion\u2002The accuracy of physicians in their daily routine is inferior to deep learning-based algorithms for determining angles in ultrasound of the newborn hip.\u200aSimilar methods could be used to support physicians.<\/jats:p>","DOI":"10.1055\/a-1177-0480","type":"journal-article","created":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T02:55:40Z","timestamp":1596768940000},"page":"e49-e55","source":"Crossref","is-referenced-by-count":8,"title":["Accuracy of Trained Physicians is Inferior to Deep Learning-Based Algorithm for Determining Angles in Ultrasound of the Newborn Hip"],"prefix":"10.1055","volume":"43","author":[{"given":"David","family":"Oelen","sequence":"additional","affiliation":[{"name":"Biotechnologie & Physik, Supercomputing Systems, Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Biotechnologie & Physik, Supercomputing Systems, Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Baumann","sequence":"additional","affiliation":[{"name":"Research Department, Institute of Primary and Community Care Lucerne, Luzern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raoul","family":"Schmid","sequence":"additional","affiliation":[{"name":"Praxis, Baarer Kinderarztpraxis, Baar, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christof","family":"B\u00fchler","sequence":"additional","affiliation":[{"name":"Biotechnologie & Physik, Supercomputing Systems, Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bayalag","family":"Munkhuu","sequence":"additional","affiliation":[{"name":"National Center for Maternal and Child Health, Ulaanbaatar, Mongolia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Essig","sequence":"additional","affiliation":[{"name":"Research Department, Institute of Primary and Community Care Lucerne, Luzern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"e20181147","DOI":"10.1542\/peds.2018-1147","article-title":"Developmental dysplasia of the hip","volume":"143","author":"S Yang","year":"2019","journal-title":"Pediatrics"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"e79427","DOI":"10.1371\/journal.pone.0079427","article-title":"Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study","volume":"8","author":"B Munkhuu","year":"2013","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"886","DOI":"10.5312\/wjo.v6.i11.886","article-title":"Developmental dysplasia of the hip: What has changed in the last 20 years?","volume":"6","author":"P Kotlarsky","year":"2015","journal-title":"World J Orthop"},{"key":"ref4","volume-title":"Hip Sonography, Diagnosis and Management of Infant Hip Dysplasia","author":"R Graf","year":"2006"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"e305","DOI":"10.1097\/BPO.0000000000001179","article-title":"A Systematic Review and Meta-analysis on the Reproducibility of Ultrasound-based Metrics for Assessing Developmental Dysplasia of the Hip","volume":"38","author":"N Quader","year":"2018","journal-title":"J Pediatr Orthoped"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1148\/radiol.14140451","article-title":"Potential for change in US diagnosis of hip dysplasia solely caused by changes in probe orientation: patterns of alpha-angle variation revealed by using three-dimensional US","volume":"273","author":"J L Jaremko","year":"2014","journal-title":"Radiology"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/BPB.0000000000000670","article-title":"Interpreting neonatal hip sonography: intraobserver and interobserver variability","volume":"29","author":"L Pedrotti","year":"2020","journal-title":"J Pediatr Orthop B"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s10396-018-0876-z","article-title":"Reproducibility of acquiring ultrasonographic infant hip images by the Graf method after an infant hip ultrasound training course","volume":"45","author":"Y Shirai","year":"2018","journal-title":"J Med Ultrason"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.media.2017.07.005","article-title":"A survey on deep learning in medical image analysis","volume":"42","author":"G Litjens","year":"2017","journal-title":"Med Image Anal"},{"key":"ref12","first-page":"130","volume-title":"Fully Automating Graf's Method for DDH Diagnosis Using Deep Convolutional Neural Networks. Deep Learning and Data Labeling for Medical Applications: First International Workshop, LABELS, and Second International Workshop, DLMIA, Held in Conjunction with MICCAI","author":"D Golan","year":"2016"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1055\/a-0642-9545","article-title":"Machine learning and deep learning applied in ultrasound","volume":"39","author":"L M Pehrson","year":"2018","journal-title":"Ultraschall in Med"},{"key":"ref14","first-page":"WS21","article-title":"Deep learning Algorithmen in der retrospektiven Bildanalyse gro\u00dfer Bilddatenbanken","volume":"40","author":"J Ritgen","year":"2019","journal-title":"Ultraschall in Med"},{"key":"ref15","volume-title":"Sonographie der S\u00e4uglingsh\u00fcfte und therapeutische Konsequenzen","author":"R Graf","year":"2009"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1136\/archdischild-2013-304143","article-title":"Swaddling and hip dysplasia: an orthopaedic perspective","volume":"99","author":"N M Clarke","year":"2014","journal-title":"Arch Dis Child"},{"key":"ref17","first-page":"116","article-title":"To swaddle, or not to swaddle? paleoepidemiology of developmental dysplasia of the hip and the swaddling dilemma among the indigenous populations of North America","volume":"21","author":"S H Blatt","year":"2014","journal-title":"Am J Hum Biol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.2106\/JBJS.K.00720","article-title":"Does swaddling influence developmental dysplasia of the hip?: An experimental study of the traditional straight-leg swaddling model in neonatal rats","volume":"94","author":"E Wang","year":"2012","journal-title":"J Bone Joint Surg Am"},{"key":"ref19","first-page":"V2. 002","article-title":"Qualit\u00e4tskonzept eines Ultraschall-basierten, nationalen Screeningprogramms f\u00fcr H\u00fcftdysplasie in der Mongolei","volume":"38","author":"S Essig","year":"2017","journal-title":"Ultraschall in Med"},{"key":"ref24","first-page":"671","article-title":"Inter-observer agreement of ultrasonographic measurement of alpha and beta angles and the final type classification based on the Graf method","volume":"134","author":"E A Simon","year":"2004","journal-title":"Swiss Med Wkly"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1055\/s-2008-1039477","article-title":"\u201eReifungskurve\u201c des sonografischen Alpha-Winkels nach GRAF unbehandelter H\u00fcftgelenke im ersten Lebensjahr","volume":"132","author":"C Tschauner","year":"1994","journal-title":"Z Orthop Unfall"}],"container-title":["Ultraschall in der Medizin - European Journal of Ultrasound"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1177-0480.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T22:43:24Z","timestamp":1665096204000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1177-0480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,6]]},"references-count":19,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2022,10,5]]},"published-print":{"date-parts":[[2022,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1177-0480","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0172-4614","1438-8782"],"issn-type":[{"value":"0172-4614","type":"print"},{"value":"1438-8782","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,6]]}}}