Diagnostic accuracy of phone messaging forwarded images for developmental dysplasia of the hip

Abstract

Objectives: The objectives of this study were to evaluate the accuracy of the diagnosis based on the phone forwarded pelvic radiographs for developmental dysplasia of the hip (DDH) and whether to accept decisions based on phone images. Methods: Two hundred and eight pelvic radiographs (416 hips) performed for DDH screening were evaluated by three orthopedic surgeons on picture archiving and communication system (PACS) and re-evaluated by the same surgeons after receiving them blindly on their phones through the WhatsApp application. Phone pictures were evaluated on both portrait and landscape viewing interfaces. Results: Nine ossification centers (2.9%) were detected on PACS but were not noticed when evaluated on the phone due to the lower phone image quality. All dislocated and dysplastic hips were correctly diagnosed by the phone. The phone overestimated the acetabular index by about two degrees, which explains why 4.8% and 7.5% of normal hips on PACS viewers were labeled dysplastic once evaluated on phone portrait and landscape viewers, respectively. However, landscape phone viewing and smaller phone screens were associated with a higher overestimation of the acetabular index. Conclusion: The phone is a valuable and safe tool for diagnosing DDH from pelvic radiographs. However, a precaution should be taken in borderline cases as the phone overestimated hip angles resulting in a misdiagnosis of normal hips as dysplastic. However, we do not recommend or encourage this practice because clinical evaluation is essential in any clinical decision-making.