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QualityControlandImprovement,Safety,InfectionControl,andPatientEducationvaryamongtheorga-nizationsandareaddressedbyeachseparately.Thispracticeparameterisintendedtoassistprac-titionersperformingultrasoundstudiesfordetectionandassessmentofdevelopmentaldysplasiaofthehip(DDH).Adherencetothefollowingrecommenda-tionswillmaximizetheprobabilityofdetectingmostoftheabnormalitiesthatrelatetoacetabularmor-phology,positionofthefemoralhead,andstability.Whenavailable,ultrasoundimagingisthepre-ferredmethodfordiagnosticimagingoftheimmatureItaffordsdirectvisualizationofthecartilagi-nousandothercomponentsofthehipjointandper-mitsadynamicexaminationthatcanbeusedtoassesshipstability.Thevalueofultrasounddimin-ishesasthefemoralheadossies;therefore,radiogra-phyispreferableforpatients6monthsofageorolder,unlesstherelationshipofthefemoralheadtotheacetabulum(includingthetriradiatecartilage)isadequatelyvisualizedwithultrasound.Indications/ContraindicationsandTimingTwoofthestrongestriskfactorsforDDHareafemaleneonateinafrankbreechpresentationatbirthandahistoryofaparentand/orasiblingwithDDH.Acceptedindicationsforultrasoundoftheinfanthipincludebutarenotlimitedto:1.Abnormalorequivocalndingsofhipinstabilityonphysicalexaminationofthehip;2.AnyfamilyhistoryofDDH;3.Breechpresentationatbirth;4.Neuromuscularconditions;and5.MonitoringinfantswithDDHundergoingRelativeindicationsforultrasoundoftheinfanthipincludebutarenotlimitedto:1.Oligohydramnios;and2.Otherintrauterinecausesofposturalmolding.Therearenoabsolutecontraindicationstoultra-soundoftheinfanthipforDDH,butasdiscussedabove,thestudybecomeslessreliablecomparedtoradiographyasossicationofthefemoralheadpro-gresses.Becauseofthepresenceofphysiologiclaxity,hipultrasoundexaminationsareusuallynotperformedonpatientsyoungerthan6weeksofageunlessindi-catedonthebasisofanabnormalndingonphysicalexamination.cationsandResponsibilitiesofSeewww.aium.orgforAIUMOfcialStatements,StandardsandGuidelinesfortheAccreditationofUltrasoundPracticesandrelevantPhy-sicianTrainingGuidelines.WrittenRequestfortheExaminationThewrittenorelectronicrequestforanultrasoundexaminationshouldprovidesufcientinformationtoallowfortheappropriateperformanceandinterpreta-tionoftheexamination.Therequestfortheexamina-tionmustbeoriginatedbyaphysicianoranotherappropriatelylicensedhealthcareproviderorunderthephysiciansorprovidersdirection.Theaccompa-nyingclinicalinformationshouldbeprovidedbyaphysicianorotherappropriatehealthcareproviderfamiliarwiththepatientsclinicalsituationandshouldbeconsistentwithrelevantlegalandlocalhealthcarefacilityrequirements.cationsoftheExaminationBothhipsshouldbeexamined.Thediagnosticexami-nationforDDHincorporates2orthogonalplanes:acoronalviewinthestandardplaneatrestandatrans-verseviewoftheexedhipwithandwithoutstress.Thisenablesanassessmentofhipposition,stability,andacetabularmorphology.Ifposition,stability,and/ormorphologycannotbeassessedwhenattemptingtoperformacompleteexamination,thereportshouldnotetheportionnotperformed.Itisacceptabletoperformtheexamina-tionwiththeinfantinasupineorineachlateraldecubituspositionseparately.Morphologyisassessedatrest.Thestressmaneuver(posteriorpushmaneuver)isperformedtoevaluateforhipinstabilitywiththehipandkneeJUltrasoundMed2018;9999:1 exedandthethighadducted(Barlowmaneuver).Ifthefemoralheadissubluxated,subluxable,dislocated,ordislocatable,reducibilitycanbeassessedbyabduct-ingandexternallyrotatingthehip(Ortolanimaneu-ver).Iftheexaminerchooses,additionalviewsandmaneuverscanbeobtained.Itisimportantthattheinfantberelaxedwhenhipsareassessedforinstabil-ity.Feedingtheinfantduringtheexaminationcanincreasecomfortandcooperation.StressmaneuversarenotperformedwhenthepatientisimmobilizedinaPavlikharnessorsplintunlessspecicallyrequestedbythereferringorthopedicsurgeon.CoronalViewTheanatomiccoronalplaneisapproximatelyparalleltotheinfantsbody.Ifthesuperioredgeofthetrans-ducerisrotated10to15(usuallyposteriorly)intoanobliquecoronalplane,theiliumwillappearstraight.Afteradjustmenttoensurethattheimagingplaneextendsthroughthedeepestpartoftheacetab-ulum(includingvisualizationofthetriradiatecartilageandtheischium),theresultingimagewillbeacoro-nalviewinthestandardplane.Thestandardplaneisdenedbyidentifyingastraightiliacline,thetipoftheacetabularlabrum,andthetransitionfromtheosiliumtothetriradiatecarti-lage(Figure1).Thecoronalviewinthestandardplanecanbeobtainedwiththehipinthephysiologicneutralposition(15exion)orintheexedposition.Thefemoralheadpositionanddisplacementarenoted.Acetabularmorphologyisassessedinthecoronalneu-tralviewandmaybevalidatedbymeasuringtheacetab-ularalphaangle(normally).Validationbyangleandfemoralheadcoveragemeasurementisoptional.Performanceofstressinthisplaneisalsooptional.Theexaminationisperformedwiththehipat90.Thetransverseplaneistheanatomictrans-verseoraxialplanewithrespecttothebody,similartotheplaneofanaxialcomputedtomographicimage(Figure2).Withthetransducernearlyparalleltothefemoralshaft,thefemoralshaftisseenanteriorly,ter-minatinginthefemoralhead,whichrestsontheischium.Thehipistestedforpositionatrestwithpassiveabductionandadduction.Thetransduceriskeptparalleltothefemoralshaftplacedinapostero-lateralpositionsothatimagingcanbeaccomplishedwhilethehipisabductedandadducted(OrtolaniandBarlowmaneuvers).Next,gentlestressisappliedtoassessstability.Iftherelationshipofthefemoralheadwiththeposterioracetabulumchangeswithgentlestress,thehipisunstable.Again,applicationofstressisomittedwhenhipsarebeingexaminedinaPavlikharnessorsplintdeviceunlessotherwiserequestedbytheorthopedicsurgeon.cationoftheDiagnosticExaminationThesupervisingphysicianmaymodifytheexamina-tiondependingonclinicalcircumstances,suchasdur-ingoraftertreatmentforDDH.Figure1.A,Coronalview:theultrasoundtransducerisplacedparalleltothelateralaspectoftheinfantship. JUltrasoundMed2018 Adequatedocumentationisessentialforhigh-qualitypatientcare.Thereshouldbeapermanentrecordoftheultrasoundexaminationanditsinterpretation.Acomparisonwithpriorrelevantimagingstudiesmayprovehelpful.Imagesofallappropriateareas,bothnormalandabnormal,shouldberecorded.Variationsfromnormalsizeshouldgenerallybeaccompaniedbymeasurements.Imagesshouldincludethepatientcation,facilityidentication,examinationdate,hipbeingimaged,imageorientation,andwhetherstressisbeingapplied.Anofcialinterpretation(report)oftheultrasoundexaminationshouldbeincludedinthepatientsmedicalrecord,indicatingacetabularmorphology,thepositionofthefemoralhead,andstability.Retentionoftheultrasoundimagesshouldbeconsistentbothwithclinicalneedsandwithrelevantlegalandlocalhealthcarefacilityrequirements.ReportingshouldbeinaccordancewiththeAIUMPracticeParameterforDocumentationofanUltrasoundExamination.EquipmentSpecicationsAhipultrasoundexaminationfordetectingDDHshouldbeperformedwithahigh-frequencylineartransducerthatpermitspenetrationofthesofttissues.Totalultrasoundexposureshouldbekeptaslowasreasonablyachievable(ALARA)whileoptimizingdiagnosticinformation.QualityControlandImprovement,Safety,InfectionControl,andPatientEducationPoliciesandproceduresrelatedtoqualitycontrol,patienteducation,infectioncontrol,andsafetyshouldbedevelopedandimplementedinaccordancewiththeAIUMStandardsandGuidelinesfortheAccreditationofUltrasoundPracticesEquipmentperformancemonitoringshouldbeinaccordancewiththeAIUMStandardsandGuidelinesfortheAccreditationofUltrasoundPracticesALARAPrincipleThepotentialbenetsandrisksofeachexaminationshouldbeconsidered.TheALARAprincipleshouldbeobservedbyadjustingcontrolsthataffecttheacousticoutputandbyconsideringtransducerdwelltimes.Fur-therdetailsonALARAmaybefoundintheAIUMpublicationMedicalUltrasoundSafety,ThirdEdition.Figure2.A,Transverseexionview:thehipandkneeareexed90,andtheultrasoundtransducerisplacedperpendiculartothelateralaspectoftheinfantshipnearlyparalleltothefemoralshaft.,Transverseultrasoundimage. JUltrasoundMed2018;9999:1 ThisparameterwasrevisedbytheAIUMincollabo-rationwiththeACR,theSPR,andtheSRUaccord-ingtotheprocessdescribedintheAIUMClinicalStandardsCommitteeManual.CollaborativeCommitteeMembersrepresenttheirsocietiesintheinitialver-sionandnalrevisionofthispracticeparameter.ACRAIUMTerryL.Levin,MD,chairBrianD.Coley,MDMariaA.Calvo-Garcia,MDT.RobinGoodman,MBBSMonicaS.Epelman,MDHarrietJ.Paltiel,MDHenriettaK.Rosenberg,MDSPRSRURichardD.Bellah,MDLynnA.Fordham,MDChristianLCarlson,MDValerieL.Ward,MDRachelleGoldsher,MDJonathanR.Wood,MDAIUMClinicalStandardsCommitteeJohnPellerito,MD,chairBryannBromley,MD,vicechairSandraAllison,MDAnilChauhan,MDStamatiaDestounis,MDEitanDickman,MD,RDMSBethKline-Fath,MDJoanMastrobattista,MDMarshaNeumyer,BS,RVTTatjanaRundek,MD,PhDKhaledSakhel,MDJamesShwayder,MD,JDAntsToi,MDJosephWax,MDIsabelleWilkins,MDOriginalcopyright2003;revised2018,2013,2008Renamed20151.RoposchA,WrightJG.Increaseddiagnosticinformationandunderstandingdisease:uncertaintyinthediagnosisofdevelopmen-talhipdysplasia.2007;242:3552.SmergelE,LosikSB,RosenbergHK.Sonographyofhipdysplasia.UltrasoundQ2004;20:2013.BacheCE,CleggJ,HerronM.Riskfactorsfordevelopmentaldys-plasiaofthehip:ultrasonographicndingsintheneonatalperiod.JPediatrOrthopB2002;11:2124.MulpuriK,SongKM,GrossRH,etal.TheAmericanAcademyofOrthopaedicSurgeonsevidence-basedguidelineondetectionandnonoperativemanagementofpediatricdevelopmentaldysplasiaofthehipininfantsuptosixmonthsofage.JBoneJointSurgAm2015;97:1718.5.AmericanInstituteofUltrasoundinMedicine.AIUMphysiciantrainingguidelines.AmericanInstituteofUltrasoundinMedicinewebsitehttps://www.aium.org/resources/ptGuidelines.aspx.AccessedJune8,2018.6.HarckeHT,GrissomLE.Performingdynamicsonographyoftheinfanthip.AJRAmJRoentgenol1990;155:8377.MorinC,HarckeHT,MacEwenGD.Theinfanthip:real-timeUSassessmentofacetabulardevelopment.1985;157:8.GrissomLE,HarckeHT,KumarSJ,BassettGS,MacEwenGD.UltrasoundevaluationofhippositioninthePavlikharness.JUltra-soundMed1988;7:19.RoposchA,MoreauNM,UlerykE,DoriaAS.Developmentaldys-plasiaofthehip:qualityofreportingofdiagnosticaccuracyfor2006;241:85410.AmericanInstituteofUltrasoundinMedicine.AIUMpracticeparameterfordocumentationofanultrasoundexamination.Amer-icanInstituteofUltrasoundinMedicinewebsite.http://www.aium.org/resources/guidelines/documentation.pdf.AccessedJune10,2018.11.AmericanInstituteofUltrasoundinMedicine.MedicalUltrasound.3rded.Laurel,MD.AmericanInstituteofUltrasoundinMedicine;2014.JUltrasoundMed2018 PRACTICEGUIDELINESSRUPracticeParameterforthePerformanceofanUltrasoundExaminationforDetectionandAssessmentofDevelopmentalDysplasiaoftheHipheAmericanInstituteofUltrasoundinMedicine(AIUM)isamultidisciplinaryassociationdedicatedtoadvancingthesafeandeffectiveuseofultrasoundinmedicinethroughprofessionalandpubliceducation,research,developmentofparameters,andaccreditation.TheAIUMrepresentstheentirerangeofclinicalandbasicscienceinterestsinmedicaldiagnosticultrasound,and,withhun-dredsofvolunteers,theAIUMhaspromotedthesafeandeffectiveuseofultrasoundinclinicalmedicinesince1952.Thisdocumentandotherslikeitwillcontinuetoadvancethismission.PracticeparametersoftheAIUMareintendedtoprovidethemedicalultrasoundcommunitywithparametersfortheperfor-manceandrecordingofhigh-qualityultrasoundexaminations.TheparametersreectwhattheAIUMconsiderstheminimumcriteriaforacompleteexaminationineachareabutarenotintendedtoestablishalegalstandardofcare.AIUM-accreditedpracticesareexpectedtogenerallyfollowtheparameterswithrecognitionthatdeviationsfromtheseparameterswillbeneededinsomecases,dependingonpatientneedsandavailableequipment.Practicesareencouragedtogobeyondtheparameterstoprovideadditionalser-viceandinformationasneeded.Theclinicalaspectscontainedinspecicsectionsofthispracticeparameter(Introduction,Indications/ContraindicationsandTim-ing,SpecicationsoftheExamination,andEquipmentSpecitions)wererevisedcollaborativelybytheAIUM,theAmericanCollegeofRadiology(ACR),theSocietyforPediatricRadiology(SPR),andtheSocietyofRadiologistsinUltrasound(SRU).Rec-ommendationsforQualicationsandResponsibilitiesofPerson-nel;WrittenRequestfortheExamination;Documentation;anddoi:10.1002/jum.14829 ©2018bytheAmericanInstituteofUltrasoundinMedicine JUltrasoundMed2018;9999:10278-4297www.aium.org