# Can AI Automatically Assess Scan Quality of Hip Ultrasound? [PERSON], [PERSON], [PERSON], [PERSON]  
1 Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada; [EMAIL_ADDRESS] (B.S.C. ); [EMAIL_ADDRESS] (S.K.D. ); [EMAIL_ADDRESS] (J.L.J) 1  
[PERSON]  
1 Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada; [EMAIL_ADDRESS] (B.S.C. ); [EMAIL_ADDRESS] (S.K.D. ); [EMAIL_ADDRESS] (J.L.J) 1  
[PERSON]. 2 College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK S7N 5E5, Canada; [EMAIL_ADDRESS] 2  
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During hip examination, 2D ultrasound images are usually acquired and interpreted based on the Graf technique [14] which measures the alpha angle between the ilium and acetabular roof. Alpha angles greater than 60 degrees are considered normal and those less than 43 degrees are considered severely dysplastic [14]. This technique relies heavily on obtaining a single 2D image in the Graf plane containing all landmarks such as illum, labrum, os ischium and femoral head (Figure 1A). Acquiring such images requires many hours of training, since slight variations in probe orientation can result in suboptimal images. Previous studies have shown that deviation from the Graf plane by novice users can result in incorrect diagnosis in two-thirds of neonates and half of infants evaluated [15]. These variations can be reduced to some extent by using 3D Ultrasound (3 DUS). Since 3 DUS covers a larger area, it is more likely to contain the Graf plane, thereby making it more reliable than 2 DUS, especially when scanning is performed by novice sonographers [16]. However, in both 2 DUS and 3 DUS, reliability of the ultrasound examination depends to a large extent on scan quality. In current clinical practice, sonographers manually assess scan quality based on visibility of key landmarks. This approach is prone to high inter-observer variance. As a result, poor-quality images can be presented to radiologists, risking misdiagnosis. Examples of images of varying scan quality are shown in Figure 1. In earlier work [17], a semi-quantitative scoring technique that evaluates individual imaging landmarks (such as ilium, labrum, femoral head and os ischium) and artifacts (such as movement and other artifacts) is proposed. While such approaches make scan quality assessment less subjective, there can still be variability in the manual assessment of individual features. Automatic assessment of scan quality could address these issues and provide the sonographer with a reliable and non-subjective assessment of image adequacy at the time of scanning. Automatic assessment of ultrasound is challenging due to various factors such as the presence of spurious image effects that resemble anatomical structures, blurred image boundaries, mirror artifacts and shadowing artifacts.