ACETABULAR INDEX OF DEPTH APP
Radiographic evaluation of the acetabular morphology is paramount importance for diagnosis, treatment, and follow-up management in dysplasia of the hip in children. One useful index for objective evaluation, how deep the acetabulum is, is the Acetabular Depth Ratio (ADR) or Acetabular Index of Depth. The app helps to measure the acetabular depth and acetabular width and calculates the Acetabular Depth Ratio (ADR). The behaviour of ADR as the child ages normally changes and increases as the acetabulum deepens with grow and reaches in adulthood its normal value usually over 48%. Monitoring the ADR index during treatment of hip dysplasia is crucial. The ADR offers an objective value in order to evaluate the acetabular remodelling.
The Acetabular Depth Ratio App is medical software aimed for orthopaedic surgeons, providing tools that allow doctors to:
-Securely import medical images directly from the camera or stored photos
-Offers a very convenient way to determine the most accurate possibly way the acetabular depth in percentage. By clicking three points and inserting the age, the gender and the side of the patient in the App, the measured value is compared with values from normal reference database. In case the measured value is beyond the normal range according to reference database, the hips are categorised as borderline, mild or severe dysplastic.
-Save the planned images, for later review or consultation.
All information received from the software output must be clinically reviewed regarding its plausibility before patient treatment! Acetabular Depth Ratio App indicated for assisting healthcare professionals. Clinical judgment and experience are required to properly use the software. The software is not for primary image interpretation.
In a busy everyday practice measuring in X-rays in clinical settings it is time consuming and cumbersome. Accessory instruments like protractors, goniometers, well sharped pencils, rulers or even transparent papers must be available. The app offers a very convenient and accurate way to measure the value of Acetabular Depth Ratio by clicking three points. Also offers the ability all the data to be compared with medical reference database and help decide what could be considered normal or pathologic.
The app is not a simple goniometer, is an enhanced product which help to monitor objectively during the course of the treatment how much is deepening the acetabulum and evaluate the remodelling. This App is particular useful especially in clinical settings where you need a quick results without loosing time .
1. Novais EN1, Pan Z, Autruong PT, Meyers ML, Chang FM.Normal Percentile Reference Curves and Correlation of Acetabular Index and Acetabular Depth Ratio in Children. J Pediatr Orthop. 2016 Jun 2. [Epub ahead of print]
2.Murphy SB, Ganz R, Muller ME: The prognosis inuntreated dysplasia of the hip: A study of radio-graphic factors that predict the outcome. J BoneJoint Surg 77A:985–989, 1995
3.Li P, Ganz R Morphologic features of congenital acetabular dysplasia: one in six is retroverted.
Clinical orthopaedics and related research, issue 416 (2003) pp. 245-53
How to measure acetabular depth ratio (ADR)
The app offers a very convenient way to measure acetabular depth ratio (ADR) . The first thing is to load one image from your photo library or capture a photo from x-rays photos of a patient. In the empty boxes above you fill in the age of the patient ,in years or months, the gender of the patient and the side left or right respectively.
The circular template appears on the screen in order to determine the points of interest. By moving the template with a finger over the screen the template is following the movement and the centre point helps to locate easily and
mark the points accurately. You can also zoom in and out with both fingers. You aim first the inferior teardrop of the acetabulum and by clicking the button ‘point’ you mark the w1 point. Next with the transparent circular template you aim at the lateral margin of the acetabulum and you mark by clicking the button ‘point’ the w2 point. Finally you aim with the transparent circular template the deepest point of the roof the acetabulum -usually at the halfway of the acetabular width- and by clicking the button ‘point’ the d3 point is marked. A semicircle is printed, passing the w1, d3, and w2 point .The Acetabular depth (line D) is defined as the perpendicular distance from line (line W) - line between the points w1w2 which depicts the acetabular width- , to d3 point. The ratio of acetabular depth (line D) to /acetabular width (line W) * 100% is the acetabular depth ratio (ADR). The app after marking the above mentioned points, calculates the acetabular depth ratio (ADR), values are expressed in percentage %. The values printed over the screen after being compared with the normal reference database according the age, gender and side of the patient. The hips are categorised as normal, borderline dysplastic, mildly dysplastic or severe dysplastic. For the toddlers and children the reference database is included in the app. Please see tutorial videos