US Neonatal Hip (DDH Screening) — Dictation, Appropriateness, and Dose for Residents
The peds team just sent down a 6-week-old for a hip ultrasound to rule out Developmental Dysplasia of the Hip (DDH). The baby is fussy, the schedule is packed, and your attending expects a perfect Graf angle, a clear assessment of stability under stress, and a definitive Graf classification in the report. Getting those coronal planes just right on a squirming infant is half the battle; dictating it cleanly and quickly is the other half. When I was a resident, this was one of those studies where small measurement errors could lead to a big change in management, from simple follow-up to a Pavlik harness.
This guide breaks down the US Neonatal Hip exam into a structured template you can use right now. We’ll cover the key measurements, the dynamic assessment, and how to put it all together in a report that gives the pediatricians exactly what they need. For more high-yield guides like this, check out our free residents and fellows resource hub.
What a US Neonatal Hip (DDH Screening) Covers and What Attendings Look For
A neonatal hip ultrasound is the primary screening tool for DDH in infants under 6 months old. After that, the femoral head ossifies, making X-ray the better modality. The exam combines static morphological assessment (the Graf method) with dynamic stress maneuvers to evaluate both the anatomy of the acetabulum and the functional stability of the femoral head within it.
Your attending is looking for a concise report that answers these key clinical questions:
- Acetabular Morphology: Is the bony acetabular roof steep and well-formed (normal) or shallow (dysplastic)? This is quantified by the Graf alpha angle.
- Femoral Head Position: Is the femoral head seated correctly within the acetabulum?
- Hip Stability: Does the femoral head sublux or dislocate with gentle stress maneuvers? This is a critical functional assessment.
- Femoral Head Coverage: In the transverse view, what percentage of the femoral head is covered by the acetabulum? Greater than 50% is normal.
- Overall Classification: What is the final Graf classification (Type I, II, III, or IV) for each hip? This classification directly guides clinical management.
The ideal time for this scan is at or after 4-6 weeks of age. Scanning earlier can lead to false positives due to normal physiologic laxity of the hip joint in the immediate neonatal period.
Radiology Report Template for US Neonatal Hip (DDH Screening)
This template provides a solid foundation. Use the key principles below to guide your dictation. Remember: alpha angle ≥60° is mature (Type I), while <60° indicates some degree of immaturity or dysplasia. Dynamic stress is key—a morphologically normal hip that is unstable is still a significant finding.
Technique
Real-time grayscale ultrasound evaluation of the bilateral hips was performed using a high-frequency linear transducer. Static coronal images were obtained for morphologic assessment and Graf angle measurements. Dynamic coronal and transverse imaging was performed with flexion, adduction, and gentle posterior stress to assess for hip stability.
Findings
RIGHT HIP:
Static Coronal View:
The acetabulum is well-formed. The bony roof is sharp and covers the femoral head appropriately. The cartilaginous roof is normal in appearance. The labrum is well-positioned.
Alpha Angle: [e.g., 65] degrees.
Beta Angle: [e.g., 50] degrees.
Graf Classification: [e.g., Type I (Mature)].
Dynamic Assessment:
With gentle stress, there is no evidence of subluxation or dislocation. The femoral head remains seated within the acetabulum.
Transverse View:
The femoral head is located within the acetabulum, with greater than 50% coverage.
LEFT HIP:
Static Coronal View:
The acetabulum is [e.g., shallow]. The bony roof is [e.g., rounded and deficient]. The cartilaginous roof is [e.g., displaced superiorly]. The labrum is [e.g., everted].
Alpha Angle: [e.g., 52] degrees.
Beta Angle: [e.g., 65] degrees.
Graf Classification: [e.g., Type IIa (Physiologically Immature)].
Dynamic Assessment:
With gentle stress, [e.g., there is mild posterior subluxation of the femoral head, which reduces spontaneously / the hip is stable].
Transverse View:
The femoral head is located within the acetabulum, with approximately [e.g., 50%] coverage.
Impression
1. Right Hip: Normal, mature hip by Graf criteria (Type I). No evidence of instability.
2. Left Hip: Physiologically immature hip (Graf Type IIa). No evidence of dislocation, though [e.g., mild laxity is noted on stress views]. Recommend follow-up ultrasound in 6-8 weeks to ensure maturation.
Free Template Sources
Building a personal library of templates is a rite of passage in residency. If you’re looking for more examples or templates for other modalities, two great free repositories exist. The Radiological Society of North America (RSNA) curates a comprehensive library at RadReport.org, and an excellent Australian-maintained collection can be found at RadiologyTemplates.com.au. They are solid resources for standardized language across a wide range of studies.
The Next-Level Move: Free-Form Dictation to Structured Report
Clicking through macros and filling in blanks works, but it can feel clunky, especially when you have multiple positive findings. The real bottleneck is translating your observations into a perfectly structured report that meets attending expectations every time. This is where AI-powered dictation tools can streamline your workflow.
Instead of navigating a rigid template, you can dictate your findings conversationally: “Left hip shows a shallow acetabulum with a blunted bony rim, alpha angle is 54 degrees, beta is 68. It’s a Graf Type IIa. The hip is stable under stress.” The GigHz Precision AI reporting assistant parses this free-form dictation and automatically generates a clean, structured report based on ACR-standard templates. It’s designed to help you create high-quality, consistent reports faster, and it can automatically surface relevant Clinical Decision Support (CDS) when a reportable framework like LI-RADS or Bosniak is involved.
When Should You Order a Neonatal Hip Ultrasound? ACR Appropriateness Criteria
The decision to order a hip ultrasound versus an X-ray is almost entirely age-dependent. The American College of Radiology (ACR) provides clear guidance on this topic.
According to the ACR Appropriateness Criteria for Developmental Dysplasia of the Hip-Child, ultrasound of the hips is Usually Appropriate for the initial imaging of an infant younger than 6 months with suspected DDH. This includes infants with risk factors (breech presentation, family history) or an abnormal physical exam (positive Ortolani/Barlow maneuvers, hip click, or asymmetry).
The key alternative imaging modality is a single AP radiograph of the pelvis. X-ray is the appropriate first-line study for infants older than 4 to 6 months. By this age, the femoral head begins to ossify, creating an acoustic shadow that limits the diagnostic utility of ultrasound. MRI is rarely used and typically reserved for complex cases or assessing for complications of treatment.
How Much Radiation Does a Neonatal Hip Ultrasound Deliver?
One of the primary advantages of ultrasound for pediatric imaging is its safety profile. A neonatal hip ultrasound delivers no ionizing radiation.
The estimated effective radiation dose is 0 mSv. This is a key reason why it is the preferred modality for infants, avoiding any radiation exposure at a critical developmental stage. For comparison, even a low-dose pediatric pelvic X-ray involves a small amount of radiation.
| Imaging Study | Estimated Effective Dose |
|---|---|
| US Neonatal Hip | 0 mSv |
| AP Pelvis X-ray (Infant) | ~0.1 mSv |
| Natural Background Radiation (per year) | ~3 mSv |
Source: ACR Dose Registry and Radiation Safety information.
US Neonatal Hip (DDH Screening) Protocol — Views, Measurements, and Stress Maneuvers
A successful DDH ultrasound relies on a standardized protocol that assesses both morphology and function. The exam is performed with a high-frequency (7-15 MHz) linear transducer in a warm room with the infant calm and comfortable. The protocol consists of three main components for each hip.
| Component | Technique | Purpose |
|---|---|---|
| Static (Graf) Coronal View | Infant in lateral decubitus or supine position, hip in 15-20° flexion. Transducer placed over the greater trochanter. | Morphological assessment. Measure the alpha angle (bony roof) and beta angle (cartilaginous roof) to determine the Graf classification. |
| Dynamic Stress View | Hip flexed to 90° and adducted. Gentle posterior pressure is applied while observing the femoral head in the coronal plane. | Functional stability assessment. Watch for posterior movement (>1-2 mm = subluxation) or complete egress of the femoral head from the acetabulum (dislocation). |
| Transverse View | Hip flexed to 90°. Transducer placed transversely over the hip joint. | Confirms reduction of the femoral head. Assess femoral head coverage by the acetabulum (should be >50%). |
Common protocol pitfalls: A common point of confusion is the distinction between the Graf and Harcke methods. The Graf method is purely for static morphological assessment (the angles), while the Harcke method refers to the dynamic stability assessment. Most modern protocols incorporate both: a static Graf assessment followed by dynamic stress maneuvers.
The 3-Months-Free Offer for Radiology Residents and Fellows
Look like a rockstar on your reports — dictate positive findings in free form, and the AI generates a structured report using ACR + SIR templates with the appropriate clinical decision support firing automatically.
We’re offering 3+ months of free access to GigHz Precision AI for all radiology residents and fellows. All we ask is for your feedback so we can keep improving the product for trainees.
Signup is simple. There is no credit card required and no long forms. To get started, just provide these three items:
- Your PGY year (e.g., PGY-2, PGY-4)
- Your training type (radiology residency or specific fellowship — IR, body, MSK, neuro, peds, breast, nucs)
- Your training program / hospital name
To get your free account, apply for the residents free-access program and reply to the confirmation email with the information above.
Free GigHz Tools That Pair With This Article
Three free tools that complement the material above:
- ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
- GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
- GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.
Frequently Asked Questions
Is it HIPAA-compliant?
Yes. The platform is designed for de-identified workflows by default. It processes the clinical content of your dictation without requiring or storing patient-identifying information (PHI). All data is encrypted in transit and at rest.
Do I need IT to set it up?
No. It’s a secure, browser-based tool. There’s no software to install on hospital computers. It works on any modern browser, including the one on your call-room workstation or personal iPad.
Does it work with PowerScribe or other dictation systems?
Yes. It works alongside your existing PACS and dictation system. You can dictate into the GigHz web app, and once the structured report is generated, you can copy and paste it directly into your EMR or RIS/PowerScribe report field.
Can I use it on my phone or iPad?
Yes, the platform is fully responsive and designed to work on desktops, tablets, and mobile devices, making it accessible whether you’re at a workstation or on the go.
Can I customize the templates?
Yes. While the system comes pre-loaded with standard ACR and society-based templates, you can create, modify, and save your own templates to match your personal preferences or your institution’s specific formatting requirements.
What happens after my residency or fellowship ends?
We offer continuity plans for graduating trainees who want to continue using the platform in their practice. Your free access runs for the specified period, after which you can choose to transition to a standard plan.
Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026
