Neonatal Cranial Ultrasound

What it does

Neonatal Cranial Ultrasound reads the transfontanellar scans taken through the anterior fontanelle of preterm and sick newborns in the neonatal intensive care unit. Upload the coronal and sagittal (including parasagittal) stills, or the sweeps from which they come; the run sorts the images by plane and level before reading them.

It returns two sections. The haemorrhage section detects germinal-matrix and intraventricular haemorrhage and grades it with the Papile system from I to IV, identifying periventricular haemorrhagic infarction. The ventricular section measures the ventricular index, anterior-horn width and thalamo-occipital distance and flags post-haemorrhagic ventricular dilatation (PHVD), which neonatal teams follow closely after a bleed.

Intended use

Decision support for the serial scans of a preterm infant: the first-week screening scan, the follow-up that decides whether a haemorrhage has extended, and the repeated measurements that track ventricular size after a bleed. Cranial ultrasound in the NICU is often performed at the cot side by neonatologists and read later by a radiologist; a structured grade and measurements make scans comparable from one week to the next.

Who it is for

Neonatologists, paediatric and neuro-radiologists, neonatal fellows and advanced neonatal nurse practitioners who scan, and paediatric neurosurgeons following ventricular dilatation. Developers add the run to NICU charting and neonatal follow-up registries.

Accepted input

• Stills: DICOM Ultrasound Image objects in the standard coronal and sagittal planes through the anterior fontanelle.
• Sweeps: Ultrasound Multi-frame objects or MP4 covering the coronal and sagittal planes, from which the standard planes are taken.

Requirements

Requirement	Why
Coronal planes from frontal to occipital	Ventricular index and anterior-horn width are measured on coronal planes
Parasagittal planes through each lateral ventricle	Germinal-matrix haemorrhage, intraventricular blood and thalamo-occipital distance are seen there
Both hemispheres imaged	Each side is graded and measured separately
SequenceOfUltrasoundRegions calibration	Ventricular measurements in millimetres

Optional context

Gestational age at birth, age at the scan and the clinical question (screening, follow-up of a known haemorrhage, growing head circumference) go in clinical_context.

The result

One JSON result in sections with findings, measurements and classifications. Each grade and measurement points to the image it was taken on, with calipers drawn on that image.

Section	Content
Intraventricular haemorrhage	Germinal-matrix and intraventricular haemorrhage, Papile grade I–IV and periventricular haemorrhagic infarction
Ventricular size	Ventricular index, anterior-horn width and thalamo-occipital distance, with a PHVD flag
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• Haemorrhage grading: Papile grading of germinal-matrix and intraventricular haemorrhage.
• Ventricular size: Levene ventricular index, reported with anterior-horn width and thalamo-occipital distance.
• DICOM: SR Measurement Report TID 1500; GSPS for calipers on the coronal and parasagittal images; key frames and Encapsulated PDF.

Grading notes

Papile grade I is confined to the germinal matrix. Grade II is blood in the ventricle without dilatation, and grade III distends the ventricle. Grade IV extends into the parenchyma; current practice describes this lesion as periventricular haemorrhagic infarction, and the result names it so. The ventricular index is compared with the Levene reference chart for postmenstrual age. Because the same three measurements are taken on every scan, serial scans line up and dilatation can be followed over weeks.