TL;DR: Different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, the authors need to design studies in order to compare them and select the method best suited to Pakistani children.
Abstract: The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. Radiography of the hand & wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation based techniques of visualizing hand & wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. By the age of 18 years, bone age cannot be computed from hand & wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18-22 years. CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. MRI based methods are being developed but require more research. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated. As different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children. Sources of Data/Study Selection: Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review.
TL;DR: The reliability of the computer-assisted skeletal age score (CASAS) is considerably greater than that of the usual manual method and a much smoother progression of skeletal maturity scores with age is achieved.
Abstract: In 1992 we described a computer-assisted method for assigning Tanner-Whitehouse RUS skeletal maturity scores to hand-wrist radiographs. An operator positions each epiphysis in turn beneath a video camera, views the image on the computer screen and corrects the position of the radiograph by matching to templates of the TW stages displayed on the screen. The process is then automatic; the computer, not the operator, rates the bone. The image is digitized and then represented by a large number of mathematical coefficients. These coefficients are then compared to those generated by each stage of the TW standards, and the closest match is sought. Since the comparison is quantitative the system produces continuous stage scores instead of the old discrete ones such as B, C, D, etc. Thus in longitudinal data a much smoother progression of skeletal maturity scores with age is achieved. The reliability of the computer-assisted skeletal age score (CASAS) is considerably greater than that of the usual manual method. Differences between duplicate readings of a bone by a single observer average about 0.25 stage, and reach 1.0 stage or more only in about 3% of instances, compared with 15-20% characteristic of manual ratings.
TL;DR: Bone age calculated by Greulich & Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g. medicolegal cases), however, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children.
Abstract: Objective: To assess the degree of applicability of bone age calculated by Greulich & Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes. Methods: Two Hundred and Twenty children (139 males, 81 females) between ages of 56 and 113 months (4.5 to 9.5 years) were randomly selected from 4 primary schools of Shireen Jinnah & Clifton, Karachi. Digital images of hand and wrist radiographs were obtained by a computed radiography at Ziauddin Hospital Clifton. Bone ages were computed using Greulich & Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi. Results: On average, the Greulich & Pyle Atlas underestimates chronological age by 6.65 ± 13.47 months in females and 15.78 ± 12.83 months in males (p-values < 0.001). High correlation was found between chronological age and bone age in both genders (Females r=0.778; p-value < 0.001, Males r=0.816; p-value < 0.001). Conclusion: Bone age calculated by Greulich & Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g. medicolegal cases). However, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children.
TL;DR: The Korean standard growth curve and the Korean bone age chart allow determination of the presence of any existent growth abnormalities and prediction of future remaining growth in lower extremities and can be used for leg-length equalization purposes in children with anisomelia.
Abstract: To develop a standard growth curve of the lower extremity in Korean children from 3 to 16 yr of age, the lengths from a total of 2087 normal long bone segments (582 femurs and 645 tibias in boys, and 417 femurs and 443 tibias in girls) were measured. Children were grouped by years of bone age, which was determined by using the Korean specific bone age standard; TW2-20 method. The growth spurt occurred in girls from eight to eleven years by bone age, and in boys from eleven to thirteen years. The mean tibial length relative to the mean femoral length was 0.78 in boys and 0.79 in girls. The overall growth pattern was similar to that observed in American children in the 1960s. Korean children and adolescents appear to have a different tempo of skeletal maturation during pubertal growth from that of English and American children and adolescents. The Korean standard growth curve and the Korean bone age chart allow determination of the presence of any existent growth abnormalities and prediction of future remaining growth in lower extremities. These normative growth standards can be used for leg-length equalization purposes in children with anisomelia.