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Bone age assessment practices in infants and older children among Society for Pediatric Radiology members

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Abstract

Background

Numerous bone age estimation techniques exist, but little is known about what methods radiologists use in clinical practice.

Objective

To determine which methods pediatric radiologists use to assess bone age in children, and their confidence in these methods.

Materials and methods

Society for Pediatric Radiology (SPR) members were invited to complete an online survey regarding bone age assessment. Respondents were asked to identify the methods used and their confidence with their technique for the following groups: Infants (<1 year old), 1- to 3-year-olds and 3- to 18-year-olds.

Results

Of the 937 SPR members invited, 441 responded (47%). For infants, 70% of respondents use the hand/wrist method of Greulich and Pyle, 27% use a hemiskeleton method (e.g., Sontag or Elgenmark), and 14.4% use the knee method of Pyle and Hoerr. Of these respondents, 34% were not confident with their technique. For 1- to 3-year-olds, 86% used Greulich and Pyle, and 19% used a hemiskeleton method; 21% were not confident with their technique in this age group. For 3- to 18-year-olds, 97% used Greulich and Pyle, and only 6% of respondents were not confident with their technique in this category. A logistic regression analysis demonstrated that the chronological age of the patient had the greatest impact on reader confidence, with the odds ratios for confidence being 4 times greater in the 3- to 18-year-olds category compared to the younger groups.

Conclusion

For children older than 3 years, the majority of pediatric radiologists are very confident in their use of Greulich and Pyle for bone age assessment. However a variety of methodologies are used when assessing bone age in infants and younger children, and pediatric radiologists are less confident assessing bone age in these children. This survey highlights the need for a consensus protocol on bone age assessment of younger children and infants that provides readers with a higher degree of confidence.

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Author information

Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA

    Micheál A. Breen, Andy Tsai, Aymeric Stamm & Paul K. Kleinman

Authors
  1. Micheál A. Breen
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  2. Andy Tsai
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  3. Aymeric Stamm
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  4. Paul K. Kleinman
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Corresponding author

Correspondence to Micheál A. Breen.

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Appendix A

Appendix A

  1. Q1.

    How many years’ experience do you have as an attending radiologist?

    Options: Less than 1 year, 1–5 years, 6–10 years, 11–20 years, >20 years

  2. Q2.

    On average, how often do you perform bone age assessment in your practice?

    Options: Less than once per week, 1–10 times per week, 11–20 times per week, more than 20 times per week

    Which bone age assessment technique do you use for the following age categories?

    If you use more than one method, please select all methods you use for that age group.

    Methods listed as options:

    • Greulich, Pyle. Radiographic Atlas of Skeletal Development of the Hand and Wrist

    • Hoerr, Pyle, Francis. Radiographic Atlas of Skeletal Development of the Foot and Ankle

    • Pyle, Hoerr. A Radiographic Standard of Reference for the Growing Knee

    • Tanner, Whitehouse et al. (TW2 method for scoring the hand and wrist)

    • Gilsanz, Ratib. Hand Bone Age. A Digital Atlas of Skeletal Maturity

    • Roche, Chumlea, Thiessen. Assessing the Skeletal Maturity of the Hand and Wrist: Fels Method

    • Other (please specify)

  3. Q3.

    Birth to 11 months category (chronologic age)

  4. Q4.

    1 year to 2 years, 11 months category (chronologic age)

  5. Q5.

    3 years to 18 years category (chronologic age)

  6. Q6.

    When you encounter a child that has a skeletal bone age that is substantially delayed compared to their chronologic age, do you ever then adopt a different assessment technique?

    Options: Frequently, occasionally, never

  7. Q7.

    When using an atlas/template matching method, if you cannot decide between two bone age standards, which one of the following best describes the strategy you adopt?

    Options: Pick one of the two reference standards, provide a mid-point interpolation between two reference standards, provide the range of the two reference standards, use another method/technique/interpolation strategy (if so, please describe)

  8. Q8.

    How confident are you with the accuracy of your chosen technique for bone age assessment in the Birth to 11 months category (chronologic age)?

    Options: Very confident, somewhat confident, somewhat unconfident, very unconfident.

  9. Q9.

    How confident are you with the accuracy of your chosen technique for bone age assessment in the 1 year to 2 years, 11 months category (chronologic age)?

    Options: Very confident, somewhat confident, somewhat unconfident, very unconfident.

  10. Q10.

    How confident are you with the accuracy of your chosen technique for bone age assessment in the 3 years to 18 years category (chronologic age)?

    Options: Very confident, somewhat confident, somewhat unconfident, very unconfident

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Breen, M.A., Tsai, A., Stamm, A. et al. Bone age assessment practices in infants and older children among Society for Pediatric Radiology members. Pediatr Radiol 46, 1269–1274 (2016). https://doi.org/10.1007/s00247-016-3618-7

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  • DOI: https://doi.org/10.1007/s00247-016-3618-7

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