Abstract
PurposeTo assess reader performance and subjective workflow experience when reporting bone age studies with a digital bone age reference as compared to the Greulich and Pyle atlas (G&P). We hypothesized that pediatric radiologists would achieve equivalent results with each method while digital workflow would improve speed, experience, and reporting quality.Materials and methodsIRB approval was obtained for this HIPAA-compliant study. Two pediatric radiologists performed research interpretations of bone age studies randomized to either the digital (Digital Bone Age Companion, Oxford University Press) or G&P method, generating reports to mimic clinical workflow. Bone age standard selection, interpretation-reporting time, and user preferences were recorded. Reports were reviewed for typographical or speech recognition errors. Comparisons of agreement were conducted by way of Fisher’s exact tests. Interpretation-reporting times were analyzed on the natural logarithmic scale via a linear mixed model and transformed to the geometric mean. Subjective workflow experience was compared with an exact binomial test. Report errors were compared via a paired random permutation test.ResultsThere was no difference in bone age determination between atlases (p = 0.495). The interpretation-reporting time (p < 0.001) was significantly faster with the digital method. The faculty indicated preference for the digital atlas (p < 0.001). Signed reports had fewer errors with the digital atlas (p < 0.001).ConclusionsBone age study interpretations performed with the digital method were similar to those performed with the Greulich and Pyle atlas. The digital atlas saved time, improved workflow experience, and reduced reporting errors relative to the Greulich and Pyle atlas when integrated into electronic workflow.
Highlights
The determination of pediatric skeletal maturity is important for a number of clinical indications; for example, the diagnosis of disorders of growth and development, the timing of pediatric corrective surgeries for limb-length discrepancy and scoliosis, and the assessment of treatment response in certain endocrine conditions [1]
A left hand radiograph was a component of each examination, and nearly 14,000 left hand radiographs were obtained during the study and painstakingly analyzed by Greulich, Pyle, and their associates during the development of Greulich and Pyle atlas (G&P)
We identified 96 bone age examinations (Table 1), which had been previously interpreted at least 1 year previously at a tertiary care center by two fellowship-trained faculty pediatric radiologists (10 and 29 years of focused pediatric radiology experience) using the G&P method
Summary
The determination of pediatric skeletal maturity is important for a number of clinical indications; for example, the diagnosis of disorders of growth and development, the timing of pediatric corrective surgeries for limb-length discrepancy and scoliosis, and the assessment of treatment response in certain endocrine conditions [1]. These assessments have important applications in forensic science [2]. Greulich and Pyle selected representative radiographs to correspond with each chronological age represented in the atlas Comparing these chosen standards with hundreds of normal children of similar chronological age, they were able to calculate standard deviations at each chronological age represented by their chosen standards. This rigorous approach and extensive data from repeated radiation exposure in normal children have contributed to the longevity of G&P
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