Bone Maturity Scores Research Articles

SVTNet: Automatic bone age assessment network based onTW3method and vision transformer

AbstractThis study aims to develop a proficient and clinically applicable algorithm that can accurately assess bone age. This algorithm is based on the principles of the Tanner‐Whitehouse 3 (TW3) integral approach, and aims to achieve efficiency, scalability, and interpretability. We developed a model for bone age prediction in children. The model was tested on a pediatric dataset from a tertiary care hospital consisting of left‐hand radiographs of children between the age of 0 and 18. Our model consists of removing the arm portion using a pre‐trained YOLO network, localizing 37 key points in the hand bone portion using a spatial configuration network, and segmenting the original image through 20 of these points to obtain 20 fixed‐size patches. Finally, each of the 20 bone images is classified by training a visual transformer (ViT) model. In this study, a hybrid network, SVTNet, was developed that incorporates visual transformers to obtain estimates of bone age in the carpal (C series) and metacarpal (RUS series) bones. The sum of the clinical TW3 scoring region scores and bone maturity scores were utilized to determine the bone age for each corresponding region. The performance of the algorithm was evaluated in terms of both training and testing by evaluating 3871 left hand X‐ray micrographs obtained from a tertiary hospital in China. The results showed that the average absolute error of bone age estimation was 0.50 years for the RUS series of bones and 0.47 years for the C series of bones. The main contribution of this study is to propose, for the first time, a ViT‐based bone age assessment method that automates the entire process of the TW3 algorithm and is clinically interpretable, with predictive accuracy comparable to that of an experienced orthopedic surgeon.

Sports participation reduces the progression of idiopathic scoliosis and the need for bracing. An observational study of 511 adolescents with Risser 0-2 maturation stage.

In clinics and the literature, there are doubts about the indications and contraindications of sports to support rehabilitation treatment for adolescents with idiopathic scoliosis (IS). The aim of the study is to assess sports activities' effect and frequency in a large population of adolescents with idiopathic scoliosis (IS). Retrospective observational cohort study. Tertiary referral institute specialized in the conservative treatment of scoliosis. consecutive patients in a clinical database of age ≥10, with juvenile or adolescent IS diagnosis, 11-25° Cobb curve, Risser Bone Maturity Score 0-2, no brace prescription, radiographic follow-up radiographs at 12±3 months. At 12-month follow-up, radiograph, we considered progression an increase of scoliosis curve ≥5° Cobb and failure an increase to ≥25° Cobb - need of a brace. We calculated the Relative risk (RR) to compare the outcome of participants performing sports (SPORTS) or not (NO-SPORTS). We run a logistic regression with covariate adjustment to assess the effect of sports participation frequency on the outcome. We included 511 patients (mean age 11.9±1.2, 415 females). Participants in the NO-SPORTS group showed a higher risk of progression (RR=1.57, 95% CI: 1.16-2.12, P=0.004) and failure (RR=1.85, 95% CI: 1.19-2.86, P=0.007) than participants in SPORTS. Logistic regression confirmed that the more frequent the sports activities, the less probable progression (P=0.0004) and failure (P=0.004) were. This study shows that sports activities have a protective role against progression at 12-month follow-up in adolescents with milder forms of IS. Excluding high-level sports activities, the risks of progression and failure decrease with the increase in sports frequency per week. Albeit non-specific, sports can help in the rehabilitation of patients with idiopathic scoliosis and reduce brace prescription.

Effects of Local Application of Adipose-Derived Stromal Vascular Fraction on Tendon-Bone Healing after Rotator Cuff Tear in Rabbits.

Effects of Local Application of Adipose-Derived Stromal Vascular Fraction on Tendon-Bone Healing after Rotator Cuff Tear in Rabbits.

Ethnic and sex differences in skeletal maturation among the Birth to Twenty cohort in South Africa

AimTo examine ethnic and sex differences in the pattern of skeletal maturity from adolescence to adulthood using a novel longitudinal analysis technique (SuperImposition by Translation And Rotation (SITAR)).SettingJohannesburg, South Africa.Participants607...

Transplantation of Human Dental Pulp Stem Cells: Enhance Bone Consolidation in Mandibular Distraction Osteogenesis

The main aim of the present study was to evaluate the capacity of stem cells from human exfoliated deciduous teeth (SHED) to enhance mandibular distraction osteogenesis (DO) in rabbits. A randomized controlled trial was conducted. Eighteen skeletally immature New Zealand white rabbits were divided into 2 groups, with 9 in the control group and 9 in the SHED group. The SHED were isolated, expanded, and characterized. Six million cells were transplanted into the distracted area during the osteotomy period. After a 4-day latency period, a total of 6 mm was distracted for 6 days. The newly formed bone was analyzed radiologically, histologically, and histomorphometrically at 2, 4, and 6 weeks postoperatively. Nonparametric analysis of variance (Kruskal-Wallis test) was used for data analysis, and P < .05 was considered statistically significant. The cell lineage was positive for the 2 mesenchymal stem cell markers tested (CD105 and CD166). More mature bone in the SHED transplanted group was observed radiographically and histologically. Histomorphologically, the percentage of newly formed bone after 2, 4, and 6 weeks was 18.41% and 41.53%, 31.68% and 59.78%, and 52.34% and 65.24% in the control and SHED groups, respectively. The difference between the groups was statistically significant (P = .012). The bone union and stage of bone maturity scores were significantly different between the control and SHED groups (P = .006 and P = .011, respectively). Our findings suggest that SHED can serve as an additional cell resource for DO enhancement in rabbits and might be a promising model for the reconstruction of large mandibular defects in human oral maxillofacial surgery.

Prediction of Contralateral Slipped Capital Femoral Epiphysis Using the Modified Oxford Bone Age Score

The purpose of the present study was to determine whether the modified Oxford bone score can be used as a predictor for the risk of developing contralateral slipped capital femoral epiphysis (SCFE) in children who present with a unilateral slip. We identified 260 patients treated for unilateral SCFE between 1980 and 2002 and followed them up to skeletal maturity or until development of contralateral slip. Exclusion criteria included patients with endocrine or metabolic disorder, Down syndrome, and those with radiographs inadequate to determine the modified Oxford bone score. The initial radiographs were given a score ranging from 16 to 26. Statistical analysis was used to determine whether the modified Oxford bone score was predictive of future development of contralateral slip. A linear regression model was used to estimate the probability of future development of a contralateral slip as related to the modified Oxford bone score. Of the 260 patients, 64 (24%) developed a contralateral slip, at an average of 10 months after initial presentation. Race, sex, age, and weight at initial presentation were not predictive of the development of contralateral slip. The modified Oxford score and a triradiate score of 1 were found to be significant (P<0.0001) predictors, with the modified Oxford score a better overall predictor. The modified Oxford bone age score is the best predictor of the risk of development of a contralateral SCFE in patients presenting with a unilateral slip. Controversy exists regarding prophylactic pinning of a normal hip in patients presenting with unilateral SCFE. The benefits of prophylactic pinning must outweigh risk. This study provides probability data for predicting a contralateral slip based on the modified Oxford bone maturity score that can be shared with families and allows physicians to decide their threshold for prophylactically pinning the contralateral hip in patients presenting with a unilateral slip. Therapeutic level IV, Case series.

Effects of implant regimens (trenbolone acetate-estradiol administered alone or in combination with zeranol) and vitamin D3 on fresh beef color and quality.

In the first oftwo experiments, 123 calf-fed steers were used over a 2-yr period to evaluate the effects of trenbolone acetate (TBA)-based implants administered alone or in combination with zeranol implants on fresh beef muscle quality, color, and physiological maturity of the carcass. Implant treatments decreased (P < 0.05) a* values (d 0 and d 3 of retail display) and b* values (d 0, d 1, and d 3 of retail display) after 14 d of aging. Carcasses from cattle initially implanted with Revalor-S and reimplanted with Revalor-S on d 60 of the finishing period showed increased lean and bone maturity scores and ash content of the 9th to 11th thoracic buttons and Warner-Bratzler shear force values (WBS) compared to those initially implanted with Ralgro and subsequently reimplanted with Revalor-S or control cattle. In addition, implants decreased (P < 0.05) marbling, percentage of the carcasses grading Choice, and kidney, pelvic, and heart fat (KPH). Implant treatments increased (P < 0.05) ADG, hot carcass weights, and longissimus muscle (LM) area. In the second experiment over a 2-yr period, 166 steers fed as yearlings were allotted to one of two implant treatments and one of two vitamin D3 preharvest supplementation treatments. Implanted steers had heavier (P < 0.05) final body weights and higher (P < 0.05) ADG, less (P < 0.05) KPH fat, and larger (P < 0.05) LM. Also, implanted steers had more (P < 0.05) advanced bone maturity scores, higher (P < 0.05) ash content of the 9th to 11th thoracic buttons, and higher (P < 0.05) WBS values on 5-d postmortem loin steaks. Vitamin D3 feeding decreased (P < 0.05) final live weight, ADG (P < 0.05), and LM (P < 0.05), but did not significantly improve WBS values. In Experiment 2, neither implant treatment nor vitamin D3 supplementation had significant effects on L*, a*, or b* values of muscles in steaks before or during simulated retail display.

Standard bone-age of infants and children in Korea

To evaluate the developmental status of children and adolescents, a bone-age chart based on the radiograph of hand and wrist has been used in many countries. Bone-age reflects not only the functional status of various hormones but also the influence of chronic disease and it has been used more widely than other indices such as the height-weight-age table. As a standard bone-age chart has not been established in Korea, a foreign bone-age chart has been used in clinics. To make a Korean standard bone-age chart, we took the radiographs of the left hand of about 5,400 children covering the whole country, and 3,407 radiographs of 1,830 boys and 1,577 girls ranging from two months to 16 years of age were selected and analyzed for bone maturity scores by the TW2-20 method. The range of ages were divided into 27 groups, and the radiographs of 50th percentile score were chosen as the standard bone-ages for the median age of each group. The youngest and oldest chronological age which had the same TW2-20 score of the standard bone-age were decided as the range of variation from the median age. We hope that a Korean standard bone-age chart can be used as the radiological index in the evaluation of the developmental status in Korean children and adolescents.

Main problems associated with bone age and maturity evaluation.

In scientific papers, skeletal maturation-expressed as bone maturity scores or bone age-is often used as a quantifiable variable similar to height or weight. This paper discusses whether this approach is appropriate. The questions addressed are whether skeletal maturation can be measured on a quantitative scale, whether its use is appropriate in computing, and what the 'numbers' used represent. Reference will be made mainly to the Tanner-Whitehouse method, which, in the opinion of the authors, has been the most reliable method of assessment to date. Many of the remarks made in this paper may be extended to other methods of assessment, and have been stressed by Tanner himself. The authors are aware that, in the future, some of the remarks could be made redundant by the development of more detailed definitions of bone maturation. This is becoming feasible with the advent of expert systems for the automatic recognition of different stages of bone maturation.

Assessment of bone ages by the Tanner-Whitehouse method using a computer-aided system.

A computer-aided system to estimate bone age based on Fourier analysis was assessed by reference to the original radiographs used to produce the Tanner-Whitehouse 2 (TW2) standards for the radius, ulna and short finger bones. The computer-aided system involved matching a template of each bone to the scanned image of the radiograph. The computer then generated a stage of bone maturity, individual and total bone scores and a value for bone age. The bone ages assessed by the computer-aided system were no different from the original TW2 reference values, indicating the applicability of the system. The system was used to assess the bone ages of tall Dutch girls, and the results obtained were compared with more traditional assessments made by an experienced rater. For the radiographs from the tall girls, there was good agreement for individual bones between this method and the traditional assessment by the rater, but less agreement for the total 13-bone score and bone age.

The Tanner-Whitehouse II Skeletal Maturity Method: Rationale and Applicability

The problem of skeletal maturity assessment is to measure, stage by stage, the metamorphosis of the cartilaginous and membranous skeleton of the foetus into the fully ossified bones of the adult. Whilst skeletal maturation is a continuous process its assessment requires the identification of discrete indicators of development that are sequential, invariate between individuals, universal, and that cover the full range of development from birth to full maturity. The Tanner-Whitehouse II method is a bone-specific scoring technique in which a numerical score is assigned to selected hand-wrist bones depending on the appearance of certain well defined maturity indicators. The advantage of this technique over previous Atlas methods is that the maturational differences between bones is statistically minimised thus reducing disagreement between bones. The resulting bone maturity score is indicative of a specific maturational level in the sample to which the bone maturity scores are compared. Whilst the TW II technique has been applied to a variety of samples from many countries it is accepted that population and geographic differences exist in rate of maturation and that, therefore, there is a need to develop population specific “standards”. Such national standards would allow the sensitive diagnosis and treatment of children with growth disorders.

Differences in adult height between well-off North-west Indians and britains as a product of lower height gain per unit bone maturity advance during the adolescent years

Attained mean heights of well-off North-west Indian children showed close parity with British children up to 12 years in girls and 14 years in boys. Thereafter their attained means become less, resulting in shorter mean adult stature. Comparison of the tempo-unconditional single 1-year velocities of height showed that the total adolescent gain in both the populations was similar. The shorter mean adult height in well-off North-west Indians could be explained by lower height gain per unit RUS bone maturity score advance (growth potential). This may result from tropical climate and lower amounts of circulating calcium.

Tempo-unconditional 1-year bone score velocities in well-off North-west Indian children

Tempo-unconditional 1-year bone maturity score velocities in well-off 6-16 year-old North-west Indian children from Chandigarh (245 boys and 238 girls) are presented for the first time using the TW2 system. Rater's replicability/comparability was high. The peak RUS bone maturity score velocity is reached at 13 years in girls and at 15 years in boys, maintaining a standard 2-year difference. Velocities of the three bone maturity scores are relatively larger, but their respective standard deviations are smaller than those reported for American whites and blacks. North-west Indian children seem to be maturing faster than the British standards.

Effect of plane of nutrition and age on carcass maturity of sheep.

One hundred twenty ewe and wether lambs were fed high (76% TDN, 12.3% crude protein) or low (70.6% TDN, 16.1% crude protein) energy diets and slaughtered at average ages of 261, 356 or 469 d. High planes of nutrition for lambs at 356 or 469 d of age resulted in heavier carcasses, thicker fat depth and higher flank streaking scores compared to lambs fed low planes of nutrition. Rib bone, break joint and overall maturity scores were not influenced (P greater than .05) by diet. Metacarpal and metatarsal bones from lambs fed high planes of nutrition were slightly longer and heavier and required more force to break (P less than .05) compared with bones from lambs fed low planes of nutrition. The majority of the ewes fed high or low planes of nutrition had fused growth plates and possessed spool joints by 469 d; none of the wethers had spool joints. An additional 27 wethers were slaughtered at an average of 480, 578 or 662 d. Rib bone, break joint and overall maturity scores were not different (P greater than .05) for animals fed the high or low energy diets, but bone weight and shaft break force values were higher for those fed high energy diets. At 662 d of age, only 20% of the wethers on each dietary regimen possessed fused growth plates. Overall, plane of nutrition in market-weight lambs and yearlings had very little influence on the presence or absence of a break joint or on other bone maturity scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Skeletal maturity in Danish schoolchildren assessed by the TW2 method.

Skeletal maturity was assessed from hand-wrist radiographs in a sample of 3,817 Danish schoolchildren aged 7 to 18 years using the new version of the bone-specific Tanner-Whitehouse scoring system, the TW2 method. In most of the age groups in both sexes the distributions of the bone maturity scores displayed marked departures from normality; percentiles for the scores were therefore counted from the raw data. On the average, over the total age range, the differences between the age equivalents (bone ages) for the fiftieth percentile and chronological age were close to zero in both sexes, indicating good agreement with the British standards. However, in the individual age groups, and in particular at adolescence, characteristic divergences from the standards occurred, apparently reflecting the developmental spurt.

The effects of protein supplementation on the growth and skeletal maturation of New Guinean school children.

SummaryThe response to protein supplementation was studied in 86 Bundi children, aged 7·7 to 13·0 years, in the New Guinea highlands. Group 1 (22 males, 8 females) served as a control and received only their normal school diet, averaging 5440 kJ and 11 g protein per day. Group 2 children (22 males, 8 females) were supplemented with 10 g of protein per day for five days a week and group 3 (18 males, 8 females) received 20 g protein per day. The supplement was skim milk powder and the experiment lasted for eight months. Increments of growth and of skeletal maturation of individuals were analysed, by group, for the eight-month period. Height, weight, skinfold thickness (triceps and subscapular), compact bone breadths of the second metacarpal, and Tanner-Whitehouse bone maturity scores were studied. Supplemented children showed increased growth in height, weight, and periosteal bone breadth, as well as increased increments of skeletal maturation. While unsupplemented children showed increases in skinfold thicknesses, the increments of the supplemented groups did not differ significantly from zero. There were no differences in either the endosteal breadth or the thickness of the compact bone layer of the second metacarpal. Children receiving 20 g of protein displayed consistently greater increments than those receiving 10 g but the differences were significant only in the case of body weight. The relative response of height to protein supplementation was greater than the response of skeletal maturation.

The growth and development of rats given a low-protein diet.

1. Weanling (24-d-old) rats of a black and white hooded strain were allowed free access for 28 d to a diet containing 5% casein supplemented with methionine, and sucrose as the carbohydrate. Controls were fed on a 25% casein diet with a corresponding reduction in sucrose. Animals given the deficient diet were killed either at 52 d of age or after subsequent rehabilitation on the 25% casein diet when aged 140 d. These animals were compared with controls killed at these two ages and at the start of the experiment.2. The skeletons were X-rayed, skeletal maturity was determined according to a scoring system, and various bones were measured. The forebrain and cerebellum were analysed for cholesterol and DNA and the brain stem for cholesterol only. The DNA content of the paired quadriceps muscles and the livers was also determined.3. On the low-protein diet the body-weight rose by 7 g compared with the control value of 115 g. On rehabilitation, the body-weight of the previously malnourished group showed the expected growth spurt, but failed to attain that of the controls at 140 d.4. With the exception of the pelvis width, all the bones grew a little during the period on the low-protein diet. After rehabilitation, the hind limb, pelvis, iliac and spine lengths and the bi-iliac width remained smaller than these measurements in the corresponding controls, whereas there was no difference in the length of the fore limb, width of the pelvis or in the bone maturity score.5. The forebrains and cerebellums of the malnourished rats did not increase in weight, whereas some increase occurred in the brain stem. The concentration of cholesterol in the forebrains of the deficient animals was the same as that in controls of the same age, but on rehabilitation the concentration did not rise to the control value. The concentration of cholesterol in the cerebellum and brain stem of the deficient rats was lower than in controls of the same age but, whereas that in the cerebellum attained an almost normal level on rehabilitation, that in the brain stem remained significantly lower. The low-protein diet prevented the normal increase in cerebellum DNA and the amount remained low in the rehabilitated animals.6. The experimental diet caused a complete cessation of growth of the quadriceps muscles, and even after rehabilitation they weighed less than their controls. The DNA content, however, was not significantly lower.7. The low-protein diet did not permanently affect either the weight or DNA content of the liver.