Bone In Children Research Articles

Associations of linear growth and weight gain in the first 2 years with bone mass at 4 years of age in children in Dhaka, Bangladesh.

Growth faltering is widespread in many low- and middle-income countries, but its effects on childhood bone mass accrual are unknown. The objective of this study was to estimate associations between length (conditional length-for-age z-scores, cLAZ) and weight (conditional weight-for-age z-scores, cWAZ) gain in 3 age intervals (ages 0-6, 6-12, 12-24 months) with dual-energy x-ray absorptiometry (DEXA)-derived measures of bone mass (total-body-less-head (TBLH) bone mineral content (BMC), areal bone mineral density (aBMD), and bone area) at 4 years of age. Associations between interval-specific growth parameters (cLAZ and cWAZ) and bone outcomes were estimated using linear regression models, adjusted for maternal, child, and household characteristics. Data collection occurred in Dhaka, Bangladesh. 599 healthy children enrolled in the BONe and mUScle Health in Kids Study. cLAZ in each age interval was positively associated with TBLH BMC, aBMD, and bone area at 4 years; however, associations attenuated towards null upon adjustment for concurrent height-for-age z-scores (HAZ) at age 4 years and confounders. cWAZ from 0-6 and 6-12 months was not associated with bone mass, but every SD increase in cWAZ between 12-24 months was associated with greater BMC (7.6g; 95%CI:3.2, 12.0) and aBMD (0.008g/cm2; 95%CI:0.003, 0.014) after adjusting for concurrent WAZ, HAZ, and confounders. Associations of linear growth (birth to 2 years) with bone mass at age 4 years were explained by concurrent HAZ. Weight gain in the second year of life may increase bone mass independently of linear growth in settings where growth faltering is common.

Musculoskeletal Sepsis in the Pediatric Intensive Care Unit

Background: Childhood bone and joint infection (BJI) ranges in severity, with the most unwell children requiring pediatric intensive care unit (PICU) support. We describe demographic and prehospital features of BJI cases associated with PICU admission and report treatment outcomes and costs for these cases. Methods: This study includes a retrospective cohort of children ≤15 years of age hospitalized with acute hematogenous osteomyelitis or septic arthritis in Auckland between 2018 and 2023. Cases admitted to PICU were compared to non-PICU hospitalized BJI cases. Direct medical hospitalization costs, treatment type and outcomes were described up to 1 year following discharge. Results: Of 563 BJI cases, 43 (8%) were admitted to PICU. PICU cases had shorter prehospital symptom duration (3.78 vs. 5.73 days, P = 0.0002). Sensitive Staphylococcus aureus was equally likely to cause disease in PICU and non-PICU cases (P = 0.86). Average hospitalization was longer (35.78 vs. 8.71 days, P ≤ 0.0001) for those admitted to PICU. Readmission and complication rates were both higher within the first year. Average cost per admission was $378,120 NZ dollars (±$796,891.64) for PICU cases versus $32,219 (±$201,797.33), P = 0.01 for cases not requiring PICU admission. In regression analysis, Māori ethnicity, previous history of infections and congenital conditions were statistically associated with PICU admission. Conclusion: In this study, children admitted to PICU with severe BJIs were more likely to have a history of congenital conditions or previous infections. Those of Māori ethnicity are overrepresented. Children treated in PICU have longer hospitalizations and experience more adverse outcomes at 1 year following discharge.

Chondroblastoma of Bone in Children: A Study of 3 Cases

Chondroblastoma is a benign bone tumor arising most often in the epiphyses of long bones. Nearly 90% occurred in patients between the ages of 5 and 25 years, but tumors were found in later adulthood and even in old age. A few chondroblastomas were predominantly cystic, and some contained zones that were indistinguishable microscopically from aneurysmal bone cysts. Conservative surgical removal, nearly always effective, should be thorough so as to minimize the risk of the occasional troublesome recurrence. Late sarcomatous change has been reported in a few cases whether radiation therapy was employed or not. We report a series of 3 boys with chondroblastoma, with an average age of 12 years. All our patients underwent biopsy for confirmation and then surgical treatment consisting of curettage of the lesion followed by bone autograft filling. The aim is to discuss the anatomoclinical and evolutionary aspects of this rare tumour, to evaluate the results of surgical treatment and to identify the factors influencing the rate of recurrence after treatment.

Perda precoce dos elementos 11 e 12 por trauma dental, com intervenção ortodôntica preventiva na odontopediatria: relato de caso

Dental trauma is one that affects the hard tissues embraced, supporting structures or soft tissues in the oral cavity. It is observed more frequently in male children of school age (07 to 12 years old). The most affected teeth in the trauma taken are central and lateral incisors. With regard to tooth avulsions, the protection of children's bone tissue favors a higher frequency in this population than in the adult population. Dental avulsion occurs after displacement of the element out of its alveolus. There is a break in the blood supply to the pulp of the tooth and when this happens the chance of replantation achieved is totally impossible. Thus bringing several harms to the patient such as difficulty in speech, poor aesthetics, or even mesialize or distalize some other acquired element. Space maintainers are used as removable or fixed appliances to treat malocclusion or esthetic defects. They are braces made of acrylics with two extended teeth. Choosing a removable appliance comes with benefits such as better hygiene, satisfactory aesthetics, low cost, and maintenance of the cervico-occlusal space, in addition to the mesio-distal space. The objective of this study was to report a clinical case of avulsion of element 11 and 12 caused by trauma in childhood with the use of a space maintainer. We conclude that it is possible to treat a patient with dentoalveolar trauma with intervention using a space maintainer, since in the present case success was obtained in the selection of therapy, restoring aesthetics and function to the patient. Thus reducing possible orthodontic problems of the child, with follow-up until his/her old age.

Meeting report from the 3rd ISCBH-ERN BOND Achondroplasia Workshop on Long Bone Pathology in Children with Achondroplasia, Salzburg, Austria 22nd June 2024

A pre-meeting workshop on Long Bone Pathology in Children with Achondroplasia was held in Salzburg, Austria at the 11th International Conference on Children's Bone Health (ICCBH) 22–25 June 2024. There remains poor understanding and awareness amongst physicians managing achondroplasia of the underlying pathophysiology, radiology, natural history and orthopaedic procedures available for long bone deformities and restrictions. The structure of the workshop consisted of presentation of the results of a multinational patient survey on views of leg lengthening in achondroplasia, lectures, a debate and an interactive round table discussion. In total 150 attendees from 71 different cities and 31 countries were in attendance.

The Seasonality of Childhood Bone and Joint Infection with Focus on Kingella kingae

Background: Seasonal trends in hospitalization for childhood bone and joint infection (BJI) are reported inconsistently. True seasonal variation would suggest an element of disease risk from environmental factors. This review evaluates all reported seasonal variations in childhood BJI, with additional analysis of seasonal trends for diseases secondary to Kingella kingae. Methods: A systematic review of the literature was undertaken from January 1, 1980, to August 1, 2024. Data were extracted on the hospitalization rate by season and/or month. Pathogen-specific studies for BJI secondary to K. kingae were examined separately. Results: Twenty studies met inclusion criteria encompassing 35,279 cases of childhood BJI. Most studies reported seasonal variation (n = 15, 75%). Eight studies specifically considered disease secondary to K. kingae, and all reported more frequent hospitalization in autumn and/or winter. This is in keeping with the role of respiratory pathogens and seasonal viruses in disease etiology for K. kingae BJI. Findings from other studies on the seasonality of childhood BJI were inconsistent. There were reported seasonal peaks in autumn/winter (4 studies), summer/spring (5 studies), or no variation (5 studies). Where microbiologic data were available, Staphylococcus aureus was the primary pathogen. The quality assessment demonstrated confounding and heterogeneous inclusion criteria affecting the seasonal analysis. Conclusion: For childhood BJI caused by K. kingae, there appears to be a higher risk of hospitalization in autumn and/or winter months. This may relate to the seasonal circulation of respiratory viruses. There is currently insufficient evidence to support other forms of seasonal variation. Reported findings are likely affected by regional disease and pathogen characteristics. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Moderate-to-vigorous physical activity modulates the association between serum 25-hydroxyvitamin D and bone stiffness in European children and adolescents

It remains unclear how serum 25-hydroxyvitamin D (25(OH)D) concentrations relate to childhood bone health. We hypothesized that 25(OH)D was inversely associated with bone turnover biomarkers and positively associated with bone stiffness. Cross-sectional analyses were performed using data from participants (2-15-year-old, 51% boys) from the IDEFICS/I.Family cohort, comprising 3,638 serum 25(OH)D measurements collected in 2007/2008 and 2012/2013 across eight European countries. A biomarker of bone formation (serum osteocalcin), a biomarker of bone resorption (serum C-terminal telopeptides of type I collagen [CTx]), and stiffness index measured using calcaneal quantitative ultrasound were considered outcomes. Linear mixed-effects models were used to adjust for confounders (i.e., age, sex, parental education, time spent in sports club, dairy products consumption, sedentary behavior, height and weight z-scores), the cluster effect of country and repeated measurements. Interactions of calcium intake, moderate-to-vigorous physical activity (MVPA) and weight status with 25(OH)D on outcomes were tested. Only 1 in 3 participants reached the sufficient 25(OH) D concentration of 20 ng/ml. Sufficient 25(OH)D was associated with higher stiffness index if participants had MVPA ≥ 60 min/day (β = 12.14, p < 0.05). Moreover, 25(OH)D was inversely associated with CTx (β = -7.09, p < 0.05); this association was positive but not statistically significant among primary school children living with overweight/obesity. No interaction was observed for calcium intake. In conclusion, serum 25(OH)D and CTx were inversely associated. MVPA interacted the positive association between 25(OH)D and bone stiffness, highlighting the importance of promoting MVPA guidelines in future vitamin D and bone health interventions.

Impact of BMI on childhood growth, pubertal timing, and bone maturation: A comprehensive review and clinical implications

Introduction: Childhood obesity and undernutrition significantly affect growth patterns, pubertal timing, and bone maturation, leading to long-term health implications. Materials and Methods: A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and Scopus. Twenty-four studies, including a total of 40,732 patients, were analyzed from two tables examining the impact of BMI, growth patterns, pubertal timing, and bone maturation. Results: Children with high BMI exhibit accelerated linear growth during early childhood, that may be driven by elevated leptin levels, which stimulate growth before puberty. Despite early growth advantages, these children experience reduced height gain during adolescence due to advanced bone maturation and earlier closure of growth plates. High BMI is strongly linked to early puberty, especially in girls, as increased adipose tissue raises leptin levels, triggering early pubertal onset. Boys, however, show variability in pubertal timing, with severe obesity sometimes delaying puberty. In contrast, children with low BMI or undernutrition demonstrate delayed linear growth and delayed puberty. Nutritional deficits lead to reduced growth velocity, delayed pubertal onset, and extended pubertal periods due to a lack of adipose tissue and hormonal deficiencies in leptin and kisspeptin. Nutritional rehabilitation promotes catch-up growth, allowing for extended growth potential by delaying growth plate closure. However, full recovery may not occur in cases of prolonged or severe undernutrition. Advanced bone age in high BMI children shortens the pubertal growth spurt, while delayed bone maturation in undernourished children offers a prolonged period for potential growth, contingent on timely nutritional support. Conclusion: Timely interventions for childhood obesity and undernutrition are critical to improving growth outcomes and preventing long-term developmental delays. Early identification, nutritional rehabilitation, and lifestyle modifications can help optimize growth and pubertal development by addressing both advanced and delayed growth trajectories.

Optimal Timing for Advanced Imaging in Childhood Bone and Joint Infection

Objective: Advanced imaging in the management of childhood bone and joint infection (BJI) has the potential to improve disease outcomes. Knowledge about the optimal timing for magnetic resonance imaging (MRI) in relation to both surgically and nonsurgically managed BJI is limited. This study examines the impact of MRI timing on number of surgeries, length of stay (LOS), hospitalization cost, and disease recurrence in childhood BJI. Methods: This is a retrospective review of patients younger than 16 years with acute hematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region from 2018 to 2023. Cases undergoing MRI as part of diagnostic workup were included. Treatment, hours between admission and MRI, LOS, hospitalization cost, and infection recurrence were assessed. Results: There were 563 cases of BJI, of which 390 met the inclusion criteria. Cases were primarily AHO (85%). The percentage of cases having MRI increased over time from 54% (2018) to 80% (2023). Locally disseminated infections such as subperiosteal abscess or adjacent septic arthritis occurred in 48%. Children with preoperative (n = 145) versus postoperative MRI (n = 60) had a lower reoperation rate (33% vs 77%, P = 0.001) and shorter LOS (14.1 vs 22.4 d, P = 0.002). Hospitalization costs appeared lower but did not differ statistically ($59,419 vs $159,353, P = 0.12). In nonoperative cases, LOS was shorter if an MRI occurred within 48 hours of admission (7.3 vs 10 d, P = 0.03). Disease recurrence was not associated with MRI timing. Conclusion: Overall, children with BJI who underwent MRI scans before surgery had lower reoperation rates. Children receiving MRIs within 48 hours of admission had shorter LOS.

Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and childhood bone mineral density: A prospective birth cohort study

Background and aimPerfluoroalkyl and polyfluoroalkyl substances (PFAS) have demonstrated potential toxicity in skeletal development. However, the relationship between prenatal PFAS exposure and offspring bone health remains unclear in epidemiological studies. Therefore, we aim to investigate whether prenatal exposure to PFAS is associated with bone mineral density (BMD) in offspring. MethodThis study population included 182 mother-child pairs in the Shanghai Obesity and Allergy Cohort, enrolled during 2012–2013. 10 PFAS were measured by liquid chromatography-mass spectrometry (LC-MS) in cord plasma. The child's spinal BMD was measured using a dual-energy X-ray absorptiometry (DXA) scanner at the age of 8. Multivariable linear regression models were used to estimate the associations between individual PFAS concentrations (as a continuous variable or categorized into quartiles) and child BMD. Bayesian kernel machine regression (BKMR) was employed to explore the joint effects of PFAS mixtures on BMD. ResultsAmong the 10 PFAS, 8 of them had a detection rate >90% and were included in the subsequent analysis. We observed no significant associations between individual PFAS (as a continuous variable) and spinal BMD in 8-year-old children using the multivariable linear regression model. When treated as quartile categories, the second and fourth quartiles of perfluorobutane sulfonate (PFBS) was associated with higher BMD in the first lumbar vertebra, compared with the lowest quartile. BKMR analysis revealed no association between the PFAS mixture and child BMD. ConclusionWe observed no associations of prenatal PFAS exposure with child BMD at 8 years of age. Given the inconsistent epidemiological evidence, further research is needed to confirm these findings from other studies or elucidate the potentially toxic effects of PFAS on bone.

Children's bone age development is delayed with increasing altitude: a multicentre study.

To investigate the bone age (BA) characteristics of children living in high-altitude regions and determine the impact of altitude on the development of BA. From June 2014 to July 2022, 1318 children with left-hand-wrist radiographs were retrospectively enrolled from 3 different geographical altitudes (Beijing 43.5 m above sea level [asl], Lhasa 3650 m asl, and Nagqu 4500 m asl). The predicted age difference (PAD), defined as the difference between BA and chronologic age (CA), was considered the indicator for delayed or advanced growth. The PAD of children from the 3 regions in total and according to different age groups, genders, and ethnicities were compared. The linear regression model was used to assess the effect of altitude on PAD. A total of 1284 children (CA: 12.00 [6.45-15.72] years; male: 837/1284, 65.2%) were included in the study with 407 from Beijing, 491 from Lhasa, and 386 from Nagqu. The PAD for Beijing, Lhasa, and Nagqu were 0.1 [-0.30 to 0.65], -0.40 [-1.20 to 0.27], and -1.42 [-2.32 to -0.51] years, respectively. A linear regression analysis showed that altitude significantly contributed to PAD (compared to Beijing, Lhasa coefficient = -0.57, P < .001; Nagqu coefficient = -1.55, P < .001). High altitude might be an independent contributor to the delayed BA development of children. The impact of altitude on BA development was revealed for the first time, highlighting the necessity of considering the altitude of the area when evaluating BA development for children residing in high-altitude regions.ke.

Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies.

The incidence of osteoporosis in children is increasing because of the increased survival rate of children with chronic diseases and the increased use of bone-damaging drugs. As childhood bone fragility has several etiologies, its management requires a thorough evaluation of all potentially contributing pathogenetic mechanisms. This review focuses on the main causes of primary and secondary osteoporosis and on the benefits and limits of the different radiological methods currently used in clinical practice for the study of bone quality. The therapeutic and preventive strategies currently available and the most novel diagnostic and treatment strategies are also presented. Optimal management of underlying systemic conditions is key for the treatment of bone fragility in childhood. DXA still represents the gold standard for the radiologic evaluation of bone health in children, although other imaging techniques such as computed tomography and ultrasound evaluations, as well as REMS, are increasingly studied and used. Bisphosphonate therapy is the gold standard for pharmacological treatment in both primary and secondary pediatric osteoporosis. Evidence and experience are building up relative to the use of monoclonal antibodies such as denosumab in cases of poor response to bisphosphonates in specific conditions such as osteogenesis imperfecta, juvenile Paget's disease and in some cases of secondary osteoporosis. Lifestyle interventions including adequate nutrition with adequate calcium and vitamin D intake, as well as physical activity, are recommended for prevention.

Epidemiology of childhood bone and joint disease during the COVID-19 pandemic in New Zealand.

It is unknown whether social distancing impacts frequency of presentation and severity of childhood bone and joint infection (BJI). In New Zealand, the COVID-19 disease elimination strategy involved strict social isolation policies spanning March 2020-September 2022. Examination of this period may provide insight around risk factors for BJI. A retrospective review of all patients < 16 years with presumed acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region was performed between 2018 and 2023. Frequency and severity of presentations has been examined before, during, and after periods of social restriction. Severe cases included those with intensive care admission, recurrent infection, or multiple surgeries. Pre-hospital experience, length of stay, and disease outcomes have also been assessed. A total of 563 cases met inclusion criteria. Compared to the pre-pandemic period, monthly case averages reduced between April 2020 to September 2022 (10.1 vs. 7.9 cases/month, p = 0.008). Separating cases by causative microbiology shows a statistically significant drop in culture negative and Kingella kingae mediated BJI cases (4.2 vs. 2.9 cases/month, p = 0.006) but not for cases secondary to Staphylococcus aureus and Streptococcus pyogenes (4.2 vs. 3.9 cases/month, p = 0.6). The frequency of severe disease reduced during this period (5.6 vs. 4.1 cases/month, p = 0.01) together with lower rates of recurrent infection (9% vs. 4%, p = 0.03). The COVID-19 management strategy in New Zealand utilised strict social isolation, mask wearing, and hand hygiene measures to control disease spread between 2020 and 2022. These measures coincided with reduction in frequency and severity of presentations for childhood BJI.

PLCG2 variants in cherubism

BackgroundCherubism is most commonly caused by rare heterozygous gain-of-function (GOF) missense variants in SH3BP2, which appear to signal through Phospholipase C Gamma 2 (PLCG2) to cause excessive osteoclast activity leading to expansile lesions in facial bones in childhood. GOF variants in PLCG2 lead to autoinflammatory PLCG2-associated antibody deficiency and immune dysregulation (autoinflammatory PLAID, or PLAID-GOF), characterized by variably penetrant autoinflammatory, autoimmune, infectious, and atopic manifestations. Cherubism has not been reported in PLAID to date. ObjectiveTo determine whether GOF PLCG2 variants may be associated with cherubism. MethodsClinical, laboratory, and genomic data from two patients with cherubism and other clinical symptoms observed in patients with PLCG2 variants were reviewed. Primary B-cell receptor (BCR)-induced calcium flux was assessed by flow cytometry. ResultsTwo patients with lesions consistent with cherubism but no SH3BP2 variants were found to have rare PLCG2 variants previously shown to be GOF in vitro, leading to increased BCR-induced calcium flux in one patient’s B cells. Variable humoral defects, autoinflammatory rash, and other clinical and laboratory findings consistent with PLAID were observed as well. ConclusionGOF PLCG2 variants likely represent a novel genetic driver of cherubism and should be assessed in SH3BP2-negative cases. Expansile bony lesions expand the phenotypic landscape of autoinflammatory PLAID, and bone imaging should be considered in PLAID patients.

Abstracts of the 11th International Conference on Children's Bone Health

Abstracts of the 11th International Conference on Children's Bone Health

The emerging application of ultrasound technology in pediatric bone fractures: Clinical application, related issues and development prospect

AbstractUltrasonography has begun to be applied to the examination of fractures in recent years owing to its safety, noninvasiveness, portability, and high sensitivity. The subcutaneous soft tissue of children is thinner than that of adults, children's bones have a high level of elasticity and a low level of brittleness, and the pediatric fractures heal quickly and produce more callus, therefore ultrasonography is a more suitable examination in pediatric bone fractures. In this paper, we intend to review the mechanism, performance, and examination effect of ultrasound examination in bone fractures, analyze the advantages and disadvantages between ultrasound imaging and X‐ray imaging, and further propose an outlook for the application of ultrasound technology in pediatric bone fractures.

Radiographic and Tomographic Study of the Cranial Bones in Children with the Idiopathic Type of West Syndrome.

Radiographic and Tomographic Study of the Cranial Bones in Children with the Idiopathic Type of West Syndrome.

Effective counseling for children's bone health

Poor bone health is a significant contributing factor to the frequency and severity of many childhood injuries and fractures. Osteoporosis starts in childhood. Therefore, it is important to optimize bone health in children in order to decrease the risk of injury, improve healing and maximize peak bone mass. To do this, pediatricians and pediatric orthopedists need to effectively counsel patients and families to give them the tools necessary to effect lasting change. Bone health is a recipe that requires ingredients including calcium, vitamin D, vitamin C, vitamin K and physical exercise. Required amounts of each component change as children grow and are lifelong requirements. Unfortunately, at this time, there is no uniform consensus on vitamin D supplementation guidelines or optimal serum levels. Current vitamin D dosing guidelines are age-based, but vitamin D is stored in adipose tissue and higher weights/BMIs require higher doses of vitamin D. Routine monitoring of vitamin D is recommended in all patients. However, re-evaluating the dosing guidelines to base them on weight/BMI, rather than age, should be considered. Key Concepts(1)Bone health needs to be prioritized so that peak bone mass is reached by age 30.(2)Patient counseling and patient buy-in are imperative to create lasting impact.(3)Bone health is a recipe and amounts of ingredients needed will vary according to growth and body size.(4)Vitamin D dosing should take weight and body mass into consideration to achieve optimal serum levels.

Clinical Characteristics and Outcomes of Limb Fractures in Saudi Children.

Children's bones are at high risk of fracture as they grow. The clinical characteristics of fractures in children differ from those in adults. Studying fractures in healthy children is critical for identifying cases of fragility fractures. The aim of this study was to assess the clinical characteristics of limb fractures as well as clinical indicators of fracture healing outcomes in healthy Saudi children seen in an emergency room. A retrospective review of the treatment course of all pediatric fractures and related factors treated at King Abdullah Specialist Children's Hospital (KASCH) in Riyadh between 2016 and 2018 was conducted. Children with a primary bone disorder or chronic comorbidities known to affect bone health were excluded. The study included 143patients(mean age ±SD =8.23 + 3.76 years), and 71% (n= 102) were males. Motor vehicle accidents (MVAs) were the most common mechanism of injury, accounting for 50 (35%) cases, followed by fall injuries, sports injuries, and pedestrian accidents at 45 (31.4%), 16 (11.2%), and 13 (9.1%), respectively. A total of 178 fractures were reported, with the femur (n= 75, 42.1%) being the most common of the reported fracture sites, followed by the forearm (n= 44, 24.7%). The most common type of fracture was transverse fracture (n= 96, 54% of patients). Vitamin D levels were measured in 53/143 cases. Of these, vitamin D deficiency was found in 38 (71.7%) patients. The average time for fracture healing was 32.9 ± 30.2 weeks. The mechanisms of injury, including MVAs and sports injuries, as well as femur and forearm fractures, were clinical factors that were independently associated with a longer duration of fracture healing time (p< 0.001), but age, gender, and vitamin D status were not associated with that outcome. MVAs andfall injurieswere the most common causes of fracture in our patients. MVAs and sports injurieswere associated with prolonged healing time. Large prospective, multicenter, or field studies may be required to further explore clinical characteristics, outcomes, and environmental factors.

Phantom study of a self-shielded X-ray bone age assessment instrument against scattered radiation in children.

Hand-wrist radiography is the most common and accurate method for evaluating children's bone age. To reduce the scattered radiation of radiosensitive organs in bone age assessment, we designed a small X-ray instrument with radioprotection function by adding metal enclosure for X-ray shielding. We used a phantom operator to compare the scattered radiation doses received by sensitive organs under three different protection scenarios (proposed instrument, radiation personal protective equipment, no protection). The proposed instrument showed greater reduction in the mean dose of a single exposure compared with radiation personal protective equipment especially on the left side which was proximal to the X-ray machine (≥80.0% in eye and thyroid, ≥99.9% in breast and gonad). The proposed instrument provides a new pathway towards more convenient and efficient radioprotection.