Skeletal Age Assessment Research Articles

Maturity Status and Injury Risk in Youth Soccer Players

To investigate the association of relative skeletal age and other risk factors with injury in elite schoolboy footballers (soccer players). Prospective cohort study, with players participating for varying numbers of years. Manchester United Football Club Academy, 2001 to 2007. Players were recruited to the club by scouts. At intake, the boys were medically screened to ensure they could be fully involved in the training and games program. Computerized medical records for the boys were maintained for the entire study period. The investigation included boys 9 to 16 years of age. Numbers varied between 98 and 144 per year (mean n/y = 130) over 6 years. Overall, 292 players were represented in the sample. Mean drop out per season was 21%. Each year consenting players had a radiograph of the left wrist and hand for the assessment of skeletal age (SA), using the Fels method. Eighty-five players had at least 1 radiograph and 12 players had 6 radiographs, 1 in each year of the study. Early and late maturers were those with an SA >1 year older or younger, respectively, than their chronologic age (CA). Information on demographics, height and weight, playing and training times, and position played was collected. The main outcome measure was the relation of maturity status to the occurrence of injuries. For the total sample across all the age groups the incidence of injuries was 1.44 per 1000 hours of training (n = 244 injuries), and 10.5 per 1000 match hours (n = 169 injuries). The mean number of injuries per season was 79.3, with a mean loss of 12.5 injury days per player per season. Boys aged <14 years were most vulnerable. Most injuries resulted from overuse rather than from trauma. Most common injury type and location were, respectively, soft tissue and knee joint. Mean SA for the total sample was in advance of mean CA (12.08y vs 11.74y; P < 0.05). Injury incidence did not differ significantly among late, normal, and early maturing players (1.4, 1.5, and 1.8, respectively) when training time, playing time, height, and playing position were statistically controlled as covariates (P = 0.73). However, results of general log linear analysis of mean data over the 6 seasons indicated a relationship between injury occurrence and training time, match-play time, and the CA-SA difference (P < 0.05). The 3 variables together explained 48% of the variance in injury incidence. Position played, foot dominance, and mean height gain were not related to injury occurrence. Maturity status and time spent in match play and training were significant predictors of injuries in 9- to 16-year-old elite male soccer players.

Assessment of skeletal age using MP 3 and hand-wrist radiographs and its correlation with dental and chronological ages in children

The purpose of the study was to assess skeletal age using MP3 and hand-wrist radiographs and to find the correlation amongst the skeletal, dental and chronological ages. One hundred and sixty North-Indian healthy children in the age group 8-14 years, comprising equal number of males and females were included in the study. The children were radiographed for middle phalanx of third finger (MP3) and hand-wrist of the right hand and intra oral periapical X-ray for right permanent maxillary canine. Skeletal age was assessed from MP3 and hand-wrist radiographs according to the standards of Greulich and Pyle. The dental age was assessed from IOPA radiographs of right permanent maxillary canine based on Nolla's calcification stages. Skeletal age from MP3 and hand-wrist radiographs shows high correlation in all the age groups for both sexes. Females were advanced in skeletal maturation than males. Skeletal age showed high correlation with dental age in 12-14 years age group. Chronological age showed inconsistent correlation with dental and skeletal ages.

The digital atlas of skeletal maturity by Gilsanz and Ratib: a suitable alternative for age estimation of living individuals in criminal proceedings?

As a collection of radiographic standards of the normal hand development with a homogenous degree of maturity of all skeletal elements, the digital atlas of skeletal maturity by Gilsanz and Ratib combines the possibilities of digital imaging with the principle of a conventional atlas method. The present paper analyses the forensic applicability of skeletal age assessment according to Gilsanz and Ratib to age estimation in criminal proceedings. For this, the hand X-rays of 180 children and adolescents aged 10-18 years old were examined retrospectively. For the entire age range, the minima and maxima, the mean values and standard deviations as well as the medians with upper and lower quartiles are specified by sex. For the legally relevant age groups from 14 to 18 years, there is a risk of overestimation of the chronological age of up to 7.2 months in females. The method of Gilsanz and Ratib is therefore only suitable to forensic age estimation in criminal proceedings to a limited extent.

“This child, whose bone age is fourteen . . .” Ethical dimensions of skeletal age assessment

Forensic age estimation in living subjects is an important task for forensic experts, especially in countries where birth records are not well maintained. The process often is used to confirm the chronological age of a criminal or victim when there is a lack of available evidence, such as birth records and witnesses. Focusing on the case of Turkey where the Greulich and Pyle method is often the only method used in forensic estimation of age, this paper seeks to discuss the ethical implications of the process, which are of special concern for women.

“This child, whose bone age is fourteen ...” Ethical dimensions of skeletal age assessment

Forensic age estimation in living subjects is an important task for forensic experts, especially in countries where birth records are not well maintained. The process often is used to confirm the chronological age of a criminal or victim when there is a lack of available evidence, such as birth records and witnesses. Focusing on the case of Turkey where the Greulich and Pyle method is often the only method used in forensic estimation of age, this paper seeks to discuss the ethical implications of the process, which are of special concern for women.

A Bayesian Approach to Multistage Fitting of the Variation of the Skeletal Age Features

Accurate assessment of skeletal maturity is important clinically. Skeletal age assessment is usually based on features encoded in ossification centers. Therefore, it is critical to design a mechanism to capture as much as possible characteristics of features. We have observed that given a feature, there exist stages of the skeletal age such that the variation pattern of the feature differs in these stages. Based on this observation, we propose a Bayesian cut fitting to describe features in response to the skeletal age. With our approach, appropriate positions for stage separation are determined automatically by a Bayesian approach, and a model is used to fit the variation of a feature within each stage. Our experimental results show that the proposed method surpasses the traditional fitting using only one line or one curve not only in the efficiency and accuracy of fitting but also in global and local feature characterization.

Comparison of the three age estimation methods: Which is more reliable for Turkish children?

Background Three atlases—the GÖK, the Greulich–Pyle (GP), and the Tanner–Whitehouse (TW3)—are used frequently for age determination in Turkey. The purpose of this study was to evaluate the applicability of these three methods related to the skeletal age assessment for Turkish adolescents. Materials and methods The conventional roentgenograms of the left hands and wrists, elbows, shoulders, and pelvises of 333 healthy Caucasian children (164 females, 169 males) who fit the study and the criteria of each atlas were obtained. The mean differences (± standard deviation [S.D.] in years) between the chronologic age (CA) and the skeletal age (BA), which were obtained by using each age estimation method, were calculated and tested using t-test. Results For girls, the most accurate method was the TW3 (mean differences ( d): −0.21 ( p < 0.05)), following by the GP ( d: 0.66 ( p < 0.001), and the GÖK ( d: 2.99 ( p < 0.001)). For boys, the most accurate method was the GP ( d: −0.02 ( p > 0.05)), followed by the TW3 ( d: −0.18 ( p < 0.05)) and GÖK ( d: 1.05 ( p < 0.001)). Discussion and conclusions Results show that the TW3 (for girls) and the GP (for boys) methods are more appropriate than the GÖK atlas for estimating the BA. GÖK could be used for boys aged 11–14 years but it should not be used for girls.

Skeletal age assessment from elbow radiographs. Review of the literature

Skeletal age is important to evaluate remaining growth. In 50% of normal children and adolescents, skeletal age does not differ from chronological age. During puberty, skeletal age is an important tool when performing a lower limb epiphysiodesis or when treating (conservatively or surgically) patients with spinal deformities. Skeletal age alone is not enough and should be assessed together with other clinical and radiological findings such as standing and sitting heights, Risser sign, Tanner stages and annual growth rate. Puberty starts at 11 years of skeletal age and ends at 13 years of skeletal age in girls; in boys, puberty starts two years later (13 years of skeletal age) and then ends at a skeletal age of 15. Most current clinical and radiographic markers do not help paediatric orthopaedic surgeons to clearly distinguish maturity levels prior to Risser I. Sauvegrain et al. developed a method to assess skeletal age by using elbow radiographs (AP and lateral projections). Between 11 and 13 years of skeletal age in girls and between 13 and 15 years of skeletal age in boys, the olecranon apophysis is characterised by a clear morphological development. This method is a reliable tool to assess skeletal age during puberty because significant morphological changes in the elbow happen every six months.

Use of Elbow Radiographs to Assess Skeletal Age in Scoliosis

Orthopedics| April 01 2008 Use of Elbow Radiographs to Assess Skeletal Age in Scoliosis AAP Grand Rounds (2008) 19 (4): 40. https://doi.org/10.1542/gr.19-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Use of Elbow Radiographs to Assess Skeletal Age in Scoliosis. AAP Grand Rounds April 2008; 19 (4): 40. https://doi.org/10.1542/gr.19-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bone age, idiopathic scoliosis, olecranon, radiography of elbow, scoliosis Source: Charles YP, Dimeglio A, Canavese F, et al. Skeletal age assessment from the olecranon for idiopathic scoliosis at Risser grade 0. J Bone Joint Surg Am. 2007;89(12):2737–2744; doi:10.2106/JBJS.G.00124 Skeletal maturity and remaining growth must be considered in the evaluation of the risk of curve progression in idiopathic scoliosis. Because spine films are not sensitive enough to measure the progression of skeletal maturity during the rapid growth phase of adolescence, many orthopedists use radiographs of the elbow and the method of Sauvegrain1 to measure skeletal maturational changes during this time period. This French study compared the accuracy of a simplified method2 of assessing skeletal age with traditional methods during the acceleration stage of growth in adolescents with idiopathic scoliosis. The authors retrospectively evaluated data obtained between 1988 and 2006 from 100 boys and 100 girls, randomly selected from a group of 561 patients evaluated for idiopathic scoliosis who had been followed at six-month intervals, had a complete set of radiographs, and had known outcomes. Skeletal maturity was measured using the “simplified olecranon method,” the method of Sauvegrain, and assessment of the triradiate cartilage found in the developing acetabulum. The simplified method of skeletal age assessment evaluates five evolving shapes of the developing olecranon ossification center that change over six-month time intervals using a lateral radiograph of the elbow. The Sauvegrain method determines skeletal age from anteroposterior and lateral radiographs of the left elbow and is based on a 27-point scoring system evaluating four ossification centers. The triradiate cartilage of the developing acetabulum is monitored for fusion, which usually occurs midway through the rapid stage of growth. Radiograph interpretation was performed by three experienced observers blinded to patient information, other than gender. The 100 girls averaged 12.0±1.2 years of age (range 10.0–13.1), and the 100 boys averaged 13.9±1.01 years (range 12.2–15.5). The pubertal growth spurt began at an average skeletal age of 11 years in girls and 13 years in boys with an average annual standing height velocity of 7.2±0.8 cm/year (range 6.0–8.5 cm/year) in girls and 8.1±0.9 cm/year (range 6.0–10.0 cm/year) for boys. Menarche occurred at an average chronological age of 13.11±1.03 years (range 11.0–16.0 years). There was excellent concordance between the simplified olecranon method and the Sauvegrain method, with an average concordance of r = 0.977 for boys and r = 0.938 for girls. The concordance between the three observers was equally excellent. Skeletal age corresponded within six months in 49% of boys and 51% of girls, and was advanced >6 months in approximately 25% and delayed by approximately 25% for both sexes. The triradiate cartilage closed when the olecranon apophysis had a rectangular shape in 61% of girls and 65% of boys and within six months before or after appearance of a rectangular shape in 88% of girls and 91% of boys, corresponding to a skeletal age of 12 years in girls and 14 years in boys. The authors conclude that the morphological development of the olecranon represents a simple but... You do not currently have access to this content.

Skeletal Age Assessment from the Olecranon for Idiopathic Scoliosis at Risser Grade 0

The main progression of idiopathic scoliosis occurs during peak height growth velocity, which is between the ages of eleven and thirteen years in girls and thirteen and fifteen years in boys and corresponds to the accelerating phase of pubertal growth. The Risser sign remains at grade 0 during this stage of growth. Triradiate cartilage closure occurs at approximately twelve years of age in girls and fourteen years in boys, which is in the middle of this phase. In addition to regular height measurements, a more detailed evaluation of skeletal maturity would be desirable prior to the identification of Risser grade 1. From the method of Sauvegrain et al., Diméglio derived a simplified method based on the radiographic appearance of the olecranon, which allows skeletal age to be assessed in six-month intervals. The purpose of this study was to determine the accuracy and the value of this simple method for the follow-up of patients with scoliosis. Five radiographic images demonstrate the typical characteristics of the olecranon during pubertal growth: two ossification nuclei, a half-moon image, a rectangular shape, the beginning of fusion, and complete fusion. This classification method was evaluated by three experienced and independent observers from lateral radiographs of the elbow in 100 boys and 100 girls with idiopathic scoliosis during the time of peak height velocity. Skeletal ages were correlated with the integral Sauvegrain method. The degree of interobserver concordance was determined, and skeletal age was compared with chronological age and the time of triradiate cartilage closure. For the three observers, the average concordance between the Sauvegrain and olecranon methods was excellent (r = 0.977 for boys and r = 0.938 for girls). The interobserver agreement was also excellent (r = 0.987 for the olecranon method and r = 0.958 for the Sauvegrain method for boys, and r = 0.992 and r = 0.985, respectively, for girls). Skeletal and chronological age were considered to correspond to each other within a six-month range for 49% of the boys and 51% of the girls, while 25% of the boys and 26% of the girls had an advanced skeletal age and 26% of boys and 23% of girls had a delayed skeletal age. Triradiate cartilage closure occurred at the same time as the appearance of the rectangular shape of the olecranon in 65% of the boys and 61% of the girls, corresponding to skeletal ages of fourteen and twelve years, respectively. In 91% of the boys and 88% of the girls, the triradiate cartilage fused within six months before to six months after the appearance of the rectangular shape of the olecranon, which occurred between the half-moon image and the beginning of fusion of the olecranon. The method of assessing skeletal age from the olecranon allows skeletal maturity to be evaluated in regular six-month intervals during the phase of peak height velocity. This method is simple, precise, and reliable. It complements the Risser grade-0 and the triradiate cartilage evaluation.

Three-dimensional reconstruction of individual cervical vertebrae from cone-beam computed-tomography images

The visualization of cervical vertebral morphology has potential in skeletal age assessment; however, thus far, it has only been described in planar images. The objective of this article is to present a novel segmentation algorithm for automatic 3-dimensional (3D) reconstruction of individual cervical vertebrae from cone-beam computed-tomography (CBCT) volumetric data sets. CBCT data sets of 3 subjects representing different skeletal age groups with no potential health influences on cervical anatomy were identified from a larger subject sample. A visualization toolkit was used to demonstrate the surface topologic shape of cervical vertebrae C1 through C3. The cervical vertebrae were segmented by using a custom algorithm based on individual voxel intensity distribution analysis and propagation from a densitometric start point to generate the whole vertebra. The segmentation algorithm was combined with toolkit visualization to render and save the cervical vertebra in 3D space. The developed segmentation algorithm separated individual cervical vertebrae successfully. It was robust and efficient. Observed 3D cervical vertebral morphologic features from the 3 examples matched the known 2-dimensional sagittal shape changes of the cervical vertebra with respect to subject age and skeletal maturation. Segmentation of individual vertebrae proved possible from CBCT volumetric data sets. This provides a 3D approach to the biologic aging of orthodontic patients by using images of the cervical spine. It also has potential in studying disease processes such as spinal fractures consequent to osteoporosis.

Age determination by magnetic resonance imaging of the wrist in adolescent male football players

Background: In football there are established age-related tournaments for males and females to guarantee equal chances within the game for all the different age groups. To prevent participation in the...

Skeletal age assessment: A comparison of 3 methods

The aim of this study was to evaluate the applicability of 3 methods of skeletal age assessment. The skeletal assessment methods of Greulich and Pyle (GP), Tanner et al (TW3), and Eklöf and Ringertz (ER) were used to analyze the dorsopalmar hand-wrist radiographs of 360 Brazilian children and adolescents (180 boys, 180 girls; ages, 7-15 years). The standard error of the mean and confidence intervals of the 3 assessment methods as well as the mean chronologic ages of both sexes and the age ranges studied were calculated. Skeletal age means obtained with the GP and TW3 methods were close to chronologic age for both sexes. The ER method tended to overestimate skeletal age for the lower age groups, to correspond for the intermediate age groups, and to underestimate for the higher age groups in both sexes. The confidence interval confirmed that these data did not represent a statistically significant difference between chronologic and assessed skeletal ages; this means there is a high relationship between the studied sample data and the 3 standard methods. Determinate correction factors (regression equation) make each method more useful for the studied population. Although all methods reliably assessed age, correction factors are recommended for better adaptability to the studied population.

Skelettaltersbestimmung am Ellbogen während des pubertären Wachstums

The Sauvegrain et al. method of assessing skeletal age from elbow radiographs is useful during the 2 years of the pubertal growth spurt: between 11 and 13 years in girls and between 13 and 15 years in boys. This method uses four ossification centers of the elbow: lateral condyle, trochlea, olecranon apophysis, and proximal radial epiphysis. It is based on a 27-point scoring system. The scores of these structures are summed, a total score is determined, and a graph is then used to determine the skeletal age. This simple, reliable, and reproducible method complements the Greulich and Pyle atlas, which does not allow assessment of skeletal age in 6-month intervals during the phase of accelerating growth velocity. In clinical practice, maturity can best be evaluated by associating skeletal age, annual growth rate, and Tanner stages. Skeletal age assessment from the elbow is useful to plan the timing of epiphysiodesis in limb length inequality or to evaluate the progression risk of idiopathic scoliosis.

Accuracy of the Sauvegrain Method in Determining Skeletal Age During Puberty

The method of Sauvegrain et al. for the assessment of skeletal age from radiographs of the elbow is useful during the two years of the pubertal growth spurt. The purpose of this study was to determine the accuracy of the method and its value in pediatric orthopaedics. The Sauvegrain method uses four anatomical landmarks of the elbow: the lateral condyle, trochlea, olecranon apophysis, and proximal radial epiphysis. It is based on a 27-point scoring system. The scores for these structures are summed, and a total score is determined. A graph is then used to determine the skeletal age. The method was evaluated by three independent observers who used it to assess skeletal age on anteroposterior and lateral radiographs of the left elbow of sixty boys and sixty girls and compared the results with assessments made with use of the Greulich and Pyle atlas on posteroanterior radiographs of the left hand and wrist. Skeletal age determinations were performed twice by each observer at a four-week interval. The skeletal age determination from radiographs of the elbow was more precise because a clear semiannual age determination was possible. On the basis of the rating by the observers, the Sauvegrain method presented excellent interobserver correlation (r = 0.93) and excellent reproducibility (r = 0.96). The correlation between the methods of Sauvegrain et al. and Greulich and Pyle was good (r = 0.85). Nevertheless, certain elbow growth centers showed an intermediate developmental morphology, which failed to correspond to the score described by Sauvegrain et al. This led to errors in the interpretation of data. We suggest an intermediate score for these cases, and we modified the original graph to make it more accurate. The modified method of Sauvegrain et al. is simple, reliable, and reproducible, and it complements the Greulich and Pyle atlas. In clinical practice, maturity can best be evaluated by associating skeletal age, annual growth rate, and secondary sexual characteristics. Therefore, this method is useful when major decisions such as the timing of epiphysiodesis or spinal arthrodesis are necessary during puberty.

Assessment of skeletal age at the wrist in children with a new ultrasound device

Determination of skeletal development in children is important. The most common method of evaluation uses the standards of Greulich and Pyle (G and P) to assess the left hand radiograph. Numerous assessments may be made during follow-up. The aim of our study was to compare the accuracy of a new sonographic method with the standard radiographic method. Seventy consecutive patients (age 6-17 years; 34 girls, 36 boys) underwent radiography of the left hand, followed by sonographic examination of the same hand using the BonAge system (Sunlight Medical Ltd., Israel). This system evaluates the relationship between the velocity of sound passing thorough the distal radial and ulna epiphysis and growth, using gender- and ethnicity-based algorithms. One experienced paediatric radiologist analysed the radiograph and assigned bone age scores based on the G and P atlas for the whole left hand and for the distal radius alone. The radiologist was blinded to the chronological age (CA), height of the patient and the BonAge result. Correlation between BonAge and G and P was undertaken. In 65 patients, BonAge measurement could be performed successfully. In five patients, the scanning process was impossible using the ultrasound device. The r(2) (r is the Pearson correlation coefficient) of the BonAge ultrasound measurement and the G and P method was 0.82. The averaged accuracy (i.e. absolute difference in years between G and P reading and BonAge ultrasonic results) was calculated. Results were similar for boys and girls: 1.0+/-0.8 years for the whole left hand and 0.8+/-0.7 year for the distal radius. On average, the difference between BonAge and CA is the same as the difference between G and P and CA, i.e. 1.4 years. The BonAge device demonstrates the ability of ultrasound to produce an accurate assessment of bone age. The results are highly correlated with skeletal age evaluated conventionally using the G and P method. Obvious advantages of the ultrasound device are objectivity, lack of ionizing radiation, and easy accessibility.

Evaluation of the possibility to assess bone age on the basis of DXA derived hand scans-preliminary results.

The classical method of skeletal age assessment is based on the recognition of changes in the radiographic appearance of the maturity indicators in hand-wrist radiographs by comparison with a reference atlas. The purpose of this study was the evaluation of the possibility to assess bone age using a less invasive method such as dual-energy X-ray absorptiometry (DXA). Bone ages of 50 children free of any chronic diseases (5-18 years old) and ten with multihormonal pituitary deficiency (MPD) (8-20 years old) were assessed using an Expert-XL densitometer. Hand scans and classical hand-wrist radiographs were evaluated by two independent observers for bone age by visual comparison with reference standards of skeletal development published in the atlas. The precision errors of duplicate bone age ratings were low both for radiographs (<1%) and DXA hand scans (<0.9%). A high degree of agreement between bone age ratings done by two observers was assessed by intraclass correlation coefficients. The same bone age based on radiographs and DXA hand scans was assessed in 44 of 60 cases (73.3%); in 16 cases the differences between bone age were no higher than 0.5 year. No significant difference between mean bone age based on radiographs and DXA hand scans was observed ( P>0.05). Moreover, there was a very strong correlation between bone age results ( r=0.998; r(2)=0.996; P<0.0001), indicating agreement of bone age assessments based on DXA and radiographic images. Remarkable differences (up to 3 years) between bone age and chronological age were observed in healthy subjects, probably reflecting the effect of the secular trend towards earlier maturation or alterations in pubertal development. The study indicates that evaluation of skeletal maturity using DXA images is less invasive (up to 8 micro Sv) than radiography, giving results comparable to the classical method.

Assessment of skeletal maturity and prediction of adult height (TW3 method).

The Journal of Bone and Joint Surgery. British volumeVol. 84-B, No. 2 Book ReviewsFree AccessAssessment of skeletal maturity and prediction of adult height (TW3 method).3rd edition. Edited by J. M. Tanner, M. J. R. Healy, H. Goldstein and N. Cameron. Pp 110. London, etc: W. B. Saunders, 2001. ISBN: 0-7020-2511-9. £69.95.Helen CartyHelen CartySearch for more papers by this authorPublished Online:1 Mar 2002https://doi.org/10.1302/0301-620X.84B2.0840310cAboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByEvaluation and management of a child with short statureMinerva Pediatrica, Vol. 72, No. 6Bone Age Assessment Empowered with Deep Learning: A Survey, Open Research Challenges and Future Directions3 October 2020 | Diagnostics, Vol. 10, No. 10Carpal Bone Segmentation Using Fully Convolutional Neural NetworkCurrent Medical Imaging Formerly Current Medical Imaging Reviews, Vol. 15, No. 10Deep learning for automated skeletal bone age assessment in X-ray imagesMedical Image Analysis, Vol. 36 Vol. 84-B, No. 2 Metrics Downloaded 289 times History Published online 1 March 2002 Published in print 1 March 2002 InformationCopyright © 2002, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Correlation of cervical vertebra maturation with hand-wrist maturation in children.

The purpose of this study was to evaluate the reliability of cervical vertebra maturation as an indicator of skeletal age during the circumpubertal period. This was determined by correlating cervical vertebra maturation to hand-wrist maturation. The vertebral skeletal age was assessed using lateral cephalometric radiographs according to maturity indicators modified from Lamparski. The hand-wrist skeletal age was evaluated in radiographs with the system developed by Fishman. The sample consisted of 503 subjects (244 boys and 259 girls), aged 8 through 18 years. The Spearman rank correlation coefficients and Wilcoxon sign rank test showed that a statistically significant relationship existed between the two assessments. Both the intra- and inter-judge tests of reliability displayed no significant differences. The results of this study indicate that skeletal age assessment made from the maturational changes of cervical vertebrae were reliable, reproducible and valid.

Pediatric skeletal age: determination with neural networks.

To develop a neural network to calculate skeletal age based on measurements taken from digitized hand radiographs. From a database of 521 hand radiographs obtained in healthy patients, four parameters were calculated from seven linear measurements and were used to train a neural network, with use of the jackknife method, to calculate skeletal age. The results were compared with those of an experienced pediatric radiologist using a standard pediatric skeletal atlas. The mean difference from biologic age for the neural network was -0.261 years +/- 1.82 (standard deviation) and for the radiologist, -0.232 years +/- 1.54; this difference was not significantly different (P = .67, Wilcoxon signed rank test). Skeletal age determined by the neural network was closer to the biologic age than that assigned by the radiologist in 243 of 521 cases (47%). A simple neural network may assist radiologists in the assessment of skeletal age.