Whitehouse Method Research Articles

Tanner–Whitehouse skeletal maturity score derived from ultrasound images to evaluate bone age

ObjectiveThe complexity of radiographic Tanner–Whitehouse method makes it less acceptable by radiologists and endocrinologists to assess bone age. Conventional ultrasound could be used to measure the ratio of the height of the ossification center to the epiphysis of the bone to evaluate maturity of bone. The purpose of this study is to obtain radiographic TW3 skeletal maturity score with ultrasound images.MethodsIn this prospective diagnostic study, participants aged between 1 and 18 years undergoing radiography for bone age evaluation were evaluated from April 2019 to November 2021. Ultrasonic skeletal maturity scores of participants were transformed into radiographic skeletal maturity scores with the fitted formulas established in this study. Diagnostic performances of the transformed scores to diagnose advanced or delayed bone age were confirmed. Ultrasound images of 50 participants in the validation group were re-evaluated to confirm inter-rater reliability.ResultsA total of 442 participants (median age, 9.5 years [interquartile range, 7.8–11.1 years]; 185 boys) were enrolled. Ultrasound determination of bone age had a sensitivity of 97% (34/35, 95% CI: 83, 99) and a specificity of 98% (106/108, 95% CI: 93, 99) to diagnose advanced or delayed bone age. The intra-class correlation coefficient for inter-rater reliability was 0.993 [95% CI: 0.988, 0.996], p < 0.0001.ConclusionsRadiographic Tanner–Whitehouse skeletal maturity score could be obtained from ultrasound images in a simple, fast, accurate, and radiation-free manner.Key Points• The fitting formulas between radiographic TW3 skeletal maturity score and ultrasonic skeletal maturity score were developed.• Through measurement of ossification ratios of bones with ultrasound, TW3 skeletal maturity score was obtained in a simple, fast, and radiation-free manner.

Comparison of Bone Age Assessments by Gruelich-Pyle, Gilsanz-Ratib, and Tanner Whitehouse Methods in Healthy Indian Children.

Background:There are several methods of bone age (BA) assessment, which include Gruelich-Pyle (GP), Gilsanz-Ratib (GR), and Tanner Whitehouse-3 (TW-3) methods. Although GP atlas is the most widely used, there are concerns about its accuracy in children of different ethnicities, making the use of the TW-3 method an attractive option in Indian children.Objectives:1) To assess the relationship of BA with chronological age (CA) as assessed by different methods (GP, GR, and TW-3) in healthy Indian children 2) To assess which of the three methods of BA assessment is more suitable in Indian children.Methodology:X-rays of 851 children (438 boys and 413 girls, aged 2–16.5 years) were analyzed by four independent observers using three different methods of BA estimation (GP, GR, and TW-3). Mean BAs were converted to Z-scores. For purpose of deciding which method of BA was most suitable in our cohort, a test of proportions and root mean square (RMS) deviations were computed.Results:Using the test of proportions, the TW-3 method was most suitable overall (P < 0.05). TW-3 method was again most applicable in prepubertal boys (P < 0.05), in prepubertal girls (although not significant, P > 0.1), and pubertal girls (P < 0.05). However, in pubertal boys, the GR atlas method was most suitable (P < 0.05). The same results were obtained when root mean square (RMS) deviations were computed. Interestingly, BA was underestimated in Indian boys irrespective of the method used. In Indian girls, however, the BA was underestimated till the pubertal growth spurt, after which there was rapid advancement of BA.Conclusions:Among the three methods (GP, GR, and TW-3), the BAs estimated by the TW-3 method were closest to CAs. Hence, it seems reasonable to recommend the use of the TW-3 method for BA estimation in the Indian population till an Indian standard bone age atlas is developed.

Fully automatic ROI extraction and edge-based segmentation of radius and ulna bones from hand radiographs

Bone age is a reliable measure of person's growth and maturation of skeleton. The difference between chronological age and bone age indicates presence of endocrinological problems. The automated bone age assessment system (ABAA) based on Tanner and Whitehouse method (TW3) requires monitoring the growth of radius, ulna and short bones (phalanges) of left hand. In this paper, a detailed analysis of two bones in the bone age assessment system namely, radius and ulna is presented. We propose an automatic extraction method for the region of interest (ROI) of radius and ulna bones from a left hand radiograph (RUROI). We also propose an improved edge-based segmentation technique for those bones. Quantitative and qualitative results of the proposed segmentation technique are evaluated and compared with other state-of-the-art segmentation techniques. Medical experts have also validated the qualitative results of proposed segmentation technique. Experimental results reveal that these proposed techniques provide better segmentation accuracy as compared to the other state-of-the-art segmentation techniques.

A Fuzzy Inference System for Skeletal Age Assessment in Living Individual

Skeletal age assessment is applied as an indicator of skeletal development for finding out growth pathologies related to hormonal diseases, and in endocrine and nutritional diagnosis. Other more recent applied methods include the Tanner and Whitehouse method as well as the Greulich and Pyle method. However, both methods need an expert to manually compare and assess the stages of skeletal growth. This is a time-consuming process involving subjective decision-making in pediatric radiology. The objective of this research is to develop a new fully automated and highly accurate approach based on a fuzzy inference system for the assessment of skeletal age in a living individual. Fuzzy logic as an intelligent computing technique is presented to deal with uncertainty as well as incomplete data. The system is implemented using MATLAB’s fuzzy tool box. Our system attempts to quantify eight features that correlate highly with growth and maturity of skeletal age. The system was evaluated with standard cases of hand radiographs for subjects between 11 and 17 years old. It has conclusively been found that there was a high linear relation between the system age assessment and chronological age, and our new method provides reliable results in the estimation of the skeletal age.

Skeletal age estimation in a contemporary Western Australian population using the Tanner–Whitehouse method

Various age estimation techniques have been utilised in Australia to evaluate the age of individuals who do not have documentation to determine legal majority/culpability. These age estimation techniques rely on the assessment of skeletal development as visualised in radiographs, CT scans, MRI or ultrasound modalities, and subsequent comparison to reference standards. These standards are not always population specific and are thus known to be less accurate when applied outside of the original reference sample, leading to potential ethical implications. Therefore, the present study aims to: (i) explore the variation in developmental trajectories between the established Tanner–Whitehouse (TW) age estimation standards and a Western Australian population; and (ii) develop specific hand-wrist age estimation standards for the latter population.The present study examines digital anterior–posterior hand-wrist radiographs of 360 individuals 0 to 24.9 years of age, equally represented by sex. Each radiograph was assessed using the RUS, Carpal and 20-bone methods of Tanner et al. The standard error of the estimate (SEE) was calculated for each method (range: ♀ SEE ±0.4–11.5 years; ♂ SEE ±0.9–10.1 years). The most accurate method was TW3 RUS for females and the TW2 Carpal system for males. The 50th centile skeletal maturity scores for each year age group were plotted against average chronological age to produce polynomial regression standards with a demonstrated accuracy of (♀ SEE ±0.09–3.46 years; ♂ SEE ±0.02–3.42 years) for females and males, respectively. The standards presented here can be used in future forensic investigations that require age estimation of hand-wrist bones in a Western Australian population, however, they are not appropriate for establishing age of majority (18 years), as skeletal maturity was attained on average earlier than 15 years of age in both sexes for all three systems examined.

Impact of ensemble learning in the assessment of skeletal maturity.

The assessment of the bone age, or skeletal maturity, is an important task in pediatrics that measures the degree of maturation of children's bones. Nowadays, there is no standard clinical procedure for assessing bone age and the most widely used approaches are the Greulich and Pyle and the Tanner and Whitehouse methods. Computer methods have been proposed to automatize the process; however, there is a lack of exploration about how to combine the features of the different parts of the hand, and how to take advantage of ensemble techniques for this purpose. This paper presents a study where the use of ensemble techniques for improving bone age assessment is evaluated. A new computer method was developed that extracts descriptors for each joint of each finger, which are then combined using different ensemble schemes for obtaining a final bone age value. Three popular ensemble schemes are explored in this study: bagging, stacking and voting. Best results were achieved by bagging with a rule-based regression (M5P), scoring a mean absolute error of 10.16 months. Results show that ensemble techniques improve the prediction performance of most of the evaluated regression algorithms, always achieving best or comparable to best results. Therefore, the success of the ensemble methods allow us to conclude that their use may improve computer-based bone age assessment, offering a scalable option for utilizing multiple regions of interest and combining their output.

Implementation and Statistical Evaluation of a Web-Based Software for Bone Age Assessment

Bone age assessment is a tedious procedure carried out for assessing growth disorders of children using the left hand radiograph. The purpose of this work was to implement and evaluate a web-based software based on the Tanner and Whitehouse method in a pediatric endocrine department of a social security hospital processing 600-1,000 radiographs per year. The system was evaluated by using a statistical technique for comparing measurement methods in order to test the performance of the procedure and a time study to assess its feasibility under local conditions. It was found that the intra-observer variation for the web-based Tanner and Whitehouse method was smaller (95% confidence limits, -0.77 to 0.97 vs. -0.45 to 0.37) then the conventional Greulich and Pyle manual method and the average net time required for an age assessment was 2.4 min. We therefore concluded that the web-based system should be adopted for its higher precision and relatively low turnaround time for cases requiring serial readings on the same patient. The statistical method demonstrated in this study can also serve as an example for evaluating similar biomedical parameter assessing software.

Implementation of Whitehouse's method for calculating properties of self-affine fractal profiles

Many software packages for roughness analysis offer the possibility of calculating the fractal dimension D of surface profiles by techniques, which assume them to be self-similar and therefore uniquely defined by D. However, fractal profiles are not self-similar but self-affine, so that two profiles of quite different roughnesses may share the same fractal dimension. To distinguish between them requires the calculation of an additional scaling factor, the so-called topothesy Λ. Traditionally, D and Λ are derived laboriously from the slope and intercept of the profile's structure function. A quicker and more convenient derivation from standard roughness parameters has been suggested by Whitehouse. Based on this derivation, it is here shown that D and Λ depend on two dimensionless numbers: the ratio of the mean peak spacing to the rms roughness and the ratio of the mean local peak spacing to the sampling interval. Using this approach, values of D and Λ are calculated from the measurements on surface profiles produced by polishing, plateau honing, and various single-point machining processes. Different processes are shown to occupy different regions in D–Λ space, and polished surfaces show a relationship between D and Λ, which is independent of the surface material.

Âge osseux du noir béninois

The purpose of this work is to study the skeleton maturation in the black population of Benin by means of Tanner Whitehouse method (TW2) in comparison with the populations of the developed countries.The study was transversal and analytic. It included 297 boys and 303 girls aged from 9 to 18 years. This was conducted from October 2002 to May 2003 in Cotonou City, the economic capital of Benin. The corrected minimum size of the sample was 384 x 1.19. The sampling technique was chancy, multiphasic, stratified and in clusters. Every one of the 13 districts of Cotonou was considered as a stratum. The interpreter of the anteroposterior radiograph of the left wrist and hand was selected after an intra and extra observer test. The data treatment and analysis were performed by the logiciels Epi info and SPSS. The statistical tests used were Khi 2 test and Kappa index.The sample was mainly composed of pupils: 84.16% among the boys, 77.23% among the girls. 91.01% of the parents of the children had a middle standard of living. The skeleton maturation score increased with age in all TW2 methods. With the TW2 20 bone and RUS methods, the mature score was reached at percentile 50 among the boys at 18.5 years and among the girls at 17 years. It was precociously reached at percentile 97 respectively at 14 and 14.3 years among the boys and 12.7 years among the girls. With the Carpal bone method, the age of mature score at percentile 50 was 18.2years among the boys and 17.2 years among the girls. The early maturation was obtained at percentile 97 among the boys and the girls respectively at 13.2 and 12.5 years.The skeleton maturation score of the girls in Benin is I to 1.5 years higher than the one of the boys. With the TW2 bone and the RUS methods, the maturation shows a delay of 0.5 to 2.5 years at the percentile 50 and of 1.5 to 2 years at the percentile 97 in relation to the Belgian, British, Chinese, Korean, Japanese, and North American standards. These delays seem to be mainly due to the less favourable socioeconomic conditions in Benin. In the other hand, the more considerable delay of 1 to 4 years with the Carpal bone method remains to be elucidated.The osseous age stemming from this work is representative of the middle social stratums of the city backgrounds. It would gain to be completed by a similar work concerning the country backgrounds of Benin.

A longitudinal study on hand and wrist skeletal maturation in chimpanzees ( Pan troglodytes), with emphasis on growth in linear dimensions.

Skeletal maturation in the chimpanzee hand and wrist (the RUS system; radius, ulna, and short bones) was studied both longitudinally and cross-sectionally. Maturity states were evaluated in each of the 13 bones of the RUS system based on the TW2 method (Tanner and Whitehouse method), and the RUS score was calculated by the summation of scores for these bones. Individual variation was examined by means of residual curves and pseudo-velocity curves of RUS score and anterior trunk length (ATL). Norms of the age change pattern in RUS skeletal maturation and the growth of ATL were determined for each sex, and the relationships among ATL growth and skeletal and reproductive maturation were examined. We found a fairly good relationship between ATL growth and RUS skeletal maturation. Comparison of growth and development between humans and chimpanzees showed that growth characteristics are coupled with each other at puberty in male chimpanzees and in both sexes of humans. Although nutritional condition influenced ATL growth in infancy, it had no effect on the RUS maturational process. Social relationships appeared to influence both ATL growth and RUS maturation. Analyses on relationships between RUS skeletal maturation, ATL growth, and reproductive maturation, showed that RUS skeletal maturation is a good indicator of "physiological age".

Automatic Analysis of Hand Radiographs for the Assessment of Skeletal Age: A Subsymbolic Approach

The assessment of skeletal maturity is crucial for the analysis of growth disorders and plays an important role in paediatrics. For this reason, several methods have been developed for estimating skeletal maturity. Among them, the Tanner and Whitehouse method (TW2), which is based on the analysis of hand radiographs, is usually considered the most accurate and reliable. Nevertheless, TW2 is applied only in a small fraction of cases, due to its complexity and long examination times. Thus, the development of automated systems which reliably implement this method is highly desirable. However, major difficulties have been found in the development of computer-based systems for the assessment of skeletal maturity. In particular the extraction of the bones of interest has proved to he extremely challenging. In this paper, we propose a system architecture for the implementation of the TW2 method, which is based on artificial neural networks. For each bone considered, the maturation stage is determined by means of a two-step process which first locates the position of the bone in the radiograph and then analyzes the bone shape. Experimental results obtained with our implementation of the carpal version of TW2 are in good agreement with those provided by trained observers.

Which bone age in chronic renal insufficiency and end-stage renal disease?

One hundred radiographs of the left hand and wrist from 40 children with chronic renal insufficiency or end-stage renal disease were examined to determine which method of bone age estimation provided the most useful information in these children. The Tanner and Whitehouse method showed better repeatability than the Greulich and Pyle atlas or the Buckler handbook when a sample of the radiographs were assessed twice by the same observer. The Tanner and Whitehouse 20 (TW20) bone age showed less inter-observer bias than the radius, ulna and short bone age or the carpal bone age when three observers independently assessed the same sample of radiographs. TW20 was the most useful method of bone age assessment in this study of British children. An unexpected finding was that the carpal bones were significantly more retarded than the radius, ulna and short bones. Separate assessment of the carpal bone age may provide extra information of clinical relevance.

Assessment of bone age: a comparison of the Greulich and Pyle, and the Tanner and Whitehouse methods

A comparison of two methods of bone-age estimation has been made using the hand and wrist radiographs of 66 boys and 58 girls. An estimate made using the specialist auxological technique of Tanner and Whitehouse was compared with three separate estimates obtained by the atlas matching method of Greulich and Pyle (1971). Two of the latter estimates were carried out by two dedicated radiologists whose results showed close agreement. The third estimate made using the Greulich and Pyle method was derived from the routine reports of a number of radiologists at initial presentation. Only in one narrow age-range for girls was there a significant inter-observer difference, and the reasons for this are discussed. Estimates made using the method of Greulich and Pyle were younger than those made using that of Tanner and Whitehouse. There was a linear relationship between the two methods for the boys but not for the girls. It is suggested that atlas matching methods still have a valuable place in non-specialist hospitals concerned with initial diagnosis rather than with the long-term care of growth problems.

The population genetics of the self-incompatibility polymorphism in Papaver rhoeas. IV. The estimation of the number of alleles in a population

Three methods of estimating the number of S-alleles in a population have been proposed in the literature (Bateman, 1947; Whitehouse, 1949; Paxman, 1963). These methods, all of which assume that genotype frequencies in the population are equal, are described briefly and are used to estimate the number of alleles in populations of Trifolium pratense (Williams and Williams, 1947), Oenothera organensis (Emerson, 1939) and Papaver rhoeas (Campbell and Lawrence, 1981b; Lawrence and O'Donnell, 1981). The estimates yielded by Bateman's and White-house's methods are similar to those given by Paxman's maximum likelihood method with the Trifolium and Oenothera data where there is little reason to suppose that the allele frequencies are other than equal. Bateman's method, however, breaks down when used on the Papaver data in which the S-allele frequencies are known to be unequal; and Whitehouse's and the maximum likelihood methods yield estimates which are biased downwards when used on these data. An attempt has been made, therefore, to devise two new estimators of the number of S-alleles in a population which do not assume that their frequencies are equal. The properties of these estimators has been investigated with data from eight populations generated on the computer in which the numbers and frequencies of alleles are known. One of these new estimators (E2) yields estimates which are less biased downwards than those given by Paxman's method when allele frequencies are unequal, but gives estimates which are biased upwards when these frequencies are equal. The other estimator (E1) is generally less satisfactory than the first, particularly when the number of alleles in the population is large. Though neither of these new estimators are wholly satisfactory, there is some justification for using E2 when allele frequencies are known to be unequal. Estimates given by E2 when used on the Papaver data range from 34 to 42 alleles which, bearing in mind that these estimates are still likely to be biased downwards, suggests that the number of alleles in natural populations of this species is likely to be between 40 and 45. A new procedure for calculating confidence intervals for maximum likelihood estimates, assuming equal allele frequencies, is also described and applied to the Oenothera and Papaver data.

Skeletal age changes in puberty.

Changes in skeletal age and height of 34 Leeds schoolboys were studied in a four year longitudinal survey covering puberty. Tanner and Whitehouse method TW2 was used. In each boy, skeletal age advanced rapidly during puberty, reaching a peak at an age related to that of peak height velocity. The importance of recognising that this acceleration of bone age is normal is stressed, in order to avoid attributing it to other causes.

THE LONG‐TERM EFFECTS OF PROTEIN ENERGY MALNUTRITION IN EARLY CHILDHOOD ON BONE AGE, BONE CORTICAL THICKNESS AND HEIGHT

Three groups of Ugandan children, 18 in each group, and one comparison group of 18 children were examined at 11-17 years of age. The three groups had previously been admitted for treatment of protein energy malnutrition between the ages of 8 to 15, 16 to 21 and 22 to 27 months respectively. The comparison group had not been clinically malnourished throughout the period up to 27 months of age. The children came from one tribe and from similar socio-economic background, and were individually matched on age and sex. The bone age was estimated by hand wrist radiography scored for maturity by the Tanner & Whitehouse method. The metacarpal index, a ratio derived from the medullary width and full diameter of the mid-point of the second metacarpal, was used as a measure of bone cortical thickness. The three malnourished groups are significantly shorter in height than the comparison group, but are not different in bone age and metacarpal index. No differences are observed between the three groups of children who had been admitted for protein energy malnutrition at different ages. The findings are discussed as they relate to the existing literature.

A NOTE ON THE BONE AGE AT WHICH PATIENTS WITH TRUE ISOLATED GROWTH HORMONE DEFICIENCY ENTER PUBERTY

Nineteen boys with true isolated growth hormone deficiency developed the first stages of puberty at an average bone age of 12.0"years" (Tanner Whitehouse Method 2, RUS score). The average chronological age was 15.0 years. Seven similar girls entered puberty at 10.9"years" in bone age and 13.7 years in chronological age. The means and ranges of bone age at beginning of puberty of these patients are very close to those of normal children.