Importance and accuracy of bone age ratings in a computerized growth evaluation system

Effect of knowledge of chronologic age on the variability of pediatric bone age determined using the Greulich and Pyle standards

OBJECTIVE

The purpose of this study was to investigate the impact of knowing chronologic age on the variability of pediatric bone age determination using the method of Greulich and Pyle.

MATERIALS AND METHODS

Radiographs of the left hand of 107 patients were interpreted by four radiologists on two separate occasions, once with and once without knowledge of the patient's chronologic age at time of interpretation. Twenty-five radiographs were randomly selected and reevaluated twice by each radiologist. Interobserver and intraobserver variability were calculated and compared for the two conditions. The distribution of studies with normal and abnormal findings was then compared across knowledge conditions for all observers and by individual observer, using two standard deviations above and below chronologic age as the range of "normal".

RESULTS

When the chronologic age was known, the interobserver reliability coefficient for knowledge of chronologic age was 0.954 and when not known, 0.952. The intraobserver reliability coefficients when chronologic age was known ranged from 0.944 to 0.967, and when not known from 0.938 to 0.980. Observers interpreted 58% (248/428) of the radiographs as having normal findings when chronologic age was known and 48% (205/428) when chronologic age was not known.

CONCLUSION

Knowing chronologic age before assessing bone age radiographs does not affect the reproducibility of assessment. However, observers are more likely to interpret the radiograph as showing normal findings when chronologic age is known than if the interpretation is performed with the observer unaware of chronologic age.

Modified Greulich-Pyle, Tanner-Whitehouse, and Roche-Wainer-Thissen (knee) methods for skeletal age assessment in a group of Italian children and adolescents

Modified Greulich-Pyle (GP), Tanner et al. 2, radius, ulna and short bones (TW2-RUS), TW2-20-bone and Roche-Wainer-Thissen RWT (knee) skeletal age assessments were made in an Italian population sample of 128 males and 93 females aged 4.1-16.9 years. All the scales appear to be well-suited to the Italian population despite minor differences. A very high correlation was found between the assessment of knee skeletal ages by the RWT method and that of the hand-wrist by the GP and TW2 systems in the same subject without sex and age-associated variations.

Theoretical growth evaluation (TGE). A computerized screening system for growth disorders

A computerized screening system for growth disorders is presented. Its aim is to save time and to facilitate the decision of whether a patient with a suspected growth problem should be referred for specialized evaluation. It uses accepted methods and common sense, and has been shown to be effective. A radiography of the hand and wrist, and a completed data sheet (birth date, date of x-ray, height and weight, parental height, and in girls, whether menarche has occurred) are mailed for analysis. Bone age is rated according to Greulich and Pyle, and Tanner et al. by trained technicians, and the results are supervised by a consultant pediatric endocrinologist. The supplied data and bone age values are then processed by a computer, which compares them with normal values, calculates three different height predictions (Bayley and Pinneau, Roche et al., Tanner et al.), as well as "target height" (estimation of genetic potential), and prints an easy-to-read growth curve. Depending on the constellations of height (normal, below 3rd, above 97th percentile), bone age (normal, retarded, advanced in comparison with chronologic age), and height predictions vs. target height (predictions within, below, above target height range), different messages suggesting the most likely diagnostic possibilities are listed on a computer printout.