Bone age maturity assessment using hand-held device

Purpose: Assessment of bone maturity is traditionally performed through visual comparison of a hand and wrist radiograph with existing reference images in textbooks. Our goal was to develop a digital index based on idealized hand Xray images that can be incorporated in a hand held computer and used for visual assessment of bone age for patients. Material and methods: Due to the large variability in bone maturation in normals, we generated a set of "ideal" images obtained by computer combinations of images from our normal reference data sets. Software for hand-held PDA devices was developed for easy navigation through the set of images and visual selection of matching images. A formula based on our statistical analysis provides the standard deviation from normal based on the chronological age of the patient. The accuracy of the program was compared to traditional interpretation by two radiologists in a double blind reading of 200 normal Caucasian children (100 boys, 100 girls). Results: Strong correlations were present between chronological age and bone age (r > 0.9) with no statistical difference between the digital and traditional assessment methods. Determinations of carpal bone maturity in adolescents was slightly more accurate using the digital system.. The users did praise the convenience and effectiveness of the digital Palm Index in clinical practice. Conclusion: An idealized digital Palm Bone Age Index provides a convenient and effective alternative to conventional atlases for the assessment of skeletal maturity.