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      Validation of a New Method for Automated Determination of Bone Age in Japanese Children

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          Abstract

          BoneXpert, an automated method for analysis of hand radiographs of children, has recently been developed and validated in European children. It determines Tanner-Whitehouse (TW) and Greulich Pyle (GP) bone ages (BA). The purpose of this work is to validate BoneXpert BA in Japanese children and determine the following two properties of the method: (1) The accuracy of the BA, i.e. the standard deviation from an experienced Japanese TW BA rater. (2) The precision of the BA, i.e. BoneXpert’s ability to yield the same BA value on a repeated radiograph. The data consist of two studies: 185 radiographs of 22 normal children followed longitudinally from approximately 7 years to full maturity, and 284 radiographs of 22 patients with growth hormone deficiency treated with growth hormone and gonadotropin-releasing hormone analogue followed from an age of 4–11 years to almost full maturity. All radiographs were rated manually according to the TW-Japan system. BoneXpert processed all images, and the accuracy (SD) of TW-Japan BA was 0.72 years (95% CI 0.68–0.76). The precision error (SD) on a single determination of GP BA was 0.17 years (95% CI 0.15–0.19). It is concluded that BoneXpert performs as well in Japanese children as it does in Caucasian children. This study accomplishes a calibration of BoneXpert to the TW-Japan standard, which performs well for the entire BA range from 4 years up to full maturity.

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          Most cited references 5

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          The BoneXpert method for automated determination of skeletal maturity.

          Bone age rating is associated with a considerable variability from the human interpretation, and this is the motivation for presenting a new method for automated determination of bone age (skeletal maturity). The method, called BoneXpert, reconstructs, from radiographs of the hand, the borders of 15 bones automatically and then computes "intrinsic" bone ages for each of 13 bones (radius, ulna, and 11 short bones). Finally, it transforms the intrinsic bone ages into Greulich Pyle (GP) or Tanner Whitehouse (TW) bone age. The bone reconstruction method automatically rejects images with abnormal bone morphology or very poor image quality. From the methodological point of view, BoneXpert contains the following innovations: 1) a generative model (active appearance model) for the bone reconstruction; 2) the prediction of bone age from shape, intensity, and texture scores derived from principal component analysis; 3) the consensus bone age concept that defines bone age of each bone as the best estimate of the bone age of the other bones in the hand; 4) a common bone age model for males and females; and 5) the unified modelling of TW and GP bone age. BoneXpert is developed on 1559 images. It is validated on the Greulich Pyle atlas in the age range 2-17 years yielding an SD of 0.42 years [0.37; 0.47] 95% conf, and on 84 clinical TW-rated images yielding an SD of 0.80 years [0.68; 0.93] 95% conf. The precision of the GP bone age determination (its ability to yield the same result on a repeated radiograph) is inferred under suitable assumptions from six longitudinal series of radiographs. The result is an SD on a single determination of 0.17 years [0.13; 0.21] 95% conf.
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            Automatic determination of Greulich and Pyle bone age in healthy Dutch children.

            Bone age (BA) assessment is a routine procedure in paediatric radiology, for which the Greulich and Pyle (GP) atlas is mostly used. There is rater variability, but the advent of automatic BA determination eliminates this. To validate the BoneXpert method for automatic determination of skeletal maturity of healthy children against manual GP BA ratings. Two observers determined GP BA with knowledge of the chronological age (CA). A total of 226 boys with a BA of 3-17 years and 179 girls with a BA of 3-15 years were included in the study. BoneXpert's estimate of GP BA was calibrated to agree on average with the manual ratings based on several studies, including the present study. Seven subjects showed a deviation between manual and automatic BA in excess of 1.9 years. They were re-rated blindly by two raters. After correcting these seven ratings, the root mean square error between manual and automatic rating in the 405 subjects was 0.71 years (range 0.66-0.76 years, 95% CI). BoneXpert's GP BA is on average 0.28 and 0.20 years behind the CA for boys and girls, respectively. BoneXpert is a robust method for automatic determination of BA.
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              Reliability and Validity of Computer-Assisted Estimates of Tanner-Whitehouse Skeletal Maturity (CASAS): Comparison with the Manual Method

              Three observers rated 57 X-rays from normal healthy children in Project HeartBeat! twice each by CASAS, the computer-assisted version of the TW2 RUS bone age method. Differences between duplicates of individual bone ratings which reached or exceeded 1.0 unit (or 1 stage) were 5% within observer and 8% between observers for CASAS, and 17 and 33%, respectively, for the unassisted MANUAL method. In children followed longitudinally, CASAS scores increased much more steadily than MANUAL scores, largely because the bones were rated, in the former system, on a continuous rather than a discrete-integer scale. We conclude that CASAS is a more reliable and probably a more valid estimator of skeletel maturity than the MANUAL version of the TW2 RUS method.
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                Author and article information

                Journal
                HRP
                Horm Res Paediatr
                10.1159/issn.1663-2818
                Hormone Research in Paediatrics
                S. Karger AG
                1663-2818
                1663-2826
                2010
                April 2010
                14 April 2010
                : 73
                : 5
                : 398-404
                Affiliations
                aTübingen University, Tübingen, Germany; bTohoku University, Sendai, and cToho University and dTanaka Growth Clinic, Tokyo, Japan; eVisiana, Holte, Denmark
                Article
                308174 Horm Res Paediatr 2010;73:398–404
                10.1159/000308174
                20389112
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 5, References: 11, Pages: 7
                Categories
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