![]() ![]() 10 It contains reference images of male and female standards of the left wrist and hand from birth till 18 years for females and 19 years for males. A brief description of the commonly used methods is given below.ġ: The Greulich & Pyle (GP) Atlas: Is a holistic method based on “The Radiographic Atlas of Skeletal Development of the Hand and Wrist”, by Dr William Walter Greulich and Dr Sarah Idell Pyle, its last edition published in 1959, is still one of the most commonly used atlas for bone age measurement by radiologists in Pakistan 9 and in the West. Various methods have been developed to compute bone age score from these radiographs by comparing the maturity of hand & wrist bones to idealized standards. 8 This dose is less than 20 minutes of natural background radiation or the amount of radiation received by an individual on a 2 minutes transatlantic flight. The hand radiographs are quite safe to obtain as the effective dose of radiation received during each exposure is between 0.0001-0.1 mSV. A standard posterior-anterior (PA) view of the hand and wrist is ideal for visualization of features of hand bones. Visualization by plain hand & wrist radiographs: There have been great advancements in radiological techniques over the past few decades but to date, plain radiographs of the hand are the investigation of choice for bone age assessment. Traditionally, the extent of growth and development of hand bones has been visualized by plain wrist radiographs, however newer methods such as ultrasound of hand bones are being tried but have yet not been validated. Thus, the standards of bone age have been derived by comparing the level of maturation of hand and wrist bones with normal age levels. The pattern of ossification in the hand and wrist bones is in a fairly predictable manner and age specific until end of adolescence when the elongation of bone is complete. A critical comparison of these methods is given below.īone age by visualization of Hand & Wrist bones In order to compute bone age various methods have been developed using different skeletal elements and various visualization techniques. 6 In these cases bone age is used to provide the closest estimate of chronological age. 3 Thus need for accurate estimation of age arises in conditions where the age of a child needs to be accurate, such as during immigration 4, in law suits 5 and in competitive sports. In South Asia, 65% of all births are not registered by the age of 5 years. Absent birth data is a big problem in our part of the world. 2Ĭalculation of bone age is also employed for estimation of chronological age in conditions were accurate birth records are not available. 1 Furmulae have also been designed for computing the final adult height of children from bone age values in normal healthy children. Serial measurements are also used to assess the effectiveness of treatments for these diseases. Bone age is often requested by pediatricians and endocrinologists for comparison with chronological age for diagnosing diseases which result in tall or short stature in children. This is different from chronological age, which is calculated using the date of birth of an individual. Sources of Data/Study Selection: Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review.īone age is an indicator of the skeletal and biological maturity of an individual. ![]() The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated.Īs different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. MRI based methods are being developed but require more research. ![]() CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. By the age of 18 years, bone age cannot be computed from hand & wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18-22 years. ![]() Non radiation based techniques of visualizing hand & wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Radiography of the hand & wrist is the commonest modality used to calculate bone age. The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. ![]()
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