2nd ed. Am J Clin Nutr. In order to achieve a greater accuracy and diagnostic reproducibility, it is important that bone age determination has the lowest intra- and interoperator variability. Olesen T, Egeblad M, Dige-Petersen H, Ahlgren P, Nielsen AM, Vesterdal J. Somatic manifestations in children suspected of having been maltreated. Background radiation: natural and man-made. Karger editor. The two diseases that were most often identified in the studied cohort were celiac disease and an abnormality of the growth hormone axis.3 If history and physical examination findings do not suggest a cause, a complete blood count, comprehensive metabolic panel, and measurement of bone age, insulinlike growth factor 1, and insulinlike growth factor binding protein 3 might be useful to screen for chronic disease and growth hormone deficiency. Thus, gender-specific images are compared with the one obtained by patients by evaluating first the nearest chronological age and subsequently the adjacent standards. Cavallo F, Mohn A, Chiarelli F, Giannini C. Evaluation of bone age in children: a mini review. The determination of bone age is important to properly assess and guide the evaluation of short or tall stature, impaired or accelerated growth, and delayed or early puberty (10). doi: 10.1097/NNR.0b013e3181b4b921, 16. Endocrine effects of inhaled corticosteroids in children. Loder RT, Estle DT, Morrison K, Eggleston D, Fish DN, Greenfield ML, et al. Cox LA. doi: 10.1515/jpem.2010.138, 63. Eur Radiol. But perfectly healthy kids also can have bone ages that differ from their actual ages. [] The other applications of BA include height prediction and estimation of age in children seeking asylum in other countries and in competitive sports where chronological age (CA) may be unknown. [4] Other uses of bone age measurements include assisting in the diagnosis of medical conditions affecting children, such as constitutional growth delay, precocious puberty, thyroid dysfunction, growth hormone deficiency, and other causes of abnormally short or tall stature. Clin Pediatr Endocrinol. Acta Paediatr Scand. doi: 10.1136/adc.2005.090134, 121. The GreulichPyle tables can be applied in subjects belonging to Australia and the Middle East (108110) but not to African or Asian populations (106, 111, 112). In particular, estrogens and oral contraceptives or creams containing testosterone or estrogens can cause an early closure of the growth plate. doi: 10.1297/cpe.23.27, 55. Tanner-Whitehouse method of assessing skeletal maturity: problems and common errors. 110. [24] The Sontag method uses x-rays of all the bones and joints of the upper and lower limbs on the left side of the body. J Coll Physicians Surg Pak. [17][20] Finally, only the wrist and hand are imaged out of a desire to minimize the amount of potentially harmful ionizing radiation delivered to a child. Acta Paediatr. The X-ray image is black and white. [1][2], Bone age acts as a surrogate for physiological development because growth and maturation of the skeletal system depend on the presence of hormones like growth hormone, sex steroids (e.g., estrogen and testosterone), and thyroxine. [1][2][3] As a person grows from fetal life through childhood, puberty, and finishes growth as a young adult, the bones of the skeleton change in size and shape. De Martino M, Galli L, Chiarelli F, Verrotti A, Rossi ME, Bindi G, et al. This information, associated to the characterization of the shape and changes of bone components configuration, represent an important factor of the biological maturation process of a subject. Figure 1. Another method is the RocheWainerThissen (RWT) algorithm, which calculates predicted adult height directly from a linear combination of the child's weight, recumbent length, and bone age, together with parental height, by using a gender- and age-specific coefficients. (2005) 32:31625. Bassett JH, Williams GR. In some psychiatric conditions, such as anorexia and in subjects with states of psychosocial stress or abuse, the presence of delayed skeletal maturation is documented (4345). 1. A child with advanced bone age is likely to reach this milestone earlier, whereas a child with delayed bone age will probably enter puberty later than normal. This evaluation is more detailed than a simple comparison and takes into consideration a detailed analysis of structural characteristics of different bones with the assignment of a score to each element (3, 113, 114). Hjern A, Brendler-Lindqvist M, Norredam M. Age assessment of young asylum seekers. In addition, children with PA appeared to be affected by a BA . An X-ray of the left hand and wrist will measure your child's bone age. (2014) 16:424. doi: 10.1186/s13075-014-0424-1, 34. Hill RJ, Brookes DS, Lewindon PJ, Withers GD, Ee LC, Connor FL, et al. (2007) 51:5003. Int J Pediatr Endocrinol. X-rays are commonly done in doctors offices, radiology departments, imaging centers, and dentists offices. In the last 20 years, newer methods have also been studied with the principal aim to mainly eliminate the variability related to interpretation according to the different methods. doi: 10.4158/EP13193.OR, 52. If findings from the initial evaluation do not suggest a diagnosis, laboratory testing may be performed (Table 4).1,3,13,14,16,19,20 A retrospective study found that a complete laboratory evaluation of an asymptomatic child with idiopathic short stature is low yield and expensive. Then, the remaining centers progressively appear (Figure 1) (80). Table 1. Using an atlas-based method gives a great possibility of intra- and interoperator variability, so in the last 20 years, new methods have been studied such as computerized automatic systems. Lodish MB, Gourgari E, Sinaii N, Hill S, Libuit L, Mastroyannis S, et al. 3rd ed. [5] For example, a patient's bone age may be less than their chronological age suggesting a delay in growth as may be caused by a growth hormone deficiency. Therefore, carpal bones are not ossified at birth, and this process typically advances from the center of ossification (80). In particular, subjects with severe hypothyroidism may have a delayed bone age. As known, operator variability (intravariability) is defined by the degree of variability in the interpretation of same data performed at two different times by the same operator. Biological maturation of youth athletes: assessment and implications. Evaluation for pathologic etiologies is guided by history and physical examination findings. Bone age and factors affecting skeletal maturation at diagnosis of paediatric Cushing's disease. [19] Further, most people are right-hand dominant and the left hand is therefore less likely to be deformed due to trauma. The bone age/chronological age ratio decreased significantly to 1.120.1 at the end of treatment (P<0.05). Your body age is a measure of how healthy and typical your physical condition is compared to what is expected for your chronological age. Thus, the variability in the bone age at onset of puberty was greater than the variability in the chronological age at onset of puberty ( Fig. Bone age advancement in prepubertal children with obesity and premature adrenarche: possible potentiating factors. Heyman R, Guggenbuhl P, Corbel A, Bridoux-Henno L, Tourtelier Y, Balencon-Morival M, et al. Chronological age vs. bone age in 169 children with Cystic Fibrosis Dots under the line represented a delay in bone age. (1999) 51:16872. [39] Liver weight increases with age and is different between males and females. Vaska AI, Benson J, Eliott JA, Williams J. TW2 and TW3 bone ages: time to change? Br Med Bull. [2][5], To assign a bone age to the patient under review, a radiologist compares the patient's hand and wrist x-ray to images in the Greulich and Pyle atlas. Powell SG, Frydenberg M, Thomsen PH. Similarly, an excessive intake of foods containing phytoestrogens such as soya, according to some studies, may have an effect on bone age progression (5663). Haffner D, Nissel R. Growth and puberty in chronic kidney disease. 21. Evaluation of skeletal maturity is a common procedure frequently performed in clinical practice. The role of puberty in variations in BA is poorly understood as hypothalamic-pituitary-gonadal (HPG) axis maturation and skeletal maturation are regulated in parallel but independently by multiple different factors. These methods differ according to the technique of the procedure and particularly to peculiar advantages and disadvantages (Table 1). Discussion. The issue here is the size of the standard deviation (SD) of the difference between bone age and chronological age, which is 15 months or more. A score is assigned to each bone based on maturation and sex of the patient. 4. The applicability of Greulich and Pyle atlas to assess skeletal age for four ethnic groups. Rosemont, IL: American Academy of Orthopaedic Surgeons (2000). Calculating the midparental height (Table 1) is an important part of the evaluation because most short or tall children have short or tall parents. This lack of precision impacts on the value of bone age as evidence . Stanhope R, Albanese A, Azcona C. Growth hormone treatment of russell-silver syndrome. (1997) 48:18490. (2012) 101:47. A growth velocity that is less than normal should prompt further investigation. In this study of prepubertal children with and without obesity and/or PA, obesity was highly associated with BA advancement. Constitutional Delay of Growth and Puberty. doi: 10.1093/qjmed/hcs230, 66. (2008) 122:30914. IEEE Trans Med Imaging. Advanced bone age and hyperinsulinemia in overweight and obese children. (2009) 94:223944. International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes. Because children grow in spurts, two measurements at least three to six months apart, and preferably six to 12 months apart, are needed to accurately determine growth velocity.4. (2010) 126:93844. Acta Paediatr Scand. The CDC and WHO growth charts are available at http://www.cdc.gov/growthcharts/ and http://www.who.int/childgrowth/standards/en/. The image in the reference atlas that most closely resembles the patient's x-ray is then used to assign a bone age to the patient. (2001) 50:6248. Since bone age measurements are inherently approximations, they are conventionally reported with a standard deviation which serves as an estimate of the associated error. This process is strongly affected by numerous factors, including GH and insulin-like growth factor-1 (IGF-1). Interleukin-6 release by cultured peripheral blood mononuclear cells inversely correlates with height velocity, bone age, insulin-like growth factor-I, and insulin-like growth factor binding protein-3 serum levels in children with perinatal HIV-1 infection. X-ray exam: bone age study. Images of hand and wrist x-rays in four female subjects compatible with physiological skeletal maturation in different ages: A (4 years), B (8 years), C (12 years), D (16 years). Most children with short or tall stature have normal variants of growth. Constitutional advancement of growth in tall children is the equivalent of constitutional delay of growth and puberty in short children.1,19,20 Children with constitutional advancement of growth have accelerated growth until two to four years of age and then track parallel to the growth curve. Tanner JM. So the confidence interval around the chronological age estimated from bone age is 30 months (i.e. This method has the advantage of being more reproducible, and it is not based on the subject age but on skeletal maturity of several bone elements and population-based references. Although encouraging results have been shown, this method still requires improvements in terms of reproducibility and elimination of confounding factors (135, 136). Ann Hum Biol. doi: 10.1007/BF02171555, 116. Constitutional delay of growth and puberty is one of the most common causes of delayed bone age (10). The atlas has a set of images arranged in chronological order by age for males ranging from 3 months to 19 years and for females ranging from 3 months to 18 years in varying intervals of 3 months to 1 year. [41] The cells of the mesenchyme can become bone by one of two primary methods: (1) intramembranous ossification where mesenchymal cells differentiate directly into bone or (2) endochondral ossification where mesenchymal cells become a cartilaginous model of chondrocytes which then become bone. Horm Res. Childrens bones have areas of new bone growth called growth plates at both ends. 2nd ed. Bone age in the 21st century: is Greulich and Pyle's atlas accurate for Israeli children? Kim JR, Lee YS, Yu J. The Pediatric Endocrine Society website was searched for consensus statements and clinical guidelines. Bone age delay is also associated with genetic syndromes such as trisomy 21, Turner syndrome, and RussellSilver syndrome (10, 4648). In fact, the bone maturation process lasts longer in male than in female individuals (8385), and the moment of closure of the epiphyseal region occurs is roughly 2 years earlier in girls than in boys. Kapadia CR, Nebesio TD, Myers SE, Willi S, Miller BS, Allen DB, et al. Serinelli S, Panetta V, Pasqualetti P, Marchetti D. Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. Arthritis Res Ther. All authors contributed to manuscript revision and read and approved the submitted version. doi: 10.1007/s00247-004-1385-3, 136. Chronological age versus bone age for boys. Congenital adrenal hyperplasia. These are based on longitudinal data from 116 boys and 95 girls of the Harpenden Growth Study and the London group of the . (1996) 45 Suppl 2:428. (1990) 149:3147. We present three pre-pubertal female children with a diagnosis of NC-CAH treated with anastrozole monotherapy after presenting with advanced bone age, early adrenarche, no signs of genital virilization, and normal peak cortisol in response to ACTH stimulation. The evaluation of potential pathologic causes of short or tall stature should be guided by the history and physical examination findings.13, The first step in the evaluation of a child with suspected short or tall stature is to obtain accurate measurements and plot them on the appropriate growth chart. Assessments of skeletal maturity in prepubertal children are primarily based on the epiphyseal size of the phalanges as they relate to the adjacent metaphyses. In fact, the images obtained by hand and wrist X-ray reflect the maturity of different types of bones of the skeletal segment evaluated. Clin Immunol. This means a child tends to be shorter than average and to enter puberty later than average, while growing at a normal rate. However, this system has some limits that must be considered, in particular, the absence of carpal bones evaluation, the opposition of local administrations to install the software, and the higher cost compared to available methods (GP and TW) (134). The bone age (also called the skeletal age) is measured in years. J Pediatr. Thereafter, the pisiform and the sesamoid become recognizable. (2012) 42:3438. Kulin HE, Bwibo N, Mutie D, Santner SJ. Skeletal maturation in children with Cushing syndrome is not consistently delayed: the role of corticotropin, obesity, and steroid hormones, and the effect of surgical cure. 29. Many devices approved for pediatric use were not tested in a clinical trial involving children. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Benso L, Vannelli S, Pastorin L, Angius P, Milani S. Main problems associated with bone age and maturity evaluation. A clinically oriented method based on hand-wrist films. doi: 10.1007/s00414-008-0237-3, 65. Briers PJ, Hoorweg J, Stanfield JP. doi: 10.1016/S0022-3476(97)90000-7, 8. In terms of height growth and height growth related to bone age, average females stop growing taller two years earlier than average males. Salsberry PJ, Reagan PB, Pajer K. Growth differences by age of menarche in African American and White girls. Tanner JM. (1995) 154:627. doi: 10.1007/BF02079065, 142. Soudack M, Ben-Shlush A, Jacobson J, Raviv-Zilka L, Eshed I, Hamiel O. Bone age may be significantly advanced in genetic overgrowth syndromes, such as Sotos syndrome, Beckwith-Wiedemann syndrome and Marshall-Smith syndrome. (1982) 36:52736. Usually, the first ossification center to appear is in the context of capitate and hamate at the second month in female individuals and around the fourth month in male individuals and remain the only useful observable features for the next 6 months. 2015;24(4):143-152. doi:10.1297/cpe.24.143. Birth Date Issues. Tanner JM. Aust Orthod J. [3][21], Images in the Greulich and Pyle atlas came from healthy white boys and girls enrolled in the Brush Foundation Study for Human Growth and Development between the years 1931 and 1942. In a study conducted by King and collaborators in which bone aging was performed by three different operators using either GP or TW method, there was a significant intraindividual variability with values equal to 0.96 and 0.74 years, respectively (94). Copyright 2021 Cavallo, Mohn, Chiarelli and Giannini. Accessed November 22, 2021. https://kidshealth.org/en/parents/xray-bone-age.html, 2. Med Phys. Chronological age and bone age were 8.7 4.0 and 8.8 4.3 years, respectively, for the entire population. (1984) 73:5306. New MI. (2006) 29:2416; discussion 8690. doi: 10.1016/j.ghir.2017.10.005. doi: 10.1002/mpo.2950210104, 40. The mean growth velocity ranges from 8 to 10 cm/year, roughly +2 to +4 SD for chronological age, and results in increased heights, between +1.5 and +2.5 SD for age on average. Nat Rev Endocrinol. In addition, subjects with long-lasting and untreated growth hormone (GH) deficiency have a delay in bone maturation. These different methods are characterized by a significant and variable intraindividual variability with values ranging from 0.96 to 0.74 years, which seems to be strongly affected by several factors including ethnicity, gender, and pubertal age (93105). Nurs Res. Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods. (1998) 75:4929. Although most children with short or tall stature have variants of normal growth, children who are more than three standard deviations from the mean for age are more likely to have underlying pathology. (2010) 2010:298937. doi: 10.1186/1687-9856-2010-298937, 56. Front Pediatr. This method has the advantage of eliminating the need for additional radiographic exposure in cases where the vertebrae have already been recorded on a lateral cephalometric radiographic. Furthermore, the GP method has not been updated from its initial publication, representing important limits of applications especially in some ethnic groups such as African or Hispanic female subjects and in Asian and Hispanic male subjects during late infancy and adolescence (95, 96). Genetic potential is determined by mid-parental height, which is calculated by averaging sex-adjusted parental heights.Kutney shared the following examples. [30][31][32][33][34], There are exceptions with people who have an advanced bone age (bone age is older than chronological age) due to being an early bloomer (someone starting puberty and hitting PHV earlier than average), being an early bloomer with precocious puberty, or having another condition. First the capitate forms at an average age of 2 months, followed shortly by the hamate, then the triquetrum around 14 months, and so on.[44]. Further, there can be moderate levels of variability in the bone ages assigned to the same patient by different assessors. Pituitary. [2] A paediatric radiologist specially trained in estimating bone age assesses the patient's x-ray for growth, shape, size, and other bone features. (1990) 65:110912. J Paediatr Child Health. J Pediatr Gastroenterol Nutr. doi: 10.1080/03014469000001142, 117. Pediatrics. doi: 10.1136/adc.81.2.172, 94. It is defined by the age expressed in years that corresponds to the level of maturation of bones. The best time to start and stop such therapies can be determined based on a patient's bone age. [21] Other downsides are that the atlas has not been updated since 1959 and the images in the atlas were acquired from healthy white children living in Cleveland, Ohio in the 1930s and 1940s and therefore may not yield accurate bone age assignments when applied to non-white patients or unhealthy children. Bone age is an interpretation of skeletal maturity. [28], For the average person with average puberty, the bone age would match the person's chronological age. There is a separate equation for each half year of chronological age; and for pre- and postmenarcheal girls at ages 11 to 14. Most children with short stature have normal variants such as familial short stature, constitutional delay of growth and puberty, or idiopathic short stature. Zhang H, Geng N, Wang Y, Tian W, Xue F. Van Wyk and Grumbach syndrome: two case reports and review of the published work. (1997) 24:25761. doi: 10.3348/kjr.2015.16.1.201, 100. [42][43] The bones of the limbs form and lengthen through endochondral ossification beginning by the 12th week after fertilization.[41]. After dividing the population into two different age groups: children < 11 years and adolescents 11 years, children showed an average delay in bone age of 3.4 months and adolescents of 2.4 months. Hogler W, Baumann U, Kelly D. Growth and bone health in chronic liver disease and following liver transplantation in children. Stanford, CA (1959). doi: 10.1080/03014469700004982, 120. These images were performed in 355 male and 322 female children born between 1928 and 1974, from the first month of life up to the age of 22 years (124). doi: 10.1046/j.1365-2265.2003.01905.x, 50. There are extremes to be mindful of, Kutney added. The growth hormone insulin-like growth factor 1 axis in children and adolescents with inflammatory bowel disease and growth retardation. (2010) 6:145. Received: 05 July 2020; Accepted: 08 January 2021; Published: 12 March 2021. J Pediatr. Guidelines on Policies and Procedures in Dealing With Unaccompanied Children Seeking Asylum. Bol Med Hosp Infant Mex. (2001). Acta Paediatr Scand. J Forensic Sci. As growth nears conclusion and attainment of adult height, bones begin to approach the size and shape of adult bones. doi: 10.1088/0952-4746/23/1/302, 88. doi: 10.1007/978-1-4419-1795-9_176, 124. Bone age continues to be a valuable tool in assessing children's health. (2007) 356:47985. Similarly, a bone age that is older than a person's chronological age may be detected in a child growing faster than normal. Copyright 2023 American Academy of Family Physicians. Coefficients used in the RWT method are tabulated to 14 years of age for girls and 16 years of age for boys (138). Bone growth estimation using radiology (GreulichPyle and Tanner-Whitehouse Methods). N Engl J Med. By contrast, subjects with hyperthyroidism may present precocious puberty associated with advanced bone age (18, 19). Bone age assessments can provide pediatricians with a rough estimate of when a child will enter puberty, Kutney stated. J Paediatr Child Health. Clin Pediatr Endocrinol. London: Academic Press (1983). Because the WHO growth charts are based on an international study of exclusively breastfed infants raised in optimal nutritional conditions, they are less likely to incorrectly identify breastfed infants as underweight. [1 2 3]The two major methods of BA assessment used commonly are i . 5. Assessment of the carpals, metacarpals, and phalanges are used to find the closest match in the atlas; the chronological age of the patient in the atlas becomes the bone age assigned to the patient under review. Ann Hum Biol. The middle finger axis should be in line with the forearm axis, and the center of the X-ray tube should be over the distal end of the third metacarpus. Herman TE, Crawford JD, Cleveland RH, Kushner DC. In fact, in the beginning, data were obtained from Caucasian children, so it is easy to understand that results assessed by the GP and TW standards are strongly dependent on ethnic group. In Sweden, many asylum applications in 2016 were made by lone refugee children, thus requiring novel proposed guidelines. It is important to highlight that all the available methods might be carefully used in the daily clinical approach in order to avoid unreliable expectation in children and parents. doi: 10.1210/er.2015-1106, 20. Children with short stature and no identified cause and children with certain other identifiable causes of short stature should be referred to a pediatric endocrinologist. Therefore, chronological age differs from bone age, so the two indexes need to be distinguished: chronological age is defined as the age in years between birth and the evaluation of a subject; bone age is defined by the age expressed in years that corresponds to the level of maturation of bones. Children with normal variants of height tend to have a normal growth velocity (5 cm [2 in] per year for children between five years of age and puberty) after catch-up or catch-down growth. Speiser PW, White PC. This means a child's height is part of his or her family's pattern of inherited tall height. [12] The Greulich and Pyle atlas contains x-ray images of the left hands and wrists of different children deemed to be good models of the average appearance of the bones of the hand at a given age. As well, height prediction methods might be affected by ethnicity-related differences, thus either underestimating or overestimating adult height, with wide variations in accuracy. However, bone age itself cannot be considered the only absolute and incontrovertible datum to define the chronological age (6879); therefore, limits and accuracy of this examination in predicting chronological age, especially in relation to different ethnic groups and underlying diseases, need to be considered. A child with GHD may have a bone age that is much less than his/her chronological age. doi: 10.1258/ar.2012.120443, 122. 5. Viii + 339 pp. Springfield, IL: Blackwell Scientific Publications (1962). Angle Orthod. (2005) 154:312. Since then, more than 15 new computerized automatic systems have been developed (128, 129). Chronological age and bone age were 8.12 4.1 and 8.4 4.4 years, respectively, for girls and 9.0 3.9 and 9.1 4.2 years, respectively, for boys. A newborn's size and growth are a result of the intrauterine environment, and growth hormone does not play a major role. New growth references for assessment of stature and skeletal maturation in Australians. Giovanni XXIII Children's Hospital, Italy, University of Modena and Reggio Emilia, Italy, Children's Hospital at Montefiore, United States. The bone ages of hand and elbow were different at puberty, and the elbow was a more reliable location for bone-age assessment at puberty. doi: 10.1136/bjsports-2012-091296. Furthermore, the impact of being overweight or obese on bone age could be identified correctly by BoneExpert. Gastroenterol Clin Biol. 78. Children with this condition are born appropriate for gestational age, but will then fall to the 3rd percentile for height during catch-down growth. [3] However, most pediatric radiologists still use the Greulich and Pyle technique for estimating bone age in infancy. 2019;29(6):2910-2923. doi:10.1007/s00330-018-5792-5. Meet the Board: Vivian P. Hernandez-Trujillo, MD, FAAP, FAAAAI, FACAAI. doi: 10.1109/42.108597, 128. Numerous scales have been produced that can convert bone maturity score into bone age for different European and non-European populations (7, 114119). The use of AI as a monotherapy for children with NC-CAH has never been reported. Mora S, Boechat MI, Pietka E, Huang HK, Gilsanz V. Skeletal age determinations in children of European and African descent: applicability of the Greulich and Pyle standards. Gaskin CM, Kahn SL, Bertozzi JC, Bunch PM. Therefore, the bone maturation process can be better characterized by the evaluation of the knee region in children under the age of 3, while in those older than 3 years, the assessment of hand and wrist bones is the most appropriate (8082). For this reason, pediatricians should evaluate each prediction of future height on the bases of all the available knowledge about the child, particularly their personal growth history. Forensic Sci Int. Woods CP, Argese N, Chapman M, Boot C, Webster R, Dabhi V, et al. Finally, children with later than normal puberty timing, are expected to grow along a height percentile below their final adult height, but continue growing longer than their peers. doi: 10.1136/adc.68.5.677, 37. 83. (2005) 35:42933. doi: 10.1097/MPG.0b013e31818cb4b6, 32. (2006) 22:110. Assessing the skeletal maturity of the hand-wrist: FELS method. Katherine Kutney, MD, a pediatric endocrinologist at Rainbow Babies and Childrens Hospital in Cleveland, Ohio, said bone age assessments are typically done with an x-ray of the left hand. (2007) 92:3712. These tables have been formulated on bone age assessment according to the standards of Greulich and Pyle. doi: 10.1159/000184848, Keywords: skeletal development, height, X ray, children, bone age, Citation: Cavallo F, Mohn A, Chiarelli F and Giannini C (2021) Evaluation of Bone Age in Children: A Mini-Review.

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