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Liang Y, Chen X, Zheng R, Cheng X, Su Z, Wang X, Du H, Zhu M, Li G, Zhong Y, Cheng S, Yu B, Yang Y, Chen R, Cui L, Yao H, Gu Q, Gong C, Jun Z, Huang X, Liu D, Yan X, Wei H, Li Y, Zhang H, Liu Y, Wang F, Zhang G, Fan X, Dai H, Luo X. Validation of an AI-Powered Automated X-ray Bone Age Analyzer in Chinese Children and Adolescents: A Comparison with the Tanner-Whitehouse 3 Method. Adv Ther 2024:10.1007/s12325-024-02944-4. [PMID: 39085749 DOI: 10.1007/s12325-024-02944-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Automated bone age assessment (BAA) is of growing interest because of its accuracy and time efficiency in daily practice. In this study, we validated the clinical applicability of a commercially available artificial intelligence (AI)-powered X-ray bone age analyzer equipped with a deep learning-based automated BAA system and compared its performance with that of the Tanner-Whitehouse 3 (TW-3) method. METHODS Radiographs prospectively collected from 30 centers across various regions in China, including 900 Chinese children and adolescents, were assessed independently by six doctors (three experts and three residents) and an AI analyzer for TW3 radius, ulna, and short bones (RUS) and TW3 carpal bone age. The experts' mean estimates were accepted as the gold standard. The performance of the AI analyzer was compared with that of each resident. RESULTS For the estimation of TW3-RUS, the AI analyzer had a mean absolute error (MAE) of 0.48 ± 0.42. The percentage of patients with an absolute error of < 1.0 years was 86.78%. The MAE was significantly lower than that of rater 1 (0.54 ± 0.49, P = 0.0068); however, it was not significant for rater 2 (0.48 ± 0.48) or rater 3 (0.49 ± 0.46). For TW3 carpal, the AI analyzer had an MAE of 0.48 ± 0.65. The percentage of patients with an absolute error of < 1.0 years was 88.78%. The MAE was significantly lower than that of rater 2 (0.58 ± 0.67, P = 0.0018) and numerically lower for rater 1 (0.54 ± 0.64) and rater 3 (0.50 ± 0.53). These results were consistent for the subgroups according to sex, and differences between the age groups were observed. CONCLUSION In this comprehensive validation study conducted in China, an AI-powered X-ray bone age analyzer showed accuracies that matched or exceeded those of doctor raters. This method may improve the efficiency of clinical routines by reducing reading time without compromising accuracy.
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Affiliation(s)
- Yan Liang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Pediatric Genetic Metabolic and Endocrine Rare Diseases, Wuhan, 430030, China
| | - Xiaobo Chen
- Department of Endocrinology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Rongxiu Zheng
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xinran Cheng
- Department of Pediatric Endocrine Genetics and Metabolism, Chengdu Women's and Children's Center Hospital, Chengdu, 610074, China
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019 Yitian Road, Shenzhen, 518038, China
| | - Xiumin Wang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Hongwei Du
- Department of Paediatrics, First Hospital of Jilin University, Changchun, 130021, China
| | - Min Zhu
- Department of Endocrinology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yan Zhong
- Department of Child Health Care, Hunan Children's Hospital, Changsha, 410007, China
| | - Shengquan Cheng
- Department of Pediatrics, First Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Baosheng Yu
- Department of Pediatrics, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210003, China
| | - Yu Yang
- Department of Endocrinology and Genetics, Jiangxi Provincial Children's Hospital, Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, China
| | - Ruimin Chen
- Department of Endocrinology, Genetics and Metabolism, Fuzhou Children's Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Lanwei Cui
- Department of Pediatric, The First Affiliated Hospital of Harbin Medical University, Harbin, 150007, China
| | - Hui Yao
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430015, China
| | - Qiang Gu
- Department of Pediatrics, First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Chunxiu Gong
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, 100045, China
| | - Zhang Jun
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiaoyan Huang
- Department of Genetics, Metabolism and Endocrinology, Hainan Women and Children's Medical Center, Haikou, 570312, China
| | - Deyun Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Xueqin Yan
- Department of Pediatrics, Boai Hospital of Zhongshan, Zhongshan, 528400, China
| | - Haiyan Wei
- Department of Endocrinology and Metabolism, Genetics, Henan Children's Hospital (Children's Hospital Affiliated to Zhengzhou University), Zhengzhou, 450018, China
| | - Yuwen Li
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Huifeng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yanjie Liu
- Department of Pediatrics, Inner Mongolia People's Hospital, Hohhot, 010017, China
| | - Fengyun Wang
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Gaixiu Zhang
- Department of Endocrine and Genetics and Metabolism, Children's Hospital of Shanxi, Taiyuan, 030006, China
| | - Xin Fan
- Department of Pediatric, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 537406, China
| | - Hongmei Dai
- Department of Pediatric, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Key Laboratory of Pediatric Genetic Metabolic and Endocrine Rare Diseases, Wuhan, 430030, China.
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Prijatelj V, Grgic O, Uitterlinden AG, Wolvius EB, Rivadeneira F, Medina-Gomez C. Bone health index in the assessment of bone health: The Generation R Study. Bone 2024; 182:117070. [PMID: 38460828 DOI: 10.1016/j.bone.2024.117070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/25/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
Bone Health Index (BHI) has been proposed as a useful instrument for assessing bone health in children. However, its relationship with fracture risk remains unknown. We aimed to investigate whether BHI is associated with bone mineral density (BMD) and prevalent fracture odds in children from the Generation R Study. We also implemented genome-wide association study (GWAS) and polygenic score (PGS) approaches to improve our understanding of BHI and its potential. In total, 4150 children (49.4 % boys; aged 9.8 years) with genotyped data and bone assessments were included in this study. BMD was measured across the total body (less head following ISCD guidelines) using a GE-Lunar iDXA densitometer; and BHI was determined from the hand DXA scans using BoneXpert®. Fractures were self-reported collected with home questionnaires. The association of BHI with BMD and fractures was evaluated using linear models corrected for age, sex, ethnicity, height, and weight. We observed a positive correlation between BHI and BMD (ρ = 0.32, p-value<0.0001). Further, every SD decrease in BHI was associated with an 11 % increased risk of prevalent fractures (OR:1.11, 95 % CI 1.00-1.24, p-value = 0.05). Our BHI GWAS identified variants (lead SNP rs1404264-A, p-value = 2.61 × 10-14) mapping to the ING3/CPED1/WNT16 locus. Children in the extreme tails of the BMD PGS presented a difference in BHI values of -0.10 standard deviations (95% CI -0.14 to -0.07; p-value<0.0001). On top of the demonstrated epidemiological association of BHI with both BMD and fracture risk, our results reveal a partially shared biological background between BHI and BMD. These findings highlight the potential value of using BHI to screen children at risk of fracture.
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Affiliation(s)
- Vid Prijatelj
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - Olja Grgic
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands.
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Furdock RJ, Moyal AJ, Benedick A, Lin FC, Hao Y, Cooperman DR, Sanders JO, Liu RW. Optimizing calibration of modern skeletal maturity systems. J Child Orthop 2024; 18:229-235. [PMID: 38567044 PMCID: PMC10984147 DOI: 10.1177/18632521241229954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Greulich and Pyle is the most used system to estimate skeletal maturity but has significant drawbacks, prompting the development of newer skeletal maturity systems, such as the modified Fels skeletal maturity systems based on knee radiographs. To create a new skeletal maturity system, an outcome variable, termed a "skeletal maturity standard," must be selected for calibration of the system. Peak height velocity and 90% of final height are both considered reasonable skeletal maturity standards for skeletal maturity system development. We sought to answer two questions: (1) Does a skeletal maturity system developed using 90% of final height estimate skeletal age as well as it would if it was instead developed using peak height velocity? (2) Does a skeletal maturity system developed using 90% of final height perform as well in lower extremity length prediction as it would if it was instead developed using peak height velocity? Methods The modified Fels knee skeletal maturity system was recalibrated based on 90% of final height and peak height velocity skeletal maturity standards. These models were applied to 133 serially obtained, peripubertal antero-posterior knee radiographs collected from 38 subjects. Each model was used to estimate the skeletal age of each radiograph. Skeletal age estimates were also used to predict each patient's ultimate femoral and tibial length using the White-Menelaus method. Results The skeletal maturity system calibrated with 90% of final height produced more accurate skeletal age estimates than the same skeletal maturity system calibrated with peak height velocity (p < 0.05). The 90% of final height and peak height velocity models made similar femoral and tibial length predictions (p > 0.05). Conclusion Using the 90% of final height skeletal maturity standard allows for simpler skeletal maturity system development than peak height velocity with potentially more accuracy.
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Affiliation(s)
- Ryan J Furdock
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Andrew J Moyal
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Feng-Chang Lin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yajing Hao
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - James O Sanders
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raymond W Liu
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Sinkler MA, Furdock RJ, Halloran S, Liu RW. The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System. J Pediatr Orthop 2024; 44:281-285. [PMID: 38270347 DOI: 10.1097/bpo.0000000000002621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND The Modified Fels Wrist system is potentially the most accurate clinically accessible skeletal maturity system utilizing hand or wrist radiographs. During development, parameters distal to the metacarpals were excluded. We attempted to further optimize the Modified Fels wrist system through the inclusion of hand parameters distal to the metacarpals. METHODS Forty-three new anteroposterior (AP) hand radiographic parameters were identified from the Fels and Greulich and Pyle (GP) skeletal maturity systems. Twelve parameters were eliminated from further evaluation for poor correlation with skeletal maturity, poor reliability, and lack of relevance in the peripubertal years. In addition to the 8 previously described Modified Fels Wrist parameters, 31 hand radiographic parameters were evaluated on serial peripubertal AP hand radiographs to identify the ones most important for accurately estimating skeletal age. This process produced a "Modified Fels hand-wrist" model; its performance was compared with (1) GP only; (2) Sanders Hand (SH) only; (3) age, sex, and GP; (4) age, sex, and SH; and (5) Modified Fels Wrist system. RESULTS Three hundred seventy-two radiographs from 42 girls and 38 boys were included. Of the 39 radiographic parameters that underwent full evaluation, 9 remained in the combined Modified Fels Hand-Wrist system in addition to chronological age and sex. Four parameters are wrist specific, and the remaining 5 are hand specific. The Hand-Wrist system outperformed both GP and SH in estimating skeletal maturity ( P <0.001). When compared with the Modified Fels Wrist system, the Modified Fels Hand-Wrist system performed similarly regarding skeletal maturity estimation (0.36±0.32 vs. 0.34±0.26, P =0.59) but had an increased (worse) rate of outlier predictions >1 year discrepant from true skeletal maturity (4.9% vs. 1.9%, P =0.01). CONCLUSIONS The addition of hand parameters to the existing Modified Fels Wrist system did not improve skeletal maturity estimation accuracy and worsened the rate of outlier estimations. When an AP hand-wrist radiograph is available, the existing Modified Fels wrist system is best for skeletal maturity estimation. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | | | - Raymond W Liu
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland
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Shu W, Niu W, Zhang Y, Li H. Association between sex hormones and bone age in boys aged 9-18 years from China. J Cell Mol Med 2024; 28:e18181. [PMID: 38506077 PMCID: PMC10951883 DOI: 10.1111/jcmm.18181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 03/21/2024] Open
Abstract
This study aimed to analyse the association between sex hormones and bone age (BA) in boys aged 9-18 years, both individually and interactively, and further to explore whether nutritional status may influence this association. A retrospective analysis was performed among 1382 Chinese boys with physical measurements, sexual characteristics, BA radiographs and sex hormone indicators from February 2015 to February 2022. A total of 470 (34.0%) boys had advanced BA. BA was positively associated with estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone in both advanced and normal BA groups after adjusting for age, genetic height and body mass index. Multiple logistic regression showed that after adjusting for covariates, estradiol (odds ratio [OR] = 1.66, 95% confidence interval [CI]: 1.14-2.12), LH (OR = 1.43, 95% CI: 1.04-1.96), and testosterone (OR = 1.58, 95% CI: 1.17-2.13) were significantly associated with the increased risk of advanced BA in boys, and the association was reinforced when these hormones were interactively explored. Stratified by nutritional status, the interaction between estradiol, LH, and testosterone showed a strong association with advanced BA in boys with normal weight.
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Affiliation(s)
- Wen Shu
- Department of Growth and DevelopmentCapital Institute of PediatricsBeijingChina
- Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Wenquan Niu
- Center for Evidence‐Based MedicineCapital Institute of PediatricsBeijingChina
| | - Yaqin Zhang
- Department of Growth and DevelopmentCapital Institute of PediatricsBeijingChina
| | - Hui Li
- Department of Growth and DevelopmentCapital Institute of PediatricsBeijingChina
- Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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Furdock RJ, Sun KJ, Ren B, Folkman M, Glotzbecker MP, Son-Hing JP, Gilmore A, Hardesty CK, Mistovich RJ, Liu RW. The Reliability of the Modified Fels Knee Skeletal Maturity System. J Pediatr Orthop 2024; 44:e192-e196. [PMID: 37899511 DOI: 10.1097/bpo.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND The recently described Modified Fels knee skeletal maturity system (mFels) has proven utility in prediction of ultimate lower extremity length in modern pediatric patients. mFels users evaluate chronological age, sex, and 7 anteroposterior knee radiographic parameters to produce a skeletal age estimate. We developed a free mobile application to minimize the learning curve of mFels radiographic parameter evaluation. We sought to identify the reliability of mFels for new users. METHODS Five pediatric orthopaedic surgeons, 5 orthopaedic surgery residents, 3 pediatric orthopaedic nurse practitioners, and 5 medical students completely naïve to mFels each evaluated a set of 20 pediatric anteroposterior knee radiographs with the assistance of the (What's the Skeletal Maturity?) mobile application. They were not provided any guidance beyond the instructions and examples embedded in the app. The results of their radiographic evaluations and skeletal age estimates were compared with those of the mFels app developers. RESULTS Averaging across participant groups, inter-rater reliability for each mFels parameter ranged from 0.73 to 0.91. Inter-rater reliability of skeletal age estimates was 0.98. Regardless of group, steady proficiency was reached by the seventh radiograph measured. CONCLUSIONS mFels is a reliable means of skeletal maturity evaluation. No special instruction is necessary for first time users at any level to utilize the (What's the Skeletal Maturity?) mobile application, and proficiency in skeletal age estimation is obtained by the seventh radiograph. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
| | - Kristie J Sun
- Case Western Reserve University School of Medicine, Cleveland
| | - Bryan Ren
- Department of Orthopaedics, University of Michigan Medical School, Ann Arbor, MI
| | - Matthew Folkman
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Michael P Glotzbecker
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
| | - Jochen P Son-Hing
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
| | - Allison Gilmore
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
| | - Christina K Hardesty
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
| | - R Justin Mistovich
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
| | - Raymond W Liu
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
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Requist MR, Mills MK, Carroll KL, Lenz AL. Quantitative Skeletal Imaging and Image-Based Modeling in Pediatric Orthopaedics. Curr Osteoporos Rep 2024; 22:44-55. [PMID: 38243151 DOI: 10.1007/s11914-023-00845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE OF REVIEW Musculoskeletal imaging serves a critical role in clinical care and orthopaedic research. Image-based modeling is also gaining traction as a useful tool in understanding skeletal morphology and mechanics. However, there are fewer studies on advanced imaging and modeling in pediatric populations. The purpose of this review is to provide an overview of recent literature on skeletal imaging modalities and modeling techniques with a special emphasis on current and future uses in pediatric research and clinical care. RECENT FINDINGS While many principles of imaging and 3D modeling are relevant across the lifespan, there are special considerations for pediatric musculoskeletal imaging and fewer studies of 3D skeletal modeling in pediatric populations. Improved understanding of bone morphology and growth during childhood in healthy and pathologic patients may provide new insight into the pathophysiology of pediatric-onset skeletal diseases and the biomechanics of bone development. Clinical translation of 3D modeling tools developed in orthopaedic research is limited by the requirement for manual image segmentation and the resources needed for segmentation, modeling, and analysis. This paper highlights the current and future uses of common musculoskeletal imaging modalities and 3D modeling techniques in pediatric orthopaedic clinical care and research.
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Affiliation(s)
- Melissa R Requist
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr., Salt Lake City, UT, 84112, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N Mario Capecchi Dr. 2 South, Salt Lake City, UT, 84112, USA
| | - Kristen L Carroll
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
- Shriners Hospital for Children, 1275 E Fairfax Rd, Salt Lake City, UT, 84103, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr., Salt Lake City, UT, 84112, USA.
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Rassmann S, Keller A, Skaf K, Hustinx A, Gausche R, Ibarra-Arrelano MA, Hsieh TC, Madajieu YED, Nöthen MM, Pfäffle R, Attenberger UI, Born M, Mohnike K, Krawitz PM, Javanmardi B. Deeplasia: deep learning for bone age assessment validated on skeletal dysplasias. Pediatr Radiol 2024; 54:82-95. [PMID: 37953411 PMCID: PMC10776485 DOI: 10.1007/s00247-023-05789-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Skeletal dysplasias collectively affect a large number of patients worldwide. Most of these disorders cause growth anomalies. Hence, evaluating skeletal maturity via the determination of bone age (BA) is a useful tool. Moreover, consecutive BA measurements are crucial for monitoring the growth of patients with such disorders, especially for timing hormonal treatment or orthopedic interventions. However, manual BA assessment is time-consuming and suffers from high intra- and inter-rater variability. This is further exacerbated by genetic disorders causing severe skeletal malformations. While numerous approaches to automate BA assessment have been proposed, few are validated for BA assessment on children with skeletal dysplasias. OBJECTIVE We present Deeplasia, an open-source prior-free deep-learning approach designed for BA assessment specifically validated on patients with skeletal dysplasias. MATERIALS AND METHODS We trained multiple convolutional neural network models under various conditions and selected three to build a precise model ensemble. We utilized the public BA dataset from the Radiological Society of North America (RSNA) consisting of training, validation, and test subsets containing 12,611, 1,425, and 200 hand and wrist radiographs, respectively. For testing the performance of our model ensemble on dysplastic hands, we retrospectively collected 568 radiographs from 189 patients with molecularly confirmed diagnoses of seven different genetic bone disorders including achondroplasia and hypochondroplasia. A subset of the dysplastic cohort (149 images) was used to estimate the test-retest precision of our model ensemble on longitudinal data. RESULTS The mean absolute difference of Deeplasia for the RSNA test set (based on the average of six different reference ratings) and dysplastic set (based on the average of two different reference ratings) were 3.87 and 5.84 months, respectively. The test-retest precision of Deeplasia on longitudinal data (2.74 months) is estimated to be similar to a human expert. CONCLUSION We demonstrated that Deeplasia is competent in assessing the age and monitoring the development of both normal and dysplastic bones.
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Affiliation(s)
- Sebastian Rassmann
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | | | - Kyra Skaf
- Medical Faculty, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Alexander Hustinx
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | - Ruth Gausche
- CrescNet - Wachstumsnetzwerk, Medical Faculty, University Hospital Leipzig, Leipzig, Germany
| | - Miguel A Ibarra-Arrelano
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | - Tzung-Chien Hsieh
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | | | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Roland Pfäffle
- Department for Pediatrics, University Hospital Leipzig, Leipzig, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Mark Born
- Division of Paediatric Radiology, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Klaus Mohnike
- Medical Faculty, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Peter M Krawitz
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany
| | - Behnam Javanmardi
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Venusberg-Campus 1 Building 11, 2nd Floor, 53127, Bonn, Germany.
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Sariyilmaz K, Abali S, Ziroglu N, Cingoz T, Ozkunt O, Abali ZY, Kalayci CB, Hayretci M, Semiz S. Interdisiplinary and intraobserver reliability of the Greulich-Pyle method among Turkish children. J Pediatr Endocrinol Metab 2023; 36:1181-1185. [PMID: 37844258 DOI: 10.1515/jpem-2023-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Greulich-Pyle (GP) is one of the most used method for bone age determination (BAD) in various orthopedic, pediatric, radiological, and forensic situations. We aimed to investigate the inter- and intra-observer reliability of the GP method between the most relevant disciplines and its applicability to the Turkish population. METHODS One-hundred and eighty (90 boys, 90 girls) patients with a chronological age younger than 18 (mean 9.33) were included. X-rays mixed by the blinded investigator were evaluated by two orthopedists, two radiologists, and two pediatric endocrinologists to determine skeletal age according to the GP atlas. A month later the process was repeated. As a statistical method, Paired t-test was used for comparison, an Intraclass Correlation Coefficients test was used for reliability and a 95 % confidence interval was determined. Results were classified according to Landis-Koch. RESULTS All results were consistent with chronological age (p<0.001), according to the investigators' evaluations compared with chronological age. At the initial evaluation, the interobserver reliability of the method was 0.999 (excellent); at the second evaluation, the interobserver reliability was 0.997 (excellent). The intra-observer reliability of the method was 'excellent' in all observers. When results were separately evaluated by gender, excellent intraobserver correlation and excellent correlation with chronological age were found among all researchers (>0.9). When X-rays were divided into three groups based on age ranges and evaluated, 'moderate' and 'good' correlations with chronological age were obtained during the peripubertal period. CONCLUSIONS The GP method used in skeletal age determination has excellent inter- and intra-observer reliability. During the peripubertal period, potential discrepancies in bone age assessments should be kept in mind. This method can be used safely and reproducibly by the relevant specialists.
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Affiliation(s)
- Kerim Sariyilmaz
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye
| | - Saygin Abali
- Department of Pediatric Health and Diseases, Pediatric Endocrinology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye
| | - Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Tunca Cingoz
- Department of Orthopedics and Traumatology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Okan Ozkunt
- Department of Physical Medicine and Rehabilitation, Medicine Faculty, Biruni University, Istanbul, Türkiye
| | - Zehra Yavaş Abali
- Department of Pediatric Health and Diseases, Pediatric Endocrinology, Pendik Training and Research Hospital, Marmara University, Istanbul, Türkiye
| | - Cem Burak Kalayci
- Department of Radiology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Merve Hayretci
- Department of Radiology, Acibadem Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Serap Semiz
- Department of Pediatric Health and Diseases, Pediatric Endocrinology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye
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Brenneis M, Thewes N, Holder J, Stief F, Braun S. Validation of central peak height method for final adult height predictions on long leg radiographs. Bone Jt Open 2023; 4:750-757. [PMID: 37813396 PMCID: PMC10562078 DOI: 10.1302/2633-1462.410.bjo-2023-0105.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Aims Accurate skeletal age and final adult height prediction methods in paediatric orthopaedics are crucial for determining optimal timing of growth-guiding interventions and minimizing complications in treatments of various conditions. This study aimed to evaluate the accuracy of final adult height predictions using the central peak height (CPH) method with long leg X-rays and four different multiplier tables. Methods This study included 31 patients who underwent temporary hemiepiphysiodesis for varus or valgus deformity of the leg between 2014 and 2020. The skeletal age at surgical intervention was evaluated using the CPH method with long leg radiographs. The true final adult height (FHTRUE) was determined when the growth plates were closed. The final height prediction accuracy of four different multiplier tables (1. Bayley and Pinneau; 2. Paley et al; 3. Sanders - Greulich and Pyle (SGP); and 4. Sanders - peak height velocity (PHV)) was then compared using either skeletal age or chronological age. Results All final adult height predictions overestimated the FHTRUE, with the SGP multiplier table having the lowest overestimation and lowest absolute deviation when using both chronological age and skeletal age. There were no significant differences in final height prediction accuracy between using skeletal age and chronological age with PHV (p = 0.652) or SGP multiplier tables (p = 0.969). Adult height predictions with chronological age and SGP (r = 0.769; p ≤ 0.001), as well as chronological age and PHV (r = 0.822; p ≤ 0.001), showed higher correlations with FHTRUE than predictions with skeletal age and SGP (r = 0.657; p ≤ 0.001) or skeletal age and PHV (r = 0.707; p ≤ 0.001). Conclusion There was no significant improvement in adult height prediction accuracy when using the CPH method compared to chronological age alone. The study concludes that there is no advantage in routinely using the CPH method for skeletal age determination over the simple use of chronological age. The findings highlight the need for more accurate methods to predict final adult height in contemporary patient populations.
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Affiliation(s)
- Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Niklas Thewes
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Jana Holder
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Felix Stief
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Center for Musculoskeletal Surgery, Charité - University Hospital Berlin, Berlin, Germany
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Martín Pérez SE, Martín Pérez IM, Vega González JM, Molina Suárez R, León Hernández C, Rodríguez Hernández F, Herrera Perez M. Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review. Diagnostics (Basel) 2023; 13:3124. [PMID: 37835867 PMCID: PMC10572703 DOI: 10.3390/diagnostics13193124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
AIM The aim was to identify, evaluate, and summarize the findings of relevant individual studies on the precision and accuracy of radiological BA assessment procedures among children from different ethnic groups. MATERIALS AND METHODS A qualitative systematic review was carried out following the MOOSE statement and previously registered in PROSPERO (CRD42023449512). A search was performed in MEDLINE (PubMed) (n = 561), the Cochrane Library (n = 261), CINAHL (n = 103), Web of Science (WOS) (n = 181), and institutional repositories (n = 37) using MeSH and free terms combined with the Booleans "AND" and "OR". NOS and ROBINS-E were used to assess the methodological quality and the risk of bias of the included studies, respectively. RESULTS A total of 51 articles (n = 20,100) on radiological BA assessment procedures were precise in terms of intra-observer and inter-observer reliability for all ethnic groups. In Caucasian and Hispanic children, the Greulich-Pyle Atlas (GPA) was accurate at all ages, but in youths, Tanner-Whitehouse radius-ulna-short bones 3 (TW3-RUS) could be an alternative. In Asian and Arab subjects, GPA and Tanner-Whitehouse 3 (TW3) overestimated the BA in adolescents near adulthood. In African youths, GPA overestimated the BA while TW3 was more accurate. CONCLUSION GPA and TW3 radiological BA assessment procedures are both precise but their accuracy in estimating CA among children of different ethnic groups can be altered by racial bias.
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Affiliation(s)
- Sebastián Eustaquio Martín Pérez
- Departamento de Farmacología y Medicina Física, Área de Radiología y Medicina Física, Sección de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (I.M.M.P.); (F.R.H.)
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, San Cristóbal de La Laguna, 38203 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Isidro Miguel Martín Pérez
- Departamento de Farmacología y Medicina Física, Área de Radiología y Medicina Física, Sección de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (I.M.M.P.); (F.R.H.)
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, San Cristóbal de La Laguna, 38203 Santa Cruz de Tenerife, Spain
| | - Jesús María Vega González
- Institute of Legal Medicine and Forensic Sciences of Santa Cruz de Tenerife, 38230 San Cristóbal de La Laguna, Spain;
| | - Ruth Molina Suárez
- Pediatric Endocrinology Unit, Pediatric Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, 38320 Santa Cruz de Tenerife, Spain;
| | - Coromoto León Hernández
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Apdo. 456, San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, España;
| | - Fidel Rodríguez Hernández
- Departamento de Farmacología y Medicina Física, Área de Radiología y Medicina Física, Sección de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (I.M.M.P.); (F.R.H.)
| | - Mario Herrera Perez
- School of Medicine (Health Sciences), Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain;
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, San Cristóbal de La Laguna, 38320 Santa Cruz de Tenerife, Spain
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张 庆, 李 丽, 戴 娟. [The current status and expectation of pediatric total facial management]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:619-621. [PMID: 37551567 PMCID: PMC10645520 DOI: 10.13201/j.issn.2096-7993.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Indexed: 08/09/2023]
Abstract
The pediatric total facial management refers to a series of diagnosis and treatment processes to achieve the healthy development of the face through reasonable medical intervention. The main reason for the poor treatment effect is that the first contact doctor is limited to his own disciplinary analysis and treatment. The importance of multidisciplinary cooperation in the diagnosis and treatment of facial dysplasia in children has become increasingly prominent. it is necessary to comprehensively analyze and find the pathogenic factors of patients and formulate a comprehensive treatment plan to restore normal upper airway structure and nasal breathing, and then reshape the healthy craniomaxillofacial tissue structure, and the monitoring of the results of medical intervention should accompany the whole process of children's growth and development. This paper summarizes the current situation of the treatment of children with facial dysplasia and puts forward the concept of orderly individualized multi-disciplinary diagnosis and treatment of pediatric oral maxillofacial management.
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Affiliation(s)
- 庆丰 张
- 深圳大学总医院 深圳大学临床医学科学院 耳鼻咽喉头颈外科(广东深圳,518055)Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen, 518055, China
| | - 丽明 李
- 深圳大学总医院 深圳大学临床医学科学院 耳鼻咽喉头颈外科(广东深圳,518055)Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen, 518055, China
| | - 娟 戴
- 深圳大学总医院口腔科 深圳大学口腔医学研究所Department of Stomatology, General Hospital of Shenzhen University, Institute of Stomatology, Shenzhen University
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Furdock RJ, Kuo A, Chen KJ, Liu RW. Applicability of Shoulder, Olecranon, and Wrist-based Skeletal Maturity Estimation Systems to the Modern Pediatric Population. J Pediatr Orthop 2023; Publish Ahead of Print:01241398-990000000-00285. [PMID: 37205836 DOI: 10.1097/bpo.0000000000002430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND The proximal humerus ossification system (PHOS), olecranon apophyseal ossification system (OAOS), and modified Fels wrist skeletal maturity system (mFWS) were recently developed or updated using a historical, mostly White, pediatric population. These upper extremity skeletal maturity systems have demonstrated skeletal age estimation performance superior or equivalent to Greulich and Pyle in historical patients. Their applicability to modern pediatric populations has not yet been evaluated. METHODS We reviewed anteroposterior shoulder, lateral elbow, and anteroposterior hand and wrist x-rays of 4 pediatric cohorts: White males, Black males, White females, and Black females. Peripubertal x-rays were evaluated: males 9 to17 years and females 7 to 15 years. Five nonpathologic radiographs for each age and joint were randomly selected from each group. Skeletal age estimates made by each of the 3 skeletal maturity systems were plotted against the chronological age associated with each radiograph and compared between cohorts, and with the historical patients. RESULTS Five hundred forty modern radiographs were evaluated (180 shoulders, 180 elbows, and 180 wrists). All radiographic parameters had inter- and intra-rater reliability coefficients at or above 0.79, indicating very good reliability. For PHOS, White males had delayed skeletal age compared with Black males (Δ-0.12 y, P=0.02) and historical males (Δ-0.17 y, P<0.001). Black females were skeletally advanced compared with historical females (Δ0.11 y, P=0.01). For OAOS, White males (Δ-0.31 y, P<0.001) and Black males (Δ-0.24 y, P<0.001) had delayed skeletal age compared with historical males. For mFWS, White males (Δ0.29 y, P=0.024), Black males (Δ0.58 y, P<0.001), and Black females (Δ0.44 y, P<0.001) had advanced skeletal age compared with historical counterparts of the same sex. All other comparisons were not significant (P>0.05). CONCLUSIONS The PHOS, OAOS, and mFWS have mild discrepancies in skeletal age estimates when applied to modern pediatric populations depending on the race and sex of the patient. LEVEL OF EVIDENCE Level III - retrospective chart review.
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Affiliation(s)
- Ryan J Furdock
- Department of Orthopaedics; University Hospital Cleveland Medical Center
| | - Andy Kuo
- Case Western Reserve University School of Medicine
| | - Kallie J Chen
- Department of Orthopaedics; University Hospital Cleveland Medical Center
| | - Raymond W Liu
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Cleveland, OH
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Tanner-Whitehouse skeletal maturity score derived from ultrasound images to evaluate bone age. Eur Radiol 2023; 33:2399-2406. [PMID: 36462047 PMCID: PMC10017602 DOI: 10.1007/s00330-022-09285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The complexity of radiographic Tanner-Whitehouse method makes it less acceptable by radiologists and endocrinologists to assess bone age. Conventional ultrasound could be used to measure the ratio of the height of the ossification center to the epiphysis of the bone to evaluate maturity of bone. The purpose of this study is to obtain radiographic TW3 skeletal maturity score with ultrasound images. METHODS In this prospective diagnostic study, participants aged between 1 and 18 years undergoing radiography for bone age evaluation were evaluated from April 2019 to November 2021. Ultrasonic skeletal maturity scores of participants were transformed into radiographic skeletal maturity scores with the fitted formulas established in this study. Diagnostic performances of the transformed scores to diagnose advanced or delayed bone age were confirmed. Ultrasound images of 50 participants in the validation group were re-evaluated to confirm inter-rater reliability. RESULTS A total of 442 participants (median age, 9.5 years [interquartile range, 7.8-11.1 years]; 185 boys) were enrolled. Ultrasound determination of bone age had a sensitivity of 97% (34/35, 95% CI: 83, 99) and a specificity of 98% (106/108, 95% CI: 93, 99) to diagnose advanced or delayed bone age. The intra-class correlation coefficient for inter-rater reliability was 0.993 [95% CI: 0.988, 0.996], p < 0.0001. CONCLUSIONS Radiographic Tanner-Whitehouse skeletal maturity score could be obtained from ultrasound images in a simple, fast, accurate, and radiation-free manner. KEY POINTS • The fitting formulas between radiographic TW3 skeletal maturity score and ultrasonic skeletal maturity score were developed. • Through measurement of ossification ratios of bones with ultrasound, TW3 skeletal maturity score was obtained in a simple, fast, and radiation-free manner.
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Applicability of the Modified Fels and Optimized Oxford Skeletal Maturity Estimation Systems to the Modern Pediatric Population. J Pediatr Orthop 2023; 43:e254-e259. [PMID: 36537250 DOI: 10.1097/bpo.0000000000002330] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The recently developed modified Fels knee and optimized Oxford hip skeletal maturity systems (SMS) have demonstrated impressive performance compared with the Greulich and Pyle skeletal age atlas when applied to the same historical, mostly white, pediatric population. We sought to determine whether these 2 systems require modification before being used in modern children. METHODS We collected knee and hip radiographs between January 2015 and September 2020 from our electronic medical record from 4 groups of children: (1) white males, (2) black males, (3) white females, and (4) black females. Males between 9 and 17 years and females between 7 and 15 years were included. After reliability analyses, 5 nonpathologic radiographs for each age and joint were randomly selected from each group and evaluated with the appropriate SMS. The mean discrepancy between each group's chronological age at the time of radiograph and estimated skeletal age was compared between our modern cohort and the historical Bolton-Brush children. After normality testing, paired t tests or Wilcoxon signed-rank tests were performed, as appropriate. A Bonferroni correction was applied to address multiple testing. RESULTS Three hundred sixty modern radiographs were evaluated (180 knees and 180 hips). All 7 modified Fels knee parameters and all 5 optimized Oxford hip parameters had inter and intrarater reliability coefficients ≥0.7, indicating good to very good reliability. For the modified Fels knee SMS, white males (Δ0.74 y, P <0.001), black males (Δ0.69 y, P <0.001), and black females (Δ0.4 y, P =0.04) had advanced skeletal age compared with their historical counterparts of the same sex. No differences were found between historical and modern patients for the optimized Oxford hip SMS. No differences were found for either SMS comparing modern patients along racial lines ( P >0.05 for all). CONCLUSIONS Discrepancies in skeletal age estimates made by the modified Fels knee SMS exist between modern pediatric white males, black males, and black females and their historic counterparts. No differences were found when using optimized Oxford hip SMS. Future studies should evaluate how these translate to clinical decision-making. LEVEL OF EVIDENCE Level III; retrospective chart review.
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Şatir S, Büyükçavuş MH, Sari ÖF, Çimen T. A novel approach to radiographic detection of growth development period with hand-wrist radiographs: A preliminary study with ImageJ imaging software. Orthod Craniofac Res 2023; 26:100-106. [PMID: 35506492 DOI: 10.1111/ocr.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study is to determine whether or not the ImageJ program can be used to automatically determine the growth period of the hand and wrist which have different growth-development periods according to the density values in the phalanges in radiographs. SETTING AND SAMPLE POPULATION Our study included hands-wrist radiographs of 270 individuals aged 8-17 years. MATERIAL AND METHODS The study's participants were classified into 7 groups according to their skeletal maturation stage (PP2=, MP3=, MP3cap, DP3u, PP3u, MP3u, and Ru) which included pre-peak, peak, and post-peak periods. The total density values (TDV) and pure density values (PDV) in the distal, medial, and proximal phalanges were calculated using each radiograph in the ImageJ program. Analysis of variance (ANOVA) was used to evaluate the density values and chronological age, and pairwise comparisons were made using the post-hoc LSD test. RESULTS The total density value was graphically zigzagged in the mesial, distal, and proximal phalanges. However, the pure density value increased continuously until the post-peak period and decreased after the DP3u period until the Ru period. While no significant difference in total density values was observed between the growth periods for all three phalanges, a significant difference in pure density values was observed. CONCLUSION It has been demonstrated in the ImageJ program that the peak growth period can be distinguished using the pure density values obtained from all phalanges of the third finger and that this method can be used as an alternative to the growth period detection through artificial intelligence.
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Affiliation(s)
- Samed Şatir
- Department of Oral and Maxillofacial Radiology, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | | | - Ömer Faruk Sari
- Department of Orthodontics, Suleyman Demirel University, Isparta, Turkey
| | - Tansu Çimen
- Department of Oral and Maxillofacial Radiology, Alanya Alaaddin Keykubat University, Antalya, Turkey
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Sinkler MA, Furdock RJ, Chen DB, Sattar A, Liu RW. The Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on Lateral Elbow Radiographs. J Bone Joint Surg Am 2022; 104:1993-1999. [PMID: 36000756 DOI: 10.2106/jbjs.22.00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Skeletal maturity estimation is central in the management of scoliosis and lower-limb deformity. Utilizing demographic characteristics and modern computing, we sought to create a reliable, rapid, and accurate method for measuring skeletal maturity on an elbow radiograph. METHODS Utilizing the Bolton-Brush Collection, 4 parameters from the modified Sauvegrain method and 7 novel parameters were screened. Ten parameters were evaluated on serial peripubertal elbow radiographs, using Greulich and Pyle (GP) skeletal age from corresponding hand radiographs as a comparison. Stepwise linear regression and generalized estimating equations were used to identify radiographic and demographic parameters for estimating skeletal maturity based on 90% of final height. The elbow system was compared with GP only; olecranon apophysis only; age, sex, and GP; age, sex, and olecranon apophysis; age, sex, and elbow system with anteroposterior and lateral parameters; age, sex, and elbow system with anteroposterior parameters; and age, sex, and elbow system with lateral parameters. RESULTS In this study, 367 radiographs from 77 patients (40 girls and 37 boys) were included. Following stepwise linear regression, 4 radiographic parameters were included in the anteroposterior and lateral elbow system; 3 were included in the anteroposterior elbow system; and 4 were included in the lateral elbow system. The lateral elbow system predicted skeletal maturity with a mean discrepancy of 0.41 year and produced similar mean discrepancies to GP with age and sex (0.42; p = 0.93), and it trended toward better performance than the olecranon apophysis system with age and sex (0.43; p = 0.06). The lateral elbow system had the lowest percent of outlier predictions >1 year discrepant from the skeletal maturity reference (4.6%), although it was only significantly better than the GP-only group (29.4%) and the olecranon apophysis-only group (21.0%) (p < 0.001 for both). CONCLUSIONS We systematically developed a lateral elbow system that performed equivalently to GP using 4 simple parameters and trended toward outperforming the olecranon apophysis systems in skeletal maturity estimation. Future clinical validation will be necessary to understand the utility of this system. CLINICAL RELEVANCE The lateral elbow system may be a more accurate prediction of skeletal maturity compared with the previously described olecranon apophysis system and can be used to guide the management of many pediatric orthopaedic conditions.
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Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Daniel B Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Abdus Sattar
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raymond W Liu
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Pediatric Orthopaedics, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Cruz-Priego GA, Guagnelli MA, Miranda-Lora AL, Lopez-Gonzalez D, Clark P. Bone Age Reading by DXA Images should not Replace Bone Age Reading by X-ray Images. J Clin Densitom 2022; 25:456-463. [PMID: 36109296 DOI: 10.1016/j.jocd.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022]
Abstract
X-ray image of the hand is the most used technique to estimate bone age in children. For the analysis of bone mineral density using DXA in children, bone age may help to adjust such measurement in some cases. During image acquisition in DXA, an anteroposterior image of the hand may be acquired and used to evaluate bone age but few studies have evaluated the agreement between conventional X-ray and DXA images. The aim of the study was to determine bone age estimation agreement between conventional X-ray images and DXA in children and adolescents aged 5 to 16 years of age. We performed an analytical cross-sectional study of 711 healthy subjects. Subject´s bone age, both in conventional X-ray, and DXA images were read independently by two expert evaluators blinded for chronological age. Intraobserver and inter-observer reproducibility were evaluated using Intraclass Correlation Coefficient (ICC), and the agreement between bone age estimations made by both evaluators was analyzed using ICC and Bland-Altman analysis. General agreement between techniques measured through ICC was 0.99 with a mean difference of 6 months between techniques being older the ages obtained by DXA. The agreement limits were around ±2 years, which means that 95% of all differences between techniques were covered within this range. We found a high level of ICC agreement in bone age readings from X-ray and DXA images although we observed overestimation of bone age measurements in DXA. Differences between techniques were greater in women than in men, especially at the ages corresponding to puberty. Bone age measurement in DXA images appears not to be reliable; hence it should be suggested to perform conventional radiography of the hand to assess bone age taking into account that X-ray images have better resolution.
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Affiliation(s)
- Griselda-Adriana Cruz-Priego
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel-Angel Guagnelli
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Desiree Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Kakumanu NR, Ch G, G KA, Rathore K, Badam R, Erukala DS, Tadakamadla J, Tadakamadla SK, Balla SB. Premolar maturity index (IPM) for indicating legal age 12 years in a sample of south Indian children - A digital pantomographic study. Leg Med (Tokyo) 2022; 59:102145. [PMID: 36103783 DOI: 10.1016/j.legalmed.2022.102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022]
Abstract
Legal age of 12 years has been set as the minimum age of criminal responsibility in many countries. This paper concerned a method for predicting the legal age 12 years based on the maturation of lower first and second premolars. The sample consisted of 900 digital pantomographs of south Indian children (450 males, 450 females) aged between 8 and 16 years. Among them, 580 DPTs were used as test sample and 320 DPTs as validation sample. New cut-offs at the age threshold 12 years were determined by using the measurement of open apices in first premolars (IPM1 < 0.10), second premolars (IPM2 < 0.14) and the combined method (IPM1 + IPM2 < 0.12). The sensitivity (Se), specificity (Sp) and posttest probability (PTP) were established. For IPM1 < 0.10, the Se, Sp and PTP were 92.4 %, 91.3 % and 91.1 % for males and 90.8 %, 87 % and 86.5 % for females. For IPM2 < 0.14, they were 92.6 %, 93.6 % and 93.4 % for males and 91.5 %, 83.1 % and 83.4 % for females. And, for the combined predictor (IPM1 + IPM2 < 0.12), these values were 92.6 %, 94.8 % and 94.6 % and 90.5 %, 84.9 % and 84.7 % in males and females respectively. The best score of positive predictive value and specificity was obtained for males with the combined predictor (IPM1 + IPM2 < 0.12) and with single predictor (IPM1 < 0.10) for females. To conclude, the combined predictor has resulted in better discrimination in males, while in females the single predictor (IMP1 < 0.10) did slightly better. Further studies are warranted to test the combination of dental and skeletal indicators for the prediction of 12 years in the studied population.
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Affiliation(s)
| | - Gayathri Ch
- Department of Oral Pathology and Microbiology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, India.
| | | | - Kiran Rathore
- Department of Prosthodontics, Army College of Dental Sciences, Secunderabad, India.
| | - Rajkumar Badam
- Department of Oral Medicine and Radiology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, India.
| | | | | | - Santosh Kumar Tadakamadla
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia.
| | - Sudheer B Balla
- Department of Forensic Odontology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana, India.
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Huang LF, Furdock RJ, Uli N, Liu RW. Estimating Skeletal Maturity Using Wrist Radiographs During Preadolescence: The Epiphyseal:Metaphyseal Ratio. J Pediatr Orthop 2022; 42:e801-e805. [PMID: 35575791 DOI: 10.1097/bpo.0000000000002174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although skeletal maturity is most relevant during adolescence, it has utility in treatment of younger patients in some circumstances, such as scoliosis, limb length discrepancy, or endocrinopathies. Currently, a quick, accurate, and reproducible method of estimating skeletal maturity in preadolescents using wrist radiographs is lacking. METHODS Serial anteroposterior wrist radiographs taken at historical growth study visits leading up to the chronological age (CA) associated with 90% of the final height (an enhanced skeletal maturity standard as compared with peak height velocity) were analyzed in 102 children. Epiphyseal and metaphyseal widths of 5 physes were evaluated: distal radius, distal ulna, first metacarpal, third metacarpal, and fifth metacarpal. Ulnar styloid height and radial styloid height were also measured, for a total of 7 epiphyseal:metaphyseal radiographic parameters. Greulich and Pyle (GP) bone age was also measured. A combination of stepwise linear regression and generalized estimating equation analyses was used to produce a skeletal maturity estimation model incorporating demographics (CA and sex) and the epiphyseal:metaphyseal ratios significantly correlated with skeletal maturity. RESULTS A total of 273 left anteroposterior hand-wrist radiographs from 56 girls (163 radiographs, range 4 to 13 y) and 46 boys (112 radiographs, range 3.8 to 15 y) were included. The demographics+ratios model had better prediction accuracy than GP only and GP with demographics (0.44, 0.87, and 0.47 y mean discrepancy from actual skeletal age, P <0.05 for both comparisons). There was no significant difference in the rate of outlier skeletal age estimates, defined as an estimate >1 year off from the true skeletal age, between the demographics+ratios model and the demographics+GP model (5.9% vs. 8.4%, P =0.12). CONCLUSIONS When combined with CA and sex data, measurement of the epiphyseal:metaphyseal ratios of the left first and third metacarpals allows for improved skeletal maturity estimation compared with the GP technique. CLINICAL RELEVANCE Our modified wrist skeletal maturity system offers a relatively quick and reproducible method for estimating skeletal maturity extending into the juvenile age range. This study is a level III retrospective study of longitudinal human growth data obtained from the Bolton Brush Collection in Cleveland, Ohio.
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Affiliation(s)
| | - Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Naveen Uli
- Center for Diabetes and Endocrinology, Akron Children's Hospital, Akron, OH
| | - Raymond W Liu
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland
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21
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Abstract
This article provides researchers with the background and guidance necessary to practically incorporate skeletal maturity estimation into any study of adolescents with imaging of the shoulder, elbow, hand, hip, knee, or foot. It also provides clinicians with a comprehensive, concise synopsis of systems that can be used to estimate skeletal maturity in clinical practice. In the article, we provide a relatively brief overview of each currently available skeletal maturity system that has been validated on a longitudinal dataset. The supplementary files include 2 PowerPoint files for each skeletal maturity system. The first PowerPoint file offers examples and instructions for using each radiographic system. The second PowerPoint file includes 20 graded radiographs that can be used for reliability analyses in the research setting. We have also developed a free mobile application available on the iOS and Android platforms named "What's the Skeletal Maturity?" that allows clinicians to rapidly estimate skeletal maturity on any patient using any commonly obtained orthopaedic radiograph.
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Affiliation(s)
- Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
| | - James O Sanders
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Daniel R Cooperman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Raymond W Liu
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
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22
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Bowden JJ, Bowden SA, Ruess L, Adler BH, Hu H, Krishnamurthy R, Krishnamurthy R. Validation of automated bone age analysis from hand radiographs in a North American pediatric population. Pediatr Radiol 2022; 52:1347-1355. [PMID: 35325266 DOI: 10.1007/s00247-022-05310-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 12/21/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiographic bone age assessment by automated software is precise and instantaneous. OBJECTIVE The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment. MATERIALS AND METHODS We compared a total of 586 bone age radiographs from 451 patients, which had been assessed by three radiologists from 2013 to 2018, with bone age analysis by BoneXpert, using the Greulich and Pyle method. We made bone age comparisons in different patient groups based on gender, diagnosis and race, and in a subset with repeated bone age studies. We calculated Spearman correlation (r) and accuracy (root mean square error, or R2). RESULTS Bone age analyses by automated and manual assessments showed a strong correlation (r=0.98; R2=0.96; P<0.0001), with the mean bone age difference of 0.12±0.76 years. Bone age comparisons by the two methods remained strongly correlated (P<0.0001) when stratified by gender, common endocrine conditions including growth disorders and early/precocious puberty, and race. In the longitudinal analysis, we also found a strong correlation between the automated software and manual bone age over time (r=0.7852; R2=0.63; P<0.01). CONCLUSION Automated bone age assessment was found to be reliable and accurate in a large cohort of pediatric patients in a clinical practice setting in North America.
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Affiliation(s)
| | - Sasigarn A Bowden
- Department of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Lynne Ruess
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Brent H Adler
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Houchun Hu
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ramkumar Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Schlégl ÁT, O’Sullivan I, Varga P, Than P, Vermes C. Alternative methods for skeletal maturity estimation with the EOS scanner—Experience from 934 patients. PLoS One 2022; 17:e0267668. [PMID: 35522608 PMCID: PMC9075679 DOI: 10.1371/journal.pone.0267668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Hand-wrist bone age assessment methods are not possible on typical EOS 2D/3D images without body position modifications that may affect spinal position. We aimed to identify and assess lesser known bone age assessment alternatives that may be applied retrospectively and without the need for extra imaging. Materials and methods After review of 2857 articles, nine bone age methods were selected and applied retrospectively in pilot study (thirteen individuals), followed by evaluation of EOS images of 934 4-24-year-olds. Difficulty of assessment and time taken were recorded, and reliability calculated. Results Five methods proved promising after pilot study. Risser ‘plus’ could be applied with no difficulty in 89.5% of scans (836/934) followed by the Oxford hip method (78.6%, 734/934), cervical (79.0%, 738/934), calcaneus (70.8%, 669/934) and the knee (68.2%, 667/934). Calcaneus and cervical methods proved to be fastest at 17.7s (95% confidence interval, 16.0s to 19.38s & 26.5s (95% CI, 22.16s to 30.75s), respectively, with Oxford hip the slowest at 82.0 s (95% CI, 76.12 to 87.88s). Difficulties included: regions lying outside of the image—assessment was difficult or impossible in upper cervical vertebrae (46/934 images 4.9%) and calcaneus methods (144/934 images, 15.4%); position: lower step length was associated with difficult lateral knee assessment & head/hand position with cervical evaluation; and resolution: in the higher stages of the hip, calcaneal and knee methods. Conclusions Hip, iliac crest and cervical regions can be assessed on the majority of EOS scans and may be useful for retrospective application. Calcaneus evaluation is a simple and rapidly applicable method that may be appropriate if consideration is given to include full imaging of the foot.
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Affiliation(s)
- Ádám Tibor Schlégl
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
- * E-mail:
| | - Ian O’Sullivan
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Varga
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
- Department of Primary Health Care, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Than
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
| | - Csaba Vermes
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
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24
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Liu R, Zhu H, Wang L, Han B, Du J, Jia Y. Coarse-to-fine segmentation and ensemble convolutional neural networks for automated pediatric bone age assessment. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Castillo Tafur JC, Furdock RJ, Sattar A, Liu RW. The Optimized Oxford Hip Skeletal Maturity System Proves Resilient to Rotational Variation. J Pediatr Orthop 2022; 42:186-189. [PMID: 35089879 DOI: 10.1097/bpo.0000000000002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The recently described optimized Oxford skeletal maturity system utilizes anteroposterior (AP) hip radiographs to accurately, rapidly, and reliably estimate skeletal maturity. However, in the real-world setting, significant positional variation in AP hip radiographs may influence the accuracy of optimized Oxford skeletal age estimates. We sought to evaluate the consistency of skeletal age estimations using the optimized Oxford system between differently rotated radiographs. METHODS Thirty normal computerized tomography scans of males (15 children, 9 to 15 y) and females (15 children, 8 to 14 y) were obtained retrospectively, converted into 3D reconstructions, and then used to produce simulated hip radiographs in five different rotational positions. The optimized Oxford system was applied to the 150 simulated AP hip radiographs (5 differently rotated views of 30 hips) to produce a skeletal age estimate for each. RESULTS Rotational position did not have a statistically significant effect on the skeletal age (P=0.84) using 1-way repeated measures analysis of variance. Of the 5 radiographic parameters in the optimized Oxford system, only greater trochanter height showed significant rotational variation after Greenhouse-Geisser correction (F2.58, 74.68=5.98, P<0.001). However, post hoc analyses showed that the greater trochanter height obtained at the most centered position was not different from the other 4 rotational positions (P>0.05 for all). CONCLUSION The optimized Oxford skeletal maturity system is resilient to rotational variation. Mildly to moderately rotated radiographs obtained in the modern clinical setting can be used for skeletal age estimation by this method, broadening the clinical usage of this system. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- Julio C Castillo Tafur
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
| | - Ryan J Furdock
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
| | - Abdus Sattar
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Raymond W Liu
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
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Furdock RJ, Huang LF, Sanders JO, Cooperman DR, Liu RW. Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on Anteroposterior Wrist Radiographs. J Bone Joint Surg Am 2022; 104:530-536. [PMID: 35045055 DOI: 10.2106/jbjs.21.00819] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ability to make a continuous skeletal maturity estimate from a wrist radiograph would be useful in the treatment of adolescent forearm fractures, scoliosis, and other conditions. We attempted to create a reliable, rapid, and accurate method to do this. METHODS Many anteroposterior wrist radiographic parameters from 3 skeletal maturity systems were simplified to 23 based on relevance to the peripubertal age range, univariate correlation with skeletal maturity, and reliability. These 23 parameters were evaluated on serial peripubertal anteroposterior hand-wrist radiographs. We determined the Greulich and Pyle (GP) skeletal age and Sanders hand system (SHS) stage. We used stepwise linear regression and generalized estimating equation (GEE) procedures to identify important radiographic and demographic parameters for estimating skeletal maturity, creating the "Modified Fels wrist skeletal maturity system." Its accuracy predicting skeletal maturity was evaluated and compared with that of 4 other systems: (1) GP system, (2) SHS, (3) GP parameters along with age and sex, and (4) SHS parameters along with age and sex. RESULTS Three hundred and seventy-two radiographs of 42 girls (age range, 7 to 15 years) and 38 boys (age range, 9 to 16 years) were included. Fifteen radiographic parameters were excluded from the Modified Fels wrist system by stepwise regression and GEE analyses, leaving age, sex, and 8 radiographic parameters in the final model. Use of the Modified Fels wrist system resulted in more accurate skeletal maturity estimations (0.34-year mean discrepancy with actual skeletal maturity) than all other systems (p < 0.001 for all). The Modified Fels wrist system had a similar rate of outlier skeletal maturity estimations as the age, sex, and SHS model (1.9% versus 3.5%, p = 0.11) and fewer outliers than all other systems (p < 0.05 for all). CONCLUSIONS A system that included demographic factors and 8 anteroposterior wrist radiographic parameters estimates skeletal maturity more accurately than the 2 most-used skeletal maturity systems in the United States. CLINICAL RELEVANCE The Modified Fels wrist skeletal maturity system may allow for more accurate, reliable, and rapid skeletal maturity estimation than current systems, and also may be used when treating adolescent forearm fractures as it does not require imaging past the metacarpals. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lauren F Huang
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - James O Sanders
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniel R Cooperman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Raymond W Liu
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Abstract
BACKGROUND The recently described Modified Fels knee system allows for accurate skeletal maturity estimation using a single anteroposterior knee radiograph but requires evaluation of 7 parameters. A faster method may have clinical utility in the outpatient setting. METHODS Seven anteroposterior knee radiographic parameters associated with 90% of the final height (an enhanced skeletal maturity standard compared with peak height velocity) were analyzed in 78 children. Segmented linear regression and generalized estimating equation analyses were used to identify the subsets of parameters most important for accurate skeletal maturity estimation for different patient demographics and parameter scores. This process produced abbreviated skeletal maturity systems, which include fewer parameters and are quicker to use. The accuracy of the resulting abbreviated skeletal maturity systems was evaluated and compared with the full 7-parameter Modified Fels knee system and with the Greulich and Pyle (GP) left-hand bone age. RESULTS A total of 326 left knee radiographs from 41 girls (range, 7 to 15 y) and 37 boys (range, 9 to 17 y) were included. Models generated by segmented regression and generalized estimating equation analysis required fewer parameters (range, 1 to 5 parameters) than the full Modified Fels knee system (7 parameters). Skeletal age estimates produced by segmented regression models were more accurate than GP (P<0.05) and not significantly different from the full Modified Fels system (P>0.05). The percentage of outlier estimations (estimations >1 y off from actual skeletal age) made by segmented regression models was not significantly different from GP (P>0.05) or the Modified Fels knee system (P>0.05). CONCLUSION An abbreviated version of the Modified Fels knee system estimates skeletal maturity more accurately than the GP system with just 2 to 3 radiographic knee parameters. CLINICAL RELEVANCE The abbreviated Modified Fels knee system may allow for rapid skeletal age estimation (~30 s) appropriate for routine outpatient practice.
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Alshamrani K. The Application of Magnetic Resonance Imaging in Skeletal Age Assessment. Appl Bionics Biomech 2022; 2022:9607237. [PMID: 35237346 PMCID: PMC8885254 DOI: 10.1155/2022/9607237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
METHOD The study includes 80 patients identified from an endocrine clinic, two males and two females from each of 5 age groups (<5, 5 to 7, 8 to 10, 11 to 13, and 14 to 16 years). Skeletal age as determined from an open MRI scanner and radiographs performed on the same day was compared for each child. Two observers assess the skeletal age from radiographs and MRI images independently. After a period of at least three weeks, observers determined the skeletal age of all patients independently. All of the images were in different and random orders, on both of the assessment occasions. The agreement was assessed using the interclass correlation coefficient and Bland Altman plots. Problem Statement. The recurrent use of left-hand radiography in children with chronic conditions might result in the patient being exposed to the same image several times throughout the course of their lives. Use of radiation-free methods such as magnetic resonance imaging (MRI) may be able to assist in reducing the risks associated with radiation exposure, if done properly. RESULTS Patients' age ranged from 3 to 16 years, in which the mean of the chronological age was 9.3 years (±2.9) and 9.8 years (±2.7) in girls and boys, respectively. The interrater agreement for skeletal age determination was 0.984 for radiographs and 0.976 for MRI scans. Using the G&P technique, for Observer 1, intraobserver agreement for radiographs and DXA was 0.993 and 0.983, respectively, and 0.995 and 0.994, respectively, for Observer 2. Plotting the rater readings against the line of equality shows no significant differences between readings acquired from radiographs and MRI scans. CONCLUSION For the study contribution, it is possible to employ open compact MRI to determine the skeletal age of a person. Our results showed that left-hand MRI scans were of better quality than the radiographs.
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Affiliation(s)
- Khalaf Alshamrani
- Radiological Sciences Department, College of Applied Medical Science, Najran University, Najran, Saudi Arabia
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Deshmukh S, Khaparde A. Faster Region-Convolutional Neural network oriented feature learning with optimal trained Recurrent Neural Network for bone age assessment for pediatrics. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Eng DK, Khandwala NB, Long J, Fefferman NR, Lala SV, Strubel NA, Milla SS, Filice RW, Sharp SE, Towbin AJ, Francavilla ML, Kaplan SL, Ecklund K, Prabhu SP, Dillon BJ, Everist BM, Anton CG, Bittman ME, Dennis R, Larson DB, Seekins JM, Silva CT, Zandieh AR, Langlotz CP, Lungren MP, Halabi SS. Artificial Intelligence Algorithm Improves Radiologist Performance in Skeletal Age Assessment: A Prospective Multicenter Randomized Controlled Trial. Radiology 2021; 301:692-699. [PMID: 34581608 DOI: 10.1148/radiol.2021204021] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Previous studies suggest that use of artificial intelligence (AI) algorithms as diagnostic aids may improve the quality of skeletal age assessment, though these studies lack evidence from clinical practice. Purpose To compare the accuracy and interpretation time of skeletal age assessment on hand radiograph examinations with and without the use of an AI algorithm as a diagnostic aid. Materials and Methods In this prospective randomized controlled trial, the accuracy of skeletal age assessment on hand radiograph examinations was performed with (n = 792) and without (n = 739) the AI algorithm as a diagnostic aid. For examinations with the AI algorithm, the radiologist was shown the AI interpretation as part of their routine clinical work and was permitted to accept or modify it. Hand radiographs were interpreted by 93 radiologists from six centers. The primary efficacy outcome was the mean absolute difference between the skeletal age dictated into the radiologists' signed report and the average interpretation of a panel of four radiologists not using a diagnostic aid. The secondary outcome was the interpretation time. A linear mixed-effects regression model with random center- and radiologist-level effects was used to compare the two experimental groups. Results Overall mean absolute difference was lower when radiologists used the AI algorithm compared with when they did not (5.36 months vs 5.95 months; P = .04). The proportions at which the absolute difference exceeded 12 months (9.3% vs 13.0%, P = .02) and 24 months (0.5% vs 1.8%, P = .02) were lower with the AI algorithm than without it. Median radiologist interpretation time was lower with the AI algorithm than without it (102 seconds vs 142 seconds, P = .001). Conclusion Use of an artificial intelligence algorithm improved skeletal age assessment accuracy and reduced interpretation times for radiologists, although differences were observed between centers. Clinical trial registration no. NCT03530098 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Rubin in this issue.
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Affiliation(s)
- David K Eng
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Nishith B Khandwala
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Jin Long
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Nancy R Fefferman
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Shailee V Lala
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Naomi A Strubel
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Sarah S Milla
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Ross W Filice
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Susan E Sharp
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Alexander J Towbin
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Michael L Francavilla
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Summer L Kaplan
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Kirsten Ecklund
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Sanjay P Prabhu
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Brian J Dillon
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Brian M Everist
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Christopher G Anton
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Mark E Bittman
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Rebecca Dennis
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - David B Larson
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Jayne M Seekins
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Cicero T Silva
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Arash R Zandieh
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Curtis P Langlotz
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Matthew P Lungren
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
| | - Safwan S Halabi
- From the Department of Computer Science, Stanford University, 300 N Pasteur Dr, Stanford, CA 94305 (D.K.E., N.B.K.); Departments of Pediatrics (J.L.) and Radiology (D.B.L., J.M.S., C.P.L., M.P.L., S.S.H.), Stanford University School of Medicine, Stanford, Calif; Department of Radiology, New York University School of Medicine, New York, NY (N.R.F., S.V.L., N.A.S., M.E.B.); Department of Radiology, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga (S.S.M.); Department of Radiology, MedStar Health and Georgetown University School of Medicine, Washington, DC (R.W.F., A.R.Z.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (S.E.S., A.J.T., C.G.A.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.L.F., S.L.K., R.D.); Department of Radiology, Harvard Medical School and Boston Children's Hospital, Boston, Mass (K.E., S.P.P.); Department of Radiology, Yale School of Medicine, New Haven, Conn (B.J.D., C.T.S.); and Department of Radiology, Kansas University School of Medicine, Kansas City, Kan (B.M.E.)
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Seo H, Hwang J, Jeong T, Shin J. Comparison of Deep Learning Models for Cervical Vertebral Maturation Stage Classification on Lateral Cephalometric Radiographs. J Clin Med 2021; 10:jcm10163591. [PMID: 34441887 PMCID: PMC8397111 DOI: 10.3390/jcm10163591] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to evaluate and compare the performance of six state-of-the-art convolutional neural network (CNN)-based deep learning models for cervical vertebral maturation (CVM) on lateral cephalometric radiographs, and implement visualization of CVM classification for each model using gradient-weighted class activation map (Grad-CAM) technology. A total of 600 lateral cephalometric radiographs obtained from patients aged 6–19 years between 2013 and 2020 in Pusan National University Dental Hospital were used in this study. ResNet-18, MobileNet-v2, ResNet-50, ResNet-101, Inception-v3, and Inception-ResNet-v2 were tested to determine the optimal pre-trained network architecture. Multi-class classification metrics, accuracy, recall, precision, F1-score, and area under the curve (AUC) values from the receiver operating characteristic (ROC) curve were used to evaluate the performance of the models. All deep learning models demonstrated more than 90% accuracy, with Inception-ResNet-v2 performing the best, relatively. In addition, visualizing each deep learning model using Grad-CAM led to a primary focus on the cervical vertebrae and surrounding structures. The use of these deep learning models in clinical practice will facilitate dental practitioners in making accurate diagnoses and treatment plans.
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Affiliation(s)
- Hyejun Seo
- Department of Pediatric Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (H.S.); (T.J.)
| | - JaeJoon Hwang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan 50612, Korea;
- Dental and Life Science Institute & Dental Research Institute, School of dentistry, Pusan National University, Yangsan 50612, Korea
| | - Taesung Jeong
- Department of Pediatric Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (H.S.); (T.J.)
- Dental and Life Science Institute & Dental Research Institute, School of dentistry, Pusan National University, Yangsan 50612, Korea
| | - Jonghyun Shin
- Department of Pediatric Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (H.S.); (T.J.)
- Dental and Life Science Institute & Dental Research Institute, School of dentistry, Pusan National University, Yangsan 50612, Korea
- Correspondence: ; Tel.: +82-55-360-5183
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Xu Y, Liu X, Pan L, Mao X, Liang H, Wang G, Chen T. Explainable Dynamic Multimodal Variational Autoencoder for the Prediction of Patients with Suspected Central Precocious Puberty. IEEE J Biomed Health Inform 2021; 26:1362-1373. [PMID: 34388097 DOI: 10.1109/jbhi.2021.3103271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Central precocious puberty (CPP) is the most common type of precocious puberty and has a significant effect on children. A gonadotropin-releasing hormone (GnRH)-stimulation test is the gold standard for confirming CPP. This test, however, is costly and unpleasant for patients. Therefore, it is critical to developing alternative methods for CPP diagnosis in order to alleviate patient suffering. This study aims to develop an artificial intelligence (AI) diagnostic system for predicting response to the GnRH-stimulation test using data from laboratory tests, electronic health records (EHRs), and pelvic ultrasonography and left-hand radiography reports. The challenges are in integrating these mul-timodal features into a comprehensive deep learning model in order to achieve an accurate diagnosis while also accounting for the missing or incomplete modalities. To begin, we developed a dynamic multimodal variational autoencoder (DMVAE) that can exploit intrinsic correlations between different modalities to im-pute features for missing modalities. Next, we combined features from all modalities to predict the outcome of a CPP diagnosis. The experimental results (AUROC 0.9086) demonstrate that our DMVAE model is superior to standard methods. Additionally, we showed that by setting appropriate operating thresholds, clinicians could diagnose about two-thirds of patients with confidence (1.0 specificity). Only about one-third of patients require confirmation of their diagnoses using GnRH (or GnRH analog)-stimulation tests. To interpret the results, we implemented an explainer Shapley additive explanation (SHAP) to analyze the local and global feature attributions.
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Quantifying the ossification of the carpus: Radiographic standards for age estimation in a New South Wales paediatric population. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Karlas A, Pleitez MA, Aguirre J, Ntziachristos V. Optoacoustic imaging in endocrinology and metabolism. Nat Rev Endocrinol 2021; 17:323-335. [PMID: 33875856 DOI: 10.1038/s41574-021-00482-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 02/02/2023]
Abstract
Imaging is an essential tool in research, diagnostics and the management of endocrine disorders. Ultrasonography, nuclear medicine techniques, MRI, CT and optical methods are already used for applications in endocrinology. Optoacoustic imaging, also termed photoacoustic imaging, is emerging as a method for visualizing endocrine physiology and disease at different scales of detail: microscopic, mesoscopic and macroscopic. Optoacoustic contrast arises from endogenous light absorbers, such as oxygenated and deoxygenated haemoglobin, lipids and water, or exogenous contrast agents, and reveals tissue vasculature, perfusion, oxygenation, metabolic activity and inflammation. The development of high-performance optoacoustic scanners for use in humans has given rise to a variety of clinical investigations, which complement the use of the technology in preclinical research. Here, we review key progress with optoacoustic imaging technology as it relates to applications in endocrinology; for example, to visualize thyroid morphology and function, and the microvasculature in diabetes mellitus or adipose tissue metabolism, with particular focus on multispectral optoacoustic tomography and raster-scan optoacoustic mesoscopy. We explain the merits of optoacoustic microscopy and focus on mid-infrared optoacoustic microscopy, which enables label-free imaging of metabolites in cells and tissues. We showcase current optoacoustic applications within endocrinology and discuss the potential of these technologies to advance research and clinical practice.
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Affiliation(s)
- Angelos Karlas
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Partner Site, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Miguel A Pleitez
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Juan Aguirre
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany.
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
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Keller MM, Barnes R, Brandt C, Hepworth LM. Hand rehabilitation programmes for second to fifth metacarpal fractures: A systematic literature review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1536. [PMID: 34192208 PMCID: PMC8182452 DOI: 10.4102/sajp.v77i1.1536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/08/2021] [Indexed: 11/01/2022] Open
Abstract
Background Metacarpal fractures, one of the most prevalent upper limb fractures, account for 10% of all bony injuries. Objective Our systematic review aimed to review, appraise and collate available evidence on hand rehabilitation programmes for the management of second to fifth metacarpal fractures in an adult human population after conservative and surgical management. Since 2008, no review on a similar topic has been performed, thus informing clinical practice for physiotherapists and occupational therapists. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) principles guided the reporting. Experimental, quasi-experimental, cohort and case-control studies between January 2008 and September 2018 were included. Searches were conducted on Medline, Academic Search Ultimate, CINAHL, CAB Abstracts, Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information and MasterFILE Premier, Web-of-Science and Scopus. Screening, selection, appraisal and data extraction were independently performed by two reviewers. No meta-analysis was performed. Results A total of 1015 sources were identified, 525 duplicates removed and 514 excluded. Three articles were included in the final data extraction: one randomised controlled trial (RCT) and two observational studies. Conclusion Limited evidence is available that a well-designed, well-implemented home-based exercise programme results in statistically significant improved hand function (p ˂ 0.0001) and digital total active motion (TAM) (p = 0.013) compared with traditional physiotherapy (PT) post-surgically. Clinical implications Our study contributes to the knowledge base of hand rehabilitation after an individual sustained a second to fifth metacarpal fracture. The authors identified a gap where future studies should further investigate the effect of hand rehabilitation after conservative and surgical management.
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Affiliation(s)
- Monique M Keller
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa
| | - Roline Barnes
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa
| | - Corlia Brandt
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Farid M, Shibu M. A rare case of Seymour fracture in an adult with non-fused growth plates. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:72-75. [PMID: 34104672 PMCID: PMC8143599 DOI: 10.1080/23320885.2021.1927738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The mechanism for growth plate fusion is not fully understood yet. We present the first reported Seymour fracture (Salter Harris I) in an adult with failed growth plate fusion. The management of Seymour fractures should be according to radiological bone age rather than actual age.
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Affiliation(s)
- Mohammed Farid
- Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Mohamed Shibu
- Plastic Surgery, The Royal London Hospital, London, UK
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Remy F, Saliba-Serre B, Chaumoitre K, Martrille L, Lalys L. Age estimation from the biometric information of hand bones: Development of new formulas. Forensic Sci Int 2021; 322:110777. [PMID: 33845225 DOI: 10.1016/j.forsciint.2021.110777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In the judicial context of the age estimation of living individuals, a new method was recently proposed, based on the collection of biometric information on hand bones radiographs. The aim of this study was to apply this method to a large French sample to provide new tools for age estimation MATERIALS AND METHODS: The study sample consisted of metacarpals and proximal phalanges measurements of 1003 individuals aged less than 21 years. This sample was divided into two subgroups 1-12 and 13-21 years as the age of 13 is a relevant legal threshold for most European countries. A quadratic discriminant analysis was performed to identify the group to which an individual was most likely to belong. Age estimation formulas were also constructed from linear models: for each subgroup and the total sample. RESULTS The belonging of an individual to the 1-12 or 13-21 subgroup was determined with a correct classification rate of 89.8%. Age estimation formulas became less precise with age, with a mean absolute error ranging between 11 and 21 months. CONCLUSION We proposed a two-step procedure for age estimation: firstly, the identification of the age group to which the individual is most likely to belong, and secondly, the age estimation of this individual by applying the appropriate formula.
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Affiliation(s)
- Floriane Remy
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
| | | | - Kathia Chaumoitre
- Department of Medical Imaging, A.P.-H.M, North University Hospital, Marseille, France
| | - Laurent Martrille
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France; Department of Forensic Medicine, Montpellier University Hospital, Montpellier, France
| | - Loïc Lalys
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
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The NIMH Intramural Longitudinal Study of the Endocrine and Neurobiological Events Accompanying Puberty: Protocol and rationale for methods and measures. Neuroimage 2021; 234:117970. [PMID: 33771694 DOI: 10.1016/j.neuroimage.2021.117970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Delineating the relationship between human neurodevelopment and the maturation of the hypothalamic-pituitary-gonadal (HPG) axis during puberty is critical for investigating the increase in vulnerability to neuropsychiatric disorders that is well documented during this period. Preclinical research demonstrates a clear association between gonadal production of sex steroids and neurodevelopment; however, identifying similar associations in humans has been complicated by confounding variables (such as age) and the coactivation of two additional endocrine systems (the adrenal androgenic system and the somatotropic growth axis) and requires further elucidation. In this paper, we present the design of, and preliminary observations from, the ongoing NIMH Intramural Longitudinal Study of the Endocrine and Neurobiological Events Accompanying Puberty. The aim of this study is to directly examine how the increase in sex steroid hormone production following activation of the HPG-axis (i.e., gonadarche) impacts neurodevelopment, and, additionally, to determine how gonadal development and maturation is associated with longitudinal changes in brain structure and function in boys and girls. To disentangle the effects of sex steroids from those of age and other endocrine events on brain development, our study design includes 1) selection criteria that establish a well-characterized baseline cohort of healthy 8-year-old children prior to the onset of puberty (e.g., prior to puberty-related sex steroid hormone production); 2) temporally dense longitudinal, repeated-measures sampling of typically developing children at 8-10 month intervals over a 10-year period between the ages of eight and 18; 3) contemporaneous collection of endocrine and other measures of gonadal, adrenal, and growth axis function at each timepoint; and 4) collection of multimodal neuroimaging measures at these same timepoints, including brain structure (gray and white matter volume, cortical thickness and area, white matter integrity, myelination) and function (reward processing, emotional processing, inhibition/impulsivity, working memory, resting-state network connectivity, regional cerebral blood flow). This report of our ongoing longitudinal study 1) provides a comprehensive review of the endocrine events of puberty; 2) details our overall study design; 3) presents our selection criteria for study entry (e.g., well-characterized prepubertal baseline) along with the endocrinological considerations and guiding principles that underlie these criteria; 4) describes our longitudinal outcome measures and how they specifically relate to investigating the effects of gonadal development on brain development; and 5) documents patterns of fMRI activation and resting-state networks from an early, representative subsample of our cohort of prepubertal 8-year-old children.
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De Micco F, Angelakopoulos N, Martino F, Corbi G, Cameriere R, Campobasso CP. Skeletal age estimation in a contemporary South African population using two radiological methods (Bo/Ca and TW2). AUST J FORENSIC SCI 2021. [DOI: 10.1080/00450618.2021.1882569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Francesco De Micco
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Nikolaos Angelakopoulos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Federica Martino
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Roberto Cameriere
- AgEstimation Project, University of Macerata, Macerata, Italy
- Department of Forensic Medicine, University of Sechenov, Moscow, Russia
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
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Abstract
BACKGROUND The purpose of this investigation was to develop a quantitative and reproductible method for estimating skeletal maturity based on measurements of the height of the bony greater trochanter (GT) using timing to 90% of final height as a gold standard. METHODS Bony GT height was measured using serial anteroposterior pelvic radiographs in 76 healthy pediatric patients obtained from the Bolton-Brush (BB) Study with corresponding Greulich-Pyle (GP) bone ages. Chronologic age at 90% of final height was calculated. GT height was then measured in 300 contemporary patients aged 4 to 18 years, evenly divided based on sex and race. Bony GT height was compared between BB and contemporary patients, while linear mixed-effects models were used to examine for potential predictors of years to 90% final height using patient sex, GP bone age and bony GT height measurements. RESULTS Bony GT height was measured in 303 radiographs from the BB Collection (n=37 males; n=39 females) with corresponding GP bone ages, chronological ages, and heights to represent skeletal maturity. Mean age at 90% final height was 13.3±0.6 years for males and 11.4±0.8 years for females. When controlling for patient age and sex, multiple regression analysis revealed that contemporary patients possessed significantly greater bony GT height (mean difference: 1.15 mm; P=0.001) when compared with BB patients. Multivariate analysis showed that combining bony GT height, GP bone age, and sex significantly predicted years to 90% total growth (P<0.001) and explained ∼85% (95% confidence interval for R2: 82%-87%) of the total variance in years using 90% of final height, with sex, GP bone age, and GT height all significant contributors. CONCLUSIONS Including bony GT height provides more accurate prediction of 90% final height when combined with GP bone age and sex. GT height offers an efficient and accurate parameter that may be utilized in pediatric orthopedic conditions requiring a quantitative estimate of bone age in children with prior pelvis or hip imaging. LEVEL OF EVIDENCE Level II-diagnostic study.
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Automated Bone Age Assessment with Image Registration Using Hand X-ray Images. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10207233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
One of the methods for identifying growth disorder is by assessing the skeletal bone age. A child with a healthy growth rate will have approximately the same chronological and bone ages. It is important to detect any growth disorder as early as possible, so that mitigation treatment can be administered with less negative consequences. Recently, the most popular approach in assessing the discrepancy between bone and chronological ages is through the subjective protocol of Tanner–Whitehouse that assesses selected regions in the hand X-ray images. This approach relies heavily on the medical personnel experience, which produces a high intra-observer bias. Therefore, an automated bone age prediction system with image registration using hand X-ray images is proposed in order to complement the inexperienced doctors by providing the second opinion. The system relies on an optimized regression network using a novel residual separable convolution model. The regressor network requires an input image to be 299 × 299 pixels, which will be mapped to the predicted bone age through three modules of the Xception network. Moreover, the images will be pre-processed or registered first to a standardized and normalized pose using separable convolutional neural networks. Three steps image registration are performed by segmenting the hand regions, which will be rotated using angle calculated from four keypoints of interest, before positional alignment is applied to ensure the region of interest is located in the middle. The hand segmentation is based on DeepLab V3 plus architecture, while keypoints regressor for angle alignment is based on MobileNet V1 architecture, where both of them use separable convolution as the core operators. To avoid the pitfall of underfitting, synthetic data are generated while using various rotation angles, zooming factors, and shearing images in order to augment the training dataset. The experimental results show that the proposed method returns the lowest mean absolute error and mean squared error of 8.200 months and 121.902 months2, respectively. Hence, an error of less than one year is acceptable in predicting the bone age, which can serve as a good supplement tool for providing the second expert opinion. This work does not consider gender information, which is crucial in making a better prediction, as the male and female bone structures are naturally different.
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Koç U, Ercan I, Özdemir S, Bolu S, Yabaci A, Taydaş O. Statistical shape analysis of hand and wrist in paediatric population on radiographs. Turk J Med Sci 2020; 50:1288-1297. [PMID: 32490637 PMCID: PMC7491272 DOI: 10.3906/sag-2002-176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/19/2020] [Indexed: 11/23/2022] Open
Abstract
Background/aim The goal of this study was to compare differences in hand and wrist shapes and to evaluate these according to growth and allometry in children on radiographs related to bone age. Materials and methods The study included 263 males and 189 females. A total of 452 left hand and wrist radiographs were retrospectively collected. Standard anatomical landmarks marked on radiographs. Results There were seen to be significant differences in comparisons of hand and wrist shapes according to sex (P = 0.009). The most suitable model in the growth models was seen as the Gompertz growth model for both females and males (model P < 0.001). For the relationship between shape and size to evaluate allometry, significant models were obtained in females (model P = 0.017, MSE = 0.0002) and in males (model P < 0.001, MSE = 0.0002). In our study, the difference between the sexes was found mostly in the radiocarpal region. It was observed that the deformation of the carpal bones started in the distal row carpal bones. Conclusion Significant differences were found in hand and wrist shapes according to sex. Models for growth and allometry of hand and wrist shapes were found to be significant in children.
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Affiliation(s)
- Ural Koç
- Department of Radiology, Ankara Şehit Ahmet Özsoy State Hospital, Ankara, Turkey
| | - Ilker Ercan
- Department of Biostatistics, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Senem Özdemir
- Department of Anatomy, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Semih Bolu
- Department of Pediatric Endocrinology, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Ayşegül Yabaci
- Department of Biostatistics, Faculty of Medicine, Uludağ University, Bursa, Turkey,Department of Biostatistics and Medical Informatics, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Onur Taydaş
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Hong SW, Roh YH, Gong HS, Baek GH. Idiopathic Avascular Necrosis of Trapezoid in Adolescence: 3-Year Follow-Up. J Hand Surg Am 2020; 45:e11-e16. [PMID: 30733102 DOI: 10.1016/j.jhsa.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/16/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
Avascular necrosis (AVN) is relatively uncommon in the carpal bones, although it most frequently involves the lunate and scaphoid. The trapezoid has abundant vascular channels from a rich network of dorsal and palmar vessels, and only a few cases of AVN have been reported in adults who sustained a traumatic insult. We present a rare case of idiopathic AVN of the trapezoid in an adolescent presenting with refractory pain at the second metacarpal base. Over a period of 36 months, follow-up symptom evaluations and serial magnetic resonance images showed prominent gradual improvement, consistent with spontaneous resolution.
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Affiliation(s)
- Seok Woo Hong
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, South Korea
| | - Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, South Korea.
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Wang F, Gu X, Chen S, Liu Y, Shen Q, Pan H, Shi L, Jin Z. Artificial intelligence system can achieve comparable results to experts for bone age assessment of Chinese children with abnormal growth and development. PeerJ 2020; 8:e8854. [PMID: 32274267 PMCID: PMC7127473 DOI: 10.7717/peerj.8854] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/05/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Bone age (BA) is a crucial indicator for revealing the growth and development of children. This study tested the performance of a fully automated artificial intelligence (AI) system for BA assessment of Chinese children with abnormal growth and development. Materials and Methods A fully automated AI system based on the Greulich and Pyle (GP) method was developed for Chinese children by using 8,000 BA radiographs from five medical centers nationwide in China. Then, a total of 745 cases (360 boys and 385 girls) with abnormal growth and development from another tertiary medical center of north China were consecutively collected between January and October 2018 to test the system. The reference standard was defined as the result interpreted by two experienced reviewers (a radiologist with 10 years and an endocrinologist with 15 years of experience in BA reading) through consensus using the GP atlas. BA accuracy within 1 year, root mean square error (RMSE), mean absolute difference (MAD), and 95% limits of agreement according to the Bland-Altman plot were statistically calculated. Results For Chinese pediatric patients with abnormal growth and development, the accuracy of this new automated AI system within 1 year was 84.60% as compared to the reference standard, with the highest percentage of 89.45% in the 12- to 18-year group. The RMSE, MAD, and 95% limits of agreement of the AI system were 0.76 years, 0.58 years, and -1.547 to 1.428, respectively, according to the Bland-Altman plot. The largest difference between the AI and experts' BA result was noted for patients of short stature with bone deformities, severe osteomalacia, or different rates of maturation of the carpals and phalanges. Conclusions The developed automated AI system could achieve comparable BA results to experienced reviewers for Chinese children with abnormal growth and development.
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Affiliation(s)
- Fengdan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao Gu
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shi Chen
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongliang Liu
- Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou, China
| | - Qing Shen
- Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou, China
| | - Hui Pan
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Shi
- Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Ren X, Li T, Yang X, Wang S, Ahmad S, Xiang L, Stone SR, Li L, Zhan Y, Shen D, Wang Q. Regression Convolutional Neural Network for Automated Pediatric Bone Age Assessment From Hand Radiograph. IEEE J Biomed Health Inform 2019; 23:2030-2038. [DOI: 10.1109/jbhi.2018.2876916] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Artioli TO, Alvares MA, Carvalho Macedo VS, Silva TS, Avritchir R, Kochi C, Longui CA. Bone age determination in eutrophic, overweight and obese Brazilian children and adolescents: a comparison between computerized BoneXpert and Greulich-Pyle methods. Pediatr Radiol 2019; 49:1185-1191. [PMID: 31152212 DOI: 10.1007/s00247-019-04435-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/29/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bone age determination is usually employed to evaluate growth disorders and their treatment. The Greulich-Pyle method is the simplest and most frequently used type of evaluation, but it presents huge interobserver variability. The BoneXpert is a computer-automated method developed to avoid significant bone age variability among distinct observers. OBJECTIVE To compare the BoneXpert and Greulich-Pyle methods of bone age determination in eutrophic children and adolescents, as well as in overweight and obese pediatric patients. MATERIALS AND METHODS The sample comprised 515 participants, 253 boys (159 eutrophic, 53 overweight and 41 obese) and 262 girls (146 eutrophic, 76 overweight and 40 obese). Left hand and wrist radiographs were acquired for bone age determination using both methods. RESULTS There was a positive correlation between chronological age and Greulich-Pyle, chronological age and BoneXpert, and Greulich-Pyle and BoneXpert. There was a significant increase (P<0.05) in bone age in both the Greulich-Pyle and BoneXpert methods in obese boys when compared to eutrophic or overweight boys of the same age. In girls, there was an increase in bone age in both obese and overweight individuals when compared to eutrophic girls (P<0.05). The Greulich-Pyle bone age was advanced in comparison to that of BoneXpert in all groups, except in obese boys, in which bone age was similarly advanced in both methods. CONCLUSION The BoneXpert computer-automated bone age determination method showed a significant positive correlation with chronological age and Greulich-Pyle. Furthermore, the impact of being overweight or obese on bone age could be identified by both methods.
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Affiliation(s)
- Thiago O Artioli
- Pediatric Endocrinology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Matheus A Alvares
- Pediatric Endocrinology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Vanessa S Carvalho Macedo
- Pediatric Endocrinology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Tatiane S Silva
- Molecular Medicine Laboratory, Santa Casa de São Paulo School of Medical Sciences, 112 Dr. Cesário Mota Jr. St., São Paulo, CEP 01221-020, Brazil
| | - Roberto Avritchir
- Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Cristiane Kochi
- Pediatric Endocrinology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Molecular Medicine Laboratory, Santa Casa de São Paulo School of Medical Sciences, 112 Dr. Cesário Mota Jr. St., São Paulo, CEP 01221-020, Brazil
| | - Carlos A Longui
- Pediatric Endocrinology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
- Molecular Medicine Laboratory, Santa Casa de São Paulo School of Medical Sciences, 112 Dr. Cesário Mota Jr. St., São Paulo, CEP 01221-020, Brazil.
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The Use of Age Assessment in the Context of Child Migration: Imprecise, Inaccurate, Inconclusive and Endangers Children's Rights. CHILDREN-BASEL 2019; 6:children6070085. [PMID: 31340464 PMCID: PMC6678520 DOI: 10.3390/children6070085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022]
Abstract
Anecdotal reports suggest migrant children at the US border have had to undergo age assessment procedures to prove to immigration officials they qualify for special protections afforded to those under age 18. There are a variety of methods to assess the chronological ages of minors, including imaging studies such as X-rays of the wrist, teeth, or collarbone. However, these procedures have come under great scrutiny for being arbitrary and inaccurate, with a significant margin of error, because they are generally based on reference materials that do not take into account ethnicity, nutritional status, disease, and developmental history, considerations which are especially relevant for individuals coming from conflict and/or resource-constrained environments. Using these procedures for migration purposes represent an unethical use of science and medicine, which can potentially deprive minors with the protections that they are owed under US and international laws, and which may have devastating consequences. We should advocate for the creation special protocols, educate law enforcement and legal actors, ensure such procedures are carried out only as a last resort and by independent actors, emphasize child protection and always put the child’s best interest at the core.
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Clinical practice recommendations for growth hormone treatment in children with chronic kidney disease. Nat Rev Nephrol 2019; 15:577-589. [PMID: 31197263 PMCID: PMC7136166 DOI: 10.1038/s41581-019-0161-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/23/2022]
Abstract
Achieving normal growth is one of the most challenging problems in the management of children with chronic kidney disease (CKD). Treatment with recombinant human growth hormone (GH) promotes longitudinal growth and likely enables children with CKD and short stature to reach normal adult height. Here, members of the European Society for Paediatric Nephrology (ESPN) CKD–Mineral and Bone Disorder (MBD), Dialysis and Transplantation working groups present clinical practice recommendations for the use of GH in children with CKD on dialysis and after renal transplantation. These recommendations have been developed with input from an external advisory group of paediatric endocrinologists, paediatric nephrologists and patient representatives. We recommend that children with stage 3–5 CKD or on dialysis should be candidates for GH therapy if they have persistent growth failure, defined as a height below the third percentile for age and sex and a height velocity below the twenty-fifth percentile, once other potentially treatable risk factors for growth failure have been adequately addressed and provided the child has growth potential. In children who have received a kidney transplant and fulfil the above growth criteria, we recommend initiation of GH therapy 1 year after transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not a feasible option. GH should be given at dosages of 0.045–0.05 mg/kg per day by daily subcutaneous injections until the patient has reached their final height or until renal transplantation. In addition to providing treatment recommendations, a cost-effectiveness analysis is provided that might help guide decision-making. This Evidence-Based Guideline developed by members of the European Society for Paediatric Nephrology CKD-MBD, Dialysis and Transplantation working groups presents clinical practice recommendations for the use of growth hormone in children with chronic kidney disease on dialysis and after renal transplantation.
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Multidisciplinary oral rehabilitation of an adolescent suffering from juvenile Gorlin-Goltz syndrome - a case report. Head Face Med 2019; 15:5. [PMID: 30736811 PMCID: PMC6367745 DOI: 10.1186/s13005-019-0189-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Gorlin-Goltz syndrome is an autosomal dominant disorder characterized by keratocystic odontogenic tumors in the jaws, multiple basal cell carcinomas and skeletal abnormities. Frequently, the manifestation of the syndrome occurs in the adolescent years. Case presentation An 11-year-old boy was referred to our clinic due to the persistence of the lower deciduous molars. The further diagnosis revealed bilateral keratocystic odontogenic tumors in the region of teeth 33 and 45 representing a symptom of a Gorlin-Goltz syndrome. This case of the oral rehabilitation of an adolescent with bilateral keratocystic odontogenic tumors shows the approach of a multidisciplinary treatment concept including the following elements: Enucleation and bone defect augmentation using a prefabricated bone graft; distraction osteogenesis to extend the graft-block vertically after cessation of growth; accompanying orthodontic treatment, guided implant placement and prosthetic rehabilitation. Six months after implant insertion, a new keratocystic odontogenic tumor in the basal part of the left sinus maxillaris had to be removed combined with the closure of the oroantral fistula. During the follow-up period of 18 months in semi-annual intervals, the patient showed no sign of pathology. Conclusion In the presented case could be shown that distraction osteogenesis of prefabricated bone blocks is possible. With a multidisciplinary approach in a long-term treatment a sufficient oral rehabilitation of the patient suffering from extended keratocystic odontogenic tumors was possible.
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Hashim HA, Mansoor H, Mohamed MHH. Assessment of Skeletal Age Using Hand-Wrist Radiographs following Bjork System. J Int Soc Prev Community Dent 2018; 8:482-487. [PMID: 30596037 PMCID: PMC6280566 DOI: 10.4103/jispcd.jispcd_315_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/23/2018] [Indexed: 11/22/2022] Open
Abstract
The knowledge of the skeletal maturation and the stage of the growth of the patients seeking orthodontic treatment are of great value in planning efficient orthodontic therapy. However, different craniofacial structures of patient show variation in growth potential. The routine use of hand-wrist radiograph for growth prediction exposes the patient to extra radiation. Cervical vertebrae in the lateral cephalograph have been recommended as an alternative method. The pubertal growth spurt is a vital period in the orthodontic treatment and should be kept in mind when planning orthodontic treatment in growing children. One of the main objectives of taking hand and wrist radiograph is to determine the amount of growth and get used of it in patients with skeletal discrepancy during adolescence. Further, this will help in the selection of the appliances required, the course of the treatment and the retention after active orthodontic therapy.
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Affiliation(s)
- Hayder A Hashim
- Division of Orthodontics, Department of Dentistry, Hamad Medical Corporation, Doha, Qatar
| | - Hussain Mansoor
- Division of Orthodontics, Department of Dentistry, Hamad Medical Corporation, Doha, Qatar
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