Bone age assessment with various machine learning techniques: A systematic literature review and meta-analysis.

BACKGROUND: The assessment of bone age and skeletal maturity and its comparison to chronological age is an important task in the medical environment for the diagnosis of pediatric endocrinology, orthodontics and orthopedic disorders, and legal environment in what concerns if an individual is a minor or not when there is a lack of documents. Being a time-consuming activity that can be prone to inter- and intra-rater variability, the use of methods which can automate it, like Machine Learning techniques, is of value. OBJECTIVE: The goal of this paper is to present the state of the art evidence, trends and gaps in the research related to bone age assessment studies that make use of Machine Learning techniques. METHOD: A systematic literature review was carried out, starting with the writing of the protocol, followed by searches on three databases: Pubmed, Scopus and Web of Science to identify the relevant evidence related to bone age assessment using Machine Learning techniques. One round of backward snowballing was performed to find additional studies. A quality assessment was performed on the selected studies to check for bias and low quality studies, which were removed. Data was extracted from the included studies to build summary tables. Lastly, a meta-analysis was performed on the performances of the selected studies. RESULTS: 26 studies constituted the final set of included studies. Most of them proposed automatic systems for bone age assessment and investigated methods for bone age assessment based on hand and wrist radiographs. The samples used in the studies were mostly comprehensive or bordered the age of 18, and the data origin was in most of cases from United States and West Europe. Few studies explored ethnic differences. CONCLUSIONS: There is a clear focus of the research on bone age assessment methods based on radiographs whilst other types of medical imaging without radiation exposure (e.g. magnetic resonance imaging) are not much explored in the literature. Also, socioeconomic and other aspects that could influence in bone age were not addressed in the literature. Finally, studies that make use of more than one region of interest for bone age assessment are scarce.

[The approaches to the optimization of forensic medical methods employed for determining age].

The analysis of the results of investigations performed at M.I. Raisky Department of Forensic Medicine, Saratov State Medical University, to elucidate the age-specific changes in the human soft tissues made it possible to distinguish several variants of reducing errors committed in association with the determination of the age of individual subjects with the help of forensic medical methods. At present, the chronological age is calculated with a different degree of accuracy from the data on the involution of aorta, skin, testicles, prostate and thyroid glands. In order to enhance the accuracy of newly developed diagnostic methods, it is proposed to take into account the necessity of fulfilling the following conditions: to increase the number of characteristics of the study object to be analysed, to use the complex of involution features of several organs belonging to a single body system, and to apply the rational approach to the choice of the methods for the mathematical analysis of the data being obtained.

Long-term secular trend of skeletal maturation of Taiwanese children between agricultural (1960s) and contemporary (after 2000s) generations using the Tanner-Whitehouse 3 (TW3) method.

BACKGROUND: The Tanner-Whitehouse (TW) method is one of the well-known techniques in determining the bone age. OBJECTIVE: According to the objectivity of TW3, the secular trend was investigated to discover whether the skeletal maturation of Taiwanese children between two generations was different. SUBJECTS AND METHODS: The large-scale database of Taiwan was collected. The first group, called mid-1960s, included 265 boys and 295 girls in the agricultural generation (between 1966 and 1967). The second group, called mid-2000s, includes 114 boys and 616 girls in the contemporary generation (after 2000s). The bone age was determined by three radiologists using the carpals-only system of the TW3 method and by two physicians using the Greulich and Pyle method. A comparison of the means (independent-samples t-test) was applied by examining the difference of the children's skeletal maturation between the two generations in the same chronological age. The significant difference was considered while the p-value was 0.05 or less (95% confidence interval). RESULTS: A significant difference of the mean bone age (by, on average, three radiologists using the TW3 method) between the mid-1960s and mid-2000s in the same gender and chronological age was presented by the independent-samples t-test (p<0.001 with 95% confidence interval), and the bone age, determined by the TW3 method, of the mid-2000s group was higher than that of the mid-1960s group. This scenario corresponded with the children's bone age determined by pediatricians. Besides, it deserved to notice that the bone age of boys in the mid-2000s was larger than that of the girls in the mid-1960s. Furthermore, by comparing the environmental condition, we suspect that the difference of bone age of children between the two generations was attributed to the discrepancy in nutrition and socioeconomic variation during the four decades in Taiwan. CONCLUSION: The study presents that the secular trend of skeletal maturation of children in the mid-2000s is faster than that in the mid-1960s.

Índices numéricos Ebrí-metacarpofalángico y carpiano para el cálculo de la edad ósea y predicción de talla adulta / Metacarpophalangeal and carpal numeric indices to calculate bone age and predict adult size

Introducción: En este trabajo se presenta unos nuevos métodos numéricos a partir de los índices metacarpofalángico y carpiano para el cálculo de la edad ósea, así como poder predecir la talla adulta por medio de ecuaciones multiregresión. Material y métodos: La casuística longitudinal comprende a 160 niños zaragozanos sanos de ambos sexos, con edades comprendidas desde los 6meses hasta los 20años, estudiados anualmente, incluido el estudio radiológico. Para la labor estadística se ha utilizado el paquete estadístico «Statistix», así como el programa Excel. Resultados: Los nuevos índices se encuentran íntimamente correlacionados con la edad cronológica, dando por ello lugar a ecuaciones predictivas para el cálculo de la edad ósea de niños hasta 20 años, presentándose además ecuaciones propias hasta los cuatro, a efectos de poder afinar más el diagnóstico a estas cortas edades. Las edades óseas calculadas pueden ser llevadas tanto a tablas numéricas de desviación típica, como a una figura de equivalencias que nos dan el diagnóstico osificativo directamente. Las ecuaciones predictivas de talla adulta permiten una estimación fiable de la talla futura del niño a estudio. Estas estimaciones analizadas por el test de Student no han dado diferencias significativas respecto a la talla adulta que los niños de la casuística al final alcanzaron. Los resultados pueden obtenerse con una calculadora o a través de un programa informático a disposición gratuita del lector. Conclusiones: Son presentadas por vez primera, por métodos propios no foráneos, estándares de edad ósea, así como ecuaciones de predicción de talla adulta para el estudio de niños. Se invita al clínico a utilizar estos métodos metacarpofalángico y carpiano a fin de conseguir la experiencia necesaria para su idónea aplicación en población sana y con diversa patología(AU)

Introduction: This work presents new numerical methods from the meta-carpal-phalangeal and carpal indexes, for calculating bone age. In addition, these new methods enable the adult height to be predicted using multiple regression equations. Materials and Methods: The longitudinal case series studied included 160 healthy children from Zaragoza, of both genders, aged between 6months and 20 years, and studied annually, including the radiological study. For the statistical analysis the statistical package "Statistix", as well as the Excel program, was used. Results: The new indexes are closely co-related to the chronological age, thus leading to predictive equations for the calculation of the bone age of children up to 20 years of age. In addition, it presents particular equations for up to 4years of age, in order to optimise the diagnosis at these early ages. The resulting bones ages can be applied to numerical standard deviation tables, as well as to an equivalences chart, which directly gives us the ossification diagnosis. The predictive equations of adult height allow a reliable forecast of the future height of the studied child. These forecasts, analysed by the Student test did not show significant differences as regards the adult height that children of the case series finally achieved. The results can be obtained with a pocket calculator or through free software available for the reader. Conclusions: For the first time, and using a centre-developed and non-foreign methods, bones age standards and adult height predictive equations for the study of children, are presented. We invite the practitioner to use these meta-carpal-phalangeal and carpal methods in order to achieve the necessary experience to apply it to a healthy population and those with different disorders(AU)

As vértebras cervicais na determinação da idade óssea

Há décadas percebeu-se não existir uma correlação significativa entre idade cronológica e idade biológica. Desde então, muitos métodos vêm sendo utilizados para a determinação da idade óssea...

[Development and prospect on skeletal age evaluation methods of X-ray film].

The traditional methods of skeletal age estimation mainly include Numeration, Atlas, and Counting scores. In recent years, other new methods were proposed by several scholars. Utilizing image logical characteristics of X-ray film to extrapolate skeletal age is a key means by present forensic medicine workers in evaluating skeletal age. However, there exist some variations when we present the conclusion of skeletal age as an "evidence" directly to the Justice Trial Authority. In order to enhance the accuracy of skeletal age determination, further investigation for appropriate methodology should be undertaken. After a collective study of pertinent domestic and international literatures, we present this review of the research and advancement on skeletal age evaluation methods of X-ray film.

Development and prospect on skeletal age evaluation methods of X-ray film / 法医学杂志

The traditional methods of skeletal age estimation mainly include Numeration, Atlas, and Counting scores. In recent years, other new methods were proposed by several scholars. Utilizing image logical characteristics of X-ray film to extrapolate skeletal age is a key means by present forensic medicine workers in evaluating skeletal age. However, there exist some variations when we present the conclusion of skeletal age as an "evidence" directly to the Justice Trial Authority. In order to enhance the accuracy of skeletal age determination, further investigation for appropriate methodology should be undertaken. After a collective study of pertinent domestic and international literatures, we present this review of the research and advancement on skeletal age evaluation methods of X-ray film.