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Inter-rater variability and repeatability in the assessment of the Tanner–Whitehouse classification of hand radiographs for the estimation of bone age

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Abstract

Objective

To determine which bones and which grades had the highest inter-rater variability when employing the Tanner–Whitehouse (T-W) method.

Materials and methods

Twenty-four radiologists were recruited and trained in the T-W classification of skeletal development. The consistency and skill of the radiologists in determining bone development status were assessed using 20 pediatric hand radiographs of children aged 1 to 18 years old. Four radiologists had a poor concordance rate and were excluded. The remaining 20 radiologists undertook a repeat reading of the radiographs, and their results were analyzed by comparing them with the mean assessment of two senior experts as the reference standard. Concordance rate, scoring, and Kendall’s W were calculated to evaluate accuracy and consistency.

Results

Both the radius, ulna, and short finger (RUS) system (Kendall’s W = 0.833) and the carpal (C) system (Kendall’s W = 0.944) had excellent consistency, with the RUS system outperforming the C system in terms of scores. The repeatability analysis showed that the second rating test, performed after 2 months of further bone age assessment (BAA) practice, was more consistent and accurate than the first. The capitate had the lowest average concordance rate and scoring, as well as the lowest overall concordance rate for its D classification. Moreover, the G classifications of the seven carpal bones all had a concordance rate less than 0.6. The bones with lower Kendall’s W were likewise those with lower scores and concordance rates.

Conclusion

The D grade of the capitate showed the highest variation, and the use of the Tanner–Whitehouse 3rd edition (T-W3) to determine bone age (BA) was frequently inconsistent. A more comprehensive description with a focus on inaccuracy bones or ratings and a modification to the T-W3 approach would significantly advance BAA.

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Data availability

Data are available upon request.

Abbreviations

BA:

Bone age

BAA:

Bone age assessment

GP:

Greulich–Pyle

T-W:

Tanner–Whitehouse

CAD:

Computer-assisted diagnosis

AI:

Artificial intelligence

JPEG:

Joint Photographic Experts Group

RUS:

Radius, ulna, and short finger bones

C:

Carpal bone

CA:

Chronological age

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Funding

This work was supported by the Beijing Jishuitan Hospital Elite Young Scholar Programme (XKGG202122), the Beijing Hospitals Authority Youth Programme (code: 20200402), and the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: ZYLX202107).

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Authors and Affiliations

  1. Department of Radiology, Beijing Jishuitan Hospital Capital Medical University, Beijing, China

    Jian Geng, Wenshuang Zhang, Ling Wang, Pengju Huang, Yandong Liu, Kangkang Ma, Dong Yan & Xiaoguang Cheng

  2. Department of Traumatology, Beijing Jishuitan Hospital Capital Medical University, Beijing, China

    Yufeng Ge

  3. Department of Radiology, Beijing Anding Hospital Capital Medical University, Beijing, China

    Pengju Huang

  4. Chinese Center for Disease Control and Prevention, National Institute of Nutrition and Health, Beijing, China

    Jia Shi

  5. School of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang City, Shaanxi Province, China

    Fengyun Zhou

  6. Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, UK

    Glen M. Blake

  7. Department of Athletic Training, Beijing Sport University, Beijing, China

    Gang Xu

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  1. Jian Geng
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  2. Wenshuang Zhang
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  11. Gang Xu
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Corresponding authors

Correspondence to Dong Yan or Xiaoguang Cheng.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Jian Geng, Wenshuang Zhang, and Yufeng Ge contribute equally and are co-first authors.

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Geng, J., Zhang, W., Ge, Y. et al. Inter-rater variability and repeatability in the assessment of the Tanner–Whitehouse classification of hand radiographs for the estimation of bone age. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04664-w

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  • DOI: https://doi.org/10.1007/s00256-024-04664-w

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