Original communicationThe applicability of Greulich and Pyle atlas to assess skeletal age for four ethnic groups
Introduction
Assessment of bone age or skeletal maturity is not only used in forensic science, but it is also utilized in the clinical environment in radiology and paediatrics.1, 2 Usually, bone age is determined by comparing the left-hand radiograph of children with a standard reference sample as an atlas. Bone age assessment (BAA) has become an interesting academic topic due to the increase in illegal border immigration in developing countries. These days, most countries have been faced with a rise in the amount of foreigners who do not have a valid ID to prove their age.3 Skeletal age (SA) is an excellent indicator for determination of the growth status, health monitoring, metabolic and genetic disorders, as well as diagnosis of precocious puberty, endocrinology diseases, nutritional disorders and orthopaedic problems in children.4
Tanner, and Greulich and Pyle (GP) are two famous methods for assessment of the skeletal age.5 While using the Tanner atlas is more complex, the GP atlas is less time consuming and less prone to errors. Hence, the GP method has become the most preferred method for estimation of the bone age among the experts and radiologists.6, 7 The primary version of the GP atlas was introduced in the 1950s, and involved the hand skeletal of the Caucasian population in the 1930s. The data were collected from 1000 radiographs of people living in Cleveland, aged between 0 and 18 years. The second edition was published in 1959 and the last version was re-edited in 1988.
Although skeletal development is the most common indicator of bone age, there is considerable literature that bone age is affected by different criteria, such as gender, ethnicity, socio-economic citation, nutritional and geographical location.8, 9, 10, 11 In this research, we investigate the comparison of the applicability of the GP atlas for assessment of the skeletal age (SA) in the sample of four different ethnic groups – Asian, African/American, Caucasian and Hispanic. For the purpose of this study, we have chosen to limit the scope to only male subjects to remove the variability involved in assessing both genders in the four ethnic groups.
Section snippets
Materials and methods
From 1400 radiographs that were collected from the Children's Hospital Los Angeles, 184 radiographs of the left hand and wrist were randomly selected. These images were obtained by the Image Processing and Informatics (IPI) Laboratory to conduct an automatic computer-aided-diagnosis (CAD) method for bone age assessment. The radiographs were collected over ten years for both the male and female categories from new born to 18 years for the Asian, African American, Caucasian and Hispanic
Results
The data selected from the 184 male samples were classified based on the ethnicity and age. The data were analysed with SPSS 21 software. The difference between chronological age (CA) and skeletal age (SA), (CA_SA) was calculated. The mean value and standard deviation (SD) of chronological age (CA), skeletal age (SA) and their difference (CA_SA) was noted based on the ethnicity for each age group. A paired t-test was performed and the p-value obtained to show the significant age for each group.
Discussion
Skeletal maturity is accepted as an important indicator to show human development or growth status. The Greulich and Pyle atlas has proved to be a reliable standard worldwide. Scientists are interested in investigating the skeletal age of children according to different conditions – social, economic, nutritional, sex and racial. Bone age is assessed by comparison of the left X-ray image of the unknown subject with a standard reference. The objective of this study was to attempt to examine the
Conclusion
This research investigated whether the Greulich–Pyle (G–P) method is applicable for determination of the skeletal maturity in four different ethnic groups of certain age groups. It could be determined from the results that:
- (1)
In the case of Asian males there is a retardation of bone age for age group 2 year to 7 years.
- (2)
In the case of African/American males the GP atlas is not reliable for assessment of the age group of 8 years–15 years.
- (3)
In the case of Caucasian and Hispanic males, the GP atlas is
Ethical approval
None declared.
Funding
No grants or financial support has been obtained for this manuscript.
Conflict of interest
I declare no conflict of interest for this manuscript as the responsible author.
Acknowledgement
This study was supported by the Grant number FL012/2011, from the University of Malaya (UM), Malaysia.
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