| Objective:(1)to determine whether the automatic software BoneXpert(BX)of bone age determination can be used to substitute for the residents of Radiology for the diagnosis of bone age in children with developmental abnormality.(2)To use G-P atlas and BX to study the development of different parts of the hand-wrist of the normal children to determine whether there is regularity of maturation.(3)To use BX software and Photoshop technology to make a new digital skeletal age atlas for boys Materials and methods:(1)the X-rays of skeletal age of children with abnormal growth were collected and evaluated by BX software and G-P atlas.If the difference between the two readings is greater than 1.0 years old,they would be rerated determined by two physicians.(2)To study the X-rays of left hand of children aged 2 to 14 years old.The bone age of the ulna,radius,metacarpal,proximal phalanx,middle phalanx and distal phalanx were determined by BX and G-P atlas.(3)To collect the X-rays of 325 children aged 5 to 14 years old with left hand trauma,the dates of X-rays were within one month later or before of their birthdays.To analysis the bone age of the ulna,radius epiphysis,metacarpal bones,and the first,third,fifth phalanx using the software of BX.The median epiphysis of each age group and bone age was selected as the standard bone.The carpal bones were chosen by the radius epiphysis;and the second and fourth phalanxes were decided by the third and fifth phalanx.To zoom,rotate and adjust the density of standard epiphysis by Photoshop to form standard atlas.Four residents evaluated 100 films of bone age and compared with G-R and G-P atlas(5 to 9 year old group and the group aged between 10 and 14).Four weeks later,the random selection of 30 films were assessed again.Paired t test and rank sum test were used for statistical analysis.Results:(1)46 cases(9.5%)showed the difference of the two reading were more than 1.0 year.After the re-evaluation of the attending physician,the ones of 28 cases(5.8%)was still more than 1.0 years old.These bone age by doctors were all more than the ones of BX and their bone age was more than 10 years old by G-P atlas.The deviation of the square root of arithmetic of both methods is 0.56 and the 95% confidence interval of 0.53-0.61 year.(2)In the group of BX evaluation and the G-P atlas,about 75.8% and 59.4% cases,respectively,showed more than 2.0 years of maturation difference between the most advanced and the most retarded epiphyseal bones.In the two methods,the middle phalanx and metacarpal bones were the most advanced and the most retarded epiphyseal groups.Proximal and distal phalanxes were closer to the biological age.(3)The inter-intra group correlation coefficients of the new digital atlas were both morer than 0.90 and there is no statistical significance in both subgroup of 5 to 9 years old and 10 to 14 years old.Conclusion: the automatic software BX can be used as a substitute for the residents in radiology department.However,the measurement of children aged 10 years and above should be further improved.There were significant differences in the maturation of different parts of the hand-wrist in normal children.It is a convenient and accurate method to use BX to select the standard epiphysis and to synthesize the skeletal age atlas with Photoshop technology. |
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