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Updated: May 25, 2026
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Validation of automatic bone age rating in children with precocious and early puberty
David D Martin1, Kathrin Meister, Roland Schweizer
1Pediatric Endocrinology and Diabetology, University Children's Hospital, Tübingen, Germany. david.martin@med.uni-tuebingen.de
Background And Aims:
Manual bone age (BA) rating in precocious puberty (PP) is associated with considerable rater variability. The aim was to evaluate a new method for automated Greulich and Pyle (GP) BA determination in children with PP.
Methods:
Seven hundred forty-one archived X-rays from 13 boys and 103 girls with PP or early puberty of various etiologies (age range at time of X-ray, 0.3-14.8 years; mean BA advancement, 2.3 years) were rated. Automatic rating (BoneXpert BA, or BXBA) was compared with the original manual GP rating (manual BA, or ManBA). X-rays where BXBA deviated from ManBA by more than 1.5 years were rerated by three raters, and the average was formed (ReferenceBA).
Results:
All 741 X-rays, except nine (three images had poor quality and six were from children with a chronological age younger than 1.5 years), were analyzed automatically. The mean difference of BXBA-ManBA was -0.19 years; the SD of the differences was 0.76 years (95% confidence interval 0.72-0.80). ReferenceBA was determined for 41 images. A discrepancy from ReferenceBA greater 1.5 years was found in four images against BXBA and in 10 images against ManBA.
Conclusion:
Automated BA is efficient and reliable in children with PP.
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