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Bone Age Practices in Infants and Older Children among Practicing Radiologists in Pakistan: Developing World
Waseem A Mirza1, Mukhtiar Memon2, Sayed Mustafa Mahmood Shah3
1Radiology, Aga Khan University Hospital, Karachi, PAK.
Insights
Radiologists in Pakistan predominantly use the Greulich and Pyle method for bone age assessment across all pediatric age groups. However, confidence in this technique is notably lower for infants and very young children.
Area of Science:
- Pediatric Radiology
- Skeletal Development Assessment
- Radiographic Interpretation
Background:
- Accurate bone age assessment is crucial for evaluating pediatric growth and development.
- Various radiographic techniques exist for determining skeletal maturity.
- Understanding current practices and confidence levels among radiologists is essential for improving diagnostic accuracy.
Purpose of the Study:
- To identify bone age assessment techniques used by Pakistani radiologists for infants, toddlers, and older children.
- To evaluate radiologists' confidence in their chosen bone age assessment methods within different pediatric age brackets.
Main Methods:
- A cross-sectional survey was administered to 147 practicing radiologists in Pakistan.
- The survey collected data on demographic information, preferred bone age assessment techniques for specific age groups (infants, 1-3 years, 3-18 years), and confidence levels.
- The survey instrument was adapted from a previously validated questionnaire used by the Society for Pediatric Radiology.
Main Results:
- The Greulich and Pyle (GP) method was the most frequently used technique across all age groups: 87.5% for infants, 85.7% for 1-3 years, and 83.7% for >3 years.
- The Gilsanz-Ratib hand bone age method and the Hoerr, Pyle, Francis atlas were used by a smaller percentage of respondents.
- Confidence levels varied, with only 26.4% of radiologists reporting high confidence for infants, increasing to 38.1% for 1-3 years and 48.6% for >3 years.
Conclusions:
- The Greulich and Pyle method remains the dominant bone age assessment technique in Pakistan for all pediatric age categories.
- There is a significant gap in radiologist confidence regarding bone age assessment in infants and young children using current methods.
- Development of clear guidelines and indigenous bone age standards for Pakistani children is recommended to enhance accuracy, particularly in younger age groups.
Abstract:
Objective To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to determine skeletal age in three defined age groups: less than one year, one to three years and three to 18 years. We also assessed the perceived confidence in skeletal age assessments made by respondents using their chosen bone age assessment technique, within each defined age group. Materials and methods A cross-sectional survey was conducted among 147 practicing radiologists in Pakistan. A pre-validated survey form was adopted from a similar study conducted amongst members of the Society for Pediatric Radiology. The survey collected demographic information, choice of bone age assessment technique in each age group and confidence of bone age assessments in each age group. Results The hand-wrist method of Greulich and Pyle was used by 87.5% of respondents when assessing bone age in infants (less than one year), followed by Gilsanz-Ratib hand bone age method (7.3%). In children aged one to three years, Greulich and Pyle method was chosen by 85.7% of respondents, followed by Gilsanz-Ratib hand bone age method (6.1%) and the Hoerr, Pyle, Francis' Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.1%). In children, older than three years, the Greulich and Pyle technique was used by 83.7% of respondents. This was followed by Gilsanz-Ratib hand bone age method (5.8%) and the Hoerr, Pyle, Francis' Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.8%). 26.4% were "very confident" in bone age assessments conducted among infants. In children aged one to three years, 38.1% were "very confident". In children, greater than three years, 48.6% were "very confident" in their chosen technique. Conclusion Greulich and Pyle is the dominant method for bone age assessments in all age groups, however, confidence in its application among infants and young children is low. It is recommended that clear recommendations be developed for bone age assessments in this age group alongside incorporation of indigenous standards of bone age assessments based on a representative sample of healthy native children.
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