Mimicking the radiologists' workflow: Estimating pediatric hand bone age with stacked deep neural networks

Pediatric endocrinologists regularly order radiographs of the left hand to estimate the degree of bone maturation in order to assess their patients for advanced or delayed growth, physical development, and to monitor consecutive therapeutic measures. The reading of such images is a labor-intensive task that requires a lot of experience and is normally performed by highly trained experts like pediatric radiologists. In this paper we build an automated system for pediatric bone age estimation that mimics and accelerates the workflow of the radiologist without breaking it. The complete system is based on two neural network based models: on the one hand a detector network, which identifies the ossification areas, on the other hand gender and region specific regression networks, which estimate the bone age from the detected areas. With a small annotated dataset an ossification area detection network can be trained, which is stable enough to work as part of a multi-stage approach. Furthermore, our system achieves competitive results on the RSNA Pediatric Bone Age Challenge test set with an average error of 4.56 months. In contrast to other approaches, especially purely encoder-based architectures, our two-stage approach provides self-explanatory results. By detecting and evaluating the individual ossification areas, thus simulating the workflow of the Tanner-Whitehouse procedure, the results are interpretable for a radiologist.