This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.The project aim of this study is to investigate the value of ultrasound for assessment of bone age and bone mineralization in children. Existing tools for these purposes are based on x-rays for bone age and dexa and CT for bone mineralization. Especially for the latter, radiation exposure is a concern. This issue is further complicated by the fact that in tertiary centers managing vulnerable populations, individuals may undergo large volumes of radiological procedures involving x-rays. Facilities for x-ray examinations for these indications are usually not portable. There is a need in pediatric populations for non-invasive, easily accessible modes of investigations without risk. Ultrasound can fulfill this role in the case of bone age and bone mineral density if it was shown to be reliable, accurate and comparable to existing gold standards. For bone age, the standards are an x-ray of the hand and wrist and bone mineralization, bone densiometry with dexa (dual energy x-ray absorptiometry) is standard. For this study, we will recruit patients who have had bone age assessments as part of their clinic assessment (also individuals who have had tanner staging). Note that there are a number of secondary objectives in this study to investigate controversies within the existing standards. For instance the relationship between ultrasound and x-ray of phalanges versus carpels for estimating bone age. Ultrasound of radii and phalanges in comparison to lumber spine versus total body versus regional changes in dexa for bone mineralization. These variables will be examined within subgroups which will include children with growth delay, short stature, small for gestational age, prematurity and hematopoietic stem cell transplantation. In this study children on growth hormone will be recruited a second time at approximately one year from the initial assessment to examine the effects of treatment.
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