Bone age assessment is a procedure frequently performed on pediatric patients to evaluate their growth. It is an important procedure in the diagnosis and management of endocrine disorders, diagnostic evaluation of metabolic and growth abnormalities, deceleration of maturation in a variety of syndromes, malformations, and bone dysplasias. It is also used for consultation in planning orthopedic procedures. A simple method for bone age assessment is atlas matching by a left-hand wrist radiograph against a small reference set of atlas patterns of normal standards developed by Greulich and Pyle in the 1950s. However, these reference radiographs do not reflect skeletal development in children and adolescents of today's European, African, Hispanic or Asian descent. Because racial diversity and racial mixing in the United States are increasing, reevaluation of the use of skeletal age standards when applied to children of diverse ethnicity is needed. This proposal is the second phase of a six-year continuing effort and intends to complete the development of a digital hand atlas with a large standard set of normal hand and wrist images of children of four diverse ethnic groups, and to implement a Web-based computer-aided diagnostic system for bone age assessment. The digital atlas, comprising a large set of 1,120 reference images and computer-extracted bone objects and quantitative features, removes the disadvantages of the currently out-of-date Greulich-Pyle atlas and allows the bone age assessment to be computerized. These images are collected from evenly distributed normal newborn to 18 years of age, male and female, European, African, Hispanic, and Asian descent. Quantitative features on a patient examined hand image are extracted on the Web server and then compared with patterns from the atlas database to assess the bone age.
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