Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Evaluation of a Computer-Aided Diagnosis System for Automated Bone Age Assessment in Comparison to the Greulich-Pyle Atlas Method

A Multireader Study

Booz, Christian, MD*; Wichmann, Julian L., MD*; Boettger, Sabine, MD*; Al Kamali, Ahmed, MD*; Martin, Simon S., MD*; Lenga, Lukas, MD*; Leithner, Doris, MD*; Albrecht, Moritz H., MD*; Ackermann, Hanns, MD; Vogl, Thomas J., MD*; Bodelle, Boris, MD*; Kaltenbach, Benjamin, MD*

Journal of Computer Assisted Tomography: January/February 2019 - Volume 43 - Issue 1 - p 39–45
doi: 10.1097/RCT.0000000000000786
Musculoskeletal Imaging

Objective The aim of this study was to investigate a novel version of a computer-aided diagnosis (CAD) system developed for automated bone age (BA) assessment in comparison to the Greulich and Pyle method, regarding its accuracy and the influence of carpal bones on BA assessment.

Methods Total BA, BA of the left distal radius, and BA of carpal bones in 305 patients were determined independently by 3 blinded radiologists and assessed by the CAD system. Pearson product-moment correlation, Bland-Altman plot, root-mean-square deviation, and further agreement analyses were computed.

Results Mean total BA and BA of the distal radius showed high correlation between both approaches (r = 0.985 and r = 0.963). There was significantly higher correlation between values of total BA and BA of the distal radius (r = 0.969) compared with values of total BA and BA of carpal bones (r = 0.923). The assessment of carpal bones showed significantly lower interreader agreement compared with measurements of the distal radius (κ = 0.79 vs κ = 0.98).

Conclusion A novel version of a CAD system enables highly accurate automated BA assessment. The assessment of carpal bones revealed lower precision and interreader agreement. Therefore, methods determining BA without analyzing carpal bones may be more precise and accurate.

From the *Department of Diagnostic and Interventional Radiology and

Institut für Biostatistik und Mathematische Modellierung, University Hospital Frankfurt, Frankfurt am Main, Germany.

Received for publication February 25, 2018; accepted May 14, 2018.

Correspondence to: Christian Booz, MD, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany (e-mail:

Disclosure: J.L.W. received speaker's fees from Siemens Healthcare and GE Healthcare. The other authors declare no conflict of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.