title: Bone age assessment practices in infants and older children among Society for Pediatric Radiology members.
abstract: BACKGROUND
  Numerous bone age estimation techniques exist, but little is known about what methods radiologists use in clinical practice.
  
  
  OBJECTIVE
  To determine which methods pediatric radiologists use to assess bone age in children, and their confidence in these methods.
  
  
  METHODS
  Society for Pediatric Radiology (SPR) members were invited to complete an online survey regarding bone age assessment. Respondents were asked to identify the methods used and their confidence with their technique for the following groups: Infants (<1 year old), 1- to 3-year-olds and 3- to 18-year-olds.
  
  
  RESULTS
  Of the 937 SPR members invited, 441 responded (47%). For infants, 70% of respondents use the hand/wrist method of Greulich and Pyle, 27% use a hemiskeleton method (e.g., Sontag or Elgenmark), and 14.4% use the knee method of Pyle and Hoerr. Of these respondents, 34% were not confident with their technique. For 1- to 3-year-olds, 86% used Greulich and Pyle, and 19% used a hemiskeleton method; 21% were not confident with their technique in this age group. For 3- to 18-year-olds, 97% used Greulich and Pyle, and only 6% of respondents were not confident with their technique in this category. A logistic regression analysis demonstrated that the chronological age of the patient had the greatest impact on reader confidence, with the odds ratios for confidence being 4 times greater in the 3- to 18-year-olds category compared to the younger groups.
  
  
  CONCLUSIONS
  For children older than 3 years, the majority of pediatric radiologists are very confident in their use of Greulich and Pyle for bone age assessment. However a variety of methodologies are used when assessing bone age in infants and younger children, and pediatric radiologists are less confident assessing bone age in these children. This survey highlights the need for a consensus protocol on bone age assessment of younger children and infants that provides readers with a higher degree of confidence.
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA. micheal.breen@childrens.harvard.edu.
authors.forename: Micheál A
authors.initials: MA
authors.lastname: Breen
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Tsai
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Stamm
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Kleinman
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical; D011795:Surveys and Questionnaires
keywords: Bone age; Children; Greulich and Pyle; Musculoskeletal; Radiography; Skeletal maturity