A paediatric bone index derived by automated radiogrammetry

Osteoporos Int. 2010 Aug;21(8):1391-400. doi: 10.1007/s00198-009-1085-9. Epub 2009 Nov 24.


Summary: Hand radiographs are obtained routinely to determine bone age of children. This paper presents a method that determines a Paediatric Bone Index automatically from such radiographs. The Paediatric Bone Index is designed to have minimal relative standard deviation (7.5%), and the precision is determined to be 1.42%.

Introduction: We present a computerised method to determine bone mass of children based on hand radiographs, including a reference database for normal Caucasian children.

Methods: Normal Danish subjects (1,867), of ages 7-17, and 531 normal Dutch subjects of ages 5-19 were included. Historically, three different indices of bone mass have been used in radiogrammetry all based on A = piTW(1 - T/W), where T is the cortical thickness and W the bone width. The indices are the metacarpal index A/W(2), DXR-BMD = A/W, and Exton-Smith's index A/(WL), where L is the length of the bone. These indices are compared with new indices of the form A/(W(a) L(b)), and it is argued that the preferred index has minimal SD relative to the mean value at each bone age and sex. Finally, longitudinal series of X-rays of 20 Japanese children are used to derive the precision of the measurements.

Results: The preferred index is A/(W(1.33) L(0.33)), which is named the Paediatric Bone Index, PBI. It has mean relative SD 7.5% and precision 1.42%.

Conclusions: As part of the BoneXpert method for automated bone age determination, our method facilitates retrospective research studies involving validation of the proposed index against fracture incidence and adult bone mineral density.

MeSH terms

  • Adolescent
  • Age Determination by Skeleton / methods
  • Aging / physiology
  • Algorithms
  • Bone Density / physiology*
  • Child
  • Child, Preschool
  • Databases, Factual
  • Female
  • Hand Bones / diagnostic imaging
  • Hand Bones / physiology*
  • Humans
  • Male
  • Radiographic Image Interpretation, Computer-Assisted / methods*
  • Reference Values
  • Young Adult