• The Journal of Pediatrics of Korean Medicine
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• v.22 no.2
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• pp.69-80
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• 2008

Objectives : The purpose of this study was to evaluate the correlation of 3 methods of bone age measurements. Methods : 102 children(49 boys, 53 girls) were involved in this study. We measured the height, weight and bone age based when they visited for the first time. We measured bone age using BoneAge of Sunlight Co.,Ltd. Two of the bone age measurement methods, Greulich-Pyle and Tanner-Whitehouse, were used to analyze the left dorsopalmar hand-wrist radiographs of 102 children who visited in Department of Pediatrics, O O University Oriental Hospital. This study was designed to investigate the correlation of the bone age between two methods. Results : The bone ages were related with age, height, weight and BMI according to this study(P<0.01). Each bone age assessment method had statistically significant correlation to each other(P<0.01). Conclusions : The ultrasound transonic velocity of inferior radiocarpal joint will become a sufficient diagnostic tool of bone age assessment if measurement error can be minimized by proper effort.

• Korean Journal of Radiology
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• v.22 no.12
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• pp.2017-2025
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• 2021

Objective: To evaluate the accuracy and clinical efficacy of a hybrid Greulich-Pyle (GP) and modified Tanner-Whitehouse (TW) artificial intelligence (AI) model for bone age assessment. Materials and Methods: A deep learning-based model was trained on an open dataset of multiple ethnicities. A total of 102 hand radiographs (51 male and 51 female; mean age ± standard deviation = 10.95 ± 2.37 years) from a single institution were selected for external validation. Three human experts performed bone age assessments based on the GP atlas to develop a reference standard. Two study radiologists performed bone age assessments with and without AI model assistance in two separate sessions, for which the reading time was recorded. The performance of the AI software was assessed by comparing the mean absolute difference between the AI-calculated bone age and the reference standard. The reading time was compared between reading with and without AI using a paired t test. Furthermore, the reliability between the two study radiologists' bone age assessments was assessed using intraclass correlation coefficients (ICCs), and the results were compared between reading with and without AI. Results: The bone ages assessed by the experts and the AI model were not significantly different (11.39 ± 2.74 years and 11.35 ± 2.76 years, respectively, p = 0.31). The mean absolute difference was 0.39 years (95% confidence interval, 0.33-0.45 years) between the automated AI assessment and the reference standard. The mean reading time of the two study radiologists was reduced from 54.29 to 35.37 seconds with AI model assistance (p < 0.001). The ICC of the two study radiologists slightly increased with AI model assistance (from 0.945 to 0.990). Conclusion: The proposed AI model was accurate for assessing bone age. Furthermore, this model appeared to enhance the clinical efficacy by reducing the reading time and improving the inter-observer reliability.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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• 2015.05a
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• pp.391-394
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• 2015

They evaluate the bone age using the GP-BP (Greulich-Pyle and Bayley-Pinneau) and TW3 (Tanner-Whitehouse 3) in clinical. The skeletal maturity in Hand AP is evaluated by clinical experience of physicians and this is qualitative evaluation not same in every physicians. In order to devise and evaluate new methods not using TW3 method in this situation. The study was conducted with 70 (Male 35, Female 35) children who visited Yangsan P Hospital from March 2014 to March 2015. The study measured the length of growth plate and distal proximal phalanx and conducted regression analysis for statistical significance test of bone age length difference. The study found average and standard deviation corresponding to certain ranges each bone age. The more bone age increase, the more the length of growth plate and distal proximal phalanx decreased. The girls have less average rather than the boys because bone grows fast. The girls have first period age of 12 to 14, it appears length variation significantly. The study conducted regression analysis and this has statistical significance.

• The Journal of Pediatrics of Korean Medicine
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• v.37 no.3
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• pp.111-120
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• 2023

Objectives The purpose of this study is to analyze the characteristic of the 157 pediatric patients who visited a Korean medical hospital for bone age (BA) measurement and to compare the BA measurement using Tanner-Whitehouse 3-based analysis software and specialists in pediatric Korean medicine to determine the relationships. Methods The study included 157 pediatric patients who visited a Korean medicine hospital for BA measurements from June 2021 to June 2023. They were analyzed to determine the characteristics and agreement of BA measurements using Tanner-Whitehouse 3-based analysis software and specialists using classification by age, intraclass correlation coefficient (ICC), and Bland-Altman plots. Results In total, 61.8% of the study population were boys and 38.2%, girls, with an average age of 11.32 ± 1.87. The types of growth were various, and the average of bone maturity was 0.48 ± 1.13 as concluded by analysis software and 0.38 ± 1.15 as concluded by the specialists. The ICC of two methods were excellent: 0.995 (overall), 0.996 (boys) and 0.994 (girls). However, BA determined by analysis software tended to be higher than that determined by specialists when the patients were young. Conclusions This study showed that patients visited the hospital for BA measurement regardless of their height, and the agreement of BA between the two methods can be used as a reference. However, there was differences in the trends between age and sex, which should be interpreted with caution.

• Clinical and Experimental Pediatrics
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• v.52 no.3
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• pp.351-355
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• 2009

Purpose : This study compared bone ages measured by the Greulich-Pyle (GP) and Tanner-Whitehouse 3 (TW3) methods and investigated the differences in predicted adult heights measured by Bayley-Pinneau (BP) and TW3 methods. Methods : Bone ages were assessed from left-wrist radiographs by two investigators, one for each GP and TW3 methods in 85 normal children, 30 precocious puberty girls, and 30 constitutional growth delay boys. The differences between the measured predicted adult heights using the BP and TW3 methods were compared in each group. Results : The bone age measured by the TW3 method was less than that by the GP method in normal children. The predicted adult heights measured by the two methods showed no significant difference in normal boys, while the predicted adult height measured by the TW3 method was higher than that by the BP method for normal girls ($156.4{\pm}4.7$ cm vs. $158.9{\pm}3.8$ cm, P<0.01) and for precocious puberty girls ($156.3{\pm}4.0$ cm vs. $159.3{\pm}4.2$ cm, P<0.01). In contrast, the predicted adult height was higher from the BP method than from the TW3 method in constitutional growth delay boys ($173.3{\pm}4.4$ cm vs. $169.7{\pm}3.2$ cm, P<0.01). Conclusion : There were significant differences in predicted adult heights between the BP and TW3 method in normal girls, precocious puberty girls, or constitutional growth delay boys. In precocious puberty and constitutional growth delay, the BP method might be preferred to predict adult height, but further studies on final adult height are needed.

• The korean journal of orthodontics
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• v.49 no.5
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• pp.319-325
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• 2019

Objective: To evaluate differences in skeletal maturity in relation to vertical facial types and to compare differences in the skeletal maturity of the cervical vertebrae and hand-wrist in females. Methods: This study included 59 females aged 7 to 9 years with skeletal Class I malocclusion. The participants were categorized into three groups (low, normal, and high) according to the mandibular plane angle. Skeletal maturity was measured using skeletal maturity indicators (SMIs) and the Tanner-Whitehouse III (TW3) method on hand-wrist radiographs and by using cervical vertebrae maturation indicators (CVMIs) on lateral cephalometric radiographs. Results: The SMI was higher in the high-angle group than in the low-angle group (p = 0.014). The median TW3 bone age was 11.4 months higher in the high-angle group than in the low-angle group (p = 0.032). There was no significant difference in CVMI among the three groups. Skeletal maturity showed a weakly positive correlation with the mandibular plane angle (SMI, r = 0.391; TW3, r = 0.333; CVMI, r = 0.259). Conclusions: The skeletal maturity of the hand-wrist in females with a high mandibular plane angle was higher than that in females with a low mandibular plane angle. Obtaining additional hand-wrist radiographs may facilitate evaluation of skeletal maturity of females. In females with a high mandibular angle, the time to commence orthodontic treatment may be earlier than that in females with a low mandibular angle.

• The Journal of Pediatrics of Korean Medicine
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• v.37 no.2
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• pp.1-11
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• 2023

Objectives We aimed to compare the bone age (BA) estimation by a deep learning-based program and by a specialist in pediatrics of Korean medicine using the Tanner-Whitehouse 3 (TW3) technique for the cases of children who visited a Korean medicine hospital for growth, and to report the effect of Korean medicine treatment. Methods For three children who visited the Korean medicine hospital for growth, BA estimation by the deep learning program and by the specialist in pediatrics of Korean medicine using the TW3 technique was compared, and the time required for estimation was investigated. The change of height, BA, and predicted adult height (PAH) using deep learning program after Korean medicine treatment was observed. Results BA estimation of the left hand bone X-ray by the specialist using the TW3 technique showed a difference of -0.03 to +0.15 years from the estimation by the deep learning program. The mean estimation time was 5 minutes and 49 seconds per one for the specialist and 48 seconds for the deep learning program. During the treatment period, the height percentile and PAH estimated by deep learning program were increased after Korean medicine treatment compared to baseline while acceleration of BA was suppressed compared to chronological age. Conclusions BA estimation using the deep learning program and the TW3 technique showed a difference of less than 0.15 years, and in three cases of patients with growth as the chief complaint, Korean medicine treatment increased height percentile and PAH without accelerating BA maturation.

• Journal of the Korean Applied Science and Technology
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• v.38 no.1
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• pp.318-331
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• 2021

This study was conducted on the assumption that bone age would be more effective when it comes to physique and physical fitness assessment for adolescents, and the purpose of this study was to identify the differences in physique and physical fitness for students in their adolescence through bone age and chronological age in order to contribute to the well-balanced physique and physical fitness development in adolescents and the health improvement in students. Total 874 adolescents(483 males, 391 females) aged 11~16 were selected as subjects out of the total population of 1100 adolescents aged 6~16 based on the PAPS(Physical Activity Promotion System) and age standards of the TW3 method; and skeletal maturation, which symbolize the indicators of biological maturation, were evaluated by using the TW3(Tanner-Whitehouse 3) method after hand-wrist radiographs, and birth date was used for chronological age. A stadiometer and InBody 270 (Biospace, Korea) were used to measure 2 components in physique. A total of 7 components in physical fitness, which included muscular strength, muscular endurance, flexibility, power, cardiovascular endurance, balance, agility, were measured as well. A independent samples t-test was conducted for data processing using SPSS 25.0, and the significance level was set at p< .05. The study results are as follows. First, bone age and chronological age used for physique comparison in males aged 11 and 12, height and weight showed significant difference; in males aged 13, weight showed signicant difference. Weight and height in females aged 11, and height in females aged 12 showed significant difference. Second, bone age and chronological age used for physical fitness comparison in males aged 11, muscular strength, power, flexibility, cardiovascular endurance showed significant difference; in males aged 12, muscular strength. power, cardiovascular endurance; in males aged 13, flexibility showed significant difference. Muscular strength, power, flexibility, muscular endurance, cardiovascular endurance in females aged 11, and flexibility in females aged 14 showed significant difference. As a result, this study concluded that in a period of rapid skeletal growth, evaluating physique and physical fitness based on bone age is more accurate than evaluating based on chronological age.

• Imaging Science in Dentistry
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• v.50 no.3
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• pp.237-243
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• 2020

Purpose: The aim of this study was to evaluate the clinical efficacy of a Tanner-Whitehouse 3 (TW3)-based fully automated bone age assessment system on hand-wrist radiographs of Korean children and adolescents. Materials and Methods: Hand-wrist radiographs of 80 subjects (40 boys and 40 girls, 7-15 years of age) were collected. The clinical efficacy was evaluated by comparing the bone ages that were determined using the system with those from the reference standard produced by 2 oral and maxillofacial radiologists. Comparisons were conducted using the paired t-test and simple regression analysis. Results: The bone ages estimated with this bone age assessment system were not significantly different from those obtained with the reference standard (P>0.05) and satisfied the equivalence criterion of 0.6 years within the 95% confidence interval (-0.07 to 0.22), demonstrating excellent performance of the system. Similarly, in the comparisons of gender subgroups, no significant difference in bone age between the values produced by the system and the reference standard was observed (P>0.05 for both boys and girls). The determination coefficients obtained via regression analysis were 0.962, 0.945, and 0.952 for boys, girls, and overall, respectively (P=0.000); hence, the radiologist-determined bone ages and the system-determined bone ages were strongly correlated. Conclusion: This TW3-based system can be effectively used for bone age assessment based on hand-wrist radiographs of Korean children and adolescents.

• Clinical and Experimental Pediatrics
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• v.46 no.8
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• pp.751-757
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• 2003

Purpose : Obesity is a significant health problem with medical and psychological consequences for children and adolescents. The purpose of this study was to assess the correlation between body fat percent using bioelectrical impedance(BI) and other variable methods. Methods : We measured height, weight, body mass index(BMI) and body fat percent by skinfold thickness(ST) and BI in 1,035(496 male; 539 female) children from seven to 18 years of age. The correlation coefficients between BI and each of the other different methods were obtained. The sensitivity and specificity to predict obesity by these several methods were studied. Results : Fat percent estimated by BI analysis and BMI showed a strong correlation(r=0.749). Fat percent estimated by BI analysis and ST showed a very strong correlation(r=0.835). At the 95th percentile cut-off point for BI, ST showed a sensitivity of 57.7%, and a specificity of 97.6% for estimating body fat. At the 95th percentile cut-off point for BI, BMI showed a sensitivity of 84.9%, and a specificity of 99.3% for estimating body fat. Conclusion : The fat percent estimated by BI analysis correlated strongly with ST or BMI. BI analysis is an objective and accurate method for estimating body fat in childhood obesity.