Skeletal Development of the Hand and Wrist by Gaskin Cree M.; Kahn S. Lowell MD MBA; Bertozzi J. Christoper

Author:Gaskin, Cree M.; Kahn, S. Lowell, MD MBA; Bertozzi, J. Christoper
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2011-04-07T04:00:00+00:00

Bone Age Equations:

ESA = Estimated Bone Age or Estimated Skeletal Age

CA = Patient’s Chronological Age

ACA = Adjusted Chronological Age (see 2a. above)

SD = Standard Deviation

Basic technique:

Normal skeletal development: CA – (2 × SD) < ESA < CA + (2 × SD)

Advanced skeletal development: ESA > CA + (2 × SD)

Delayed skeletal development: ESA < CA – (2 × SD)

Modified (longer) technique (includes step 2a. above):

ACA = CA + Modifier (modifier can be positive or negative)

Modifier = Mean skeletal age of test population – Chronological age of test population (see Tables 1-4)

Normal skeletal development: ACA – (2 × SD) < ESA < ACA + (2 × SD)

Advanced skeletal development: ESA > ACA + (2 × SD)

Delayed skeletal development: ESA < ACA – (2 × SD)

5.) This entire process can be simplified and enhanced by using the Digital Bone Age Companion software by Oxford University Press, which is available separately or bundled with this book. The Digital Bone Age Companion is a freestanding Windows™ application which further optimizes the bone age interpretation process. Users can easily zoom in on subtle radiographic features, set image level and width to their preference, and compare two or three reference standards side-by-side for those difficult cases that superficially look like adjacent standards (no more flipping pages back-and-forth!). Users will also be thrilled to abandon tedious manual calculations for automated and more reliable digital results via the flexible bone age calculator. Trainees will be enabled to rapidly and reliably interpret bone age studies with little attending support. Attending physicians will find resident check-out to be more pleasant and accurate. All users can further expedite their workflow by utilizing the built-in report generator, obviating the need to transpose data and potentially avoiding dictation altogether.

6.) Bone age practice examples:

a. Using the basic technique, determine the overall status of skeletal maturity (normal vs. delayed vs. advanced) of a 14-year-old boy whose hand and wrist radiograph matches that of the 13-Year Male Standard. Use the male data from the Brush Foundation Study (Table 1) to look up the standard deviation for a 14-year-old boy, yielding 10.72 months. Two times the standard deviation equals 21.4 months. The normal range of skeletal age is chronological age +/- 2 standard deviations. For a 14-year-old male, this is 168 months +/- 21.4 months, yielding a range of normal for the skeletal age of 146.6 to 189.4 months. The Estimated Skeletal Age for this patient is the age of the chosen 13-Year Male Standard or 156 months. Since the Estimated Skeletal Age (156 months) of the patient falls in the range of normal (146.6 to 189.4 months) for his chronological age, he is considered to have “normal skeletal development” and this is his bone age result.

b. Using the basic technique, determine the overall status of skeletal maturity of a 10-year and 9-month-old girl whose hand and wrist radiograph falls evenly between the 13-Year and 6-Month Female Standard and the 14-Year Female Standard. Her Estimated Skeletal Age is halfway between the two standards (13 years and 9 months or 165 months).

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