Clin Immunol. Pediatr Res. 110. doi: 10.1002/ajpa.1330180309, 81. [1][14][23], The bones in the hand a wrist in a newborn do not change much in the first year of life. This content is owned by the AAFP. (1975) 64:8538. The height age (HA) refers to the CA at which a child's height would be at the 50th percentile for age and sex. Bone age represents a common index utilized in pediatric radiology and endocrinology departments worldwide for the definition of skeletal maturity for medical and non-medical purpose. Children with this condition are born appropriate for gestational age, but will then fall to the 3rd percentile for height during catch-down growth. Multiple regression equations for predicting the adult height of boys and girls from height and bone age at ages 4 and upwards are presented. (2015) 7:1827. A fuller description of the use of bone age films from the University of Utrecht. (2014) 164:8016. Poulton AS, Bui Q, Melzer E, Evans R. Stimulant medication effects on growth and bone age in children with attention-deficit/hyperactivity disorder: a prospective cohort study. J Forensic Leg Med. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). They look darker on the image. Puberty usually occurs early, leading to a near-normal height.19, Obese children are tall for their age.19 However, these children often have an early onset of puberty and therefore a near-normal final height.20, Intervention is usually not needed in children with tall stature. doi: 10.1111/j.1365-2605.2005.00575.x, 17. A bone age study helps doctors estimate the maturity of a child's skeletal system. Bone age should be compared with chronologic age to help narrow the differential diagnosis of short or tall stature. First the capitate forms at an average age of 2 months, followed shortly by the hamate, then the triquetrum around 14 months, and so on.[44]. Several smartphone applications have been developed to facilitate the use of vertebral methods such as Easy Age. Pediatr Radiol. Available online at: http://www.unhcr.org/publications/legal/3d4f91cf4/guidelines-policies-procedures-dealing-unaccompanied-children-seeking-asylum.html. Nemours Kids Health. Bone age for chronological age determination - statement of the European Society of Paediatric Radiology musculoskeletal task force group Bone age for chronological age determination - statement of the European Society of Paediatric Radiology musculoskeletal task force group Authors Numerous scales have been produced that can convert bone maturity score into bone age for different European and non-European populations (7, 114119). Recent studies show that organs like the liver can also be used to estimate age and sex, because of the unique feature of liver. Bone age is the degree of a person's skeletal development. N Engl J Med. X-rays are commonly done in doctors offices, radiology departments, imaging centers, and dentists offices. Using an atlas-based method gives a great possibility of intra- and interoperator variability, so in the last 20 years, new methods have been studied such as computerized automatic systems. doi: 10.1001/jamapediatrics.2015.3526, 59. Soegiharto BM, Cunningham SJ, Moles DR. Skeletal maturation in Indonesian and white children assessed with hand-wrist and cervical vertebrae methods. (127) started a computerization project of reading using phalanxes length compared to atlas. /content/kidshealth/misc/medicalcodes/parents/articles/xray-bone-age, diseases that affect the levels of growth hormones, such as growth hormone deficiency, hypothyroidism, precocious puberty, and adrenal gland disorders, orthopedic or orthodontic problems in which the timing and type of treatment (surgery, bracing, etc.) Bones and growth plates change over time. This method is very simple and fast, needing roughly 1.4 min for the evaluation (10, 107), thus explaining why it is preferred by 76% of pediatric endocrinologists and radiologists (10). Buckwalter JA, Einhorn TA, Simon SR. Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System. Int J Androl. This process is characterized by a predictable sequence of development and progression of ossification centers. A difference between a child's bone age and their chronological age might indicate a growth problem. We present three pre-pubertal female children with a diagnosis of NC-CAH treated with anastrozole monotherapy after presenting with advanced bone age, early adrenarche, no signs of genital virilization, and normal peak cortisol in response to ACTH stimulation. Pinchi V, De Luca F, Ricciardi F, Focardi M, Piredda V, Mazzeo E, et al. Tanner JM. Oxford University Press (2011). The growth hormone insulin-like growth factor 1 axis in children and adolescents with inflammatory bowel disease and growth retardation. After this period, growth velocity will be normal and bone age delayed.22 Children with this condition have delayed onset of puberty, resulting in a normal adult height. doi: 10.1080/03014469700004982, 120. Assessment of bone age is also important for the correct diagnosis, particularly with the aim of detecting the causes of bone age alteration including mainly endocrine and nutritional causes and chronic nonendocrine disorders and syndromes. doi: 10.1210/jc.82.5.1603, 86. Stature and skeletal maturation of two cohorts of Australian children and young adults over the past two decades. Length should be measured using a horizontal rule in children younger than two years, and height should be measured using a wall-mounted stadiometer in children older than two years. Office of the United Nations High Commissioner for Refugees. (2003) 23:2942. Cox LA. This method has the advantage of eliminating the need for additional radiographic exposure in cases where the vertebrae have already been recorded on a lateral cephalometric radiographic. Common causes of tall stature include familial tall stature, obesity, Klinefelter syndrome, Marfan syndrome, and precocious puberty. doi: 10.1016/B978-0-323-04883-5.50052-0, 43. http://www.who.int/childgrowth/standards/en/. The Local. This software is validated for different ethnic groups and for children with different endocrine disorders (132134). Roche AF, Rohmann CG, French NY, Davila GH. Softer body tissues, such as the skin and muscles, allow the X-ray beams to pass through them. 42. However, there are several caveats to the diagnosis of constitutional delay of growth. Issues and advances in adolescent growth and development. Sopher AB, Jean AM, Zwany SK, Winston DM, Pomeranz CB, Bell JJ, et al. In particular, subjects with severe hypothyroidism may have a delayed bone age. The diagnosis can be made by a decreased insulinlike growth factor 1 or insulinlike growth factor binding protein 3, followed by negative growth hormone provocation test results.23, Small for Gestational Age. Obesity (Silver Spring). Factors influencing skeletal maturation at diagnosis of paediatric Cushing's disease. 109. (2009) 33:10914. This information, associated to the characterization of the shape and changes of bone components configuration, represent an important factor of the biological maturation process of a subject. This determination is based on the presence of particular centers of bone formation as well as the dimension and structure of the bones (3, 58). (1988) 77:15460. Forensic Sci Int. Projected height can be estimated by projecting the current growth curve to adulthood in children with normal bone age, or by using a bone age atlas in those with delayed bone age.. I NTRODUCTION. Prepubertal gynecomastia linked to lavender and tea tree oils. Forensic Sci Int. medicolegal cases). The bone age is often marginally advanced with premature adrenarche, when a child is overweight from a young age or when a child has lipodystrophy. Acta Paediatr Scand. Children do not mature at exactly the same time. The TannerWhitehouse method was developed in 1,930 using data obtained in European children (3, 113). doi: 10.1056/NEJM199409083311002, 24. Means and standard deviations of weight, height, chronological age, SA, P-TW3 and P-KR were determined by group 1 and 2 (model and validation groups) and by sex, for all 497 (group 1 = 252; group . J Forensic Sci. doi: 10.1016/S0022-3476(97)90000-7, 8. Then the remaining centers appear, including Triquetrum at 2 years in females and 3 years in males, Lunate at 3 years in females and 4 years in males, Trapezium at 3 years in females and 4 years in males, Trapezoid at 4 years in females and 6 years in males, Scaphoid at 4 years in females and 6 years in males, Pisiform at 9 years in females and 12 years in males [77]. doi: 10.1088/0952-4746/23/1/302, 88. [39] Liver weight increases with age and is different between males and females. Patel PS, Chaudhary AR, Dudhia BB, Bhatia PV, Soni NC, Jani YV. (1996) 167:13958. Look for a Mllerian anomaly as well. Skeletal age of individuals with Down syndrome. doi: 10.1159/000329372, 11. doi: 10.1136/adc.65.10.1109, 14. The Pediatric Endocrine Society website was searched for consensus statements and clinical guidelines. 114. Zafar AM, Nadeem N, Husen Y, Ahmad MN. doi: 10.1007/978-1-4419-1795-9_176, 124. doi: 10.1111/jog.12181, 18. doi: 10.1159/000023352, 115. Between six and 18 months of age, children exhibit catch-up or catch-down growth until they reach their genetically determined growth curve based on midparental height. J Clin Endocrinol Metab. 3rd ed. doi: 10.1007/s00247-019-04435-z. Chronological age and bone age were 8.7 4.0 and 8.8 4.3 years, respectively, for the entire population. The issue here is the size of the standard deviation (SD) of the difference between bone age and chronological age, which is 15 months or more. Anink J, Nusman CM, van Suijlekom-Smit LW, van Rijn RR, Maas M, van Rossum MA. 102. Am J Hum Biol. Loder RT, Estle DT, Morrison K, Eggleston D, Fish DN, Greenfield ML, et al. By evaluating the data obtained from bone age in the clinical setting, it is possible to distinguish three main groups of subjects: patients with delayed bone age, patients with bone age appropriate to chronological age, and patients with advanced bone age (3, 810). [5] Other techniques for estimating bone age exist, including x-ray comparisons of the bones of the knee or elbow to a reference atlas and magnetic resonance imaging approaches. J Clin Endocrinol Metab. Data described in the TW3 method show a progression of bone age typically between 10 and 12 years compared to that reported in the TW2 method; in particular, TW3 estimates of bone age are younger than TW2 especially in children with idiopathic short stature and constitutional delay in growth and puberty. Tanner JM HM, Goldstein H, Cameron N. Assessment of Skeletal Maturity and Prediction of Adult Height (TW3 Method). They can be seen on an X-ray because they're softer and contain less mineral, making them appear darker on an X-ray image than the rest of the bone. However, bone age itself cannot be considered the only absolute and incontrovertible datum to define the chronological age (6879); therefore, limits and accuracy of this examination in predicting chronological age, especially in relation to different ethnic groups and underlying diseases, need to be considered. Hand and wrist X-rays are considered as an important indicator of children's biological age. X-ray exam: bone age study. (1997). Physical examination may reveal microphallus or midline craniofacial abnormalities. Assessment of the carpals, metacarpals, and phalanges are used to find the closest match in the atlas; the chronological age of the patient in the atlas becomes the bone age assigned to the patient under review. [41] The cells of the mesenchyme can become bone by one of two primary methods: (1) intramembranous ossification where mesenchymal cells differentiate directly into bone or (2) endochondral ossification where mesenchymal cells become a cartilaginous model of chondrocytes which then become bone. Bone age assessments can provide pediatricians with a rough estimate of when a child will enter puberty, Kutney stated. Acta Paediatr Scand. The long-term effects of protein energy malnutrition in early childhood on bone age, bone cortical thickness and height. Bone age may be affected by several factors, including gender, nutrition, as well as metabolic, genetic, and social factors and either acute or chronic diseases, including endocrine dysfunction (39). 1988, $57.50. Philadelphia, PA: Mosby (2008). 113. Eur J Pediatr. doi: 10.1007/s00247-011-2302-1. The numbers of participants with data from each age are presented in Figure 1 and in a footnote to the Table. Comprehensive Pediatric Nephrology. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). (2017) 37:1925. It is administered through daily injections over several years. Manzoor Mughal A, Hassan N, Ahmed A. Not only hormones but also gender might affect this process. (2013) 19:615. Malina RM, Rogol AD, Cumming SP, Coelho e Silva MJ, Figueiredo AJ. Br J Radiol. (2010) 2010:298937. doi: 10.1186/1687-9856-2010-298937, 56. In adolescence, growth is affected by the onset of puberty, and sex hormones become the predominant factor in growth. Furthermore, the GP method has not been updated from its initial publication, representing important limits of applications especially in some ethnic groups such as African or Hispanic female subjects and in Asian and Hispanic male subjects during late infancy and adolescence (95, 96). Eur J Endocrinol. Particularly, in the TW3, the possibility to predict final height has been introduced. Int J Paediatr Dent. This may be inherited. (TW 2 method). Bone growth assessments can be useful when it comes to gauging growth rates, especially when it comes to understanding1: Pediatricians can look to a childs parents for some of this information, but more specialized assessments can help, particularly if there is a concern for any disorders or conditions that may affect growth, development, or bone health. doi: 10.1016/S0022-3476(52)80205-7, 138. [11][7] Alternative techniques for estimating bone age in infancy include tallying the number of ossification centers present in the left half of the infant's body requiring a hemiskeleton x-ray. When the bone age reaches 16 years in females and 18 years in males, growth in height is over, and they have reached their full adult height. They do this by taking a single X-ray of the left wrist, hand, and fingers. Hum Biol. doi: 10.3923/pjbs.2009.702.706. (2001) 50:6248. doi: 10.1056/NEJMoa064725, 62. 79. Arch Dis Child. doi: 10.1136/adc.2005.090134, 121. For this reason, in the TW3 method, skeletal age evaluation ends at 15 years in women and 16.5 years in men (while in the TW2 set, 18 and 19 years, respectively, with a bone maturity anticipation of 2.53 years) (120). [3][21], Images in the Greulich and Pyle atlas came from healthy white boys and girls enrolled in the Brush Foundation Study for Human Growth and Development between the years 1931 and 1942. This method has the advantage of being more reproducible, and it is not based on the subject age but on skeletal maturity of several bone elements and population-based references. doi: 10.1159/000184848, Keywords: skeletal development, height, X ray, children, bone age, Citation: Cavallo F, Mohn A, Chiarelli F and Giannini C (2021) Evaluation of Bone Age in Children: A Mini-Review. doi: 10.1097/00004032-199811000-00005, 87. Bone age delay is also associated with genetic syndromes such as trisomy 21, Turner syndrome, and RussellSilver syndrome (10, 4648). High-dose sex steroids have been used to promote growth plate closure, but use has decreased over the past 20 years because of adverse effects.28 Surgical destruction of the growth plates has also been performed, but this procedure is controversial. (1970) 108:5115. Khan K, Elayappen AS. doi: 10.1097/MPG.0b013e31818cb4b6, 32. This lack of precision impacts on the value of bone age as evidence . Horm Res. Das S, Ghosh R, Chowdhuri S. A novel approach to estimate age and sex from mri measurement of liver dimensions in an Indian (Bengali) Population A pilot study. Effect of training on replicability of assessments of skeletal maturity (Greulich-Pyle). (1993) 21:148. Similarly, an excessive intake of foods containing phytoestrogens such as soya, according to some studies, may have an effect on bone age progression (5663). TW2 and TW3 bone ages: time to change? Thus, the liver can be employed in special medico-legal cases of skeletal deformities or mutilation. [2] A paediatric radiologist specially trained in estimating bone age assesses the patient's x-ray for growth, shape, size, and other bone features. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics recommend using the World Health Organization (WHO) growth charts for children younger than two years and the CDC growth charts for children older than two years.5 The CDC growth charts are a population-based reference that include data from bottle-fed and breastfed infants. Moradi M, Sirous M, Morovatti P. The reliability of skeletal age determination in an Iranian sample using Greulich and Pyle method. doi: 10.1093/bmb/lds014. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Ahmed ML, Warner JT. Giovanni XXIII Children's Hospital, Italy, University of Modena and Reggio Emilia, Italy, Children's Hospital at Montefiore, United States. Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. doi: 10.1016/S0022-3476(78)81071-3, 139. [5][9] The first atlas published in 1898 by John Poland consisted of x-ray images of the left hand and wrist. (2014) 30:40911. The use of AI as a monotherapy for children with NC-CAH has never been reported. Pediatrics. Since then, more than 15 new computerized automatic systems have been developed (128, 129). Haffner D, Nissel R. Growth and puberty in chronic kidney disease. 2 SDs), a range of 5 years. TannerWhitehouse method is more complex and time consuming, requiring approximately 7.9 min if the TW2 (121) method is used. doi: 10.1542/peds.2009-3649, 140. Thodberg HH. (1952) 40:42341. Acta Radiol. They can be seen on an X-ray because they're softer and contain less mineral, making them appear darker on an X-ray image than the rest of the bone. Figure 2 is an algorithm for the evaluation of tall stature.19 Although the percentage of children with tall stature is equal to that of children with short stature, children with tall stature are much less likely to be referred to subspecialty care. Discrepancies between bone age and biological age can be seen in people with stunted growth, where bone age may be less than biological age. [1][6], Estimating the bone age of a living child is typically performed by comparing images of their bones to images of models of the average skeleton for a given age and sex acquired from healthy children and compiled in an atlas. A number of factors can help determine your body age. The bone age/chronological age ratio decreased significantly to 1.120.1 at the end of treatment (P<0.05). If a child has bone age 10 years, it means that the child maturation is as advanced as the average of the 10-year old children from Ohio in 1930-1940 that Greulich and Pyle studied. [7][8][16], The two most common techniques for estimating bone age are based on a posterior-anterior x-ray of a patient's left hand, fingers, and wrist. (1991) 10:61620. Guidelines on Policies and Procedures in Dealing With Unaccompanied Children Seeking Asylum. doi: 10.1590/S1806-83242005000300010, 36. Hjern A, Brendler-Lindqvist M, Norredam M. Age assessment of young asylum seekers. Cambridge. Two experienced readers first derived skeletal age estimates using the GP atlas. The BoneXpert method for automated determination of skeletal maturity. Recent data on pubertal milestones in United States children: the secular trend toward earlier development. It is defined by the age expressed in years that corresponds to the level of maturation of bones. Girls: 8 to 12 cm (3 to 5 in) Boys: 10 to 14 cm (4 to 6 in) However, in children with certain conditions (e.g., growth hormone deficiency), normal . Skeletal age estimation for forensic purposes: a comparison of GP, TW2 and TW3 methods on an Italian sample. (2007) 173:14653. (2003) 349:77688. Cushing's syndrome in children and adolescents. doi: 10.1111/j.1365-263X.2007.00892.x, 39. [24] Then, a radiologist counts the number of ossification centers present and uses a chart to convert the sum of ossification centers to a bone age. King DG, Steventon DM, O'Sullivan MP, Cook AM, Hornsby VP, Jefferson IG, et al. The image in the reference atlas that most closely resembles the patient's x-ray is then used to assign a bone age to the patient. Applicability of Greulich and Pyle skeletal age standards to Indian children. 2nd ed. [24] Since most of the ossification centers counted using this technique appear early in life, this method is only valid for measuring bone age up to around 5 years of age. Cambridge. In fact, the images obtained by hand and wrist X-ray reflect the maturity of different types of bones of the skeletal segment evaluated. Ann Hum Biol. (2007) 356:47985. Among them, the most used is based on the tables developed by Bayley and Pinneau in 1946 and revised in 1959. Contemporary Pediatrics sat down with one of our newest editorial advisory board members: Vivian P. Hernandez-Trujillo, MD, FAAP, FAAAAI, FACAAI to discuss what led to her career in medicine and what she thinks the future holds for pediatrics. BMJ Case Rep. (2015) 2015:bcr2015212216. chronological and bone age for each sex and age group, the equality of the mean for each age was compared (Student's t-test for paired (1990) 149:3147. As growth nears conclusion and attainment of adult height, bones begin to approach the size and shape of adult bones. 22. Degree of a person's skeletal development, Evaluation of the bones of the hand and wrist. Automatic determination of Greulich and Pyle bone age in healthy Dutch children. Over the years, many standardized methods have been developed to evaluate a skeletal maturity score for hand and wrist X-rays. In: Geary DF, Schaefer F, editors. Bone age (BA) is a measure of the development of the skeleton incorporating the size, shape and degree of mineralization of the epiphyses and physeal plates of a bone to define their proximity to full maturity [1].BA differs from chronological age (CA), which is calculated from the date of birth and does not necessarily reflect an individual's stage of puberty. Pediatr. (1982) 36:52736. GH treatment and its effect on bone mineral density, bone maturation and growth in short children born small for gestational age: 3-year results of a randomized, controlled GH trial. Horm Res. Front. (2014) 12:2005. (1989). Because of this, those who are short with an advanced bone age, need medical attention before their bones fully fuse. (1987) 14:35765. Images of hand and wrist x-rays in four female subjects compatible with physiological skeletal maturation in different ages: A (4 years), B (8 years), C (12 years), D (16 years). Bone health in children with inflammatory bowel disease: adjusting for bone age. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department or the U.S. Army Service at large. Cameron N. Can maturity indicators be used to estimate chronological age in children? doi: 10.1530/EJE-15-0608, 60. doi: 10.1002/mpo.2950210104, 40. are guided by the child's expected growth. Tall stature has the same prevalence as short stature, but it is a much less common reason for referral to subspecialty care. doi: 10.1016/j.gcb.2008.09.020, 30. In the table below, you can find a few other numbers for different ages. These different methods are characterized by a significant and variable intraindividual variability with values ranging from 0.96 to 0.74 years, which seems to be strongly affected by several factors including ethnicity, gender, and pubertal age (93105). Am J Orthod Dentofacial Orthop. Accessed November 22, 2021. https://kidshealth.org/en/parents/xray-bone-age.html, 2. Basel; Freiburg; Paris; London; New York, NY; New Delhi; Bangkok; Singapore; Tokyo; Sydney, NSW: Karger Publishers (2002) doi: 10.1159/isbn.978-3-318-00778-7. J Pediatr. (2000) 172:5536. If the image is blurred, the X-ray technician might take another one. doi: 10.1210/jc.2008-2474, 133. Puberty onset according to elbow occurred slightly earlier than expected. This system does not take into account the state of carpus bones maturation and allows a bone age assessment between 2.5 and 17 years and 2.0 and 15.0 years for male and female individuals, respectively. (1987) 79:7434. For the Fels method, the prediction of adult height is calculated with the RocheWainerThissen formula. This means a girl who falls into this category may grow along the 25th percentile in childhood but continue growing longer than other children due to delayed puberty and have a final height at the 50th percentile. Woods CP, Argese N, Chapman M, Boot C, Webster R, Dabhi V, et al. Furthermore, the image was digitized and transformed into a series of mathematical coefficients produced mostly from standard image of the left hand and wrist X-rays. Speiser PW, White PC. The evaluation of potential pathologic causes of short or tall stature should be guided by the history and physical examination findings.13, The first step in the evaluation of a child with suspected short or tall stature is to obtain accurate measurements and plot them on the appropriate growth chart. By contrast, subjects with hyperthyroidism may present precocious puberty associated with advanced bone age (18, 19). In addition, children with PA appeared to be affected by a BA . (2016) 31:939. J Pediatr Endocrinol. X-rays should be perpendicular to the rigid plane and usually be performed with a tube of 4560 kVp potential. Bone age is measured in years and assigned by a trained radiologist or endocrinologist by comparing the childs measurements with existing standards. [5][17] The reason for imaging only the left hand and wrist are that a hand is easily x-rayed with minimal radiation[18] and shows many bones in a single view. doi: 10.1002/1520-6300(200009/10)12:5<610::AID-AJHB5>3.0.CO;2-D. 82. Tanner J, Oshman D, Bahhage F, Healy M. Tanner-Whitehouse bone age reference values for North American children. doi: 10.1520/JFS2005020. There are extremes to be mindful of, Kutney added. [11], A drawback associated with the Greulich and Pyle method of assessing bone age is that it relies on x-ray imaging and therefore requires exposing the patient to ionizing radiation. (2010) 6:145. Zhang H, Geng N, Wang Y, Tian W, Xue F. Van Wyk and Grumbach syndrome: two case reports and review of the published work. Moreover, the score based on 20 bone segments was abolished, and the reference values and the graphs were modified and based on data obtained from native North American children. doi: 10.1016/S0022-3476(95)70347-0, 12. [24] This technique was created to avoid errors in estimating bone age though to arise from focusing on only one area of the body. Available online at: https://treaties.un.org/Pages/ViewDetails.aspx?src=IND&mtdsg_no=IV-1&chapter=4&clang=_en. doi: 10.1159/000184846, 130. van Rijn RR, Lequin MH, Thodberg HH. Every 6-12 months, height and bone age should be assessed. Thus, gender-specific images are compared with the one obtained by patients by evaluating first the nearest chronological age and subsequently the adjacent standards. This chart depicts bone age as compared with chronological age in boys. Therefore, while in the TW1 version, the score is derived from the evaluation of all the 20 bones selected, in the TW2 update, three different ways are distinguished: 20 bones score (as in TW1), RUS score (radius, ulna, and metacarpal bones and phalanx), and CARPAL, limited to carpus bones. (1998) 75:4929. Discrepancies between bone age and biological age can be seen in people with stunted growth, where bone age may be less than biological age. Br J Sports Med. (2015) 51:235. doi: 10.1111/jpc.12837, 61. Henley DV, Lipson N, Korach KS, Bloch CA. These images were performed in 355 male and 322 female children born between 1928 and 1974, from the first month of life up to the age of 22 years (124). [19] Further, most people are right-hand dominant and the left hand is therefore less likely to be deformed due to trauma. Although encouraging results have been shown, this method still requires improvements in terms of reproducibility and elimination of confounding factors (135, 136). US Immigration and Customs Enforcement, Office of Detention and Removal Operations, US Department of Homeland Security. Therefore, during the procedure, the standard that seems similar is initially chosen, and then, the examination of each bone segment in an ordered sequence is performed by assigning the corresponding bone age to the individual segments, according to the instructions contained in the atlas text.
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