A comprehensive validation study of the latest version of BoneXpert on a large cohort of Caucasian children and adolescents

Klara Maratova; Dana Zemkova; Petr Sedlak; Marketa Pavlikova; Shenali Anne Amaratunga; Hana Krasnicanova; Ondrej Soucek; Zdenek Sumnik

doi:10.3389/fendo.2023.1130580

A comprehensive validation study of the latest version of BoneXpert on a large cohort of Caucasian children and adolescents

Front Endocrinol (Lausanne). 2023 Mar 24:14:1130580. doi: 10.3389/fendo.2023.1130580. eCollection 2023.

Authors

Klara Maratova¹, Dana Zemkova¹, Petr Sedlak², Marketa Pavlikova³, Shenali Anne Amaratunga¹, Hana Krasnicanova¹, Ondrej Soucek¹, Zdenek Sumnik¹

Affiliations

¹ Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.
² Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czechia.
³ Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physic, Charles University, Prague, Czechia.

Abstract

Introduction: Automated bone age assessment has recently become increasingly popular. The aim of this study was to assess the agreement between automated and manual evaluation of bone age using the method according to Tanner-Whitehouse (TW3) and Greulich-Pyle (GP).

Methods: We evaluated 1285 bone age scans from 1202 children (657 scans from 612 boys) by using both manual and automated (TW3 as well as GP) bone age assessment. BoneXpert software versions 2.4.5.1. (BX2) and 3.2.1. (BX3) (Visiana, Holte, Denmark) were compared with manual evaluation using root mean squared error (RMSE) analysis.

Results: RMSE for BX2 was 0.57 and 0.55 years in boys and 0.72 and 0.59 years in girls, respectively for TW3 and GP. For BX3, RMSE was 0.51 and 0.68 years in boys and 0.49 and 0.52 years in girls, respectively for TW3 and GP. Sex- and age-specific analysis for BX2 identified the largest differences between manual and automated TW3 evaluation in girls between 6-7, 12-13, 13-14 and 14-15 years, with RMSE 0.88, 0.81, 0.92 and 0.84 years, respectively. The BX3 version showed better agreement with manual TW3 evaluation (RMSE 0.64, 0.45, 0.46 and 0.57).

Conclusion: The latest version of the BoneXpert software provides improved and clinically sufficient agreement with manual bone age evaluation in children of both sexes compared to the previous version and may be used for routine bone age evaluation in non-selected cases in pediatric endocrinology care.

Keywords: BoneXpert; Greulich-Pyle; Tanner-Whitehouse; bone age; validation study.

Publication types

Validation Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Age Determination by Skeleton* / methods
Child
Female
Humans
Male
Software*
White People

Grants and funding

This study was supported by a grant from the Czech Ministry of Health (conceptual support project to research organization 00064203 - FN Motol).