BoneXpert (Visiana, Denmark) is a software that enables the automated assessment of bone age (BA) and Bone Health Index (BHI) using a child's hand X-ray. It also produces a standard deviation score for ΒΗΙ (BHI-SDS) relative to the scores for a healthy cohort of children of the same BA (Fig. 1). The purpose of this presentation is to describe the advantages, disadvantages and the difficulties encountered during its pilot application in a single center.

79 radiographs of the left hand were obtained from children with various indications, aged 3.3-15.3 years. The films were rated manually using Greulich and Pyle (GP) atlas by two different raters (an experienced and an inexperienced consultant radiologist) and also with BoneXpert (BGP). Accuracy, precision and bias of conventional methods of bone age evaluation compared with BoneXpert were investigated. Children with low BHI-SDS were further investigated with laboratory basic bone profile.

The hand X-rays from 49 girls (4.15-15.33 years old) and 30 boys (3.32-15.16 years old) were included in the study. BoneXpert couldn't analyze the hand X-ray from a girl with Rett’s syndrome due to severe finger contractions (Fig. 2). In another child, the BHI was not calculated because of a short fourth metacarpal bone (Fig. 3). The manual GP versus BoneXpert GP scores are statistically analyzed and presented (Fig. 4). No statistically significant difference was found between manual GP (experienced examiner) scores and BoneXpert GP...

BoneXpert may deliver a precise and standardised reading of bone age in daily clinical routine, unlike the conventional manual rating which is more burdensome and may be influenced by the evaluator‘s skills. The assessment of BHI is also a valuable tool for skeletal health evaluation, especially for toddlers, for which DXA reference data are scarce. However, in some children the extent of under- or overestimation of BA may be of clinical concern, therefore BoneXpert is no substitute for the radiologist’s full evaluation of bone abnormalities,...

Thodberg HH. Clinical review: An automated method for determination of bone age. J Clin Endocrinol Metab. 2009 Jul;94(7):2239-44. Thodberg HH, Sävendahl L. Validation and reference values of automated bone age determination for four ethnicities. Acad Radiol. 2010 Nov;17(11):1425-32. van Rijn RR, Thodberg HH. Bone age assessment: automated techniques coming of age? Acta Radiol. 2013 Nov;54(9):1024-9.

Glykeria Petrocheilou1, Konstantinos Tsilikas2, Aikaterini Andrianaki3, George Polyzois4, Spyridon Droulias1, Evaggelos Labiris1, Sotiria Stathopoulou2, Artemis Doulgeraki4 1Radiology Department, Spiliopouleio “Agia Eleni” Hospital,Athens, Greece 2Radiology Department, Penteli Children’s Hospital, Athens, Greece 3Radiologist Consultant, Private Practice, Heraklion, Greece 4Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece