# Comparison of bone age assessment using manual Greulich and Pyle method versus automated BoneXpert method in South African children

## TL;DR

This study compares manual and automated methods for assessing bone age in South African children, finding the automated method highly correlated with manual assessments.

## Contribution

The study evaluates the BoneXpert automated method in a South African population and determines optimal weighting for composite bone age calculation.

## Key findings

- The interclass correlation between manual readers was over 0.9, indicating strong agreement.
- BoneXpert's composite bone age showed a 0.982 correlation with manual assessments.
- A 50% weighting of carpal and tubular bone ages in BoneXpert best aligns with manual results.

## Abstract

The Greulich and Pyle (GP) method is the most commonly used manual bone age assessment method but it is associated with interrater variability. The BoneXpert method is fully automated, eliminates interrater variability and has been validated for use in various populations.

To compare the manual GP method with the automated BoneXpert method in performing bone age assessment of children with various paediatric endocrinology diagnoses.

Three manual readers performed manual bone age assessment, and BoneXpert software performed automated bone age assessment on 260 left hand-wrist radiographs. Images where the average of three manual readers (Manual BA) deviated from BoneXpert BA by > 1.5 years, were re-read by an external reader, producing a Reference BA. Manual BA was compared to Carpal BA that was produced by the software. A composite bone age (Comp BA) for the software was defined to estimate the weighting on carpal and tubular bones to achieve the best agreement with Manual BA.

The interclass correlation (ICC) between each manual reader was > 0.9, indicating a high positive correlation. The ICC between Manual BA and BoneXpert BA was 0.982. The Comp BA for BoneXpert that would achieve the best fit with Manual BA, places a 50% weighting on Carpal BA and 50% weighting on Tubular BA.

The BoneXpert method is efficient, well-validated and shows a positive correlation with the manual GP method. An estimated weightage of 50% to carpal bones and 50% to tubular bones resulted in an automated Comp BA with the best agreement with Manual BA.

This original research article compares manual and automated bone age assessment methods to evaluate the use of artificial intelligence tools in the South African context.