Background/Aims: A more advanced bone age (BA) has been reported for the left hand relative to the right hand, while another study has found no such effect. The aim was to study the average difference of automated BoneXpert BA determination (left- vs. right-hand) for normal children, examine the precision of automatic BA and provide a BA reference for normal Caucasian children. Methods: Radiographs of both hands (age range: 2–20 years) were digitised and analysed automatically to determine Greulich-Pyle BA, producing analysis results for 3,374 left-hand and 2,752 right-hand images. Results: Comparison of left- and right-hand BA showed no average difference (<0.07 years, 95% confidence). The SD of the differences between left and right sides was 0.25 years for boys as well as girls, implying the precision of automated Greulich-Pyle BA determination was 0.18 years or better. Greulich-Pyle BA for boys and girls were on average 0.10 and 0.21 years below the chronological age. Conclusion: The left and right hand give the same BA on average and the SD between the sides is 0.25 years, indicating an excellent precision of the automated method.

Prader A, Largo RH, Molinari L, Issler C: Physical growth of Swiss children from birth to 20 years of age. First Zurich longitudinal study of growth and development. Helv Paediatr Acta Suppl 1989;52:1–125.
Gasser T, Sheehy A, Largo RH: Statistical characterization of the pubertal growth spurt. Ann Hum Biol 2001;28:395–402.
Roche AF: A study of skeletal maturation in a group of Melbourne children. Austral Paediatr J 1967;3:123–127.
Baer MJ, Djrkatz J: Bilateral asymmetry in skeletal maturation of the hand and wrist: a roentgenographic analysis. Am J Phys Anthropol 1957;15:181–196.
Roche AF, Chumlea W, Thissen D: Assessing the Skeletal Maturity of the Hand-wrist: FELS Method. Springfield, Thomas, 1988.
Thodberg HH, Kreiborg S, Juul A, Damgaard-Petersen K: The BoneXpert method for automated determination of skeletal maturity. IEEE Trans Med Imaging 2009;28:52–66.
van Rijn RR, Lequin MH, Thodberg HH: Automatic determination of Greulich and Pyle bone age in healthy Dutch children. Pediatr Radiol 2009;39:591–597.
Martin DD, Deusch D, Schweizer R, Binder, G, Thodberg HH, Ranke MB: Clinical application of automated Greulich-Pyle bone age determination in children with short stature. Pediatr Radiol 2009;39:598–607.
Thodberg, HH: An automated method for determination of bone age. J Clin Endocrinol Metab 2009;94:2239–2244.
Oldfield, RC: The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 1971;9:97–113.
Roche AF, Rohmann C, French N, Davila G: Effect of training on replicability of assessments of skeletal maturity (Greulich-Pyle). Am J Roentgenol 1970;108:511–515.
Bull R, Edwards P, Kemp P, Fry S, Hughes I: Bone age assessment: a large scale comparison of the Greulich and Pyle, and Tanner and Whitehouse (TW2) methods. Arch Dis Child: 1999;31:172–173.
Martin D, Thodberg HH, Sato K, Sato M, Tanaka T: Validation of a new method for automated determination of bone age in Japanese children. Hormone Research 2009, accepted for publication.
Tanner JM, Healy MJR, Goldstein H, Cameron N: Assessment of Skeletal Maturity and Predicting of Adult Height (TW3 method), ed 3. London, Saunders, 2001.
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