Existing Methods for BA Assessment

  • Greulich & Pyle (G&P) – The most widely used method, based on evaluating hand or wrist radiographs against a reference Bone Age “Atlas” published in 1950.
  • Atlas Contains hand X-ray images of middle upper class healthy Caucasian American children, taken between 1930-1940.
  • Tanner & Whitehouse (TW3) – a more recent atlas, rarely used, is also based on hand X-ray images. It is regarded as being more precise than the G&P, but it is more difficult to perform and more time-consuming.
Reference hand X-Ray image From G&P Atlas

Reference hand X-Ray image From G&P Atlas


Current BA methods have several disadvantages:

  • Results are based on a considerable inter and intra-individual variability in interpretation and evaluation of X-ray images, that often leads to low precision diagnosis.
  • Biohazard radiation is emitted through the X-ray process, especially when many children patients might need several X-rays per year over a period of a few years.
  • The existing standard atlases of skeletal development are outdated and do not represent the changes evolved in children’s growth pattern, due to different nutrition and changes in social environments, since the atlases were published.
  • High costs for healthcare providers for maintaining X-ray facilities personnel and applicable services.
  • Accessibility – obligatory use of X-ray facilities, available mainly in hospitals and special facilities that often are scarce or unavailable in rural areas and developing countries. Consequently, creating a severe under-diagnosed case for growth disorders, worldwide.
  • Current methods are time consuming, cost-ineffective.
  • Medical professionals agree that current conventional BA methods carry many deficiencies.



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