• Jisun Hwang, Hee Mang Yoon, Jae-Yeon Hwang, Pyeong Hwa Kim, Boram Bak, Byeong Uk Bae, Jinkyeong Sung, Hwa Jung Kim, Ah Young Jung, Young Ah Cho, and Jin Seong Lee.
• Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
• Yonsei Med. J. 2022 Jul 1; 63 (7): 683691683-691.

PurposeTo evaluate the applicability of Greulich-Pyle (GP) standards to bone age (BA) assessment in healthy Korean children using manual and deep learning-based methods.Materials And MethodsWe collected 485 hand radiographs of healthy children aged 2-17 years (262 boys) between 2008 and 2017. Based on GP method, BA was assessed manually by two radiologists and automatically by two deep learning-based BA assessment (DLBAA), which estimated GP-assigned (original model) and optimal (modified model) BAs. Estimated BA was compared to chronological age (CA) using intraclass correlation (ICC), Bland-Altman analysis, linear regression, mean absolute error, and root mean square error. The proportion of children showing a difference >12 months between the estimated BA and CA was calculated.ResultsCA and all estimated BA showed excellent agreement (ICC ≥0.978, p<0.001) and significant positive linear correlations (R²≥0.935, p<0.001). The estimated BA of all methods showed systematic bias and tended to be lower than CA in younger patients, and higher than CA in older patients (regression slopes ≤-0.11, p<0.001). The mean absolute error of radiologist 1, radiologist 2, original, and modified DLBAA models were 13.09, 13.12, 11.52, and 11.31 months, respectively. The difference between estimated BA and CA was >12 months in 44.3%, 44.5%, 39.2%, and 36.1% for radiologist 1, radiologist 2, original, and modified DLBAA models, respectively.ConclusionContemporary healthy Korean children showed different rates of skeletal development than GP standard-BA, and systemic bias should be considered when determining children's skeletal maturation.© Copyright: Yonsei University College of Medicine 2022.

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