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Endocrine Abstracts (2014) 36 P53 | DOI: 10.1530/endoabs.36.P53

BSPED2014 Poster Presentations (1) (88 abstracts)

Bone age study in children (BASIC): a study of the quality of bone age X-rays and an intervention to improve quality and reduce re-X-ray rates

Toby Cockill 1 , Amanda Hewitt 2 , Neil Wright 2 & Charlotte Elder 2


1University of Sheffield, Sheffield, UK; 2Sheffield Children’s NHS Foundation Trust, Sheffield, UK.


Background: Bone age studies require X-ray of the left hand and wrist to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides an objective framework for calculating bone age and specifies exact placement of the hand. In our service we have noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, with time, financial and radiation exposure consequences.

Aim: To assess X-ray quality and need for re-X-ray in patients having TW3 bone ages.

Method: We performed a prospective study of all bone age X-rays conducted at Sheffield Children’s Hospital from May 2013 to February 2014. The quality of bone age X-rays was rated by a single specialist Auxology Nurse. The position of the thumb, fingers and the overall clarity of the X-ray were scored on a simple 1–3 scale (poor, adequate, good), generating a score out of 9. The need for re-X-ray was noted.

Results: Of the 259 bone ages studied, from patients aged 1.92 to 18.48 years, 123 were females. There were 12 X-rays scoring 1 (4.63%) (poor quality) for both the finger and thumb positions and nine for X-ray clarity (3.47%). The number of studies scoring <3 for position of fingers, thumb and overall clarity was 38 (14.67%), 26 (10.04%) and 77 (29.73%) respectively. The number of re-X-rays required was 28 (10.81%).

Discussion: We have shown that achieving good quality films on which to assess bone age may be more difficult than presumed. We believe the re-X-ray rate to be unnecessarily high and have devised a simple hand outline template, placed on the X-ray plate, to encourage the correct positioning of the hand. We are currently evaluating its efficacy using the same scoring system.

Volume 36

42nd Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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