Clinical assessment of skeletal maturity is based on a visual comparison of a left-hand wrist radiograph with atlas patterns. Using a new digital hand atlas an image analysis methodology is being developed. To assist radiologists in bone age estimation. The analysis starts with a preprocessing function yielding epiphyseal/metaphyseal regions of interest (EMROIs). Then, these regions are subjected to a feature extraction function. Accuracy has been measured independently at three stages of the image analysis: detection of phalangeal tip, extraction of the EMROIs, and location of diameters and lower edge of the EMROIs. Extracted features describe the stage of skeletal development more objectively than visual comparison.

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In this study we propose two new methods, namely iso-transmission line and subregion direct approximation methods, for dual energy image decomposition calculations. These two methods are compared with two other conventional techniques, i.e. non-linear equations and direct approximation. The computation accuracy, sensitivity to quantum noise and efficiency are used as indices for comparison. Both the subregion direct approximation method and the iso-transmission line method give better accuracy than the two conventional methods. The iso-transmission line, direct approximation and subregion methods are computationally more efficient than the non-linear equations method. The image calculated by the iso-transmission line and the subregion methods are more sensitive to noise.

A computerized approach to the problem of the assessment of skeletal maturity in pediatric radiology is presented. A CR (computed radiography) hand image to be analyzed is first standardized to obtain a left hand, upright, PA view. Then the phalangeal region of interest is defined and thresholded. After the separation of the third finger, the lengths of the distal, middle, and proximal phalanx are measured automatically. Using the standard phalangeal length table, the skeletal age is estimated. The assessed age has been compared to the estimates obtained by a radiologist using the atlas matching method as well as the chronological age.

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