Bone age assessment based on hand X‐ray imaging is important in pediatry medicine. At present, prediction of bone age is mainly performed by the manual comparison with the existing atlas. To develop an automatic regression framework based on deep learning with high performance and efficiency. A landmark‐based multi‐region convolutional neural networks for automatic bone age assessment based on left hand X‐ray images was proposed. The deep alignment network localized multiple landmarks distributed over the hand, and cropped the local regions to establish the multi‐region ensemble convolutional neural networks with different sub‐network combinations. The modified loss function and the optimized bone sub‐regions were applied to train the networks. The experiments on Digital Hand Atlas Database revealed that the mean absolute error of bone age assessment was 0.52 ± 0.25 years. It is the first study to predict bone age using deep learning methods throughout the entire process including image preprocessing, landmark localization and bone age predication. The proposed method outperformed most of the existing state‐of‐the‐art deep learning methods and achieved good results compared with the expert's experience. It can improve the efficiency of the medical doctors while minimizing the subjective errors.

Cover illustration: The cover image is based on the Research Article Landmark‐based multi-region ensemble convolutional neural networks for bone age assessment by Shaomeng Cao et al., https://doi.org/https://doi.org/10.1002/ima.22323.

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