Pediatric Bone Age and Developmental Assessment

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Radiological evaluation of bone age from x-rays of the left hand is the diagnostic standard for physicians looking to assess pediatric growth disorders.

While assessing bone age, radiologists use the Greulich & Pyle method and must do a manual comparison of digital radiographs from patients with reference images in an atlas, a time-consuming task with a high level of inter-rater variability.

IB Lab PANDA uses deep learning technology to report bone age based on the Greulich & Pyle scale and saves time by presenting the results within 5 seconds. IB Lab PANDA’s automated bone age measurement according to Greulich & Pyle is precise to 4.3 months mean absolute deviation [3]. The derived adult height estimation according to Bailey and Pineau is precise to ±2.5 cm [4]. Standardized measurements and reporting schemes facilitate monitoring of treatment progress, highlights relevant clinical findings by applying the latest international medical standards to enable timely and accurate decision making. The findings are summarized in a visual output report, attached to the original x-ray image and saved automatically in the PACS system. The AI-results are fed as text into your pre-defined RIS-template for accelerated reporting. The AI facilitates monitoring of disease progression by facilitating comparison of radiographic disease parameters over time.



Radiological findings, measurements, and results including: pediatric bone age according to Greulich & Pyle, natural standard deviation, delayed/advanced bone age patient status, growth potential and height estimation according to Bayley&Pinneau.


  • Saves time: less than 5 seconds for calculating the pediatric bone age according to Greulich & Pyle
  • Enhances the consistency in reading and reporting of hand radiographs for bone age and height estimation
  • Facilitates monitoring and forecasting of physicians’ therapeutic success

Intended Use

The estimation of pediatric bone age according to the Greulich & Pyle method on hand radiographs of children aged between 36 months and 192 months (girls) or 204 months (boys). The software should not be used in lieu of full patient evaluation or solely relied upon to make or confirm a diagnosis. The software is to be used by trained professionals including, but not limited to, radiologists, pediatricians, and endocrinologists.

The IB Lab PANDA software is intended to be used on juvenile humans aged between 36 months and 192 months (female) or 204 months (male) for the determination of bone age.

It should not be used in-lieu of full patient evaluation or solely relied upon to make or confirm a diagnosis. The system is to be used by trained medical professionals including, but not limited to, orthopedists and radiologists.

Training and Validation

  • Trained on over 12,000 hand radiographs from two institutions in the US (Lucile Packard Children’s Hospital at Stanford University and Children’s Hospital Colorado)
  • IB Lab PANDA uses an ensemble of decision models to report bone age based on the Greulich & Pyle atlas [3]
  • The standard deviation for a given chronological age is determined by rounding down to the next age in the Brushtable for the appropriate sex [6]
  1. D. G. King, D. M. Steventon, M. P. O’Sullivan, A. M. Cook, V. P. L. Hornsby, I.G. Jefferson, and P. R. King: Reproducibility of bone ages when performed byradiology registrars: an audit of Tanner and Whitehouse II versus Greulich andPyle methods, The British Institute of Radiology, 2014.
  2. S.Serinellia, V.Panettab, P. Pasqualettib, D. Marchetti: Accuracy of three agedetermination X-ray methods on the left hand-wrist: A systematic review andmeta-analysis, Legal Medicine, 2011.
  3. Halabi, S. S., Prevedello, L. M., Kalpathy-Cramer, J., Mamonov, A. B., Bilbily,A., Cicero, M., … Flanders, A. E.: The RSNA Pediatric Bone Age Machine LearningChallenge, Radiology, 290(2), 2018. 498–503.
  4. Gaskin, C. M., Kahn, S. L., Bertozzi, J. C., & Bunch, P. M.: SkeletalDevelopment of the Hand and Wrist. Oxford University Press, 2011.
  5. IB Lab Clinical Evaluation Study
  6. Simmons K, Greulich WW. 1944. The Brush Foundation Study of Child Growth andDevelopment: II. Physical Growth and Development. Monogr. Soc. Res. Child Dev.9(1):i–87.

What experts say

Jack Farr - Orthopedist

ImageBiopsy AI software is highly accurate and efficient within our PACS system, which provides valuable information on the status of the knee along the continuum of chondrosis to arthrosis.

Jack Farr, MD

The integration of the AI ​​solutions by ImageBiopsy Lab into our RIS and PACS is easy and well done. It is fun to work with and the clarity of the visualized report is an ideal support for our patient consultation.

Jochen Mueller-Stromberg, MD

AI-based solutions reduce the amount of work and the findings become more accurate. An objective value is given which can be used both for monitoring and forecasting the progress. We offer something that others don’t have.

Michael Gruber, MD

Exact diagnosis and reproducible follow-up exams are indispensable for a successful osteoarthritis therapy. Software-based methods can assist the physician in the therapy management and adjustment process.

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