ArticleBMC medical imaging2026
Bone age assessment: comparative analysis of Greulich-Pyle and Tanner-Whitehouse 3 by pediatric radiologists and endocrinologists.
Article in BMC medical imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionTwo widely used bone age assessment (BAA) methods—Greulich-Pyle (GP) and Tanner-Whitehouse 3 (TW3) methods—differ in complexity, accuracy, and clinical utility.
objectiveTo compare GP and TW3 bone age estimations and assess inter- and intra-observer agreement between pediatric radiologists and endocrinologists.
methodsThis retrospective study analyzed 1,725 left-hand radiographs of children aged 0–19 years (2008–2022). Twelve experts (six radiologists, six endocrinologists) independently assessed bone age using GP and TW3 radius-ulnar-short bones (RUS) methods following standardized training. Assessment time and method preference were recorded. Statistical analyses included descriptive statistics, intra-class correlation coefficients (ICC), Bland–Altman analysis, and comparative tests (p < 0.05).
resultsGP estimates ranged from 6 to 228 months, whereas TW3-RUS estimates were slightly lower due to age-range limitations. Inter- and intra-observer reliability were excellent for both methods (ICC > 0.9). Mean bone age did not differ significantly between specialties using GP, whereas minor differences were observed with TW3-RUS for overall (p < 0.001) and when stratified by sex (males p = 0.016, female p = 0.005). Age-stratified analysis demonstrated low mean absolute differences (MAD) between specialties across most age groups, with slightly greater variability in 84.1–180 months. MAD between GP and TW3-RUS was modest in most age groups (approximately 2.5–3.3 months) but increased in older adolescents, particularly ≥ 180 months. GP assessments were significantly faster than TW3-RUS (p = 0.002). Experts preferred GP for routine use due to speed and ease, while TW3-RUS offered greater accuracy, specificity, and detail for complex and borderline cases.
conclusionsBoth specialists demonstrated excellent agreement using both GP and TW3-RUS. We recommend GP as the primary method, reserving TW3-RUS for complex cases. Moreover, developing a GP-analog atlas with narrower, finely defined age intervals may improve clinical applicability.
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