Objective: To assess the degree of applicability of bone age calculated by Greulich and Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes.
Bone ages were computed using Greulich and Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi.
Results: On average, the Greulich and Pyle Atlas underestimates chronological age by 6.65 +- 13.47 months in females and 15.78 +- 12.83 months in males (p-values Less than 0.001).
Conclusion: Bone age calculated by Greulich and Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g.
One of the oldest, simplest5 and most frequently used method of bone age calculation in Pakistan is the Greulich and Pyle Atlas.6 This atlas was developed by Dr.
It is considered to compute a bone age which is comparable to chronological age in children from developed countries of West8 and Middle east9 but great difference exists between the two in children from developing countries such as Iran10 and India.11A couple of studies have been conducted to assess the reliability of Greulich and Pyle Atlas in Pakistani children.
Table-I: Differences and relationship between chronological age (CA) and bone age by Greulich and Pyle Atlas (GP) in different genders.
Table-II: Differences between chronological age (CA) and bone age by Greulich and Pyle Atlas (GP) in different age quartiles.
Various international studies have reported different results regarding the applicability of the Greulich and Pyle Atlas for estimation of chronological age.
This extreme discrepancy makes the Greulich and Pyle Atlas invalid for forensic application of bone age in the estimation of chronological age in Pakistani children.
Bone age calculated by Greulich and Pyle Atlas significantly underestimates chronological age in Pakistani children between the ages of 54-113 months.
Then the image is analyzed by tak- ing account of selected regions of interest for calcu- lating bone age by Tanner-Whitehouse method or by comparison with standard images for estimation by Greulich and Pyle Atlas
.Older methods of automated Image-processing that detect features of ossification in hand bones showed significant variation from bone age calcu- lated by manual methods.