Using ultrasound as an accurate method of determining bone age: A safe method specially in young athletes

Mehdi Karami--- Department of Diagnostic Radiology, Isfahan university of Medical science, Isfahan, Iran.,
Reza Khaleghnejad--- Pediatric Surgery Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Fatemeh Karami--- Department of Diagnostic Radiology, Isfahan university of Medical science, Isfahan, Iran.



BACKGROUND: Bone age determination is used in situations such a migration and sports. Radiography, MRI and ultrasound are different methods of determining bone age. This study was designed to evaluate the effectiveness of ultrasound in determining bone age in 14 -18 year olds.

METHOD: 100 male and 100 female students between 14 and 18 years old were evaluated. The thickness of the epiphysis of the left distal radius in the ventral, dorsal and lateral views, were measured.

RESULTS: In the females most of the growth plates were closed and the rest were inconclusive therefore ultrasound cannot be used in females in this age group. In the males, a minimum thickness of 0.7mm in dorsal and 0.8mm in ventral view in 14 and 15 year olds can be used to differentiate them from the 16 and 17 year olds. A maximum thickness of 1.6mm in dorsal and 1.1mm in ventral view can be used to differentiate 16 and 17 year olds from 14 and 15 year olds. Finally a maximum thickness of 0.8mm in the dorsal view can be used to differentiate 17 year olds from 16 year olds and younger.

CONCLUSION: Bone age determination via sonographic evaluation of the distal radius is an easy, fast and radiation free method that if confirmed by future studies can be used to differentiate 15 and younger from 16 and older boys. Ultrasound cannot be used to differentiate 14 to 18 year old girls. 


Bone age; Skeletal age; Ultrasound; Sonography; Distal radius; Growth plate

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Tanner JM, Whitehouse RH, Marshall WA, et al. Assessment of skeletal maturity and prediction of adult height (TW2 method). New York: Academic Press, 1975.

Malina Robert M. Skeletal Age and Age Verification in Youth Sport. Sports Med 2011;41(11):925-947.

Mokone T. Poverty no excuse for cheating. 2004 July 27.

Kwenaite T. Little cheats: who to blame? The Star, 26 August 1998.

Engebretsen L, Steffen K, Bahr R, et al. The International Olympic Committee consensus statement on age determination in high-level young athletes. Br J Sports Med. 2010; 44:476–484.

Malina R M, Pen˜a Reyes M E, Figueiredo A J,et al. Skeletal Age in Youth Soccer Players: Implication for Age Verification. Clin J Sport Med 2010;20:469–474.

Buckler JM. How to make the most of bone ages. Arch Dis Child; 1983;58:761–763.

Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. Stanford University Press, Stanford, CA 1959.

Dvorak J, George J, Junge A, et al. Application of MRI of the wrist for age determination in international U-17 soccer competitions. Br J Sports Med 2007;41:497–500.

Johnston FE. The use of the Greulich–Pyle method in a longitudinal growth study. Am J Phys Anthropol 1971Nov35:353–357.

Dvorak J, George J, Junge A, et al. Age determination by magnetic resonance imaging of the wrist in adolescent male football players. Br J Sports Med 2007;41:45–52.

King DG, Steventon DM, O’Sullivan MP, et al. Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods. Br J Radiol 1994;67:848–851.

Mentzel HJ, Vilser C, Eulenstein M, et al. Assessment of skeletal age at the wrist in children with a new ultrasound device. Pediatr Radiol. 2005 Apr; 35(4):429-33. Epub 2005 Feb 24.

Shimura N, Satomi K, Osamu A, et al. Assessment of measurement of children’s bone age ultrasonically with sunlight Bonage. ClinPediatrEndocrinol 2005; 14:17-20.

Bilgili Y, Hizel S, Altan Kara S, et al. Accuracy of Skeletal Age Assessment in Children From Birth to 6 Years of Age With the Ultrasonographic Version of the Greulich-Pyle Atlas. J Ultrasound Med 2003;22:683-690.

Wagner UA, Diedrich V, Schmitt O. Determination of skeletal maturity by ultrasound: a preliminary report. Skeletal Radiol 1995; 24:417–420.

Nessi R, Garattini G, Zaffaroni R, et al. Ultrasonography assessment of ossification foci of the wrist and pubertal growth spurt [in Italian]. Radiol Med (Torino) 1997; 94:43-46.

Castriota-Scanderbeg A, De Micheli V. Ultrasound of femoral head cartilage: a new method of assessing bone age. Skeletal Radiol. 1995 Apr;24(3):197-200.

CNN Sports Illustrated. ‘‘Cheating does not pay’’: Asia bans teams, players for over-age infractions. 2001. soccer/news/2001/05/10/Asia. Accessed June 14, 2001.

Tritrakarn A, Tansuphasiri V. Roentgenographic assessment of skeletal ages of Asian junior youth football players. J Med Assoc Thai. 1991;74: 459–464.

Asian Cricket Council. U-15 ACC elite age-verification results issued. 2007. cfm. Accessed January 15, 2008.

Dvorak J, George J, Junge A, et al. Application of MRI of the wrist for age determination in international U-17 soccer competitions. Br J Sports Med. 2007;41:497–500.

Fe´de´ration Internationale de Football Association. FIFA to introduce MRI screening at Nigeria 2009 to combat the fielding of over-age players. 2009. Accessed September 22, 2009.

Orchard JJ, Orchard JW, Grenfell T, et al. Ionising radiation: three game-changing studies for imaging in sports medicine. Br J Sports Med. April 2014;48 (8).

Forster BB. The game has changed…but it still needs to be played: the role of imaging tests using ionising radiation in the practice of sports medicine. Br J Sports Med April 2014;48(8).

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307-10.

Castriota-Scanderbeg A, Sacco MC, Emberti-Gialloreti L, et al. Skeletal age assessment in children and young adults: comparison between a newly developed sonographic method and conventional methods. Skeletal Radiol. 1998 May;27(5):271-7

Khan KM, Miller BS, Hoggard E, et al. Application of ultrasound for bone age estimation in clinical practice. J Pediatr. 2009 Feb;154(2):243-7

Schmidt S, Mühler M, Schmeling A, et al. Magnetic resonance imaging of the clavicular ossification. Int J Legal Med. 2007 Jul;121(4):321-4

Hillewig E, De Tobel J, Cuche O, et al. Magnetic resonance imaging of the medial extremity of the clavicle in forensic bone age determination: a new four-minute approach. Eur Radiol. 2011 Apr;21(4):757-67

Castriota-Scanderbeg A, De Micheli V, et al. Precision of sonographic measurement of articular cartilage: inter- and intraobserver analysis. Skeletal Radiol. 1996 Aug;25(6):545-9



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