The use of a radiolucent template to improve bone age X-ray quality (BASIC study)
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Toby G. Cockill
Abstract
Background:
Left hand and wrist X-rays are conventionally used to assess skeletal maturity using methods such as Tanner-Whitehouse 3 (TW3). We noted a number were poor quality, caused by difficulty with hand placement. We introduced a simple radiolucent hand template to assist in hand positioning and assessed changes in X-ray quality and repeat X-ray rates.
Methods:
The position of fingers, thumb and overall clarity of bone age X-rays were prospectively scored. In the absence of a validated tool to assess quality a 1–3 scale (poor, borderline, good) was devised. A radiolucent hand template was introduced for use in the intervention group. Need for repeat X-ray was determined by set criteria.
Results:
The intervention improved scores. More patients scored 3 (good) for positioning of fingers (89.29% and 85.33%, p=0.38), thumb (98.21% and 89.96%, p=0.06) and overall clarity (76.79% and 70.27%, p=0.41) for the intervention (n=56) and control groups (n=259), respectively. No patient required repeat X-ray from the intervention group, compared with 28 in the control group (p=0.007).
Conclusions:
Achieving good quality bone age X-rays is more difficult than previously assumed. The use of a radiolucent hand template has been shown to improve hand position and significantly reduce the need for repeat X-ray.
Acknowledgments
We would like to thank the patients and their parents who agreed to take part in this study and Dr. Offiah for her advice on the scoring of X-rays.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Tanner JM, Healy M, Goldstein H, Cameron N. Assessment of skeletal maturity and prediction of adult height (TW3 method), 3rd ed. London: WB Saunders, Harcourt Publishers Ltd, 2001.Search in Google Scholar
2. Huda W, Gkanatsios NA. Radiation dosimetry for extremity radiographs. Health Phys 1998;75:492–9.10.1097/00004032-199811000-00005Search in Google Scholar PubMed
©2017 Walter de Gruyter GmbH, Berlin/Boston
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- Mini Review
- Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature
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