Validation of automated bone age analysis from hand radiographs in a North American pediatric population

Background Radiographic bone age assessment by automated software is precise and instantaneous. Objective The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment. Materials and methods We compared a total of 586 bone age radiographs from 451 patients, which had been assessed by three radiologists from 2013 to 2018, with bone age analysis by BoneXpert, using the Greulich and Pyle method. We made bone age comparisons in different patient groups based on gender, diagnosis and race, and in a subset with repeated bone age studies. We calculated Spearman correlation (r) and accuracy (root mean square error, or R 2 ). Results Bone age analyses by automated and manual assessments showed a strong correlation (r=0.98; R 2 =0.96; P