Attributes of the radiographic standard of reference for the National Health Examination Survey

In 1964, this standard was prepared at the request of the National Center for Health Statistics so that the skeletal age of the bones in the growing hand and wrist could be read from the films of the children and youths–age 5 to 18 years—from 40 areas of the United States who have been included in the National Health Survey. The major directive from the National Center was to prepare a standard so that a skeletal age could be assigned to each growing bone without any reference to the sex or the age of the subjects in the Survey. Between 1928 and 1964, the attributes of the present standard had been tested in the United States and abroad using films of children and youths of all races and several forms of standards. The widely‐used radiographic form was chosen. Contact‐size prints of 26 films of the hand and wrist were arranged as a maturity series to illustrate transitional osseous features which appear in the radiographic shadows of each bone during growth. A description of these features and standardized bone ages for males completed each standard plate. Copies of a Manual containing the standard as used by the NHS film readers, details of its preparation, bone age equivalents for females related to the 26 standard films, and some new examples of use of bone ages will be provided for participants to this evaluation of skeletal age standards for children and youths.