Protocol - Bone Age

Description

The latest Tanner and Whitehouse Method, sometimes referred to as TW2, involves the interpretation of a radiograph of the left hand and wrist by a trained radiologist. The procedure includes the assessment of regions of interest (ROI) on 20 bones. The ROI include the epiphysis, metaphysis and diaphysis of each bone. The radiologist gives each ROI a numerical score and records the result. The numerical score of each ROI is summed to produce a total score.

Specific Instructions

This protocol must be administered by a radiologist professionally trained to evaluate bone age via the Tanner and Whitehouse Method. Since the online tool collects personal identifying information (PII), the researcher should use the individual’s initials and not include other identifiable information such as the person’s address.

Availability

This protocol is freely available; permission not required for use.

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Protocol

The Tanner-Whitehouse Test is an online tool which was developed by Lorentz Jantschi and Sorana Bolboaca and is available at:

vl.academicdirect.org/medical_informatics/bone_age/v1.0/

The tool describes various findings associated with each of the following 20 regions of interest (ROI) of the left hand as seen on x-ray. The ROIs are the:

Radius
Ulna
First, third, and fifth metacarpal
Proximal phalanx of the thumb, third finger, and fifth finger
Middle phalanx of the third and fifth finger
Distal phalanx of the thumb, third finger, and fifth finger
Capitate
Hamate
Triquetral
Lunate
Scaphoid
Trapezium
Trapezoid

Users select a finding that matches what they see on the x-ray. Each finding has two x-ray images, a drawing and a written description. Once a selection is made for each ROI, the users enters the patient’s name*, address, x-ray date, diagnostic, gender, weight, height and age (in years and months, for example 11 years and 3 months). Then the program calculates the individual’s bone age based upon the standard atlas associated with the Tanner and Whitehouse method. *See Specific Instructions for suggestions regarding personal identifying information.

Personnel and Training Required

A radiologist professionally trained to evaluate bone age via the Tanner and Whitehouse Method.

Equipment Needs

X-ray machine

Requirements

Requirement Category	Required
Major equipment	Yes
Specialized training	Yes
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	Yes

Mode of Administration

Noninvasive radiologic assessment

Lifestage

Toddler, Child, Adolescent

Participants

Ages 2-18 years old

Selection Rationale

The Rare Genetic Conditions Working Group selected the Tanner and Whitehouse Method because it is the most reproducible and, potentially, the most accurate procedure to determine bone age.

Language

English

Standards

Standard	Name	ID	Source
Human Phenotype Ontology	Delayed bone age	HP:0002750	HPO
Human Phenotype Ontology	Dysharmonic bone age	HP:0200000	HPO
Human Phenotype Ontology	Accelerated skeletal maturation	HP:0005616	HPO
caDSR Form	PhenX PX220301 - Bone Age	6201642	caDSR Form
Logical Observation Identifiers Names and Codes (LOINC)	PhenX - bone age protocol 220301	93149-3	LOINC

Derived Variables

None

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Protocol Name from Source

Tanner and Whitehouse Method (TW2)

Source

Online tool for assessment:

Jantschi, L., & Bolboaca, S. (2003). Tanner and Whitehouse Test. Available at vl.academicdirect.org/medical_informatics/bone_age/v1.0/

Original source:

Tanner, J. M., Whitehouse, R. H., Marshall, W. A., Healey, M. J. R., Goldstein, H. (1976). Assessment of skeletal maturity and prediction of adult height (TW2 method). London: Academic Press.

General References

Bull, R. K., Edwards, P. D., Kemp, P.M., Fry, S., & Hughes, I.A. (1999). Bone age assessment: A large scale comparison of the Greulich and Pyle, and Tanner and Whitehouse (TW2) methods. Archives of Disease in Childhood, 81, 172-173.

Ostojic, S. M. (2013). Prediction of adult height by Tanner-Whitehouse method in young Caucasian male athletes. QJM, 106, 341-345.

Protocol ID

220301

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX220301_Bone_Age_Capitate
	PX220301140000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Diagnostic
	PX220301240000	Diagnoistic Code	N/A
PX220301_Bone_Age_DistalPhalanx_Thumb
	PX220301110000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Distal_Phalanx_FifthFinger
	PX220301130000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Distal_Phalanx_ThirdFinger
	PX220301120000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Fifth_Metacarpal
	PX220301050000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_First_Metacarpal
	PX220301030000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Hamate
	PX220301150000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Lunate
	PX220301170000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Middle_Plananx_FifthFinger
	PX220301100000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Middle_Plananx_ThirdFinger
	PX220301090000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Patient_Address
	PX220301220000	Patient's Address	N/A
PX220301_Bone_Age_Patient_Age
	PX220301270000	Patient Age in Years and Months	N/A
PX220301_Bone_Age_Patient_Gender
	PX220301250000	Patient gender	N/A
PX220301_Bone_Age_Patient_Height
	PX220301280000	Patient Height	N/A
PX220301_Bone_Age_Patient_Name
	PX220301210000	Patient Full Name	N/A
PX220301_Bone_Age_Patient_Weight
	PX220301260000	Patient Weight	N/A
PX220301_Bone_Age_ProximalPhalanxa_Fifth_Finger
	PX220301080000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_ProximalPhalanxa_Third_Finger
	PX220301070000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_ProximalPhalanxa_Thumb
	PX220301060000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Radius
	PX220301010000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Scaphoid
	PX220301180000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Third_Metacarpal
	PX220301040000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Trapexoid
	PX220301200000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Trapezium
	PX220301190000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Triquetral
	PX220301160000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Ulna
	PX220301020000	findings associated with each of the more following 20 regions of interest (ROI) of the left hand as seen on x-ray show less	N/A
PX220301_Bone_Age_Xray_Date
	PX220301230000	Date of X-Ray	N/A