STUDIES IN THE RELIABILITY OF ASSESSING SKELETAL MATURITY FROM X-RAYS: PART III. GREULICH-PYLE ATLAS AND TANNER-WHITEHOUSE METHOD CONTRASTED

• Published in: Human biology 1966-09, Vol.38 (3), p.204-218
• Main Authors: ACHESON, ROY M., VICINUS, JOAN H., FOWLER, GILLIAN B.
• Format: Article
• Language: English
• Subjects: Bones; Carpus; Confidence limits; Hands; Random errors; Reading tables; Systematic errors; Tanneries; Wrist; X ray film
• ISSN: 0018-7143; 1534-6617

Hand x-rays of 50 children (25 boys and 25 girls) aged 2-18 years were studied. Skeletal age assessments were made, using the Greulich-Pyle Atlas and the Tanner-Whitehouse method, by each of six assessors who came from five different countries. Two assessors read all 50 films twice, and two others read a random sub-sample twice. It was found that: a) the magnitude of systematic error was independent of the sex of the child; b) according to the Tanner-Whitehouse method the average readings of all six assessors of the 50 films were nearly one skeletal year higher than the same averages using the Greulich-Pyle Atlas; c) there was no relationship between the rank orders of the readings of the six assessors by the two methods; d) the 95% confidence limits of a single reading of an observer using the Tanner-Whitehouse method tended to be smaller than those of the same observer using the Greulich-Pyle Atlas—for this and other reasons it was concluded that the Tanner-Whitehouse method gave rise to the smaller random variation of the two; e) the Greulich-Pyle Atlas gave rise to significantly less systematic error (bias) than the Tanner-Whitehouse method. However, the bias associated with the Tanner-Whitehouse method was considerably reduced if the skeletal age of the carpus was excluded from the total assessment. Possible reasons for, and practical applications of, these findings are discussed.