Comparison of bone age assessment in hand and wrist radiographs of individuals aged 12-18 using the Gilsanz-Ratib and Kahn-Gaskin atlases: a single-center study
DOI:
https://doi.org/10.17986/blm.1748Keywords:
Bone age, Forensic medicine, Age Determination, Gilsanz Ratib Atlas, Kahn Gaskin AtlasAbstract
Objective: Age estimation is a critical component of forensic medicine. This study aimed to assess the concordance and discrepancies between age estimations derived from the Kahn Gaskin (KG) and Gilsanz Ratib (GR) atlases and individuals’ chronological ages, as well as to evaluate the agreement between these atlases and their applicability to the Turkish population.
Methods: A retrospective analysis was conducted on hand and wrist radiographs of individuals aged 12–18 years who presented to Sivas Cumhuriyet University Hospital between 2019 and 2023. A total of 700 subjects (50 males and 50 females per age group) meeting the inclusion criteria were randomly selected. Bone age was assessed using the GR and KG atlases.
Results: Bone age estimations based on the GR Atlas were significantly higher than chronological age in all male and female groups, except for the 18-year-old cohort. The maximum overestimation was 1.59 years in females and 0.97 years in males. Similarly, the KG Atlas indicated higher bone ages in all female groups except for 18-year-olds and in all male groups except for 15- and 18-year-olds, with overestimation reaching 0.69 years in females and 0.72 years in males.
Conclusion: The findings demonstrate substantial discrepancies between estimated bone age and chronological age across atlases. To establish a population-specific bone age atlas, further large-scale, multicenter studies encompassing all seven geographical regions of Turkey are warranted.
Downloads
References
Baransel Isır A, Büken B. Yaş Tayini. İçinde: Dokgöz H, editör. Adli Tıp ve Adli Bilimler. 2.baskı. Ankara: Akademisyen Kitabevi; 2019. 807–834.
Baransel Isır A. Adli Hekimlikte Yaş Tayini. İçinde: Koç S, editör. Birinci Basamakta Adli Tıp. 2.baskı. İstanbul: İstanbul Tabip Odası; 2011. 222–234.
Demirkıran SD, Çelikel A, Zeren C, Arslan MM. Yaş tespitinde kullanılan yöntemler. Dicle Medical Journal. 2014;41(1):238-243. https://doi.org/10.5798/diclemedj.0921.2014.01.0410 DOI: https://doi.org/10.5798/diclemedj.0921.2014.01.0410
Gilsanz V, Ratib O. Hand bone age: a digital atlas of skeletal maturity. Springer Science & Business Media; 2005.
Gilsanz V, Ratib O. Digital Bone Age Atlas. Springer; 2012. DOI: https://doi.org/10.1007/978-3-642-23762-1
Kahn SL, Gaskin CM, Sharp VL, Keats TE, Li B. Radiographic Atlas of Skeletal Maturation. Thieme Medical Publishers; 2012. DOI: https://doi.org/10.1055/b-002-74276
Focardi M, Pinchi V, De Luca F, Norelli GA. Age estimation for forensic purposes in Italy: ethical issues. International journal of legal medicine. 2014;128(3):515–522. https://doi.org/10.1007/s00414-014-0986-0 DOI: https://doi.org/10.1007/s00414-014-0986-0
Pekşen TF. Karadeniz Teknik Üniversitesi Farabi Hastanesine Başvuran 10-19 Yaşları Arası Türk Çocuklarda El ve El Bileği Röntgen Görüntülerinin Kemik Yaşı Tayini Açısından Gilsanz-Ratib Dijital Atlasıyla Karşılaştırılması [Tıpta Uzmanlık Tezi]. Trabzon: Karadeniz Teknik Üniversitesi; 2022. 116s.
Schmidt S, Nitz I, Schulz R, Tsokos M, Schmeling A. The digital atlas of skeletal maturity by Gilsanz and Ratib: a suitable alternative for age estimation of living individuals in criminal proceedings? International journal of legal medicine. 2009;123(6):489–494. https://doi.org/10.1007/s00414-009-0367-2 DOI: https://doi.org/10.1007/s00414-009-0367-2
Koç U, Taydaş O, Bolu S, Elhan AH, Karakas SP. The Greulich-Pyle and Gilsanz-Ratib atlas method versus automated estimation tool for bone age: a multi-observer agreement study. Japanese Journal of Radiology. 2021;39(3):267–272. https://doi.org/10.1007/s11604-020-01055-8 DOI: https://doi.org/10.1007/s11604-020-01055-8
Mirza WA, Memon M, Shah SMM, Hussain U e L, Ali A, Hashmani N, et al. Bone Age Practices in Infants and Older Children among Practicing Radiologists in Pakistan: Developing World Perspective. Cureus. 2019;11(1):1–10. https://doi.org/10.7759/cureus.3936 DOI: https://doi.org/10.7759/cureus.3936
Kaplowitz P, Srinivasan S, He J, McCarter R, Hayeri MR, Sze R. Comparison of bone age readings by pediatric endocrinologists and pediatric radiologists using two bone age atlases. Pediatric radiology. 2011;41(6):690–3. https://doi.org/10.1007/s00247-010-1915-0 DOI: https://doi.org/10.1007/s00247-010-1915-0
Çelik H. Comparison of Greulich-Pyle and Gilsanz-Ratib Atlases Through An Intelligent Bone Age Assessment System. International Conference on Artificial Intelligence and Data Processing, 2018. https://doi.org/10.1109/IDAP.2018.8620817 DOI: https://doi.org/10.1109/IDAP.2018.8620817
Öcal ZA, Meral O. Comparison of the Reliability of the “GÖK Atlas” and the “Gilsanz-Ratib Atlas” in the Determination of Bone Age in Turkish Children. Medical Records. 2022;4(3):274–278. https://doi.org/10.37990/medr.1072145 DOI: https://doi.org/10.37990/medr.1072145
Koçulu M. Gaziantep Doğumlu 15-18 Yaşlarındaki Türk Çocuklarında El ve El Bileği Grafilerinden Gök, Greulich-Pyle ve Gilsanz-Ratib Atlaslarına Göre Yaş Tespitindeki Korelasyonun Değerlendirilmesi [Tıpta uzmanlık tezi]. Gaziantep: Gaziantep Üniversitesi; 2023. 143s.
Poslu M. Gaziantep Doğumlu 15-18 Yaşlarındaki Türk Çocuklarında El ve El Bileği Grafilerinden Gök Atlası ve İskelet Olgunlaşmasının Radyografik Atlası (Kahn Gaskin)’na Göre Yaş Tespitindeki Korelasyonun Değerlendirilmesi [Tıpta uzmanlık tezi]. Gaziantep: Gaziantep Üniversitesi; 2022. 131s.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Nermin Malkoçoğlu- Fatma YÜCEL BEYAZTAŞ- Mehmet Haydar ATALAR- Ahmet MALKOÇOĞLU- Ali YILDIIRM- Celal BÜTÜN

This work is licensed under a Creative Commons Attribution 4.0 International License.
The Journal and content of this website is licensed under the terms of the Creative Commons Attribution (CC BY) License. The Creative Commons Attribution License (CC BY) allows users to copy, distribute and transmit an article, adapt the article and make commercial use of the article. The CC BY license permits commercial and non-commercial re-use of an open access article, as long as the author is properly attributed.