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

Authors

DOI:

https://doi.org/10.17986/blm.1748

Keywords:

Bone age, Forensic medicine, Age Determination, Gilsanz Ratib Atlas, Kahn Gaskin Atlas

Abstract

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.

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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.

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Published

2025-08-30

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Research Article

How to Cite

1.
Malkoçoğlu N, YÜCEL BEYAZTAŞ F, ATALAR MH, MALKOCOGLU A, YILDIRIM A, BÜTÜN C. 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. Bull Leg Med [Internet]. 2025 Aug. 30 [cited 2025 Sep. 6];30(2):115-23. Available from: https://www.adlitipbulteni.com/index.php/atb/article/view/1748