SKELETAL BONE AGE ASSESSMENT

Case Review #1

WHAT IS IT?The degree of skeletal maturation in childrenA comparison of chronological age to skeletal development

Bone Age Assessment can be used to monitor...... A child’s growth progress and guide

treatment Endocrinopathies Orthopedic and orthodontic treatment

(i.e. surgery, bracing) Forensic applications Adoption of a child Congenital and genetic disorders

Ossification Time

Line

CASE STUDY....... A beautiful, happy and active 4 ½ year old maleShort statureCo operativeBorn premature, as stated by motherConcerns about skeletal growth

PACS Image - Accession # 473 8364.001K

THINGS THAT WE NEED TO CONSIDER DURING A

PROCEDURE......

Frightened childMay not want/able to sit stillWearing leadDelayed gross and fine motor skillsFragile – prone to fractures

As technologists, we can help.........

Be friendly and inviting to the child and their family

Invite family members to stay and help

Reassurance Make it fun Praise and reward!!

What’s next?

Possible treatment and follow up......

Regular evaluation of growth patterns

Growth Hormone Administration

Adequate Caloric and Calcium intake

Medical treatment for psychosocial distress in

adolescence

Stay active and be aware of limitations

Something Interesting....... Bone age assessment and IBD in children Ability to properly interpret growth

status and improve treatment Researchers measured bone age in 49

pediatric patients with Crohn’s, ages 5-17

Found that 41% had Z scores <-2 Poor growth may be the only presenting

sign

WHAT ARE Z-SCORES?

The number of standard deviations away from the average value of a reference group (same age and gender)Used by pediatricians to interpret the height of a child

How to calculate Z-scores:Patient’s BMD - Expected BMD/SD

“Poor growth may be the only sign of active disease. Including the x-ray as part of routine care allows a more clinically meaningful interpretation of statural growth and therefore enables us to improve our treatment recommendations.”

Neera Gupta, MD, MASPediatric GastroenterologistUCSF Benioff Children’s Hospital

SOMETHING ELSE.......Bone age determination can also be based on studying the medial extremity of the clavicle using CT MRI, more recentThe first fetal bone to undergo primary ossification2 primary ossification centres and 1 secondary ossification centre

“Based on large systematic studies, it has been shown that the epiphyseal development of the medial clavicle and its union with the clavicular shaft may be used in estimating the age of osseous remains.”

Kreitner, K. F., Nafe, B., Riepert, T., Schweden, F. J., & Thelen, M. (1998).

5th and 6th week of intrauterine life

Late Adolescence (18-20 yrs)

References..... Bone age necessary to correctly interpret growth status in pediatric

crohn's disease. (2012, May 25). Retrieved from http://www.news-medical.net/news/20120525/Bone-age-necessary-to-correctly-interpret-growth-status-in-pediatric-Crohns-disease.aspx?page=2

Clarke, MD, P. A. (2013, Feb 15). Constitutional growth delay workup. Retrieved from http://emedicine.medscape.com/article/919677-workup

Contemporary Pediatrics Staff. (2012, June 07). Measure bone age routinely in crohn disease. Retrieved from http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/measure-bone-age-routinely-crohn-disease

Huffman, S. M. (n.d.). Bones and crohn's in the pediatric population. Retrieved from http://www.advancesinibd.com/assets/slides/nurse/Huffman-print.pdf

Kreitner, K. F., Nafe, B., Riepert, T., Schweden, F. J., & Thelen, M. (1998). Bone age determination based on the study of the medial extremity of the clavicle. Muskuloskeletal radiology, 8(1116-1122), Retrieved from http://link.springer.com/article/10.1007/s003300050518

Sherk, S. (n.d.). Skeletal developement. Retrieved from http://www.healthofchildren.com/S/Skeletal-Development.html