With the advent of digital imaging, several investigators have attempted to provide an objective computer-assisted measure for bone age determinations and have developed image processing techniques from reference databases of normal children that automatically extract key features of hand radiographs [13-17]. To date, however, attempts to develop automated image analysis techniques capable of extracting quantitative measures of the morphological traits depicting skeletal maturity have been hindered by the inability to account for the great variability in development and ossification of the multiple bones in the hand and wrist. In an attempt to overcome these difficulties, automated techniques are being developed that primarily rely on measures of a few ossification centers, such as those of the epiphy-ses.
In the design of this digital atlas, the complexities associated with the design of software that integrates all morphological parameters was circumvented through the selection of an alternative approach. We designed artificial, idealized, sex- and age-specific images of skeletal development that incorporated the different degrees of maturation of each ossification center in the hand and wrist. The idealized image was derived from a composite of several hand radiographs from healthy children and adolescents that were identified as the perfect average for each ossification center in each age group.
Our aim was to provide a portable alternative to the reference books currently available, while avoiding the complexity of computer assisted image analysis. The wide adoption of personal digital assistants (PDAs) and pocket computer devices allowed the implementation of a low-cost portable solution that could effectively replace the traditional reference books. Technical challenges included the development of proper compression and image enhancement techniques for interpretation of hand radiographs on a small screen with adequate quality, and the need to store a large number of images on instruments with limited memory capacity.
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