Endocrine Abstracts

Background: X-rays of the left hand and wrist are used to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides a framework for calculating bone age but specifies exact hand position. We noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, resulting in additional time, cost and radiation exposure. We introduced a simple radiolucent hand template to assist in positioning of the patient’s hand and assessed changes in X-ray quality and need for re-X-ray.

Method: The position of fingers, thumb and overall clarity of bone age X-rays were prospectively scored by a single Auxology Nurse blinded to whether or not the template was used. In the absence of a validated tool to assess quality a 1–3 scale (poor, adequate, and good) was devised. A radiolucent hand template was used in the intervention group. The need for re-X-ray was determined by set criteria.

Results: There were no significant differences between the control (n=259) or intervention groups (n=56) in terms of gender. The intervention group were slightly younger (P=0.03). Patients age ranged between 0.9 and 18.48 years (mean=9.99±3.84). The intervention improved scores. Fewer patients scored <3 for the position of fingers (14.67 and 10.71%, P=0.38), thumb (10.04 and 1.79%, P=0.06), and overall clarity (29.73 and 23.21%, P=0.41) for the intervention and control groups respectively. The template significantly reduced the numbers requiring repeat X-ray. No patient required a re-X-ray from the intervention group, compared to 28 in the control group (P=0.007).

Discussion: Achieving good quality bone age X-rays may be more difficult than previously assumed. The use of a simple radiolucent hand template has been shown to improve the positioning of the hand and significantly reduce the need for re-X-ray.