Bone age assessment: comparative analysis of Greulich-Pyle and Tanner-Whitehouse 3 by pediatric radiologists…

StudyBMC medical imaging· Apr 2026

Bone age assessment: comparative analysis of Greulich-Pyle and Tanner-Whitehouse 3 by pediatric radiologists and endocrinologists.

Nipaporn Tewattanarat, Wichuda Chaisiwamongkol, Pitchaya Wiratchotisatian … Ratikorn Chaisiwamongkol

Pediatric RadiologyStudyDiagnosisQ1IF 4.4

GP and Tanner-Whitehouse 3 bone age estimates differ by 2.5–3.3 months in most ages

Bone age assessment: comparative analysis of Greulich-Pyle and Tanner-Whitehouse 3 by pediatric radiologists and endocrinologists.

Nipaporn Tewattanarat … Ratikorn Chaisiwamongkol

BMC medical imaging · Apr 2026 · Q1 in Radiology

Background

Two widely used bone age assessment (bone age assessment) methods—Greulich-Pyle (Greulich-Pyle) and Tanner-Whitehouse 3 (TW3) methods—differ in complexity, accuracy, and clinical utility.

Purpose

To compare Greulich-Pyle and TW3 bone age estimations and assess inter- and intra-observer agreement between pediatric radiologists and endocrinologists.

Methods

This retrospective study analyzed 1,725 left-hand radiographs of children aged 0–19 years (2008–2022).

n = 1,725 left-hand radiographs

Results

2.5–3.3 months

Average difference between the two bone age methods was small in most age groups.

n = 1,725 left-hand radiographs

More results

Greulich-Pyle estimates ranged from 6 to 228 months, whereas TW3-RUS estimates were slightly lower due to age-range limitations.

Mean bone age did not differ significantly between specialties using Greulich-Pyle, whereas minor differences were observed with TW3-RUS for overall (p < 0.001) and when stratified by sex (males p = 0.016, female p = 0.005).

More results

Age-stratified analysis demonstrated low mean absolute differences (mean absolute differences) between specialties across most age groups, with slightly greater variability in 84.1–180 months.

Greulich-Pyle assessments were significantly faster than TW3-RUS (p = 0.002).

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Conclusion · 1 of 2

Both specialists demonstrated excellent agreement using both Greulich-Pyle and TW3-RUS. We recommend Greulich-Pyle as the primary method, reserving TW3-RUS for complex cases.

Conclusion · 2 of 2

Moreover, developing a Greulich-Pyle-analog atlas with narrower, finely defined age intervals may improve clinical applicability.

Bone age assessment: comparative analysis of Greulich-Pyle and Tanner-Whitehouse 3 by pediatric radiologists and endocrinologists.

Bone age assessment: comparative analysis of Greulich-Pyle and Tanner-Whitehouse 3 by pediatric radiologists and endocrinologists.

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