Post on 08-Jan-2017
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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