Product: IB Lab PANDA, BoneXpert Company: ImageBiopsy Lab, Visiana

Comparison of BoneXpert and IB-Lab-PANDA automated Bone Age Evaluation in Children With Growth and Puberty Disorders

Journal of the Endocrine Society, 2025

Abstract

Context

Bone age (BA) evaluation in children presenting growth problems is time-consuming. Artificial intelligence (AI) BA assessment programs are increasingly used. However, agreement between different commercially available methods in the same population, or possible age-, puberty- or sex-related differences have not been sufficiently evaluated.

Methods

BA assessment of 521 left hand radiographs of patients aged 2-19 years with IB-lab-PANDA® and BoneXpert® were compared. Of the 521 radiographs, 213 were compared to the Greulich-Pyle (GP) reference. We analyzed gender, age, diagnosis, body mass index (BMI) and puberty categories. Accuracy was calculated as mean-absolute-deviation (MAD) and root-mean-square-error (RMSE).

Results

MAD was 0.61 years and the RMSE 0.83 years between BoneXpert and IB-lab-PANDA, with poor agreement in girls over 14 years (MAD 1.18 years).

Compared to the manual rating, both methods showed a positive bias in boys (0.28 years BoneXpert vs 0.51 years IB-lab-PANDA) and in children with pathologies associated with BA delay (BoneXpert 0.18 years vs IB-lab-PANDA 0.35 years). IB-lab-PANDA underestimated BA in girls after 14 years (−0.67 years). IB-lab-PANDA had a MAD of 0.64 years and RMSE of 0.85 years compared to manual assessment, whereas BoneXpert had a MAD of 0.63 years and RMSE of 0.82 years.

BoneXpert was significantly more accurate than IB-lab-PANDA in prepubertal children (MAD 0.7 vs 0.83 years; P = .027).

Conclusion

The direct agreement between IB-lab-PANDA® and BoneXpert® falls within human inter-rater variability. Their agreement on manual BA determination is equivalent except in prepubertal children, where BoneXpert seems more accurate. Both are fast, valuable tools for determining BA accurately and efficiently.

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