Purpose or Case Report: Assessing and reporting pediatric bone age is a subjective and often tedious multi-step process. The typical reporting workflow at our institution requires perusing a hardcopy of a bone age atlas to find an image matching the PACS screen, finding reference values in a table, and performing rote arithmetic to determine the progress of skeletal maturity.
Methods & Materials: We developed and implemented a website with an atlas of reference images and a dynamic report generator, using HyperText Markup Language (HTML), Cascading Style Sheets (CSS), JavaScript, jQuery, and additional open source web development tools. Data and images were obtained from the commonly used Greulich and Pyle (G&P) reference atlas as well as our institution. This website is universally accessible and does not require any special hardware, software, or storage media.

Using this website, interpreting radiologists simply select the patient’s sex and date of birth, then use the mouse to scroll through reference images. A standardized structured report is dynamically generated for use in a radiology reporting system.
Results: This method of assessing and reporting pediatric bone age was implemented in our radiology department and found widespread acceptance, with nearly all users noting increased accuracy and efficiency based on a survey following several months of implementation. 14 of 14 (100%) users indicated increased accuracy, 14 of 14 (100%) indicated increased efficiency, and 9 of 10 surveyed residents (90%) indicated improved resident-attending concordance following implementation. Furthermore, blinded retrospective comparison of this web-based method with the traditional method across 50 studies showed a 96% concordance within 6 months estimated bone age.
Conclusions: Modern web development technology tools can help improve quality and efficiency in many domains of radiology, such as assessing and reporting pediatric bone age, by streamlining and automating workflow.