Bone Age (BA) Analysis from Bone X-Ray
Noor Syazana Bt Abd Ghani (20775)
Student of Electrical & Electronic Engineering
Universiti Teknologi Petronas
31750, Tronog, Perak
noorsyazanaabdghani@gmail.com
Abstract— Bone age is a method to analyze the
child skeleton’s maturity according to their age
level. Bone age assessment involves left hand
radiograph image for clear observation of the
growth plate which appeared darker on the
radiograph. Manual bone age assessment
basically take time f task in for radiologist and
there are always issue related to intra observer
and inter observer differences. In the study, the
analysis and classification of hand x-ray image is
experimented in order to determine the bone age
of young children from newborn to 12 years old.
To achieve the objectives, the bone age
classification method will involve image
segmentation of the x-ray, feature extraction
from the segmented images and lastly,
classification of bone age level. Results from the
classification can be used to access children
skeleton growth abnormality in which can be
observe that the ratio from 0.3 to 0.7
corresponding to the development child’ age 0
until 8 years old and the ratio with 1 value
correspond to the age 8 years and above.
Therefore, the result indicate that the algorithm
works well in analyze the bone age assessment.
I. INTRODUCTION
Bone age (BA) is the degree of bone
maturation and commonly use in diagnosis of
various children growth disorder. According to the
Ranjan S. (2011), the BA not only used for the
diagnosing but also for the monitoring and
treatment of growth abnormality related to the
endocrinology disorder, pediatric syndrome, or
hormone therapy [1].
Senior Lect. Dr. Norashikin Bt Yahya
Electrical & Electronic Engineering Department
Universiti Teknologi Petronas
31750, Tronoh, Perak
norashikin_yahya@utp.edu.my
The BA analysis usually take the x-ray of
left hand easy to observe and can see on how fast
and slow of their growing. The child’s bone, such as
those in finger and wrist, which have the growing
zone at the ends that’s called the growth plate.
Growth plate in fact is very easy to spot on an X-
ray, as they are softer and contain less mineral
which can make them darker and appeared clearly
on the radiograph compared to the others bone [2].
BA helps in analysis of the acceleration or the
delay of maturity of the skeleton growth but it does
not always indicate disease. Because of this, to
analyze the BA basically depending on the
experience and skills of the radiologist as required
extensive knowledge to get accurate result with the
standard atlas as the information of the BA has large
shape, size and textural variability.
In this assessment with the bone
development in technology will be focus on
analysis the x-ray image segmentation of the left
hand. This analyzing estimate the BA by take ROI
part and extracting image of the normal region of
hand. Therefore, this research will resulted in
development of automated BA prediction algorithm
using deep learning based on x-ray image for the
metaphysis, epiphysis and diaphysis bone. The
assessment is aiming to achieve a few goals that
must be accomplished with a specific target which
are to analyze bone from the x-ray image at
different level of age and to develop and evaluate
bone age prediction algorithm by utilizing machine
learning technique.
 II. LITERATURE REVIEW
In the study, the BA is the degree of
maturation of the skeleton growth of the child in
which keep growing from the born stage until the
finish growth as adult stage. According to the
Professor Peter (2016), maturity of the growth
plates in skeleton measured that determines by
radiologist examination of the left hand wrist as it
has a lot of growth center that can be scored and
appear more darker on the radiograph. [8]. BA
basically has been carried out by many researchers
to automate the BA analysis in order to help the
radiologist in doing their work for the observation
and analyzation in medical field.
In 2018 by Sabeti et. Al [2] said that in this
article, the BA analysis has been done by applying
three version of particle swarm optimization (PSO)
which are the standard PSO, the worst behavior –
based (PSO) and adaptive inertia weight (PSO) and
implement to image processing method of the x-ray
image in term of three segmentation criteria, the
classification accuracy, robustness against noise,
and computational complexity.
Compared to others article, in 2017, by C.
Spampinato et.Al, [9], automated BA approached
(relying on the TW method )using the deep learning
algorithm .The automated BA mostly rely on the
TW method which can be arranged dependent on
the picture preparing strategy as in the year 2000s,
Pietka et. Al (2003), [10] proposed an ROI
segmentation way by the phalanges distance
extraction which follow the TW method using the
fuzzy classifier. ROI segmentation also have been
used for accuracy of BA assessment. [1]
Therefore, from the ROI segmentation
which take the epiphysis bone as part of
segmentation, the deep learning or the convolution
neural network approached for the algorithm stage
are used the data set about 1400 x-ray image. It is
proved the deep learning solution are able to cope
effectively with the automated BA assessment using
the 1) off – the –shelf: provide an input image to the
network and reading the output vector of a fully-
connected layer that to be used to train into SVM
classifier. 2) Fine tuning pre trained CNN models:
this alternative reuse the existing model as the
initial condition on the target dataset. This will help
to speed up the training of the dataset. 3) Building
ad hoc CNN to take into account the weirdness part
which include the bone deformation on the x-ray
image. This approach aiming the scratch a CNN
designed ad-hoc and train with specific image.
Same as in 2017, the L.Hyunkwang et. Al,
in the fully automated deep learning system for BA
assessment which using the same method of CNN
to automated the BA analysis [11]. The article
approaches the full x-ray image radiograph of the
left hand as the input preprocessing to automate the
BA assessment: utilize the CNN which is to detect
the bones and tissue to extract the intensity,
contrast, and grayscale base as the feature extraction
followed by the vision pipeline that segment the
hand wrist by enhance the bone edges and reduce
noise of image that prior to training and testing.
From that, the ground truth binary is resulted and
classified use the ImageNet pre trained, fine tune
CNN and got the average 95 % accuracy for the
testing in female and male test radiograph.
Moreover, in 2014, the concept of the BA
analysis based on the ROI segmentation was also
proposed by the C Chin- Yen et. Al that evaluate
children’ BA on the radiograph of epiphysis and
metaphysis as the ROI location and segmentation
using the preprocessing technique [14]. After that,
the bone feature extraction is based on the
geometrical calculation concept that relates the
diameter between the epiphysis bone and the
metaphysis bone part. Geometrical feature can gives
clear indication of child bone development [3] and
before this, there is the same automated BA based
on the diameter calculation as the feature extraction
which is in year 2012 by L. Hsiu-Hsia et. Al [15].
With that, the ROI feature extraction has classified
using the KNN classifier under the binary decision
tree structure and giving an average accuracy of
71.25 %. And shows that the BA analysis is reliable
and effective assessment for aiding the pediatricians
in clinical practice.
Therefore, in this paper, our proposed
strategy demonstrated that it is adequate for BA
assurance in youthful kids between the ages of 0
until 12.
III. RESEARCH METHODOLOGY
The detection and features extraction of the
bone x-ray images play the main roles technique in
determine the different classes of the age
chronological development of bone.
The block diagram summarize the procedure
that illustrate in Figure 1 below.
Figure 1 Block Diagram of Bone Age Analysis
from Bone X-Ray
A) Input Image
The bone hand x-ray image dataset was
downloaded from the Kaggle.com website which
comprises the 200 testing images and 2000 training
images in each folder. The folders consists of left
and right hand x-ray images. The dataset of images
X-ray are obtained with the CSV containing the
information on what is to be predicted (training
folder) in such as age, gender, and some additional
information with reference to the standard of the
Greulish and Pyle (GP).
B) ROI Extraction
The first stage to analyze the bone age
basically doing the preprocessing pipeline in order
to extract the Region of Interest (ROI) from the x-
ray image and remove the unnecessary noise and
objects. The input dataset comes from different size
and different intensity of x-ray images. The simple
background removal function method also cannot
be general in all the x-ray images. Therefore, we
come out with several detection algorithm of the
ROI image in such as the Cascade and ACF
detection algorithm. However, these type of
detection algorithm basically requires large
manually labeled training set by using the Image
Labeler Application in the Matlab. Throughout
these method, the ACF detection algorithm can
detect more ROI accurately compare to the Cascade
as it requires more training dataset. Furthermore,
the processing image of ROI is used in such
enhancement image and convert to binary image in
order to calculate the pixel scanning.
We applied the image enhancement which is
the process of adjusting the images to become more
suitable for display by adjusting the contrast and
sharpen of an ROI image. Moreover, for image
segmented, we do the converting grayscale images
into binary images using the threshold technique
and edge detection to get the data boundaries of
object within image that detecting in brightness as
to measure the length feature of the images
C) Feature Extraction and Feature
Selection
By converting ROI images to the binary, we
split into two part which the epiphysis part and
diaphysis part. Rows scanning is used to measure
the length of the epiphysis and diaphysis in order to
measure the minimum and maximum of column.
Then, the ratio is measure by extracting that two
minimum and maximum of column.
D) Classification
The feature extraction will undergo the
classification method. The proposed method
basically using the SVM technique which perform
well when the dataset is noisier and that is why
SVM is commonly recommended for the
classification and nonlinear function approaches.
 Another method is manually classified
according to the theory classification which we
manually create the table and classified the length
of feature extraction to the classes of BA.
IV. RESULT AND DISCUSSION
A) Input data Figure 2 Detection of Bounding Box
The input data is retrieved from the In Figure2 shows the detected bounding box
Kaggle.com website which contributed 12612 comes with value of confidence level. The
images of x-ray radiographs including the age data confidence level means that the detection of the
information that correspond to the classes of bone score returned as M- by- 1 vector of classification
age. The input data divided into two part in which scores. The larger score value will indicate the
to be use for the training and testing data. In order higher confidence in epiphysis detection and the
to get the ROI image. correct ROI which is the epiphysis of the middle
finger.
B) Preparation of Data
In our approach, we fixed the 100 training
image that consists of different classes of the bone
age to train into several deep networks architectures
to evaluate how the various bones contributed to the
model’s performance across the development of
bone stages. As the input data come from different Figure 3 ROI Detection on Testing Image
type in such the intensity of color, the size of the
radiograph and so on, there is compelling need for C) Extract the ROI Part
the reliable and general hand segmentation
For this stage, we removed unnecessary part
technique. However, mostly detection algorithm
by cropping out the exact detectable bounding box.
typically need in a large amount manually labeled
Use the command imcrop to crop the original
training set. Therefore, we use the image labeler
detectable box according to the rectangle of box
application in the Matlab to employ the technique
which indicates the size and position of the yield
called positive instances.
square shape (x, y, width, tallness) or can called as
In general, the positive instances/images is the coordinates. The trimmed picture incorporates
an iterative procedure where manual label that all pixels in the info picture that are totally or
combine with automated processing code. This will halfway encased by the square shape. The resulting
allows in quickly obtain accurate masks for the output image is 122-by-123.
testing image in the training set using Aggregated
Channel Feature Detector Method
As the ACF is the detection framework, this
framework uses to detect object at multi scale so in
this assessment, the x-ray image segmentation need
to train first by train ACF object detector to create
an ACF object or part that can detect the epiphysis Figure 3 ROI Detection
bone.
E)Enhancement of the ROI Epiphysis.
 Getting the several technique of the image
enhancement approaches and comparing the
effectiveness as illustrated in Figure 4 and details
technique below:
1. 1) Imadjust. This technique increase the contrast of
the image of the input intensity image. Thus,
imadjust increase the contrast by default, saturates
the bottom 1% and top 1% of all pixel value.
2. 2) Histreq. Histreq performs the histogram
equalization. Enhance the image of the contrast by
transforming value in intensity image output image
will approximately matched to the specific
histogram which is the uniform distribution by
default.
3. 3) Adapthisteq. This technique perform the contrast
limit adaptive histogram equalization. Adapthisteq
is the other way instead of using the histreq
technique which operate on the small regions in the
image as well as tiles. It contrast of the each tiles to
get the output region approximately matches to the
specified histogram.
Figure 4 Enhancement of ROI; Image a) Before
Enhancement; b) Imadjust; c) Histogram
(Histreq) d) Adapt Histrogram (Adapthistreq)
D)Converting to the Binary Image
In this part, we imbinarized the ROI part which
functioned to create the binary image from 2D
grayscale image by replacing all values above a
globally determined threshold value. The threshold
value converts the intensity of the image. Next,
from the binary image, we get the value of 0 and 1
to calculate the length of the epiphysis and
diaphysis.
Figure 5 Binary ROI
D) Measuring of Epiphysis and
Diaphysis
The ROI part is then divide into two part
which are the upper part and below part to get the
ratio of length of development of the bones.
Basically, the binary image is to normalize
radiographs for a grayscale image. The image have
the black background and white color in bones.
Image size varies considerably from a few numbers
to a few hundred pixels.
The epiphysis (upper part) of image, we
calculated the pixel mean of the last 15 rows with
all columns image patches while the lower part of
ROI, we take the first 15 rows with all columns
image patches. By the row scanning, we extract the
change point which selecting the smallest and the
largest column.
Figure 5 Illustration of Calculating Epiphysis
Pixel Length
Same as the Diaphysis (lower part), we extract the
length by the rows scanning which calculate the
pixel mean and find the minimum and maximum of
column of the first 15 rows as figure 6 below.
Figure 6 Illustration of Calculating Diaphysis
Pixel Length
E) Classification of Bone Age
After the image detection and processing,
the feature extractions are used for the classifier
analysis. The length and ratio of the metaphysis and
diaphysis have been calculated after scanning the
image as in the table 1 and the performance of the
chronological bone age is correspond with the
theoretical true means.
Table 1 Classification of the Bone Age
V. CONCLUSION
In conclusion, the bone age reflects the
skeletal maturity when differing significantly from
chronological age. In this analysis, the reliable
feature extraction is the most important key point
for analyze the development of the bone age.
However, the method contains the detection of ROI
of the epiphysis and diaphysis part and the mean
pixel for measured the length and ratio.
Therefore, the detection algorithm and the
image processing enable works in fine even if the
image is not scanned exactly as per the standard
radiologist’s prescription. Future work can be done
to improve the method of measuring the epiphysis
and diaphysis length. A possible technique would
be to introduce object detector technique at splitting
of epiphysis and diaphysis. We believe this method
will generalized well to other X-ray dataset and by
develop algorithm for automatic classification of
bone age using multi-level technique, this will
involve preparing table which it corresponding the
features. The possible feature extraction method
include area, ratio and mean. This feature variable
will be fed into multiclass classifier for bone age
assessment.
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