Protocol - Bone Age
The latest Tanner and Whitehouse Method, sometimes referred to as TW2, involves the interpretation of a radiograph of the left hand and wrist by a trained radiologist. The procedure includes the assessment of regions of interest (ROI) on 20 bones. The ROI include the epiphysis, metaphysis and diaphysis of each bone. The radiologist gives each ROI a numerical score and records the result. The numerical score of each ROI is summed to produce a total score.
This protocol must be administered by a radiologist professionally trained to evaluate bone age via the Tanner and Whitehouse Method. Since the online tool collects personal identifying information (PII), the researcher should use the individual’s initials and not include other identifiable information such as the person’s address.
The Tanner-Whitehouse Test is an online tool which was developed by Lorentz Jantschi and Sorana Bolboaca and is available at:
The tool describes various findings associated with each of the following 20 regions of interest (ROI) of the left hand as seen on x-ray. The ROIs are the:
- First, third, and fifth metacarpal
- Proximal phalanx of the thumb, third finger, and fifth finger
- Middle phalanx of the third and fifth finger
- Distal phalanx of the thumb, third finger, and fifth finger
Users select a finding that matches what they see on the x-ray. Each finding has two x-ray images, a drawing and a written description. Once a selection is made for each ROI, the users enters the patient’s name*, address, x-ray date, diagnostic, gender, weight, height and age (in years and months, for example 11 years and 3 months). Then the program calculates the individual’s bone age based upon the standard atlas associated with the Tanner and Whitehouse method. *See Specific Instructions for suggestions regarding personal identifying information.
Personnel and Training Required
A radiologist professionally trained to evaluate bone age via the Tanner and Whitehouse Method.
|Specialized requirements for biospecimen collection||No|
|Average time of greater than 15 minutes in an unaffected individual||Yes|
Mode of Administration
Noninvasive radiologic assessment
Toddler, Child, Adolescent
Ages 2-18 years old
The Rare Genetic Conditions Working Group selected the Tanner and Whitehouse Method because it is the most reproducible and, potentially, the most accurate procedure to determine bone age.
|caDSR Common Data Elements (CDE)||Bone Growth Calculated Bone age Value||4798035||CDE Browser|
|Human Phenotype Ontology||Delayed bone age||HP:0002750||HPO|
|Human Phenotype Ontology||Dysharmonic bone age||HP:0200000||HPO|
|Human Phenotype Ontology||Accelerated skeletal maturation||HP:0005616||HPO|
Process and Review
This section will be completed when reviewed by an Expert Review Panel.
Protocol Name from Source
Tanner and Whitehouse Method (TW2)
Online tool for assessment:
Jantschi, L., & Bolboaca, S. (2003). Tanner and Whitehouse Test. Available at vl.academicdirect.org/medical_informatics/bone_age/v1.0/
Tanner, J. M., Whitehouse, R. H., Marshall, W. A., Healey, M. J. R., Goldstein, H. (1976). Assessment of skeletal maturity and prediction of adult height (TW2 method). London: Academic Press.
Bull, R. K., Edwards, P. D., Kemp, P.M., Fry, S., & Hughes, I.A. (1999). Bone age assessment: A large scale comparison of the Greulich and Pyle, and Tanner and Whitehouse (TW2) methods. Archives of Disease in Childhood, 81, 172-173.
Ostojic, S. M. (2013). Prediction of adult height by Tanner-Whitehouse method in young Caucasian male athletes. QJM, 106, 341-345.
|Variable Name||Variable ID||Variable Description||dbGaP Mapping|
|PX220301140000||findings associated with each of the more||Variable Mapping|
|PX220301110000||findings associated with each of the more||Variable Mapping|
|PX220301130000||findings associated with each of the more||Variable Mapping|
|PX220301120000||findings associated with each of the more||Variable Mapping|
|PX220301050000||findings associated with each of the more||Variable Mapping|
|PX220301030000||findings associated with each of the more||Variable Mapping|
|PX220301150000||findings associated with each of the more||Variable Mapping|
|PX220301170000||findings associated with each of the more||N/A|
|PX220301100000||findings associated with each of the more||Variable Mapping|
|PX220301090000||findings associated with each of the more||Variable Mapping|
|PX220301270000||Patient Age in Years and Months||N/A|
|PX220301210000||Patient Full Name||N/A|
|PX220301080000||findings associated with each of the more||Variable Mapping|
|PX220301070000||findings associated with each of the more||Variable Mapping|
|PX220301060000||findings associated with each of the more||Variable Mapping|
|PX220301010000||findings associated with each of the more||Variable Mapping|
|PX220301180000||findings associated with each of the more||N/A|
|PX220301040000||findings associated with each of the more||Variable Mapping|
|PX220301200000||findings associated with each of the more||N/A|
|PX220301190000||findings associated with each of the more||N/A|
|PX220301160000||findings associated with each of the more||Variable Mapping|
|PX220301020000||findings associated with each of the more||Variable Mapping|
|PX220301230000||Date of X-Ray||N/A|
April 30, 2015
A clinical assessment of the bone growth of the left hand via an x-ray.
Bone age is an assessment of skeletal maturity and can be compared with chronological age to determine if there are abnormalities in development.
Bone, age, bone age, x-ray, radiologist, Tanner and Whitehouse Method, TW2, growth, height, developmental delay, adolescent, short stature, endocrine disorders, bone age assessment, BAA, hormone therapy, skeletal maturity