This audit analysed the Tanner and Whitehouse II twenty bone (TW2) method of bone age assessment which was used in our department, and compared it with the Greulich and Pyle (GP) method. 50 previous bone ages were independently re-calculated by each of three registrars using both techniques, with the time taken to perform each assessment being recorded. For each method the interobserver variation was analysed in terms of the spread of results. The intraobserver variation in TW2 was determined by comparing the bone age originally reported with that subsequently calculated on the same film by the same registrar. The average spread of results was 0.74 years for TW2 method, and 0.96 years for the GP method and this difference is not statistically significant at the 5% level. The average intraobserver variation to TW2 was 0.33 years, but with 95% confidence limits of -0.87 to +1.53 years. The average time taken was 7.9 min for TW2 and 1.4 min for GP assessments. It was concluded that the GP method gave similar reproducibility and was faster than the TW2 method. Following clinical discussion the routine departmental bone age assessment method was changed from the TW2 to the GP method.
A woman of 31 years presented acutely to her general practitioner with left sided pleuritic chest pain of short duration. She had no significant past medical history and was otherwise asymptomatic. On examination, her doctor found no abnormality in the chest, but discovered a large ill defined mass in the left upper abdomen.
He requested a plain radiograph of the abdomen (Fig. 1) and an upper abdominal ultrasound (Fig. 2) before referring the patient to hospital where a computed tomographic (CT) scan of the abdomen was performed (Fig. 3).
What is the diagnosis and how should the patient be managed?
The plain abdominal radiograph confirms the presence of a large rounded mass of soft-tissue density in the left upper quadrant.
Extra-cranial skeletal metastases from primary intra-cranial gliomas are very rare. A case is reported of a patient who developed widespread skeletal deposits fifteen months after the excision of a cystic frontal astrocytoma.
I was very interested to read a recent article, “Testing a policy for skull radiography (and admission) following mild head injury” (de Lacey et al, 1990). It occurred to me that it might be an interesting exercise to cost out the financial implications of abandoning our “loose and liberal” policies on skull radiography and the impact of doing that on the hospital admission rate.
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