利用Tanner and Whitehouse方法且具使用者權限分級之雲端骨齡判讀服務系統研製

Implementation of A Cloud Bone Age Assessment Service System Using Tanner and Whitehouse Method With User Privilege Classification

楊志聖(Chih-Sheng Yang)

指導教授 ： 鐘太郎

國立清華大學/電機資訊學院/電機工程學系/碩士(2013年)

https://doi.org/10.6843/NTHU.2013.00778

摘要

在醫學應用上手骨骨齡評估主要用於衡量幼兒骨骼發育情形，可經由骨齡來判斷兒童的發育情況與成熟度，不僅可以得知兒童是否有發育不良的情形，還可用來預測成年後的身高，對於小兒科內分泌診斷有許多幫助。現今骨齡評估方法以Tanner and Whitehouse (TW3)法最常被使用，TW3骨齡評分法的評分方式是使用手骨X光片中20個骨頭部位與各自的8~9張不同年齡層的標準圖做比對獲得成熟度分數，再將所有分數加總起來對照年齡換算表可獲得評估骨齡。
在以往使用TW3紙本評分需耗費許多計算時間與紙張，並且評估者手上必須要有不同年齡層的標準圖才能比對，本論文則是以雲端網路為基礎架構，透過使用PHP、MySQL與Javascript將Tanner and Whitehouse (TW3)評分法實際應用於網頁系統上，使評分過程可以無紙化且變得更為方便，也可隨時連上網路即可操作評分。本系統還應用了使用者權限分級的架構，讓不同層級的使用者可以使用不同的功能與服務，而每位使用者也可擁有屬於自己的資料，並且藉由分享資料與授權資料功能，可讓使用者間的交流更為方便。在TW3評分方式上也改進了前一版本無法直接選擇評分部位選項的問題，本版本可直接點選手骨部位圖即可顯示此部位的標準圖，並對此部位做評分，讓評分作業變得更容易也更有效率。此外也新增能夠放大想評分的X光片部位與儲存圖片，讓TW3評分方式能夠更趨向於自動化評分。另外對於骨齡判讀還新增了一套以腕骨面積比為特徵來自動判讀骨齡的功能，可直接自動化判讀骨齡。
本系統主要發展的使用者階層分級架構可以推廣至各級醫院使用，使用者權限分級的概念可讓醫院上層、醫師與醫護人員等不同使用者行使不同的權限與功能，達到雲端醫療的階層分級制度，更可有效的保護個人病歷資料。

關鍵字

骨齡評估 ； PHP ； MySQL ； Javascript ； Tanner and Whitehouse Method ； 雲端醫療 ； 使用者權限分級

並列摘要

In medical applications, bone age assessment is mainly used to measure children's bone development situations, which can not only provide an insight into whether a child is experiencing growth problems, but also be used to predict the adult height of the child. It makes a lot of help for the diagnosis of pediatric endocrinology. Currently the most popular method for bone age assessment used clinically is the Tanner and Whitehouse (TW3) method. TW3 scoring method examines 20 regions of the hand bone X-ray film against standard sketches of 8 or 9 different growth stages of each region respectively to get the maturity scores for each region. Finally, the bone age is determined by summing up all the scores and comparing to the age conversion table.
In the past, when performing bone age assessment using TW3 method, the physicians or trained technicians/nurses would spend quite a bit of time in computing the scores and converting the scores to ages. Meanwhile sheets of papers for scoring were needed. Therefore, we propose a web-based bone age assessment system which is based on cloud network architecture and can provide the physicians or trained technicians/nurses with a quick and convenient way of performing TW3 assessment without paper. The system is implemented by using open resources such as PHP, MySQL and Javascript. It makes the TW3 scoring process become more convenient. And the user can use the system by connecting to the Internet at anytime and anywhere. The system also supports a user privilege classification framework. Therefore, different users can use different features and services from different privilege levels. Each user can have their owned data. Communications between users become more convenient by the provided mechanism of sharing assessment results and authorizing data. In TW3 scoring aspect, this system also improved the problem in previous versions of not being able to select the rating bone region directly. This version can select growth stage options directly by pointing to the bone region on the hand bone diagram, which make the scoring operation easier and more efficient. In addition it can also magnify whichever region the user wants to compare on the X-ray film and store the magnified picture. It can let the TW3 scoring be more automatic. Besides, our system also add a set of feature that can interpret the bone age fully automatically by using the area ratio of carpals.
The main purpose in this system is to develop a user privilege classification that can be extended to all levels of hospitals. The concept of user hierarchy provides three privilege levels for hospital’s superiors, doctors and medical technicians/nurses. So different users have different privileges and can use features, including data and functions, corresponding to his/her privilege levels. With this mechanism, the proposed system not only achieves a hierarchical classification system of medical cloud, but also protects the personal medical records effectively.

並列關鍵字

bone age assessment ； PHP ； MySQL ； Javascript ； Cloud computing ； Tanner and Whitehouse method, ； user privilege classification

參考文獻

[1]J. M. Tanner, Assessment of skeletal maturity and prediction of adult height (TW2 method). London; New York: Academic Press, 1975.

[2]J. M. Tanner, H. Goldstein, N. Cameron, W. B. Saunders, and M. J. R. Healy, Assessment of skeletal maturity and prediction of adult height (TW3 method), 3rd ed. W.B. Saunders, 2001.

[3]W. W. Greulich and S. I. Pyle, Radiographic Atlas of Skeletal Development of the Hand and Wrist, 2nd ed. Stanford, CA: Stanford University Press, 1959.

[5]W. W. Greulich and S. I. Pyle, Radiographic atlas of skeletal development of the hand and wrist. Stanford, CA: Stanford University Press, 1959.

[6]D. G. King, D. M. Steventon, M. P. O'Sullivan, A. M. Cook, V. P. Hornsby, I. G. Jefferson, and P. King, "Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods," British Journal of Radiology, vol. 67, pp. 848-851, Sept. 1994.