Author contributions: Guarantors of integrity of entire study, A. To collect up-to-date data in healthy children to create a digital hand atlas DHA that can be used to evaluate, on the basis of the Greulich and Pyle atlas method, racial differences in skeletal growth patterns of Asian, African American, white, and Hispanic children in the United States. Informed consent was obtained from all subjects or their guardians. From May to March , a DHA containing hand and wrist radiographs obtained in male and female Asian, African American, white, and Hispanic children with normal skeletal development was developed. The age of subjects ranged from 1 day to 18 years. Each image was read by two pediatric radiologists working independently and without knowledge of the subject's chronologic age, and evaluation was based on their experience with the Greulich and Pyle atlas. Statistical analyses were performed with the paired-samples t test and analysis of variance to study racial differences in growth patterns.
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