In pediatric patients, skeletal maturity is an important tool for detection of hormonal, growth or genetic disorders. The Fels method is a well-known visual assessment method in which the skeletal age is estimated by grading 98 skeletal indicators in the hand-wrist radiographic (x-ray) image. These indicators are features that reflect the three-dimensional shape of the bones and change during the maturation process. Generally, the Fels indicators could be categorized into three main groups of the status of ossification, the ratios of bone widths, and epiphysealdiaphyseal fusion.
& Wischgoll, T.
(2016). A Semi-Automated Computer Program for Assessment of Skeletal Maturity in Children. .