Papers by Mikaela Reynolds
Anatomical variation is the norm: A novel curriculum framework
Anatomical sciences education, Apr 23, 2024
Background Bone age (BA) assessments are a clinically relevant indicator of biological maturation... more Background Bone age (BA) assessments are a clinically relevant indicator of biological maturation and are frequently conducted in paediatric radiology. The applicability of traditional bone age estimation techniques to a Queensland, Australian population are questioned as the standards are based on non-contemporary samples derived from different reference populations to Australia. The Greulich and Pyle (GP) method requires the analysis of radiographs of the left hand and wrist and is one of the most widely utilised to estimate bone age, despite the method being subjective. Due to secular trends in maturation, new contemporary bone age estimation standards are required in order to represent ossification timings seen in modern populations. Additionally, studies have demonstrated that there is a need for population-specific standards due to environmental and social influences observed between populations, which are likely to cause variations in growth trajectories. Aims This study aimed to measure the rate of ossification in the hand and wrist to construct modern qualitative and quantitative bone age standards specific to the Queensland population, and to compare skeletal maturation rates between Australian Aboriginal and Torres Strait Islander and Australian multi-ancestral subadult populations. Specifically, the objective was to use digital radiographs to conduct areal measurements, various linear measurements and a novel scoring technique to investigate the pattern of ossification of the bones of the hand and wrist. Overall, this study aimed to provide novel methodological approaches to reduce the subjective error Constructing Improved Standards for Bone Age Assessment of Australian Children iii associated with current techniques, and to improve bone age estimation in the Queensland population. Methods De-identified, retrospective digital radiographs of the left hand and wrist were attained from 610 individuals (n=278 females; 332 males) aged birth to 20 years, scanned in a clinical/hospital setting between 2009 and 2018 predominately for clinical trauma evaluation. The radiographs were acquired from various geographical locations Queensland-wide, thus are representative of a Queensland, Australian population. The two-dimensional (2D) dorsi-palmer hand-wrist plain film radiographs were imported into DICOM viewer software Weasis for morphometric and morphological analyses. Carpal bone area (B.Ar) and tissue area of the carpus (T.Ar) were quantified along with linear length and width measurements of all metacarpals and phalanges, and ossification of primary and secondary centres were assessed using a modified sevenstage scoring criteria derived from developmental milestones reported in the literature. All methodological approaches demonstrated high repeatability and reliability in intraand inter-observer error testing (ICC >0.99, Kappa >0.87). Ethical approval was granted by The Children'
helped me more than I can explain, and I hope someday I will be able to return what you have give... more helped me more than I can explain, and I hope someday I will be able to return what you have given so willingly. To my partner Josh, thank you for your patience and emotional support, you have been so understanding and caring considering I have spent hours in front of my computer every night! To the members of the Skeletal Biology and Forensic Anthropology Research Program-my supervisors, Dr Laura Gregory and Ms Donna MacGregor, thank you so much for your advice, hours of drafting and guidance, this thesis is a result of a combined effort and would not be the same without your assistance, and Miss Nicolene Lottering thank you for your input, encouragement and friendship. I also extend my thanks to Mr Matthew Meredith and the Queensland Health Forensic and Scientific Services for the supply of Mortuary data, I am very grateful for your efforts to keep the samples rolling through. High Performance Computing and Research Services staff, Mr Mark Barry and Dr Lance Wilson, as well as Dr Beat Schmutz from the Trauma Research Group, your technical expertise has been invaluable and my research could not have gone ahead without your advice and suggestions. I also extend many thanks to Dr Clair Alston for your statistical input, I am very appreciative of your generosity and assistance with the Bayesian statistics.
Journal of Anatomy, Apr 25, 2022
Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical asses... more Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical assessment and management of both paediatric and sub-adult patients presenting with heel pain. Despite this, the current understanding of calcaneal apophyseal development is constrained by the limitations of the imaging modalities used to examine the apophysis, with no current literature reporting the development of the medial and lateral processes. This study aimed to overcome these limitations by investigating the ossification and fusion of the calcaneal apophysis using three-dimensional computed tomography analysis, and statistically predicting the apophyseal developmental stage in contemporary Australian children. The development and fusion status of the apophysis was scored using a novel 11-stage scoring system on 568 multi-slice computed tomography scans (295 females; 274 males) and 266 lateral radiographic scans (119 females; 147 males) from the Queensland Children's Hospital. Multinomial logistic regression along with classification tables and predictive probabilities were then utilised to assess developmental stage likelihood from known age and sex. The apophysis commenced ossification at a mean age of 5.2 years for females and 7.2 years for males, and then elongated to form the apophyseal cap around 10 years for females and 12.4 years for males. Fusion of the apophysis commenced at a mean age of 11.18 years for females and 13.3 years for males, with the earliest age of complete fusion observed at 10 years for females and 14 years for males. The results demonstrate significant sexual dimorphism in ossification and fusion with females developing and fusing significantly earlier. Furthermore, the use of computed tomography in this study allowed for the first time evaluation of the ossification and fusion of the medial and lateral processes of the calcaneus. The medial process formed at a mean age of 9.5 years for females and 10.9 years for males while the lateral process formed at around 9.8 years for females and 11.7 years for males. The medial process demonstrated slower rates of fusion compared to the lateral process. The present study provides Queensland specific standards for assessing the calcaneal apophyseal developmental stage as well as novel predictive regression models for apophyseal stage estimation using known age and sex to aid in the diagnosis of heel pain conditions such as apophysitis or screen for developmental delays in children and subadults.
Quantifying the ossification of the carpus in skeletal age estimation: Radiographic standards for Australian subadults
Forensic Science International, Aug 1, 2019
An evaluation of the development of a child's skeleton and estimation of bone age provides an... more An evaluation of the development of a child's skeleton and estimation of bone age provides an insight into a child's overall maturation. This study aimed to introduce a contemporary method for assessing bone age of Australian children using formulae incorporating carpal areal measurements. The standards introduced in this study can be used to assess the developmental status of Australian children who may be affected by growth-related illnesses. Additionally, in situations where the living age of a subadult is unknown, methodologies to accurately estimate age are required, particularly in the Western world where knowledge of the age of an individual is necessary for legal reasons. The sample consisted of retrospective hand and wrist radiographs acquired from 541 children (females: 246, males: 295) aged from birth to 20 years. Using the DICOM viewer Weasis, the carpal area ratio (B.Ar/T.Ar) was calculated for each individual radiograph by measuring the carpal bone area (B.Ar) and total tissue area of the carpus (T.Ar). A changepoint regression model demonstrated that the model constructed in this study was the most accurate in the younger age groups and was able to accurately determine whether a child was under 12 years if female and 13 years if male. A rapid acceleration of growth was observed at approximately 12-13 years in our sample, which may represent the onset of the pubertal growth spurt; this resulted in a high data variance and low model prediction accuracy in female and male children older than 12 and 13 years, respectively.
BMC Medical Education, Jun 17, 2022
Background: Bioscience is essential knowledge for nursing practice and is an important component ... more Background: Bioscience is essential knowledge for nursing practice and is an important component of undergraduate nursing education, however students commonly feel anxious about studying the subject. The purpose of this study was to develop appropriately scoped contextually relevant bioscience lesson resources to enhance student engagement and performance and reduce attrition and unit failures over a sustained period. Methods: Participants included students enrolled in the core bioscience unit for an undergraduate Bachelor of Nursing degree from a central campus and a widening participation (WP) campus. From 2016 to 2018, unit learning resources were progressively revised to include a structured learning and teaching manual, signposted lectures, and digital resources. Online surveys and formal institutional data collection metrics were used to assess the impact of the changes to unit learning resources. Results: Student attrition rates and failure rates for the unit were reduced over a two-year period across a diverse student cohort. Conclusions: Scaffolded and diverse learning materials support the success of undergraduate bioscience students by improving student engagement and reducing cognitive load.
Calcified Tissue International, Aug 31, 2022
Whilst quantitative ultrasound can be reliably used to assess bone health in adults, the fixed lo... more Whilst quantitative ultrasound can be reliably used to assess bone health in adults, the fixed ___location of the transducers in current devices may result in inaccurate and unreliable measurements in bone assessment in children due to the variation in foot size during growth. To improve positioning for paediatric assessment, Jaworski et al. (1995) created an anatomical method to identify the region of interest (ROI), however, there have been no medical imaging studies to confirm that the Jaworski method results in consistent placement of the transducer on the centre of the calcaneal body to avoid edge artefacts. In this study, computed tomography scans of the tarsus were collected from 498 individuals (258 females; 240 males) aged 2 to 20 years and used to create three novel anatomical methods to identify ROI on the calcaneus using palpable landmarks. In addition, the established Jaworski method was applied to the same scans and compared to our novel methods. The maximum ROI significantly increased with age with males having significantly greater diameters, supporting the recommendation that ½ inch diameter transducers should be used on individuals younger than 7 years of age. We identified that 79% of the 'Jaworski points' lied anterosuperior to the ROI centre point identified in this study, with 10% of the points lying outside the ROI. Of the three novel methods, only the calcaneal insertion method demonstrated small measurement variance between individuals of the same age in each sex and is therefore the preferred method for ultrasound clinical application.
Journal of forensic radiology and imaging, 2014
Brough et al. in response to the recently published article: Introducing standardized protocols f... more Brough et al. in response to the recently published article: Introducing standardized protocols for anthropological measurement of virtual sub-adult crania using computed tomography.
Forensic Science International, Aug 1, 2018
Despite the recognized flaws in applying traditional stature estimation equations such as those o... more Despite the recognized flaws in applying traditional stature estimation equations such as those of Trotter and Gleser (1952) to a contemporary population, there are currently no available alternatives for stature estimation in Australia that address these limitations. Post mortem computed tomography (PMCT) DICOM scans of the left and right femora were acquired from 76 Australian deceased individuals aged 17-76 years for metric analysis. Femoral bicondylar length, femoral epicondylar breadth and anterior-posterior (AP) diameter, medial-lateral (ML) diameter, circumference and cortical area at the femoral midshaft were measured on threedimensional (3D) models to build statistical models for estimating stature. In addition, Australian individuals aged 16-63 years (n=111) were measured in standing and supine positions to aid in the adjustment of supine stature of deceased individuals utilized in this study to standing stature. The results of this preliminary evaluation strongly indicate that the optimal model for estimating stature includes bicondylar femoral length and epicondylar breadth, that the effect of sex as an independent variable is very low, and there is limited practical benefit in including age in the estimation of stature. Our study indicates that the Australian population sampled represents a small yet significant shift in stature from the original Trotter and Gleser sample. Additionally, in the case of fragmentary remains, it was found that epicondylar breadth and AP diameter had the highest probability of accurate stature estimation in the absence of bicondylar femoral length. As stature forms a significant component of a biological profile and therefore aids in the personal identification of human remains, it is important that forensic anthropologists utilize the most accurate methodologies available. Stature estimation of Australian individuals is therefore achieved with higher accuracy through utilizing the femoral equations proposed in this study.
Calcified Tissue International
Whilst quantitative ultrasound can be reliably used to assess bone health in adults, the fixed lo... more Whilst quantitative ultrasound can be reliably used to assess bone health in adults, the fixed ___location of the transducers in current devices may result in inaccurate and unreliable measurements in bone assessment in children due to the variation in foot size during growth. To improve positioning for paediatric assessment, Jaworski et al. (1995) created an anatomical method to identify the region of interest (ROI), however, there have been no medical imaging studies to confirm that the Jaworski method results in consistent placement of the transducer on the centre of the calcaneal body to avoid edge artefacts. In this study, computed tomography scans of the tarsus were collected from 498 individuals (258 females; 240 males) aged 2 to 20 years and used to create three novel anatomical methods to identify ROI on the calcaneus using palpable landmarks. In addition, the established Jaworski method was applied to the same scans and compared to our novel methods. The maximum ROI significa...
Quantifying the ossification and fusion of the calcaneal apophysis using computed tomography
Journal of Anatomy
Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical asses... more Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical assessment and management of both paediatric and sub-adult patients presenting with heel pain. Despite this, the current understanding of calcaneal apophyseal development is constrained by the limitations of the imaging modalities used to examine the apophysis, with no current literature reporting the development of the medial and lateral processes. This study aimed to overcome these limitations by investigating the ossification and fusion of the calcaneal apophysis using three-dimensional computed tomography analysis, and statistically predicting the apophyseal developmental stage in contemporary Australian children. The development and fusion status of the apophysis was scored using a novel 11-stage scoring system on 568 multi-slice computed tomography scans (295 females; 274 males) and 266 lateral radiographic scans (119 females; 147 males) from the Queensland Children's Hospital. Multinomial logistic regression along with classification tables and predictive probabilities were then utilised to assess developmental stage likelihood from known age and sex. The apophysis commenced ossification at a mean age of 5.2 years for females and 7.2 years for males, and then elongated to form the apophyseal cap around 10 years for females and 12.4 years for males. Fusion of the apophysis commenced at a mean age of 11.18 years for females and 13.3 years for males, with the earliest age of complete fusion observed at 10 years for females and 14 years for males. The results demonstrate significant sexual dimorphism in ossification and fusion with females developing and fusing significantly earlier. Furthermore, the use of computed tomography in this study allowed for the first time evaluation of the ossification and fusion of the medial and lateral processes of the calcaneus. The medial process formed at a mean age of 9.5 years for females and 10.9 years for males while the lateral process formed at around 9.8 years for females and 11.7 years for males. The medial process demonstrated slower rates of fusion compared to the lateral process. The present study provides Queensland specific standards for assessing the calcaneal apophyseal developmental stage as well as novel predictive regression models for apophyseal stage estimation using known age and sex to aid in the diagnosis of heel pain conditions such as apophysitis or screen for developmental delays in children and subadults.
Stature estimation of a contemporary Australian sub-population: An evaluation of the Trotter and Gleser method using computed tomography of the femur
Utilising computed tomography scans to allow a virtual analysis of three-dimensional reconstructi... more Utilising computed tomography scans to allow a virtual analysis of three-dimensional reconstructions of the femur, this project confirms that the traditional 1952 Trotter and Gleser stature estimation equations are inapplicable for a contemporary Queensland population. Therefore, this study introduces modern stature estimation equations for femoral length and fragmentary femoral remains using Bayesian statistics for application in forensic anthropological casework. In addition, it was found that caution needs to be applied when comparing estimated stature to reported stature on the missing persons database due to inaccuracy in Queensland drivers' licences.
Author response to: Brough et al. in response to the recently published article: Introducing standardized protocols for anthropological measurement of virtual sub-adult crania using computed tomography
Firstly, we would like to thank Ms. Alison Brough and her colleagues for their positive commentar... more Firstly, we would like to thank Ms. Alison Brough and her colleagues for their positive commentary on our published work [1] and their appraisal of our utility of the “off-set plane” protocol for anthropometric analysis. The standardized protocols described in our manuscript have wide applications, ranging from forensic anthropology and paleodemographic research to clinical settings such as paediatric practice and orthopaedic surgical design. We affirm that the use of geometrically based reference tools commonly found in computer aided design (CAD) programs such as Geomagic Design X® are imperative for more automated and precise measurement protocols for quantitative skeletal analysis. Therefore we stand by our recommendation of the use of software such as Amira and Geomagic Design X® in the contexts described in our manuscript...
Background Bone age (BA) assessments are a clinically relevant indicator of biological maturation... more Background Bone age (BA) assessments are a clinically relevant indicator of biological maturation and are frequently conducted in paediatric radiology. The applicability of traditional bone age estimation techniques to a Queensland, Australian population are questioned as the standards are based on non-contemporary samples derived from different reference populations to Australia. The Greulich and Pyle (GP) method requires the analysis of radiographs of the left hand and wrist and is one of the most widely utilised to estimate bone age, despite the method being subjective. Due to secular trends in maturation, new contemporary bone age estimation standards are required in order to represent ossification timings seen in modern populations. Additionally, studies have demonstrated that there is a need for population-specific standards due to environmental and social influences observed between populations, which are likely to cause variations in growth trajectories. Aims This study aimed to measure the rate of ossification in the hand and wrist to construct modern qualitative and quantitative bone age standards specific to the Queensland population, and to compare skeletal maturation rates between Australian Aboriginal and Torres Strait Islander and Australian multi-ancestral subadult populations. Specifically, the objective was to use digital radiographs to conduct areal measurements, various linear measurements and a novel scoring technique to investigate the pattern of ossification of the bones of the hand and wrist. Overall, this study aimed to provide novel methodological approaches to reduce the subjective error Constructing Improved Standards for Bone Age Assessment of Australian Children iii associated with current techniques, and to improve bone age estimation in the Queensland population. Methods De-identified, retrospective digital radiographs of the left hand and wrist were attained from 610 individuals (n=278 females; 332 males) aged birth to 20 years, scanned in a clinical/hospital setting between 2009 and 2018 predominately for clinical trauma evaluation. The radiographs were acquired from various geographical locations Queensland-wide, thus are representative of a Queensland, Australian population. The two-dimensional (2D) dorsi-palmer hand-wrist plain film radiographs were imported into DICOM viewer software Weasis for morphometric and morphological analyses. Carpal bone area (B.Ar) and tissue area of the carpus (T.Ar) were quantified along with linear length and width measurements of all metacarpals and phalanges, and ossification of primary and secondary centres were assessed using a modified sevenstage scoring criteria derived from developmental milestones reported in the literature. All methodological approaches demonstrated high repeatability and reliability in intraand inter-observer error testing (ICC >0.99, Kappa >0.87). Ethical approval was granted by The Children'
Background Bioscience is essential knowledge for nursing practice and is an important component o... more Background Bioscience is essential knowledge for nursing practice and is an important component of undergraduate nursing education, however students commonly feel anxious about studying the subject. The purpose of this study was to create student learning resources for undergraduate bioscience that would enhance student engagement and performance and reduce attrition and unit failures over a sustained period. Methods Online surveys and formal institutional data collection metrics were used to assess the impact of the changes to unit learning resources. Results Student attrition rates and failure rates for the unit were reduced over a two-year period across a diverse student cohort. Conclusions Scaffolded and diverse learning materials support the success of undergraduate bioscience students by improving student engagement and reducing cognitive load.
Forensic science international, 2018
Despite the recognized flaws in applying traditional stature estimation equations such as those o... more Despite the recognized flaws in applying traditional stature estimation equations such as those of Trotter and Gleser (1952) [5] to a contemporary population, there are currently no available alternatives for stature estimation in Australia that address these limitations. Post mortem computed tomography (PMCT) DICOM scans of the left and right femora were acquired from 76 Australian deceased individuals aged 17-76 years for metric analysis. Femoral bicondylar length, femoral epicondylar breadth and anterior-posterior (AP) diameter, medial-lateral (ML) diameter, circumference and cortical area at the femoral midshaft were measured on three-dimensional (3D) models to build statistical models for estimating stature. In addition, Australian individuals aged 16-63 years (n=111) were measured in standing and supine positions to aid in the adjustment of supine stature of deceased individuals utilized in this study to standing stature. The results of this preliminary evaluation strongly ind...
Standardized anthropological measurement of postcranial bones using three-dimensional models in CAD software
Forensic science international, Jan 26, 2017
This study introduces a standardized protocol for conducting linear measurements of postcranial s... more This study introduces a standardized protocol for conducting linear measurements of postcranial skeletal elements using three-dimensional (3D) models constructed from post-mortem computed tomography (PMCT) scans. Using femoral DICOM datasets, reference planes were generated and plane-to-plane measurements were conducted on 3D surface rendered models. Bicondylar length, epicondylar breadth, anterior-posterior (AP) diameter, medial-lateral (ML) diameter and cortical area at the midshaft were measured by four observers to test the measurement error variance and observer agreement of the protocol (n=6). Intra-observer error resulted in a mean relative technical error of measurement (%TEM) of 0.11 and an intraclass correlation coefficient (ICC) of 0.999 (CI=0.998-1.000); inter-observer error resulted in a mean %TEM of 0.54 and ICC of 0.996 (CI=0.979-1.000) for bicondylar length. Epicondylar breadth, AP diameter, ML diameter and cortical area also yielded minimal error. Precision testing ...
Journal of forensic sciences, Jan 25, 2016
This study contrasts the ontogeny of the iliac crest apophysis using conventional radiography and... more This study contrasts the ontogeny of the iliac crest apophysis using conventional radiography and multislice computed tomography (MSCT), providing probabilistic information for age estimation of modern Australian subadults. Retrospective abdominopelvic MSCT data acquired from 524 Australian individuals aged 7-25 and surveillance radiographs of adolescent idiopathic scoliosis patients included in the Paediatric Spine Research Group Progression Study (n = 531) were assessed. Ossification scoring of pseudo-radiographs and three-dimensional (3D) volume-rendered reconstructions using Risser (1958) quantitative descriptors indicate discrepancies in age estimates, stage allocation, and conflicting morphological progression. To mitigate visualization limitations associated with two-dimensional radiographs, we provide and validate a modified 3D-MSCT scoring tier of ossification, demonstrating complete fusion between 17.3-19.2 and 17.1-20.1 years in males and females. Legal demarcation for do...
Stature estimation of a contemporary Australian sub-population : an evaluation of the Trotter and Gleser method using computed tomography of the femur
School of Biomedical Sciences Faculty of Health Institute of Health and Biomedical Innovation, 2014
Utilising computed tomography scans to allow a virtual analysis of three-dimensional reconstructi... more Utilising computed tomography scans to allow a virtual analysis of three-dimensional reconstructions of the femur, this project confirms that the traditional 1952 Trotter and Gleser stature estimation equations are inapplicable for a contemporary Queensland population. Therefore, this study introduces modern stature estimation equations for femoral length and fragmentary femoral remains using Bayesian statistics for application in forensic anthropological casework. In addition, it was found that caution needs to be applied when comparing estimated stature to reported stature on the missing persons database due to inaccuracy in Queensland drivers' licences.
Author response to : Brough et al. in response tothe recently published article : Lottering,N., MacGregor,D.M.,Barry,M.D.,Reynolds,M.S., Gregory,L.S., 2014. Introducing standardized protocols for anthropological measurement of virtual sub-adult crania using computed tomography 2(1),34–38
School of Biomedical Sciences Faculty of Health High Performance Computing and Research Support Institute of Health and Biomedical Innovation, Jul 1, 2014
Uploads
Papers by Mikaela Reynolds