BoneXpert Server is installed on Windows PC or virtual machine in the hospital and connected to the PACS as a "DICOM node". This setup is performed by the local PACS administrator.


The workflow with BoneXpert Server is illustrated above: After an X-ray is recorded, it is stored in the local PACS. A PACS user (a radiographer or radiologist) can then send the image to the BoneXpert Server for analysis. After 10-30 seconds, the BoneXpert Server returns an annotated X-ray, which is stored in PACS as a new image under the same Study. The PACS user does not directly operate a BoneXpert user interface, what is seen is simply the result: an additional image with the results of the analysis as an overlay; an example is shown here:

The results are instantly available to the radiologist and the requesting clinician via the PACS viewer and can be read off from the image:


BA (GP):  

Greulich-Pyle bone age with decimals
(M or F indicates the gender),


Standard deviation score (SDS) of GP bone age, based on Healthy Dutch children 1997
BA SDS >0 indicates advanced bone age
BA SDS <0 indicates delayed bone age

BA (TW3):

Tanner-Whitehouse-3 bone age, TW2 can also be shown


Chronological age with decimals


Bone health index, based on cortical thickness of the metacarpals 


Standard deviation score of BHI


To obtain a 2-month free trial of BoneXpert Server for your institution, read more here.

More technical description of BoneXpert Server

BoneXpert Server is technically speaking a “DICOM Storage SCP/SCU” running as a Windows Service on a Windows computer connected to the PACS.

The software is set up via the configuration user interface shown below. Once it has been configured and started, it requires no active operation. The service receives DICOM hand X-rays, locates the bones in the image, computes the bone age and bone health index, and returns the result to the PACS as an additional image (or data set) in the same study.


The Server can run on any existing Windows machine (physical or virtual) connected to the PACS. A single BoneXpert Server can service multiple hospitals, provided they share a common PACS, or if a DICOM network exists between hospitals with different PACS systems. 

BoneXpert Server is not installed and integrated on the PACS itself, and it does not appear inside the PACS-programs with its own user interface, like some other plug-ins. It is better described as a “DICOM-node to send to and then receive from", or a “CAD-server”. So it resides at a “safe distance” from the PACS itself. Furthermore, BoneXpert Server has no Query/Retrieve, but simply accepts images sent to it by authorised PACS users or by auto-routing. The installation is very simple and can be performed in under twenty minutes by a PACS administrator.

Installation on the PACS side means enabling users to send to the BoneXpert DICOM node and allowing the BoneXpert DICOM node to push images back to the PACS.

When the service is running, any authorised PACS user can right-click on a hand image in the PACS client and select the "Send to BoneXpert service" button (which the PACS administrator has created):

Seconds later an additional image will automatically appear in the same “study” in the PACS client, i.e. it will be manifestly visible next to the original image:

So a radiologist can request the BoneXpert analysis “on demand”, when it is needed. Alternatively, the radiographer can send the image to the BoneXpert service as soon as it has been recorded. Or the PACS can be set up to route all new bone age X-rays (matching a suitable criterion, e.g. a RIS-code) automatically to the BoneXpert service.

The BoneXpert license is controlled by a username and password which are entered in the configuration user interface. The number of analyses performed is counted, and this is used as basis for the license agreement. The Server can be configured to use several license accounts, depending on the AE-title of the incoming image.

System requirements:

1) Operating system

  • a. Windows XP w/SP3
  • b. Windows Vista w/SP1
  • c. Windows 7, 8 or 10
  • d. Windows Server 2003 w/SP2, 2008, 2013 or later

2) RAM 4 Gb

3) Available disk space 3 Gb

4) Internet connection (port 80, only outgoing is used).

5) Connected to your PACS over the local network

6) Turned on during working hours