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. 2023 Apr 11;13:5870. doi: 10.1038/s41598-023-33058-6

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Overview of the steps involved in the modified SMI-based skeletal maturation assessment system. In the pre-processing step, the image size of hand-wrist radiographs is adjusted, and right-hand radiographs are mirrored. In addition to the detection and classification of each ROI, the evaluation of the whole hand as a holistic image is performed to enhance the performance by including maturity features that are not parts of the ROIs.