Bone age assessment is frequently performed in pediatric patients to evaluate growth and to diagnose and manage a multitude of endocrine disorders and pediatric syndromes. For decades, the determination of bone maturity has relied on a visual evaluation of the skeletal development of the hand and wrist, most commonly using the Greulich and Pyle atlas. With the advent of digital imaging, multiple attempts have been made to develop image-processing techniques that automatically extract the key morphological features of ossification in the bones to provide a more effective and objective approach to skeletal maturity assessments. However, the design of computer algorithms capable of automatically rendering bone age has been impeded by the complexity of evaluating the wide variations in bone mineralization tempo, shape and size encompassed in the large number of ossification centers in the hand and wrist. Clearly, developing an accurate digital reference that integrates the quantitative morphological traits associated with the different degrees of skeletal maturation of 21 tubular bones in the hand and 8 carpal bones in the wrist is not an easy task.