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In this study, we present\n                    <jats:italic>Auto-Bone-Caliper<\/jats:italic>\n                    , an automated system for the segmentation and length measurement of metacarpal and phalangeal (M&amp;P) bones, trained and evaluated on public datasets comprising both normal and dysmorphic cases. We first introduce InstanceSAM, a two-stage framework that detects and segments all 19 M&amp;P bones in pediatric hand radiographs, achieving Dice scores of 98.7% for normal bones and 95.0% for dysmorphic bones. We further develop and evaluate three methods for bone-length estimation, identifying a\n                    <jats:italic>k<\/jats:italic>\n                    -means\u2013based approach as the most accurate, with relative errors of 2.2% for normal bones and 4.5% for dysmorphic bones. Our automated pipeline,\n                    <jats:italic>Auto-Bone-Caliper<\/jats:italic>\n                    , integrates InstanceSAM with the\n                    <jats:italic>k<\/jats:italic>\n                    -means\u2013based length-estimation method. To enable scale-independent downstream analyses, we derive relative bone-length measures from the automated measurements. Using these relative measures, we statistically compare measurements obtained using\n                    <jats:italic>Auto-Bone-Caliper<\/jats:italic>\n                    on an independent dataset with a healthy reference catalog of normal bone morphologies, observing a high level of agreement (Wasserstein-1 distance = 0.012). Finally, we demonstrate a potential clinical use case of\n                    <jats:italic>Auto-Bone-Caliper<\/jats:italic>\n                    by obtaining relative metacarpophalangeal pattern profiles for three genetic conditions, namely Turner syndrome, achondroplasia, and pseudohypoparathyroidism. Our results highlight the potential of the\n                    <jats:italic>Auto-Bone-Caliper<\/jats:italic>\n                    to streamline and standardize M&amp;P length measurement, providing an objective and reproducible tool suitable for clinical application.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-69557-5","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T09:33:40Z","timestamp":1788341620000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Automated segmentation and length measurement of metacarpal and phalangeal bones for hand radiograph evaluation"],"prefix":"10.1038","volume":"16","author":[{"given":"Philip","family":"Gutberlet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aron","family":"Kirchhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eike","family":"Bolmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Hellmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Gr\u00fcn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hustinx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Andr\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schultz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Mohnike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Krawitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-6114","authenticated-orcid":false,"given":"Behnam","family":"Javanmardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"issue":"3","key":"69557_CR1","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s00247-002-0855-8","volume":"33","author":"AC Offiah","year":"2002","unstructured":"Offiah, A. 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