The bone age test uses an X-ray of the left hand to compare the patient's skeletal maturation against a standard atlas, like Greulich and Pyle! Error margins can be ±6 to ±12 months, but in my orthopaedics posting, I saw it misread by over a year for a young athlete, causing needless panic about his growth plates. The real error is when we forget the child's actual life—like my cousin whose test said he'd be short, but he shot up tall just like his Appa, no problem!
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