Forensic age estimation using computed tomography of the medial clavicular epiphysis: a systematic review

Abstract Purpose The aim of this study was to assess the impact of arm position in computed tomography (CT) of the clavicle performed for forensic age estimation on clavicular position, image noise, and radiation dose. Methods and materials Forty-seven CT scans of the medial clavicular epiphysis performed for forensic age estimation were conducted with either hands and arms held upwards (CTHU, 28 persons) or positioned at the body (CTHD, 19 persons). Presets were identical for both positions (70 mAs/140 kVp; Brilliance iCT, Philips). Each CT scan was reconstructed with an iterative algorithm (i-Dose 4) and evaluated at the middle of the sternoclavicular joint. Clavicular angle was measured on a.p. topograms in relation to a horizontal line. Quantitative image noise was measured in air at the level of medial clavicular epiphysis. Effective dose and scan length were recorded. Results Hands-up position compared with hands-down position resulted in a lower lateral body diameter (CTHU 41.1 ± 3.6 cm vs. CTHD 44.6 ± 3.1 cm; P = 0.03), a reduced quantitative image noise (CTHU: 39.5 ± 9.2; CTHD: 46.2 ± 8.3; P = 0.02), and lower CTDIvol (5.1 ± 1.4 mGy vs. 6.7 ± 1.8 mGy; P = 0.001). Scan length was longer in patients examined with hands up (HU: 8.5 ± 3.4 cm; HD: 6.2 ± 2.1 cm; P = 0.006). Mean effective dose for CTHU was 0.79 ± 0.32 mSv compared with 0.95 ± 0.38 mSv in CTHD (P = 0.12). Clavicular angle was 17° ± 6° in patients with hands down and 32° ± 7° in patients with hands up (P < 0.001). Conclusion By elevated arm positioning, the image quality of clavicular CT scans can be improved while maintaining radiation dose compared with hands down. Clavicular position differs according to the hand position. Thus, positioning patients with elevated hands is advisable for forensic clavicular CT examinations, but multiplanar CT reconstructions should be adjusted to clavicular position and scan length should be reduced to a minimum.

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Forensic age estimation using conventional radiography of the medial clavicular epiphysis: A systematic review

Medicine Science and the Law ◽

10.1177/0025802420988223 ◽

2021 ◽

Vol 61 (2) ◽

pp. 138-146

Author(s):

Rutwik Shedge ◽

Tanuj Kanchan ◽

Varsha Warrier ◽

Shilpi Gupta Dixit ◽

Kewal Krishan

Keyword(s):

Systematic Review ◽

Age Estimation ◽

Conventional Radiography ◽

Forensic Age Estimation ◽

X Rays ◽

Qualitative Synthesis ◽

Legal Professionals ◽

Box Plots ◽

Quantitative Synthesis ◽

The Many

Of the many roles that forensic anthropologists and medico-legal professionals need to perform, forensic age estimation is one of the most frequent and important. Scoring medial clavicular epiphyseal (MCE) fusion is a method used to estimate age in young adults. The aim of this systematic review is to assess the reliability and reproducibility of MCE fusion visualised by conventional radiography and scored by Schmeling’s grading system to determine whether an individual has attained the age of 18 years. Four articles were acquired after screening 4589 articles across four databases, and these were subjected to qualitative and quantitative synthesis. The risk of bias was calculated in the qualitative synthesis using the QUADAS-2 tool. Horizontal box plots were constructed to see whether MCE fusion as visualised by conventional radiography can be used to ascertain whether an individual has attained the age of maturity (18 years). It was observed that stages 4 and 5 of the Schmeling’s method of age estimation from MCE fusion are observed only in individuals aged ≥18 years. This indicates that MCE fusion, when visualised using x-rays, which are associated with less ionisation radiation compared to computed tomography, can be used to verify the attainment of the age majority in individuals.

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