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Published in: International Journal of Legal Medicine 1/2016

01-01-2016 | Original Article

Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study

Authors: Daniel Wittschieber, Christian Ottow, Ronald Schulz, Klaus Püschel, Thomas Bajanowski, Frank Ramsthaler, Heidi Pfeiffer, Volker Vieth, Sven Schmidt, Andreas Schmeling

Published in: International Journal of Legal Medicine | Issue 1/2016

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Abstract

The radiological investigation of the ossification stage of the medial clavicular epiphysis represents the crucial tool for assessing whether a living individual has completed the age of 18 years. However, exposure to radiation cannot always be accepted due to legal reasons and radiation-free methods still lack reference data or are not available. Therefore, this study examines the role of pre-existing radiographic material of the clavicles, making it necessary to prospectively validate the established five-stage classification system for evaluating the clavicular ossification process as well as to enlarge the so far very limited pool of available reference data. Accordingly, standard posterior-anterior projection radiographs of 836 sternoclavicular joints prospectively obtained during 418 forensic autopsies (age range 15–30 years) were analyzed. Stage III was first found at ages 16 and 15 (males/females), stage IV at ages 22 and 21 (males/females), and stage V at age 26 in both sexes. The presented results principally corroborate the previous reference data from 2004, suggesting reliability of the five-stage classification system. In conclusion, chest radiographs may still be useful for forensic age diagnostics in living individuals but only in certain cases. In age estimations which can be planned in advance, projection radiography of the clavicle must still be considered obsolete.
Literature
1.
go back to reference Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122(6):457–460. doi:10.1007/s00414-008-0254-2 CrossRefPubMed Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122(6):457–460. doi:10.​1007/​s00414-008-0254-2 CrossRefPubMed
3.
go back to reference Tisè M, Mazzarini L, Fabrizzi G, Ferrante L, Giorgetti R, Tagliabracci A (2011) Applicability of Greulich and Pyle method for age assessment in forensic practice on an Italian sample. Int J Legal Med 125(3):411–416. doi:10.1007/s00414-010-0541-6 CrossRefPubMed Tisè M, Mazzarini L, Fabrizzi G, Ferrante L, Giorgetti R, Tagliabracci A (2011) Applicability of Greulich and Pyle method for age assessment in forensic practice on an Italian sample. Int J Legal Med 125(3):411–416. doi:10.​1007/​s00414-010-0541-6 CrossRefPubMed
7.
go back to reference Wittschieber D, Vieth V, Domnick C, Pfeiffer H, Schmeling A (2013) The iliac crest in forensic age diagnostics: evaluation of the apophyseal ossification in conventional radiography. Int J Legal Med 127(2):473–479. doi:10.1007/s00414-012-0763-x CrossRefPubMed Wittschieber D, Vieth V, Domnick C, Pfeiffer H, Schmeling A (2013) The iliac crest in forensic age diagnostics: evaluation of the apophyseal ossification in conventional radiography. Int J Legal Med 127(2):473–479. doi:10.​1007/​s00414-012-0763-x CrossRefPubMed
8.
go back to reference Wittschieber D, Schmeling A, Schmidt S, Heindel W, Pfeiffer H, Vieth V (2013) The Risser sign for forensic age estimation in living individuals: a study of 643 pelvic radiographs. Forensic Sci Med Pathol 9(1):36–43. doi:10.1007/s12024-012-9379-1 CrossRefPubMed Wittschieber D, Schmeling A, Schmidt S, Heindel W, Pfeiffer H, Vieth V (2013) The Risser sign for forensic age estimation in living individuals: a study of 643 pelvic radiographs. Forensic Sci Med Pathol 9(1):36–43. doi:10.​1007/​s12024-012-9379-1 CrossRefPubMed
9.
go back to reference Wittschieber D, Vieth V, Wierer T, Pfeiffer H, Schmeling A (2013) Cameriere’s approach modified for pelvic radiographs: a novel method to assess apophyseal iliac crest ossification for the purpose of forensic age diagnostics. Int J Legal Med 127(4):825–829. doi:10.1007/s00414-013-0832-9 CrossRefPubMed Wittschieber D, Vieth V, Wierer T, Pfeiffer H, Schmeling A (2013) Cameriere’s approach modified for pelvic radiographs: a novel method to assess apophyseal iliac crest ossification for the purpose of forensic age diagnostics. Int J Legal Med 127(4):825–829. doi:10.​1007/​s00414-013-0832-9 CrossRefPubMed
10.
go back to reference Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118(1):5–8. doi:10.1007/s00414-003-0404-5 CrossRefPubMed Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118(1):5–8. doi:10.​1007/​s00414-003-0404-5 CrossRefPubMed
13.
go back to reference Cameriere R, De Luca S, De Angelis D, Merelli V, Giuliodori A, Cingolani M, Cattaneo C, Ferrante L (2012) Reliability of Schmeling’s stages of ossification of medial clavicular epiphyses and its validity to assess 18 years of age in living subjects. Int J Legal Med 126(6):923–932. doi:10.1007/s00414-012-0769-4 CrossRefPubMed Cameriere R, De Luca S, De Angelis D, Merelli V, Giuliodori A, Cingolani M, Cattaneo C, Ferrante L (2012) Reliability of Schmeling’s stages of ossification of medial clavicular epiphyses and its validity to assess 18 years of age in living subjects. Int J Legal Med 126(6):923–932. doi:10.​1007/​s00414-012-0769-4 CrossRefPubMed
14.
15.
go back to reference Wittschieber D, Ottow C, Vieth V, Küppers M, Schulz R, Hassu J, Bajanowski T, Püschel K, Ramsthaler F, Pfeiffer H, Schmidt S, Schmeling A (2015) Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 129(1):187–193. doi:10.1007/s00414-014-1067-0 CrossRefPubMed Wittschieber D, Ottow C, Vieth V, Küppers M, Schulz R, Hassu J, Bajanowski T, Püschel K, Ramsthaler F, Pfeiffer H, Schmidt S, Schmeling A (2015) Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 129(1):187–193. doi:10.​1007/​s00414-014-1067-0 CrossRefPubMed
16.
go back to reference Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B (1997) Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse—eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade? Rofo 166(6):481–486. doi:10.1055/s-2007-1015463 CrossRefPubMed Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B (1997) Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse—eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade? Rofo 166(6):481–486. doi:10.​1055/​s-2007-1015463 CrossRefPubMed
18.
go back to reference Schulz R, Mühler M, Mutze S, Schmidt S, Reisinger W, Schmeling A (2005) Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans. Int J Legal Med 119(3):142–145. doi:10.1007/s00414-005-0529-9 CrossRefPubMed Schulz R, Mühler M, Mutze S, Schmidt S, Reisinger W, Schmeling A (2005) Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans. Int J Legal Med 119(3):142–145. doi:10.​1007/​s00414-005-0529-9 CrossRefPubMed
19.
20.
go back to reference Kellinghaus M, Schulz R, Vieth V, Schmidt S, Schmeling A (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography. Int J Legal Med 124(2):149–154. doi:10.1007/s00414-009-0398-8 CrossRefPubMed Kellinghaus M, Schulz R, Vieth V, Schmidt S, Schmeling A (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography. Int J Legal Med 124(2):149–154. doi:10.​1007/​s00414-009-0398-8 CrossRefPubMed
21.
go back to reference Kellinghaus M, Schulz R, Vieth V, Schmidt S, Pfeiffer H, Schmeling A (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124(4):321–325. doi:10.1007/s00414-010-0448-2 CrossRefPubMed Kellinghaus M, Schulz R, Vieth V, Schmidt S, Pfeiffer H, Schmeling A (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124(4):321–325. doi:10.​1007/​s00414-010-0448-2 CrossRefPubMed
22.
go back to reference Bassed RB, Drummer OH, Briggs C, Valenzuela A (2011) Age estimation and the medial clavicular epiphysis: analysis of the age of majority in an Australian population using computed tomography. Forensic Sci Med Pathol 7(2):148–154. doi:10.1007/s12024-010-9200-y CrossRefPubMed Bassed RB, Drummer OH, Briggs C, Valenzuela A (2011) Age estimation and the medial clavicular epiphysis: analysis of the age of majority in an Australian population using computed tomography. Forensic Sci Med Pathol 7(2):148–154. doi:10.​1007/​s12024-010-9200-y CrossRefPubMed
23.
go back to reference Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) Influence of the examiner’s qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography. Int J Legal Med 128(1):183–191. doi:10.1007/s00414-013-0932-6 CrossRefPubMed Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) Influence of the examiner’s qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography. Int J Legal Med 128(1):183–191. doi:10.​1007/​s00414-013-0932-6 CrossRefPubMed
24.
go back to reference Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study. Forensic Sci Med Pathol 10(2):163–169. doi:10.1007/s12024-013-9511-x CrossRefPubMed Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study. Forensic Sci Med Pathol 10(2):163–169. doi:10.​1007/​s12024-013-9511-x CrossRefPubMed
25.
go back to reference Wittschieber D, Schmidt S, Vieth V, Schulz R, Püschel K, Pfeiffer H, Schmeling A (2014) Subclassification of clavicular substage 3a is useful for diagnosing the age of 17 years. Rechtsmedizin 24(6):485–488. doi:10.1007/s00194-014-0990-1 CrossRef Wittschieber D, Schmidt S, Vieth V, Schulz R, Püschel K, Pfeiffer H, Schmeling A (2014) Subclassification of clavicular substage 3a is useful for diagnosing the age of 17 years. Rechtsmedizin 24(6):485–488. doi:10.​1007/​s00194-014-0990-1 CrossRef
26.
go back to reference Milenkovic P, Djuric M, Milovanovic P, Djukic K, Zivkovic V, Nikolic S (2014) The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation. Int J Legal Med 128(5):825–839. doi:10.1007/s00414-014-1026-9 CrossRefPubMed Milenkovic P, Djuric M, Milovanovic P, Djukic K, Zivkovic V, Nikolic S (2014) The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation. Int J Legal Med 128(5):825–839. doi:10.​1007/​s00414-014-1026-9 CrossRefPubMed
27.
go back to reference Hua W, Guang-you Z, Lei W, Chong-liang Y, Ya-hui W (2014) Correlation between age and the parameters of medial epiphysis and metaphysis of the clavicle using CT volume rendering images. Forensic Sci Int 244:316.e1-7. doi: 10.1016/j.forsciint.2014.09.006 Hua W, Guang-you Z, Lei W, Chong-liang Y, Ya-hui W (2014) Correlation between age and the parameters of medial epiphysis and metaphysis of the clavicle using CT volume rendering images. Forensic Sci Int 244:316.e1-7. doi: 10.​1016/​j.​forsciint.​2014.​09.​006
28.
go back to reference Pattamapaspong N, Madla C, Mekjaidee K, Namwongprom S (2015) Age estimation of a Thai population based on maturation of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 246:123.e1-5. doi: 10.1016/j.forsciint.2014.10.044 Pattamapaspong N, Madla C, Mekjaidee K, Namwongprom S (2015) Age estimation of a Thai population based on maturation of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 246:123.e1-5. doi: 10.​1016/​j.​forsciint.​2014.​10.​044
29.
go back to reference Ekizoglu O, Hocaoglu E, Inci E, Sayin I, Solmaz D, Bilgili MG, Can IO (2015) Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis. Int J Legal Med 129(1):203–210. doi:10.1007/s00414-014-1121-y CrossRefPubMed Ekizoglu O, Hocaoglu E, Inci E, Sayin I, Solmaz D, Bilgili MG, Can IO (2015) Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis. Int J Legal Med 129(1):203–210. doi:10.​1007/​s00414-014-1121-y CrossRefPubMed
31.
go back to reference Lockemann U, Fuhrmann A, Püschel K, Schmeling A, Geserick G (2006) Arbeitsgemeinschaft für Forensische Altersdiagnostik der Deutschen Gesellschaft für Rechtsmedizin—Empfehlungen für die Altersdiagnostik bei Jugendlichen und jungen Erwachsenen außerhalb des Strafverfahrens. Rechtsmedizin 14(2):123–125. doi:10.1007/s00194-004-0243-9 CrossRef Lockemann U, Fuhrmann A, Püschel K, Schmeling A, Geserick G (2006) Arbeitsgemeinschaft für Forensische Altersdiagnostik der Deutschen Gesellschaft für Rechtsmedizin—Empfehlungen für die Altersdiagnostik bei Jugendlichen und jungen Erwachsenen außerhalb des Strafverfahrens. Rechtsmedizin 14(2):123–125. doi:10.​1007/​s00194-004-0243-9 CrossRef
33.
go back to reference Jit I, Kulkarni M (1976) Times of appearance and fusion of epiphysis at the medial end of the clavicle. Indian J Med Res 64(5):773–782. doi: unknown Jit I, Kulkarni M (1976) Times of appearance and fusion of epiphysis at the medial end of the clavicle. Indian J Med Res 64(5):773–782. doi: unknown
34.
go back to reference Schmeling A, Reisinger W, Loreck D, Vendura K, Markus W, Geserick G (2000) Effects of ethnicity on skeletal maturation: consequences for forensic age estimations. Int J Legal Med 113(5):253–258. doi:10.1007/s004149900102 CrossRefPubMed Schmeling A, Reisinger W, Loreck D, Vendura K, Markus W, Geserick G (2000) Effects of ethnicity on skeletal maturation: consequences for forensic age estimations. Int J Legal Med 113(5):253–258. doi:10.​1007/​s004149900102 CrossRefPubMed
37.
go back to reference Hillewig E, De Tobel J, Cuche O, Vandemaele P, Piette M, Verstraete K (2011) Magnetic resonance imaging of the medial extremity of the clavicle in forensic bone age determination: a new four-minute approach. Eur Radiol 21(4):757–767. doi:10.1007/s00330-010-1978-1 CrossRefPubMed Hillewig E, De Tobel J, Cuche O, Vandemaele P, Piette M, Verstraete K (2011) Magnetic resonance imaging of the medial extremity of the clavicle in forensic bone age determination: a new four-minute approach. Eur Radiol 21(4):757–767. doi:10.​1007/​s00330-010-1978-1 CrossRefPubMed
38.
go back to reference Hillewig E, Degroote J, Van der Paelt T, Visscher A, Vandemaele P, Lutin B, D’Hooghe L, Vandriessche V, Piette M, Verstraete K (2013) Magnetic resonance imaging of the sternal extremity of the clavicle in forensic age estimation: towards more sound age estimates. Int J Legal Med 127(3):677–689. doi:10.1007/s00414-012-0798-z CrossRefPubMed Hillewig E, Degroote J, Van der Paelt T, Visscher A, Vandemaele P, Lutin B, D’Hooghe L, Vandriessche V, Piette M, Verstraete K (2013) Magnetic resonance imaging of the sternal extremity of the clavicle in forensic age estimation: towards more sound age estimates. Int J Legal Med 127(3):677–689. doi:10.​1007/​s00414-012-0798-z CrossRefPubMed
39.
go back to reference Vieth V, Kellinghaus M, Schulz R, Pfeiffer H, Schmeling A (2010) Beurteilung des Ossifikationsstadiums der medialen Klaviculaepiphysenfuge. Vergleich von Projektionsradiographie, Computertomographie und Magnetresonanztomographie. Rechtsmedizin 20(6):483–488. doi:10.1007/s00194-010-0709-x CrossRef Vieth V, Kellinghaus M, Schulz R, Pfeiffer H, Schmeling A (2010) Beurteilung des Ossifikationsstadiums der medialen Klaviculaepiphysenfuge. Vergleich von Projektionsradiographie, Computertomographie und Magnetresonanztomographie. Rechtsmedizin 20(6):483–488. doi:10.​1007/​s00194-010-0709-x CrossRef
43.
48.
go back to reference Tomei E, Sartori A, Nissman D, Al Ansari N, Battisti S, Rubini A, Stagnitti A, Martino M, Marini M, Barbato E, Semelka RC (2014) Value of MRI of the hand and the wrist in evaluation of bone age: preliminary results. J Magn Reson Imaging 39(5):1198–1205. doi:10.1002/jmri.24286 CrossRefPubMed Tomei E, Sartori A, Nissman D, Al Ansari N, Battisti S, Rubini A, Stagnitti A, Martino M, Marini M, Barbato E, Semelka RC (2014) Value of MRI of the hand and the wrist in evaluation of bone age: preliminary results. J Magn Reson Imaging 39(5):1198–1205. doi:10.​1002/​jmri.​24286 CrossRefPubMed
49.
go back to reference Schmidt S, Vieth V, Timme M, Dvorak J, Schmeling A (2015) Examination of ossification of the distal radial epiphysis using magnetic resonance imaging. New insights for age estimation in young footballers in FIFA tournaments. Sci Justice 55(2):139–144. doi:10.1016/j.scijus.2014.12.003 CrossRefPubMed Schmidt S, Vieth V, Timme M, Dvorak J, Schmeling A (2015) Examination of ossification of the distal radial epiphysis using magnetic resonance imaging. New insights for age estimation in young footballers in FIFA tournaments. Sci Justice 55(2):139–144. doi:10.​1016/​j.​scijus.​2014.​12.​003 CrossRefPubMed
51.
52.
53.
go back to reference Jopp E, Schröder I, Maas R, Adam G, Püschel K (2010) Proximale Tibiaepiphyse im Magnetresonanztomogramm. Neue Möglichkeit zur Altersbestimmung bei Lebenden? Rechtsmedizin 20(6):464–468. doi:10.1007/s00194-010-0705-1 CrossRef Jopp E, Schröder I, Maas R, Adam G, Püschel K (2010) Proximale Tibiaepiphyse im Magnetresonanztomogramm. Neue Möglichkeit zur Altersbestimmung bei Lebenden? Rechtsmedizin 20(6):464–468. doi:10.​1007/​s00194-010-0705-1 CrossRef
54.
go back to reference Krämer JA, Schmidt S, Jürgens KU, Lentschig M, Schmeling A, Vieth V (2014) The use of magnetic resonance imaging to examine ossification of the proximal tibial epiphysis for forensic age estimation in living individuals. Forensic Sci Med Pathol 10(3):306–313. doi:10.1007/s12024-014-9559-2 CrossRefPubMed Krämer JA, Schmidt S, Jürgens KU, Lentschig M, Schmeling A, Vieth V (2014) The use of magnetic resonance imaging to examine ossification of the proximal tibial epiphysis for forensic age estimation in living individuals. Forensic Sci Med Pathol 10(3):306–313. doi:10.​1007/​s12024-014-9559-2 CrossRefPubMed
55.
56.
go back to reference Saint-Martin P, Rérolle C, Dedouit F, Bouilleau L, Rousseau H, Rougé D, Telmon N (2013) Age estimation by magnetic resonance imaging of the distal tibial epiphysis and the calcaneum. Int J Legal Med 127(5):1023–1030. doi:10.1007/s00414-013-0844-5 CrossRefPubMed Saint-Martin P, Rérolle C, Dedouit F, Bouilleau L, Rousseau H, Rougé D, Telmon N (2013) Age estimation by magnetic resonance imaging of the distal tibial epiphysis and the calcaneum. Int J Legal Med 127(5):1023–1030. doi:10.​1007/​s00414-013-0844-5 CrossRefPubMed
57.
go back to reference Ottow C, Krämer JA, Olze A, Schmidt S, Schulz R, Wittschieber D, Heindel W, Pfeiffer H, Ribbecke S, Vieth V, Schmeling A (2015) Magnetresonanztomographiestudie zur Altersschätzung von unbegleiteten minderjährigen Flüchtlingen. Rechtsmedizin 25(1):12–20. doi:10.1007/s00194-014-0991-0 CrossRef Ottow C, Krämer JA, Olze A, Schmidt S, Schulz R, Wittschieber D, Heindel W, Pfeiffer H, Ribbecke S, Vieth V, Schmeling A (2015) Magnetresonanztomographiestudie zur Altersschätzung von unbegleiteten minderjährigen Flüchtlingen. Rechtsmedizin 25(1):12–20. doi:10.​1007/​s00194-014-0991-0 CrossRef
Metadata
Title
Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study
Authors
Daniel Wittschieber
Christian Ottow
Ronald Schulz
Klaus Püschel
Thomas Bajanowski
Frank Ramsthaler
Heidi Pfeiffer
Volker Vieth
Sven Schmidt
Andreas Schmeling
Publication date
01-01-2016
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Legal Medicine / Issue 1/2016
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI
https://doi.org/10.1007/s00414-015-1285-0

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