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European Radiology
Published in: European Radiology 12/2020

Open Access 01-12-2020 | Computed Tomography | Forensic Medicine

Forensic age estimation in living adolescents with CT imaging of the clavicula—impact of low-dose scanning on readers’ confidence

Authors: Sebastian Gassenmaier, Juergen F. Schaefer, Konstantin Nikolaou, Michael Esser, Ilias Tsiflikas

Published in: European Radiology | Issue 12/2020

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Abstract

Objectives

Computed tomography (CT) imaging of the clavicula displays the reference standard for forensic bone age diagnostics in adolescents and young adults. Consequently, highest efforts on radiation reduction are warranted. Therefore, the aim of this study was to investigate the feasibility of low-dose (LD) CT imaging of the clavicula for age estimation in living adolescents.

Methods

A total of 207 non-contrast chest CT of 144 patients born between 1988 and 2012, performed in 2018 due to various clinical indications, were included in this retrospective study. The mean patient age was 16.9 ± 6.6 years. Patients were divided into a LD (n = 146) and standard-dose (SD; n = 61) group. Image quality, confidence levels, and ossification stages (using the 5-stage classification including the subgroups 2a–3c) were assessed by two radiologists independently. Radiation dose was determined via dosimetry software.

Results

Dose simulation with z-axis reduction to depict the clavicula only resulted in a median exposure of 0.1 mSv (IQR: 0.0) in LD compared with 0.9 mSv (IQR: 0.6) in SD (p < 0.001). The median image quality was rated by both readers significantly worse in LD compared with SD on a Likert scale ranging from 1 to 4 with a median of 3 (IQR: 1) versus 4 (IQR: 0; p < 0.001 for both readers). There was an almost perfect agreement for the ossification stages between both readers with a Cohen’s kappa of 0.83 (p < 0.001). Median confidence levels of both readers were not significantly different between LD and SD in the decisive subgroups 2a–3c.

Conclusions

Low-dose CT imaging of the clavicula for age estimation in living adolescents is possible without loss of readers’ confidence.

Key Points

• Radiological bone age diagnostics in young delinquents with unknown exact chronological age is important as the judicial systems differentiate between youths and adults.
• Low-dose computed tomography scanning of the medial clavicular joint for forensic age estimation is feasible in living adolescents without loss of readers’ confidence.
• Sufficient image quality of the medial clavicular joint for forensic bone age diagnostics in living adolescents is achievable using a median dose of 0.1 mSv.
Literature
1.
Greulich WW, Pyle SI By WilliamWalter Greulich and S. Idell Pyle. (1950) XIII + 190 pages, illustrated. $10.00. Stanford University Press, Stanford, California. 108:335–336
2.
Tise 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 125:411–416CrossRef
3.
Schmeling A, Grundmann C, Fuhrmann A et al (2008) Criteria for age estimation in living individuals. Int J Legal Med 122:457–460CrossRef
4.
Choi JA, Kim YC, Min SJ, Khil EK (2018) A simple method for bone age assessment: the capitohamate planimetry. Eur Radiol 28:2299–2307CrossRef
5.
De Tobel J, Hillewig E, de Haas MB et al (2019) Forensic age estimation based on T1 SE and VIBE wrist MRI: do a one-fits-all staging technique and age estimation model apply? Eur Radiol 29:2924–2935CrossRef
6.
Li Y, Huang Z, Dong X et al (2019) Forensic age estimation for pelvic X-ray images using deep learning. Eur Radiol 29:2322–2329CrossRef
7.
Vieth V, Schulz R, Heindel W et al (2018) Forensic age assessment by 3.0T MRI of the knee: proposal of a new MRI classification of ossification stages. Eur Radiol 28:3255–3262CrossRef
8.
Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B (1997) Computerized tomography of the epiphyseal union of the medial clavicle: an auxiliary method of age determination during adolescence and the 3d decade of life? Rofo 166:481–486CrossRef
9.
Kreitner KF, Schweden FJ, Riepert T, Nafe B, Thelen M (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8:1116–1122CrossRef
10.
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 124:149–154CrossRef
11.
Schmeling A, Schulz R, Reisinger W, Muhler 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 118:5–8CrossRef
12.
Schulz R, Muhler M, Reisinger W, Schmidt S, Schmeling A (2008) Radiographic staging of ossification of the medial clavicular epiphysis. Int J Legal Med 122:55–58CrossRef
13.
Wittschieber D, Ottow C, Vieth V et al (2015) Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 129:187–193CrossRef
14.
Wittschieber D, Ottow C, Schulz R et al (2016) Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study. Int J Legal Med 130:213–219CrossRef
15.
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 124:321–325CrossRef
16.
Muhler M, Schulz R, Schmidt S, Schmeling A, Reisinger W (2006) The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics. Int J Legal Med 120:15–17CrossRef
17.
Nguyen PK, Lee WH, Li YF et al (2015) Assessment of the radiation effects of cardiac CT angiography using protein and genetic biomarkers. JACC Cardiovasc Imaging 8:873–884CrossRef
18.
19.
Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–221 discussion 242-224CrossRef
20.
Hall EJ (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 32:700–706CrossRef
21.
Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296CrossRef
22.
Rigsby CK, McKenney SE, Hill KD et al (2018) Radiation dose management for pediatric cardiac computed tomography: a report from the Image Gently ‘Have-A-Heart’ campaign. Pediatr Radiol 48:5–20CrossRef
23.
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505CrossRef
24.
Mathews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 346:f2360CrossRef
25.
Hauptmann M, Meulepas JM (2012) CT scans in childhood and risk of leukaemia and brain tumours. Lancet 380:1736 author reply 1736-1737CrossRef
26.
Zopf DA, Green GE (2012) CT scans in childhood and risk of leukaemia and brain tumours. Lancet 380:1735–1736 author reply 1736-1737CrossRef
27.
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 21:757–767CrossRef
Metadata
Title
Forensic age estimation in living adolescents with CT imaging of the clavicula—impact of low-dose scanning on readers’ confidence
Authors
Sebastian Gassenmaier
Juergen F. Schaefer
Konstantin Nikolaou
Michael Esser
Ilias Tsiflikas
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07079-y

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