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

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.

Age-Related Trends in the Trabecular Micro-Architecture of the Medial Clavicle: Is It of Use in Forensic Science?

“…Typically, certain sub-regions of the human skeleton such as the pelvis, sternal end of the fourth rib and medial clavicle are matched with a "score" or "phase" from an established classification system (Schmeling et al, 2004;Franklin, 2010;Kellinghaus et al, 2010). It has been customary to use the clavicle, which provides information for estimating age-at-death when other elements of the skeleton are fused, because of its protracted maturation period (Schmeling et al, 2004;Kellinghaus et al, 2010;Milenkovic et al, 2013;Wittschieber et al, 2014Wittschieber et al, , 2016LeBel, 2015;Rudolf et al, 2018;Doyle et al, 2019). There has been a gradual transition to radiographic imaging modalities but established scoring systems continue to be implemented (Schmeling et al, 2004;Kellinghaus et al, 2010;Wittschieber et al, 2014Wittschieber et al, , 2016Rudolf et al, 2018).…”

Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin-slice computed tomography images

“…Some researchers studied the condition of clavicular ossification in anatomical sections [7][8][9][10][11][12][13][14], while others examined medial clavicular ossification by studying chest radiographies [15][16][17][18][19][20][21][22]. Projection radiographs to evaluate clavicular ossification may still be important in some cases [20,21].…”

“…Standard PA radiographies may be employed if they have been taken previously or are suitable for the evaluation of at least one of the medial clavicle epiphyses (in cases where superimposition and anatomical shape variants are not present) [20,21]. Because of the superimposition effects of projection radiography, which results in unclear evaluations [20,21], CT is the preferred method for age testing. However, projection radiography is acceptable if there is no way to perform CT scans [20,21].…”

“…Because of the superimposition effects of projection radiography, which results in unclear evaluations [20,21], CT is the preferred method for age testing. However, projection radiography is acceptable if there is no way to perform CT scans [20,21].…”

“…Some age estimation studies have adopted an anatomical perspective by assessing ossification by direct skeletal inspection [7][8][9][10][11][12][13][14], whereas other studies have adopted a radiological approach by using technologies such as X-ray [15][16][17][18][19][20][21][22], CT [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], ultrasonography [35,[39][40][41], or magnetic resonance imaging [42,43]. CT imaging and projection radiography have significant advantages and are the modalities suggested by AGFAD [6].…”