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

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.

BAPGAN: GAN-based Bone Age Progression of Femur and Phalange X-ray Images

“…Real femur images for each age category are separately distributed except for age [12][13][14][15] and [16][17][18][19] since bone growth becomes slower until it ceases altogether (Figure 5). Meanwhile, distributions of real phalange images for age [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] highly overlap due to its smaller growth. BAPGAN-generated images have similar distributions to the real ones.…”

“…Because skeletal maturity progresses through discrete stages, pediatric medicine has correlated children's chronological age with bone age to investigate endocrinology, genetic, and growth disorders; but, time-consuming manual bone age assessment methods [1,2] suffer from intra-and interobserver variability. In this context, Convolutional Neural Networks have shown great promise in age assessment on various modalities and body regions, including hand/pelvic X-ray [3,4], clavicula Computed Tomography [5], and hand Magnetic Resonance Imaging [6].…”

CT of the medial clavicular epiphysis for forensic age estimation: hands up?

“…Changes of reformation techniques have been reported to influence image quality [13] and viewing images in axial and coronal reformations are considered gold standard for the evaluation of the medial clavicular epiphysis in forensic age estimation [20][21][22]. While many important studies in the field forensic clavicular imaging have examined patients with hands positioned at the body [12], studies with retrospective analysis of the clavicle, especially those that use thoracic CT examinations, evaluated multiplanar reformations in patients with hands positioned upwards [23]. Furthermore, volume rendering techniques have been discussed for the evaluation of the medial clavicular epiphysis [24].…”

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

“…32 Alternate modalities such as low-dose CT, magnetic resonance imaging (MRI) and ultrasonography (USG) can be used to visualise MCE fusion for age estimation. Low-dose CT represents a significant improvement over standard-dose CT, as the radiation exposure of low-dose CT is a fifth of that of standard-dose CT. Gassenmaier et al 33 conducted a study on age estimation using low-dose CT in 2020, and they reported that while there is a significant difference between the image quality of the low-dose and standard-dose CT images, age can still be estimated with relative accuracy using low-dose CT. Low-dose CT thus has a distinctive advantage over conventional radiography in terms of sensitivity in identifying the stages of MCE fusion, and over standard-dose CT in terms of minimising ionisation radiation. Visualisation of indicators of skeletal maturity using low-dose CT could thus prove to be the new gold standard in the science of forensic age estimation.…”