How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update

Abstract

Possible biological side effects of exposure to X-rays are stochastic effects such as carcinogenesis and genetic alterations. In recent years, a number of new studies have been published about the special cancer risk that children may suffer from diagnostic X-rays. Children and adolescents who constitute many of the probands in forensic age-estimation proceedings are considerably more sensitive to the carcinogenic risks of ionizing radiation than adults. Established doses for X-ray examinations in forensic age estimations vary from less than 0.1 microSv (left hand X-ray) up to more than 800 microSv (computed tomography). Computed tomography in children, as a relatively high-dose procedure, is of particular interest because the doses involved are near to the lower limit of the doses observed and analyzed in A-bombing survivor studies. From these studies, direct epidemiological data exist concerning the lifetime cancer risk. Since there is no medical indication for forensic age examinations, it should be stressed that only safe methods are generally acceptable. This paper reviews current knowledge on cancer risks associated with diagnostic radiation and aims to help forensic experts, dentists, and pediatricians evaluate the risk from radiation when using X-rays in age-estimation procedures.

Magnetic resonance imaging of the medial extremity of the clavicle in forensic bone age determination: a new four-minute approach

“…The study of the clavicle in forensic bone age determination generates an effective dose of 0.6 mSv for the radiographs (0.2 mSv each radiograph) and 0.6 to 0.8 mSv for the CT examination [22][23][24]. The radiation dose of the radiographs is relatively high compared with the other radiography examinations in forensic bone age determination such as an orthopantogram (0.026 mSv) and a hand radiograph (0.0001 mSv) [18,21,22]. In general, CT examinations produce a significantly higher radiation dose than radiographs and therefore a much higher risk.…”

“…From different studies that compare radiation exposure of radiographs with natural background radiation and other life risks, it can be concluded that the resulting risks from using radiographs in forensic age determination is very low compared with other life risks. Having a fatal accident during a 2.5-h-long journey in traffic is estimated to have an equivalent risk of dying from a radiation-induced cancer after a single orthopantogram (0.026 mSv) [18,21]. The study of the clavicle in forensic bone age determination generates an effective dose of 0.6 mSv for the radiographs (0.2 mSv each radiograph) and 0.6 to 0.8 mSv for the CT examination [22][23][24].…”

“…several years after a crime has been Concerning radiation exposure in forensic bone age determination, a few remarks can be made. At first the clavicle as a bone and children in general can be considered to be vulnerable to ionising radiation [18][19][20]. From different studies that compare radiation exposure of radiographs with natural background radiation and other life risks, it can be concluded that the resulting risks from using radiographs in forensic age determination is very low compared with other life risks.…”

Forensic age estimation in living individuals: methodological considerations in the context of medico-legal practice

“…2 Further, the risks associated with radiation related to OPGs are considered harmless compared to other risks, such as fatal criminal assault, drowning, and homicide. 89,90 The Australian Radiation Protection and Nuclear Safety Agency and the Australian Society of Forensic Odontology confirm that the radiation associated with dental X-rays is minimal. However, there is a general consensus among these agencies that all deliberate exposures to radiation should be justified, subject to control, and consider the potential damages arising due to the vulnerability and age (eg, radiographs being contradicted from birth to 2 years 62 ) of the individual.…”

“…88,89 The radiographic examination of dental development is relatively noninvasive and only requires exposure to small radiation doses (0.026 mSv) to acquire a suitable orthopantomogram (OPG). 90 This level of radiation is equivalent to 4.5 days of naturally occurring radiation exposure, and is thus ethically permissible. 2 Further, the risks associated with radiation related to OPGs are considered harmless compared to other risks, such as fatal criminal assault, drowning, and homicide.…”