Estimation of pediatric skeletal age using geometric morphometrics and three-dimensional cranial size changes

Accuracy of geometric morphometrics for age estimation using frontal face photographs of children and adolescents: A promising method for forensic practice

Age estimation is crucial in legal and humanitarian contexts. Forensic professionals may use various procedures to estimate age, including dental analysis, bone density tests, evaluation of physical characteristics including facial bone structure and development, and image-based methods. Although images are often the only material available, visual observation of photographic material is an imprecise method in age estimation, which can compromise judicial decision-making. Analyzing 4000 photographs from the Brazilian Federal Police database, representing four age groups (6, 10, 14, and 18 years), the study employed automated analysis by marking 28 photogrammetric points. Data were used to establish facial patterns by age and sex using the facial geometric morphometrics method. Performance was assessed through a Multinomial Logistic Regression model, evaluating accuracy, sensitivity, and specificity across the categorical age groups. Analyses were conducted using R software, with a 5 % significance level. The study found that facial geometric morphometrics achieved an overall accuracy of 69.3 % in age discrimination, with higher accuracy in males (74.7 %) compared to females (65.8 %) (p < 0.001). The method excelled at predicting the age of 6-year-olds with 87.3 % sensitivity and 95.6 % specificity but had lower performance at 14 years. It showed greater accuracy in distinguishing age groups with larger age gaps, achieving up to 99.5 % accuracy between certain groups, and was particularly effective in differentiating ages of 6 and 10 years in females and 10, 14, and 18 years in males. The facial geometric morphometrics emerges as a promising approach for age estimation among children and adolescents in forensic settings.

Skeletal and dental age estimation via postmortem computed tomography in Polish subadults group

This article is a retrospective analysis of postmortem computed tomography scans of ossification stages of the anterior and posterior intra-occipital sutures, the anterior arch of the atlas, and the neurocentral junction of the axis. We also analyzed the development of secondary ossification centers in the proximal humeral, femoral, and tibial epiphyses, and the distal femoral and tibial epiphyses. Additionally, the development of primary ossification centers in the wrist and metacarpals, and maxillary and mandibular deciduous tooth maturation. A total of 58 cadavers (35 males, 23 females), whose age ranged from 3rd month of pregnancy to 14 years, were analyzed. The results of this study show that analysis of synchondrosis closure, primary, and secondary ossification center development and deciduous tooth changes are a good tool for age estimation in subadults group (fetuses, newborns, infants, and children). The results of the study in a Polish population are consistent with those reported by other authors.

Sex estimation of Malaysian sub-adults using craniometrics: A computed tomography study

Sex estimation is crucial in biological profiling of skeletal human remains. Methods used for sex estimation in adults are less effective for sub-adults due to varied cranium patterns during the growth period. Hence, this study aimed to develop a sex estimation model for Malaysian sub-adults using craniometric measurements obtained through multi-slice computed tomography (MSCT). A total of 521 cranial MSCT dataset of sub-adult Malaysians (279 males, 242 females; 0-20 years old) were collected. Mimics software version 21.0 (Materialise, Leuven, Belgium) was used to construct three-dimensional (3D) models. A plane-to-plane (PTP) protocol was utilised to measure 14 selected craniometric parameters. Discriminant function analysis (DFA) and binary logistic regression (BLR) were used to statistically analyze the data. In this study, low level of sexual dimorphism was observed in cranium below 6 years old. The level was then increased with age. For sample validation data, the accuracy of DFA and BLR in estimating sex improved with age from 61.6% to 90.3%. All age groups except 0-2 and 3-6 showed high accuracy percentage (≥75%) when tested using DFA and BLR. DFA and BLR can be utilised to estimate sex for Malaysian sub-adult using MSCT craniometric measurements. However, BLR showed higher accuracy than DFA in sex estimation of sub-adults.

Is facial geometric morphometrics a useful method for age estimation in children and adolescents? Limited evidence and lack of studies leave us with an uncertain answer

Facial geometric morphometrics is a non-invasive method that has recently shown potential applications, including age estimation, diagnosis of facial abnormalities, monitoring facial development, and evaluating treatment outcomes. A systematic review identified two studies that demonstrated the use of facial geometric morphometrics for age estimation in children and adolescents, showing promising results in terms of accuracy and error. This finding could be particularly relevant in forensic investigations. However, a research agenda should be established to prioritize the assessment of the diagnostic accuracy of facial morphometric geometrics in estimating age among children and adolescents.

Testing different 3D techniques using geometric morphometrics: Implications for cranial fluctuating asymmetry in humans

This study aimed to test the performance of 3D digitizer, CT scanner, and surface scanner in detecting cranial fluctuating asymmetry. Sets of 32 landmarks (6 in the midline and 13 bilateral) were acquired from 14 archeological crania using a 3D digitizer, and from 3D models generated from a CT scanner and surface scanner using Viewbox 4. Levels of shape variation were analyzed in MorphoJ using Procrustes analysis of variance and Principal component analysis. Intra-observer error accounted for 1.7%, 1.8%, and 4.5% of total shape variation for 3D digitizer, CT scanner, and surface scanner respectively. Fluctuating asymmetry accounted for 15%-16% of total shape variation. Variation between techniques accounted for 18% of total shape variation. We found a higher level of missing landmarks in our surface scan data than for both 3D digitizer and CT scanner data, and both 3D model-based techniques sometimes obscured taphonomic damage. All three 3D techniques are appropriate for measuring cranial fluctuating asymmetry. We advise against combining data collected with different techniques.

Age estimation in infant skeletal remains by measurements of the pars lateralis

The objectives of this work were to validate two published methods for subadult age estimation based on measurements of the pars lateralis, and to develop a new method based on a wider set of measurements using the Granada Osteological Collection. The pars lateralis of 127 individuals from 6 months prenatal to 4 years of age were measured, taking 6 measurements of the body, the anterior synchondrosis and the condyle. Length and width were used to validate the published methods. Regression functions using age as the independent variable were calculated using each of the six measurements taken, and functions for age estimation were obtained through classical calibration. Functions for calculation of the 95% confidence interval of the estimates were obtained through linear regression using the estimation errors. In the validation of the previous methods, one method showed a linear tendency of the differences, which can be attributed to a circularity in reasoning in the original work. In the other method, a tendency towards overestimation was found, which can be attributed to the limitations of the method itself. The new functions have a consistency rate of 92.2% to 97.1%; the functions derived from all measurements are useful from 6 months prenatal to 2 years of age. Moreover, the functions obtained are applicable to incomplete pars lateralis, allowing for age estimation in a wide set of contexts and providing straightforward age estimates with their respective margin of error.

A Raman algorithm to estimate human age from protein structural variations in autopsy skin samples: a protein biological clock

The recent increase of the number of unidentified cadavers has become a serious problem throughout the world. As a simple and objective method for age estimation, we attempted to utilize Raman spectrometry for forensic identification. Raman spectroscopy is an optical-based vibrational spectroscopic technique that provides detailed information regarding a sample’s molecular composition and structures. Building upon our previous proof-of-concept study, we measured the Raman spectra of abdominal skin samples from 132 autopsy cases and the protein-folding intensity ratio, R_PF, defined as the ratio between the Raman signals from a random coil an α-helix. There was a strong negative correlation between age and R_PF with a Pearson correlation coefficient of r = 0.878. Four models, based on linear (R_PF), squared (R_PF²), sex, and R_PF by sex interaction terms, were examined. The results of cross validation suggested that the second model including linear and squared terms was the best model with the lowest root mean squared error (11.3 years of age) and the highest coefficient of determination (0.743). Our results indicate that the there was a high correlation between the age and R_PF and the Raman biological clock of protein folding can be used as a simple and objective forensic age estimation method for unidentified cadavers.

Statistical shape analysis of hand and wrist in paediatric population on radiographs

Background/aim

The goal of this study was to compare differences in hand and wrist shapes and to evaluate these according to growth and allometry in children on radiographs related to bone age.

Materials and methods

The study included 263 males and 189 females. A total of 452 left hand and wrist radiographs were retrospectively collected. Standard anatomical landmarks marked on radiographs.

Results

There were seen to be significant differences in comparisons of hand and wrist shapes according to sex (P = 0.009). The most suitable model in the growth models was seen as the Gompertz growth model for both females and males (model P < 0.001). For the relationship between shape and size to evaluate allometry, significant models were obtained in females (model P = 0.017, MSE = 0.0002) and in males (model P < 0.001, MSE = 0.0002). In our study, the difference between the sexes was found mostly in the radiocarpal region. It was observed that the deformation of the carpal bones started in the distal row carpal bones.

Conclusion

Significant differences were found in hand and wrist shapes according to sex. Models for growth and allometry of hand and wrist shapes were found to be significant in children.

Cochlear shape reveals that the human organ of hearing is sex-typed from birth

Sex differences in behavioral and neural characteristics can be caused by cultural influences but also by sex-based differences in neurophysiological and sensorimotor features. Since signal-response systems influence decision-making, cooperative and collaborative behaviors, the anatomical or physiological bases for any sex-based difference in sensory mechanisms are important to explore. Here, we use uniform scaling and nonparametric representations of the human cochlea, the main organ of hearing that imprints its adult-like morphology within the petrosal bone from birth. We observe a sex-differentiated torsion along the 3D cochlear curve in samples of 94 adults and 22 juvenile skeletons from cross-cultural contexts. The cochlear sexual dimorphism measured in our study allows sex assessment from the human skeleton with a mean accuracy ranging from 0.91 to 0.93 throughout life. We conclude that the human cochlea is sex-typed from an early post-natal age. This, for the first time, allows nondestructive sex determination of juveniles' skeletal remains in which the biomolecules are too degraded for study but in which the petrosal is preserved, one of the most common bone within archaeological assemblages. Our observed sex-typed cochlear shape from birth is likely associated with complex evolutionary processes in modern humans for reasons not yet fully understood.

Morphometric Analysis of the Neurocranium in an Adult South African Cadaveric Sample

Craniometric studies of South Africans yield high accuracies of sex and ancestry classification, but most assess only inter-group variation of Black and White individuals, excluding the highly heterogeneous Colored group, which constitute a significant proportion of the population. This study applied a geometric morphometric approach to the neurocrania of 774 Black, Colored, and White individuals to assess sex and ancestry estimation accuracy based on the detected morphological variation. Accuracies of 70% and 83% were achieved for sex and ancestry, respectively, with ancestry-related variation contributing the largest proportion of overall observed variation. Even when comparing the closely related Black and Colored groups, relatively high accuracies were obtained. It is thus recommended that a similar approach be used to develop a contemporary three-dimensional database, which can be used to objectively, reliably, and accurately classify unknown remains in the South African forensic context.

Morphometric analysis of the humerus in an adult South African cadaveric sample

Recent studies using geometric morphometrics have shown that estimations of demographic parameters can be made using skeletal elements previously not thought useful for such purposes. This study used geometric morphometrics to assess humeral morphological variation in an adult South African sample, and evaluated the accuracy of sex and ancestry estimations based on this variation. Humeri of 1046 adult South African individuals (464 females, 582 males) were digitized. Data sets were rotated and scaled to a common centroid using Generalized Procrustes Analysis. Mean centroid sizes between groups were compared using parametric tests, while morphological variation was evaluated using multivariate analyses. Discriminant Function Analysis coupled with leave-one-out cross-validation tests were used to assess the reliability of sex and ancestry classifications based on this variation. Male humeri were relatively larger and presented with morphological features indicative of larger muscle mass and smaller carrying angles than females. White individuals had relatively larger but morphologically less robust humeri than Black or Coloured individuals, likely a reflection of both genetic and socio-economic differences between the groups as enforced under Apartheid law. When sex and ancestry were assessed together, similar variations were detected than when either parameter was individually assessed. Classification accuracy was relatively low when sex was independently assessed (73.3%), but increased when considered in conjunction with ancestry, indicating greater variation between-groups (ancestry) than within-groups. Ancestry estimation accuracies exceeded 80%, even for the highly diverse Coloured group. Classification accuracies of sex-ancestry groups all exceeded 76%. These results show that humerus morphological variation is present and may be used to estimate parameters, such as sex and ancestry, even in complex groups such as the Coloured sample of this study.

Proposal of new regression formulae for the estimation of age in infant skeletal remains from the metric study of the pars basilaris

In the context of physical and forensic anthropology, when a child's skeleton is damaged or in poor condition, which is common, many of the metric methods for the estimation of skeletal age cannot be used. In these circumstances, those more resistant bones, such as the pars basilaris, will be most useful. The aims of this study were to test existing methods for estimating skeletal age from the metric study of the pars basilaris and to propose new regression formulae. One hundred fourteen individuals aged between 5 months of gestation and 6 years were analyzed; seven measures were taken from each pars basilaris using a digital caliper. The chronological age was compared with the estimated age using the methods published by Fazekas and Kósa in 1978 and by Scheuer and MacLaughlin in 1994. New regression formulae are proposed, obtained by classical calibration, which include confidence intervals at 50 and 97.5 % to express the error. With both methods, significant differences were observed; the method of Fazekas and Kósa shows a tendency to underestimate the age, and the method of Scheuer and MacLaughlin tends to overestimate it. The proposed formulae represent a good tool for estimating age in many different contexts because they are relatively easy to apply, although other analysis systems, such as Bayesian approach or geometric morphometry, offer more robust and effective results.

Ontogeny of Size and Shape Sexual Dimorphism in the Pubis: A Multislice Computed Tomography Study by Geometric Morphometry

Few studies have been conducted to determine sex differences in the immature coxal bone and the results were often contradictory. The authors studied sexual dimorphic differences of the pubis using geometric morphometric analysis of five osteometric landmarks recorded by multislice computed tomography (MSCT), based on three-dimensional reconstructions of 188 children (95 boys, 93 girls) living in the region of Toulouse, southwestern France, ranging in age from 1 to 18 years old. They used geometric morphometric methodology first to test sexual dimorphism in size (centroid size) and shape (Procrustes residuals) and second to examine patterns of shape change with age (development) and size change with age (growth). Based on statistical significance test results, the pubic shape became sexually dimorphic at 13 years old, although visible shape differences were observed as early as 9 years old. This work showed that the trajectories of pubis shape (development) and size (growth) differed throughout ontogeny and between sexes.

Asynchronous dentofacial development and dental crowding: a cross-sectional study in a contemporary sample of children in France

Background

The causes of dental crowding are not fully understood, but it may result from an evolutionary trend towards reduced facial volume, without a proportional reduction in tooth sizes. Most previous studies conducted among modern humans have revealed a very low or non-existent correlation between tooth size and jaw size. Cross-comparison between dental age and facial skeletal age could help to provide better knowledge of the dynamic process of dental crowding. The primary objective of this research was to study the synchronism of dental maturation and skeletal facial growth in a sample of modern children living in France. The secondary objective was to assess the link between dentofacial asynchronism and dental crowding.

Results

The random sample comprised 28 subjects (16 girls, 12 boys). Mean chronological age was 13.5 years (±2.1; range 9.2–17.6). Mean dental age was 14.2 years (±2.8; range 7.5–17) and mean facial skeletal age was 12.8 years (±2.6, range 7–22). In the estimations of dental age and facial skeletal age, there was no evidence of systematic bias. There were 10 subjects (9 girls, 1 boy) with asynchronous dentofacial development. Finally, there were 13 subjects (8 girls, 5 boys) with dental crowding. A significant association was found between delayed facial skeletal growth/advanced dental maturation and dental crowding (P = 0.01).

Conclusions

Dental maturation and facial growth are not necessarily synchronous. Further understanding of the interactions between dental maturation and facial growth could have crucial implications in biological anthropology, as well as for the clinical practice of orthodontists. From an anthropological perspective, this study suggests that asynchronous dentofacial development could, at least partially, explain the frequency of dental crowding in modern populations.

Human coxal bone sexual dimorphism and multislice computed tomography: geometric morphometric analysis of 65 adults

The authors studied sexually dimorphic differences in coxal shape using geometric morphometric analysis of 15 osteometric landmarks recorded by multislice computed tomography (MSCT), based on three-dimensional reconstructions of 65 Caucasian adults. Geometric morphometric analysis, principal component analysis, canonical variates analysis, and other discriminant analysis (Goodall's F-test and Mahalanobis distance) were performed for the three separate bones of the left innominate (pubis, ilium, and ischium), the modified pubis (pubis and ischiopubic ramus), the modified ilium (ilium and ischial spine), three bone complexes (ischiopubic, iliopubic, and ilio-ischial), and the complete innominate. A cross-validation test was also performed. All areas studied were dimorphic, but results for sexual dimorphism in decreasing order were as follows: the modified pubis, followed by the ischiopubic complex, the iliopubic complex and the complete innominate, the pubis, the modified ilium, the ilio-ischial complex, the ilium, and finally the ischium. These results show the potential of this approach for future anthropological research.

Three-dimensional geometric morphometric analysis of cranio-facial sexual dimorphism in a Central European sample of known sex

This article presents an approach for estimating the sexual dimorphism of adult crania using three-dimensional geometric morphometric methods. The study sample consisted of 139 crania of known sex (73 males and 66 females) belonging to persons who lived during the first half of the 20th century in Bohemia. The three-dimensional co-ordinates of 82 ecto-cranial landmarks and 39 semi-landmarks covering the midsagittal curve of the cranial vault were digitised using a MicroScribe G2X contact digitiser. The purposes of the investigation were to define the regions of the cranium where sexual dimorphism is most pronounced and to investigate the effectiveness of this method for determining sex from the shape of the cranium. The results demonstrate that it is better to analyse apportionable parts of the cranium rather than the cranium as a whole. Significant sexual differences (significance was determined using multivariate analysis of variance) were noted in the shape of the midsagittal curve of the vault, upper face, the region of the nose, orbits, and palate. No differences were recorded either in the shape of the cranium as a whole or in the regions of the base and the neurocranium. The greatest accuracy in determining sex was found in the region of the upper face (100% of study subjects correctly classified) and the midsagittal curve of the vault (99% of study subjects correctly classified).

Dental maturational sequence and dental tissue proportions in the early Upper Paleolithic child from Abrigo do Lagar Velho, Portugal

Neandertals differ from recent and terminal Pleistocene human populations in their patterns of dental development, endostructural (internal structure) organization, and relative tissue proportions. Although significant changes in craniofacial and postcranial morphology have been found between the Middle Paleolithic and earlier Upper Paleolithic modern humans of western Eurasia and the terminal Pleistocene and Holocene inhabitants of the same region, most studies of dental maturation and structural morphology have compared Neandertals only to later Holocene humans. To assess whether earlier modern humans contrasted with later modern populations and possibly approached the Neandertal pattern, we used high-resolution microtomography to analyze the remarkably complete mixed dentition of the early Upper Paleolithic (Gravettian) child from Abrigo do Lagar Velho, Portugal, and compared it to a Neandertal sample, the late Upper Paleolithic (Magdalenian) child of La Madeleine, and a worldwide extant human sample. Some aspects of the dental maturational pattern and tooth endostructural organization of Lagar Velho 1 are absent from extant populations and the Magdalenian specimen and are currently documented only among Neandertals. Therefore, a simple Neandertal versus modern human dichotomy is inadequate to accommodate the morphostructural and developmental variation represented by Middle Paleolithic and earlier Upper Paleolithic populations. These data reinforce the complex nature of Neandertal-modern human similarities and differences, and document ongoing human evolution after the global establishment of modern human morphology.

Optic disc morphology--rethinking shape

Morphometrics, a branch of morphology, represents the study of size and shape components of biological form and their variation in the population. Assessment of optic disc morphology is essential in the diagnosis and management of many ophthalmic disorders. Much work has been performed to characterize size-related parameters of the optic disc; however, limited information is available on shape variation in the general population. In contrast to optic disc or cup sizes, which are conceptually meaningful variables with a defined unit of measurement, there are few metric constructs by which to quantify, visualize and interpret variation in optic disc or cup shape. This has significance in ophthalmic diseases with a genetic basis as recent evidence has suggested that optic disc shape may be heritable. Conventional optic disc shape measures of 'ovality' and 'form-factor' reduce a complex structure to a single number and eliminate information of potential diagnostic relevance from further analyses. The recent advent of 'geometric morphometrics', a branch of statistics that incorporates tools from geometry, biometrics and computer graphics in the quantitative analysis of biological forms, has enabled spatial relationships in shape data to be retained during analysis. The analytical methods employed in geometric morphometrics can be separated into two distinct groups: landmark-based (e.g. Procrustes analysis, thin-plate splines) and boundary outline techniques (e.g. Fourier analysis). In this review, we summarize current approaches to the study of optic disc morphology, discuss the underlying theory of geometric morphometrics within the context of analytical techniques and then explore the contemporary relevance of the subject matter to several biological fields. Finally we illustrate the potential application of geometric morphometrics to the specific problem of optic disc shape and glaucoma assessment.

Estimating age of majority on third molars developmental stages in young adults from Thailand using a modified scoring technique

The aim of this study was to achieve a referral database for dental age estimation of unaccompanied minors of Thai nationality. A total of 1199 orthopantomograms were collected from original Thai women and men equally divided in age categories between 15 and 24 years. On the radiographs, the developmental stage of the third molars was scored applying a modified scoring technique. Inter- and intra-observer reliabilities were tested using kappa statistics. Correlation between the scores of all four wisdom teeth and left-right symmetry were evaluated with Pearson's correlation coefficient. Student's t-test on asymmetry was performed and regression formulas were calculated. The present database was the first to assemble third molar developmental scores on radiographs of Thai individuals and provides more appropriate dental age estimation of unaccompanied Thai minors. Future research on similar databases of different nationalities worldwide may expose ethnical influences on dental development.

Dental developmental pattern of the Neanderthal child from Roc de Marsal: a high-resolution 3D analysis

The assessment of the degree of similarity or difference between Neanderthals and modern humans in their patterns of dental development remains a controversial matter. Here we report results from the microtomographic-based (SR-microCT) high-resolution structural investigation of the maxilla and mandible of the Neanderthal child from Roc de Marsal, Dordogne, France (likely from OIS 5a). Following their virtual extraction and 3D rendering, we assessed the maturational stage of each of the 41 dental elements (20 deciduous and 21 permanent) forming its mixed dentition. By using a Bayesian approach, we calculated the probability that its deciduous and permanent mandibular sequences are found within the extant human variation as illustrated by a tomographic CT-based sub-sample of 32 children (deciduous dentition) and a panoramic radiographic- and CT-based whole sample of 343 living children (permanent dentition). Results show that neither the deciduous nor the permanent mandibular sequences displayed by Roc de Marsal are precisely found within our modern comparative files. In both sequences, the most influential factor is represented by a slight discrepancy in the Neanderthal child between the stage of mineralization of the first molar, which is proportionally advanced, and the maturational level reached by its incisors, which are proportionally delayed. Following a quantitative volumetric analysis of the deciduous teeth, we suggest that this characteristic may be related to differences between Neanderthals and modern humans in absolute dental size and relative size proportions between front and cheek teeth, as well as to structural differences in dental tissue proportions.

Age and gender based biomechanical shape and size analysis of the pediatric brain

Injuries caused by motor vehicle crashes (MVCs) are the leading cause of head injury and death for children in the United States. This study aims to describe the shape and size (morphologic) changes of the cerebrum, cerebellum, brainstem, and ventricles of the pediatric occupant to better predict injury and assess how these changes affect finite element model (FEM) response. To quantify morphologic differences in the brain, a Generalized Procrustes Analysis (GPA) with a sliding landmark method was conducted to isolate morphologic changes using magnetic resonance images of 63 normal subjects. This type of geometric morphometric analysis was selected for its ability to identify homologous landmarks on structures with few true landmarks and isolate the shape and size of the individuals studied. From the resulting landmark coordinates, the shape and size changes were regressed against age to develop a model describing morphologic changes in the pediatric brain as a function of age. The most statistically significant shape change was in the cerebrum with p-values of 0.00346 for males and 0.00829 for females. The age-based model explains over 80% of the variation in size in the cerebrum. Using size and shape models, affine transformations were applied to the SIMon FEM to determine differences in response given differences in size and size plus shape. The geometric centroid of the elements exceeding 15% strain was calculated and compared to the geometric centroid of the entire structure. Given the same Haversine pulse, the centroid location, a metric for the spatial distribution of the elements exceeding an injury threshold, varied based on which transformation was applied to the model. To assess the overall response of the model, three injury metrics were examined to determine the magnitude of the metrics each element sustained and the overall volume of elements that experienced that value. These results suggested that the overall response of the model was driven by the variation in size, with little variation due to changes in shape. This study demonstrates a new methodology to quantify the shape and size variation of the brain from infancy to adulthood. The use of the changes in shape and size when applied to a FEM suggests that there are differences in the spatial distribution of the elements that exceed a specific threshold based on shape but the overall volume of elements experiencing the specified magnitude was more dependent on the changes in the size of the model with little change due to shape.

Ultrasound studies on the time course of clavicular ossification

When preparing forensic age estimates for living subjects over 18 years of age, it is crucial to evaluate the stage of ossification of the medial clavicular epiphysis. The establishment of radiation-free imaging techniques for assessment of clavicular ossification would be desirable in order to reduce the radiation exposure associated with forensic age estimations. In the present study, 84 right clavicles of test subjects 12-30 years of age were prospectively evaluated by means of ultrasound. Ossification stage classification was possible in 80 of the 84 medial clavicular epiphyses studied. In the remaining cases, stage classification was not possible due to the presence of developmental anomalies. The earliest ages at which the respective ossification stages were observed were 17.1 years for stage 2, 16.7 years for stage 3, and 22.5 years for stage 4. The age intervals observed for the ossification stages are consistent with the known data from radiological and computed tomography assessments. The present study results should be confirmed in a larger number of cases and with analysis of observer variability. Evaluation of medial clavicular epiphyseal ossification by ultrasound could ultimately be a rapid and economic non-ionizing diagnostic imaging procedure for forensic age estimation.

Radiographic staging of ossification of the medial clavicular epiphysis

Determination of the stage of ossification of the medial clavicular epiphysis is a crucial part of forensic age estimation when evaluating living subjects over 18 years of age. In the present study, we comparatively assessed conventional radiographs and computed tomography (CT) scans of sternoclavicular joints used to perform forensic age assessments in 57 individuals undergoing criminal proceedings. With CT, it was possible to determine the ossification stage of all clavicles studied. In the case of conventional radiography, reliable assessment of ossification stage was not possible in 15 out of 114 clavicles studied due to the superimposition of other structures. Regarding agreement between the methods, both radiography and CT produced identical staging results in 97 out of 99 clavicular epiphyses. In two cases, however, ossification was classified as stage 2 by CT and as stage 3 by conventional radiography. Regarding stages 4 and 5, both methods produced identical staging results in all cases. In forensic age estimation practice, it is necessary that conventional radiographic reference studies be used for ossification stage classification by conventional radiography and that CT reference studies be used for ossification stage classification by CT. Further studies in dead bodies of known age are required to issue a recommendation as to whether conventional radiography using obtained in three planes or CT is the method of choice for the assessment of clavicular ossification.