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Ruder TD, Kuhnen SC, Zech WD, Klaus JB, Lombardo P, Ith M. Standards of practice in forensic age estimation with CT of the medial clavicular epiphysis-a systematic review. Int J Legal Med 2023; 137:1757-1766. [PMID: 37691040 PMCID: PMC10567934 DOI: 10.1007/s00414-023-03061-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/08/2023] [Indexed: 09/12/2023]
Abstract
The AGFAD (Arbeitsgemeinschaft für Forensische Alterdiagnostik, Study Group on Forensic Age Diagnostics) has published several recommendations regarding both technical aspects of computed tomography (CT) of the medial clavicular epiphysis (MCE) and the process of reading and interpreting the CT images for forensic age estimations (FAE). There are, however, no published recommendations regarding CT scan protocols and no dose reference values for CT of the MCE. The objective of this analysis was to assess adherence to AGFAD recommendations among practitioners of FAE and analyse reported dose-relevant CT scan parameters with the objective of helping to establish evidence-based dose reference values for FAE. A systematic literature search was conducted in PubMed and in Google Scholar with specific MeSH terms to identify original research articles on FAE with CT of the MCE from 1997 to 2022. A total of 48 studies were included. Adherence to AGFAD recommendations among practitioners of FAE is high regarding the use of Schmeling main stages (93%), bone window (79%), ≤ 1 mm CT slices (67%), axial/coronal CT images (65%), and Kellinghaus sub-stages (59%). The reporting of CT technique and CT dose-relevant scan parameters is heterogeneous and often incomplete in the current literature. Considering the success achieved by the AGFAD in creating standards of practice of FAE in living subjects, there is potential for the AGFAD to establish standards for radiation protection in FAE as well.
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Affiliation(s)
- Thomas D Ruder
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Saskia C Kuhnen
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Jeremias B Klaus
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- Roentgen Institute Thun, Thun, Switzerland
| | - Paolo Lombardo
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Michael Ith
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Radiation Protection, Image Processing Systems & Radiological Processes, Hirslanden Private Hospital Group, Zurich, Switzerland
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Lehmann-Leo CD, Ramsthaler F, Birngruber CG, Verhoff MA. Assessment of renal glomerulosclerosis and thickness of the carotid intima-media complex as a means of age estimation in Western European bodies. Int J Legal Med 2021; 136:753-763. [PMID: 34773496 PMCID: PMC9005432 DOI: 10.1007/s00414-021-02705-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The estimation of age-at-death of unidentified cadavers is a central aspect of the identification process. With increasing age, the incidence of glomerulosclerosis and the thickness of the carotid wall have been observed to also increase. This correlation has been demonstrated in various international histological studies. The aim of our study was to assess whether these correlations also apply to a Western European population. METHODOLOGY In this retrospective observational study, kidney and common carotid artery samples from 216 cases autopsied at the Institute of Legal Medicine at the Justus-Liebig University in Giessen, Germany, were examined. Only cases with available tissue samples from both body sides were included. Exclusion criteria were poor sample quality and an age younger than 21 years. After histological processing, the tissue samples were assessed and digitally evaluated. Regression and classification analyses were used to investigate the correlation between age-at-death and intima-media thickness and age-at-death and the incidence of renal glomerular sclerosis. RESULTS Of the 216 autopsy cases, 183 were included for evaluation. Analysis of the carotid artery segments showed a strong correlation (Pearson correlation coefficient r = 0.887) between the intima-media-complex thickness and chronological age. Classification of the glomerulosclerotic incidence showed a correlation of 37.7-43.1% with the predicted age group. DISCUSSION Both the intima-media thickness and the proportion of sclerotic glomeruli can be used to estimate age in Western European cadavers. On the basis of these results, both methods are suited to supplement other already established methods for age-at-death estimation in the identification of an unknown cadaver.
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Affiliation(s)
- Carl Daniel Lehmann-Leo
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Kennedyallee 104, 60596, Frankfurt/Main, Germany
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital Gießen and Marburg, Gießen, Germany
| | - Frank Ramsthaler
- Institute of Legal Medicine, University of Saarland, HomburgSaar, Germany
| | - Christoph G Birngruber
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Kennedyallee 104, 60596, Frankfurt/Main, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Kennedyallee 104, 60596, Frankfurt/Main, Germany.
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Tozakidou M, Meister RL, Well L, Petersen KU, Schindera S, Jopp-van Well E, Püschel K, Herrmann J. CT of the medial clavicular epiphysis for forensic age estimation: hands up? Int J Legal Med 2021; 135:1581-1587. [PMID: 33625576 PMCID: PMC8206049 DOI: 10.1007/s00414-021-02516-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to assess the impact of arm position in computed tomography (CT) of the clavicle performed for forensic age estimation on clavicular position, image noise, and radiation dose. Methods and materials Forty-seven CT scans of the medial clavicular epiphysis performed for forensic age estimation were conducted with either hands and arms held upwards (CTHU, 28 persons) or positioned at the body (CTHD, 19 persons). Presets were identical for both positions (70 mAs/140 kVp; Brilliance iCT, Philips). Each CT scan was reconstructed with an iterative algorithm (i-Dose 4) and evaluated at the middle of the sternoclavicular joint. Clavicular angle was measured on a.p. topograms in relation to a horizontal line. Quantitative image noise was measured in air at the level of medial clavicular epiphysis. Effective dose and scan length were recorded. Results Hands-up position compared with hands-down position resulted in a lower lateral body diameter (CTHU 41.1 ± 3.6 cm vs. CTHD 44.6 ± 3.1 cm; P = 0.03), a reduced quantitative image noise (CTHU: 39.5 ± 9.2; CTHD: 46.2 ± 8.3; P = 0.02), and lower CTDIvol (5.1 ± 1.4 mGy vs. 6.7 ± 1.8 mGy; P = 0.001). Scan length was longer in patients examined with hands up (HU: 8.5 ± 3.4 cm; HD: 6.2 ± 2.1 cm; P = 0.006). Mean effective dose for CTHU was 0.79 ± 0.32 mSv compared with 0.95 ± 0.38 mSv in CTHD (P = 0.12). Clavicular angle was 17° ± 6° in patients with hands down and 32° ± 7° in patients with hands up (P < 0.001). Conclusion By elevated arm positioning, the image quality of clavicular CT scans can be improved while maintaining radiation dose compared with hands down. Clavicular position differs according to the hand position. Thus, positioning patients with elevated hands is advisable for forensic clavicular CT examinations, but multiplanar CT reconstructions should be adjusted to clavicular position and scan length should be reduced to a minimum.
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Affiliation(s)
- Magdalini Tozakidou
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Rieke L Meister
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kay U Petersen
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | | | - Eilin Jopp-van Well
- Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Using freely-available 3D software to reconstruct traumatic bone injuries detected with post mortem computed tomography. Forensic Sci Med Pathol 2019; 16:113-118. [DOI: 10.1007/s12024-019-00205-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
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Tozakidou M, Apine I, Petersen KU, Weinrich JM, Schindera S, Jopp-van Well E, Püschel K, Herrmann J. Comparison of different iterative CT reconstruction techniques and filtered back projection for assessment of the medial clavicular epiphysis in forensic age estimation. Int J Legal Med 2019; 134:355-361. [PMID: 31773319 DOI: 10.1007/s00414-019-02214-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess the impact of iterative reconstruction and filtered back projection (FBP) on image quality in computed tomography (CT)-based forensic age estimation of the medial clavicular epiphysis. METHODS AND MATERIALS CT of the clavicle was performed in 19 patients due to forensic reasons (70 mAs/140 kVp). Raw data were reconstructed with FBP and with an iterative algorithm at level 4 and 6. Clavicular ossification stage was determined by two radiologists in consensus, firstly on FBP reconstructed images and secondly after reviewing all reconstructions including iDose 4 and 6. In addition, the 3 reconstructions were compared regarding artefacts and delineation of the meta-/epiphyseal interface. Quantitative image noise was measured. RESULTS Quantitative noise was lower in iDose 6 reconstructed images than in FBP (P < 0.042), but not significantly lower between iDose 4 and FBP (P = 0.127). Side by side comparison revealed lesser qualitative image noise on both iDose reconstructed images than for FBP. The meta-/epiphyseal interface delineation was rated better on both iDose levels than with FBP. In 3 of 19 patients, the clavicular ossification stage was reclassified after iterative reconstructions had been additionally reviewed. CONCLUSION Using iterative CT reconstruction algorithms, a reduction of image noise and an enhancement of image quality regarding the meta-/epiphyseal clavicular interface can be achieved. The study highlights the importance of image standardization as variation of reconstruction technique has impact on forensic age estimation.
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Affiliation(s)
- Magdalini Tozakidou
- Department of Diagnostic and Interventional Radiology and Nuclear medicine, Section of Pediatric Radiology, University Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Ilze Apine
- Children Clinical University Hospital, Riga, Latvia
| | - Kay U Petersen
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear medicine, University Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany
| | | | - Eilin Jopp-van Well
- Department of Forensic Medicine, University Hospital Hamburg-Eppendorf, 22529, Hamburg, Germany
| | - Klaus Püschel
- Department of Forensic Medicine, University Hospital Hamburg-Eppendorf, 22529, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear medicine, Section of Pediatric Radiology, University Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany
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Anatomic shape variants of extremitas sternalis claviculae as collected from sternoclavicular thin-slice CT-studies of 2820 male borderline-adults. Int J Legal Med 2019; 133:1517-1528. [PMID: 31104134 DOI: 10.1007/s00414-019-02065-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
Within medical age assessment practice, the indicator "medial clavicular ossification" constitutes crucial evidence capable of excluding age minority "beyond reasonable doubt" concerning age-disputed individuals doubtfully claiming children's rights during legal procedures. Yet, one of its characteristics affects the morphological variability including a fair amount of downright peculiar appearances. As a result, inexperienced examiners are tempted to classify actually not-assessable formations according to the two established developmental typologies of Schmeling et al. and Kellinghaus et al. being at the same time the most frequent systemic error of age-related clavicular taxation. Since a respective overview appears missing, the study extracts not-assessable shape variants of the medial collar bone from a large sample of 2820 male borderline-adults as seen from thin-slice, sternoclavicular computed tomography. The two already highlighted configurations "more than one, medial, secondary ossification centres" and "medial metaphyseal concavity" are found as the most commonly encountered features impeding reliable delineation of staging criteria. In accordance with previous literature, it is emphasized that "qualified" rating of extremitas sternalis claviculae within age assessment practice presupposes "knowledge about the diversity of [its] anatomic shape variants."
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