The iliac crest in forensic age diagnostics: evaluation of the apophyseal ossification in conventional radiography

Due to the increasing significance of forensic age estimations in the age of globalisation, novel radiographic criteria besides clavicles and hand bones may provide additional certainty for forensic age expertises. The present study analyses the suitability of the iliac crest apophysis by means of 643 pelvic radiographs of patients between 10 and 30 years of age. Retrospective assessments were carried out according to the forensically established classification and sub-classification systems modified after Kreitner et al. (Rofo 166(6):481–486, 1997) and Kellinghaus et al. (Int J Legal Med 124(4):321–325, 2010). The basic ossification stages range from 1 to 4, and the sub-stages of stage 2 and 3 range from a to c. While stage 3c was first achieved at the age of 15 by both sexes, stage 4 was first observed in females at the age of 16 and in males at the age of 17. This indicates the possibility of a valid diagnosis of both the age of 14 and the age of 16 years which represent legally relevant age thresholds in numerous countries. Applied as targeted radiography on the iliac crest, the exposure to radiation would range between other radiographic techniques recently applied. Therefore, the iliac crest apophysis appears principally suitable as novel possible criterion for forensic age estimation in the living. However, for the establishment of the iliac crest apophysis in routine diagnostics, further studies are needed focussing on the comparison of different grading systems and different radiological techniques.     

The iliac crest in forensic age estimation: evaluation of three methods in pelvis X-rays

International Journal of Legal Medicine - Age assessment in children and young adults is a relevant forensic issue. It is requested not only in evaluating criminal responsibility in youths without...     

The ossification of the ischial tuberosity for forensic age diagnostics in conventional radiography

Age estimation in living individuals is an area of increasing importance for both radiology and forensic medicine. Owing to a relatively late completion of maturation, the ischial tuberosity can offer a valuable alternative for assessing 18?years of age. However, the ossification of the ischial tuberosity has rarely been investigated with respect to forensic requirements. The aim of the study was to clarify how strong the chronological age relates to the ossification of the ischial tuberosity in the West China Han group. Our results indicated that the ischial tuberosity ossification appears to begin from 15.34 to 16.17?years for males, and from 14.39 to 15.64?years for females. The apophyseal cartilage begins to ossify from 18.50 to 19.17?years for males, and 18.73 to 19.44?years for females, and has fully ossified from 22.93 to 23.30?years for males, and 23.62 to 24.07?years for females. The present study offers a valuable alternative for age estimation.     

The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics

Computed tomography scans originally obtained to assess the ossification status of the medial clavicular epiphyses of 40 live subjects for forensic age estimation purposes were analysed. From the data acquired we reconstructed images with slice thicknesses of 1, 3, 5 and 7 mm, and based on the classification of stages by Schmeling et al. (Int J Legal Med 118:5–8, 2004), we determined the ossification stage for each reconstructed slice thickness, separately for both sides. Of the 80 clavicular epiphysial plates examined, seven displayed slice-thickness-dependent differences at certain ossification stages. In one case a slice thickness of 1 mm led to a different diagnosis of the ossification stage than a slice thickness of 3 mm, in three cases the diagnoses differed between the slice thicknesses of 3 and of 5 mm, and in another three cases, between 5 and 7 mm. We therefore conclude that for age estimation purposes, the slice thickness should be 1 mm to ensure maximum accuracy and diagnostic reliability.     

The use of magnetic resonance imaging to examine ossification of the proximal tibial epiphysis for forensic age estimation in living individuals

The establishment of radiation-free examination procedures in the field of forensic age diagnostics in living persons is to be considered of special scientific interest so as to minimize necessary exposure to X-rays while facilitating additional assessment of skeletal development in all cases. To this end, the advantages offered by magnetic resonance imaging in securing a practical application which is as unrestricted and complication-free as possible should be among the methods exploited in investigating such indicators of skeletal maturity. Within the framework of a retrospective study, we investigated the ossification status of the proximal tibial epiphysis on the MRI scans of 124 females and 166 males aged between 10 and 30 years. All the images had been generated on a 3.0 T scanner using a T1-weighted turbo spin-echo sequence. When evaluating the ossification stage, a combination of modified classifications proposed by Schmeling et al. and by Kellinghaus et al. was used. The statistical evaluation included calculation of a variety of measures to describe specific ossification stages as well as kappa coefficients to assess intra- and inter-observer agreement on diagnoses of individual stages. In forensic contexts, completion of the 14th year of life can be adequately evidenced in females with an ossification stage IV according to Schmeling et al. and in males with an ossification stage III c according to Kellinghaus et al. or an ossification stage IV according to Schmeling et al. In forensic contexts, the presence of an ossification stage IV according to Schmeling et al. can prove that the age of 16 years has been exceeded only in the male sex, whereby for age estimation purposes the diagnosis should be in line with other skeletal maturity indicators. The results available displayed a high degree of intra- and inter-observer agreement. Examination of the ossification status of the proximal tibial epiphysis using magnetic resonance imaging represents an effective additional tool for use in radiation-free forensic age diagnostics in living persons.     

Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment

International Journal of Legal Medicine - Evaluation of the degree of ossification of the medial clavicular epiphysis plays a crucial role in determining with an adequate degree of probability...     

Contribution of third molar eruption to the estimation of the forensic age of living individuals

International Journal of Legal Medicine - Forensic age estimation of a living individual is frequently performed in clinical forensic medicine. Medicolegal physicians are usually called upon by the...     

The role of forensic medicine and forensic dentistry in estimating the chronological age of living individuals in Hamburg,Germany

International Journal of Legal Medicine - Age estimation represents one of the primary responsibilities of forensic medicine and forensic dentistry. It is an integral procedure aiming to estimate...     

Sonographic assessment of the ossification of the medial clavicular epiphysis in 616 individuals

Establishing radiation-free imaging methods for the assessment of clavicular ossification in forensic age determination is desirable as it reduces radiation exposure in living individuals. For this purpose the stage of ossification of the right medial clavicular epiphysis was determined prospectively using sonography in 309 male and 307 female healthy volunteers. The classification of stages according to Schulz et al. was used for this purpose. Stage 2 was first noticed at the age of 14.4 years in males, and at the age of 14.1 years in females. Stage 3 was first achieved by males at the age of 17.6 years and by females at the age of 17.4 years. Stage 4 first occurred in males at the age of 19.3 years and at the age of 18.9 years in females. The mean age for stage 1 was 13.6 years. The mean age of stage 2 ranged between 17.3 and 17.6 years. For stage 3 the mean age varied from 20.7 to 21.2 years, and for stage 4 from 23.3 to 23.5 years. It was concluded that sonographically determined stage 4 clavicular ossification provides evidence for the completion of the nineteenth year of life in males and the eighteenth year of life in females. In order to increase the reliability of age determination using this method it is recommended that findings be recorded by at least two experienced independent examiners who then reach a consensus.     

The Risser sign for forensic age estimation in living individuals: a study of 643 pelvic radiographs

Due to increasing international migratory movements, forensic age estimations of living individuals in criminal proceedings are gaining increasing significance for forensic physicians and radiologists involved in delivering expert opinions. The present study examines the suitability of the radiologically well-known Risser sign grading as a possible new criterion in forensic age diagnostics. For this purpose, anteroposterior pelvic radiographs of 643 patients aged between 10 and 30 years were retrospectively evaluated by means of two different Risser sign grading systems (US and French), each with 5 stages. The left and right sides of the pelvis were assessed separately. The data was analyzed with separation of the sexes. Reliable Risser sign determination was possible in 566 cases. In both sexes, stage 4 of both the US and the French grading systems was predominantly first noted at age 14 years. In the US grading system, stage 5 was also first achieved at age 14 years in the majority of both sexes. In the French grading system, females manifested stage 5 at a minimum of 16 years, whereas in males it was first observed at 17 years. As to the nature of iliac crest maturation, interesting deviations were observed at stages 1 and 5, raising doubts about Risser’s ossification process. To conclude, both Risser sign grading systems are suitable for forensic age diagnostics, especially to determine whether the 14th year of life has been completed or not. The French Risser sign system additionally allows for statements as to the completion of the 16th year of age.     

Criteria for age estimation in living individuals

This paper presents updated recommendations of the Study Group on Forensic Age Diagnostics for age estimations in living individuals in criminal proceedings. In order to increase the diagnostic accuracy and to improve the identification of age-relevant developmental disorders, a physical examination, an X-ray examination of the left hand, as well as a dental examination including the determination of the dental status and an X-ray of the dentition should be performed in each case. If the skeletal development of the hand is completed, an additional radiological examination of the clavicles should be carried out. Minimum requirements for reference studies are defined and recommendable studies are listed. Instructions for the examination and the preparation of expert reports are presented. The committee of the study group organizes annual proficiency tests for quality assurance.     

Applicability of the skeletal age determination method of Tanner and Whitehouse for forensic age diagnostics

The present paper analyses the applicability of the clinically prevalent skeletal age determination method of Tanner and Whitehouse for forensic age estimation in living individuals. For this purpose, the hand X-rays from 48 boys and 44 girls aged 12-16 years were evaluated retrospectively. The minima and maxima, the mean values with their standard deviations as well as the medians with upper and lower quartiles, are presented for the skeletal ages 12-16 years estimated by the TW2 and TW3 methods. In the legally relevant skeletal age group 14-16 years, the differences between the skeletal age and the mean value of the chronological age were between -0.1 and +1.4 years for the TW2 method. For the TW3 method, the differences between the skeletal age and the mean value of the chronological age were between -0.4 and +0.2 years in the relevant age group. Due to the risk of serious overestimations, the TW2 method seems to be unsuitable for forensic age diagnostics. The application of the TW3 method for forensic age estimations can be recommended.     

Ultrasonographic assessment of ossification of the distal radial epiphysis for estimating forensic age

International Journal of Legal Medicine - Since forensic age estimation is not a valid medical indication, research on the use of nonionizing methods is increasing. Ultrasonography is a...     

The distal femoral epiphysis in forensic age diagnostics: studies on the evaluation of the ossification process by means of T1- and PD/T2-weighted magnetic resonance imaging

The age of majority, which corresponds to the age of 18 years in most European countries, plays a crucial role for a large number of legal decisions. Accordingly, an increasing number of requests by authorities to forensic age estimation experts comprise the question of whether the age of 18 years has been reached by an individual. In recent years, novel study data suggested that magnetic resonance imaging (MRI) of the knee might likewise allow for the determination of majority beyond reasonable doubt. However, the data basis, especially concerning the distal femoral epiphysis (DFE), is still poor. For this reason, 392 routine MRI cases of the knee (204 males and 188 females of a Western Caucasian population, aged between 12 and 25 years) were retrospectively analyzed. T1-weighted and water-selective fat-saturated PD/T2-weighted sequences, generated at 1.5 and 3.0 T clinical MR scanners, were available. Ossification stages of the DFE were determined by means of the classification system by Vieth et al. (Eur Radiol 2018; 28:3255–3262). Both the intra-observer agreement and inter-observer agreement were found to be “very good” (κ = 0.899 and κ = 0.830). The present study confirmed that MRI of the DFE is suitable to determine majority in both sexes when stage 6 is present as the study revealed minimum ages above the age of 18 years for this stage (20.40 years in males and 20.60 years in females). Accordingly, the data represent a strong support for the so far existing database. Hence, the investigation of the knee using routine MRI appears to become a realistic alternative for forensic age estimation practice in the near future.

     

Magnetic resonance imaging of the iliac crest: age estimation in under-20 soccer players

Age assessment of living individuals represents a valuable tool in both forensic medicine and sports medicine. In soccer, age-related tournaments play an important role in guaranteeing equal chances to the competitors. However, age estimations in this field should not rely on imaging methods that include exposure to radiation. Therefore, the present study investigates the possibilities of magnetic resonance imaging (MRI) of the iliac crest apophysis for the purpose of evaluating skeletal maturation in under-20 (U-20) soccer players. To this end, gradient echo 3D sequences of the whole pelvis of 152 male tournament soccer players between 18 and 22 years of age were prospectively evaluated. A four stage classification system was applied for the assessment of the apophyseal ossification. Reliable stage determination was possible in all cases. Further sub-classification did not appear feasible due to the limitations of MRI. Analysis of the statistical parameters showed that age medians increased steadily from stage to stage. However, they did not allow for further differentiation of skeletal maturity in the cohort studied. Thus, MRI of the iliac crest appears to be generally suitable in age diagnostics of living individuals, but further investigations, especially in a cohort of individuals aged between 10 and 20 years, are needed in order to establish this method as novel criterion in sports or forensic medicine.     

Evaluation of the radiographic visibility of the root pulp in the lower third molars for the purpose of forensic age estimation in living individuals

The question of whether an individual has reached the age of 18 is of crucial importance in forensic age estimation practice. In some countries, the age threshold of 21 years is relevant as well. A completed mineralization of third molars is not a sufficient criterion for a diagnosis of a minimum age of 18 years with the required probability. In a material of 1,198 orthopantomograms from 629 females and 569 males aged between 15 and 40 years, the visibility of the root pulp of fully mineralized lower third molars was evaluated according to stages 0, 1, 2, and 3. In females, stage 0 was first noticed at age 17.2 years, in males at age 17.6 years. In either sex, the earliest observation of stage 1 was between 21.0 and 22.4 years. Stage 2 was first achieved by males between 22.3 and 22.7 years, by females between 23.4 and 24.7 years. The occurrence of stage 3 was first found in both sexes between 25.1 and 25.9 years. These findings indicate that for stage 0, an age below 18 years cannot be excluded. However, for stage 1, the examined individual must be over 18 years of age and most probably over 21 years of age. For stages 2 and 3, the age can safely be stated to be over 21 years of age. This method may be a powerful tool for forensic dentists in age estimation in asylum and criminal proceedings.     

Assessment of the radiographic visibility of the periodontal ligament in the lower third molars for the purpose of forensic age estimation in living individuals

The main criterion for dental age estimation in living individuals is the mineralisation of third molars. However, the mineralisation of third molars can be completed before the forensically relevant age of 18 years has been attained. In a material of 1,198 orthopantomograms from 629 females and 569 males aged between 15 and 40 years, the radiographic visibility of the periodontal membrane of fully mineralised third molars was assessed according to stages 0, 1, 2 and 3. Stage 0 first appeared at the age of 17.2 years in females and at the age of 17.6 years in males. Stage 1 was first achieved by females between 18.9 and 20.0 years and by males between 20.1 and 20.2 years. The earliest appearance of stage 2 was between 22.5 and 23.1 years in females and at 22.3 years in males. The occurrence of stage 3 was first found between 24.6 and 25.2 years in females and between 25.4 and 26.2 years in males. If stage 1 is determined, it is, therefore, possible to prove that an individual has already attained the legally relevant age of 18 years. For stages 2 and 3, it can be stated beyond reasonable doubt that a person is over 21 years of age.