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

Authors
  • Gassenmaier, Sebastian1
  • Schaefer, Juergen F1
  • Nikolaou, Konstantin1
  • Esser, Michael1
  • Tsiflikas, Ilias2
  • 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany. , (Germany)
  • 2 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany. [email protected] , (Germany)
Type
Published Article
Journal
European Radiology
Publisher
Springer-Verlag
Publication Date
Dec 01, 2020
Volume
30
Issue
12
Pages
6645–6652
Identifiers
DOI: 10.1007/s00330-020-07079-y
PMID: 32725332
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. Low-dose CT imaging of the clavicula for age estimation in living adolescents is possible without loss of readers' confidence. • 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.

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