title: Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals?
abstract: As superimposition effects often impede the evaluation of the ossification status of the medial clavicular epiphysis in standard posterior-anterior (PA) radiographs, additional oblique images (right anterior oblique, RAO, and left anterior oblique, LAO) are currently recommended to allow for reliable stage assessments. The present study examines the influence of the radiographic projection type on stage determination. To this end, 836 sternoclavicular joints were prospectively obtained during forensic autopsies of bodies aged between 15 and 30 years. Subsequently, three different radiographs (PA, RAO, and LAO) were taken from each specimen and separately evaluated as to the developmental stage of the medial clavicular epiphysis. A forensically established five-stage classification system was used. In 25 % of the cases, the medial clavicular epiphysis depicted in an oblique projection showed a different ossification stage than in the PA projection. In at least 10 % of the cases, a higher ossification stage was observed which would have significant disadvantages in criminal proceedings (ethically unacceptable error). In conclusion, the usage of the current radiographic reference data, which rely upon chest radiographs taken as PA projections, appears to be inadmissible for oblique projections. Projection radiography of the clavicle can therefore no longer be recommended for forensic age estimation practice. As to the question of whether an individual has achieved the age of 18 or 21, computed tomography of the clavicle must be regarded as the exclusive method of choice.
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany, daniel.wittschieber@ukmuenster.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wittschieber
authors.forename: Christian
authors.initials: C
authors.lastname: Ottow
authors.forename: Volker
authors.initials: V
authors.lastname: Vieth
authors.forename: Martin
authors.initials: M
authors.lastname: Küppers
authors.forename: Ronald
authors.initials: R
authors.lastname: Schulz
authors.forename: Juan
authors.initials: J
authors.lastname: Hassu
authors.forename: Thomas
authors.initials: T
authors.lastname: Bajanowski
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Frank
authors.initials: F
authors.lastname: Ramsthaler
authors.forename: Heidi
authors.initials: H
authors.lastname: Pfeiffer
authors.forename: Sven
authors.initials: S
authors.lastname: Schmidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmeling
mesh_terms: D000293:Adolescent; D000328:Adult; D000365:Age Determination by Skeleton / Q000379:methods*; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000254:growth & development; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000254:growth & development; D005260:Female; D018732:Forensic Anthropology; D006801:Humans; D008297:Male; D010012:Osteogenesis; D011446:Prospective Studies; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging* / Q000254:growth & development; D055815:Young Adult