title: Ossification of the Medial Clavicular Epiphysis on Chest Radiographs: Utility and Diagnostic Accuracy in Identifying Korean Adolescents and Young Adults under the Age of Majority.
abstract: The aim of our study was to evaluate the utility and diagnostic accuracy of the ossification grade of medial clavicular epiphysis on chest radiographs for identifying Korean adolescents and young adults under the age of majority. Overall, 1,151 patients (age, 16-30) without any systemic disease and who underwent chest radiography were included for ossification grading. Two radiologists independently classified the ossification of the medial clavicular epiphysis from chest radiographs into five grades. The age distribution and inter-observer agreement on the ossification grade were assessed. The diagnostic accuracy of the averaged ossification grades for determining whether the patient is under the age of majority was analyzed by using receiver operating characteristic (ROC) curves. Two separate inexperienced radiologists assessed the ossification grade in a subgroup of the patients after reviewing the detailed descriptions and image atlases developed for ossification grading. The median value of the ossification grades increased with increasing age (from 16 to 30 years), and the trend was best fitted by a quadratic function (R-square, 0.978). The inter-observer agreements on the ossification grade were 0.420 (right) and 0.404 (left). The area under the ROC curve (AUC) was 0.922 (95% CI, 0.902-0.942). The averaged ossification scores of 2.62 and 4.37 provided 95% specificity for a person < 19 years of age and a person ≥ 19 years of age, respectively. A preliminary assessment by inexperienced radiologists resulted in an AUC of 0.860 (95% CI, 0.740-0.981). The age of majority in Korean adolescents and young adults can be estimated using chest radiographs.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
authors.forename: Soon Ho
authors.identifier: http://orcid.org/0000-0002-3700-0165
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
authors.forename: Hye Jin
authors.identifier: http://orcid.org/0000-0002-9704-7870
authors.initials: HJ
authors.lastname: Yoo
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
authors.forename: Roh Eul
authors.identifier: http://orcid.org/0000-0002-5625-5921
authors.initials: RE
authors.lastname: Yoo
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
authors.forename: Hyun Ju
authors.identifier: http://orcid.org/0000-0002-2208-1812
authors.initials: HJ
authors.lastname: Lim
authors.affiliation: Inter-disciplinary Program in Medical Informatics, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeong Hwa
authors.identifier: http://orcid.org/0000-0002-9150-3732
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chang Min
authors.identifier: http://orcid.org/0000-0003-1884-3738
authors.initials: CM
authors.lastname: Park
authors.affiliation: Medical Examiner's Office, National Forensic Service, Wonju, Korea.
authors.forename: Sang Seob
authors.identifier: http://orcid.org/0000-0002-0171-561X
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea. yoosh@snu.ac.kr.
authors.forename: Seong Ho
authors.identifier: http://orcid.org/0000-0001-5294-0596
authors.initials: SH
authors.lastname: Yoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000365:Age Determination by Skeleton / Q000592:standards; D019540:Area Under Curve; D044466:Asian People; D002968:Clavicle / Q000000981:diagnostic imaging*; D004838:Epiphyses / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D010012:Osteogenesis / Q000502:physiology*; D012372:ROC Curve; D013902:Radiography, Thoracic; D012016:Reference Values; D056910:Republic of Korea; D055815:Young Adult
keywords: Age Estimation; Age of Majority; Clavicle; Diagnostic Accuracy; Epiphysis; Ossification; Radiograph