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      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

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          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.

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          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.
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            Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography.

            Radiological assessment of the degree of ossification of the medial clavicular epiphyseal cartilage plays a vital part in forensic age diagnosis of living adolescents and young adults. A total of 873 plain chest radiographs requested by the staff medical officer for members of staff aged 16-30 at the University Hospital Charité were evaluated retrospectively. Of these X-rays 699 permitted an assessment of ossification of at least 1 side of the clavicle. In addition to the customary stages (1: non-ossified epiphysis, 2: discernible ossification centre, 3: partial fusion, 4: total fusion) a stage 5 was also defined, characterised by the disappearance of the epiphyseal scar following total fusion. The earliest age at which stage 3 was detected in either gender was 16 years. Stage 4 was first observed in women at 20 years and in men at 21 years. In both genders, the earliest observation of stage 5 was at 26 years. It was concluded that plain chest radiographs can essentially be used to assess clavicular ossification. In practice, if overlap in posterior-anterior views impedes evaluation, a lateral view should also be taken to facilitate age estimation. In forensic practice the reference values of the present paper should be applied.
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              Forensic age estimation in human skeletal remains: current concepts and future directions.

              Skeletal identification has a long tradition in both physical and forensic anthropology. The process generally begins with formulation of a biological profile (osteobiography); specifically, estimation of sex, age, ethnicity and stature. The present paper briefly reviews a selection of the principal methods used for one aspect of the identification process; the estimation of personal age. It is well-documented that variability in the morphological features used to assess age in the human skeleton progressively increases from birth to old age. Thus choice of method is inherently related to whether unidentified remains are those of a juvenile or an adult. This review, therefore, considers methods appropriate for age estimation in both juvenile and adult remains; the former being primarily based on developmental, and the latter degenerative, morphological features. Such a review is timely as new methods are constantly being developed, concurrent with refinements to those already well established in mainstream anthropology.
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                Author and article information

                Journal
                J Korean Med Sci
                J. Korean Med. Sci
                JKMS
                Journal of Korean Medical Science
                The Korean Academy of Medical Sciences
                1011-8934
                1598-6357
                October 2016
                12 July 2016
                : 31
                : 10
                : 1538-1545
                Affiliations
                [1 ]Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
                [2 ]Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
                [3 ]Inter-disciplinary Program in Medical Informatics, Seoul National University College of Medicine, Seoul, Korea.
                [4 ]Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
                [5 ]Medical Examiner's Office, National Forensic Service, Wonju, Korea.
                [6 ]Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea.
                Author notes
                Address for Correspondence: Seong-Ho Yoo, MD. Institute of Forensic Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. yoosh@ 123456snu.ac.kr
                Author information
                http://orcid.org/0000-0002-3700-0165
                http://orcid.org/0000-0002-9704-7870
                http://orcid.org/0000-0002-5625-5921
                http://orcid.org/0000-0002-2208-1812
                http://orcid.org/0000-0002-9150-3732
                http://orcid.org/0000-0003-1884-3738
                http://orcid.org/0000-0002-0171-561X
                http://orcid.org/0000-0001-5294-0596
                Article
                10.3346/jkms.2016.31.10.1538
                4999394
                27550480
                1c0b8bca-877e-49e2-a609-ace4a8df869d
                © 2016 The Korean Academy of Medical Sciences.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 December 2015
                : 12 June 2016
                Funding
                Funded by: National Forensic Service;
                Award ID: NFS2015MED09
                Categories
                Original Article
                Humanities & Forensic Medicine

                Medicine
                age estimation,age of majority,clavicle,epiphysis,ossification,radiograph,diagnostic accuracy
                Medicine
                age estimation, age of majority, clavicle, epiphysis, ossification, radiograph, diagnostic accuracy

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