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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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      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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      The receiver operating characteristic (ROC) curve, which is defined as a plot of test sensitivity as the y coordinate versus its 1-specificity or false positive rate (FPR) as the x coordinate, is an effective method of evaluating the performance of diagnostic tests. The purpose of this article is to provide a nonmathematical introduction to ROC analysis. Important concepts involved in the correct use and interpretation of this analysis, such as smooth and empirical ROC curves, parametric and nonparametric methods, the area under the ROC curve and its 95% confidence interval, the sensitivity at a particular FPR, and the use of a partial area under the ROC curve are discussed. Various considerations concerning the collection of data in radiological ROC studies are briefly discussed. An introduction to the software frequently used for performing ROC analyses is also presented.
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        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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          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.

            Author and article information

            [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@
            J Korean Med Sci
            J. Korean Med. Sci
            Journal of Korean Medical Science
            The Korean Academy of Medical Sciences
            October 2016
            12 July 2016
            : 31
            : 10
            : 1538-1545
            27550480 4999394 10.3346/jkms.2016.31.10.1538
            © 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 ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Funded by: National Forensic Service;
            Award ID: NFS2015MED09
            Original Article
            Humanities & Forensic Medicine


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