Studies in use of the Greulich-Pyle skeletal age method to assess criminal liability.

In recent years, skeletal age determination has become increasingly important for determining the age of live subjects as part of criminal investigation. The most widely used method worldwide to determine skeletal age is the Greulich-Pyle atlas method. The present study examines the suitability of the Greulich-Pyle method given the particular requirements of forensic age estimates. It is a retrospective analysis of 649 hand radiographs originally taken from persons aged between 1 and 18 years, separately for each sex. If the Greulich-Pyle method is used exclusively, it can be claimed with a probability of 95% that a young man has reached the age of 14 years and thus the age of criminal liability if his skeletal age is at least 15.5 years. In the case of female subjects, even if they are estimated as being 16.0 years old, it cannot be asserted with a probability of 95% that they have reached the age of 14. To reduce the margin of error of age estimates, determining the skeletal age should always go hand in hand with a physical examination to determine indications of sexual maturity and a dental examination to record dental status. The reference values given in the present study can be applied to members of all ethnic groups for age estimate purposes. If the person under examination has a different socio-economic status, the expert performing the age estimate should address this issue in his expert opinion and discuss the possible effects that might have on the age diagnosis.

Radiographic staging of ossification of the medial clavicular epiphysis.

Determination of the stage of ossification of the medial clavicular epiphysis is a crucial part of forensic age estimation when evaluating living subjects over 18 years of age. In the present study, we comparatively assessed conventional radiographs and computed tomography (CT) scans of sternoclavicular joints used to perform forensic age assessments in 57 individuals undergoing criminal proceedings. With CT, it was possible to determine the ossification stage of all clavicles studied. In the case of conventional radiography, reliable assessment of ossification stage was not possible in 15 out of 114 clavicles studied due to the superimposition of other structures. Regarding agreement between the methods, both radiography and CT produced identical staging results in 97 out of 99 clavicular epiphyses. In two cases, however, ossification was classified as stage 2 by CT and as stage 3 by conventional radiography. Regarding stages 4 and 5, both methods produced identical staging results in all cases. In forensic age estimation practice, it is necessary that conventional radiographic reference studies be used for ossification stage classification by conventional radiography and that CT reference studies be used for ossification stage classification by CT. Further studies in dead bodies of known age are required to issue a recommendation as to whether conventional radiography using obtained in three planes or CT is the method of choice for the assessment of clavicular ossification.

Comparative analysis of the applicability of the skeletal age determination methods of Greulich-Pyle and Thiemann-Nitz for forensic age estimation in living subjects.

Evaluation of hand ossification is a main pillar of radiological age diagnosis in living subjects. In the present study, we comparatively assessed the Greulich-Pyle and Thiemann-Nitz methods for accuracy of age estimation and degree of acceleration in the respective reference populations. For this, the skeletal age of 649 hand X-rays from German subjects aged 1-18 years was determined by both methods. Accuracy of the age estimates was determined based on regression and measures of certainty. In terms of accuracy, both methods seem to be equally well suited for forensic age diagnostics. The degree of acceleration in the reference populations for the two methods was calculated as the mean difference between the estimated skeletal age and the actual age of a test subject. Compared to the Greulich-Pyle population, the Thiemann-Nitz population was accelerated by 0.44 years in both male and female subjects. When an expert opinion is required and one cannot exclude the possibility that the investigated subject may come from a population with a high acceleration status, the Thiemann-Nitz method should preferably be used to prevent overestimation of age.

Magnetic resonance imaging of the clavicular ossification.

Assessment of the degree of ossification of the medial clavicular epiphyseal cartilage is of vital importance in forensic age diagnostics of living individuals aged more than 18 years. To date, reference studies on the assessment of clavicular ossification using imaging procedures only relate to conventional radiography and computed tomography (CT). In this study, magnetic resonance (MR) scans of 54 sternoclavicular joints of bodies aged between 6 and 40 years were evaluated prospectively. All of the examined medial clavicular epiphyseal cartilages permitted an assessment of the degree of ossification. Stage 2 was first observed at the age of 15.0 years, the earliest age at which stage 3 was observed was 16.9 years, and stage 4 was first observed at the age of 23.8 years. The observed age intervals of the respective degrees of ossification correspond to the known data from X-ray and CT scan examinations. The achieved results should be examined with a larger number of cases. A modified examination protocol is required for the MR examination of the medial clavicular epiphyseal cartilage for the purpose of forensic age diagnostics of living individuals.

Reference data for the Thiemann-Nitz method of assessing skeletal age for the purpose of forensic age estimation.

The aim of this study was to determine the statistical parameters of deviation in the Thiemann-Nitz method for use in forensic age diagnostics. To this effect, 402 hand radiograms, originally taken in two large German cities between 1983 and 2002 for the purpose of diagnosing trauma, were analyzed. At the time of examination, the patients were aged between 10 and 18 years. The study presents the mean, standard deviation, and median, with lower and upper quartiles, for the skeletal ages of 11.0 through 18.0 years. The simple standard deviations range between 0.2 and 1.2 years. To increase the accuracy of age estimates and improve the identification of age-relevant developmental disorders in forensic age estimation practice, the methods for determining skeletal age should always be combined with a physical and dental examination. In addition, the expert opinion should pay attention to the issue of different modernization levels in relevant populations.

The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics.

Computed tomography scans originally obtained to assess the ossification status of the medial clavicular epiphyses of 40 live subjects for forensic age estimation purposes were analysed. From the data acquired we reconstructed images with slice thicknesses of 1, 3, 5 and 7 mm, and based on the classification of stages by Schmeling et al. (Int J Legal Med 118:5-8, 2004), we determined the ossification stage for each reconstructed slice thickness, separately for both sides. Of the 80 clavicular epiphysial plates examined, seven displayed slice-thickness-dependent differences at certain ossification stages. In one case a slice thickness of 1 mm led to a different diagnosis of the ossification stage than a slice thickness of 3 mm, in three cases the diagnoses differed between the slice thicknesses of 3 and of 5 mm, and in another three cases, between 5 and 7 mm. We therefore conclude that for age estimation purposes, the slice thickness should be 1 mm to ensure maximum accuracy and diagnostic reliability.

Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans.

The authors retrospectively analyzed 629 CT images of patients aged between 15 and 30 years produced during multiple trauma diagnostics at the Unfallkrankenhaus Berlin. For the purposes of this study, the authors reliably determined the ossification status of the medial epiphysis of the clavicle in 556 cases, using the classification of stages by Schmeling et al. In both sexes, stage 2 was first noted at age 15. In male patients, the earliest occurrence of stage 3 was noted at age 17, in female patients at age 16. Stage 4 was first achieved by both sexes at age 21. Stage 5 was first noted in female patients at age 21 and in male patients at age 22, which is 4 or 5 years earlier than was observed by a comparable study using conventional radiographs. The partial-volume effect in computed tomography using the thick slice scanning mode was discussed as a possible explanation for this early visualization. The question of how slice thickness affects the age intervals between ossification stages identified by CT examinations should be examined in additional studies.

The current state of forensic age estimation of live subjects for the purpose of criminal prosecution.

In recent years, many countries have experienced a sharp increase in the demand for forensic age estimates of live persons. From a legal perspective, such age estimates are carried out to determine whether a suspect without valid identity documents has reached the age of criminal responsibility and whether general criminal law in force for adults applies. In many countries, the age thresholds of relevance to criminal prosecution lie between 14 and 21 years.In line with recommendations issued by the Study Group on Forensic Age Diagnostics for determining the age of live subjects in criminal proceedings, a forensic age estimate should combine the results of a physical examination, an x-ray of the hand, and a dental examination that records dentition status and evaluates an orthopantomogram. In addition, a radiological or computed tomographic examination of the clavicles is recommended to establish whether a person has attained 21 years of age.This article addresses the influence of ethnicity on the examined developmental systems. In so doing, the authors conclude that forensic age estimates should pay due heed to the proband's socioeconomic status and ethnic origin.

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.

Statistical analysis and verification of forensic age estimation of living persons in the Institute of Legal Medicine of the Berlin University Hospital Charité.

In recent years, the increase in international migration movements has led to a greater demand for forensic age estimation of foreigners without valid identification documents in numerous countries. The growing importance of forensic age determination is underlined by a rapid rise in the number of expert reports by the Institute of Legal Medicine of the Berlin University Hospital Charité. A total of 247 expert opinions on estimated age were given between 1992 and 31 December 2000. Subject to formal court ruling, age is estimated based on the physical inspection, in combination with an X-ray of the left hand and the clavicles as well as dental assessment. However, the statistical proof of the range of scatter for the summarized age diagnosis still remains to be clarified in the context of this assessment procedure. The age estimations made by the Institute of Legal Medicine of the Berlin University Hospital Charité were statistically analyzed with respect to the validity of the different methods. For verification of the age diagnoses, the age estimates were compared with the court records and the age determined in the course of legal proceedings. In 45 cases, the age diagnoses could be verified. In all cases where the age could be verified beyond doubt, deviations from the actual age did not exceed +/-12 months. From this, it can be concluded that the combined application of the above-mentioned methods allows forensic age estimations with a sufficiently high degree of reliability.

[Age determination of an unknown body in early adulthood]. / Altersdiagnostik einer unbekannten Leiche im jungen Erwachsenenalter.

The authors report on the estimation of the age of an unidentified deceased adolescent in connection with the body's identification. A physical examination by a forensic physician and an examination by a forensic dentist, including determination of the dental status and an X-ray of the teeth were used to estimate the age. In addition, an X-ray of the left hand as well as an X-ray and MRT scan of the clavicles were carried out by forensic radiologists. Combining the results of the individual examinations, the age of the deceased was estimated to range between 18 and 21 years. In the course of the police investigation it was found out that the deceased was 20 years and 7 months old. This has led to the conclusion that combined use of methods allows the age even of adolescents to be determined with relatively high accuracy and a minimum of time and effort.

[Human identification by comparison if skull roentgen image]. / Personenidentifizierung durch Röntgenbildvergleich am Schädel.

Comparison of X-rays was found to provide information just as accurate as dactyloscopy for person identification, which is attributable to the high variability of the skeletal system. Reported in this paper is the case of an unknown dead female whose body was found in a condition of advanced decay. That is why conventional methods of criminological identification were not practicable. Only inadequate results were obtained from a muscular sample, while no findings at all were obtainable from DNA analysis of two molars. Identification was achievable only after six months had passed from discovery of the corpse, when two X-rays of the presumed person's skull were retrieved. This case of successful identification has once again provided evidence to the fact that even in our era of DNA research X-ray comparison has retained a firm position in forensic diagnostics.