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    [Study on development of hand-wrist bone in 14 year-old adolescents I: bone age standard for boys]. Li Kai,Ye Ke,Wang Jian-Wen,Ye Long-Yu,Zhang Qin-Chu Fa yi xue za zhi OBJECTIVE:To study the bone development in adolescents in China, and establish forensic skeletal age standard for estimation of the criminal responsible age in 14 years old male adolescents. METHODS:One hundred and three healthy boys aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang, Hunan, China were enrolled in this study. X-ray films of their left hand-wrist were taken dorsaventrally, and 15 selected sites on the wrist X-ray films were examined and measured under standard condition. The development grade was confirmed by maximum percentage to establish a method to estimate the bone age, which was then checked by single blind method. RESULTS:Development grade of the first metacarpal bone and the first phalanx IV was partially closed (less than 1/3), but the rest was non-closed. The cross diameters of all the osteoepiphysis were wider than that of all the diaphysis. The development grade of the fourth metacarpal bone and the fifth metacarpal bone as well as the adjacent third phalanx were different in both younger age group (<14 years, mostly non-closed) and the older age group (>14 years, mostly closed). The confirmed accuracy (in 30 boys) was 80%. CONCLUSION:Our study seems to be feasible in establishing the estimation standard for skeletal age determination using developmental metaphysis and anthropometry. The standard may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.
    [Development of hand-wrist bones of 14 year-old adolescents. II. Standard of bony age for girls]. Li Kai,Ye Ke,Zhang Zhen,Wang Jian-Wen,Ye Long-Yu,Zhang Qin-Chu Fa yi xue za zhi OBJECTIVE:To study the current development of hand-wrist bones of adolescents in China, and establish special forensic bony age standard for estimating 14 years of criminal responsible age in female adolescents. METHODS:One hundred and ten healthy girls aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang district of Hunan province were enrolled in this study. X-ray films of their left hand-wrists were taken dorsaventrally, and 15 sites on the wrist x-ray films were examined and measured under standard condition. The development grade was confirmed by maximal percentage to establish a method to estimate the bony age, which was then checked by single blind method. RESULTS:Development grade of the radius, the middle third phalanx and the fourth phalanx was partially closed (> 2/3), and the rest was wholly-closed with existence of the epiphyseal line. The development grade of the middle third phalanx and fourth phalanx was different between the younger group (< 14 years, partially closed, > 2/3) and the older group (> 14 years, mostly closed with existence of only epiphyseal line). The cross diameter of the osteoepiphysises were wider than that of all the diaphysises. The confirmed accuracy (in 30 girls) was 83.3%. CONCLUSION:Our study seemes to be feasible in establishing the estimation standard for bony age determination. The standard established by developmental metaphysis and authropometry may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.
    Validity of the use of a few hand-wrist bones for assessing bone age. Guimarey L,Moreno Morcillo A,Orazi V,Lemos-Marini S H V Journal of pediatric endocrinology & metabolism : JPEM Bone age is widely used as an osseous maturation method to assess biological development in clinical and auxological studies. Numerical methods for calculating bone age have better replicability; however, they require a wide data manipulation. The aim of this study was to evaluate the accuracy of bone age estimation by using just a few ossification centers. In 205 hand and wrist radiographs of children and adolescents, aged 0.9-17.4 years old (111 males and 94 females), bone age was determined by two trained observers employing the five-bone (B5) and the TW2 methods. To compare the results of the two methods, the mean differences by age and sex were tested by the Mann-Whitney test. The relationship of the bone age distribution estimated by B5 and TW2 was calculated and the mean of the bone age determined by the two methods was plotted by age and by differences between bone age calculated by the two methods +/- 2 SD. The bone age determined by B5 was between 1.2 and 16.8, and by TW2 was between 1.2 and 18.0 years. The mean differences between B5 and TW2 (-0.06 +/- 0.6) were not significant (p > 0.05). The distribution of mean differences by age and method demonstrated that all deviations were encompassed into +/- 2 SD with no particular bias. In general terms, a good agreement was obtained between these two methods.
    Ossification area localization in pediatric hand radiographs using deep neural networks for object detection. Koitka Sven,Demircioglu Aydin,Kim Moon S,Friedrich Christoph M,Nensa Felix PloS one BACKGROUND:Detection of ossification areas of hand bones in X-ray images is an important task, e.g. as a preprocessing step in automated bone age estimation. Deep neural networks have emerged recently as de facto standard detection methods, but their drawback is the need of large annotated datasets. Finetuning pre-trained networks is a viable alternative, but it is not clear a priori if training with small annotated datasets will be successful, as it depends on the problem at hand. In this paper, we show that pre-trained networks can be utilized to produce an effective detector of ossification areas in pediatric X-ray images of hands. METHODS AND FINDINGS:A publicly available Faster R-CNN network, pre-trained on the COCO dataset, was utilized and finetuned with 240 manually annotated radiographs from the RSNA Pediatric Bone Age Challenge, which comprises over 14.000 pediatric radiographs. The validation is done on another 89 radiographs from the dataset and the performance is measured by Intersection-over-Union (IoU). To understand the effect of the data size on the pre-trained network, subsampling was applied to the training data and the training was repeated. Additionally, the network was trained from scratch without any pre-trained weights. Finally, to understand whether the trained model could be useful, we compared the inference of the network to an annotation of an expert radiologist. The finetuned network was able to achieve an average precision (mAP@0.5IoU) of 92.92 ± 1.93. Apart from the wrist region, all ossification areas were able to benefit from more data. In contrast, the network trained from scratch was not able to produce any correct results. When compared to the annotations of the expert radiologist, the network was able to localize the regions quite well, as the F1-Score was on average 91.85 ± 1.06. CONCLUSIONS:By finetuning a pre-trained deep neural network, with 240 annotated radiographs, we were able to successfully detect ossification areas in prediatric hand radiographs. 10.1371/journal.pone.0207496
    Quantifying the ossification of the carpus in skeletal age estimation: Radiographic standards for Australian subadults. Reynolds M S,MacGregor D M,Alston-Knox C L,Gregory L S Forensic science international An evaluation of the development of a child's skeleton and estimation of bone age provides an insight into a child's overall maturation. This study aimed to introduce a contemporary method for assessing bone age of Australian children using formulae incorporating carpal areal measurements. The standards introduced in this study can be used to assess the developmental status of Australian children who may be affected by growth-related illnesses. Additionally, in situations where the living age of a subadult is unknown, methodologies to accurately estimate age are required, particularly in the Western world where knowledge of the age of an individual is necessary for legal reasons. The sample consisted of retrospective hand and wrist radiographs acquired from 541 children (females: 246, males: 295) aged from birth to 20 years. Using the DICOM viewer Weasis, the carpal area ratio (B.Ar/T.Ar) was calculated for each individual radiograph by measuring the carpal bone area (B.Ar) and total tissue area of the carpus (T.Ar). A changepoint regression model demonstrated that the model constructed in this study was the most accurate in the younger age groups and was able to accurately determine whether a child was under 12 years if female and 13 years if male. A rapid acceleration of growth was observed at approximately 12-13 years in our sample, which may represent the onset of the pubertal growth spurt; this resulted in a high data variance and low model prediction accuracy in female and male children older than 12 and 13 years, respectively. 10.1016/j.forsciint.2019.05.028
    [TW systems in estimation of carpal bone age and their potential applications in diagnosis of idiopathic precocious puberty in Chinese girls]. Ning Gang,Qu Hai-Bo,Liu Guan-Jian,Wu Kang-Min,Xie Shu-Xiang,Chen Xi-Jian Fa yi xue za zhi OBJECTIVE:To compare three assessment methods (TW2, TW2CH, and TW3) for carpal bone age and their potential applications in diagnosis of idiopathic precocious puberty (IPP) in Chinese girls. METHODS:Fifty-five (55) girls with IPP and 83 normal girls as control group were selected in this study. The X-ray films of the left hand-wrist taken at their first visit were analyzed retrospectively. Three assessment methods were used to estimate the carpal bone age with single-blinded method and percentiles were set at 5 different decision thresholds (1)>97th percentile, (2)>90 th percentile, (3)>75th percentile, (4)>50 th percentile, and (5)< or =50th percentile. RESULTS:All of the three methods showed similar high sensitivity and specificity at the threshold above 90th percentile. CONCLUSION:Our data indicate that all of the three methods for estimation of the carpal bone age are useful in diagnosis of IPP. TW2CH and TW3 methods appear to be superior to TW2 method.
    Skeletal age determination of the hand: a comparison of methods. Schmidt S,Nitz I,Ribbecke S,Schulz R,Pfeiffer H,Schmeling A International journal of legal medicine Until final completion of maturation processes at the age of approximately 18 years, determination of the skeletal age of the hand plays a central role in forensic age diagnostics in living persons in criminal proceedings. In this process, assessment of hand radiographs relies primarily on the stage of development of the epiphyseal nuclei, the increase in size of the individual bones and of the hand skeleton as a whole, changes in the shape of the various skeletal elements and ossification of the epiphyseal plates. To achieve this, there are a variety of methodological approaches based on two different fundamental principles. The methods proposed by Greulich and Pyle, Thiemann et al. and Gilsanz and Ratib rank among the so-called atlas techniques, whilst the methods proposed by Tanner et al. and Roche et al. are classified as so-called bone-specific techniques. In order to be applicable in the field of criminal procedure, the methods of estimating the skeletal age of the hand developed with clinical aspects in mind must satisfy the demands of a high degree of estimate accuracy and good reproducibility of the estimated results. In the course of the present study, a study population of 92 persons was used to compare the above-mentioned atlas and bone-specific techniques for determining hand skeleton age in view of these qualitative criteria. Estimate accuracy was studied using Pearson's correlation coefficients, and weighted kappa coefficients were determined for studying the intra-and interobserver agreement of an estimate result. In the inter-method comparison, a basically good agreement was shown between the skeletal ages and the chronological age of the test persons on the one hand and the skeletal age diagnoses of one or of two examiners on the other. No general advantage of the methodological approach of the bone-specific technique was discernible in the course of comparison; in the female gender, particularly, the RUS2 and RUS3 score of the method of Tanner et al. proved unfavourable. For age estimation practice in criminal proceedings, the atlas methods of Greulich and Pyle and Thiemann et al. are particularly recommendable. 10.1007/s00414-013-0845-4
    Maturation Disparity between Hand-Wrist Bones in a Chinese Sample of Normal Children: An Analysis Based on Automatic BoneXpert and Manual Greulich and Pyle Atlas Assessment. Zhang Ji,Lin Fangqin,Ding Xiaoyi Korean journal of radiology OBJECTIVE:To assess the maturation disparity of hand-wrist bones using the BoneXpert system and Greulich and Pyle (GP) atlas in a sample of normal children from China. MATERIALS AND METHODS:Our study included 229 boys and 168 girls aged 2-14 years. The bones in the hand and wrist were divided into five groups: distal radius and ulna, metacarpals, proximal phalanges, middle phalanges and distal phalanges. Bone age (BA) was assessed separately using the automatic BoneXpert and GP atlas by two raters. Differences in the BA between the most advanced and retarded individual bones and bone groups were analyzed. RESULTS:In 75.8% of children assessed with the BoneXpert and 59.4% of children assessed with the GP atlas, the BA difference between the most advanced and most retarded individual bones exceeded 2.0 years. The BA mean differences between the most advanced and most retarded individual bones were 2.58 and 2.25 years for the BoneXpert and GP atlas methods, respectively. Furthermore, for both methods, the middle phalanges were the most advanced group. The most retarded group was metacarpals for BoneXpert, while metacarpals and the distal radius and ulna were the most retarded groups according to the GP atlas. Overall, the BAs of the proximal and distal phalanges were closer to the chronological ages than those of the other bone groups. CONCLUSION:Obvious and regular maturation disparities are common in normal children. Overall, the BAs of the proximal and distal phalanges are more useful for BA estimation than those of the other bone groups. 10.3348/kjr.2016.17.3.435
    Carpals and epiphyses of radius and ulna as age indicators. Cameriere Roberto,Ferrante Luigi,Mirtella Dora,Cingolani Mariano International journal of legal medicine Estimation of skeletal age using radiographic images is widely used for assessing biological growth in clinical and auxological studies. The most frequent areas used for age estimation in children and adolescents are tooth and wrist/hand, both giving good results with only a low level of radiation. In particular, ossification of the carpals shows good agreement with chronological age. This study of a sample of 150 Italian children and adolescents aged between 5 and 17 years focused on analyzing the possible applications of the proportion of carpal area (Ca) mineralization as a criterion of age estimation. The ratio between the total area of carpal bones and epiphyses of the ulna and radius (Bo) and Ca was calculated. This ratio (Bo/Ca) was used for linear regression analysis. The regression model, describing age as a linear function of the ratio Bo/Ca, yielded the following equation: Age=-3.253+0.719 g+20.610 Bo/Ca, and explained 83% of the total variance (R (2)=0.83). The median of the absolute values of residuals (observed age minus predicted age) was 0.08 years, with a quartile deviation of 1.59 years, and a standard error of estimate of 1.19 years. 10.1007/s00414-005-0040-3
    A comparison of skeletal maturity assessed by radiological and ultrasonic methods. Utczas Katinka,Muzsnai Agota,Cameron Noel,Zsakai Annamaria,Bodzsar Eva B American journal of human biology : the official journal of the Human Biology Council OBJECTIVES:The estimation of skeletal maturity is a useful tool in pediatric practice to determine the degree of delay or advancement in growth disorders and the effectiveness of treatment in conditions that influence linear growth. Skeletal maturity of children is commonly assessed using either Greulich-Pyle (GP) or Tanner-Whitehouse methods (TW2 and TW3). However, a less invasive ultrasonic method, that does not use ionizing radiation, has been suggested for use in epidemiological studies of skeletal maturity. The main purpose of the present study was to determine the accuracy of an ultrasonic method based on the GP maturity indicators compared to the standard GP radiographic method. METHODS:Skeletal maturity of 1502 healthy children, aged from 6 to 18 years, was estimated by quantitative ultrasound and compared to GP bone ages estimated from left hand and wrist radiographs of a subsample of 47 randomly selected participants. RESULTS:The ultrasonic bone age estimation demonstrated very strong correlations with all the radiological age estimations. The correlation coefficients ranged between 0.895 and 0.958, and the strongest correlation of ultrasonic skeletal maturity estimation was found with the Tanner-Whitehouse RUS method. The ultrasonic bone age estimation is suggested for use between the chronological ages of 8.5-16.0 years in boys and 7.5-15.0 years in girls. CONCLUSIONS:The ultrasonic bone age estimation is suggested for use in epidemiological surveys since the sensitivity for screening for not normal bone development is appropriate, at least within the 8-15 years age interval. 10.1002/ajhb.22966
    Reference data for the Thiemann-Nitz method of assessing skeletal age for the purpose of forensic age estimation. Schmeling Andreas,Baumann Uta,Schmidt Sven,Wernecke Klaus-Dieter,Reisinger Walter International journal of legal medicine 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. 10.1007/s00414-005-0002-9
    Age estimation based on bone length using 12 regression models of left hand X-ray images for Asian children below 19 years old. Darmawan M F,Yusuf Suhaila M,Abdul Kadir M R,Haron H Legal medicine (Tokyo, Japan) Age estimation was used in forensic anthropology to help in the identification of individual remains and living person. However, the estimation methods tend to be unique and applicable only to a certain population. This paper analyzed age estimation using twelve regression models carried out on X-ray images of the left hand taken from an Asian data set for subjects under the age of 19. All the nineteen bones of the left hand were measured using free image software and the statistical analysis were performed using SPSS. There are two methods to determine age in this study which are single bone method and all bones method. For single bone method, S-curve regression model was found to have the highest R-square value using second metacarpal for males, and third proximal phalanx for females. For age estimation using single bone, fifth metacarpal from males and fifth proximal phalanx from females can be used due to the lowest mean square error (MSE) value. To conclude, multiple linear regressions is the best techniques for age estimation in cases where all bones are available, but if not, S-curve regression can be used using single bone method. 10.1016/j.legalmed.2014.09.006
    Bone age assessment methods: a critical review. Manzoor Mughal Arsalan,Hassan Nuzhat,Ahmed Anwar Pakistan journal of medical sciences The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. Radiography of the hand & wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation based techniques of visualizing hand & wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. By the age of 18 years, bone age cannot be computed from hand & wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18-22 years. CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. MRI based methods are being developed but require more research. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated. As different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children. Sources of Data/Study Selection: Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review. 10.12669/pjms.301.4295
    A Comparison of 3 Established Skeletal Age Estimation Methods in an African Group From Benin and an Italian Group From Southern Italy. Santoro Valeria,Marini Chiara,Fuzio Grazia,Introna Francesco,De Donno Antonio The American journal of forensic medicine and pathology Age estimation is a crucial matter in several forensic and legal instances. The literature recommends carrying out hand and wrist radiograph to assess skeletal age. Much research has been conducted to examine the application of various methods in different categories. Our study aims to evaluate the reliability of Greulich and Pyle, Tanner-Whitehouse 2, and FELS methods in Beninese and Italian samples, with a total of 204 subjects, 102 (51 were male and 51 were female) from Benin and 102 (51 were male and 51 were female) from Italy, aged between 4 and 19 years. Hand-wrist radiographs were carried out at Saint Luc Hospital in Cotonou for the African sample and in 2 hospitals in Southern Italy for Italian sample. Skeletal maturity was obtained, applying the 3 methodologies. The arithmetic mean of the 3 ages obtained was calculated, as well as the possible difference between the known chronological age and the estimated mean skeletal age. Data were analyzed statistically using the χ test, Student t test, and Bland-Altman plots. There are no significant statistical differences between real age and skeletal age calculated using the Greulich and Pyle and FELS methods. Comparison between Tanner-Whitehouse 2 and the average of the methods used results in statistically significant, but clinically insignificant, differences. 10.1097/PAF.0000000000000472
    Carpals and epiphyses of radius and ulna as age indicators using longitudinal data: a Bayesian approach. Cameriere Roberto,Bestetti Fiorella,Velandia Palacio Luz Andrea,Riccomi Giulia,Skrami Edlira,Parente Valentina,Ferrante Luigi International journal of legal medicine The aim of this study is to develop a new formula for age estimation in a longitudinal study of a sample from the radiological collection of wrist bones of growing infants, children, and adolescents recorded at the Burlington Growth Centre. A sample of 82 individuals (43 boys and 39 girls), aged between 3 and 16 years, were analyzed with a total of 623 X-rays of left hand-wrist bones by measuring the area of carpal bones and epiphyses of the ulna and radius (Bo) and carpal area (Ca). The intra-class correlation coefficient (ICC) and its 95% confidence interval were used to evaluate intra-observer agreement. Hierarchical Bayesian calibration has been adopted to exceed the bias deriving from the classical regression approach used for age estimation in forensic disciplines, since it tends to overestimate or underestimate the age of the individuals. Calibration distributions of the dataset obtained by the evaluation of BoCa (the ratio of Bo and Ca) suggested mean absolute errors (MAE) of 1.07 and 1.34 years in boys and girls, respectively. The mean interquartile range (MIQR) was 1.7 and 2.42 years in boys and girls, respectively. The respective bias of the estimates was β = - 0.025 and - 0.074. Furthermore, a correspondence between different BoCa values and estimated age with its standard deviation (SD) was calculated for boys and girls, respectively. In conclusion, the Bayesian calibration method appears to be suitable for assessing both age and its distribution in subadults, according to hand-wrist maturity. Furthermore, it can easily incorporate other age predictors, obtaining a distribution of the subjects with multivariate predictors. 10.1007/s00414-018-1807-7
    Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. Serinelli S,Panetta V,Pasqualetti P,Marchetti D Legal medicine (Tokyo, Japan) Age estimation of living individuals often represents a forensic challenge with important legal and social implications. In an effort to better understand the accuracy of the methods of Greulich and Pyle (GP), Tanner-Whitehouse (TW) and Fels, a systematic review and a meta-analysis of articles published from 1956 to 20 December 2009 in the Medline and Trip databases were conducted. We only selected articles on healthy people. The meta-analysis showed that GP is not as accurate a method as TW2 or TW3 for both Caucasian people and Mongoloids, even if it is the one most often used. However, due to the very wide age estimation range, in line with what has already been established by several authors, our systematic review and meta-analysis confirmed that age estimation in living individuals cannot be considered accurate when only X-ray methods on the left hand-wrist are used, but exhaustive combinations of various procedures (i.e. physical examination, dental and skeletal methods) must also be used, as proposed and already applied by the International Study Group on Forensic Age Estimation. 10.1016/j.legalmed.2011.01.004
    Skeletal age estimation in a contemporary Western Australian population using the Tanner-Whitehouse method. Maggio Ariane,Flavel Ambika,Hart Rob,Franklin Daniel Forensic science international Various age estimation techniques have been utilised in Australia to evaluate the age of individuals who do not have documentation to determine legal majority/culpability. These age estimation techniques rely on the assessment of skeletal development as visualised in radiographs, CT scans, MRI or ultrasound modalities, and subsequent comparison to reference standards. These standards are not always population specific and are thus known to be less accurate when applied outside of the original reference sample, leading to potential ethical implications. Therefore, the present study aims to: (i) explore the variation in developmental trajectories between the established Tanner-Whitehouse (TW) age estimation standards and a Western Australian population; and (ii) develop specific hand-wrist age estimation standards for the latter population. The present study examines digital anterior-posterior hand-wrist radiographs of 360 individuals 0 to 24.9 years of age, equally represented by sex. Each radiograph was assessed using the RUS, Carpal and 20-bone methods of Tanner et al. The standard error of the estimate (SEE) was calculated for each method (range: ♀ SEE ±0.4-11.5 years; ♂ SEE ±0.9-10.1 years). The most accurate method was TW3 RUS for females and the TW2 Carpal system for males. The 50th centile skeletal maturity scores for each year age group were plotted against average chronological age to produce polynomial regression standards with a demonstrated accuracy of (♀ SEE ±0.09-3.46 years; ♂ SEE ±0.02-3.42 years) for females and males, respectively. The standards presented here can be used in future forensic investigations that require age estimation of hand-wrist bones in a Western Australian population, however, they are not appropriate for establishing age of majority (18 years), as skeletal maturity was attained on average earlier than 15 years of age in both sexes for all three systems examined. 10.1016/j.forsciint.2016.03.042
    Applicability of Greulich-Pyle and Tanner-Whitehouse grading methods to MRI when assessing hand bone age in forensic age estimation: A pilot study. Urschler Martin,Krauskopf Astrid,Widek Thomas,Sorantin Erich,Ehammer Thomas,Borkenstein Martin,Yen Kathrin,Scheurer Eva Forensic science international Determination of skeletal development is a key pillar in forensic age estimation of living persons. Radiological assessment of hand bone age is widely used until the age of about 17-18 years, applying visual grading techniques to hand radiographs. This study investigated whether Greulich-Pyle (GP) and Tanner-Whitehouse (TW2) grading can be equally used for magnetic resonance imaging (MRI) data, which would offer the huge benefit of avoiding ionizing radiation. In 18 subjects aged between 7 and 17 years a radiograph and an MRI scan of the hand were performed. Epiphyseal ossification of hand bones was rated by two blinded radiologists with both GP and TW2. Correlation between hand MRIs and radiographs was analyzed by linear regression and inter-observer agreement was assessed. Correlation between age estimates from MRI and radiographs was high for both GP (r(2)=0.98) and TW2 (r(2)=0.93). MRI showed a tendency to estimate age slightly lower for 14-18 year-olds, which would be favorable regarding majority age determination in case this result could be reproduced using a currently not existing reference estimation method based on MRI data. Inter-observer agreement was similar for GP in radiographs and MRI, while for TW2, agreement in MRI was lower than in radiographs. In spite of limitations regarding sample size and recruited subjects, our results indicate that the use of GP and TW2 on MRI data offers the possibility of hand bone age estimation without the need for ionizing radiation. 10.1016/j.forsciint.2016.06.016
    What automated age estimation of hand and wrist MRI data tells us about skeletal maturation in male adolescents. Urschler Martin,Grassegger Sabine,Štern Darko Annals of human biology BACKGROUND:Age estimation of individuals is important in human biology and has various medical and forensic applications. Recent interest in MR-based methods aims to investigate alternatives for established methods involving ionising radiation. Automatic, software-based methods additionally promise improved estimation objectivity. AIM:To investigate how informative automatically selected image features are regarding their ability to discriminate age, by exploring a recently proposed software-based age estimation method for MR images of the left hand and wrist. SUBJECTS AND METHODS:One hundred and two MR datasets of left hand images are used to evaluate age estimation performance, consisting of bone and epiphyseal gap volume localisation, computation of one age regression model per bone mapping image features to age and fusion of individual bone age predictions to a final age estimate. RESULTS:Quantitative results of the software-based method show an age estimation performance with a mean absolute difference of 0.85 years (SD = 0.58 years) to chronological age, as determined by a cross-validation experiment. Qualitatively, it is demonstrated how feature selection works and which image features of skeletal maturation are automatically chosen to model the non-linear regression function. CONCLUSION:Feasibility of automatic age estimation based on MRI data is shown and selected image features are found to be informative for describing anatomical changes during physical maturation in male adolescents. 10.3109/03014460.2015.1043945
    Forensic Age Estimation. Schmeling Andreas,Dettmeyer Reinhard,Rudolf Ernst,Vieth Volker,Geserick Gunther Deutsches Arzteblatt international BACKGROUND:Forensic age estimation is requested by courts and other government authorities so that immigrants whose real age is unknown should not suffer unfair disadvantages because of their supposed age, and so that all legal procedures to which an individual's age is relevant can be properly followed. 157 age estimations were requested in Berlin in 2014, more than twice as many as in 2004. METHODS:This review is based on pertinent articles retrieved by a selective search in the PubMed and MEDPILOT databases, supplemented by relevant recommendations and by the findings of the authors' own research. RESULTS:The essential components of age estimation are the history, physical examination, X-rays of the hands, panorama films of the jaws, and, if indicated, a thin-slice CT of the medial clavicular epiphyses, provided that there is a legal basis for X-ray examinations without a medical indication. Multiple methods are always used in combination, for optimal accuracy. Depending on the legal issues at hand, the examiner may be asked to estimate the individual's minimum age and/or his or her most probable age. The minimum-age concept can be used in determinations whether an individual has reached the age of legal majority. It is designed to ensure that practically all persons classified as adults have, in fact, attained legal majority, even though some other persons will be incorrectly classified as minors. CONCLUSION:Forensic age estimation lets courts and other government authorities determine the official age of persons whose actual age is unknown-in most cases, unaccompanied refugees who may be minors. The goal is to carry out age-dependent legal procedures appropriately in accordance with the rule of law. The minimum-age concept is designed to prevent the erroneous classification of minors as legal adults. 10.3238/arztebl.2016.0044
    Analysis of carpal bones on MR images for age estimation: First results of a new forensic approach. Scendoni Roberto,Cingolani Mariano,Giovagnoni Andrea,Fogante Marco,Fedeli Piergiorgio,Pigolkin Yu I,Ferrante Luigi,Cameriere Roberto Forensic science international Current multifactorial age estimation methods are based on radiography, however, in the forensic field there is growing interest in using magnetic resonance imaging (MRI). With regard to the carpal region, MRI provides more information for defining the individual ossification nuclei and the cartilage surrounding single bones. During the phase of bone growth, the progressive reduction of the cartilage layer is accompanied by the development of a cartilage-bone interface. The aim of our study was to create a new model for age estimation, based on the ratio between the area occupied by the nucleus of ossification (NO) and the surface of growth (SG) of each carpal bone, the latter derived by adding NO to the area of cartilage-bone interface. We analyzed 57 MRI scans of Italian subjects aged between 12 and 20 years, without growth diseases, endocrine disorders or osteodystrophy. Measurements of NO and SG areas were extracted using ImageJ software, and the ratio between the NO and SG of each bone (NOSG) was calculated. A multiple linear regression model was used to estimate the individual's age as a function of the variables: gender and wrist bone measurements. The results showed that the best model was obtained with 6 predictors (nvmax=6): Gender, and the NOSG of the Trapezoid, Trapezium, Scaphoid, Pisiform, and Capitate. The median of the residuals (observed age minus predicted age) was -0.025 years, with an IQR of 0.19 years. Thus a new forensic approach to age assessment using MRI is introduced in this paper, which gives the preliminary results. 10.1016/j.forsciint.2020.110341