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Skeletal age estimation in the living : conventional radiography (CR) versus magnetic resonance imaging (MRI) and staging technique versus atlas method

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Organization
Abstract
Background: At present, forensic age estimation procedures in living adolescents and young adults rely on CR or computed tomography (CT) to visualize developing anatomical structures (1). Hand/wrist and clavicle development both contribute to the age estimate during the considered age range. Nevertheless, in several countries, only CR is considered for skeletal age estimation (2), while international recommendations advocate CT to visualize the clavicles (1). Moreover, MRI has been proposed as an alternative to CT to avoid exposure to ionizing radiation. Thus, a well-founded argumentation is needed to convince policy makers of the added value of MRI. Skeletal development is assessed by allocating stages or atlas standards, based on criteria of particular staging techniques or atlas methods, respectively. Although atlas methods seem more comprehensive, it is still unclear whether they should be preferred over staging techniques. Purpose: To compare CR and MRI of the left wrist and both clavicles for forensic age estimation in living adolescents and young adults. The following hypotheses were made: 1. MRI outperforms CR. 2. An atlas method outperforms a staging technique to assess hand/wrist development. Materials and methods: CR and 3T MRI were prospectively conducted in 108 healthy Caucasian volunteers (52 males, 56 females) with ages ranging from 16 to 21 years. Five observers allocated stages and standards to (part of) the images independently. Staging techniques were applied to the left radius and ulna, and to both clavicles as described in (3, 4). Furthermore, atlas methods were applied to the left hand/wrist as described in (5, 6). For clavicle CR, one posteroanterior and two oblique radiographs were assessed simultaneously. Inter- and intraobserver agreements were quantified, and descriptive statistics were reported. Results: Inter- and intra-observer agreements for wrist CR and MRI were similar. By contrast, the CR atlas method was less reproducible than the staging technique. Inter- and intra-observer agreements for clavicle CR were lower than those for MRI. Regarding the wrist, within-stage age distributions were similar on CR and MRI, as were those for the staging techniques and atlas methods. Regarding the clavicles, the possibility to apply (profound) substages to MRI rendered a more gradual increase in the age distributions with increasing stages, than on CR. Conclusion: For multi-factorial age estimation based on the left wrist and both clavicles, CR suffices for the wrist, while MRI is necessary for the clavicles. Furthermore, a wrist staging technique is more useful than an atlas method.
Keywords
Age Estimation, Conventional Radiography, Magnetic Resonance Imaging

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MLA
Coreelman, Heleen, et al. “Skeletal Age Estimation in the Living : Conventional Radiography (CR) versus Magnetic Resonance Imaging (MRI) and Staging Technique versus Atlas Method.” Proceedings of the American Academy of Forensic Sciences 73rd Annual Scientific Meeting, American Academy of Forensic Sciences, 2021, pp. 106–106.
APA
Coreelman, H., Hillewig, E., de Haas, M., Thevissen, P., & De Tobel, J. (2021). Skeletal age estimation in the living : conventional radiography (CR) versus magnetic resonance imaging (MRI) and staging technique versus atlas method. In Proceedings of the American Academy of Forensic Sciences 73rd Annual Scientific Meeting (pp. 106–106). Online: American Academy of Forensic Sciences.
Chicago author-date
Coreelman, Heleen, Elke Hillewig, Michiel de Haas, Patrick Thevissen, and Jannick De Tobel. 2021. “Skeletal Age Estimation in the Living : Conventional Radiography (CR) versus Magnetic Resonance Imaging (MRI) and Staging Technique versus Atlas Method.” In Proceedings of the American Academy of Forensic Sciences 73rd Annual Scientific Meeting, 106–106. American Academy of Forensic Sciences.
Chicago author-date (all authors)
Coreelman, Heleen, Elke Hillewig, Michiel de Haas, Patrick Thevissen, and Jannick De Tobel. 2021. “Skeletal Age Estimation in the Living : Conventional Radiography (CR) versus Magnetic Resonance Imaging (MRI) and Staging Technique versus Atlas Method.” In Proceedings of the American Academy of Forensic Sciences 73rd Annual Scientific Meeting, 106–106. American Academy of Forensic Sciences.
Vancouver
1.
Coreelman H, Hillewig E, de Haas M, Thevissen P, De Tobel J. Skeletal age estimation in the living : conventional radiography (CR) versus magnetic resonance imaging (MRI) and staging technique versus atlas method. In: Proceedings of the American Academy of Forensic Sciences 73rd Annual Scientific Meeting. American Academy of Forensic Sciences; 2021. p. 106–106.
IEEE
[1]
H. Coreelman, E. Hillewig, M. de Haas, P. Thevissen, and J. De Tobel, “Skeletal age estimation in the living : conventional radiography (CR) versus magnetic resonance imaging (MRI) and staging technique versus atlas method,” in Proceedings of the American Academy of Forensic Sciences 73rd Annual Scientific Meeting, Online, 2021, pp. 106–106.
@inproceedings{8698265,
  abstract     = {Background: At present, forensic age estimation procedures in living adolescents and young adults rely on CR or
computed tomography (CT) to visualize developing anatomical structures (1). Hand/wrist and clavicle
development both contribute to the age estimate during the considered age range. Nevertheless, in several
countries, only CR is considered for skeletal age estimation (2), while international recommendations advocate
CT to visualize the clavicles (1). Moreover, MRI has been proposed as an alternative to CT to avoid exposure to
ionizing radiation. Thus, a well-founded argumentation is needed to convince policy makers of the added value
of MRI.
Skeletal development is assessed by allocating stages or atlas standards, based on criteria of particular staging
techniques or atlas methods, respectively. Although atlas methods seem more comprehensive, it is still unclear
whether they should be preferred over staging techniques.
Purpose: To compare CR and MRI of the left wrist and both clavicles for forensic age estimation in living
adolescents and young adults. The following hypotheses were made:
1. MRI outperforms CR.
2. An atlas method outperforms a staging technique to assess hand/wrist development.
Materials and methods: CR and 3T MRI were prospectively conducted in 108 healthy Caucasian volunteers (52
males, 56 females) with ages ranging from 16 to 21 years. Five observers allocated stages and standards to (part
of) the images independently. Staging techniques were applied to the left radius and ulna, and to both clavicles
as described in (3, 4). Furthermore, atlas methods were applied to the left hand/wrist as described in (5, 6). For
clavicle CR, one posteroanterior and two oblique radiographs were assessed simultaneously. Inter- and intraobserver
agreements were quantified, and descriptive statistics were reported.
Results: Inter- and intra-observer agreements for wrist CR and MRI were similar. By contrast, the CR atlas
method was less reproducible than the staging technique. Inter- and intra-observer agreements for clavicle CR
were lower than those for MRI.
Regarding the wrist, within-stage age distributions were similar on CR and MRI, as were those for the staging
techniques and atlas methods. Regarding the clavicles, the possibility to apply (profound) substages to MRI
rendered a more gradual increase in the age distributions with increasing stages, than on CR.
Conclusion: For multi-factorial age estimation based on the left wrist and both clavicles, CR suffices for the wrist,
while MRI is necessary for the clavicles. Furthermore, a wrist staging technique is more useful than an atlas
method.},
  author       = {Coreelman, Heleen and Hillewig, Elke and de Haas, Michiel and Thevissen, Patrick and De Tobel, Jannick},
  booktitle    = {Proceedings of the American Academy of Forensic Sciences 73rd Annual Scientific Meeting},
  keywords     = {Age Estimation,Conventional Radiography,Magnetic Resonance Imaging},
  language     = {eng},
  location     = {Online},
  pages        = {106--106},
  publisher    = {American Academy of Forensic Sciences},
  title        = {Skeletal age estimation in the living : conventional radiography (CR) versus magnetic resonance imaging (MRI) and staging technique versus atlas method},
  url          = {https://aafs.org/common/Uploaded%20files/Meetings/2021%20Meeting/21Proceedings_Complete.pdf},
  year         = {2021},
}