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Cummaudo M, Obertova Z, Lynnerup N, Petaros A, de Boer H, Baccino E, Steyn M, Cunha E, Ross A, Adalian P, Kranioti E, Fracasso T, Ferreira MT, Lefèvre P, Tambuzzi S, Peckitt R, Campobasso CP, Ekizoglu O, De Angelis D, Cattaneo C. Age assessment in unaccompanied minors: assessing uniformity of protocols across Europe. Int J Legal Med 2024; 138:983-995. [PMID: 38279991 DOI: 10.1007/s00414-024-03157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
Age assessment of migrants is crucial, particularly for unaccompanied foreign minors, a population facing legal, social, and humanitarian challenges. Despite existing guidelines, there is no unified protocol in Europe for age assessment.The Forensic Anthropology Society of Europe (FASE) conducted a comprehensive questionnaire to understand age estimation practices in Europe. The questionnaire had sections focusing on the professional background of respondents, annual assessment numbers, requesting parties and reasons, types of examinations conducted (e.g., physical, radiological), followed protocols, age estimation methods, and questions on how age estimates are reported.The questionnaire's findings reveal extensive engagement of the forensic community in age assessment in the living, emphasizing multidisciplinary approaches. However, there seems to be an incomplete appreciation of AGFAD guidelines. Commonalities exist in examination methodologies and imaging tests. However, discrepancies emerged among respondents regarding sexual maturity assessment and reporting assessment results. Given the increasing importance of age assessment, especially for migrant child protection, the study stresses the need for a unified protocol across European countries. This can only be achieved if EU Member States wholeheartedly embrace the fundamental principles outlined in EU Directives and conduct medical age assessments aligned with recognized standards such as the AGFAD guidelines.
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Affiliation(s)
- Marco Cummaudo
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy.
| | - Zuzana Obertova
- Centre for Forensic Anthropology, School of Social Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Perth, WA, Australia
| | - Niels Lynnerup
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen, Denmark
| | - Anja Petaros
- Department of Legal Medicine Linköping, National Board of Forensic Medicine, Linköping, Sweden
| | - Hans de Boer
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Eric Baccino
- EDPFM, Department of Forensic Medicine, University of Montpellier, CHU Montpellier, 34000, Montpellier, France
| | - Maryna Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eugenia Cunha
- National Institute of Legal Medicine and Forensic Sciences, Coimbra, Portugal
| | - Ann Ross
- Human Identification & Forensic Analysis Laboratory, Department of Biological Sciences, North Carolina State University, Raleigh, NC, 276995, USA
| | - Pascal Adalian
- Aix Marseille University, CNRS, EFS, ADES, 13007, Marseille, France
| | - Elena Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, 700 13, Heraklion, Greece
| | - Tony Fracasso
- University Center of Legal Medicine (CURML), Geneva University Hospital, Geneva, Switzerland
| | - Maria Teresa Ferreira
- Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal
| | - Philippe Lefèvre
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), and Institute of Neuroscience (IoNS), Université Catholique de Louvain, 1348 Louvain-la-Neuve, 1200, Brussels, Belgium
| | - Stefano Tambuzzi
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Robin Peckitt
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138, Naples, Italy
| | - Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Güney Mahallesi 1140/1 Yenisehir, Konak, Izmir, Turkey
| | - Danilo De Angelis
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
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Qiu L, Liu A, Dai X, Liu G, Peng Z, Zhan M, Liu J, Gui Y, Zhu H, Chen H, Deng Z, Fan F. Machine learning and deep learning enabled age estimation on medial clavicle CT images. Int J Legal Med 2024; 138:487-498. [PMID: 37940721 DOI: 10.1007/s00414-023-03115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
The medial clavicle epiphysis is a crucial indicator for bone age estimation (BAE) after hand maturation. This study aimed to develop machine learning (ML) and deep learning (DL) models for BAE based on medial clavicle CT images and evaluate the performance on normal and variant clavicles. This study retrospectively collected 1049 patients (mean± SD: 22.50±4.34 years) and split them into normal training and test sets, and variant training and test sets. An additional 53 variant clavicles were incorporated into the variant test set. The development stages of normal MCE were used to build a linear model and support vector machine (SVM) for BAE. The CT slices of MCE were automatically segmented and used to train DL models for automated BAE. Comparisons were performed by linear versus ML versus DL, and normal versus variant clavicles. Mean absolute error (MAE) and classification accuracy was the primary parameter of comparison. For BAE, the SVM had the best MAE of 1.73 years, followed by the commonly-used CNNs (1.77-1.93 years), the linear model (1.94 years), and the hybrid neural network CoAt Net (2.01 years). In DL models, SE Net 18 was the best-performing DL model with similar results to SVM in the normal test set and achieved an MAE of 2.08 years in the external variant test. For age classification, all the models exhibit superior performance in the classification of 18-, 20-, 21-, and 22-year thresholds with limited value in the 16-year threshold. Both ML and DL models produce desirable performance in BAE based on medial clavicle CT.
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Affiliation(s)
- Lirong Qiu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Anjie Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
- University of Electronic Science and Technology of China, Chengdu, 611731, People's Republic of China
| | - Xinhua Dai
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Guangfeng Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhao Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Mengjun Zhan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Junhong Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yufan Gui
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Haozhe Zhu
- College of Computer Science, Sichuan University, Chengdu, 610064, People's Republic of China
| | - Hu Chen
- College of Computer Science, Sichuan University, Chengdu, 610064, People's Republic of China
| | - Zhenhua Deng
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Fei Fan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
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Ruder TD, Kuhnen SC, Zech WD, Klaus JB, Lombardo P, Ith M. Standards of practice in forensic age estimation with CT of the medial clavicular epiphysis-a systematic review. Int J Legal Med 2023; 137:1757-1766. [PMID: 37691040 PMCID: PMC10567934 DOI: 10.1007/s00414-023-03061-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/08/2023] [Indexed: 09/12/2023]
Abstract
The AGFAD (Arbeitsgemeinschaft für Forensische Alterdiagnostik, Study Group on Forensic Age Diagnostics) has published several recommendations regarding both technical aspects of computed tomography (CT) of the medial clavicular epiphysis (MCE) and the process of reading and interpreting the CT images for forensic age estimations (FAE). There are, however, no published recommendations regarding CT scan protocols and no dose reference values for CT of the MCE. The objective of this analysis was to assess adherence to AGFAD recommendations among practitioners of FAE and analyse reported dose-relevant CT scan parameters with the objective of helping to establish evidence-based dose reference values for FAE. A systematic literature search was conducted in PubMed and in Google Scholar with specific MeSH terms to identify original research articles on FAE with CT of the MCE from 1997 to 2022. A total of 48 studies were included. Adherence to AGFAD recommendations among practitioners of FAE is high regarding the use of Schmeling main stages (93%), bone window (79%), ≤ 1 mm CT slices (67%), axial/coronal CT images (65%), and Kellinghaus sub-stages (59%). The reporting of CT technique and CT dose-relevant scan parameters is heterogeneous and often incomplete in the current literature. Considering the success achieved by the AGFAD in creating standards of practice of FAE in living subjects, there is potential for the AGFAD to establish standards for radiation protection in FAE as well.
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Affiliation(s)
- Thomas D Ruder
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Saskia C Kuhnen
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Jeremias B Klaus
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- Roentgen Institute Thun, Thun, Switzerland
| | - Paolo Lombardo
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Michael Ith
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Radiation Protection, Image Processing Systems & Radiological Processes, Hirslanden Private Hospital Group, Zurich, Switzerland
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