Role of Computed Tomography in Age Estimation by Schmeling Method Using Analysis of Medial Clavicular Epiphysis

Abstract

Background: Age estimation has acquired significance due to its application in migration to various countries and legal purposes. It is a big problem in underdeveloped and developing countries, where original and genuine birth records are not available due to non-hospital births. Its application in juvenile courts for legal proceedings is very important. Application of x ray in age estimation is not much reliable in some circumstances. Schmeling method is more precise for age estimation with the help of thin slice CT scan images of medial clavicular epiphysis. Objective: The objective of this study was to use the CT scan images for establishing the relationship between ossification of medial clavicular epiphysis (radiological age) and age estimation (chronological age) of individuals. Study Design: Retrospective study. Settings: Department of Radiology, FJMU/Sir Ganga Ram Hospital, Lahore Pakistan. Duration: January to June 2022. Methods: Total 136 good quality CT scan images of patients were retrospectively assessed in this study, having age bracket of 10 to 40 years, including both males and females without any previous history of clavicular trauma or bony deformity. The included CT scans were HRCT Chest and CT Chest with contrast. CT scans of all those patients with known malignancy, post-surgical or post traumatic history of clavicle, taking immunosuppressants or radiation treatment were not enrolled in this study. Results: Out of total 136 patients, 66 (48.53%) were females and 70 (51.47%) were males. We found that at the age of 21 years, clavicular epiphyseal ossification stage shifts from 3rd to 4^th schmeling stage. Mean age for stage 1 was 11 years for males and 10.5 years for females, for stage 2 was 14 years for both males and females, for stage 3 it was 18.9 years for males and 18.5 years for females, stage 4 was 24.4 years for males and 25.1 years for females and stage 5 was 33.21 years for males and 34.3 years for females. Maximum number of patients were in stage 4 (27.21 %) and 5 (39.71%). Conclusion: Considering results of our study, we concluded that an individual aged 21 years or above shows clavicular epiphyseal ossification stage 4 (schmeling), while an individual aged less than 21 years show clavicular ossification stage 3(schmeling). Therefore, application of thin slice CT scan images of medial clavicular epiphysis has utmost legal importance for the age estimation. We recommend computed tomography as an accurate and non-invasive imaging modality for age estimation by analysis of medial clavicular epiphysis, using schmeling method.

Keywords: Epiphysis, Schmeling, Computed tomography.