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Forensic Age Estimation Using the Medial Clavicular Epiphysis: A Study Review.

PURPOSE
To discuss current literature evaluating the medial clavicular epiphysis to assess an individual's age using various imaging modalities.


METHODS
Four scholarly research databases were searched to find studies that examined living subjects. Several articles were included that used cadavers, and a textbook was used to detail the anatomy of the clavicle. Thirty-nine articles were analyzed.


RESULTS
The literature indicated that several imaging modalities, including conventional radiography, computed tomography, magnetic resonance, and sonography, are being used to evaluate the medial clavicular epiphysis to estimate an individual's age in the forensic context. In addition to multiple modalities, researchers are using various staging classification systems, ethnic groups, and interpreter criteria to establish reference data.


DISCUSSION
There is a need to determine the age of individuals involved in civil and criminal proceedings who do not have valid birth date documentation. The clavicle is the last bone in the human body to complete fusion. The clavicle begins to fuse in the early teens and completes medial epiphyseal fusion in the late 20s. Clavicle fusion spans the legally significant age range of 18 through 21. Multiple variables influence the final age estimation, including interpreters' experience, the individual's socioeconomic class or area of origin, and limitations within the imaging modalities.


CONCLUSION
Computed tomography is the modality of choice for forensic age estimation using the medial clavicular epiphysis. Radiologic technologists should be cognizant of current forensic age estimation practices, and future research should continue to provide reference data to improve accuracy of age estimation in those individuals who lack documentation of their date of birth.