Abstract
PurposeThe aim of this study was to assess the impact of arm position in computed tomography (CT) of the clavicle performed for forensic age estimation on clavicular position, image noise, and radiation dose.Methods and materialsForty-seven CT scans of the medial clavicular epiphysis performed for forensic age estimation were conducted with either hands and arms held upwards (CTHU, 28 persons) or positioned at the body (CTHD, 19 persons). Presets were identical for both positions (70 mAs/140 kVp; Brilliance iCT, Philips). Each CT scan was reconstructed with an iterative algorithm (i-Dose 4) and evaluated at the middle of the sternoclavicular joint. Clavicular angle was measured on a.p. topograms in relation to a horizontal line. Quantitative image noise was measured in air at the level of medial clavicular epiphysis. Effective dose and scan length were recorded.ResultsHands-up position compared with hands-down position resulted in a lower lateral body diameter (CTHU 41.1 ± 3.6 cm vs. CTHD 44.6 ± 3.1 cm; P = 0.03), a reduced quantitative image noise (CTHU: 39.5 ± 9.2; CTHD: 46.2 ± 8.3; P = 0.02), and lower CTDIvol (5.1 ± 1.4 mGy vs. 6.7 ± 1.8 mGy; P = 0.001). Scan length was longer in patients examined with hands up (HU: 8.5 ± 3.4 cm; HD: 6.2 ± 2.1 cm; P = 0.006). Mean effective dose for CTHU was 0.79 ± 0.32 mSv compared with 0.95 ± 0.38 mSv in CTHD (P = 0.12). Clavicular angle was 17° ± 6° in patients with hands down and 32° ± 7° in patients with hands up (P < 0.001).ConclusionBy elevated arm positioning, the image quality of clavicular CT scans can be improved while maintaining radiation dose compared with hands down. Clavicular position differs according to the hand position. Thus, positioning patients with elevated hands is advisable for forensic clavicular CT examinations, but multiplanar CT reconstructions should be adjusted to clavicular position and scan length should be reduced to a minimum.
Highlights
With increasing migration into European countries, forensic age assessment in young adults has become increasingly important [1]
The anteroposterior distance and lateral body diameter at the midlevel of the medial clavicular epiphysis was measured in subjects, in which the entire soft tissues were included in the scan
The anthropomorphic parameters were available in 23 patients with hands up and in 19 patients with hands down and did not differ between both groups
Summary
With increasing migration into European countries, forensic age assessment in young adults has become increasingly important [1]. Provided that x-ray examinations are legally permitted, the AGFAD (Arbeitsgemeinschaft für Forensische Altersdiagnostik, Study Group on Forensic Age Diagnostics) recommends a steps-wise approach beginning with a conventional xray examination of the left hand or the teeth [2]. Minimizing radiation dose remains an important part of imaging, especially since clavicular CT is. Int J Legal Med (2021) 135:1581–1587 often performed in young and borderline adults due to the greater risk of malignancy after radiation exposure [6]. In cervical spine, CT examinations with a low shoulder position allow the application of lower radiation dose with no reduction of image quality [10]. In trauma patients, arm-raising for thoracoabdominal CT results in higher image quality and lower radiation dose [7]
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