Evidence map›Paper›PMID 40439937›Full record

ArticleInternational journal of legal medicine2025

CT of the medial clavicular epiphysis for forensic age estimation - raised arms position recommended.

Saskia C Kuhnen, Martin Müller, Andreas Schmeling, Wolf-Dieter Zech, Jeremias B Klaus, Paolo Lombardo, Michael Ith, Rainer J Egli, Thomas D Ruder

Abstract read
In one paragraph

Article in International journal of legal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Saskia C KuhnenInstitute of Diagnostic, Interventional and Pediatric Radiology InselspitaI, Bern University Hospital, University of Bern, Rosenbühlgasse 27, Bern, Bern, CH-3010, Switzerland.
Martin MüllerDepartment of Emergency Medicine, Bern University Hospital, InselspitaI, University of Bern, Bern, Switzerland.
Andreas SchmelingInstitute of Legal Medicine, Münster, Germany.
Wolf-Dieter ZechInstitute of Forensic Medicine, University of Bern, Bern, Switzerland.
Jeremias B KlausInstitute of Diagnostic, Interventional and Pediatric Radiology InselspitaI, Bern University Hospital, University of Bern, Rosenbühlgasse 27, Bern, Bern, CH-3010, Switzerland.
Paolo LombardoInstitute of Diagnostic, Interventional and Pediatric Radiology InselspitaI, Bern University Hospital, University of Bern, Rosenbühlgasse 27, Bern, Bern, CH-3010, Switzerland.
Michael IthInstitute of Diagnostic, Interventional and Pediatric Radiology InselspitaI, Bern University Hospital, University of Bern, Rosenbühlgasse 27, Bern, Bern, CH-3010, Switzerland.
Rainer J EgliInstitute of Diagnostic, Interventional and Pediatric Radiology InselspitaI, Bern University Hospital, University of Bern, Rosenbühlgasse 27, Bern, Bern, CH-3010, Switzerland.
Thomas D RuderInstitute of Diagnostic, Interventional and Pediatric Radiology InselspitaI, Bern University Hospital, University of Bern, Rosenbühlgasse 27, Bern, Bern, CH-3010, Switzerland. thomas.ruder@insel.ch.ORCID http://orcid.org/0000-0002-3110-9143

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare the effect of arm positioning on radiation dose, scan length, and image noise in computed tomography (CT) scans of the medial clavicular epiphysis for forensic age estimation performed with the arms alongside the body (arms-down) versus elevated above the head (arms-up).

methodsTwenty consecutive CT scans were analysed, ten performed with arms-down and ten with arms-up. The scans were conducted at 120 kVp and 37 mAs reference tube current. Scan length extended from 10 mm above to 10 mm below the medial clavicular epiphysis. Dose-relevant parameters (effective CT tube current, volume CT dose index (CTDIvol), CT dose length product (DLP), and effective dose) as well as scan length and image noise were compared between arms-up and arms-down CT scans.

resultsPopulation characteristics: 19 males, 1 female; mean weight 65.8 ± 9.2 kg; height 174.6 ± 7.8 cm; and body mass index (BMI) 21.6 ± 2.5 kg/m². Dose-relevant parameters were significantly lower with arms-up compared to arms-down (effective tube current: 80.9 ± 21.7 mAs vs. 146.0 ± 47.5 mAs, p = 0.001; CTDIvol: 5.5 ± 1.5 mGy vs. 9.9 ± 3.2 mGy, p = 0.001; DLP: 40.2 ± 13.7 mGy*cm vs. 63.8 ± 21.9 mGy*cm, p = 0.010; effective dose: 0.6 ± 0.2 mSv vs. 0.9 ± 0.3 mSv, p = 0.010). No significant differences were found in scan length, image noise, or population characteristics.

conclusionsRemoving the arms from the CT beam path reduced radiation dose by 33% without affecting scan length or image noise. Given the importance of dose optimisation in non-medical examinations of potentially minor individuals, CT scans of the medial clavicular epiphysis should be performed with arms elevated above the head.

Indexed as

Age Determination by SkeletonArmClavicleEpiphysesPatient PositioningTomography, X-Ray ComputedAdolescentAdultFemaleHumansMaleMiddle AgedRadiation DosageYoung AdultArm positioningComputed tomographyForensic age estimationMedial clavicular epiphysisRadiation protection

Identifiers

PMID40439937
PMCPMC12354554

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.