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Guidelines for Best Practice Imaging for Age Estimation in the Living

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Guidelines for Best Practice Imaging for Age Estimation in the Living Journal of Forensic Radiology and Imaging 16 (2019) 38–49 Contents lists available at ScienceDirect Journal of Forensic Radiology and Imaging journal homepage: www.elsevier.com/locate/jofri Guidelines for best practice: Imaging for age estimation in the living T ⁎ Edel Doylea, , Nicholas Márquez-Grantb, Lisa Fieldc, Trish Holmesa, Owen J Arthursd,e,f, Rick R. van Rijng,h, Lucina Hackmani, Kathleen Kasperj, Jim Lewisk,l, Peter Loomism, Denise Elliotta, Jeroen Krolla,n, Mark Vinera,b,o, Soren Blaup, Alison Broughq,r, Stella Martín de las Herass, Pedro Manuel Garamendit,u,v a International Association of Forensic Radiographers, UK b Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom,UK c International Society of Radiographers & Radiologic Technologists, UK d Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK e UCL Great Ormond Street Institute of Child Health, London, UK f ISFRI Paediatric Working Group, Switzerland g Department of Radiology, Emma Children's Hospital – Academic Medical Center Amsterdam, the Netherlands h Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, the Netherlands i Leverhulme Centre for Forensic Science, Ewing Building, University of Dundee, Dundee, UK j Tarrant County Medical Examiner's District, Ft. Worth, Texas; Forensic Odontologist, Collin County Medical Examiner, McKinney, TX, USA k The University of Tennessee, Graduate School of Medicine, Department of General Dentistry, Division of Forensic Odontology, Knoxville, TN, USA l Alabama Department of Forensic Sciences, USA m New Mexico Office of the Medical Investigator, Albuquerque, NM,USA n Maastricht University Medical Center, Maastricht, the Netherlands o Radiography, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, UK p Victorian Institute of Forensic Medicine, Melbourne, Australia q Lecturer Liverpool John Moores University, Liverpool, UK r ISFRI Anthropology working group, Switzerland s Department of Forensic Medicine and Forensic Dentistry, University of Granada, Spain t Institute of Legal Medicine and Forensic Sciences, Huelva, Spain u Member of the Working Group on Age Estimation of Unaccompanied Minors, Spain v Member of Council of Forensic Medicine of Spain (Ministry of Justice), Spain 1. Introduction • Bone age -general degree of maturation of bone that subjects of a population reach at a certain average age. This term may be used These standards and guidelines have been developed as a colla- when referring to the bone age of a specific anatomical region (i.e., borative effort by members of the International Association of Forensic bone age in the hand and wrist). Radiographers [IAFR] and the International Society of Forensic • Dental age -general degree of development of teeth that subjects of Radiology and Imaging [ISFRI] in association with the International a population reach at a certain average age. Society of Radiographers and Radiologic Technologists [ISRRT]. • Skeletal age -general degree of maturation of the skeleton that Experts and members of other organisations from the fields of radio- subjects of a population reach at a certain average age. This term graphy, radiology, forensic medicine, forensic odontology and forensic may be used when talking about the entire skeleton. anthropology have contributed to these guidelines. • Age assessment -the three terms above are general in the sense of The aim of these guidelines is to provide guidance to Radiographers indicating the behaviour of a population in relation to skeletal and when requested to perform imaging of individuals for assessment of dental maturity. Age assessment is an individual concept. It is the age. These guidelines also include an overview of the requirements estimation of the most probable age of an individual considering from other professions (e.g. forensic physicians, anthropologists, their skeletal and dental age and their specific demographic char- odontologists or radiologists). acteristics (sex, health, physical activity, intake, etc.). Age Assessment in this document includes the estimation of age by assessing the dentition, as well as other skeletal areas such as the hand/ These guidelines have been developed to promote interna- wrist. The following commonly used terms are differentiated as: tional ‘best practice’ with regards to image acquisition and to ⁎ Corresponding author. E-mail address: [email protected] (E. Doyle). https://doi.org/10.1016/j.jofri.2019.02.001 Received 21 November 2018; Received in revised form 9 January 2019; Accepted 3 February 2019 Available online 10 February 2019 2212-4780/ © 2019 Published by Elsevier Ltd. E. Doyle, et al. Journal of Forensic Radiology and Imaging 16 (2019) 38–49 highlight established evidence-based approaches when imaging prevail and he or she shall be presumed to be a child. The Committee on for bone age estimation. The ability to adhere to ‘best practice’ is the Rights of the Child [CRC] recommends that each State party: dependent on local facilities and resources, as well as the expertise of “give the benefit of the doubt in age-disputed cases of separated the practitioner, their selection of appropriate age assessment metho- children seeking asylum, and seek experts’ guidance on how to de- dology and the availability of child-appropriate equipment. termine age” ([94], p.17). The European asylum support office [[19], p.9] have defined age assessment as 3. Who is involved in calculating age? “… the process by which authorities seek to establish the chron- ological age, or range of age, or determine whether an individual is There may be a number of specialists involved in providing age an adult or a child. The United Nations Committee on the Rights of assessments including medical practitioners and social workers. the Child (CRC) general Comment No 6 states that: the identification Forensic physicians, anthropologists, odontologists and radiologists are of a child as an unaccompanied and separated child includes age commonly asked to contribute to estimating the age of a living person assessment, which should take into account physical appearance, for legal purposes through the analysis of radiographic images. but also psychological maturity. The assessment must be conducted in a scientific, safe, child and gender-sensitive and fair manner, 3.1. Role of the forensic radiographer avoiding any risk of violation of the physical integrity of the child, giving due respect to human dignity. Age assessment should only be A forensic radiographer is a healthcare professional who is author- used where there are grounds for serious doubt of an individual's ised in their jurisdiction to deliver ionising radiation for medical pur- age.” poses and who has undertaken further postgraduate education in for- ensic radiography / forensic science and medico-legal aspects of their 2. Why is age assessment needed? profession [97]. Following liaison with other members of the investigative team (e.g. Age estimation of living individuals is important in its contribution forensic physician, anthropologist, odontologist or radiologist), the to verifying in the most accurate way possible the chronological age of forensic radiographer will use the most appropriate imaging modality an individual for whom age is unknown for both civil and criminal to provide the maximum amount of diagnostic information whilst en- proceedings. For example, in many jurisdictions the minimum age of suring that the radiation dose is kept as low as possible in accordance criminal responsibility is 18 years. Therefore, for an undocumented with the ALARA principle (International Commission on Radiological individual or in cases where someone is falsifying their age, it is es- Protection [33], 2007). sential to confirm whether or not the individual has reached the ageof The role of the Forensic Radiographer has been described by the legal liability or age of majority. Irish Institute of Radiography and Radiation Therapy [35], 2016, p. Demands for age assessments, both for civil or criminal cases, 11–12): mostly relate to young adult delinquents but also include young im- migrants and refugees seeking political asylum. Unaccompanied • To produce imaging of the highest possible quality diagnostic Asylum Seeking Children [UASC] and Separated Children are extremely quality using appropriate exposure factors / scan parameters and to vulnerable to global trends of criminalisation, imprisonment, ex- be familiar with the most common practices in processing tools and ploitation, trafficking, forced marriage and violations of their rights techniques. [9,66]. They may have false documents or may not know their age, or • They must understand how to acquire and post-process images in a they may have no documentation to prove their identity or literally may safe and hygienic environment whilst observing the medico-legal not know their date of birth [9]. It is possible that some children do not aspects of undertaking Forensic Imaging. know their age or their cultural background. • They should understand the importance of selecting the appropriate The reasons age assessments in the living may be requested include modality to answer the legal question(s) being asked, based on but are not limited to: asylum seekers who may not know their age or knowledge of the capabilities and limitations of the various aspects may attempt to falsify their age; undocumented individuals in cases of of imaging. criminal prosecution, human trafficking
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