The Reliability of the Greulich and Pyle Atlas When Applied to a Modern Scottish Population

This study examines the reliability of age estimation utilizing the Greulich and Pyle atlas in relation to a modern Scottish population. A total of 406 left‐hand/wrist radiographs (157 females and 249 males) were age‐assessed using the Greulich and Pyle atlas. Analysis showed that there was a strong correlation between chronological age and estimated age (females R² = 0.939, males R² = 0.940). When age groups were broken down into year cohorts, the atlas over‐aged females from birth until 13 years of age. The pattern for males showed that the atlas under‐estimated age until 13 years of age after which point it consistently over‐aged boys between 13 and 17 years of age. This study showed that the Greulich and Pyle atlas can be applied to a modern population but would recommend that any analysis takes into account the potential for over‐ and under‐aging shown in this study.     

Applicability of Greulich and Pyle and Demirijan aging methods to a sample of Italian population

Age estimation in forensics is essential in cases involving both living and dead subjects. For living subjects, age estimation may be used to establish an individual's status as a minor in cases involving adoption, criminal responsibility, child pornography, and those seeking asylum. Criteria for age estimation in the living have recently been put forth by The Study Group on Forensic Age Diagnostics. The group has proposed guidelines with a three-step procedure: a physical examination and anthropometrical analysis; dental analysis by orthopantomogram (OPG); and X-ray study of the left hand and wrist. The board of FASE highlighted advantages and limits of each method, and suggested practical solutions concerning the age estimation process for adults and subadults. The aim of this study was to verify the applicability of the Greulich and Pyle, and Demirjian techniques on a sample group of Italians, whose ages were known, in determining the skeletal and dental age, in addition to evaluating the reliability of these techniques. 535 subjects between the ages of 7 and 15years were examined, each one undergoing both an orthopantomography (OPG) and radiography of the left wrist and hand. The data obtained underwent statistical analysis. The analyses have shown that a correlation exists between skeletal and dental age, and real age. Age estimation carried out using the Greulich and Pyle method has shown itself to be especially accurate on the Italian sample, particularly in the age ranges of 7-9years and 10.4-11.5years. The Greulich and Pyle method has shown itself to be reliable for the sample analyzed notwithstanding the ethnic differences between the original sample of reference and those analyzed in this study. Application of the Demirjian technique resulted in an overestimation of dental age. This difference is shown to be more highly significant in the higher age ranges. The combination of the Greulich and Pyle, and Demirjian methods have revealed a difference regarding real age, which turns out to be more modest in the younger age ranges and more significant in older subjects.     

Does Mirror Imaging a Radiograph Affect Reliability of Age Assessment Using the Greulich and Pyle Atlas?*

Abstract: Age estimation is routinely undertaken by comparing radiographs of the individual in question to published reference samples of individuals of known age. This study examines the reliability of age estimation utilizing the Greulich and Pyle atlas in relation to both left‐ and right‐hand/wrist radiographs and explores whether reversing right‐hand/wrist radiographs, so that they are in the same anatomical orientation as those images used in the atlas affects reliability. A total of 403 left‐hand/wrist radiographs and 415 right‐hand/wrist radiographs were age assessed using the Greulich and Pyle atlas. Analysis showed that there is no significant loss in reliability when radiographs of the right hand (women R² = 0.887 and men R² = 0.907) are utilized instead of the left (women R² = 0.939 and men R² = 0.940) or when they are assessed as mirror images to those printed in the reference atlas (reversed female left hand R² = 0.929 and reversed male left hand R² = 0.931).     

Comparative study of Greulich and Pyle Atlas and Maturos 4.0 program for age estimation in a Portuguese sample

Age estimation of living individuals has become one of the big issues of forensic anthropology. The increase of children and adolescents with no valid proof of their chronological age is a legal concern to many countries, especially in situations of illegal immigration, sub adult delinquency and juvenile work. For this purpose, the use of radiological methods for evaluation of skeletal maturation is particularly useful. In this study we compare the two of the most common methods applied in age estimation by hand/wrist radiographs: the Radiographic Atlas of Skeletal Development of the Hand and Wrist made by Greulich and Pyle (GP), 1959,and the Sempé method developed for computer--Maturos 4.0 (MT) program. These methods were applied to a sample of 230 radiographs of the hand and wrist from Portuguese children and adolescents of known sex age and age, aged between 12 and 20 years, who performed medical examination at the University of Coimbra Hospitals during 2005. The methods achieved different performances, depending on the age group. Between 12 and 15 years the bone age with the MT program is closer to the chronological age, whereas in older ages the GP Atlas method is more trustworthy. At the ages with legal consequences in Portugal (16 and 18 years) the GP Atlas method is most accurate, namely to decide whether an individual is younger or older than 18 years. Around 16 years old, although there are doubts in relation to the accuracy of both methods, GP Atlas seems to perform better.     

Reliability of the methods applied to assess age minority in living subjects around 18 years old. A survey on a Moroccan origin population

We present a review of a population of 114 immigrant Moroccan males for which an age estimation was requested. The subjects' real chronological age was confirmed by the Moroccan Embassy in Spain. The confirmed age range was between 13 and 25, with an average age of 18.1 years and a standard deviation of 2.03. The following tests were performed to arrive at the forensic estimation of age: general physical examination, carpus X-ray (Greulich and Pyle method) and dental orthopantomography to determine the degree of maturity of the third inferior molars (Demirjian's method). Carpus X-ray (skeletal age) was the most useful method, followed by Demirjian's method (dental age), as prediction factors of a chronological age of over or under 18. The combination of skeletal and dental age variables represented a significant improvement in the prediction of the chronological age of the subjects in this population, reducing the number of ethically unacceptable test errors to a minimum.     

Age Estimation from Radiographic Images of the Knee

This study examines the reliability of age estimation utilizing the Pyle and Hoerr atlas in relation to a modern Scottish population. The knee radiographs of 442 individuals (168 females, 274 males) were age assessed using the Pyle and Hoerr atlas. Analysis showed that there was a strong correlation between chronological age and estimated age (females R² = 0.968, males R² = 0.952). For females, the atlas method was most accurate between the ages of 9 and 15 years of age with an underage of 2.27 months and an overage of 2.38 months. For males, the atlas consistently overestimated age from the age of 9 years to the age of 16 years from between 0.14 and 8.81 months. The standard deviation for females was 9.86 months and for males was 10.75 months. This study showed that the Pyle and Hoerr atlas can be applied to a modern population with small modifications.     

Comparison of the three age estimation methods: Which is more reliable for Turkish children?

BackgroundThree atlases—the GÖK, the Greulich–Pyle (GP), and the Tanner–Whitehouse (TW3)—are used frequently for age determination in Turkey. The purpose of this study was to evaluate the applicability of these three methods related to the skeletal age assessment for Turkish adolescents.Materials and methodsThe conventional roentgenograms of the left hands and wrists, elbows, shoulders, and pelvises of 333 healthy Caucasian children (164 females, 169 males) who fit the study and the criteria of each atlas were obtained. The mean differences (± standard deviation [S.D.] in years) between the chronologic age (CA) and the skeletal age (BA), which were obtained by using each age estimation method, were calculated and tested using t-test.ResultsFor girls, the most accurate method was the TW3 (mean differences (d): ?0.21 (p < 0.05)), following by the GP (d: 0.66 (p < 0.001), and the GÖK (d: 2.99 (p < 0.001)). For boys, the most accurate method was the GP (d: ?0.02 (p > 0.05)), followed by the TW3 (d: ?0.18 (p < 0.05)) and GÖK (d: 1.05 (p < 0.001)).Discussion and conclusionsResults show that the TW3 (for girls) and the GP (for boys) methods are more appropriate than the GÖK atlas for estimating the BA. GÖK could be used for boys aged 11–14 years but it should not be used for girls.     

Intra- and interobserver error of the Greulich-Pyle method as used on a Danish forensic sample

The Section of Forensic Medicine at the University of Copenhagen performs age evaluations of the living at the request of the police. The established procedure in these cases involves: (1) a physical examination; (2) an odontological examination based on evaluation of an orthopantomogram and intraoral dental radiographs. Different methods are used depending on the maturity of the individual examined; and (3) a carpal X-ray examination, using the Greulich and Pyle Atlas (GPA) method. We present the results of intra- and interobserver tests of carpal X-rays in blind trials, and a comparison of the age estimations by carpal X-rays and odontological age estimation. We retrieved 159 cases from the years 2000-2002 (inclusive). The intra- and interobserver errors are overall small. We found full agreement in 126/159 cases, and this was between experienced users and novices. Overall, the mean difference was 0.053 years, with a standard deviation of +/-0.567 years. Our results show that the direct and na?ve use of the GPA is simple and reproducible, even when applied by non-experienced users. This is probably also why the method is still widely applied, even though other authors have stated that atlas-based techniques are obsolete and ought to be replaced by other methods. Specifically, the GPA test sample consisted of American "white" children "above average in economic and educational status", leading to the question as to how comparable subjects being scored by the GPA method today are to this original sample. Indeed, we found a minor difference in the age estimations for older juveniles between odontologists and radiologists, which may indicate that more studies on comparative dental and skeletal aging for geographically different populations would be beneficial. Finally, if using the GPA method in legal cases, we would advise that one should closely adhere to the standard deviations given, and intermediary scores should be noted and not just a resultant age. The final age statement should also address the problems of reference populations.     

青少年手腕骨骨龄与生活年龄的差异观察

目的比较以不同骨龄标准所评价的青少年手腕骨骨龄与生活年龄的差异,观察生长发育长期变化对青少年年龄推测的影响。方法从中国5座大中城市抽取11464名（男5873,女5591）3～18岁汉族正常青少年儿童,并另随机抽取950名（男516,女434）12～18岁骨发育正常的汉族青少年作为验证样本。按CHN法和RC法骨龄标准评价手腕部X线片骨龄,并对不同方法评价的骨龄及生活年龄进行统计学分析。结果各年龄组CHN法骨龄中位数大于RC骨龄,其差异具有显著性意义（P〈0．05）。验证样本中,在男12—16．5岁、女12～14．5岁之间,CHN骨龄减生活年龄之差值分别为0．35—1．00岁和0．57～1．16岁（P〈0．01）;RC骨龄减生活年龄的差值分别为-0．26—0．23岁和-0．27～0．06岁（P〉0．05）。在男17～18岁、女15～17岁之间,CHN骨龄减生活年龄的差值分别为-0．52～-1．05岁和-0．16～-1．13岁（P〈0．05）,RC骨龄减生活年龄的差值分别为-0．35～-0．48岁和-0．22～-0．79岁（P〈0．05）。结论CHN法骨龄高于生活年龄,在大部分年龄组RC骨龄与生活年龄基本一致。     

RUS-CHN图谱骨龄评价法用于推侧青少年年龄

目的探讨RUS-CHN(RC)图谱评价法用于13~18岁青少年年龄推侧的应用价值。方法4 424名(男2 272,女2 152)13~18岁正常城市汉族青少年,以简化RUS-CHN法建立手腕骨发育等级图谱。另以1 048名(男530,女518)13~18岁青少年为检验样本,比较不同方法骨龄与生活年龄的差异。结果RUS-CHN图谱法可仅评价桡骨、尺骨远端和第III指的4块掌指骨骺。检验样本中男14~17岁、女13~16岁年龄组,RC图谱法骨龄与生活年龄之间的差异均无统计学显著性(W ilcoxon符号秩和检验,P>0.05),对男18岁、女17岁组出现显著性差异的可能原因进行了讨论。结论RUS-CHN图谱法骨龄适用于男13~18岁、女13~17岁青少年的年龄推测。     

Time of fusion of the basisphenoid with the basilar part of the occipital bone in northwest Indian subjects

To find out the time of fusion of the basisphenoid with the basilar part of the occipital bone in Northwest Indian subjects, a quadrilateral piece of bone extending from the posterior clinoid processes to the jugular tubercles was removed from 50 male and 34 female autopsy subjects between the ages of 10 and 20 years. The piece of bone was X-rayed and then macerated. In addition CT scan cuts of the basisphenoid were obtained in 46 male and 27 female living subjects between the age of 10 and 19 years. In the males, partial fusion was seen at 13 years while a complete fusion was noticed at 15 years in 25% of the subjects. The age of a boy showing complete fusion should be 15 years or above. If there is no fusion or partial fusion he should be below 19 years as complete fusion is seen in all male subjects at 19 years. In females, the earliest partial fusion was noted at 12 years and complete fusion was present at 13 years in 16.6%. All female subjects showed complete fusion at 17 years. The minimum age of a girl showing complete fusion should be 13 years; if no fusion or partial fusion is seen, her age should be below 17 years.     

中国5城市儿童青少年手腕骨发育差异对年龄推测影响

目的探讨中国5城市儿童青少年手腕骨发育差异对年龄推测的影响。方法收集2005年中国上海、广州、温州、大连、石家庄11635名（男5971,女5664）汉族正常儿童青少年手腕部骨X线片,按RUS—CHN法标准评价受试者手腕骨骨龄,比较各城市儿童青少年的骨龄差异。结果广州男在8岁以下以及温州男9～12岁骨发育分别延迟0．14～0．19岁和0．13～0．17岁（P〈0．05）,上海男在7～15岁之间骨发育提前0．14～0．32岁（P〈0．05）。大连女在12岁以下、石家庄女在8岁以下骨发育分别延迟0．15～0．31岁和0．18～0．31岁（P〈0．05）;广州女在5～8岁骨发育延迟0．11～0．22岁（P〈0．05）;而上海女在8～9岁骨发育提前0．12～0．13岁（P〈0．05）。结论中国5城市儿童青少年手腕骨发育在不同年龄段存在不同程度的差异。     

Suicidal deaths in childhood and adolescence

Suicide has been reported as the second or third most common cause of death in children and adolescents worldwide. In this study, cases of under the age of 19 years submitted to the Institute of Forensic Medicine, First Specialization Board between 1996 and 2000 as suicides by the Board were evaluated retrospectively. The cases included in this study were the cases bearing locally questionable components, so had been submitted to the evaluations by the Board in order to eradicate the doubts. A total of 43 cases were investigated regarding age, gender, cause of death, manner of death, place of death, time of death, and the risk factors. Of the 43 cases evaluated, 31 cases were female and 12 cases were male. The notable suicide method was found to be firearms. Although it was clear that that not all of the suicide cases in this age group had been submitted to the Institute of Forensic Medicine, the most striking result of this study, nevertheless, was that girls constituted the 72% of suicidal deaths in this age group.     

四川汉族青少年肘关节数字X线影像骨龄特征研究

目的观测四川地区青少年肘关节数字X影像的骨发育特征规律,建立肘关节推断年龄的回归方程。方法拍摄608例8～18岁青少年进行肘关节数字X线片,按性别及年龄分组,选取肘关节6个骨化中心作为观测指标,对发育特征进行分级、赋值。采用SPSS 15.0统计软件对各观测值进行描述性统计学分析,建立推算年龄的回归方程。结果得出男女性青少年肘关节继发骨化中心出现、闭合的年龄范围、平均年龄以及95%置信区间等数据。一元回归方程的复相关系数(R)范围:男性0.874～0.914,女性0.883～0.954;年龄估计值标准误(SE)范围:男性0.934～1.101岁,女性0.561～0.883岁;多元回归方程R值及SE值:男性为0.946、0.750岁,女性为0.964、0.500岁。所有方程均经统计学检验与诊断,具有较好的适用性。结论本文选择的肘关节指标发育特征与年龄有相关性,其中肱骨内上髁、桡骨小头及肱骨小头骨骺均呈高度显著相关,建立的回归方程可用于相关人群年龄推断,且多元回归方程准确性更高。     

Age estimation of Korean children based on dental maturity

The aim of this study was to evaluate the relationship between age and dental maturity and to establish the standard database of dental maturity based on the Demirjian's stages, which can be used for the age estimation of Korean children. For this purpose, dental maturity was measured by the Demirjian's stages on a randomly selected sample of panoramic radiographs taken from 2706 patients between 1 and 20 years of age and analyzed by multiple linear regression analysis based on the method of least squares. The results showed that, except for the third molars, the development of permanent teeth in Korean children was more advanced in females. The Demirjian's stage G of the second molar appeared last in both male and female subjects by age 18, showing 95th percentile at age in the male and female subjects between 16.7-17.4 years and 17.1-17.3 years, respectively. Coefficients of determination (r(2)) of the Demirjian's stages relative to age in regression analysis were 0.9721 in male and 0.9740 in female subjects. The standard error was 0.63 years in male and 0.62 years in female subjects. The estimated age according to regression analysis was within +/-1.0 year of the actual age in 92.0% of male and 92.5% of female subjects. Collectively, the data of the present study can be used as a reference for dental maturity and a standard for age estimation of Korean children.     

肘部骨骼年龄判定方法的研究

本文根据学龄儿童肘关节部位骨髂的X线解剖特点,制定出一套适用于男10～15岁,女8～13岁儿童的肘部骨骼发育年龄判定方法。该方法可分为两部分:肘骨龄标准图谱和肘骨龄计分判定法。骨龄标准图谱由男女分开的两套肘部X线标准片组成。计分法包括男女共用的肘部骨标志发育分期图和男女分开的相应骨成熟分数表和标准百分数曲线。两种方法都附有较详细的使用说明。骨龄图谱使用简便,计分法的精确性较高。     

A profile of parental homicide against children

The purpose of this study was to provide a profile of victims and offenders in cases where children were killed by their parents. The data were all incidents (3,459) in which a parent killed a child under age 18, which were recorded in theUniform Crime Reports between 1976 and 1985. In the first week of a child's life, the risk of being killed by a parent was equal for males and females. From 1 week to 15 years, males were the victims in about 55% of all parent-child homicides; the percentage of male victims increased to 77% in the 16–18 age group. Among infants in the first week of life, mothers were almost always the ones who committed the homicide. Between the first week of life and the teenage years, mothers and fathers were about equally likely to kill their child. During the 13–15 year age group, fathers committed 63% of all homicides, and this increased to 80% among the 16–18 year age group. Among very young children, the causes of death tended to be personal weaponds, asphyxiation, or drowning. As age increased, the weapons became predominantly guns and knives.     

Facial soft tissue thickness in skeletal type I Japanese children

Facial reconstruction techniques used in forensic anthropology require knowledge of the facial soft tissue thickness of each race if facial features are to be reconstructed correctly. If this is inaccurate, so also will be the reconstructed face. Knowledge of differences by age and sex are also required. Therefore, when unknown human skeletal remains are found, the forensic anthropologist investigates for race, sex, and age, and for other variables of relevance. Cephalometric X-ray images of living persons can help to provide this information. They give an approximately 10% enlargement from true size and can demonstrate the relationship between soft and hard tissue. In the present study, facial soft tissue thickness in Japanese children was measured at 12 anthropological points using X-ray cephalometry in order to establish a database for facial soft tissue thickness. This study of both boys and girls, aged from 6 to 18 years, follows a previous study of Japanese female children only, and focuses on facial soft tissue thickness in only one skeletal type. Sex differences in thickness of tissue were found from 12 years of age upwards. The study provides more detailed and accurate measurements than past reports of facial soft tissue thickness, and reveals the uniqueness of the Japanese child's facial profile.     

Suicide: a ten-year retrospective study

Suicide is a complex phenomenon associated with psychological, biological, and social factors, claiming approximately 30,000 lives each year in the United States. We retrospectively reviewed all cases referred to the Medical Examiners' Office/Forensic Pathology Section at the Medical University of South Carolina from January 1988 to December 1997. The cases of suicide totaled 678. All of the cases were analyzed as to age/race/sex, method of suicide, time of year, and toxicological results. Files were also reviewed to determine if the victim left behind a suicide note. The ages ranged from 12 to 94 years; males comprised 79.5% of the victims, and whites 78.3%. The male to female and white to black ratios were both 3.9:1. The most common methods were gunshot wounds, accounting for 64.6% of the cases. No correlation existed with time of year, and the number of cases was not increased around major holidays. The group of victims 65 years and older and the pediatric group under the age of 18 were also examined separately.     

基于CT扫描并图像重组青少年锁骨胸骨端骨龄数学模型

目的利用我国青少年锁骨胸骨端骨骺发育变化规律,探讨CT容积再现(volume rendering,VR)数据与生物学年龄的相关性,并建立推断骨龄的数学模型。方法通过对我国华东、华南地区684名15~25周岁青少年双侧锁骨胸骨端进行CT薄层扫描并VR三维图像重组,测量并计算双侧锁骨胸骨端骨骺最长径、干骺端最长径及其长度比、骨骺面积、干骺端面积及其面积比等数据,并建立骨龄推断的数学模型。再将50例训练样本代入数学模型,检验模型的准确性。结果左、右两侧骨骺与干骺端长度比、面积比在同一年龄组男女性间差异具有统计学意义(P0.05)。建立的数学模型表明锁骨胸骨端骨骼的发育规律与生物学年龄具有高度的相关性,所有模型的准确率都高于70.5%(±1.0岁)和82.5%(±1.5岁)。结论建立的骨龄数学模型的可操作性强、准确性较高。这不仅可与图谱法相互印证和支持,提高骨龄推断的准确性;同时,该方法对未来研究其他单一部位骨龄推断具有重要的意义。