International Journal of Legal Medicine

, Volume 133, Issue 3, pp 931–934 | Cite as

Technical note: utilization of 3D-rendering for CT evaluation of extremitas sternalis claviculae within medical age assessment practice

  • Ernst Rudolf
  • Josef Kramer
  • Ingomar Winkler
  • Andreas Schmeling
Short Communication


According to the acknowledged recommendations of the multidisciplinary “Study Group on Forensic Age Diagnostics,” the indicator “medial clavicular ossification” carries the potential of delivering decisive evidence to proof age majority “beyond reasonable doubt” regarding age-disputed individuals within legal procedures. Yet, sternoclavicular thin-slice computed tomography, representing its preferred imaging modality, not rarely exhibits peculiar morphologies of the site, sometimes difficult to understand from the usually obtained, axial sections together with coronal reformations. Because of that, we utilized 3D-rendering of acquired CT data in 224 cases with the purpose to gain additional visualization of certain questionable appearances. Concerning reliable classification of medial clavicular ossification in line with the typologies of Schmeling et al. and Kellinghaus et al., it is concluded that such means of illustration contribute to recognition of polygonal or irregular, epiphyseal formations including the not-assessable shape variant “multiple, medial, secondary ossification centres” and of calcification of the articular capsule.


Medical age assessment Medial clavicular ossification Sternoclavicular computed tomography 3D-rendering 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
  2. 2.
  3. 3.
    Eid M, De Cecco CN, Nance JW et al (2017) Cinematic rendering in CT: a novel, lifelike 3D visualization technique. Am J Roentgenol 209(2):370ff. CrossRefGoogle Scholar
  4. 4.
    EU-‘Asylum Procedure’ Directive 2013/32/EU (26.06.2013)Google Scholar
  5. 5.
    EU-‘Asylum Procedure’ Directive 2005/85/EC (01.12.2005)Google Scholar
  6. 6.
    EU-‘Qualification’ Directive 2011/95/EU (13.12.2011)Google Scholar
  7. 7.
    EU-‘Radiation Protection’ Directive 2013/59/EURATOM (05.12.2013)Google Scholar
  8. 8.
    EU-‘Radiation Protection’ Directive 97/43/EURATOM (30.06.1997)Google Scholar
  9. 9.
    Glemser PA, Engel K, Simons D et al (2018) A new approach for photorealistic visualization of rendered CT images. World Neurosurg 114:e283ff. CrossRefGoogle Scholar
  10. 10.
    Kellinghaus M, Schulz R, Vieth V et al (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124(4):321ff.
  11. 11.
    Kellinghaus M, Schulz R, Vieth V et al (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography. Int J Legal Med 124(2):149ff. CrossRefGoogle Scholar
  12. 12.
    Rudolf E (2016) Medical age assessment in the case of a “doubtful” claim to being an unaccompanied minor as set forth in Article 25 para 5 sentences one to three of the recast Asylum Procedures Directive 2013. The Establishment of Identity in the Migration Process. EMN-Conference Vienna: Accessed 15 Feb 2019
  13. 13.
    Rudolf E, Kramer J, Schmidt S et al (2018) Intraindividual incongruences of medially ossifying clavicles in borderline adults as seen from thin-slice CT-studies of 2,595 male persons. Int J Legal Med 132(2):629ff. CrossRefGoogle Scholar
  14. 14.
    Schmeling A, Dettmeyer R, Rudolf E et al (2016) Forensic age estimation: methods, certainty, and the law. Dtsch Arztebl Int 113(4):44ff. Google Scholar
  15. 15.
    Schmeling A, Grundmann C, Fuhrmann A et al (2008) Criteria for age estimation in living individuals. Int J Legal Med 122(6):457ff. CrossRefGoogle Scholar
  16. 16.
    Schmeling A, Schulz R, Reisinger W et al (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118(1):5ff. CrossRefGoogle Scholar
  17. 17.
    Wei H, Zhu GY, Lei W et al (2014) Correlation between age and the parameters of medial epiphysis and metaphysis of the clavicle using CT volume rendering images. Forensic Sci Int 244:316.e1ff. CrossRefGoogle Scholar
  18. 18.
    Wittschieber D, Schulz R, Pfeiffer H et al (2017) Systematic procedure for identifying the five main ossification stages of the medial clavicular epiphysis using computed tomography: a practical proposal for forensic age diagnostics. Int J Legal Med 131(1):217ff.
  19. 19.
    Wittschieber D, Schulz R, Vieth V et al (2014) Influence of the examiner’s qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography. Int J Legal Med 128(1):183ff. CrossRefGoogle Scholar
  20. 20.
    Wittschieber D, Schulz R, Vieth V et al (2014) The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study. Forensic Sci Med Pathol 10(2):163ff. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ernst Rudolf
    • 1
  • Josef Kramer
    • 2
  • Ingomar Winkler
    • 3
  • Andreas Schmeling
    • 4
  1. 1.Attnang-PuchheimAustria
  2. 2.Institute for CT and MRT DiagnosticsLinzAustria
  3. 3.JennersdorfAustria
  4. 4.Institute of Legal MedicineUniversity Hospital MünsterMünsterGermany

Personalised recommendations