Comparison of the hand and the wrist x-ray images of Turkish children aged 10-19 years who apply to Karadeniz Technical University Farabi Hospital with gilsanz-ratib digital atlas in terms of bone age determination

Introduction and Objective: Age determination is encountered in forensic medicine practices and in many areas of our social life. Forensic age determination is required in order to determine the age limits that is related to criminal responsibility, especially at 12, 15 and 18 years. The most important phase of forensic age determination is "bone age" in practice and it is determined mostly by radiological methods, most commonly by X-ray visualization of the wrist. There are many hand-wrist atlases created for the determination of bone age. The most well-known and used one in the world is the Greulich-Pyle (GP) atlas, which was created in 1959. In this research (published in 2005), The Gilsanz-Ratib (GR) atlas that used in the same methodology as the GP atlas, containing digital reference images, and easy to access and use, was preferred. The research is based on the comparison of hand-wrist radiographs of children with chronological age between 10-19, who were admitted to our hospital mostly because of hand-wrist trauma, with GR atlas reference images by 3 experienced doctors. In this way, in terms of age determination, it is aimed to determine the usability of the GR atlas for forensic age determination according to age groups, create reference images from the examined x-ray images and support the juridical inquiries carried out in our country, especially in our region. Material and Method: The research is retrospective, cross-sectional, descriptive. X-ray images of the hand and wrist (taken due to trauma, etc.) that may be suitable for bone age determination of children aged 10-19 registered in the PACS system, who applied to KTU Medical Faculty Farabi Hospital between 2012-2022 and it was examined by 3 observer doctors, one of whom is a forensic medicine research assistant, one is an orthopedic specialist, and one is a radiology specialist. Results: In the research, 1545 cases were evaluated, and the study was continued on 1147 cases who met the criteria. In the 1147 cases, 778 (67.8%) were boys and 369 (32.2%) were girls. Bone age according to the GR atlas was 0.57 (years) ahead of the chronological age for boys and 0.84 (years) for girls, on the general average for ages 10-17. According to the GR atlas, the similarity rate of average bone age and chronological age for 10-17 years old was 27% in boys and 25% in girls. It was found that the GR atlas can be used to estimate age for 14 years for boys and 10 years for girls and also comparison of the hand-wrist radiographs of the same people taken one or several years after the interval, it was found that the GR atlas succeeded in reflecting the progression in chronological age to bone age at a rate of 58%. Conclusion: Although bone age determination atlas is more useful in some age groups according to Gilsanz Ratib, conclusions are not sufficient alone for forensic age determination and should be used carefully for all ages by experienced doctors. In addition, as a result of our study, hand-wrist reference images were constituted that can be used in the determination of bone age. Keywords: Age determination, bone age, The Gilsanz Ratib Atlas, Forensic Medicine