The evidential value of developmental age imaging for assessing age of majority

AIM To consider the evidential value of developmental age images for identifying age of majority. METHODS The published literature on hand-wrist X-rays, MRI scans of the distal radius and orthopantomograms of the lower left third molar is considered in terms of the mean age of attainment of the adult appearance and the diagnostic test performance of the adult appearance to predict adult status, either administratively (under-17 football) or forensically. RESULTS The mean age of attainment of a mature hand-wrist X-ray is under 18 years and most individuals are mature before age 18. For the MRI wrist scan and the third molar the age of attainment is over 19 years and the adult appearance is an indicator of adulthood, while the immature appearance is uninformative about likely age. So MRI and third molars have high specificity, but low sensitivity. CONCLUSIONS Bone age assessed by hand-wrist X-ray is uninformative and should not be used. The adult appearance of MRI wrist scans and third molars provide evidence of being over-age, although there remains a small risk of minors being misclassified as adult. The immature appearance is uninformative about likely age and, overall, more than one third of assessments are wrong.