CT of the medial clavicular epiphysis for forensic age estimation: hands up?

Purpose: The aim of this study was to assess the impact of arm position in computed tomography (CT) of the clavicle performed for forensic age estimation on clavicular position, image noise, and radiation dose.
Methods and Materials: Forty-seven CT scans of the medial clavicular epiphysis performed for forensic age estimation were conducted with either hands and arms held upwards (CT _HU, 28 persons) or positioned at the body (CT _HD , 19 persons). Presets were identical for both positions (70 mAs/140 kVp; Brilliance iCT, Philips). Each CT scan was reconstructed with an iterative algorithm (i-Dose 4) and evaluated at the middle of the sternoclavicular joint. Clavicular angle was measured on a.p. topograms in relation to a horizontal line. Quantitative image noise was measured in air at the level of medial clavicular epiphysis. Effective dose and scan length were recorded.
Results: Hands-up position compared with hands-down position resulted in a lower lateral body diameter (CT _HU 41.1 ± 3.6 cm vs. CT _HD 44.6 ± 3.1 cm; P = 0.03), a reduced quantitative image noise (CT _HU : 39.5 ± 9.2; CT _HD : 46.2 ± 8.3; P = 0.02), and lower CTDI _vol (5.1 ± 1.4 mGy vs. 6.7 ± 1.8 mGy; P = 0.001). Scan length was longer in patients examined with hands up (HU: 8.5 ± 3.4 cm; HD: 6.2 ± 2.1 cm; P = 0.006). Mean effective dose for CT _HU was 0.79 ± 0.32 mSv compared with 0.95 ± 0.38 mSv in CT _HD (P = 0.12). Clavicular angle was 17° ± 6° in patients with hands down and 32° ± 7° in patients with hands up (P < 0.001).
Conclusion: By elevated arm positioning, the image quality of clavicular CT scans can be improved while maintaining radiation dose compared with hands down. Clavicular position differs according to the hand position. Thus, positioning patients with elevated hands is advisable for forensic clavicular CT examinations, but multiplanar CT reconstructions should be adjusted to clavicular position and scan length should be reduced to a minimum.