Age assessment in unaccompanied minors: assessing uniformity of protocols across Europe.

Age assessment of migrants is crucial, particularly for unaccompanied foreign minors, a population facing legal, social, and humanitarian challenges. Despite existing guidelines, there is no unified protocol in Europe for age assessment.The Forensic Anthropology Society of Europe (FASE) conducted a comprehensive questionnaire to understand age estimation practices in Europe. The questionnaire had sections focusing on the professional background of respondents, annual assessment numbers, requesting parties and reasons, types of examinations conducted (e.g., physical, radiological), followed protocols, age estimation methods, and questions on how age estimates are reported.The questionnaire's findings reveal extensive engagement of the forensic community in age assessment in the living, emphasizing multidisciplinary approaches. However, there seems to be an incomplete appreciation of AGFAD guidelines. Commonalities exist in examination methodologies and imaging tests. However, discrepancies emerged among respondents regarding sexual maturity assessment and reporting assessment results. Given the increasing importance of age assessment, especially for migrant child protection, the study stresses the need for a unified protocol across European countries. This can only be achieved if EU Member States wholeheartedly embrace the fundamental principles outlined in EU Directives and conduct medical age assessments aligned with recognized standards such as the AGFAD guidelines.

Digital pair-matching of iliac bones: pilot study on a three-dimensional approach with models acquired through stereophotogrammetry.

Three-dimensional (3D) pair-matching has brought about an innovative approach for the analysis of commingled skeletal remains, and it has been tested on bone models acquired through CT and laser scans. Here, 3D models of 40 innominate bones (20 left and 20 right) of 20 documented male individuals from a cemeterial skeletal collection were acquired through a stereophotogrammetric device (VECTRA M3, Canfield Scientific, Inc.). The ventral iliac surface was chosen as the anatomical region of interest (ROI) for the analysis. Each left ROI was mirrored and superimposed on the matching right ROI (contralateral element from the same individual) and mismatching ROIs (contralateral elements from different individuals). The point-to-point distance between models was calculated through the Vectra Analysis Module (VAM) software and the root mean square (RMS) point-to-point distance value was used to evaluate the sorting performance of the method, in terms of sensitivity and specificity rates. Differences in RMS between matches and mismatches were investigated through a Student's t test (p < 0.05). The state of preservation of the remains was assessed following an index of anatomical completeness and differences in RMS distances of true matches according to different anatomical completeness were assessed through the Mann-Whitney test (p < 0.05). RMS point-to-point distances of matches and mismatches were significantly different (p < 0.01), being the matches lower than mismatches. The RMS threshold of 2.9 mm identified all the true pairs; the test was 100% sensitive and 51% specific. The RMS of matches with a better state of preservation are significantly lower than the less preserved matches (p < 0.05). In general, a low RMS distance value may indicate a true match, being it to be further verified. The 3D approach for sorting innominate bones provides a valid screening test that could complete subjective and osteometric methods with numerical evidence of the match. Preliminary data suggest a possible relation between RMS distance values and taphonomic condition, which would benefit from further research.

The rights of migrants to the identification of their dead: an attempt at an identification strategy from Italy.

Europe is turning a blind eye on a humanitarian disaster unfolding at its doorsteps, with thousands of migrants dying unidentified in Mediterranean waters. Since 2014, Italy has been struggling in an almost indifferent international scenario to identify its dead migrants. Despite the lack of sufficient resources, of the difficulties in collecting post mortem data from the disseminated bodies, and of the problems of contacting and collecting ante mortem information from relatives, it has been proven, with a series of pilot studies, that not only can these bodies be identified but that relatives are also looking for their loved ones and need death certificates. This article focuses on the administrative limbo and lack of regulations obliging single states to engage in appropriate procedures to maximise identification.

Taphonomic study on drowned victims in a non-sequestered aquatic environment in the Mediterranean Sea.

Human decomposition in sea water poses several challenges to forensic practitioners tasked with the analysis of drowned bodies. Postmortem changes in the marine environment have not been extensively investigated and the current literature is mainly based on bodies retrieved from shallow waters or on limited samples. On 18 April 2015, a fishing boat carrying allegedly 1,000 migrants sank in the Mediterranean Sea. In a fifteen-month time span, humanitarian missions were carried out to recover the bodies from the sea. The present study investigates postmortem changes on the drowned victims in a non-sequestered environment in the Mediterranean Sea. A retrospective study was performed by two observers on the autopsy photographic records in the series of bodies recovered from the open sea. For 184 bodies, the postmortem changes were evaluated according to facial, body, limb, and total aquatic decomposition score (FADS, BADS, LADS, TADS, respectively). Furthermore, a modification to the current scoring system that divides upper and lower limbs was suggested. The interobserver agreement was assessed using Krippendorff's alpha coefficient. Possible relations between the decomposition scores and PMSI were investigated with Pearson correlation analysis. According to the sequence of the recovery missions, increasing FADS, BADS, LADS, and TADS were observed. The modified scoring system showed a strong agreement between observers, allowing a more accurate description of the actual extent of decomposition. The scores showed a significant relation with the PMSI (p < 0.01). Prolonged submersion in the open marine environment was confirmed to show increasing decomposition rates, from moderate decay to full disarticulation. This study provides a descriptive unicum of the postmortem changes in the open sea, which may contribute to strengthen the discipline and aid description of bodies recovered in similar circumstances, especially if a body needs to be associated to a disaster or period with respect to another, thus facilitating families or authorities in the search for specific victims.

Analysis of interrater reliability in age assessment of minors: how does expertise influence the evaluation?

Nowadays, the clinical forensic medical management of migration flows comprises the age assessment of unaccompanied minors. The process of age estimation is a fundamental pillar for legally ensuring the minors' rights and their protection needs. The procedure is complex and involves different phases and actors, from medical doctors to law enforcement officers. The present study aimed to investigate the performance of Greulich and Pyle, Demirjian, and Mincer methods when performed by raters both trained and without training. Also, the interrater reliability within groups of raters from different areas of expertise was evaluated. A total of 36 participants were enrolled for this study, divided in two groups according to their level of experience with age estimation methods. Each rater was asked to allocate stages and standards for age assessment, evaluating ten orthopantomograms and ten hand-wrist roentgenograms. The interrater reliability expressed through the Fleiss Kappa coefficient and the agreement with the reference standard were calculated. The results showed that none of the categories analyzed could reach a good interrater reliability (ĸ > 0.8) for both methods. The study results highlighted variation and disagreement in the interpretation of the sample among raters and in the subsequent stages and standards allocation. In conclusion, the results of this study highlight that expertise does influence the reliability of the most utilized methods of age estimation of living individuals and stress the importance of proper training and practice, which could greatly increase the accuracy of age assessments.

Does the choice of the reference model affect the results of 3D-3D superimposition procedure? A comparison of different protocols for personal identification.

In literature, 3D-3D superimposition has been widely recognized as a valid method for personal identification. However, very little information is available about possible variability due to differences in protocols of registration of 3D models and calculation of RMS (root mean square) point-to-point distance. Frontal sinuses from 50 CT scans were segmented twice through the ITK-SNAP software and grouped in two samples (1 and 2). Maximum breadth, height and volume were measured. 3D models belonging to the same subject were then superimposed one on each other in 50 matches. In addition, superimposition of 50 random mismatches was performed. For each superimposition, the procedure was repeated four times choosing different reference models both for registration and calculation of RMS. Differences in RMS value among protocols of registration and RMS calculation were assessed through paired Student's t-test (p < 0.05). Possible correlations between differences in RMS among groups and differences in frontal sinus size between the superimposed models were analysed through calculation of Pearson's correlation coefficient (p < 0.05). Results showed that RMS calculation did not yield significant differences according to which 3D model is used as reference; on the other hand, RMS values from registration procedure significantly differ according to which model is chosen as reference, but only in the mismatch group (p < 0.001). Differences in RMS value according to RMS calculation are dependent upon all the three measurements, whereas differences according to registration protocols were significantly related only with the breadth of frontal sinuses but only in mismatches (p < 0.001). In no case, superimpositions of RMS values were found between matches and mismatches. This article for the first time proves that the protocol of registration and calculation of RMS significantly influences the results of 3D-3D superimposition only in case of mismatches.

Exploring the potential of cranial non-metric traits as a tool for personal identification: the never-ending dilemma.

Forensic anthropologists tasked with identification of skeletal remains often have to set up new strategies to overcome the limitations of conventional individualizing markers. A sound acquaintance with non-metric traits is essential for a reliable distinction between normal variations and pathological or traumatic conditions, yet the role of cranial variants in the identification process is still somehow ill-defined. One hundred crania (50 males and 50 females) of known sex and age were selected from the Collezione Antropologica LABANOF (a documented contemporary skeletal collection) and non-metric traits were scored as present or absent and by side. The frequencies of 13 traits were used to calculate the compound probabilities to find an individual with an exact combination of cranial features in the worldwide population. The probabilities of the majority of the individuals (53%) are within the 1 out of 10 million-1 out of 1 million interval. However, a fair number of subjects (25%) of the sample have the probabilities falling into the 1 out of 1 billion-1 out of 100 million interval, while the probabilities of a small portion of the sample (10%) are less than 1 out of 1 billion. This pilot study illustrates that some combinations of cranial variants are quite rare and may represent potential evidence to discern presumptive identifications, when an appropriate set of traits is selected and antemortem data are available for comparison. However, further research on larger and various samples is needed to confirm or discard the use of combinations of cranial non-metric traits as individualizing markers.

Improving 3D-3D facial registration methods: potential role of three-dimensional models in personal identification of the living.

Personal identification of the living from video surveillance systems usually involves 2D images. However, the potentiality of three-dimensional facial models in gaining personal identification through 3D-3D comparison still needs to be verified. This study aims at testing the reliability of a protocol for 3D-3D registration of facial models, potentially useful for personal identification. Fifty male subjects aged between 18 and 45 years were randomly chosen from a database of 3D facial models acquired through stereophotogrammetry. For each subject, two acquisitions were available; the 3D models of faces were then registered onto other models belonging to the same and different individuals according to the least point-to-point distance on the entire facial surface, for a total of 50 matches and 50 mismatches. RMS value (root mean square) of point-to-point distance between the two models was then calculated through the VAM® software. Intra- and inter-observer errors were assessed through calculation of relative technical error of measurement (rTEM). Possible statistically significant differences between matches and mismatches were assessed through Mann-Whitney test (p < 0.05). Both for intra- and inter-observer repeatability rTEM was between 2.2 and 5.2%. Average RMS point-to-point distance was 0.50 ± 0.28 mm in matches, 2.62 ± 0.56 mm in mismatches (p < 0.01). An RMS threshold of 1.50 mm could distinguish matches and mismatches in 100% of cases. This study provides an improvement to existing 3D-3D superimposition methods and confirms the great advantages which may derive to personal identification of the living from 3D facial analysis.

Twenty-five years of unidentified bodies: an account from Milano, Italy.

The identification of decedents has always been a central issue in forensic pathology, for ethical, criminal, and administrative reasons, but today, it needs more attention due to issues related not only to migration but also to the weakening of family ties. This article presents a descriptive study discussing the Italian regulatory situation developed in the last decade to face the many identification issues, with all its improvements and flaws. Hence, data gathered in 25 years of at the Institute of Legal Medicine of Milan and the epidemiology of unidentified decedents are illustrated. Briefly, from 1995 to 2019, the number of unidentified human remains with no identity or requesting verification of identity amounts to 726, i.e., 3% circa of all autopsies performed at the Institute, with an average of 29 individuals per year. In total, 528 (72.7%) individuals were successfully identified, 100 (13.8%) remained without an identity, and 98 (13.5%) individuals remained with suspected yet unconfirmed identities. Percentages for each identification technique are displayed, with insight into the role of forensic anthropology and odontology compared to genetics, and into the misuse of non-scientific methods allowed by Public Prosecutors. All the data is compared, as much as possible, with the very few recent studies concerning the problem worldwide. Finally, the article aims to show the Italian experience in dealing with unidentified bodies, in order to provide food for thought for other countries toward a discussion regarding a global issue which is sometimes taken for granted and underestimated.

The potential of bone disease for personal identification: a case of tuberculosis.

In the forensic anthropology practice, bone diseases are rarely considered for personal identification. In this paper, we present a forensic skeletonized case with tuberculous bone lesions, for which bone pathology may provide an indicator for positive personal identification. Antemortem hospital records were available. Postmortem CT scans of the pathologically affected bones were performed, and 3D reconstructions with Global Illumination Reconstruction software (GIR) were realized, in order to confront antemortem and postmortem data. As a result, the juxtaposition and superimposition of antemortem and postmortem images evidenced several points of correspondence in the position, anatomical contour, character, and morphological characteristics of the bone lesions, thus demonstrating through a concrete case study the potential of morphological features of bone lesions for the personal identification of unknown deceased.

Three-dimensional analysis of sphenoid sinus uniqueness for assessing personal identification: a novel method based on 3D-3D superimposition.

Sphenoid sinuses are considered the most variable structures of human body: therefore, they may be used for personal identification, through the application of 3D segmentation procedures. This study aims at proposing a new protocol for personal identification based on 3D-3D superimposition of sphenoid sinuses segmented from head CT scans. Adult subjects (equally divided among males and females) who underwent two head CT scans were extracted from a hospital database. Sphenoid sinuses were segmented through ITK-SNAP software and the corresponding 3D models were automatically superimposed to obtain 40 matches (when they belonged to the same person) and 260 mismatches (when they were extracted from different individuals). The RMS (root mean square) point-to-point distance was then calculated for all the superimpositions: differences according to sex and group (matches and mismatches) were assessed through the Mann-Whitney test (p < 0.05). On average, the RMS value was almost ten times smaller in matches (0.22 ± 0.11 mm) than in mismatches (2.16 ± 0.57 mm) with a statistically significant difference according to group (p < 0.05), but not to sex (p > 0.05). The study proposed a new method for assessing personal identification from segmented 3D models of sphenoid sinuses, useful in the forensic contexts where other methods might not be implementable or successful.

An innovative 3D-3D superimposition for assessing anatomical uniqueness of frontal sinuses through segmentation on CT scans.

Anatomical uniqueness plays a significant role in the personal identification process of unknown deceased. Frontal sinuses have been widely used in the past decades for this purpose, mostly using 2D X-ray techniques. However, the modern 3D CT-based segmentation methods may help in developing novel and more reliable methods of identification. This study aims at assessing the anatomical uniqueness of frontal sinuses through the 3D model registration. Thirty subjects who underwent two maxillofacial CT scans (interval: 1 month to 5 years) were selected from a hospital database. Frontal sinuses were automatically segmented through ITK-SNAP open source software and the 3D models belonging to the same patient were automatically superimposed according to the least point-to-point difference between the two surfaces. Two hundred patients were randomly selected from the same database and undergo the same procedure to perform 200 superimpositions of frontal sinuses belonging to different individuals, equally divided between males and females (mismatches). Statistically significant differences of average root mean square (RMS) point-to-point distance between the group of matches and mismatches, as well as possible differences according to sex, were assessed through Mann-Whitney U test (p < 0.05). In the group of matches, RMS ranged between 0.07 and 0.96 mm (mean RMS 0.35 ± 0.23 mm), while in the group of mismatches, it ranged between 0.96 and 10.29 mm (mean RMS 2.59 ± 1.79 mm), with a statistically significant difference (p < 0.0001). Neither the matches nor the mismatches group showed statistically significant differences according to sex. This study proposes a novel 3D approach for the assessment of anatomical uniqueness of frontal sinuses, providing both morphological and quantitative analysis, and a new method of identification based on 3D assessment of frontal sinuses, applicable when ante-mortem CT scans are available.

Quantification of odontological differences of the upper first and second molar by 3D-3D superimposition: a novel method to assess anatomical matches.

PURPOSE: The introduction of modern 3D image acquisition systems has enabled researchers to develop novel procedures for personal identification. The present study aimed to assess differences between dental scans belonging to the same or different subjects, through an innovative 3D-3D superimposition and registration method. METHODS: Twelve subjects (6 males and 6 females) with pre- and post-orthodontic treatment dental casts were recruited. A 3D scan from each cast was obtained through a laser scanner and the 3D model of the upper first and second molar on the post-treatment cast was superimposed on the pre-treatment scan, for a total of 12 matches and 100 mismatches. Point-to-point RMS (root mean square) distance was then calculated. Student's t test verified possible statistically significant differences according to group (matches/mismatches; p < 0.05). RESULTS: In case of matches, on average the point-to-point distance RMS was 0.29 mm (SD: 0.08 mm), while it was 0.94 mm (SD: 0.30 mm) for mismatches, with a statistically significant difference (p < 0.001). CONCLUSIONS: Results show that the novel procedure was able to distinguish matches from mismatches through an RMS threshold (0.50 mm): a possible method for personal identification is described, which needs to be verified through the application to a larger sample of casts.

Application of 3D models of palatal rugae to personal identification: hints at identification from 3D-3D superimposition techniques.

Palatal rugae are known in literature as individualizing anatomical structures with a strong potential for personal identification. However, a 3D assessment of their uniqueness has not yet been performed. The present study aims at verifying the uniqueness of 3D models of the palate. Twenty-six subjects were recruited among the orthodontic patients of a private dental office; from every patient, at least two dental casts were taken in different time periods, for a total of 62 casts. Dental casts were digitized by a 3D laser scanner (iSeries, Dental Wings©, Montreal, Canada). The palatal area was identified, and a series of 250 superimpositions was then performed automatically through VAM©software in order to reach the minimum point-to point distance between two models. In 36 matches the models belonged to the same individual, whereas in 214 mismatches they came from different subjects. The RMS (root mean square) of point-to-point distances was then calculated by 3D software. Possible statistically significant differences were assessed through Mann-Whitney test (p < 0.05). Results showed a statistically significant difference in RMS mean point-to-point distance between matches (mean 0.26 mm; SD 0.12) and mismatches (mean 1.30; SD 0.44) (p < 0.0001).All matches reached an RMS value below 0.50 mm. This study first provided an assessment of uniqueness of palatal rugae, based on their anatomical 3D conformations, with consequent applications to personal identification.

Analysis of metallic medical devices after cremation: The importance in identification.

The recovery of a charred cadaver raises many issues concerning personal identification; the presence of prosthetic materials may provide very important and decisive information. Who is involved in the recovery of a charred body or of burnt human fragments, should therefore be able to recognize medical devices even if modified by fire effects. Metallic residues (585kg) that came from 2785 cremations were studied. Medical devices were then divided by type and material in order to esteem the representativeness of each typology. The study illustrates the great presence of metal medical devices that could be of great help in identifying bodies and underlines that metallic medical devices types and morphology should be known by forensic practitioner involved in identification cases and that this kind of material can still be identified by physician and dentists, even if exposed to very high temperatures.

Dental Age Estimation Helps Create a New Identity.

Age estimation involves the reconstruction of age by biological parameters such as skeletal and dental development in minors, or reduction of pulp chamber in adults, to gain indications concerning the chronological age of the person. In most cases, it is needed in forensic scenarios to verify if the supposed age of an individual is correct; in exceptional cases, age estimation is instead required by judicial authorities to create a new identity usually in persons who do not remember who they are.This article aims at reporting the case of J. who was found in 2005 with signs of amnesia because he did not remember his name and age. After several unsuccessful attempts at identifying him, the judicial authority decided to assign a new identity, which was to be constructed according to the real biological data of the individual. The help of a forensic pathologist and a forensic odontologist was then requested, and age estimation was reached by applying methods for adults based on the physiological reduction of pulp chamber. Dental age estimation yielded a final result of approximately 31 years, which was the new age assigned to the person.This article shows a peculiar application of dental age estimation, which can be used not only to ascertain or deny supposed age, but is sometimes needed to create a new identity.

Age estimation from canine volumes.

Techniques for estimation of biological age are constantly evolving and are finding daily application in the forensic radiology field in cases concerning the estimation of the chronological age of a corpse in order to reconstruct the biological profile, or of a living subject, for example in cases of immigration of people without identity papers from a civil registry. The deposition of teeth secondary dentine and consequent decrease of pulp chamber in size are well known as aging phenomena, and they have been applied to the forensic context by the development of age estimation procedures, such as Kvaal-Solheim and Cameriere methods. The present study takes into consideration canines pulp chamber volume related to the entire teeth volume, with the aim of proposing new regression formulae for age estimation using 91 cone beam computerized scans and a freeware open-source software, in order to permit affordable reproducibility of volumes calculation.

Assessment of Anatomical Uniqueness of Maxillary Sinuses through 3D-3D Superimposition: An Additional Help to Personal Identification.

Paranasal sinuses represent one of the most individualizing structures of the human body and some of them have been already analyzed for possible applications to personal identification, such as the frontal and sphenoid sinuses. This study explores the application of 3D-3D superimposition to maxillary sinuses in personal identification. One hundred head CT-scans of adult subjects (equally divided among males and females) were extracted from a hospital database. Maxillary sinuses were segmented twice from each subject through ITK-SNAP software and the correspondent 3D models were automatically superimposed to obtain 100 matches (when they belonged to the same person) and 100 mismatches (when they were extracted from different individuals), both from the right and left side. Average RMS (root mean square) point-to-point distance was then calculated for all the superimpositions; differences according to sex, side, and group (matches and mismatches) were assessed through three-way ANOVA test (p < 0.017). On average, RMS values were lower in matches (0.26 ± 0.19 mm in males, 0.24 ± 0.18 mm in females) than in mismatches (2.44 ± 0.87 mm in males, 2.20 ± 0.73 mm in females) with a significant difference (p < 0.001). No significant differences were found according to sex or side (p > 0.017). The study verified the potential of maxillary sinuses as reliable anatomical structures for personal identification in the forensic context.

Rumor has it: A narrative review on the use of skeletal non-metric traits and variants for personal identification.

The human skeleton displays an immense array of traits and variant features that are elements of inter-individual variability. The general assumption is that they may represent individualizing markers for the personal identification of unidentified decedents, but very few works consider them as such. This review provides an overview on the possible use of non-metric traits and skeletal variants for personal identification. The paper discusses the issues related to unquantified comparisons, then it presents a statistical approach based on frequencies of these features for identifying unknown remains. Narrowing down an initial number of 1000 papers, the core of the review is represented by 10 papers that considered non-metric traits and skeletal variants as individualizing features, according to both qualitative and quantitative assessments. Despite visual examination remains the gold-standard, more sound methods are requested to quantify the strength of a match or a mismatch. This especially applies in the wake of juridical demands, hence also satisfying the desire of prosecutors and judges to rely on a "quantified" risk. To this purpose, non-metric traits and skeletal variants seem to be a suitable tool to provide quantified evidence, when related frequencies are known.

Physical assessment of tortures: Interobserver analysis of medico-legal degrees of consistency based on the Istanbul protocol.

The Istanbul Protocol section on medicolegal evaluation delineates the guidelines for the correct management of the physical examination and the methods of assigning the degrees of consistency. Considering that most cases exhibit highly heterogeneous lesions, the examiner is forced to rely on his own experience, and their evaluation may be very subjective. The purpose of this work is to understand how subjective such an evaluation may be and whether the "experience" factor, interpreted as years dedicated to this profession and the number of cases evaluated, is statistically significant. To this end, a survey containing eleven cases of pre-evaluated asylum seekers was sent to thirty Italian clinical forensic practitioners. The participants were invited to assign a degree of consistency to each case according to the Istanbul Protocol guidelines, besides answering a few questions regarding their professional record. The doctors were divided into groups based on the number of cases evaluated and the experience collected expressed in years, and then interobserver analysis was performed. Results showed that the Fleiss' Kappa coefficient acquired significant values when attention was turned to the sub-samples composed of more experienced participants. Therefore, the introduction of appropriately trained health professionals - "experts in migrations and torture" - could lower the risks of misinterpretation and make the assessment as reproducible as possible.