J Korean Med Sci.  2016 Oct;31(10):1538-1545. 10.3346/jkms.2016.31.10.1538.

Ossification of the Medial Clavicular Epiphysis on Chest Radiographs: Utility and Diagnostic Accuracy in Identifying Korean Adolescents and Young Adults under the Age of Majority

  • 1Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 2Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
  • 3Inter-disciplinary Program in Medical Informatics, Seoul National University College of Medicine, Seoul, Korea.
  • 4Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 5Medical Examiner's Office, National Forensic Service, Wonju, Korea.
  • 6Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea. yoosh@snu.ac.kr


The aim of our study was to evaluate the utility and diagnostic accuracy of the ossification grade of medial clavicular epiphysis on chest radiographs for identifying Korean adolescents and young adults under the age of majority. Overall, 1,151 patients (age, 16-30) without any systemic disease and who underwent chest radiography were included for ossification grading. Two radiologists independently classified the ossification of the medial clavicular epiphysis from chest radiographs into five grades. The age distribution and inter-observer agreement on the ossification grade were assessed. The diagnostic accuracy of the averaged ossification grades for determining whether the patient is under the age of majority was analyzed by using receiver operating characteristic (ROC) curves. Two separate inexperienced radiologists assessed the ossification grade in a subgroup of the patients after reviewing the detailed descriptions and image atlases developed for ossification grading. The median value of the ossification grades increased with increasing age (from 16 to 30 years), and the trend was best fitted by a quadratic function (R-square, 0.978). The inter-observer agreements on the ossification grade were 0.420 (right) and 0.404 (left). The area under the ROC curve (AUC) was 0.922 (95% CI, 0.902-0.942). The averaged ossification scores of 2.62 and 4.37 provided 95% specificity for a person < 19 years of age and a person ≥ 19 years of age, respectively. A preliminary assessment by inexperienced radiologists resulted in an AUC of 0.860 (95% CI, 0.740-0.981). The age of majority in Korean adolescents and young adults can be estimated using chest radiographs.


Age Estimation; Age of Majority; Clavicle; Epiphysis; Ossification; Radiograph; Diagnostic Accuracy

MeSH Terms

Age Determination by Skeleton/standards
Area Under Curve
Asian Continental Ancestry Group
Clavicle/*diagnostic imaging
Epiphyses/anatomy & histology/*diagnostic imaging
ROC Curve
Radiography, Thoracic
Reference Values
Republic of Korea
Young Adult
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