No Medical Indication

It is to be welcomed that the authors correctly use the term age “estimate,” rather than “determination,” for the result of their age assessment efforts (1). Furthermore, we notice the admission that the X-ray investigations in the context of forensic age estimation are undertaken without medical indication. This means that the central demand of the German X-Ray Ordinance—the justifying indication requires the statement that the health benefits of the use in humans outweighs the risk posed by radiation (§ 23, 1 RöV)—is not met. In order to make possible the use of X-rays in spite of this, “a requirement for a legal basis for authorization” is described in the article. The relevant case-law is extraordinarily controversial. To refer to an alleged “benefit for the general public” is a questionable construct, which is not covered by our medical professional code. Under no circumstances should we delegate our very own medical responsibility for using ionizing radiation to judges who lack the specialist expertise. The use of X-rays is not as harmless as described. Comparisons with the natural effective dose or even with everyday risks, such as participation in road traffic, lead us nowhere. Background radiation as a pathogenic factor is by no means trivial (2). Additional radiation exposure should be avoided wherever possible, especially in children and adolescents (“minimization requirement,” [§ 25, 2 RöV]).

Studies from all over the world have shown that computed tomography scanning in childhood and adolescence results in an increased risk for certain cancers, especially leukemia (3); increased rates of thyroid cancer have been described after dental X-ray examinations (4).

X-rays should not be used in the context of forensic age estimation; they are dangerous, have no medical indication, and cannot provide any answer to the crucial question “younger or older than 18.”