How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update

Possible biological side effects of exposure to X-rays are stochastic effects such as carcinogenesis and genetic alterations. In recent years, a number of new studies have been published about the special cancer risk that children may suffer from diagnostic X-rays. Children and adolescents who constitute many of the probands in forensic age-estimation proceedings are considerably more sensitive to the carcinogenic risks of ionizing radiation than adults. Established doses for X-ray examinations in forensic age estimations vary from less than 0.1 mu Sv (left hand X-ray) up to more than 800 mu Sv (computed tomography). Computed tomography in children, as a relatively high-dose procedure, is of particular interest because the doses involved are near to the lower limit of the doses observed and analyzed in A-bombing survivor studies. From these studies, direct epidemiological data exist concerning the lifetime cancer risk. Since there is no medical indication for forensic age examinations, it should be stressed that only safe methods are generally acceptable. This paper reviews current knowledge on cancer risks associated with diagnostic radiation and aims to help forensic experts, dentists, and pediatricians evaluate the risk from radiation when using X-rays in age-estimation procedures.