Dispute over clavicle scans affects asylum-seekers

A Dutch court has overruled the opinions of two of the Netherlands' leading pediatric radiologists and authorized continued use of a controversial technique that uses x-rays of the clavicle to determine the age of young immigrants.

The ground-breaking decision allows the IND, the Dutch naturalization and immigration service, to continue using the method to identify and deport young refugees older than 18, who do not qualify for political asylum.

Many countries use x-rays of the hand and wrist as part of the process for settling disputes over the age of immigrants with no documentary proof. In 1998, Dutch authorities began testing an experimental technique based on x-rays of the epiphysis of the medial clavicle, the last site of growth-plate closure in the human body.

Some radiologists and human rights organizations, including the Dutch Refugee Council, have questioned the validity of the method. A case was brought before a panel of three judges in the district court of Arnhem in August on behalf of two young male asylum-seekers from Togo in West Africa. The panel announced in October its decision to allow the IND to continue using the technique.

The IND called Prof. Koenraad Verstraete, a radiologist at University Hospital in Gent, Belgium, as an expert witness. He claims the technique is reliable because the earliest age at which there is fusion of clavicle head and shaft in humans is 20. Any asylum applicant presenting with fused clavicle would certainly be older than the 18-year maximum.

"The issue in this case was whether it is possible to distinguish between a clavicle with and without a fused head, and if there is a projection in which it is likely that a radiologist could mistake a partially fused bone for one in which the growth plate is fully closed," Verstraete said.

Prof. Johan Blickman, chair of radiology at the University of Nijmegen, disputes the reliability of the clavicular ossification technique. He was called as an expert witness by lawyers representing the two young Togolese.

"The whole basis of my argument was that there have been no rigorous scientific studies to support the use of this technique in the live human body. You can only use this method if you have an atlas like the one that has been put together for the hand and wrist, but we don't," Blickman said.

His comments echo those of fellow pediatric radiologist Dr. Simon Robben of Maastricht University Hospital.

"There is no frame of reference in the medical literature for determining if someone's collarbone is fully mature. Conclusions are being drawn too quickly and easily by radiologists on the basis of subjective assessments," Robben said.

Blickman, who spent 27 years working in the U.S., most recently at Massachusetts General Hospital, has extensive experience in forensic radiology in immigration cases. He is indignant about the way the Arnhem court has handled the case.

"It is a travesty that expert opinion was dealt with in this manner by the judges," he said. "The scientific aspects of the case have been ignored."

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