Journal of Forensic and Legal Medicine 63 (2019) 11–17

Contents lists available at ScienceDirect

Journal of Forensic and Legal Medicine

journal homepage: www.elsevier.com/locate/yjflm

Research Paper

Accuracy and reliability of virtual femur measurement from CT scan T

a,b c d
Normaizatul Afizah Ismail , Nurliza Abdullah , Mohamad Helmee Mohamad Noor ,
Poh Soon Laic, Mohamed Swarhib Shafieb, Faridah Mohd Norb,∗
a
Kulliyyah of Medicine and Health Sciences, Universiti Islam Antarabangsa Sultan Abdul Halim Mu'adzam Shah, 09300, Kedah, Malaysia
b
Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
c
National Institute of Forensic Medicine, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
d
Radiology Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia

ARTICLE INFO ABSTRACT

Keywords: Background: In the application of scientific human skeletal variation in medico-legal matters, virtual anthro-
Virtual method pology is the current technique performed to examine skeleton and its body parts. Hence, this study was con-
Forensic anthropology ducted to assess the accuracy and reliability of virtual femur measurement through intra and inter-observer error
Bone analysis, and comparison was made between the virtual and conventional methods.
Malaysia
Methods: A total of 15 femora were examined with four parameters i.e. maximum length of femur (FeMl),
Forensic
diameter of femoral head (FeHd), transverse diameter of midshaft (FeMd) and condylar breadth (FeCb).
Osteometric board and vernier calipers were employed for the conventional method, while CT reconstructed
images and Osirix MD software was utilised for the virtual method.
Results: Results exhibited that there were no significant differences in the measurements by conventional and
virtual methods. There were also no significant differences in the measurements by the intra or inter-observer
error analyses. The intraclass correlation coefficients (ICC) were more than 0.95 by both intra and inter-observer
error analyses. Technical error of measurement had displayed values within the acceptable ranges (rTEM < 0.08
for intra-observer, < 2.25 for inter-observer), and coefficient of reliability (R) indicated small measurement
errors (R > 0.95 for intra-observer, R > 0.92 for inter-observer). By parameters, FeMl showed the highest R
value (0.99) with the least error in different methods and observers (rTEM = 0.02–0.41%). Bland and Altman
plots revealed points scattered close to zero indicating perfect agreement by both virtual and conventional
methods. The mean differences for FeMl, FeHd, FeMd and FeCb measurements were 0.01 cm, −0.01 cm, 0.02 cm
and 0.01 cm, respectively.
Conclusion: This brought to suggest that bone measurement by virtual method was highly accurate and reliable
as in the conventional method. It is recommended for implementation in the future anthropological studies
especially in countries with limited skeletal collection.

1. Background In Malaysia, virtual autopsy was introduced in 2010 by the Ministry

Virtual anthropology is a new term coined by researchers, high-
lighting the importance of skeletal imaging technique as a tool to assist
in the investigation of forensic anthropology cases.1–4 The field of vir-
tual anthropology has emerged from the routine application of multi-
detector computed tomography (MDCT) in forensic medicine and for-
ensic anthropology in the mid-1990s.3–6 Recently, CT has been used
routinely in several medico-legal institutions across the world, where
forensic anthropologists are regularly being exposed to post-mortem CT
scan.7–9
of Health to the National Institute of Forensic Medicine, Hospital Kuala
Lumpur for a trial research project in assessing the effectiveness of
virtual autopsy. With the trial project, all post-mortem computed to-
mography (PMCT) images of forensic cases were kept as virtual records.
This has become a great source for further researches in the field of
anthropology. Since skeletal collection in Malaysia is very limited due
to law practices and religious restrictions, research in anthropology has
remained inactive. It is hoped that virtual bone images will become an
alternative method, and more research can be conducted, particularly
on virtual bone measurements.

∗
Corresponding author. Pathology Department, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala
Lumpur, Malaysia.
E-mail address: faridah.nor@ukm.edu.my (F.M. Nor).

https://doi.org/10.1016/j.jflm.2019.02.010
Received 19 September 2018; Received in revised form 9 February 2019; Accepted 15 February 2019
Available online 21 February 2019
1752-928X/ © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
N.A. Ismail, et al.
Practice on anthropological bone measurement was done by the
conventional methods i.e. osteometric board and calipers, which is the
gold standard in forensic anthropology. However, the introduction of
multi-detected computed tomography (MDCT) in forensic service had
inevitably offered an alternative in bone measurements. The introduc-
tion of MDCT has allowed a significant improvement in three dimen-
sional (3D) image resolution, which can be visualized on dedicated
software in x, y and z planes. The benefit is great, and studies are done
to explore its full potential. As the result, researchers had resorted to
radiological method to conduct bone measurements on CT images.10–18
Previously, in order to quantitatively assess the accuracy of the
existing anthropological methods and/or to formulate new standards,
human bone collections were accessed; however, with the availability
of large digital samples, this requirement is to be abolished.2 Introdu-
cing a new method (virtual measurement) over the current method
(conventional measurement) requires a series of test on accuracy and
reliability,19,20 and this is important to ensure that these measurements
would produce the same result. Accuracy is the term used to express
deviation of measurement from its true value, while reliability is the
degree of variation in repeated measures, which is also known as pre-
cision.21–24 If the measurements of both methods are accurate and re-
liable, the new method may replace the established method. In this
case, the virtual method is preferable as it is non-invasive, and will
solve the issue of scarce bone collection.
It is the aim of this study to assess the accuracy and reliability of
femur measurements by virtual method and conventional methods.
Intra- and inter-observational error analyses were important evalua-
tions in this study. The results of this pilot study will set a new direction
to future researches in virtual anthropology in Malaysia.
2. Materials and methods
A pilot study was conducted on 15 femora, which was intact and
free from deformities, trauma or diseases. The samples were taken from
multitude of bone collections with unknown identity from the National
Institute of Forensic Medicine (IPFN). The femora were scanned by
PMCT using TOSHIBA Aquilion 64 CT Scanner (Toshiba Medical
System, Japan), with detector collimation of 1 mm, pitch 0f 0.844. The
exposure setting for tube voltage was 120 kVp with automatic exposure
control for tube current and FOV of 320 mm. All images were re-
constructed with 2.0 mm thickness and slice interval of 1.6 mm. Prior to
the study, ethical approval was obtained from the Institutional Ethics
Committee of the University.
Observers in this study were selected based on their skill and ex-
perience level. One observer was an anthropological expert (Observer
A), another observer was well-trained in bone measurement (Observer
B), while the third observer was a novice (Observers C). For inter-ob-
server error analysis, measurements by the conventional method were
performed by Observer A and B, whilst measurements on virtual
method were performed by Observer B and C. Each observer for intra-
observer error analysis replicated the measurements twice on two dif-
ferent days, and an average was taken in centimetre (cm).
In conventional method, measurements were taken by osteometric
board (WARD’S Forensics, with a precision of 0.1 cm) and vernier ca-
lipers (TED PELLA, INC, with a precision of 0.01 cm). In virtual method,
measurements were taken by a digital ruler in Osirix MD (precision of
0.01 cm). The OsiriX MD V.8.5 was installed in a 27-inch iMac com-
puter, and measurements were performed on 3D volume rendering
images.
The parameters were maximum length of femur (FeMl), diameter of
femoral head (FeHd), transverse diameter of midshaft (FeMd) and
condylar breadth (FeCb). Definitions of all the landmarks were de-
scribed (Table 1). Illustrations of parameters in both conventional and
virtual methods were given (Figs. 1 and 2).
12
Journal of Forensic and Legal Medicine 63 (2019) 11–17
2.1. Statistical analysis
Normality of the study sample was performed by the Shapiro-Wilk's
test as the sample size was small (n = 15) and the data were analysed
by SPSS v. 23.0 and Excel, Microsoft Office 2013. The intra and inter-
observer differences were analysed by paired t-test and ANOVA in GLM
(General Linear Model). The absolute differences between two sets of
measurements were calculated to obtain maximum absolute difference.
In assessing the reliability of measurements for intra and inter-observer
error, the intraclass correlation coefficient (ICC) was performed, and
the Bland and Altman plot was generated for inter-method measure-
ments. In ICC, correlation coefficient was obtained to demonstrate the
strength of the relationship (similarities) between two measurements.
The value for reliability coefficient ranges from 0 to 1. A coefficient
value below 0 indicates ‘no reliability’, > 0 to < 0.2 is slight reliability,
0.2 - < 0.4 is fair reliability, 0.4 - < 0.6 is moderate, 0.6 - < 0.8 is
substantial, while 0.8–1.0 is almost perfect reliability.25
The Bland and Altman plots were used to provide an illustration of
the spread of differences in measurements, mean difference and upper
and lower limits of agreement to compare between the virtual and
conventional measurements. The Bland and Altman plot is a method
comparison technique, and the averages of two measurements are
plotted along the horizontal axis, and the differences between two
methods are plotted along the vertical axis. There is no such ‘accep-
table’ range for Bland and Altman plots. If each measurement method
produces accurate measurements, the only difference between the
means would be due to random error, and any systematic difference is
called the bias. The bias between two methods is measured by taking
the mean difference of values. The upper and lower limit of agreement
is calculated by using Equations (1) and (2) as follows:
Upper limit of agreement = + 1.96 x SD (1)
Lower limit of agreement = + 1.96 x SD (2)
The assessment of accuracy for intra and inter-observer was ana-
lysed by technical error of measurements (TEM), relative TEM (rTEM)
and coefficient of reliability (R). The TEM is an accuracy index, which
calculates standard deviation between repeated measures. The lower
the TEM value, the higher the reliability of the results. The coefficient of
reliability (R) ranges from 0 (not reliable) to 1 (completely reliability),
and R value above 0.95 is indicative of negligible errors.23 The standard
of ‘acceptable measurement error’ varies depending on the magnitude
of the effect one is testing. In anthropological measurements, any
measurement with an R value below 0.90 should be treated with due
caution, especially if the associated rTEM is more than 5%.26
The formulas for TEM calculation are shown in Equations (3)–(5).
26,27
In equation (3), absolute TEM will be generated, where the Σd2 is
the summation of deviations raised to the power of two, and n is the
number of samples. Then, the absolute TEM is transformed into relative
TEM (using Equation (4)) in order to obtain the percentage of error
corresponding to the total variable average value (VAV). The VAV is
obtained by summing up the average for both sets of measurements,
and divided by two. In Equation (4), rTEM is the relative technical error
of measurement expressed in percentage, and VAV is the variable
average value. In order to get the R value, Equation (5) is used, where R
is the coefficient of reliability, TEM is the technical error of measure-
ment, and SD is the standard deviation.
d²
TEM =
2n (3)
rTEM (%) =
TEM
x 100
VAV (4)
(TEM ) 2
R=1
SD 2 (5)
N.A. Ismail, et al. Journal of Forensic and Legal Medicine 63 (2019) 11–17

Table 1
Definition of landmarks for all parameters.
Label Parameters Definition of landmarks

FeMl Maximum length of femur Distance from the most superior point on the head of femur to the most inferior point on the distal condyles.
FeHd Maximum diameter of femoral head The maximum diameter of femoral head, wherever it occurs.
FeMd Transverse diameter of midshaft Distance between the medial and lateral surfaces of midshaft of femur.
FeCb Condylar breadth Distance between the two most laterally projecting points on the two condyles of femur.

Table 2
Descriptive statistics for all parameters in conventional and virtual methods.
Parameters Conventional Method Virtual Method

Observer A Observer B Observer B Observer C

FeMl Min 41.70 41.70 41.72 41.67

Max 47.70 47.70 47.73 47.71
Mean 43.50 43.47 43.48 43.42
SD 1.63 1.63 1.63 1.66
FeHd Min 3.70 3.72 3.69 3.63
Max 5.00 5.02 5.02 4.90
Mean 4.31 4.33 4.32 4.27
SD 0.36 0.37 0.37 0.35
FeMd Min 2.10 2.08 2.12 2.15
Max 2.80 2.86 2.82 2.96
Mean 2.44 2.43 2.45 2.48
SD 0.19 0.19 0.18 0.19
FeCb Min 6.70 6.72 6.68 6.66
Max 8.80 8.83 8.83 8.84
Mean 7.75 7.78 7.78 7.79
SD 0.55 0.54 0.55 0.52

Fig. 1. The parameters as measured by the conventional method. *FeMl - maximum length of femur, FeHd - maximum diameter of femoral head,
FeMd - transverse diameter of midshaft, FeCb - condylar breadth, min–
minimum, max – maximum, SD− standard deviation.

significant difference in the measurements between different observers

and methods.

3.2. Interclass correlation coefficient

The maximum absolute difference of measurement in intra and

inter-observer error analyses were calculated for each parameter
(Table 3). The highest absolute difference was observed in the inter-
observer error analysis for the virtual method (FeMl = 0.96 cm). The
intraclass coefficients (ICC) for all parameters were mostly above 0.95,
with CI mostly more than 0.94 suggesting a strong correlation between
measurements within the same observer and between observers,
pointing to a high degree of reliability between the observers in their
measurements.

3.3. Technical Error Measurement and reliability test

Fig. 2. The parameters as measured by the virtual method.
3. Results
3.1. Descriptive statistics
The data were normally distributed for all parameters (FeMl, FeHd,
FeMd, FeCb) by Shapiro-Wilk's test (p > 0.05). The descriptive statis-
tics for all parameters were tabulated separately for each observer using
the average values (Table 2). Overall, the measurements by Observer C
were slightly deviated from measurements by the other observers. The
intra-observer error analysis was further analysed by paired t-test, and
the results showed no significant difference in both methods
(p > 0.05). The inter-observer error analysis was performed by
ANOVA in general linear model (GLM), and results showed no
The accuracy of measurements was assessed by ‘Technical Error
Measurement’ (TEM) (Table 4). The rTEM for intra-observer error
analysis was below 0.08%, which indicated negligible error. By inter-
observer error analysis, similar findings were observed in rTEM, where
most values were below 2.25%, which were highly reliable (R > 0.92).
Of all parameters, FeMl showed the least error by different methods and
observers (rTEM ranging from 0.02 to 0.41%) and the highest R value
(0.99).
3.4. Bland and Altman plots
Bland and Altman plots were presented for all parameters to com-
pare measurements made by the virtual and conventional methods
(Fig. 3). The plots showed that the measurement difference were all
within the upper and lower limits of agreement. The FeMl measure-
ments by virtual method were consistent with those by conventional

13
N.A. Ismail, et al. Journal of Forensic and Legal Medicine 63 (2019) 11–17

Table 3
Intraclass correlation (ICC) for intra- and inter-observer measurement by two different methods.
Parameters Intra-observer Inter-observer

Conventional (Observer A) Virtual (Observer B) Conventional (Observers A & B) Virtual (Observers B & C)

FeMl Maximum 0.10 0.18 0.10 0.96

ICC 1.00 1.00 1.00 0.99
CI > 0.99 > 0.99 > 0.99 > 0.98
FeHd Maximum 0.07 0.28 0.07 0.17
ICC 0.99 0.98 0.99 0.98
CI > 0.99 > 0.94 > 0.99 > 0.94
FeMd Maximum 0.10 0.14 0.10 0.14
ICC 0.98 0.95 0.98 0.95
CI > 0.95 > 0.86 > 0.95 > 0.86
FeCb Maximum 0.05 0.05 0.11 0.25
ICC 0.99 0.99 0.99 0.99
CI > 0.99 > 0.99 > 0.99 > 0.98

FeMl - maximum length of femur, FeHd - maximum diameter of femoral head, FeMd - transverse diameter of midshaft, FeCb - condylar breadth, min – minimum, max-
maximum, ICC-Intraclass correlation, CI-Confidence interval.

Table 4
The technical error measurements (TEM) and reliability test for intra- and inter-observer error analysis.
Parameters Analysis Intra-observer Inter-observer

Conventional (Observer B) Virtual (Observer B) Conventional (Observer A & B) Virtual (Observer B & C)

FeMl rTEM 0.03 0.02 0.10 0.41

R 0.99 0.99 0.99 0.99
FeHd rTEM 0.02 0.04 0.64 1.22
R 0.99 0.99 0.99 0.98
FeMd rTEM 0.01 0.08 0.30 2.25
R 0.99 0.99 0.99 0.92
FeCb rTEM 0.04 0.04 0.69 0.81
R 0.99 0.99 0.99 0.99

FeMl - maximum length of femur, FeHd - maximum diameter of femoral head, FeMd - transverse diameter of midshaft, FeCb - condylar breadth, rTEM - relative
technical error of measurement, R - coefficient of reliability.

method with an average difference of 0.01 cm (upper limit of 0.05 cm
and lower limit of −0.03 cm). The average differences for FeHd, FeMd
and FeCb measurements were −0.01 cm, 0.02 cm and 0.01 cm, re-
spectively. The values were distributed closely to zero, showing almost
perfect data agreement.
4. Discussion
This study assessed the accuracy and reliability of the virtual
method by intraclass correlation coefficient (ICC), technical error of
measurement (TEM), relative TEM (%TEM), coefficient of reliability (R)
and Bland and Altman plots. Results showed that virtual method was
highly accurate and reliable in bone measurements, even though it was
evident that the conventional method was more accurate in its mea-
surements, as shown by less value variation made between Observers A
and B.
Interestingly, Observer C was found to be the contributor for the
highest absolute difference (FeMl = 0.96 cm) and the highest rTEM
(FeMd = 2.25%) between Observer B and C in virtual method.
Nevertheless, these values were acceptable for the purpose of anthro-
pometric measurements. The value may be improved further, con-
sidering that Observer C was a novice, and the measurements made in
other parameters have only slightly deviated from the other observers.
These findings indicated that training and experience are necessary for
producing accurate measurements.
The ICCs for all parameters were more than 0.95, and ICC for FeMl was
1.00 suggesting a perfect correlation by both virtual and conventional
methods in the intra and inter-observer error analyses. The Bland and
Altman plots for all parameters exhibited that the points were distributed
within the upper and upper limits of agreement for FeMl, FeHd and FeCb.
Nevertheless, there was one measurement in FeMd (0.09 cm difference) that
was slightly above the upper limit (0.087 cm) (Fig. 3). Since this assessment
is not for clinical diagnostic purposes, difference as much as 0.10 cm is
acceptable considering measurement for FeMd and FeHd are rather chal-
lenging compared to FeMl and FeCb. The findings could not be compared
with other studies due to paucity of similar studies.
In the literature, the accuracy of virtual bone measurements by
PMCT was found to be accurate and reliable2,14,28–32 but none has
been done using femur. Among the earliest study, analyse the accuracy
of skull measurement between CT image reconstruction from CT and
measurements by calipers32. The result disclosed no significant differ-
ence between both methods. However, the virtual method should be
used with caution, as it was stated that measurement error of 5 mm or
more were not tolerated. These findings had opened new avenues for
future research in anthropologic imaging studies.
An interesting study had demonstrated the accuracy and reliability
of osteometric measurements from dried skeletal elements and from CT
images, with and without soft tissues.33 In the study, seven crania were
utilised and enumerated by three observers. The findings demonstrated
mean percentage of differences between measurements from three data
sources ranging from 1.4% to 2.9%. The accuracy of these measure-
ments was evaluated by technical error of measurement (TEM) and
relative technical error of measurement (rTEM). The intra-observer
TEM and rTEM in three observers and the craniometric variables
ranged between 0.46 mm and 0.77 mm, and 0.56% and 1.06%, re-
spectively. The inter-observer TEM and rTEM for craniometric variables
were 2.6 mm and 2.26%, respectively. Overall, minimal differences
were observed from these data sources, and high accuracy was noted
between the observers, which proved that CT image is an acceptable
technique to measure the osteometric variables.33

14
N.A. Ismail, et al.
Fig. 3. Bland and Altman plots for FeMl, FeHd, FeMd and FeCb.
Researches were also conducted on a comparison study of skull
measurements by calipers and 3D CT images.30 Results had demon-
strated no significant differences between the conventional method
(calipers) and virtual method (3D CT images). Similar findings were
revealed by using clavicle31 and complete skeletal measurements.33
Majority of these studies disclosed high accuracy in measurements
derived from dried bone element and also, from 3D-CT image of the
bone.31,32 Several studies have further compared measurements from
bone with soft tissues, and measurements of the same bone following
removal of soft tissues.4,8 Another study, stated that bone measure-
ments on PMCT images were accurate, albeit with significant difference
in measurements.14 These measurements were believed to be accurate
i.e. with maximum difference of 0.6 mm in variable measurement, and
a difference of approximately 1.5 mm in stature estimation.14
Several factors such as image quality, precision of landmarks and
availability of trained personnel may contribute to the reproducibility
of bone measurements by the virtual method. Image quality in CT scan
15
Journal of Forensic and Legal Medicine 63 (2019) 11–17
varies depending on the reconstructed image created in the 3D volume
rendering. It is recommended that a maximum slice thickness of
1.25 mm may be utilised, when 3D reconstructions of anatomical fea-
tures or other fine details are desired.34 The higher the slice thickness,
the lesser the resolution quality. Images of low resolution quality will
affect measurements due to unclear visibility of borders, lines and
points of landmarks. The adjustable contrast setting on the screen may
sometimes play an important role.
Another contributing factor is the precise definition of landmarks. In
the literature, there were several definitions given by different re-
searchers.12,35 One needs to apply only one definition, and adhere to
the definition consistently in every measurement. The most common
error in measurement was evident from the midshaft diameter for in-
stance, the maximum diameter of midshaft, wherever it occurs, and
another parameter was the maximum diameter at the most lateral to the
medial point at midshaft of femur.
Finally, the availability of trained personnel or observer is important.
N.A. Ismail, et al.
The observer must be well-trained in positioning the bone anatomically i.e.
in placing the landmarks36 and measuring the parameter. A random ob-
server with insufficient knowledge in computer software will not perform
well. In Osirix MD, the ‘anatomical plane’ will give direction on the ana-
tomical view of the body. The positioning process will be easy, if it involves
a single bone. In PMCT image, the body was often improperly positioned,
leading to difficulties in its measurements. The observer needs to be skilful
in positioning the image by manually operating to its correct anatomical
position. However, the observer should not rely on the ‘anatomical plane’
guide because it usually refers to the anatomical position of the whole
image, and not the bone in specific.
The use of CT image bears the advantage of elimination of the soft
tissue around the bone,8,31 which enables for measurements to be taken
accurately than with direct bone measurements. In the standard pro-
tocol of direct bone measurement, the soft tissue need to be removed
beforehand, which can be tedious and time-consuming. Thus, it is clear
that CT image has an inherent advantage compared to dry bone mea-
surements. Besides being quick, CT scan is also non-invasive.
This study was a pilot study, which requires further research to
validate the findings with extended samples. Limitation of this study
involves the limited femora available from the institute. Besides, the
identities were unknown as to their specific sexes or ages, and that only
Observer B had the chance to measure bones in both virtual and con-
ventional methods. It is recommended that this study would be ex-
panded to other skeletal parts with larger sample size by multiple ob-
servers in all methods available for better comparison.
5. Conclusion
In this study, femora measurements were found to be highly accu-
rate and reliable by both conventional and virtual methods. There were
good correlation coefficients (more than 0.95) in both intra and inter-
observer error analyses by ICC. The technical error of measurement
displayed negligible errors (rTEM < 0.04% for intra-observer and <
2.25% for inter-observer), and the coefficient of reliability (R) in-
dicated small error in the measurements (> 0.95). Bland and Altman
plots were within the upper and lower limits of agreements, and the
data were closely distributed to zero suggesting an almost perfect
agreement.
This study has explored the benefits of virtual anthropology by in-
troducing an innovative, standardized method as an alternative method
to dry bone osteometric technique. Virtual anthropology is an advanced
technique with great possibility, and is highly recommended for future
anthropological research studies, especially in Malaysia, where bone
collections are restricted.
Acknowledgements
We would like to thank the Director General of Health Malaysia for
his permission to publish this article. Special thanks to Datuk Dr. Mohd
Shah Mahmood (Head of Forensic Department), Mr. Mohd Tarmizi
Othman (radiographer), Mrs. Nur Shazuwani Ruzlan (Scientific Officer)
and all the staff in the National Institute of Forensic Medicine, Hospital
Kuala Lumpur for their assistance and expert advice in this study. A
special thanks goes to UKM for funding this research project (Grant No:
FRGS/1/2015/SKK13/UKM/02/1).
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.jflm.2019.02.010.
References
1. O'Donnell C, Iino M, Mansharan K, Leditscke J, Woodford N. Contribution of post-
mortem multidetector CT scanning to identification of the deceased in a mass
16
Journal of Forensic and Legal Medicine 63 (2019) 11–17
disaster: experience gained from the 2009 Victorian bushfires. Forensic Sci Int.
2011;205(1):15–28 2011/02/25/.
2. Franklin D, Swift L, Flavel A. 'Virtual anthropology' and radiographic imaging in the
forensic medical sciences. Egypt J Food Sci. 2016;6:31–43.
3. Dedouit F, Telmon N, Costagliola R, Otal P, Joffre F, Rougé D. Virtual anthropology
and forensic identification: report of one case. Forensic Sci Int.
2007;173(2–3):182–187 12/20/.
4. Verhoff MA, Ramsthaler F, Krähahn J, et al. Digital forensic osteology—possibilities
in cooperation with the Virtopsy® project. Forensic Sci Int. 2008;174(2):152–156
2008/01/30/.
5. Wüllenweber R, Schneider V, Grumme T. [A computer-tomographical examination of
cranial bullet wounds (author's transl)]. 1977/11// Z Rechtsmed.
1977;80(3):227–246 PubMed PMID: 602451. ger.
6. Sidler M, Jackowski C, Dirnhofer R, Vock P, Thali M. Use of multislice computed
tomography in disaster victim identification—advantages and limitations. Forensic
Sci Int. 2007;169(2):118–128 2007/07/04/.
7. Torimitsu S, Makino Y, Saitoh H, et al. Stature estimation in a contemporary
Japanese population based on clavicular measurements using multidetector com-
puted tomography. Forensic Sci Int. 2017;275:316 e1-.e6.
8. Robinson C, Eisma R, Morgan B, et al. Anthropological measurement of lower limb
and foot bones using multi-detector computed tomography. J Forensic Sci.
2008;53(6):1289–1295.
9. Grabherr S, Cooper C, Ulrich-Bochsler S, et al. Estimation of sex and age of “virtual
skeletons”–a feasibility study. Eur Radiol. 2009;19(2):419–429.
10. Hishmat AM, Michiue T, Sogawa N, et al. Virtual CT morphometry of lower limb long
bones for estimation of the sex and stature using postmortem Japanese adult data in
forensic identification. Int J Leg Med. 2015;129(5):1173–1182.
11. Karakas HM, Celbis O, Harma A, Alicioglu B. Total body height estimation using
sacrum height in Anatolian Caucasians: multidetector computed tomography-based
virtual anthropometry. Skeletal Radiol. 2011;40(5):623–630.
12. Torimitsu S, Makino Y, Saitoh H, et al. Stature estimation based on radial and ulnar
lengths using three-dimensional images from multidetector computed tomography in
a Japanese population. Leg Med. 2014;16(4):181–186 7//.
13. Torimitsu S, Makino Y, Saitoh H, et al. Stature estimation in Japanese cadavers based
on pelvic measurements in three-dimensional multidetector computed tomographic
images. Int J Leg Med. 2014;129(3):633–639.
14. Zech W-D, Näf M, Siegmund F, Jackowski C, Lösch S. Body height estimation from
post-mortem CT femoral F1 measurements in a contemporary Swiss population. Leg
Med. 2016;19:61–66 3//.
15. Sarajlić N, Cihlarž Z, Klonowski EE, Selak I. Stature estimation of Bosnian male
population. Bosn J Basic Med Sci. 2006;6(1):62–67.
16. Hasegawa I, Uenishi K, Fukunaga T, Kimura R, Osawa M. Stature estimation for-
mulae from radiographically determined limb bone length in A modern Japanese
population. Leg Med. 2009;11(6):260–266.
17. Farsinejad M, Rasaneh S, Zamani N, Jamshidi F. Relationship between the stature
and the length of long bones measured from the X-rays; modifed trotter and gleser
formulae in Iranian population: a preliminary report. Soud Lek. 2014;59(2) 20-11.
18. Amal Hayati ZA, Khairul O, Pawita Albakri AH Sri, Noor Hazfalinda H, Normaizatul
Afizah I. Stature approximation of malays, Chinese and Indian in Malaysia using
radiographs of femur, Tibia and Fibula. Jurnal Sains Kesihatan Malaysia.
2011;9(1):45–50.
19. Dirkmaat DC, Cabo LL, Ousley SD, Symes SA. New perspectives in forensic anthro-
pology. Am J Phys Anthropol. 2008;137(47):33–52.
20. Guyomarc’h P, Santos F, Dutailly B, Desbarats P, Bou C, Coqueugniot H. Three-di-
mensional computer-assisted craniometrics: a comparison of the uncertainty in
measurement induced by surface reconstruction performed by two computer pro-
grams. Forensic Sci Int. 2012;219(1):221–227 2012/06/10/.
21. Goto R, Mascie-Taylor CG. Precision of measurement as a component of human
variation. J Physiol Anthropol. 2007 Mar;26(2):253–256 PubMed PMID: 17435374.
Epub 2007/04/17. eng.
22. Ousley S. Should we estimate biological or forensic stature? J Forensic Sci.
1995;40(5):768–773.
23. Ulijaszek SJ, Kerr DA. Anthropometric measurement error and the assessment of
nutritional status. Br J Nutr. 2007;82(3):165–177 Epub 03/01.
24. Adams B, Byrd J. Interobserver Variation of Selected Postcranial Skeletal Measurements.
2002; 2002.
25. Jamaiyah H, Geeta A, Safiza MN, et al. Reliability, technical error of measurements
and validity of length and weight measurements for children under two years old in
Malaysia. Med J Malaysia. 2010;65(Suppl A):131–137 PubMed PMID: 21488474.
26. Perini TA, Oliveira GLd, Ornellas JdS, Oliveira FPd. Technical error of measurements
in anthropometry. Rev Bras Med do Esporte. 2005;11(1):86–90.
27. Goto R, Mascie-Taylor CGN. Precision of measurement as a component of human
variation. J Physiol Anthropol. 2007;26(2):253–256.
28. Giurazza F, Del Vescovo R, Schena E, et al. Determination of stature from skeletal and
skull measurements by CT scan evaluation. 10/10/ Forensic Sci Int.
2012;222(1–3):398 e1-.e9.
29. Lorkiewicz-Muszyńska D, Kociemba W, Żaba C, et al. The conclusive role of post-
mortem computed tomography (CT) of the skull and computer-assisted super-
imposition in identification of an unknown body. Int J Leg Med. 2013 May
01;127(3):653–660.
30. Sakuma A, Ishii M, Yamamoto S, et al. Application of postmortem 3d‐CT facial re-
construction for personal identification. J Forensic Sci. 2010;55(6):1624–1629.
31. Brough AL, Bennett J, Morgan B, Black S, Rutty GN. Anthropological measurement of
the juvenile clavicle using multi‐detector computed tomography—affirming relia-
bility. J Forensic Sci. 2013;58(4):946–951.
32. Hildebolt CF, Vannier MW, Knapp RH. Validation study of skull three‐dimensional
N.A. Ismail, et al.
computerized tomography measurements. Am J Phys Anthropol.
1990;82(3):283–294.
33. Stull KE, Tise ML, Ali Z, Fowler DR. Accuracy and reliability of measurements ob-
tained from computed tomography 3D volume rendered images. Forensic Sci Int.
2014;238:133–140.
34. Ford JM, Decker SJ. Computed tomography slice thickness and its effects on three-
dimensional reconstruction of anatomical structures. Journal of Forensic Radiology
17
Journal of Forensic and Legal Medicine 63 (2019) 11–17
and Imaging. 2016;4:43–46 March 2016.
35. Bass WM. Human Osteology: A Laboratory and Field Manual. fifth ed. Missouri
Archaelogical Society: University of Columbia; 2005.
36. Lee S, Gong HH, Hyun JY, et al. Estimation of stature from femur length measured
using computed tomography after the analysis of three-dimensional characteristics of
femur bone in Korean cadavers. Int J Leg Med. 2017;131(5):1355–1362.