Forensic Radiology Research Articles

Forensic Radiology and the Testimony of Shadows

This article examines how radiological images became accepted by courts as visual evidence of death in the 20th century. Initially conceived as a speciality of photography, X-rays confounded courts, eliciting a range of judicial responses, from outright refusal to consider the images as any kind of evidence, to mocking them as cheap parlour tricks for an unwitting public, to recognising them as more reliable than the testimony of the expert witness. The article contends that courts moved towards recognising X-rays as proof of death only by both affirming forensic radiology's promise of ‘mechanical objectivity’ while acknowledging its reliance on the fallibility of ‘human subjectivity’. We suggest that this history has broader implications in socio-legal studies for comprehending how the invention of novel optical techniques continues to problematise legal epistemologies of death in the 21st century.

Korean radiographers’ awareness, experiences, and education needs in forensic medicine and forensic radiology

This study assesses the need for education in forensic medicine and forensic radiology among radiographers by investigating the perceptions and experiences of Korean radiographers working in medical institutions. A structured questionnaire was administered to participants, collected, and analyzed. The results showed that despite receiving frequent forensic cases, Korean radiographers face difficulties in taking appropriate measures about forensic radiology due to a lack of awareness and knowledge of its forensic aspects. The participants indicated that university education in forensic medicine and forensic radiology is necessary. Therefore, it is imperative to develop and implement policies for forensic education programs to enhance radiographers’ forensic knowledge and capabilities. Universities should conduct courses on forensic radiology and provide continuing education for radiographers working in this field.

Virtopsy concept around the world: Institute-based survey of worldwide forensic postmortem imaging

Introduction: Forensic routine postmortem imaging in excess of photography and conventional X-ray has been pushed since a few years, in some instances under the name ”Virtopsy”. It constitutes a pivotal innovation in forensic medicine as it allows for the non-invasive exploration of the deceased through diverse imaging techniques. This study offers an analysis of a survey with focus on the worldwide adoption and application of postmortem imaging. Our goal is to uncover and understand regional variances in its deployment application. Methods: A survey comprising 18 questions, both closed-ended and open-ended, was designed collaboratively and distributed globally via email and social network. The survey addressed topics such as autopsy rates, imaging modalities, indications for postmortem imaging, personnel involved, evaluation methods, and communication of findings. The survey was initially sent to institutes with published postmortem imaging research, and later, it was distributed through international forensic radiology and radiographer associations. Statistical analysis was conducted to interpret the results. Results: Responses were obtained from 29 countries, representing 6 continents, with a total of 100 participating institutions. European institutions were predominant (69%), followed by Australia (9), North America (8), Asia (7), Africa (6) and South America (1). The majority of institutions reported 100-500 autopsies annually (31). Among the institutes that reported that they perform post mortem imaging (PMI), most listed postmortem computed tomography (PMCT) as modality (89%). The request to perform PMI was issued by institutes of forensic medicine (51%), researchers (42%), police (43%) or public prosecutor’s office (54%). 48% of the respondents stated that an autopsy must always be performed, even if the cause and manner of death can be ascertained by postmortem imaging. radiographers were primarily responsible for technically performing PMCT (65%) whereas physicians were listed in 28%, autopsy technicians in 18%. The majority of the institutions (32%) identified clinical radiologists as the primary individuals responsible for reading, evaluating radiological images, and writing reports. Many respondents (64%) reported that their image readers had attended specialized postmortem imaging courses. Communication of findings typically involved written reports (28%) or a combination of written reports and illustrated images (31%). Membership of survey respondents was indicated in 38% for the International Society of Forensic Radiology and Imaging (ISFRI) and 5% for the International Association of Forensic Radiographers (IAFR). The question was how many of the responders are members of a PMI focused radiological society or work group. 52% (44 out of 85) respondents indicated they were not a member of a postmortem imaging society. The memberships listed are ISFRI (38%), IAFR (5%) and AGFB (Arbeitsgruppe Forensische Bildgebung, 4%). Conclusion: This study provides a global perspective on the utilization of postmortem imaging in forensic medicine, revealing regional variations in practices and technology adoption. It offers insights into the personnel, techniques, and procedures involved in this field in different countries.

The cardiothoracic ratio on postmortem CT as a screening tool for cardiomegaly in the Thai population.

IntroductionIn forensic radiology, the cardiothoracic ratio (CTR) calculated from postmortem computed tomography (PMCT) images can be used to detect cardiomegaly. In this study, a new measurement method is studied that involves measurement in the anteroposterior (AP) and transverse directions, with a reference level based on the Thai population. ObjectiveTo screen for cardiomegaly using the CTR calculated from PMCT images. Research methodA sample size of 116 deceased Thai individuals who underwent PMCT before autopsy was obtained. Individuals were divided into two groups: normal heart weight and overweight heart. Hearts heavier than the mean plus one standard deviation were categorized into the overweight group. The CTR was calculated in both the AP and transverse directions at six reference levels. Receiver operating characteristic curves (ROC) were calculated to determine the CTR cutoff point for the diagnosis of cardiomegaly. ResultsThe CTR cutoff values for diagnosing cardiomegaly were as follows: 1) CTR >0.5 in the transverse direction at the mid-vertebra of T7 (sensitivity, 75.6%; specificity, 70.6%; area under the ROC curve 0.81), 2) CTR >0.49 in the transverse direction at the mid-vertebra of T8 (sensitivity 71%, specificity 81.4%, area under the ROC curve 0.80). The selection of the cutoff values depended on the location of the heart. The area under the ROC curve in the AP direction was in the range 0.5-0.7, which is inferior compared to the transverse direction (0.7-0.9). ConclusionCalculating the CTR with a reference level on PMCT images can assist in the diagnosis of cardiomegaly.

ASSESSMENT OF LOCATION AND COURSE OF INFERIOR ALVEOLAR CANAL USING CONE BEAM COMPUTED TOMOGRAPHY

Background and Rationale:Forensic radiology is an evolving integral branch of forensic medicine. The most challenging tasks for forensic dentists and anthropologists has been identification and determination of sex of unknown human skeletal remains. Morphological and morphometric analysis of course and relationship with adjacent structures of mandibular canal can be useful in determining gender. CBCT being very useful in forensic contexts offering several advantages for postmortem forensic imaging including good resolution for skeletal imaging, relatively low cost, portability, and simplicity. Aim and objectives:To determine the sexual dimorphism of mandibular canal using cone beam computed tomography (CBCT) images. Materials and Methods:Course of mandibular canal classified into types based on considerable distance between the mandibular canal and the root apexes of premolars and molars, A) Catenary, B) Progressive descending, C) Straight. Location of mandibular canal was evaluated in 4 different points. Comparison of length and width of mandibular canal, prevalence of anterior loop, bifid mandibular canal, accessory mental and mandibular canal among genders. Comparison of continuous variables such as distance, length and width of canal with gender and side was done using unpaired t-test. Comparison of categorical variables with gender and side was performed using Chi-square test. The level of significant was 5%. Results:The prevalence of type of canal was highest in straight canals 53.9% followed by progressive descending and catenary canals 23.7% and 22.4% respectively. Measuring the length of canal showed statically significant result as mean length of IAC was 68.36 ± 5.24, 64.10 ± 3.18 in males and females respectively. Width and distance to adjacent structures had no significant result but dimensions were slightly lesser in females. Prevalence of anterior loop was found to be 57.9%.The most frequently observed type of bifid canal was retromolar42.9% followed by forward 28.6%, dental 19%and buccolingual 9.5%. There was no significant difference of assessing prevalence of anterior loop, accessory mental and mandibular foramen in relation to gender and side. Conclusion:Sex determination becomes one of the first priorities in the process of identification by a forensic investigator in the case of mishaps, chemical and nuclear bomb explosions, natural disasters, crime investigations, and ethnic studies.Advanced cross-sectional imaging modalities especially CBCT is a suitable tool for observing anatomic characteristics of mandibular canal in forensic odontology. In the current study we found significant result on type of course and length of canal for gender determination.

Review of the book “Radiology in Forensic Medicine. From Identification to Postmortem Imaging” translated from English under the editorship of Professor V.A. Klevno

The book Radiology in Forensic Medicine. From Identification to Postmortem Imaging, translated from English under the editorship of Professor V.A. Klevno, is reviewed.
 The review aimed to objectively evaluate the content of the scientific and practical publication and to determine its value for science and practice.
 The book consists of 29 chapters. Each chapter includes a list of references. The history of forensic radiology is briefly described, and the advantages, and disadvantages of traditional autopsy versus postmortem imaging are reviewed. This book focuses on postmortem imaging in forensic medicine and special forensic radiology, including imaging of corpses after various types of external exposure, during sudden death, of fetuses, and newborns and of putrefied and charred corpses. Several chapters are devoted to imaging in clinical forensic medicine to assess injuries, detect drug smuggling by body packers, and diagnose some occupational diseases. The role of postmortem imaging in identifying victims of mass disasters is discussed. The authors critically evaluate the advantages and limitations of virtual autopsy.
 Given the advancements of interdisciplinary approaches in forensic medicine and the increasing role of radiologists in forensic practice, the publication of this book in Russian is more relevant than ever. It will be of interest to both forensic physicians and radiologists.

The future role of forensic radiology — scope and challenges

The future role of forensic radiology — scope and challenges

Under-reporting of forensic findings: craniocervical emergency imaging in cases of survived hanging

To determine the diagnostic bias between clinical and forensic radiology in cases of nonfatal hanging and determine and describe typical underreported imaging findings. In a retrospective, single-center study, all patients admitted for attempted suicide with near-hanging or fatal hanging between January 2008 and December 2020 who received CT or MRI of head and neck were reviewed and missed findings in the original report were documented. A binary regression with disagreement as dependent variable was fitted for the imaging modality, fatality, age, and sex. A total of 123 hanging incidents were retrospectively analyzed. The vast majority (n = 108; 87.8%) had attempted suicide with a nonfatal outcome. Fatal outcome occurred in 15 (12.0%). The extra- and intracranial injuries documented on CT and MRI scans were laryngeal (n = 8; 6.5%), soft tissue (n = 42; 34.1%), and vascular injuries (n = 1; 0.8%). Intracranial pathology was evident on 18 (14.6%) scans. Disagreement occurred in 36 (29.3%) cases and represented 52 (69.2%) of all cases with a radiological finding. Disagreement was strongly associated with fatality (OR: 2.7–44.9.4, p = 0.0012). In most cases, nonfatal hangings cause no or only minor injuries. Fatal cases are associated with a greater probability of missed minor imaging findings. This suggests that findings deemed clinically irrelevant are probably not reported in such severe emergency cases. This association indicates that minor abnormalities are underreported when major pathologies are evident on imaging in victims of strangulation.

Evaluation of Frontal Sinus Morphology in Gender Determination by Using PNS View in U.P. Population: A Radiomorphometric Study

Background: The importance of frontal sinuses in Forensic Radiology has been well documented. Literature revealed few studies on the morphometric analysis of frontal sinuses on paranasal radiographs in sex determination. This initiated this radiographic study with the aim of analysing the dimensions of the frontal sinuses through digital PNS radiographs for gender determination. Materials and Methods: The study group comprised 150 healthy adults of either gender over the age of 20 years. One paranasal sinus radiograph was made for each patient using the standardized radiographic technique. Digital measurements of the height, width and area of the frontal sinuses were recorded using AutoCAD 2014 software. The data collected was subjected to statistical analysis. Results: This study found an accuracy rate of 68.6% for sex determination through paranasal sinus radiographs. It was noted that the right height of the frontal sinus was a better predictor than any other parameter assessed for identifying the gender. Conclusion: From the present study, we conclude that the dimensions of frontal sinuses on PNS views can be used as an essential tool for gender determination in forensic sciences.

Forensic odontology identification in a case of flash-fire death

Forensic dentistry, or forensic odontology is a great chapter in forensic pathology that focuses on the dental remains of unrecognizable cadavers to perform their recognition. In some cases, dental identification is the only method available to make or refute the identification of a cadaver. During a crime scene investigation, human remains were found in a completely burned-out car. At the external examination, the cadaver was unrecognizable. At complete autopsy, the presence of soot in the airways was ascertained as a vitality marker. A forensic dental examination was performed. Dental photos of a suggested missing man were analyzed and showed the same anatomical dental features as those of the cadaver. The comparison of the orthopantomogram (OPT) obtained ante mortem from the missing person with the one obtained post mortem from the cadaver matched perfectly. Hence, forensic odontology proved valuable to identify the cadaver working in conjunction with forensic pathology and forensic radiology.

CVIP-Net: A Convolutional Neural Network-Based Model for Forensic Radiology Image Classification

Automated and autonomous decisions of image classification systems have essential applicability in this modern age even. Image-based decisions are commonly taken through explicit or auto-feature engineering of images. In forensic radiology, auto decisions based on images significantly affect the automation of various tasks. This study aims to assist forensic radiology in its biological profile estimation when only bones are left. A benchmarked dataset Radiology Society of North America (RSNA) has been used for research and experiments. Additionally, a locally developed dataset has also been used for research and experiments to cross-validate the results. A Convolutional Neural Network (CNN)-based model named computer vision and image processing-net (CVIP-Net) has been proposed to learn and classify image features. Experiments have also been performed on state-of-the-art pertained models, which are alex_net, inceptionv_3, google_net, Residual Network (resnet)_50, and Visual Geometry Group (VGG)-19. Experiments proved that the proposed CNN model is more accurate than other models when panoramic dental x-ray images are used to identify age and gender. The specially designed CNN-based achieved results in terms of standard evaluation measures including accuracy (98.90%), specificity (97.99%), sensitivity (99.34%), and Area under the Curve (AUC)-value (0.99) on the locally developed dataset to detect age. The classification rates of the proposed model for gender estimation were 99.57%, 97.67%, 98.99%, and 0.98, achieved in terms of accuracy, specificity, sensitivity, and AUC-value, respectively, on the local dataset. The classification rates of the proposed model for age estimation were 96.80%, 96.80%, 97.03%, and 0.99 achieved in terms of accuracy, specificity, sensitivity, and AUC-value, respectively, on the RSNA dataset.

Role of Artificial Intelligence in Forensic Radiology

Role of Artificial Intelligence in Forensic Radiology

Veterinary forensic radiology–Development of a cost-effective and easily performed post mortem computed tomographic angiography protocol

Veterinary forensic radiology–Development of a cost-effective and easily performed post mortem computed tomographic angiography protocol

Value of Maxillary Sinus Morphology in Identification of Gender by Using Digital Radiography

Background: Human being recognition is significant for a variety of purposes, including for the humanitarian and sentimental needs for others, for relatives as well as for the court before rendering a decision. In forensic radiology, the radiographic tests and procedures that are relevant to the law or the courts are performed, interpreted, and then reported. Comparing radiography to three-dimensional (3D) cone beam computed tomography, radiography has the benefits of being more widely available, having a lower radiation dose, and having a lower cast. The systemic change in size or shape between individuals of varying sexes belonging to the same species is known as sexual dimorphism. Sexual dimorphism is reflected by different species' maxillary sinuses. The first paranasal sinus to develop in utero at the age of 10 weeks are the maxillary sinuses, which are two air-filled cavities found in the maxillary bone. They are the largest of the paranasal sinuses. Bones like the pelvis, skull, and femur are used in radiology to identify gender. Maxillary sinuses can be utilized for identification in mass tragedies like aero plane accidents, war, explosions, burnt, decomposing remains, and other calamities. In these situations, all the bones suffer severe damage, but the sinuses are left undamaged. Aim and objective: This research used digital radiography to identify gender based on the morphology of the maxillary sinus. Materials and Methods: From the radiographs (A.P view) of 128 subjects ( 64 males and 64 females), the morphometric characteristics of the maxillary sinus were assessed using microdicom software. Results: The right maxillary sinus average height and width in males was 28.15mm and 25.04mm whereas, in females it 22.39mm and 22.54mm respectively and was found statistically highly significant. Likewise, the left maxillary sinus average height and width in males was 28.91mm and 25.33mm and in females it was 22.39mm and 20.81mm respectively and was statistically highly significant. Conclusion: It was concluded from my study that the anteroposterior (AP) view of digital radiographs can be used to detect the gender based on the height and width of the maxillary sinuses. Keywords: Forensic radiography, maxillary sinus, sexual dimorphism, gender determination mass disaster.

The application of CT for 3D visualization of concealed bodies

In forensic radiology, computed tomography (CT) is often used as a medical imaging technique to identify the cause and manner of death of deceased victims of a possible crime. In this study, medical imaging is used to examine concealed bodies and packaging materials. Medical imaging techniques, mainly CT scan, were used to scan packaged or concealed bodies inside containers to identify clues and evidence indicating whether a crime might have been committed. Also, scene integrity and scene safety along with a systematic search for relevant evidentiary items value were considered.Eighteen concealed bodies that had been assessed using medical imaging techniques between 2010 and 2018 at the request of the Dutch National Police were selected. The file records of each case contained imaging data, a photographic record of the unpacking procedure, a list of all items and traces found in the package, and the forensic pathology report. The images were assessed with respect to the different aspects of the case and through a systematic approach.The packages included adult males, adult females, newborn infants, and animals. All human cases were related to criminal offences. In nine adult cases, evidence of a possible violent death could be determined using CT imaging. The cause of death in newborn infants, however, could not be determined. In cases of dismemberment, the completeness of the body could be determined by CT imaging, and the cutting surfaces of bones could be matched on CT images. Regarding scene safety and integrity, in this study all relevant macroscopic items were detected on the CT images.The CT-scans were supplemented with fiduciary markers to better map CT data with the real objects. This information in combination with 2D and 3D images provided the forensic investigator with information on how to unwrap the package layer by layer and help determine different types of packaging materials. Different textiles could not always be identified. The orientation of the body within the packages was provided in all cases, and advice could be given on the optimal approach to access the contents. The overall detection rate of items was 78%.This is one of the first studies to illustrate the contribution of medical imaging, specifically CT scan, to the analysis of concealed bodies and packaging materials prior to unpacking. This demonstrates its contribution to a systematic approach of the investigation by ensuring the safety and health of the investigator while documenting and maintaining the integrity of the crime scene. Imaging also provides information that can be helpful to determine whether a crime might have been committed and reducing the risk of damaging a concealed body. Medical imaging also provides the forensic investigator with information to draw up a workplan prior to unpacking, minimising loss of evidence and determining whether different forensic specialists (e.g., digital or DNA) are needed. It is therefore strongly recommended to use medical imaging, especially CT scanning, before opening a package containing a concealed body.

Veterinary Forensic Radiology- Development of a Cost-Effective and Easily Performed Post Mortem Computed Tomographic Angiography Protocol

Veterinary Forensic Radiology- Development of a Cost-Effective and Easily Performed Post Mortem Computed Tomographic Angiography Protocol

Overview on Updates on Digital Dental Radiography

Wilhelm Roentgen first discovered X-rays in 1895. Since its introduction in the mid-1980s, digital radiography has surpassed traditional screen-film radiography. Since 2000, more than 75 percent of medical clinics in the United States have migrated to digital radiography (DR). In fact, the US government has ordered that all medical records be converted to digital. Indirect, direct, or semi-direct digital radiography pictures are types of digital radiography currently available. Forensic radiology is a branch of medical imaging technology that helps clinicians. Radiology technology has evolved and grown tremendously in recent years. When comparing aggregated antemortem and postmortem information, radiographs are crucial. Adopting new technologies into a dental business demands a certain amount of bravery. After all, why alter things if your practise is running smoothly? To grasp the new equipment and procedures, the dentist and his or her staff will need further training. It's not always apparent how the new strategy will influence the practice's present logistics. These factors may cause the practitioner to be hesitant to alter present techniques. In this article we’ll reviewing digital dental radiography, and what are the advantages of going digital. And also what are the challenges that face us.

COVID-19 pandemic: a reminder to develop forensic radiology facility.

COVID-19 outbreak has resulted in a substantial morbidity and mortality, and has put the health system under tremendous stress. A need for devising and adopting newer methods and techniques is being emphasized in the healthcare facilities to combat the effects of the SARS-CoV-2. Besides patient care, focus needs to be laid on the effective and dignified management of the deceased and medico-legal services provided by the hospitals and medical institutions during the COVID-19 pandemic. Considering the likelihood of forensic experts and autopsy personnel being exposed to SARS-CoV-2 inadvertently during the autopsy, it is recommended to resort to safer and minimally invasive techniques of postmortem examination of the dead. In this regard, employing radiological techniques for postmortem examination appears to be a promising option during the COVID-19 pandemic. An inherent advantage of postmortem radiography over conventional autopsies is the minimization of the risk of transmission of infection to the health care workers. Our correspondence highlights on the possibility of using radiological facilities as an effective replacement of high-risk conventional autopsy procedures during the COVID-19 pandemic.

Imaging protocols for the autopsy service in a time of pandemic emergency minimizing the contagion of SARS-CoV-2 expert government agents

Objective: To contribute to the construction of parameters of biosafety in order to protect government agents in the exercise of their investigative functions in the context of a pandemic, as well as to resolve clinical, pathological and possibly legal issues. Methodology: The development of an exploratory review study with a qualitative approach was defined. The methodological design was carried out on the platforms: PubMed and SciELO through the descriptors: Human identification, Radiology, Virtópsia and Autopsy. The exclusion criteria include articles with duplicate information or that do not have information related to the objectives of the study. For inclusion, materials published in Portuguese, English or Spanish were used and at the end 76 articles were obtained. Results and discussion: Conventional autopsy is the most common method for post-mortem investigation in humans. However, with the evolution of imaging methods and the current pandemic threatening the health of government agents, Virtópsia has shown itself to be the most promising way to remedy the dichotomy of occupational risk and legal benefit. Final considerations: In this article, the main advances in Forensic Radiology in the last 11 years were described, with regard to the use of ante and post mortem radiographs in the identification process. Among the various radiological techniques treated, the following stand out: radiographic techniques produced by radiology professionals with different assessments in the radiological area. The images produced are security methods with invasive manipulation and use of all PPE, suitable for the pandemic moment.

Research Progress on Computer-Aided Skeleton-Based Individual Identification in Forensic Radiology.

Individual identification based on imaging data of the skeleton of a corpse is a key technique for forensic identification. To reduce the influence of artificial factors, computer-aided semi-automatic or automatic individual identification has become one of the research directions of skeleton-based individual identification in forensic radiology. Therefore, this paper reviews and summarizes literatures related to estimation of anthropological information such as, age and sex by computer-aided forensic radiology bone characteristics and individual identification based on bone imaging characteristics, in order to provide reference on skeleton-based individual identification in forensic radiology.