Forensic Radiology Research Articles

Forensic imaging in legal medicine in the Netherlands: Retrospective analysis of over 1700 cases in 15 years' experience

Abstract Introduction Forensic radiology in the living and postmortem is a new horizon in legal medicine for the detection and documentation of forensic evidence and reconstruction of the manner of death. A collaboration was undertaken 15 years ago between the Netherlands Forensic Institute, where all forensic autopsies in the Netherlands are performed, and the department of radiology in the Groene Hart Hospital (GHH). Methods Without exception, all forensic radiological cases performed/interpreted in the GHH between 2000 and 2015 were included in the database. Radiologic imaging was always performed in addition to autopsy or medico-legal investigation. Retrospectively, the corresponding autopsy/forensic reports were studied to obtain case information. Imaging modalities, sex, age, cause and manner of death/trauma were analyzed in both living and postmortem cases. Results A total of 1734 radiology cases was included, of which 82% was post-mortem. Male/female ratio was 2:1, mean age was 36 years (0‐98). Performed imaging modalities were: total body CT: 656, cranial CT: 571, skeletal x-ray: 349, larynx-hyoid x-ray: 327, MRI: 118. Reported preliminary diagnoses were: blunt trauma (battering: 458, blunt objects: 121, transportation accidents: 156, airplane accidents: 34, explosions: 8, falls: 137), penetrating trauma: 199, ballistic trauma: 150, asphyxial deaths (strangulation, suffocation): 305, submersion: 98, fire: 80, diseases: 156, no anatomical cause of death (discovered corpses: 159, exhumed bodies: 27, sudden unexplained death in infancy: 76). Conclusion This annually growing forensic radiological database enables data analysis in pre- and post-mortem cases and has proved to be a useful source for retrospective research and scientific collaboration.

Radiological Study of Union of Lower End of Humerus and Femur for Estimation of 16 and 18 Years Age in Agra Region

The bony age is determined from the study of growing ends of long bones i.e. the appearance and fusion of epiphysis with the diaphysis. The bony age is considered nearest to accuracy in estimating the clinical age. The actual bony age can't be determined in living, therefore the law enforcing agencies has to rely upon radiological estimation of bony age that too with many limitations and conditions. The present series of work was conducted at Forensic Medicine and Radiology Department of Sarojini Naidu Medical College, Agra. The study was based on 200 cases of males and females 10–20 years of different school and colleges running in the Agra city. In male all epiphysis of lower end of humerus are fused except medial epicondyle at age of 16 years. Lower end of femur not fused in both males and females at age of 16 years. In both males and females lower end of femur fused at age of 16 years.

Joint Congress of the ISFRI and IAFR 2015: 4th Congress of the International Society of Forensic Radiology and Imaging (ISFRI) and 10th Anniversary Meeting of the International Association of Forensic Radiographers (IAFR) – Impressions from Leicester

Joint Congress of the ISFRI and IAFR 2015: 4th Congress of the International Society of Forensic Radiology and Imaging (ISFRI) and 10th Anniversary Meeting of the International Association of Forensic Radiographers (IAFR) – Impressions from Leicester

How does post-mortem imaging compare to autopsy, is this a relevant question?

The rapid development of imaging techniques used for the investigation of death invites the question “how does imaging compare with autopsy”. This paper is based on an invited talk given to the International Society of Forensic Radiology and Imaging in 2015 and attempts to show that this question cannot be answered, as it is in fact several questions depending on the circumstances of death. Review of the literature is fraught with difficulties due to the rapid evolution of technology, the varied circumstances of death investigation and the multiple possible post-mortem investigations that imaging can be compared with. The article focuses on the assessment of adult sudden natural death and suggests the questions that need to be answered.

The use of forensic radiology in determination of unexplained head injuries in child mummies – Cause of death or mummification damage?

Abstract The role of forensic radiology imaging in the study of two ancient Egyptian wrapped child mummies allowed for different views of areas of interest where there was uncertainty in the interpretation of head injuries that may have been related to cause of death or mummification damage. The objective of this study was to determine the cause of the head injuries. Images were obtained with a Toshiba Aquilion 64 Computerised Tomography (CT) scanner set to acquire 64×0.5mm 2 data that was loaded into a Vitrea 2 advanced visualisation workstation for processing. Ancient texts and recent publications were consulted for descriptions of mummification techniques. Virtual images showed that both children had suffered comminuted fractures of the skull. One child had been eviscerated and appeared to have been excerebrated via the anterior fontanelle during mummification. The second child also suffered a comminuted fracture which was at the vertex of the skull but had not been excerebrated or eviscerated. The injury to the skull of this child suggested that the defect was caused by a sharp edged tool and that this injury may have caused death.

Role of Multi-detector Computed Tomography in Medicolegal Evaluation of Non-Fatal Firearm Injuries in the Head in Assiut University Hospital

Background: Firearm injuries may cause physical disabilities, permanent infirmities, psychological harm or death of injured individuals. Multi-detector computed tomography (MDCT) became a mainstay noninvasive diagnostic tool in investigation of firearm injuries as it gives three dimensional imaging (3-D) and colored images. Objective: This study was designed to through light on the role of MDCT in medicolagal evaluation of non-fatal firearm injuries in the head which examined in Assiut University hospital. Subjects and Methods: this study was conducted on 67 cases of non-fatal firearm injuries in the head including an age group 16-70 years which presented in the trauma unit and outpatient clinic of neurosurgery department during the period from June 2013 to June 2015. After forensic examination, the cases were examined blindly by two consultant radiologists using 16-row multi-detector CT in diagnostic radiology department of Assiut University hospital after giving an informed consent. The obtained images were post-processed using an advanced diagnostic computer workstation to obtain multi-planar reformatted and three-dimensional volume-rendered images to examine soft tissues, skull and intracranial structures. The relevant disclosing MDCT images were documented, interpreted and data were discussed between participants of the research from departments of the forensic medicine and diagnostic radiology and compared to results of forensic examination. Statistical analysis of data was done. Results: Most of injuries occurred in males which represented 89.45% of total cases and the highest percentage of victims was in the age group 21-30 years which represented 31.3%. MDCT images help in determining details of inlets and exits (in soft tissue, bone and intracranial structures), recognizing the type of used firearm weapons (weapons firing shots represented 73.1%), retained projectiles, determination of the distance of firing (79.1 % of total). In addition it demonstrated retained projectiles which represented 46.3% of total cases and their details (types, numbers, shapes, sizes, trajectory and deflection inside the skull), intracranial hemorrhage, edema, skull fractures. It can help in determination of permanent infirmity (which represented 17.9% of total cases) and in planning for surgical interference. Conclusion: This study demonstrated that MDCT is an accurate diagnostic tool in the medicolegal investigations of firearm injuries. The MDCT images are documented forensic evidence which can be stored, electronically sent for medicolegal consultation and can be shown in the court. In addition, medicolegal experts can trust on MDCT for determination of permanent infirmities which can help injured persons to obtain compensations and determine responsibility of physicians about faults in malpractice claims.

Postmortem computed tomography (PMCT) and disaster victim identification.

Radiography has been used for identification since 1927, and established a role in mass fatality investigations in 1949. More recently, postmortem computed tomography (PMCT) has been used for disaster victim identification (DVI). PMCT offers several advantages compared with fluoroscopy, plain film and dental X-rays, including: speed, reducing the number of on-site personnel and imaging modalities required, making it potentially more efficient. However, there are limitations that inhibit the international adoption of PMCT into routine practice. One particular problem is that due to the fact that forensic radiology is a relatively new sub-speciality, there are no internationally established standards for image acquisition, image interpretation and archiving. This is reflected by the current INTERPOL DVI form, which does not contain a PMCT section. The DVI working group of the International Society of Forensic Radiology and Imaging supports the use of imaging in mass fatality response and has published positional statements in this area. This review will discuss forensic radiology, PMCT, and its role in disaster victim identification.

Managing transformational change: Implementing cross-sectional imaging into death investigation services in the United Kingdom

In general, healthcare is constantly re-building to provide better, quicker, more dependable services and care and, as a result, change is an inevitable part of our professional lives. The process of death investigation is no different. Traditionally the ‘true’ cause of death can only be determined by an invasive autopsy. Considered the ‘gold standard’ investigation, this highly specialised surgical procedure consists of a thorough examination of the corpse, evaluating the contribution of any natural disease or injury identified to the cause and manner of death. It involves the processes of external and internal examination, supplemented with laboratory investigations when required, followed by reconstruction of the body. However, a radical adjunct or alternative to the traditional autopsy has now been developed, challenging the concept of the ‘gold standard’, using the ‘so-called’ minimally invasive radiological autopsy. This approach uses post-mortem computed tomography (PMCT) and/or post-mortem magnetic resonance (PMMR) imaging, possibly supplemented with angiography, pulmonary ventilation, needle biopsy and, where available, surface scans of corpses. When combined with an external examination this innovative translation of clinical radiological imaging provides fresh insights and a new horizon for death investigation worldwide. In the beginning there was considerable doubt, resistance and uncertainty concerning the use of cross-sectional imaging in autopsy practice from the global medical community. Nevertheless, time has seen change in death investigation practices across the world, and a growing number of centres are investigating and instigating PMCT and PMMR into autopsy practice, including Japan, Australia, United States and parts of Europe (Denmark, Germany and Switzerland to name only a few) [1–9]. Recently practitioners and researchers from around the world united with the formation of the International Society of Forensic Radiology and Imaging (http://www.isfri.net/ last visited October 2014) which included the launch of the first dedicated journal for this specialist area of work, the Journal of Forensic Radiology and Imaging (http://www.jofri.net/ last visited October 2014). Despite these international developments, and some local enthusiasts, the forensic, pathology, criminal justice system and radiology communities in the United Kingdom (UK) have, in general, been slow to use post-mortem cross-sectional imaging. Possible reasons include unawareness of its potential, financial concerns, lack of experience and lack of educational opportunities. However, it has been questioned by UK practitioners within the forensic press whether, in terms of the adoption of imaging technology, the world is running before it can walk [10].

Age estimation from canine volumes.

Techniques for estimation of biological age are constantly evolving and are finding daily application in the forensic radiology field in cases concerning the estimation of the chronological age of a corpse in order to reconstruct the biological profile, or of a living subject, for example in cases of immigration of people without identity papers from a civil registry. The deposition of teeth secondary dentine and consequent decrease of pulp chamber in size are well known as aging phenomena, and they have been applied to the forensic context by the development of age estimation procedures, such as Kvaal-Solheim and Cameriere methods. The present study takes into consideration canines pulp chamber volume related to the entire teeth volume, with the aim of proposing new regression formulae for age estimation using 91 cone beam computerized scans and a freeware open-source software, in order to permit affordable reproducibility of volumes calculation.

The basics of disaster victim identification

Abstract Mass fatality incidents can occur due to an environmental, medical, vehicle, industrial or terrorist event. They can be major, mass or catastrophic in size and generally involve large numbers of victims. Identification of these victims is of upmost importance in these situations for legal and compassionate reasons. Whilst radiography has been used for this purpose since 1949, it has since been suggested that post-mortem computed tomography (PMCT) could provide a more rapid and logistically beneficial modality-reducing the number of on-site personnel and minimizing the number of different imaging modalities required. The International Society of Forensic Radiology and Imaging (ISFRI), who include disaster victim identification (DVI) as one of their six key areas of development, support this idea. The DVI sub-group of the ISFRI supports the use of radiology including PMCT in mass fatality responses through the DVI group’s published positional statements. This review will discuss the basics of disaster victim identification and the role that radiology has in it, both in the past and in the future.

Racking the brain: Detection of cerebral edema on postmortem computed tomography compared with forensic autopsy

PurposeThe purpose of this study was to compare postmortem computed tomography with forensic autopsy regarding their diagnostic reliability of differentiating between pre-existing cerebral edema and physiological postmortem brain swelling. Materials and methodsThe study collective included a total of 109 cases (n=109/200, 83 male, 26 female, mean age: 53.2 years) and were retrospectively evaluated for the following parameters (as related to the distinct age groups and causes of death): tonsillar herniation, the width of the outer and inner cerebrospinal fluid spaces and the radiodensity measurements (in Hounsfield Units) of the gray and white matter.The results were compared with the findings of subsequent autopsies as the gold standard for diagnosing cerebral edema. p-Values <0.05 were considered statistically significant. ResultsCerebellar edema (despite normal postmortem swelling) can be reliably assessed using postmortem computed tomography and is indicated by narrowed temporal horns and symmetrical herniation of the cerebellar tonsils (p<0.001). There was a significant difference (p<0.001) between intoxication (or asphyxia) and all other causes of death; the former causes demonstrated higher deviations of the attenuation between white and gray matter (>20Hounsfield Units), and the gray to white matter ratio was >1.58 when leukoencephalopathy was excluded. ConclusionsDespite normal postmortem changes, generalized brain edema can be differentiated on postmortem computed tomography, and white and gray matter Hounsfield measurements help to determine the cause of death in cases of intoxication or asphyxia. Racking the brain about feasible applications for a precise and reliable brain diagnostic forensic radiology method has just begun.

Forensic radiology in dentistry.

Radiography can play an important part in forensic odontology, mainly to establish identification. This may take the precise form of comparison between antemortem and postmortem radiographs. Radiographs may also be taken to determine the age of a minor victim and even help in the assessment of the sex and ethnic group. Comparable radiographs are an essential factor to confirm identification in a mass disaster.

English

English

Application of Radiology Techniques and Technologies in Forensic Investigations

Forensic radiology is a specialized area of medical imaging which is used for the purpose of evaluation by the forensic experts, physicians, pathologists and anthropologists in cases related with the law. The imaging technologies and techniques can be potential and powerful tools in solving the medico legal cases in the field of Forensic Medicine &amp; Toxicology. Here Forensic experts evaluate the medico legal cases by effectively utilizing their knowledge and experience of recent radiological techniques and technologies. In this article along with the brief history, different modalities of Radiology which have various applications in medico legal investigations with certain advantages and disadvantages, record keeping of data produced, the safety aspects of these technologies, economical aspect of using them along with its current status in a global perspective and its future role and challenges have been discussed.

The use of cone beam computed tomography in forensic radiology

Abstract Cone beam computed tomography (CBCT) is a relatively recently-developed CT technology that is currently used primarily in maxillofacial applications. CBCT may also be very useful in some forensic contexts, offering several advantages for postmortem forensic imaging including good resolution for skeletal imaging, relatively low cost, portability, and simplicity. Here we present an overview of CBCT technology, comparing and contrasting to conventional CT in regards to various forensic applications, and conclude that CBCT may be an advantageous and accessible alternative in many cases.

Use of post-mortem computed tomography in Disaster Victim Identification. Positional statement of the members of the Disaster Victim Identification working group of the International Society of Forensic Radiology and Imaging; May 2014

Use of post-mortem computed tomography in Disaster Victim Identification. Positional statement of the members of the Disaster Victim Identification working group of the International Society of Forensic Radiology and Imaging; May 2014 Bruno Morgan , Abdullah Alminyah , Allan Cala , Chris O'Donnell , Denise Elliott , Guillaume Gorincour , Paul Hofman , Morio Iino , Yohsuke Makino , Artur Moskata , Claire Robinson , Guy N. Rutty , Antti Sajantila , Jacquie Vallis , Noel Woodford , Krzysztof Woźniak , Mark Viner 2

3rd Congress of the International Society of Forensic Radiology and Imaging (ISFRI) – Impressions from Marseille

3rd Congress of the International Society of Forensic Radiology and Imaging (ISFRI) – Impressions from Marseille

İnsan İskeletinden Kimliklendirmede Kemik Protezlerinin Önemi Olgu Sunumu

Bu çalışmamızda; fethi kabir yapılarak elde edilen kemiklerden Radyolojik inceleme yoluyla cesedin iddia edilen kişiye ait olmadığı tespit edilen bir negatif kimliklendirme vakası sunulmaktadır. 2009 yılında ölen bir kadın kasaba mezarlığına defnedilmiş, bunun ertesi günü aynı kasabadan diğer bir kadın hayatını kaybederek aynı mezarlığın başka bir bölgesine defnedilmiştir. Davacıların iddiasına göre; ölen ablasının mezar yerini unutması nedeniyle davalı tarafından annelerine ait mezarın başındaki taş sökülerek hemen yanındaki boş bir mezara dikilmiş, inceleme konusu mezara da davalının ablasının ismi bulunan mermer bir mezar yaptırılmıştır. Davacılar, annelerinin 2006 yılının sonlarında sağ kalçasındaki kırık nedeniyle ameliyat olduğunu ve protez takıldığını belirterek buna ait tıbbi belgeleri mahkemeye delil olarak sunmuşlardır. Fethi kabir yapılarak çıkarılan ceset üzerindeki makroskopik incelemede proteze rastlanmaması üzerine kemiklerin radyografileri de çekilmiştir. Mezardan çıkarılan kemiklerde herhangi bir protez, ortez vida ya da metal cisim olmadığı, her iki femur başının yerinde olduğu saptanmıştır. Dolayısı ile davacıların iddiasının aksine inceleme konusu mezardaki cesedin annelerine ait olmadığı tespit edildiğinden DNA incelemesine gerek görülmemiştir. Sonuç olarak olgumuz, antemortem ve postmortem radyografilerin karşılaştırılmasının kimliklendirmede ne kadar büyük bir değere sahip olabileceğini ortaya koymaktadır. Bu durum, sağlık kuruluşlarında radyolojik görüntü kayıtlarının olabildiğince uzun süreyle ve güvenli bir biçimde saklanması gerektiğini de göstermektedir.Anahtar Kelimeler: Kimliklendirme; Adli Radyoloji; Kemik Protezi; Fethi Kabir

Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death.

Whole-body postmortem computed tomographic (CT) angiography is a promising new development in forensic radiology that has the potential to improve vascular and soft-tissue imaging beyond levels currently achievable with unenhanced postmortem CT. Postmortem access to the vascular system and injection of contrast medium are different from those steps in clinical (antemortem) radiology. Because there is no circulation in a corpse that could transport or dilute a contrast medium, the injection must be performed by using a roller pump to fill the vasculature (arterial and venous) with a mixture of a water-soluble iodized contrast medium and polyethylene glycol. In contrast to a classic autopsy, postmortem CT angiography is a minimally invasive procedure. It allows the diagnosis of vascular lesions without the disruption or destruction of anatomic structures, which could result in a loss of evidence in a criminal investigation. Furthermore, postmortem CT angiography facilitates the display of vascular pathologic conditions in areas that are not typically covered with autopsy alone, such as the craniocervical junction and the small pelvis. Therefore, postmortem CT angiography adds substantial value to the classic forensic autopsy; cross-sectional data can be reevaluated objectively at any time and are fully reproducible as counterexpertise, which is as useful in the fields of forensic medicine and pathology as in clinical research. Familiarity with the capabilities of postmortem CT angiography may help radiologists working with forensic cases improve their diagnostic performance.

Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols.

Forensic radiology is a new subspecialty that has arisen worldwide in the field of forensic medicine. Postmortem computed tomography (PMCT) and, to a lesser extent, PMCT angiography (PMCTA), are established imaging methods that have replaced dated conventional X-ray images in morgues. However, these methods have not been standardized for postmortem imaging. Therefore, this article outlines the main approach for a recommended standard protocol for postmortem cross-sectional imaging that focuses on unenhanced PMCT and PMCTA. This review should facilitate the implementation of a high-quality protocol that enables standardized reporting in morgues, associated hospitals or private practices that perform forensic scans to provide the same quality that clinical scans provide in court.