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Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Radiographing Prison Inmates and Forensic Radiology 7 18 2012

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Page 1: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Radiographing Prison Inmates

and

Forensic Radiology

7 18 2012

Page 2: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Radiographing Prison Inmates

Base on article by Linda Rarey, MA, CNMT, R.T. (R)(N)Radiology Technology magazine May/June 2011

Page 3: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

US has highest incarnation rate in world (2008)

• 754 inmates per 100,000 US residents

• Or approximately 2.2 million total• (includes Federal, State, City, & County)

• Thousands will be brought to medical facilities to be treated for diseases and injuries

Page 4: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Prison vs. Jail

• One year or less generally stay in City or County: jail

• (may have own basic medical units)

• Longer sentences go to state or federal: prison

• (may have huge medical facilities available)

Page 5: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Prisoners have many medical issues

• Hepatitis B &C• AIDS and HIV• Tuberculosis• Dementia (2X rate regular population- may eventually require 24 hr care)

• Substance abuse• Medication/pharmacy needs• Skin problems- lice, scabies• Cirrhosis • Women must receive mammograms after age 40

Page 6: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

“Maximum Security Nursing Home”

• Most prisoners considered to have health of someone 10 yrs older than non-incarcerated person due life style and poor previous health care

• Inmates over 50 are considered “older”

• By 2025 estimated over half of prison population will be over 55 yrs old

Page 7: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Conditions warranting transfer to outside hospital facility

• Cardiac arrhythmia or suspected heart attack

• Severe hypertension or shock

• Respiratory conditions requiring blood gas monitoring (severe asthma or need intubation

• 2-3 epileptic seizures per day

• Closed head injuries with loss of consciousness, nausea or vomiting

• Acute mental status change

• Suspected TB

• Drug overdose

Page 8: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Federal and State can have huge medical facilities

• May have hospital wards with several beds up to full ward equal to a secondary hospital

• Some institutions have mobile unit come to parking lot

• Usually no ultrasound, MRI,PET (positive emission tomography) or CT

• Majority of injuries are sports or work related

So you may get them at your hospital or clinic!

Page 9: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Transportation of Correctional Pt.s

Page 10: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

• Extensive logistical planning to get pt to hospital

• Correctional environment well controlled, have cameras aimed at all areas

• Once the prisoner is outside the correctional institution, all bets are off

• Vulnerable to possible escape attempt or gang attack to free member

• Prisoner comes in handcuffed, possibly shackled

• May be several armed guards, usually from sheriff’s dept.

Transporting Inmate

Page 11: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Ethics• Prisoners should be treated with

same kindness, compassion and professionalism as any other pt.

• Provide sound and visual privacy when possible

• However, safety of yourself and others must be considered!

• All inmates should be considered to be potentially violent

Page 12: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Safety considerations

• Introduce yourself with title only, not your name

• Remove or cover name tag

• Turn film badge backwards

• Remove any personal effects in area that might help inmate find way to contact you

Page 13: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Safety tips cont’d

• Remove sharp objects or anything that could be used as a weapon

• Remove any drugs from room!

• Do not give pt newspaper, access to restroom or visitors

• Do not ride in same elevator as correctional pt

• Do not discuss time, date or location of next medical business with prisoner

Page 14: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Correctional Pt’s Attitude

• May be scared and confused in strange environment

• May have mental disturbances such as paranoia

• May be going through drug withdrawal

• May not be good at following directions

• May not like being told what to do!

• May have poor impulse control

• May become belligerent and uncooperative

May think you look pretty cute!

Page 15: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Finding out what prisoner is in for…

• Don’t do it!

• It may compromise your ability to treat pt without bias

• Guards, guns and handcuffs tell you all you need to know!

Page 16: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Engage in friendly conversation

• If you have a death wish!

• Most inmates will be friendly and are grateful for a little adventure –some aren’t!

• Avoid having personal conversations with inmate or with others within earshot of inmate

– (You don’t want to inadvertently reveal personal information about yourself, family or co-workers)

• Do not share e-mail or phone #

• Prisoner may try to gain your sympathy and manipulate you to help him/her out in some way

• Do not distract correctional officer with idle conversation

• Some released inmates commit crimes to return for continued health care!

Page 17: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Work around restraints

• If possible, leave all restraints on and be creative

• If they must be removed to perform exam (by

officers, only at their discretion !) leave leg shackles on for upper body, handcuffs on for lower body

• Have them put back on ASAP

• Plastic ties may be used on feet or wrists during CT or MRI

• Make sure deputy stays close by! (major cause of hospital escapes, injuries and death are

because officer not vigilant!)

Page 18: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

If Inmate begins acting hostile or strange:

• Position yourself close to the exit door

• Step back cautiously never turning your back

• Immediately enlist aid of every deputy in earshot!

Page 19: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

The End

More

Complete exam accurately and quickly and send pt on way ASAP!

Page 20: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Forensic Radiology

Based on article “Forensic Radiology” by Lois Romans, BS, RT (R)(CT) University of Michigan

Page 21: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

• Science of using X-rays and other imaging technology to assist in investigating and gathering evidence for use in a court of law, in civil and criminal cases

• Radiologist becomes a detective

• Radiographer has key role in producing the images that will serve as clues and evidence

Forensic Radiology

Page 22: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Brief history of Forensic Radiology

• Ability to produce images using x-radiation was discovered in 1895

• (considered to have had largest impact on medicine in history)

• Within weeks , man shot another man in leg– Bullet not found by probe or physical

exam– Wound healed, but remained

symptomatic– Received x-ray, bullet found, shooter

convicted of attempted murder, got 14 years in jail

Page 23: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Considerable controversy at time

One judge refused to admit x-ray as evidence- claimed it was “like using a picture of ghost”

Dec 1896 judge handed down landmark decision allowing x-rays to be used as evidence

• Main problems:

– up to 70 minutes to produce image – huge dose radiation dose

Page 24: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Uses of X-ray for Forsenic Radiology

Investigating suspicious deaths and murders– X-rays of deceased taken prior to autopsy sometimes reveal cause of death, or

suspicious circumstances

• Analyzing "adverse medical events“– During a hospital stay or medical procedure, something goes wrong -causing injury

to pt, forensic radiology can provide clues and evidence of what has happened

• Legal Matters---in assault, X-ray shows proof of injury

• Child Abuse Cases---evidence of acute and chronic injury

• Drug Trafficking---determines if suspect smuggling drugs by ingestion or insertion into body cavities

Page 25: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Adolph Hitler

• After war, speculated and rumored he had not committed suicide and not dead

• Antemortem (before death) skull x-rays were found showing distinctive dental work

• Burned remains were x-rayed, positive ID made

Page 26: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Dr. Josef Mengele

• “Angel of Death” in Germany during WWll– Performed surgeries without anesthesia– Experimented on twins then killed them and

dissected bodies– Limbs cut off, isolation experiments, froze victims to

death– Injected bodies with different chemicals to see how

they would responds– When he was done, person sent to oven

• Escaped after war

• Went from Germany to S. America-practiced medicine

• In 1985 a body was found purported to be his• Corpse x-rayed found to have abnormalities

consistent with known accidents and illnesses but no antemortem radiographs to compare

• Family reluctantly gave up dental x-rays• -result positive ID

Page 27: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Fingerprinting

• In late 1800’s tips of fingers lightly coated with powered lead teroxide and radiographed revealing fine fingerprints

• Ink replaced- cheaper and faster– Lead dust a health hazard

• Now a method used for recovering latent prints on difficult surfaces (wax, cardboard, cloth, skin)

– Uses XFR: (X-ray Fluoresence Radiography) uses emission of secondary or “compton scatter” when bombarded with high-energy x-rays

Page 28: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

HOW XRF WORKS

Reveals elemental composition of sample by shining a thin beam of X-rays onto it without disturbing sample

All chemical elements emit and absorb radiation at a "signature" frequency of light. (sodium emits primarily orange light, while oxygen (used in neon lights) emits green light)

Scientists can pass collected light through instrument called a spectrograph to spread it into a spectrum, much like visible light spreads into a rainbow of colors by a prism

Scientists can tell what chemical elements are present in a given sample by carefully studying how the spectrum becomes brighter or darker at each wavelength

Page 29: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Mummies

Detection of hidden valuables, age, sex, embalming methods injuries and diseases

Page 30: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Volume-rendered image of CT

Mummy

Page 31: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Never trust anyone!

• One attorney x-rayed a will on parchment

– Radiograph showed it was extremely thin in one area, suggesting some names were erased, others added

Page 32: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Standards and Credentials

• There is none!

• Anyone can read or take images with no additional training

• X-rays often taken by people with no training

No consistency, positioning not accurate -difficult to match and compare postmortem with antemortem studies

Page 33: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Advantages of being Forensic Radiographer

• Pt never has to get up to go to bathroom

• Pt never complains of waiting too long

• Never breaths in middle of exam

• Never moves in middle of exam

• Doesn’t have to be shielded

• Doesn’t complain about repeats or too much radiation exposure

Page 34: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

But do you have the stomach for it?

Page 35: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Body Bags• Initial fluoroscopy

screening of body bags prevented pathologists from harming themselves on unexpected sharp objects

• Forensic radiographers have on rare occasions found unexploded grenades!

Page 36: Radiographing Prison Inmates and Forensic Radiology 7 18 2012
Page 37: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Forensic Radiography can:

• Find bullets that may have migrated to be used as evidence in court

• Detect fx’s in suspected child abuse cases

• Help determine causes of death

• Along with dental records and DNA analysis, radiological images can identify unknown victims

• Give families closure ( by body Identification) even from as far back as Korea and Viet Nam

• Makes possible to issue a death certificate (id) so wills may be probated, death benefits paid out, or spouses can remarry (otherwise must wait 7 years to be declared legally dead)

Page 38: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

• When body decomposed or severely burned in fire, radiograph may still be able to help ID pt and possibly determine cause of death

Page 39: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

World Trade Center

• Huge team of fingerprint examiners, anthropologists, radiologists must work together for ID

• Forsensic odontologist- works with dental charts

• Forsensic Anthropologist- determines height, weight, ethnic group, sex

Page 40: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Forensic Radiologist can:

• ID body from fX’s, surgeries, diseases even phleboliths in abdomen

Page 41: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Determining Sex of Victim

Page 42: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Age Determination

• Can be accurately determined from 20th week of gestation until early adulthood (using dental and bone age exams)

• Over age 25 difficult to determine biological age of person

Page 43: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Detecting Fraud By X-raying Paintings

Page 44: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Art ForgerySome art dealers claim that 15% of all art pieces sold at auctions are fake

Past curator at Metropolitan Museum of Art in New York stated approx 40% of all art pieces proposed to him for purchase by museum were forgeries

Throughout history canvas and wood panels have been very expensive so many artists just painted over the top of previous paintings

Sometimes as many as 7 times (layers underneath known as “underpaintings”)

Page 45: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Art Forgery cont’d

• Legitimate art may have underpainting (or be an underpainting!)

• Alleged painting by Picasso (Absinthe Drinker) was found to have abstract painting below it which historically is impossible

• Another painting was alleged to be painted by Strigel in 1460. After being radiographed, a painting by another artist who lived 250 yrs later was found underneath it

Page 46: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Van Gogh

Page 47: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Master Forgers

• Yves Chaudron: (C 1900)

Reputed to be one of most gifted counterfeiter in art world

A respected conservator but really a master forger

Would copy great paintings which had been lost or stolen, which his collaborator would then sell collectors

Most notoriously responsible for copying Mona Lisa after 1911 painting theft from Louvre

Page 48: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Migrant Worker Smuggling Detection

Page 49: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Migrant Worker Smuggling Bust

• 513 migrants packed into 2 trucks

• Each paid up to $ 7,000 USD for trip from Guatemala to United States, risking life in order to find work

Page 50: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Drug smuggling

Page 51: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Drug Smuggling

Labrador retriever with parcels of cocaine inserted between stomach and skin lining by vet in Colombia prior to export to Europe

Page 52: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Drug Smuggling

Page 53: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Airport Scanner

Page 54: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Airport Scanner

Page 55: Radiographing Prison Inmates and Forensic Radiology 7 18 2012
Page 56: Radiographing Prison Inmates and Forensic Radiology 7 18 2012
Page 57: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Effects of x-raying scanning on film at airport

Page 58: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Courtroom Testimony

• Radiologic technologist could be called into court to testify under oath as “fact witness”– Product liability– Personal liability– Property liability– Malpractice– Testifies only about what can be perceived by 5 senses

• (proper ID of Pt, labeling, procedure etc)

• Radiologist may be called in as “Expert witness”- not only testifies on basis of personal knowledge- but offers opinion– Simplifies complex or scientific issues for easy understanding by those

with no experience

Page 59: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

MRI and CT

• Studies have shown that “digital (or Virtual) autopsy” can be very useful, possibly replacing classic forensic autopsy

– Faster– Cheaper (30 minutes vs

several hours)– Leaves body intact– Images can be

reconstructed in different ways

Page 60: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Three-dimensional volume-rendered image of skull

Shows comminuted fracture of posterior skull

Page 61: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

Is you diamond fake?

• Real diamonds do not show up on an x-ray

• Glass, cubic zirconium and crystals all have slightly radiopaque quailities

• Diamonds are radiolucent

Page 62: Radiographing Prison Inmates and Forensic Radiology 7 18 2012

The End