Presentation forensic radiology

Forensic radiology

Dr.Nashwa MostafaMahmoudForensic Med & Clinical

Outlines:

• Def

• Historical overview

• Common techniques

• Scope of Forensic

radiology

Forensic radiology

Definition:

• Radiography is the creation of

radiographs by exposing a

photographic film or other image

receptor to X-rays. It is thus an

examination of the structure of

materials by non-destructive

methods.

• Forensic radiography is the

creation of radiographs for the

purpose of assisting with legal

investigations.

History

The first time an X-ray was used for a forensic

purpose was shortly after the technology was

invented.

In 1895, Wilhelm Roentgen discovered X-rays

and just a few months later, a bullet lodged in the

leg of a gunshot victim was shown in an X-ray

and the evidence was used in court to

successfully prosecute the accused for attempted

murder. In addition to living subjects, forensic

radiology is commonly used just before

autopsies. The science has developed over the

years to include CAT scan, MRI and ultrasound

technologies.

Common techniques:

1. x-ray (roentgen ray):

• an energy form of ionizing

radiation from which may be

produced fluorescent or

photographic images “films”.

• forensic radiology depended

almost exclusively on the x-

ray and the static image

captured on the radiograph. Chest roentgenogram,

radiograph, Or X-ray

“film.

2. Fluoroscopy :electronically

enhanced and directly visualized

x-ray in real-time motion, cine-

photographed, videotaped, or

digitized and stored on magnetic

tape or disks for replay

A modern fluoroscope with an

image intensifier connected to a

television camera. The televised

image (arrow) can be seen

without darkening the room.

Common techniques:

Mortuary X-Ray RoomDental x-ray machine

Common techniques:

3. Computed axial

tomography : “CAT

Scan” as computed

tomography or CT scans

passed through the body

over multiple diametric

pathways in the axial or

cross-sectional plane

resulting in a series of

images of cross- axial

sectional ‘slices ‘, a much

higher differentiation

between body tissues

than conventional x-ray .

Common techniques:

CT slice of heart showing tumor

(arrows)

in interventricular septum

4. Magnetic resonance imaging

(MRI) :

• Utilizes strong magnetic fields to

generate electromagnetic signals

from elements and compounds

found in body fluids and tissues .

• Can obtain multiplanar,

multidirectional, sectional images

or slices (MR scans)

Common techniques:

MRI of cardiac tumor

(arrows) shown in the

previous figure

5. Ultrasound or

ultrasonography :

• Sound waves generated

outside the body by transponders

are reflected back from internal

structural interfaces to be

recaptured and converted into

real-time or static images.

• The image is a sonogram

Common techniques:

US of the same heart showing

a tumor (arrows) in

interventricular septum

6-Angiography

:

•Vertebral

angiography in

case of

subarachnoid

hemorrhage

•In case of

cerebral

embolism

Common techniques:

right carotid

arteriogram shows

occlusion of the right

middle cerebral artery

by lead pellet

embolus (arrow).

The situations in which forensic

radiology can be applied to

resolve legal matters are many

and varied:

1. Determination of Identity

2. Evaluation & documentation

of Injury or cause of Death

3. Criminal Litigation

4. Civil Litigation

5. Recent advances ; Virtopsy.

6. Education & Research

SCOPE OF FORENSIC RADIOLOGY

Radiograph

y can

speak

I. Identification

Radiological techniques allow forensic personal identification of:

the ripped, lacerated corpses,

charred or carbonized corpses

macerated, putrefied or skeletonized corpses

in mass disasters, transportation injuries, airchrach, bomb explosions

I. Identification

I. Deductive (general or reconstructive)

identification:

Sex: radiographs of skull, pelvis and

sternum.

Age:

Appearance of ossific centers

Union of epiphysial plates

Calcification of laryngeal and costal

cartilages

Skull radiographs for examination of

fontanels, sutures and teeth.

Race; negro skull,

Stature

I. Identification

II. Comparative Identification:

Depends on comparing antemortem to postmortem X-Rays of a person.

Comparison includes:

Normal structures:

Comparison of skull bones, sinuses especially frontal sinuses regarding the size and shape ,Sellatursica & others

Other bones; ribs, hip, dental, chest and vertebral areas

Abnormal structures: congenital anomalies of bones, deformities and/or fractures, metallic prosthesis..

Dental radiographs: comparing root shapes, teeth fillings and abnormal teeth eruptions.

Personal objects & Jewells:

I. Identification

The frontal sinus is a triangular, pyramidal air

cavity in between the tables of the frontal

bone

highly variable nature, even among

identical twins.

stable structure during adult life

Its resiliency :It has very strong walls and

preserved intact in human remains.

Head & paranasal sinus radiographs are

taken commonly for diagnostic purposes

and almost everybody has one in his/her

health folder.

1. The frontal sinus

I. Identification

X-ray Comparison : matching of unique features; of external and internal

bony anatomy (several-fold, curvatures, trabuclae, septae) can be

made by superimposition or coding systems.

1. The frontal sinus

Comparison of frontal sinuses between ante-mortem (AM) and post-

mortem

(PM) skull films showing duplication of distinctive pattern of air cells,

margins, and septae.

I. Identification

1. The frontal

sinus

Appearance of Several Frontal

Sinuses in CTs

Frontal sinus CT is a more

precise than conventional

radiographs;

• avoiding the

superimposition of

structures beyond the

plane of interest

• the images can be easily

manipulated and internal

points that should be

evaluated can be shown

by images segmentation.

I. Identification

1. The frontal

sinus Frontal sinus CT is a more precise than

conventional radiographs;

• allowing the visualization of small

differences of density & thickening

• Craniometric points; precisely located and

measurements more accurately performed

than on conventional radiographs.

Volumes and areas can be determined.

CT skull using a “bone window”.

• C; bony thickening of inner table of frontal

bone on CT

• D; The “topogram” preliminary to the CT

scan, showing craniometric points,

I. Identification

2. Dental

radiographyPartially

skeletonized, badly

decomposed

remains of a female

body.Characteristic dental

features:

comparing root

shapes, teeth

fillings , abnormal

teeth eruptions,

artificial teeth

fillings, dental

sutures or teeth

archades Comparison of A : AM dental radiograph, with B :

PM one of disarticulated mandible. There is a

perfect match of both the restoration in the molar

and the broken- off drill bit tip.

I. Identification

2. Dental

radiography

A : PM radiograph of

mandibular fragment

compared with B : AM

bitewing radiograph. The

root canal work and

restorations are identical.bit

tip.

I. Identification

2. Dental

radiography

A : PM facial

roentgenogram shows

unique restorations and a

wire suture in the orbital

floor. B : AM panoramic

dental examination shows

identical findings.

I. Identification

3. Any characteristic bony

features

Dismembered trunk of a

female found in a sewer.

A : PM radiograph shows

peculiar beak-like

calcification of the 1st

costochondral junction, cx rib

bilaterally (arrows); B : AM

chest with identical

calcifications (arrow).A

B

I. Identification

A

B

A: PM and B: AM X-ray of the

forearm of a air crash victim

with “plate and screws”

fixation devices in place.

A: PM and B: AM X ray of an air

crash victim who had undergone

hip replacement surgery.

I. Identification

A

B

Radiograph of severely burned

remains on which no personal

effects were evident on external

examination. A wristwatch and

ring, clearly seen on the

radiograph, were not found on

initial autopsy. When recovered,

both items were instrumental in

identifying the victim.

4. Personal objects &

Jewells

II.Radiological detection & documentation of injury OR the cause of death

Radiological examinations play significant

role:

in differential diagnosis of non-

accidental fractures from accidental

fractures

in determination of radiological evidence

of physical abuse, Torture

medical malpractice cases

localization and type of bullets or shots

remained within body.

Pre autopsy ; to diagnose air embolism,

cerebral air embolism, barotrauma,

pneumothorax or pneumopericardium,

asphyxia

A. Radiology of injury

• Swelling, edema or

hemorrhage:

Subdural hematoma

around frontal lobe

(arrows) on CT.

I. Soft tissue

injury:



• Laceration of an

organ: knife wound to

the heart (arrow)

shown by MRI

I. Soft tissue

injury:



• Abnormal collection of

air in the chest →

pneumothorax:

• Right-sided

pneumothorax (arrow)

on plain CXR

I. Soft tissue

injury:



• Abnormal collection of air in the chest → pneumothorax: Left-sided pneumothorax (arrow) on CT scan of the chest with chest tube in place

I. Soft tissue

injury:



Pneumopericardium >> the dark

halo of air surrounding the heart

(arrows). There also is

pneumomediastinum outlining

the inferior border of the thymus

(open arrows).

I. Soft tissue

injury:



Battered child

cases:

A. Multiple

regional

fractures →

skull

II. Fractures:

In child abuse



Battered child cases: A. Multiple regional fractures → skull

II. Fractures:

In child abuse

Skull fissures on plain XR Skull fissures on CT



Battered child cases:Multiple regional fractures

→ Long bones →

metaphyseal fractures

(avulsion and dislocation

of epiphyseal ends):

Typical bucket-handle

metaphyseal fracture of

the distal humerus on plain

XR.

II. Fractures:In child abuse



II. Fractures: In child abuse


Rib fractures. A : typical healed posterior fracture

from AP compression. B : healed lateral rib

fractures.


II. Fractures:

In child abuse


Rib fractures. D :

(beads of string) with

multiple bilateral healing

fractures (note hazy

callus surrounding ribs).


2. Battered child

cases:

B. Fractures of different

ages: a new rib

fracture (arrow)

through one of the old,

healed fractur

II. Fractures:In child abuse


A. Radiology of injury `

II. Fractures:In domestic

abuse


depressed fracture of the

left zygomatic arch (arrows)

D : panorex study

shows fractures

through the left

mandibular angle and

right mentalis,

separation of teeth at

fracture site

hand showing new (arrows),

healing (open arrows), and

healed (curved arrows)

fractures with residual

deformity, and dislocation


typical “bumper

fracture” in an adult

pedestrian hit from the

right.

II. Fractures:In transporation

fractures



stabbing by glass

piece

III. Foreign

bodies:


Retained instruments after surgery: clamp

III. Foreign

bodies:

Retained instruments

after surgery: curved

needle (arrow)


A bottle was driven into the

victim’s face. The cap

stayed

behind as the bottle was

withdrawn.

III. Foreign

bodies:


III. Foreign

bodies:

A woman was found burned beyond recognition after a house fire. The

remains were radiographed in order to try to match them with the

occupant’s ante-mortem chest film. Showing; B revealed several coils of a

wire ligature around the victim’s neck. C positive radiological identification.

In charred mutilated

bodies


III. Foreign

bodies:

This middle-aged man was sent for a chest film ( A )

because of suspected heart disease. A round mass in the

left lung prompted a tomogram ( B and C ) which defined

the mass in frontal and lateral projections.

In transportation

injuries


III. Foreign

bodies:

At surgery ( D ) a gearshift knob

encapsulated in fibrous scar was removed.

The man had been in an automobile

accident 22 years earlier!


IV. Firearm

injuries

bullets: Fragmented

bullet within the head and

neck areas of a gunshot

wound victim.

Radiology role in gunshot

wounds:• In the location of the bullet

• Reveal whether there are bullets of a different

caliber (in cases where multiple weapons are

involved).

• The number of bullets is also important and

must be correlated with the entrance and exit

wounds .

• May also reveal information about the angle

and direction of fire. Small metallic fragments

produced when a bullet strikes bone may lead

directly to the bullet and clearly indicate the

bullet’s path

• The radiographs may reveal clues as to the

type of weapon . Shots; leave a characteristic

“lead snowstorm”


IV. Firearm

injuries

bullets: A bullet traversed the posterior elements of the C-1 vertebra (small

arrows), impacted on the posterior body of C-2 (open arrows), then dropped in the

spinal canal before coming to rest at the C-5 level (large arrow).

•The radiographs may reveal

clues as to the type of weapon .

Shots; leave a characteristic

“lead snowstorm”

• X-rays may be the first

indication that a crime has

been committed when

decomposed bodies are

discovered.

Radiology role in gunshot

wounds:


IV. Firearm

injuries

bullets: A : frontal and B : lateral view of the skull show a left temporal wound

of entry (arrowheads). There are scattered bone and bullet fragments

throughout. The bullet bounced off the sella (open arrow). The jacket (short

arrow) separated, and the bullet (long arrow) came to rest against the right

parietal bone posteriorly.


IV. Firearm

injuries

bullets: the characteristic sharp projections of the jacket

,exposed as the bullet mushrooms(dumdamized bullets)


IV. Firearm

injuries

bullets: CT reveals bullet deep in

posterior costophrenic sulcus (star

pattern). Bullet obscured on

routine chest film by density of full-

thickness liver.

A : bullet fired into the base of the skull

cut a groove in the occipital bone (large

arrow) scattering fragments (small

arrows) into the posterior fossa as shown

on CT examination.


IV. Firearm

injuries shots: (snowstorm

appearance)

A shotgun wound to the

back. The two pellets

overlying the lower pelvis

entered the urinary bladder

(arrow) after passing

through the right ureter.


V. Pre- autopsy :Pre autopsy ; to diagnose air embolism, cerebral air

embolism, barotrauma, pneumothorax or

pneumopericardium, asphyxia

A : fracture of the hyoid bone (arrow) from strangulation. B :

fractures of the superior cornua of the thyroid cartilage from

strangulation.


V. Pre-

autopsy :

Example of air in the heart of

a person suffering fatal

massive injuries in a

vehicular accident.

A : cervical spine examination shows massive

dissection of air in the soft tissue planes of the

neck. B : the CT scan demonstrates the fracture

of the anterior commissure of the larynx (arrow)

and air dissection in the soft tissues of the neck

(open arrows).


:Detection of

smuggling

I. Addictive agents (body packer):

Abdominal radiograph of a body

packer >> rounded and ovoid,

hyperdense packages,

III. In criminal cases:

Latex-covered narcotic

packages are shown in the

opened stomach of a body

packer who died of an

overdose when one of the

packages ruptured

:Detection of

smuggling


I. Addictive agents (body packer): CT of a body packer:

shows multiple drug packages somewhat denser than

the bowel, most of which contain entrapped air at the

ends of the packages.

:Detection of

smuggling


II. Jewels (larceny by

ingestion):

X-ray of the abdomen of a

suspected jewel thief.

Note the dense object

(arrow) in the shape of a

brilliant cut diamond.

IV. In civil cases:

• Determination of age for; Marriage, Consent of rape, Juvenile courts

• Evaluation , documentation & follow up in cases of disability & infirmity for compensation

• Evaluation , documentation & follow up in cases of medical malpractise X-ray on hands & wrist joint

>> less than 18 yr

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V.VIRTOPSY

The term virtopsy was created from the terms virtual and autopsy:

• “virtual” is ancient Latin for “useful

• autopsy is a combination of the Greek terms “autos” (self or with

one’s own) and “opsomei” (seeing with eyes): so “autopsy” means

“seeing with one’s own eyes.” we merged the two terms virtual and

autopsy deleting “autos” to create virtopsy

Virtopsy meant an objective documentation and analysis process of

physical features and evidence BASED on multislice computed

tomography (MSCT) and magnetic resonance imaging (MRI)

technology,(increasing both contrast and resolution and offering

possibilities of 2D and 3D reconstruction).

The aim was to establish an observer-independent, objective, and

reproducible forensic assessment method using modern imaging

technology, eventually leading to minimally invasive “virtual” forensic

autopsy.

V.VIRTOPSY

Virtopsy Technique: PM whole body imaging basically consists of

(a) body volume documentation and analysis using CT, MRI and

microradiology

(b) 3D body surface documentation using forensic photogrammetry

and 3D optical scanning. The resulting data set contains high-

resolution 3D color-encoded documentation of the body surface

and 3D volume documentation of the interior of the body

MLI of Virtopsy: Identification

Diagnosis of injuries & cause of death

Locatization of FB, firearm injuries,

Diagnosis of body packer

V.VIRTOPSY

Advantages over classic autopsy: •It brings information without body destruction of classic autopsy

•It can be used in cultures refusing classic autopsy

•Easily examination in contaminated bodies by infection, toxins &

radiation

• Mobile stable records can be visualized in courts

•Complete easily retrieval digital data archives with good

preservation evidences

Disadvantages or limitations: •Decomposed changes can be mistaken with pathological

changes

•Multiple gun shot injuries crossing with false tracts, cant be

differentiated

•Surface anatomic features & pathological changes cant be

captured as petechiae, pigmentation & colour change

Corpse identification with CT in different cases. (a) Oblique VR bone image in a

burned corpse shows a helical wire in the left humerus representing a rare

technique of humeral osteosynthesis. (b) AP the pelvis shows two screws in the

left femur. (c) AP of the knees shows replacement of the right anterior cruciate

ligament with screws in the femur and tibia. (d) AP of the lumbar spine shows

vertebroplasty with cement in the vertebral bodies, a finding that can be used for

identification.

(3) Increased intracranial pressure as the cause of death. (a) Coronal T2-weighted MR image

shows herniation of basilar parts of the cerebellum into the foramen magnum. (b) Autopsy

photograph shows the cerebellum, with swelling of the tonsils (solid arrows) and a pressure

mark caused by the foramen magnum (dashed arrows).

(4) Traumatic bleeding. (a) shows local hypointense areas (arrow) in the left temporal lobe that

reach the subarachnoidal space. These areas represent degenerative products of hemoglobin

and indicate trauma.

(b) Autopsy photograph of a slice through the temporal lobe of the formalin-fixed brain shows

trauma-related bleeding, predominantly in the cortex and subcortex (arrow).

Natural cardiac death. (a) MRI shows local hypointense areas (arrow) in the left

lateral wall, with areas of hyperintensity in the surrounding myocardial tissue. (b)

autopsy specimen shows hemorrhagic myocardial infarction (arrow) in the lateral

wall of the left ventricle.

(c) MR in a patient with chronic uremic cardiomyopathy shows massive eccentrically

hypertrophic ventricles in a so-called cor bovinum. (d) autopsy specimen helps

confirm biventricular eccentric hypertrophy (heart weight, 1070 g).

stab wound to the heart (a) MR I shows a myocardial injury (solid white arrow).

Subsequent pericardial tamponade (dashed white arrows) with medium signal intensity

and an upper layer of serum (black arrows) with increased signal intensity. (b) autopsy

specimen demonstrates transmural laceration of the left ventricle in the apical region

(arrow).

Lethal air embolism of the pulmonary artery in the victim of a gunshot wound to the

head. (a) AP 3D VR shows the air-filled right ventricle and pulmonary artery. CT-

volumetry showed 59 mL of gas within these two structures. (b) Autopsy photograph

demonstrates the procedure used to confirm the presence of an air embolism turning the

scalpel produces ascending air bubbles (arrow )

Pulmonary edema. (a) MRI of the thorax shows a global increase in signal

intensity throughout the lungs caused by an increased fraction of

intrapulmonary water. (b) autopsy specimen shows the loss of tissue water

after sectioning. Note the accumulation of the drained edema (arrows)

surrounding the thumbs of the forensic pathologist.

Severe postmortem bronchopneumonia. (a) CT scan shows complete air

displacement in the right lung. Only parts of the left lung are ventilated. (b)

MRI demonstrates increased signal Intensity throughout the right lung and in

parts of the left lung.

a gunshot wound to the head. (a) AP 3D VR CT shows an entrance wound

with sharp external margins and a cone-shaped bone defect from external

to internal. (b) Autopsy shows findings similar to those seen in a. (c) 3D VR

CT shows the exit wound and a cone-shaped defect from internal to

external. (d) Autopsy photograph reveals findings similar to those seen in c.

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Health & Medicine

Presentation forensic radiology