radiology in identification.pdf

Introduction
• The use of radiological identification of skeletal
structures fall into 3 main groups:
1. General grouping: to determine whether bone are
actually present, whether they are human or not, and
basic features such as age sex.
2. Comparison of 2 sets of radiographs :one set taken
for diagnostic or therapeutic purposes while the other
set taken at time of examination>
3. Detection of bone abnormality (by comparison or
single bone examination): fractures, bone deformity,
congenital defects or diseases

General grouping identification
Species identification:
• Serology
• Where as there are soft tissue fragments,
radiology may be more convenient than
dissection.
Bear paw mistaken for a human hand.

Sex identification
• Differentiation of sex by skeletal radiology is unreliable
until after puberty.
• In general, the male skeleton is more robust and heavier,
with more prominent attachment for muscles and
tendons.
• With aging, there is a tendency for more degenerative
and hyperostotic changes in the male skeleton. Male long
bones are about 110% the length of female long bones.

Sex identification: Pelvis
• Pelvis offers the most definitive traits of sexual differentiation.
1. The subpubic arch: (subpubic concavity) is narrow and triangular
with an inverted V-shape in the male and broad and with an inverted
U-shape in the female.
2. The pubic bone tends to be long and narrow in the male and broad
and rectangular in the female.
3. The sciatic notch is deep and narrow in the male, and is wide and
shallow in the female.
4. The preauricular sulcus (paraglenoid sulcus) when present is one of
the most dependable indicators of femaleness.
A: male pelvis and B: female pelvis, victims of the Air India disaster. Note the
differences in configuration and, especially, the preauricular sulcus (arrows) in the female.
A: male pelvis. B: female pelvis. Differential characteristics are
emphasized with
bold lines and arrows

• Pelvis offers the most definitive traits of sexual differentiation.
5. The obturator foramina are large and oval or round in the
male, but small and triangular in the female.
6. The acetabular fossae are large and directed laterally in the
male, and are smaller and directed anterolaterally in the
female.
7. The ilial alae are high and vertical in the male, and broad
and laterally divergent in the female.
8. The sacrum in the male is narrow, has a relatively flattened
curve and has five or more segments. The female sacrum is
broad and short with five segments and an anterior
concavity.

• Pelvis offers the most definitive traits of sexual
differentiation.
9. The pelvic inlet is triangular or heart-shaped in the male,
ovoid in the female.
10. The muscle markings are more prominent and rugged in
the male. The female bony pelvis tends to be smooth
and gracile.
11. Osteitis condensans ilii is a triangular area of increased
bony density on the ilial side of the sacroiliac joint,
usually bilateral, found almost exclusively in parous
women in the child-bearing years
Osteitis condensans ilii. A triangular area of increased density (arrowheads) on
the ilial side of the sacroiliac joint in women during the child-bearing years.

Sex identification: Skull
• Hyperostosis interna frontalis is an overgrowth of
the inner table of the frontal bone, often florid,
found almost exclusively in middle-aged or older
females and is a valuable characteristic for sex
determination .
• Parietal thinning is a condition of postmenopausal
females in which profound osteoporosis causes
symmetrical resorption and virtual disappearance of
the outer table and diploë of the parietal bones

Sex identification: others
• Costal cartilage mineralization patterns
Schematic drawing of patterns of costal
cartilage ossification useful in determining
the sex of human remains.
A: typical male pattern;
B: male pattern initially involving
only the inferior margin of the costal cartilage;
C: typical female pattern;
D: uncommon pattern more often found in
females than males;
E: string of rounded ossifications believed
specific for elderly females.

Sex identification: others
• Bi-partite patella
Bi-partite patella is a common
anatomical variant in adolescents,
and is nine times more common in
boys than girls. It is seen as a
separate ossicle (or ossicles)
occupying the upper outer
quadrant of the patella.

Age identification: Ossification center appearance
Intra uterine
9th week IU: all cervical & thoracic vertebral bodies,
iliac wings, femoral, tibial and fibular shaft centers
21th – 25th week: calcaneus
24th – 28th week: talus
35th week: lower end of femur
39th week: proximal tibia
N.B. biological variations

Age identification: Ossification center appearance
Extra uterine
• 1 year : head of humerus ,femur and tibia .
• 2 years : lower radius and tibia.
• 3 years ; Patella.
• 4 years ; upper fibula ,greater trochanter of femur.
• 5 years lower fibula
• 6 years ;head of radius ,lower ulna.calcanium
N.B. biological variations

• Below1 year as
ossific center of the
head of femur not
appeared.

What is the age ?
• Above 2 years.
Ossific center of
lower radius

Age identification: Epiphysial fusion
Long bones
Development and ossification of a long bone.
A : cartilagineous anlage
;B appearance of primary ossification center in shaft or diaphysis;
C: primary center begins reorganization into cortex, medulla, and (with perichondral
ossification) the metaphysis or growing end of the shaft;
D: appearance of (2) secondary ossification center
E: the differential between cortex and medulla is well established, epiphyseal development
continues with growth in length taking place at (3) the epiphyseal cartilagineous plate ;
F: the epiphyseal plates (4) have closed by ossification, growth has ceased; the bone has been
modeled into its adult shape and form with well-defined cortex (c) and medullary canal (m).

Cervical vertebra
Atlas: 2 halves of the arch unites posteriorly at the
age of 6 years
Axis : formed from 4 portions which unites
• Posteriorly at the age of 1.5 yrs
• Anteriorly at the age of 6 years

Long bones
Upper limb:
• Humerus:
1. Trochlea & capitulum together at 14 years
2. Trochlea & capitulum with the shaft at 15 years
3. Medial epicondyle at 16 years
4. Lateral epicondyle at 17
5. Upper end at 20 years

What is the age ?
• >20 years (united
head of humerus)

What is the age ?
• <20 (not united head of
humerus with the body)

Long bones
Upper limb:
• Radius, ulna and hand bones:
1. Upper end of radius at 16 years
2. Upper end of ulna at 17
3. Lower end of radius and ulna at 20 years
4. Metacarpal and phalyngeal bones at 18 years

What is the age ?
• < 20 ( non united lower
ends of radius and ulna)

Long bones
Lower limb:
• Femur:
1. Lesser trochanter at 16 years
2. Greater trochanter at 17 years
4. Lower end at 21 years

What is the age ?
• >18 years (united head of
femur)

Long bones
Lower limb:
• Tibia and fibula:
2. Lower end at 18 years
• Metatarsal and phalyngeal bones:
At 18 years

What are the ages ?
• above18
• below18

Long bones
The final epiphysis to close is at the medial end of
the clavicle during the third decade of life

Long bones
• From about age 25 to 50, the anthropologists rely
heavily on the external appearance of the skull sutures
and the pubic symphysis, and these criteria do not lend
themselves readily to radiological evaluation.

Age identification: progressive resorption and
remodeling
• Medullary cavity of upper humerus: reaches surgical
neck at fifth decade and by sixth and seventh decade
moves up to the epiphyseal line.
• At the proximal end of the femur, the cavity
advances (at the expense of trabecular bone) to the
level of the surgical neck during the fourth decade
and reaches the epiphyseal line between 61 and 74
yr.

Determination of age from flat bone
examination
- Sternum

What is the age?
• < 15 y (non-
united
segments)

Age from hip bone examination:
• Two pubic rami of the hip (6y)
• Suture at the acetabulum (15y).
• Ischeal tuberosity with the ischium (21y).
• Iliac crest with the ilium (23y).

What is the age?
• >23 y (iliac crest)

>18 y (head of femur)<23 opened iliac crest >23 y (iliac crest)

Comparative identification
Cephalometric indices
• The essential process in visual matching is
the presence of 2 sets of radiograph.
1. Obtained from previous diagnostic episode.
2. Taken at the time of examination.
• The most helpful area is the skull.

Cephalometric indices
• 8 measurments used for the comparison:
1. 5 breadthes:
I. Bigonial
II. Bimaxillary
III. Bizygomatic
IV. Maximum cranial
V. Sinus
2. 3 heights:
I. Mastoid to apex
II. Total facial
III. Incisor height

Frontal sinus radiology
• The frontal sinuses, especially, develop unique
scalloped margins with internal septae and
pseudoseptae.
• The frontal sinuses are as unique to the
individual as his fingerprints.
• Even identical twins will have different frontal
sinus patterns.

• Comparison of frontal sinus configuration is easy on
frontal view radiographs of the skull, even with
considerable variations in angulation or projection
between two radiographs.
• Elaborate systems of mensuration and classification of
the sinuses, have been proposed particularly by the
anthropologists, but such elaboration is not really
required.
• Simple “eyeball” comparison will suffice in virtually
every case.

• Frontal sinus are raiographes in 2 views:
1. Occipito-mental
2. Occipito-frontal

• Unfortunately, the frontal sinuses are susceptible
to severe fracturing and distortion in automobile
and aircraft crashes, and, sinuses may explode
inconditions of extreme sudden heat.
• Even fragments of frontal sinuses may contain
such distinctive patterns that comparative
identification is possible

• The measurements are done according
to the sequence bellow :
a) The first step was to place the
radiography on a viewer box and draw
a line directly on it between both
orbital cavities, at the nasofrontal
suture;
b) The diameter of the frontal sinuses at the
widest points that was the distance
between two projected lines that
delineate the maximum lateral limits of
the rightand left sinuses
c) The height was done by drawing a parallel
line to the nasofrontal line at the highest
superior point of the frontal sinuses; and
d) measure the distance between both.

(A) The antemortem view has a different projection than (B) the postmortem view.
Still, there is no doubt that the sinuses are exactly the same in terms of
configuration and the shape of the central septum.

Wrist and hand radiology
• Shape and proportion of phalanges
• Width of cortices and medullary cavities
• Shape and size of styloid processes of radius
and ulna

Chest
• The pattern of costal cartilage ossification
may be unique. Ossification of costal cartilage
is a dynamic progressive process and attempts
to match patterns over time lapses are fraught
with difficulty.
• Sternum, clavicle or scapula

(A to D) Detail of the cervicothoracic junction of chest radiographs of the same person over a
50-year interval. Note the identical configuration of the bony landmarks. The first
costochondral cartilage became ossified during this period of observation.
(E to H) The same studies are shown on the right with anatomic details outlined to assist the
inexperienced viewer in seeing the similarities.

Detection of bone abnormality (by
comparison or single bone
examination)
• Anomalous or Unusual Development
• Disease
• Tumors
• Fracture and related sequelae
• Iatrogenic interference
• Harris lines

examination)
• Anomalous or Unusual Development
The dorsal defect of the patella,

examination)
Disease or Degeneration
• Judging from the literature, matching skeletal
remains by lesions secondary to a disease
process is rare.
• However degenerative changes are frequently
helpful or definitive.
Ante and post mortem CT for a case of paget disease of the
bone help in identification

examination)
Bone tumors
• Bone tumors are relatively uncommon.
• In young persons, bone islands, nonossifying
fibromata, or osteochondromata might
sometime be found in a decedent.
A: post-mortem and B: ante-mortem pelvic radiographs matched by
an unusual bony excrescence on the left iliac crest (arrows).

examination)
Fracture and related sequelae
Old fractures with deformity, callus formation,
angulations, or other unique abnormalities
which can be compared on two films
separated in time form a vital part in
identification.
A: dried skeletal remains of a young adult male. B: slight deformity of the left clavicle from an old healed
fracture of the lateral third. C: close-up of left clavicle in corner of ante-mortem chest radiograph. Note the
irregular configuration and altered trabecular pattern related to the old healed fracture. D: with careful
positioning of the dried clavicle a radiograph, E: reproduces the findings seen in the clavicle on the chest
radiograph.

examination)
Iatrogenic Interference
• Doctors and dentists leave their indisputable
markers in some bodies and they are a
godsend for identification purposes.
A: post-mortem and B: ante-mortem
roentgenograms of the forearm of a air
crash victim with “plate and screws” fixation
devices in place.

examination)
Harris’s lines
• Growth Arrest/Recovery Lines. Transverse dense lines
(black arrows) perpendicular to the long axis
of the bone in the metaphysis and migrate towards the
diaphysis with growth may indicate
a previous prolonged illness or debilitating state.
• Disappear after correction of the cause , so comparison
with previous x ray film must be close in time of
examination

radiology in identification.pdf

radiology in identification.pdf

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radiology in identification.pdf