Forensic Radiology

Forensic Radiology
Prepared And Presented By: Majd Al-Qudah, MD

Outline
 Historical view
 Definition
 Modalities
 The scope of forensic radiology

Historical overview
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 CT scan, MRI
and ultrasound technologies.
Forensic Radiology by B. G. Brogdon, M.D

Definition
• Forensic radiology is the discipline which comprises the
performance, interpretation and reportage of
the radiological examinations and procedures which are needed in
court procedures or law enforcement.
• Radiological methods are widely used in identification, age
estimation and establishing cause of death. Comparison of ante
mortem and post mortem radiographs is one of the means of
identification. The scanning of baggage, vehicles and individuals
have many applications.

Definition
• Tools like helical computed tomography can be used for detailed
documentation of injuries, tissue damage and complications
like air embolism and pulmonary aspiration of blood. This type of
digital autopsies offer certain advantages when compared to
traditional autopsies.

Modalities and Techniques of
imaging:
The X-ray
The Fluorescent Image
Nuclear Radiology
Ultrasonography
Tomography ( CT Scan)
Magnetic Resonance Imaging (MRI)
Dental Identification
Angiography And Venography

Radiographs must be
taken before dissection.

X-Rays
• X-ray is the most common, basic and essential imaging method used
in forensic medicine.
• It serves to display and localize the foreign objects in the body and
helps to detect various traumatic and pathological changes.
• X-ray allows non-invasive evaluation of important findings before the
autopsy and thus selection of the optimal strategy for dissection.
• In child abuse and anthropologic cases, radiography is the imaging
modality of choice to evaluate subtle bone detail.
[The application of X-ray imaging in forensic medicine]. Kučerová S, Safr M, Ublová M, Urbanová P, Hejna P.

X-Rays
• Basic indications for postmortem X-ray imaging in forensic
medicine include gunshot and explosive fatalities (identification and
localization of projectiles or other components of ammunition,
visualization of secondary missiles), sharp force injuries (air
embolism, identification of the weapon) and motor vehicle related
deaths.
• The method is also helpful for complex injury evaluation in abused
victims or in persons where abuse is suspected.
[The application of X-ray imaging in forensic medicine]. Kučerová S, Safr M, Ublová M, Urbanová P, Hejna P.

X-ray imaging still remains the gold
standard method for identification of
unknown deceased.

Frontal radiograph of the chest from
a victim of a gunshot wound to the
chest. This image shows metallic
bullet fragments overlying the
heart and right lower chest. There
are right posterior rib fractures.
Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins

Fluoroscopy
• Fluoroscopy is a type of medical imaging that shows a continuous X-
ray image on a monitor, much like an X-ray movie.
• Fluoroscopy may be used to facilitate the localization and
recovery of metallic fragments or foreign bodies at autopsy
when they are not readily retrievable at dissection based
upon the localization of the object on radiographs.
• It may also be used for limited angiographic assessment of
vascular integrity by directly injecting the vessel of concern
with iodinated contrast material under fluoroscopic
observation.

Computed Tomography (CT)
Imaging
• CT imaging is a primary imaging modality in postmortem forensic
pathology.
• It is able to provide detailed visualization of skeletal
pathologies (bone age, intentional/unintentional injuries
and wounds) and air inclusions, as well as the presence of
foreign bodies (eg, drug ovules/packets, surgical sponges,
bullets).

Computed tomography (CT) imaging
• Its use in forensic pathology has been focused on cases of unnatural
deaths or suspected crime, and is preferred over the standard
autopsy in specific situations/settings (eg, putrefied, carbonized,
badly damaged bodies; preliminary evaluation in mass disasters).

(a) 2 separated fractures in the frontal and
temporal bone,(b) corresponding contusions

A CT scan showing retained surgical
sponge next to the uterus.
https://www.researchgate.net/figure/A-CT-scan-showing-retained-surgical-sponge-next-to-the-uterus_fig1_257536156

CT Angiography
CT angiography (CTA) aids in the evaluation of pathologies
of the cardiovascular system, particularly parietal and
luminal coronary changes (but it's not as effective for
detecting myocardial ischemia and necrosis).

Coronal maximum intensity-projection
reconstruction of superior mesenteric
artery shows extravasation around left
proximal branch of vessel. Rupture was
caused by massive compression of
thorax and upper abdomen.
Postmortem Whole-Body CT Angiography: Evaluation of Two Contrast Media Solutions. Steffen Ross, Danny Spendlove1 Stephan Bolliger1 Andreas Christe2 Lars
Oesterhelweg1 Silke Grabherr3 Michael J. Thali1 Erich Gygax4

Limitations Of CT Imaging
• Low soft-tissue contrast.
• The lack of haptic, olfactory, and color impressions.
• The absence of body samples for histopathologic, toxicologic,
or microbiological analysis (which can be overcome with
postmortem percutaneous biopsies).
• Access, cost, and operator experience are also potential
limitations.

Multidetector CT (MDCT) scanning
• MDCT scanning, also known as multislice CT (MSCT) scanning, is
emerging as the foremost cross-sectional imaging modality in forensic
medicine.
• Its speed, ease of use, and compatibility with metallic
fragments make it an excellent complement to autopsy.
• The cost and availability of MDCT scanners and personnel is the
most important limitation in integrating cross-sectional imaging with
autopsy.

Axial multidetector computed tomography
(MDCT) scan of the brain from a motor
vehicle accident victim who died from
multisystem blunt trauma. This axial MDCT
scan shows a hyperattenuating acute right
subdural hematoma (arrow). There is
diffuse edema of the right cerebral
hemisphere, compression of the ventricular
system, and subfalcine herniation.

Magnetic Resonance Imaging (MRI)
• Postmortem MRI has been used to assess soft-tissue and visceral
hemorrhage, ischemia, and tumors.
• Although the technical complexity, expense, and availability
of MRI make it more complicated to use as a routine imaging
modality compared to MDCT, it provides superior contrast resolution
relative to MDCT, making it a more optimal imaging modality to
visualize soft tissues.

Magnetic Resonance Imaging (MRI)
• Caution should be taken when imaging bodies that contain metal,
because ferromagnetic substances may pose potential harm or
cause significant image degradation when placed in the magnetic
field of the scanner.

MRI (T2-weighted) of the neck of
a victim of alleged manual
strangulation at the level of the
larynx. At external inspection,
the skin of the neck only
displayed very discreet
superficial excoriations. MRI,
however, showed a fluid (blood)
accumulation (arrow) on the
left side of the larynx.
Imaging and virtual autopsy: looking back and forward, Stephan A. Bolliger and Michael J. Thali, Published:05 August 2015

Nuclear Scan
• This is a nuclear scan for a dead
person who died in radioactive
environment. It shows some of
the isotope is taken up by the
kidneys and excreted into the
bladder which should have been
emptied before the scan was
done.

Dental Identification
• Forensic odontology has long been an essential discipline in the post-
mortem identification of human remains, the determination
of the age of live subjects and in wider aspects of forensic
investigation.
Post-Mortem Forensic Dental Radiography - a review of current techniques and future developments, Mark D.VinerabJohnRobsonc

Dental Identification
• Much of forensic dental identification is based upon the
comparison of one set of records with another.
• Aside from the documented dental records, casts and photographs,
radiographs and scans are one of the main sources of evidence.
Previous scans and radiographs can be compared with
contemporaneous images taken of the subject.
• In the identification of the deceased, these examinations will be
performed on the cadaver.

The scope of forensic radiology
Determination Of Identity
Evaluation & Documentation Of Injury Or Cause Of Death
Criminal Litigation
Civil Litigation
Education & Research

Determination of Identity
• There is no greater challenge and no heavier responsibility
than that facing the professionals charged with identifying
the dead. Something deep within the human psyche abhors
loss of identity, even for the deceased.
• Aims to bring evidence to help confirm, determine, or eliminate the
identity of both living and dead persons.

Determination of Identity
Human or Animal
Age
Sex
Race

The comparison of ante & post mortem
radiographs is one of the most
accurate means of identification.

Animal or Human
• It is not uncommon for animal parts or bones to be brought to the
attention of law enforcement agencies or forensic investigators.
• Ordinarily, the trained forensic scientist easily can determine the
nonhuman nature of the specimen.
• At times, the true nature of the item may be obscured by its
condition. A bear’s paw, with claws and terminal phalanges torn away
for souvenirs, and with hide and fur removed by the skinning knife or
by decomposition, may closely resemble a human hand to the lay
hunter or hiker who discovers it. The radiograph quickly reveals the
difference

Bear paw mistaken for a human hand Human hand

Age Determination
Appearance Of Ossific Centers
Union Of Epiphysial Plates
Calcification Of Laryngeal And Costal Cartilages
Skull Radiographs For Examination Of Fontanels, Sutures
And Teeth.

Age Determination
• At birth the primary ossification centers (diaphyses) of the long
bones of the extremities, including the hands and feet, are present.
The vertebral bodies and posterior elements have begun their process
of ossification, as have the scapulae, pelvic, clavicles, base of the
skull, calvaria, and facial bones.
• For the next two decades, radiological determination of age is
based on the appearance and eventual fusion of the secondary
ossification centers.

Age Determination
• 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.
• Beginning about age 40, wear-and-tear degenerative changes
start to appear at the margins of the articular surfaces of major joints,
especially at the margins of vertebral endplates

A: knee of premature newborn. The distal femoral and
proximal tibial epiphyses are not ossified. B: term
newborn with knee epiphyses (arrows) present

Degenerative hypertrophic changes (spurring,
lipping, osteophyte production) at the margins of
vertebral end-plates.

Sex Determination
Differentiation of sexes by skeletal radiology is
unreliable until after puberty. It is then that the
sexual characteristics discernible by radiography
begin to appear.

Sex Determination
• 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. The male femoral head is larger in all dimensions. All of
these general findings are helpful but not definitive in
establishing the sex of unidentified human remains. There are certain
skeletal components, and both skeletal and extra skeletal findings,
which are more useful in determining sex.

Sex Determination- Pelvis
The bony pelvis often survives the attack of factors which diminish or
destroy the usefulness of other body parts. This is fortunate since the
pelvis offers the most definitive traits of sexual
differentiation

• 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.
• The pubic bone tends to be long and narrow in the male and broad and
rectangular in the female.
• The sciatic notch is deep and narrow in the male, and is wide and shallow
in the female.
• The preauricular sulcus (paraglenoid sulcus) when present is one of the
most dependable indicators of femaleness. This variable groove in the
ilium at the inferior end of the sacroiliac joint is missing or manifest very
rarely as a thin groove in the male, and a deep groove is found only in
females.

• The ilial alae are high and vertical in the male, and broad and laterally
divergent in the female.
• The sacrum in the male is narrow, has a relatively flattened curve. The
female sacrum is broad and short.
• The pelvic inlet is triangular or heart-shaped in the male, ovoid in the
female.

Sex Determination- Skull and
Mandible
• The bony characteristics of the skull and mandible may be useful in
assigning sexual identification to unknown remains.
• The male skull tends to range from mesocephalic to
dolichocephalic; the female skull is more likely to be mesocephalic
to brachycephalic.
• The male has a larger brow or supraorbital ridge and a more sloping
forehead. The male zygomatic arch is wider and heavier. The male
nuchal crest is prominent.

Sex Determination- Skull and
Mandible
• The male mastoid process is larger and heavier. The male mandible is
larger and more rugged with a wide ascending ramus. Male orbits
tend to be larger and higher. The inferior nasal spine is longer in the
male.
• 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.

Hyperostosis interna frontalis. Dense bony
thickening of the inner table of the frontal bone
seen in A: frontal and B: lateral
roentgenograms, and C: on a CT scan of the
skull using a “bone window”. The “topogram”
preliminary to the CT scan, D, is sufficiently
detailed that it could be used for purposes of
identification comparison.

Sex Determination- Sternum
• The gender-predictive value of sternal length is not often used
radiographically because it requires cross-table radiographs of the
chest with a partially radiopaque ruler in place. With “chest plate”
preparations direct measurements can be obtained.
• A combined length of manubrium and gladiolus of 17.3 cm includes
only males; a combined length of manubrium and glandulous of less
than 12.1 cm includes only females. Sternal lengths of 14.3 to 15.7
cm were indeterminate.

Determination of Race or Population
Ancestry
• The physical anthropologists have many elaborate methods of evaluating
race or population ancestry if bare bones are available. Some fleshed or
partially fleshed remains can be evaluated radiographically.
• Skull — The skull reflects certain characteristics of population ancestry
that are reasonably dependable but may be confused by racial mixing.
• Intercondylar shelf angle — A method of determining race from the
intercondylar shelf angle can be used with skeletal or fleshed remains. It
requires only true lateral positioning of the distal femur. The measurement
of the angle between the roof of the intercondylar notch (or intercondylar
shelf) and the long axis of the femoral shaft is independent of
magnification.

AA: Caucasoid
BB: Negroid
CC: Mongoloid

Determination of Race or Population
Ancestry
• In Blacks, the tibia is long relative to the femur and the radius is long
relative to the humerus, but the ratios are variable and overlap in the
U.S. population, probably due to racial mixing.
• Compared to Blacks, the femoral shafts are bowed anteriorly in
Whites and Mongoloid populations.
• Again there is considerable variability, but a markedly
bowed femur is unlikely to belong to a Black.

Evaluation Of Injury Or Death
• Evaluation of injury or death by radiological methods is greatly
enhanced by historical information, physical findings, and appropriate
laboratory data when available.
• Such evaluation frequently requires elements of detection, pattern
recognition, interpretation, and comparison, all solidly based on
radiologic training and experience with normal and abnormal findings
in patients of both sexes and all age groups.

The osseous skeleton is the prime target of forensic
radiological evaluation, but in many situations the
soft tissues of the musculoskeletal framework and the
abdominal and thoracic viscera may offer key findings.

Evaluation of injury or death
• The location and type of fracture, considered with reference to the
age and expected level of activity of the individual, may be highly
suggestive of whether the injury is accidental or inflicted.
• Certain fractures, dislocations, and epiphyseal separations are
relatively common in the course of “normal” activities in certain age
ranges; others are virtually impossible to sustain accidentally within
those parameters.

A: this is a so-called “toddler’s
fracture” commonly seen in young
children in the early years as they
begin to walk and run, but are not
yet very steady or coordinated. It is
a “normal” fracture for this age
group.
B: this nonambulatory infant has a
similar-looking fracture, but one
impossible to acquire naturally in
the course of infantile movement.
Rather, this fracture was caused by a
twisting force or torsion at the
hands of an adult caregiver.

• The configuration and direction of fractures in the skull may locate
the impact point and direction of impact, indicate the sequence of
repetitive blows and, sometimes, the shape of the wounding object
or weapon.
• The appearance and location of some skeletal injuries may be clues to
their origin. Some skeletal injuries are typically defensive in nature.
• The time span since the original injury often can be estimated with
some degree of accuracy and may be important.

A: “fending fracture” of the ulna —
the result of trying to ward off a
blow by blocking it with the
upraised forearm. These have also
been called “night-stick” or “pool-
cue” fractures.
B: a subtle, undisplaced fending
fracture.

Criminal Litigation
• The usefulness of appropriate radiological images in cases of murder,
suicide, attempted murder, manslaughter, harm, assault, battery,
abuse, terrorism, or any other type of criminal activity directed to
the person is self-evident and widely known.
• Less well-appreciated is the contribution the radiologic method can
make in other nonviolent crimes such as smuggling, larceny and
fraud, faking, or counterfeiting.

Civil Litigation
• The radiologist may be called as a defendant, plaintiff, ordinary
witness, or expert witness in court cases dealing with liability, be it
professional liability or malpractice, personal liability, property
liability, or product liability.
• Expert testimony may be required in civil actions in cases of wrongful
death or birth, civil rights violation or, quite commonly, personal
injury.

Education
• The forensic sciences have educational obligation to the public, that
is, to alert them to situations discovered to be hazardous to
public health or public safety. Examples would be research
leading to bicycle helmet laws, warning of the danger of larger
waterfilled buckets to infants and children (who have a high center of
gravity, and cannot extricate themselves after tumbling in), or
publicity alerting citizens to the peril of urban hyper- or hypothermia
during spells of severe weather.

Conclusion
Modern imaging techniques are increasingly being utilized
not only in postmortem study to help determine cause of
death or injury, but also to help identify remains at local
medical examiner offices or at the scenes of mass casualties.

References
• Forensic Radiology by B. G. Brogdon, M.D
• [The application of X-ray imaging in forensic medicine]. Kučerová S, Safr M, Ublová M, Urbanová
P, Hejna P
• Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief
Editor: Kim A Collins
• Imaging and virtual autopsy: looking back and forward, Stephan A. Bolliger and Michael J. Thali,
Published:05 August 2015
• Post-Mortem Forensic Dental Radiography - a review of current techniques and future
developments, Mark D.VinerabJohnRobsonc
.

Thank You
Prepared And Presented By: Majd Al-Qudah, MD
Supervised By : Dr Imad Abdallat
Course Title : Forensic Sciences , 2020

Forensic Radiology

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