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Imaging techniques in forensic medicine
1. Imaging techniques
in forensic medicine
Author:
Pathan Arbaz Khan, 3rd year student of foreign faculty
Scientific guides:
MD, PhD, prof. HOD of forensic medicine E.Yu. Kalinina
MD, assistant professor of the Department of radiology,
radiotherapy, oncology M.L. Kalinina
Orenburg state medical university
Department of forensic medicine
2. What is forensic radiology
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,
• establishing cause of death.
Comparison of ante mortem and post mortem radiographs
is one of the means of identification .
3. Tools used
1. Radiography (X-ray)
2. Computed Tomography (CT)
3. Magnetic Resonance Imaging (MRI)
4. Ultrasound (US)
4. Injuries
On the x-ray image the white arrow
indicates abrupt loss of the normal sacral
foraminal margin on the right consistent
with fracture.
The yellow arrows indicate the superior
and inferior pubic rami fractures.
Transverse patellar fracture with
retraction of the proximal fractured
fragment. There is associated soft tissue
swelling.
6. Foreign Body Detection
Well-defined opacities (packs of drugs)
present in the rectum, in keeping with
foreign bodies. Body packing
Metallic foreign body (coin) in the
upper portion of the oesophagus.
7. Gun Shot Injury
This post mortem x-ray
demonstrates a fatal gun shot
wound to the head.
Metallic screw owing to
a gunshot projects over the left
upper abdomen quadrant.
8. Child abuse
Presentation
Brought into hospital by Mother after she noticed her to be irritable
after inadvertent forceful twisting of the thigh when changing nappy.
Radiographic findings
Spiral midshaft right femoral fracture.
Spiral fracture of the femur in a non-mobile infant is always worrying
for non-accidental injury (child abuse).
9. Child abuse (same patient)
Bone scan however
revealed focal increased
uptake in the right 4th to
7th ribs posteriorly (red
circle)consistent with
fracture.
This is the most common
site of non-accidental
rib fracture in infants
due to a compressive
squeezing force applied
to the chest.
10. Determination of life birth and stillbirth
Life born neonate
lungs are air filled
Stillborn neonate
lungs have soft tissue density
11. Age estimation:
ossification centers
Ossification of bones of different body parts occurs in specific sequence.
Knowing this sequence can help age estimation by looking at radiograph.
0 yo 1 yo 4
yo
7 yo 9 yo 13
yo
14
yo
3 yo
12. Age estimation:
changes in elderly patients
Costochondral
calcification usually
occurs in elderly patient
Osteoarthritis of both
knee joints
Senile
osteoporosis
13. Gender estimation
Female pelvis
AP radiograph
Male pelvis is narrower and less flared,
exhibiting an oval or heart-shaped pelvic
inlet, and the angle of the pubic arch is less
than 90 degrees.
Male pelvis
AP radiograph
Female pelvis is usually broader and
exhibits a round pelvic inlet, and the
angle of the pubic arch is greater than 90
degrees
14. Postmortem CT scan
Postmortem CT scan is usage of CT scanning for determining the
cause of death. It is limited by relatively low soft tissue contrast
and poor visualization of the vascular system
Practical uses of PMCT
• involving blunt force trauma,
• firearm injuries,
• and identification of human remains.
• abuse,
• hanging,
• attempted strangulation,
• decomposition,
• thermal injuries,
• religious opposition to autopsy, and
• mass casualty situations.
18. Blunt Forced Trauma
Sagittal CT image (without contrast)
of a skull with blunt force trauma.
Arrows identify large hemorrhages.
Hard Hits: Blunt Force Trauma
19. PMCT soft tissue window. The blue line
delineates the bullet track and
introduction of air into the cranium.
Intraventricular blood is present.
PMCT bone window. Bone window
reveals internal beveling at the entry site
with the bullet lodged in the left calvaria
with associated metal artifact.
B
20. PMCT 3D volume rendering of pedestrian struck by metro train
demonstrating cervical spine fracture–dislocation as well as multiple
skull, facial, and extremity fractures.
21. PMCT volume rendering. Soft tissues in blue, bones in green, and high-density
material in red. The bullet was originally seen on a scout view of this hanging
decedent between the tenth and eleventh rib.
At autopsy, the bullet was found to be scarred down from a remote firearm
injury, unrelated to cause of death
22. Thermal Injury
PMCT volume rendering of the cervical
spine shows C5–6 dislocation in a man
who could not extricate himself from a
burning vehicle.
Axial slice through the neck
reveals thermal tissue loss of the
anterior neck at the level of
dislocation.
23. Decomposition
PMCT of the head. Intracranial gas–fluid level is present
in this decomposed decedent. Also note skin slippage.
24. Religious and cultural objection
• PMCT form a case of
religious opposition to
autopsy.
• PMCT reveals free fluid
and mesenteric fat
stranding around the
pancreas.
• Lab results supported
the radiologist’s
interpretation of acute
pancreatitis.
25. Summary
• Forensic radiology is evolving around the world. However,
cost, availability, and quality remain key obstacles.
• The field lacks standardization of training for personnel
performing and interpreting forensic radiography.
• Furthermore, the literature lacks large-scale double-
blinded studies for specific injury categories.
• Once validated applications are better defined and quality
standards are established.
• Forensic radiology has the potential to improve forensic
diagnostic productivity by merging the skills of forensic
pathologists and radiologists.
