Presentation forensic radiology

Forensic radiology
Dr.Nashwa Mostafa
Mahmoud

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 FORENSICRADIOLOGY
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,

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 ,Sella
tursica & 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,

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
radiography
Partially
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& documentationof 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,

A. Radiology of injury
• Swelling, edema or
hemorrhage:
Subdural hematoma
around frontal lobe
(arrows) on CT.
I. Soft tissue
injury:
II.Radiological detection& documentation of injury OR the cause of death

• 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

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

: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

‫تعبت‬ ‫انا‬ ‫اكيد‬
‫خخخخخخخخخخخ‬

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

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

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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