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Description : Check out this medical presentation on Radiology and Imaging, which is titled "Forensic Radiology", to know about historical view, definition, modalities, and, the scope of forensic radiology.

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Forensic Radiology Prepared And Presented By: Majd Al-Qudah, MD
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Outline Historical view Definition Modalities The scope of forensic radiology
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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
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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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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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
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Radiographs must be taken before dissection.
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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.
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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.
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X-ray imaging still remains the gold standard method for identification of unknown deceased.
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Bullet in the nose
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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
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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. Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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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). Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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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). Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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(a) 2 separated fractures in the frontal and temporal bone,(b) corresponding contusions Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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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
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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). Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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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
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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. Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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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. Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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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. Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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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. Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins
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Magnetic Resonance Imaging (MRI) Postmortem Radiology and Imaging, Updated: Aug 05, 2019 , Author: Angela D Levy, MD; Chief Editor: Kim A Collins 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.
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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
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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.
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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
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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. Post-Mortem Forensic Dental Radiography - a review of current techniques and future developments, Mark D.VinerabJohnRobsonc
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Post-Mortem Forensic Dental Radiography - a review of current techniques and future developments, Mark D.VinerabJohnRobsonc
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The scope of forensic radiology Forensic Radiology by B. G. Brogdon, M.D Determination Of Identity Evaluation & Documentation Of Injury Or Cause Of Death Criminal Litigation Civil Litigation Education & Research
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Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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Determination of Identity Human or Animal Age Sex Race
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The comparison of ante & post mortem radiographs is one of the most accurate means of identification. Forensic Radiology by B. G. Brogdon, M.D
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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 Forensic Radiology by B. G. Brogdon, M.D
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Bear paw mistaken for a human hand Human hand
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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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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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 Forensic Radiology by B. G. Brogdon, M.D
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A: knee of premature newborn. The distal femoral and proximal tibial epiphyses are not ossified. B: term newborn with knee epiphyses (arrows) present Forensic Radiology by B. G. Brogdon, M.D
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Degenerative hypertrophic changes (spurring, lipping, osteophyte production) at the margins of vertebral end-plates. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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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.
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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 Forensic Radiology by B. G. Brogdon, M.D
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Sex Determination- Pelvis 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. Forensic Radiology by B. G. Brogdon, M.D
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Sex Determination- Pelvis 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.
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Forensic Radiology by B. G. Brogdon, M.D
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The preauricular sulcus
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Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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Forensic Radiology by B. G. Brogdon, M.D
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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.
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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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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AA: Caucasoid BB: Negroid CC: Mongoloid Forensic Radiology by B. G. Brogdon, M.D
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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.
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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. Forensic Radiology by B. G. Brogdon, M.D
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Evaluation Of Injury Or Death 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.
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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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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Evaluation Of Injury Or Death 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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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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. Forensic Radiology by B. G. Brogdon, M.D
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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.
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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
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Thank You Prepared And Presented By: Majd Al-Qudah, MD Supervised By : Dr Imad Abdallat Course Title : Forensic Sciences , 2020