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Forensic medicine generally covers a heterogeneous group of various disciplines or subspecialties sharing a common interest. The application of specialized scientific and/or technical knowledge aim is to aid in civil and criminal law. Among those disciplines, forensic radiology is a specialized area of medical imaging using radiological techniques to assist physicians and pathologists in matters related to the law. The forensic application of diagnostic medical radiology can be applied in many fields where the prime target of evaluation is the skeleton.
Due to technological progress in the radiology field, a lot of potential tools are added to forensic radiology that allows wider fields of applications in this matter.
Forensic radiology is not just to imaging human remains or bullet fragments; it is the application of diagnostic imaging technology and examinations to answer questions of law. However, the definition, scope, and use of forensic radiology examination results are poorly defined. Although radiography is one of the most common scientific methods used to accumulate and analyze forensic evidence, forensic radiology is not recognized formally as a branch of forensic sciences.
The credit of the field of radiology goes back to Wilhelm Conrad Rontgen, professor of physics, director of the Physics Institute, and Rector of the University of Würzburg who observed an unusual phenomenon while experimenting with cathode ray tubes on November 1895. After intensive investigation, he determined that he had discovered a new kind of ray, which penetrate solid, opaque materials and give photographic representations about their contents. These rays are called “X-rays” as “x” was the symbol of the unknown, Roentgen’s findings announced in 1896.
Professor Arthur William Wright, director of the Sloan Physics Lab. Yale University is accorded primacy in the production of X-ray images in the United States on January 1896. He exposed one rabbit’s carcass to an X-ray beam for an hour, then a photographic plate revealed a lead shot within the body. There were small, round objects inside the rabbit that appeared as dark spots on the positive film. This was the first time to establish a cause of death through radiography which was the first step in forensic radiology.
Forensic radiology application in life was introduced later, one year after the X-ray discovery, when lead bullets were discovered inside the head of a victim which is the first court case with the aid of forensic radiology.
The first civil case where a Court accepted an x-ray took place in the United States, which began on June 1895 when James Smith fell from a ladder. Dr. Grant found no evidence of a fracture and let him do his normal activity and requested he returns after 1 week. The diagnosis was free. On April 1896, Mr. Smith brought a $10,000 suit for malpractice against Dr. Grant, as his hip was injured and he suffered from limb shortening and disability due to a misdiagnosing of the impacted fracture in the left femoral neck. Several x-rays of Mr. Smith’s hip were made, the last of which showed the outline of an impacted fracture of the proximal femur.
In 1935, Feet X-rays played an important role related to the identification of dead bodies. On September 15, 1935, Dr. Ruxton’s wife and her nursemaid disappeared suddenly from the family home and were never again seen. After two weeks, some human remains were found in the surrounding area and the search continued for another month until most of the two female bodies could be collected. Unfortunately, the faces were mutilated, the teeth were extracted, the terminal digits of the hands amputated and other distinguishing topographical features were excised from soft tissues, all to preclude identification.
In 1949, the Great Lakes liner Noronic caught fire and burned totally in Toronto, with many fatalities. Dr. Arthur C Singleton, a professor & head of the Radiology Department at the University of Toronto, is considered the father of mass casualty radiology as he was able to identify 24 of 119 fatalities by radiologic comparison alone.
In 1981, Evans and Knight’s book, described applications of radiology for the purpose of identification and to confirm the diagnosis of abuse, mishaps, and malpractice, as well as for the identification, age determination, and other anthropological issues and its relation with forensic pathology, gunshot wounds, head injuries and several types of trauma.
In 1994 Austin and Maples have published a study that aim to evaluate the accuracy of methods of image superimposition and they found that with two frontal and lateral views of skull antemortem radiographs and without dental data, identification can be made.
In 1995 Andersen and Wensel have assessed the capacity of individual identification by analyzing the conventional bite-wing films and radiographic subtraction through antemortem and postmortem simulation.
Just under 80 years later, a new technology sparked a great revolution in the medical community, more than the first X-ray images had done before which is computed tomography. Computed tomography (CT) is also based on X-ray technology, but it visualizes the inside of the body on screen, one slice at a time. In conventional X-ray images, different structures are superimposed on top of each other. In advanced systems, these slices are just 0.5 to 1 millimeter thick, allowing physicians to see even the tiniest changes in tissue.
It is, in general, slow to implement modern diagnostic imagining modalities, partly due to unawareness of its potential and probably also for financial reasons. Now CT and other imaging techniques such as magnetic resonance imaging are gaining access to forensic medicine. The CT in forensic investigation is growing and other technologies once reserved primarily for diagnostic medical imaging are proving useful to forensic investigators.
The forensic application of diagnostic medical radiology can be applied in many fields: human identification (particularly in investigations of mass disasters and decomposed bodies), evaluation and documentation of injury or cause of death (accidental or non-accidental), criminal and civil litigation (fatal or non-fatal), administrative proceedings, education, research, and administration.
The prime target of forensic radiological evaluation is the osseous skeleton, but in many cases, the soft tissues and the abdominal and thoracic viscera may offer key findings.
Radiology’s role in the identification and determination of individual identity may be presumptive upon demonstration of pre-existing injuries, illness, or congenital and/or developmental peculiarities but radiological identification needs direct comparison of antemortem and post-mortem images of the body or its parts.
Radiology also has a great role in the evaluation of injury which requires elements of detection, pattern recognition, interpretation, and comparison, all based on radiologic experience with normal and abnormal findings.
Radiology’s role in bone fracture is to analyze the localization and the type of fracture and determine whether the injury is accidental or inflicted. Some types of fractures, dislocations, and epiphyseal separations are common in the course of normal activities in certain age ranges; others are instead impossible to sustain accidentally in daily activities.
In skull fractures, radiology imaging offers information about the impact point and direction of impact, indicating the sequence of repetitive blows, and sometimes, the shape of the object or weapon used.
Fractures of the hyoid bone or thyroid cornu seen by radiology usually suggest strangulation. In vehicular injuries associated with certain fractures/dislocations, radiology imaging may actually suggest the velocity of impact or deceleration.
Gunshot wounds, missiles, and other foreign bodies in the body such as knives are the objects of many forensic scenarios and their radiological evaluation may provide important information.
Other trauma can be revealed with injected contrast media such as intracranial hemorrhage from shaking (battered child syndrome), penetrating wounds…etc.
Identification of mass-disaster victims is one of the most important fieldworks in forensic radiology, in cases where the deceased needs to be identified. CT scanning is playing a vital role in these cases as it gives a quick overview of the body, revealing old fractures, transplants, and dentition. CT scanning may be helpful in cases of terror bombings by allowing a quick evaluation of the distribution and type of shell fragments.
One of the advantages of CT imaging is its ability to 3D reconstruct in cases where the deceased presents in a non-standard way. Reconstruction of skeletal structures using 3-D volume rendering software on a workstation allows soft tissue to be removed without mechanical intervention or maceration.
The benefits of the CT scan in sex determination are evident and include (i) facilitation of the identification of unknown deceased individuals, (ii) avoidance of time-consuming maceration procedures, (iii) non-destructiveness of the procedure, and (iv) availability of large datasets of recent samples from various populations.
Given the noninvasive nature of the CT technology, together with the relative speed with which it may be performed, it has generated interest from certain religious denominations. Similarly, the non-destructive nature of a radiological examination allows access to historical remains, such as Egyptian mummies, performed while still wrapped in ceremonial bindings.
An effort to document the body by objective and noninvasive means began at the “Institute of Forensic Medicine”, “Diagnostic Radiology”, and “Neuroradiology” at the University of Bern. This effort resulted in the ‘Virtopsy’ project, which aimed to detect forensic findings in corpses using CT and MRI, as well as compare these results with traditional autopsy findings.
Virtopsy is a word combining ‘virtual’ and ‘autopsy’ and employs imaging methods that are also used in clinical medicine such as computed tomography (CT), magnetic resonance imaging (MRI), etc., for the purpose of autopsy and to find the cause of the death. Virtopsy can be employed as an alternative to standard autopsies for broad and systemic examination of the whole body as it is less time-consuming, aids in better diagnosis, and renders respect to religious sentiments. Virtopsy is quickly gaining importance in the field of medico-legal cases but still has its own disadvantages.
Traditional autopsy still remains the best method for post-mortem examination and is the gold standard when evaluating postmortem imaging techniques. CT may, however, contribute important new information. CT scanning was introduced as a routine procedure at every autopsy at the Institute of Forensic Medicine in the United Kingdom.
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