1. Forensic radiology Dr.Nashwa Mostafa Mahmoud
Forensic Med & Clinical Tox. Dep

2. Outlines: Def Historical overview Common techniques
Scope of Forensic radiology

3. 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.

4. 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.

5. Common techniques: 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.

6. Common techniques:
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.

7. Common techniques:
Dental x-ray machine
Mortuary X-Ray Room

8. Common techniques:
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 .
CT slice of heart showing tumor (arrows)
in interventricular septum

9. Common techniques: 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)
MRI of cardiac tumor (arrows) shown in the previous figure

10. Common techniques: 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
US of the same heart showing a tumor (arrows) in interventricular septum

11. Common techniques: 6-Angiography :
Vertebral angiography in case of subarachnoid hemorrhage
In case of cerebral embolism
right carotid arteriogram shows occlusion of the right middle cerebral artery by lead pellet embolus (arrow).

12. SCOPE OF FORENSIC RADIOLOGY
The situations in which forensic radiology can be applied to resolve legal matters are many and varied:
Determination of Identity
Evaluation & documentation of Injury or cause of Death
Criminal Litigation
Civil Litigation
Recent advances ; Virtopsy.
Education & Research
Radiography can speak

13. 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

14. I. Identification Sex: radiographs of skull, pelvis and sternum. Age:
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,
Stature

15. 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:

16. I. Identification 1. The frontal sinus
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.

17. I. Identification 1. The frontal sinus
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.
Comparison of frontal sinuses between ante-mortem (AM) and post-mortem
(PM) skull films showing duplication of distinctive pattern of air cells, margins, and septae.

18. I. Identification 1. The frontal sinus
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.
Appearance of Several Frontal Sinuses in CTs

19. CT skull using a “bone window”.
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,

20. 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.

21. 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.

22. 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.

23. I. Identification 3. Any characteristic bony features
Dismembered trunk of a female found in a sewer.
I. Identification
3. Any characteristic bony features B
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

24. I. Identification 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. A

25. I. Identification 4. Personal objects & Jewells
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. B A

26. II.Radiological detection & documentation of 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, asphyxia

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

28. A. Radiology of injury I. Soft tissue injury:
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
I. Soft tissue injury:
Laceration of an organ: knife wound to the heart (arrow) shown by MRI

29. A. Radiology of injury I. Soft tissue injury:
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
I. Soft tissue injury:
Abnormal collection of air in the chest → pneumothorax:
Right-sided pneumothorax (arrow) on plain CXR

30. A. Radiology of injury I. Soft tissue injury:
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
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

31. A. Radiology of injury I. Soft tissue injury:
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
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).

32. A. Radiology of injury II. Fractures: Battered child cases:
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
II. Fractures:
In child abuse
Battered child cases:
A. Multiple regional fractures → skull

33. Skull fissures on plain XR
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
II. Fractures:
In child abuse
Battered child cases: A. Multiple regional fractures → skull
Skull fissures on plain XR
Skull fissures on CT

34. A. Radiology of injury II. Fractures: In child abuse
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
II. Fractures:
In child abuse
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.

35. A. Radiology of injury II. Fractures: In child abuse
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
II. Fractures:
In child abuse
Rib fractures. A : typical healed posterior fracture from AP compression. B : healed lateral rib fractures.

36. A. Radiology of injury II. Fractures: In child abuse
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
II. Fractures:
In child abuse
Rib fractures. D : (beads of string) with multiple bilateral healing fractures (note hazy callus surrounding ribs).

37. A. Radiology of injury II. Fractures: In child abuse
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
II. Fractures:
In child abuse
2. Battered child cases:
B. Fractures of different ages: a new rib fracture (arrow) through one of the old, healed fractur

38. A. Radiology of injury ` II. Fractures: In domestic abuse
II.Radiological detection & documentation of injury OR the cause of death
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

39. A. Radiology of injury II. Fractures: In transporation fractures
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
II. Fractures:
In transporation fractures
typical “bumper fracture” in an adult pedestrian hit from the right.

40. A. Radiology of injury III. Foreign bodies: stabbing by glass piece
II.Radiological detection & documentation of injury OR the cause of death
A. Radiology of injury
III. Foreign bodies:
stabbing by glass piece

41. III. Foreign bodies: Retained instruments after surgery: clamp
II.Radiological detection & documentation of injury OR the cause of death
III. Foreign bodies:
Retained instruments after surgery: clamp
Retained instruments after surgery: curved needle (arrow)

42. II.Radiological detection & documentation of injury OR the cause of death
III. Foreign bodies:
A bottle was driven into the victim’s face. The cap stayed
behind as the bottle was withdrawn.

43. II.Radiological detection & documentation of injury OR the cause of death
III. Foreign bodies:
In charred mutilated 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.

44. II.Radiological detection & documentation of injury OR the cause of death
III. Foreign bodies:
In transportation injuries
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.

45. II.Radiological detection & documentation of injury OR the cause of death
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!

46. II.Radiological detection & documentation of injury OR the cause of death
IV. Firearm injuries
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 “lead snowstorm”
bullets: Fragmented bullet within the head and neck areas of a gunshot wound victim.

47. II.Radiological detection & documentation of injury OR the cause of death
IV. Firearm injuries
Radiology role in gunshot wounds:
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.
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).

48. II.Radiological detection & documentation of injury OR the cause of death
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.

49. II.Radiological detection & documentation of injury OR the cause of death
IV. Firearm injuries
bullets: the characteristic sharp projections of the jacket ,exposed as the bullet mushrooms(dumdamized bullets)

50. II.Radiological detection & documentation of injury OR the cause of death
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.

51. II.Radiological detection & documentation of injury OR the cause of death
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.

52. II.Radiological detection & documentation of injury OR the cause of death
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.

53. II.Radiological detection & documentation of injury OR the cause of death
V. Pre- autopsy :
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).
Example of air in the heart of a person suffering fatal massive injuries in a vehicular accident.

54. : Detection of smuggling
III. In criminal cases:
: Detection of smuggling
Latex-covered narcotic packages are shown in the opened stomach of a body packer who died of an overdose when one of the packages ruptured
Addictive agents (body packer):
Abdominal radiograph of a body packer >> rounded and ovoid, hyperdense packages,

55. : Detection of smuggling
III. In criminal cases:
: 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.

56. : Detection of smuggling
III. In criminal cases:
: 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.

57. 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

58. اكيد انا تعبت خخخخخخخخخخخ
اكيد انا تعبت خخخخخخخخخخخ

59. 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.

60. V.VIRTOPSY
Virtopsy Technique: PM whole body imaging basically consists of
body volume documentation and analysis using CT, MRI and microradiology
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

61. 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

62. Corpse identification with CT in different cases
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.

63. (3) Increased intracranial pressure as the cause of death
(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 trauma-related bleeding, predominantly in the cortex and subcortex (arrow).

64. 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).

65. 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 )

66. 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 parts of the left lung.

67. a gunshot wound to the head
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.

68. THANK YOU