Forensic Radiography

A General Overview of Forensic Practice

 Definition of Forensic

Pertaining to, connected with, or used in courts of

judicature or public discussion and debate

Brogden, B.G. Forensic Radiology, 1998, CRC Press

 Ante Mortem

Any x-
x-ray is potentially forensic

Elder abuse

Images of traumatic injuries that become
evidence in criminal or civil court cases

Child abuse

Criminal investigations

Drug mules, FB search of prisoners

Analysis of adverse medical events
 Paediatric Non-
Non-Accidental Trauma
In Britain:

7% of children experienced serious physical abuse at the hand of
their parents or caregivers during childhood.

Up to 55% of fatally abused children have been seen within the
previous month by a healthcare professional.

The incidence of injury sufficient to cause fracture is reported as
occurring in 6% - 55% of physically abused children depending on
age and nature of the population studied.

Non
Non--accidental Head Injury with brain injury show outcomes of 20%
mortality, severe disability in 34% and mild disability in 25% of
survivors.

Royal College of Paediatrics and Child Health, Standards for Radiological Investigations of Suspected Non-Accidental Injury, March 2008
 Recommendations for
Paediatric Non-
Non-Accidental Trauma

Purpose of a Skeletal Survey is to allow the

detection of occult bony injuries, obtain further
information about a clinically suspected injury,
aid in dating bone injuries and help in the
diagnosis of any underlying skeletal disorder
which may predispose to fractures.

Royal College of Paediatrics and Child Health, Standards for Radiological Investigations of Suspected Non-Accidental Injury, March 2008
 Recommendations for
Paediatric Non-
Non-Accidental Trauma
Canadian Association of Radiologists Standard
for Skeletal Surveys in Children

The skeletal survey examination should be performed in accordance

with the traditional principles of high quality diagnostic radiography.
These include proper technique factors, positioning, collimation, image
identification, restraining methods, and patient shielding.

Each anatomic region should be imaged with a separate radiographic

exposure to insure uniform image density and minimize image
un-sharpness. The portions of each extremity should be radiographed in
at least the frontal projection. The axial skeleton should be obtained in
two projections.

CAR Standard for Skeletal Surveys in Children, 1998

 Recommendations for
Paediatric Non-
Non-Accidental Trauma
Canadian Association of Radiologists Standard
for Skeletal Surveys in Children

No specific view recommendations

The Alberta Children’s Hospital Routine

AP and Lateral Skull
AP and lateral complete spine
AP pelvis
AP and lateral long bones
PA hands
AP feet
AP Chest to include clavicles
 The Royal College of Radiologists

· Skull (SXR) - AP and lateral, plus Towne's view for occipital injury.
Skull x-rays should be taken with a skeletal survey even if a CT scan
has been performed.
· AP Chest (including clavicles)
· Oblique views of the ribs (left and right)
· AP Abdomen with pelvis and hips
· Lateral spine - cervical and thoracic-lumbar
· AP Humeri
· AP Radius / Ulna
· AP Femurs
· AP Tibia/Fibula
· PA hands and AP feet

Royal College of Paediatrics and Child Health, Standards for Radiological Investigations of Suspected Non-Accidental Injury, March 2008
 Recommendations for
Paediatric Non-
Non-Accidental Trauma

The above should be supplemented by:

· Lateral views of any suspected shaft fracture.
· Lateral coned views of the elbows/wrists/knees/ankles.

These may demonstrate metaphyseal injuries in greater detail

than AP views of the limbs alone.
 Corner and Bucket Handle Fractures

http://www.radiologyassistant.nl/en/43c63c41ef792

http://www.hawaii.edu/medicine/pediatrics/pemxray/v4c02.html

Loren Yamamoto, MD, MPH

Associate Professor of Pediatrics
University of Hawaii John A. Burns School of Medicine
 Post Mortem

The aim Post Mortem examination is to

establish the cause and manner of death
and to record evidence needed for
establishing either a positive or a
presumptive identification.

The Scientific Investigation of Mass Graves, Cambridge University Press, 2008

 Medical Examiner vs. Coroner

Coroner

Is an elected or appointed official

Not necessarily required to have any training
in science, law or medicine.

Would appoint experts to assist the Coroner’s
office in performing it’s duties.
 Medical Examiner vs. Coroner

Medical Examiner

is a physician

is charged with investigation and examination
of persons dying a sudden, unexplained or
violent death.

usually a Pathologist, but not required to be
so.
 It’s Not CSI

Images from forensic shows are now on

TV every night.

The special effects crew replicate the
visual conditions of the deceased very
accurately.
The forensic radiographer must be prepared
for reality.
 ID of Deceased
Every unidentified body brought to the medical
examiner or coroner represents a person
missing to friends and family.

Non--x-ray methods
Non

Visual ID in recognizable individuals

Fingerprints

DNA
 Radiographic Identification

Surgical implants

Comparative skeletal anatomy

Chest x-
x-ray / Thoracic Spine

Frontal Sinuses

Any comparative finding with ante mortem
images.
Implants
Comparative Anatomy
Dental Examination
Intra Oral x-
x-rays
 Intra Oral x-
x-rays

Parallel Technique

The film is positioned
parallel to the long
axis of the tooth. CR
is perpendicular to the
film

UK Forensic Radiography Team

 Intra Oral x-
x-rays

Bisecting Angle Technique

CR is perpendicular to the
bisecting angle between the
film and long axis of the
tooth.

UK Forensic Radiography Team

Intra Oral x-
x-rays
Intra Oral x-
x-rays
Intra Oral x-
x-rays

The mouth sometimes
is immobile.

Sometime the subject
has no mouth to open
and loose teeth or
jaw fragments are
imaged.
Dental X-
X-Rays Palate
Dental X-
X-Rays Palate

The palate is
sometimes removed
from the subject if the
mouth is immobile.
 Ancient Remains

Skeletal remains are sometimes found at

construction sites or by hikers.
Ancient Remains
 Criminal investigations

Chain of evidence / continuity

GSW

Location of FB – knife tip

Suspicious death

Survey of burn victims

Babygrams
GSW
GSW
Shotgun Wound
Shotgun Wound
Survey of Burn Victims
Survey of Burn Victims
 Survey of Burn Victims

Possible shell casing

 Babygram

Any death of an infant or toddler that

cannot be attributed to a known medical
condition or observed accident may
involve a radiographic survey.

This includes SIDS deaths.
Babygram

Survey is more limited

than a Ante-
Ante-mortem
exam.

The images taken will
be determined by the
Medical Examiner.
Babygram
 Mass Fatalities

The USA and United Kingdom have dedicated teams of

x-ray technologists to assist in forensic work in the event
of mass fatalities.

In the USA these teams work under DMORT – Disaster
Mortuary Operational Response Teams. Their last
deployment was for the aftermath of Hurricane Katrina.

From Katrina they helped identify 1,100 victims with an
additional 612 indentified from disinterred caskets.
 Mass Fatalities

The UK Forensic Radiography Response Team (UKFRRT)

was born out of the London Subway bombings.

Its members have deployed to the Indonesian Tsunami
and assisted in the identification of victims in mass
graves in Bosnia.

The UK government has recently established a program
similar to the US DMORT system with established
equipment stores and funding.
 Mass Fatalities

Nationally, Canada has no system to

deploy forensic teams in a mass fatality
incident.

Planning is left to the individual Provinces
and municipalities.
 Mass Fatalities

Primary Survey of Body Bag

undertaken ideally with a fluoroscopy machine

For speed and versatility

The Primary Survey will indicate:

Anatomical Parts seen

One individual or more?

Location and nature of hazardous material

unexploded ordnance, metallic sharps, glass, etc

Location of Personal Effects
Primary Survey of Body Bag

Presence of unique identifying features, which

might require further x-
x-ray investigation

Dental work

The body bag will then be transferred to the pathology area for
examination and autopsy.
 Secondary Survey

Full dental survey of the victim

Tertiary Survey
• Any unique skeletal features observed by
fluoroscopy or identified at autopsy
• difficult cases which for which a
radiograph may be useful
 Resources

Inforce – Human Rights

NGO investigating atrocity
crimes and assistance in
Forensic Radiology mass fatality incidents.
B.G. Brogdon
ISBN: 0849381053
Thanks to:

Calgary Office - The Office of the Chief Medical

Examiner, Alberta Justice

International Association of Forensic
Radiographers

Matthew Spidell – Medical Photographer, Office
of the Chief Medical Examiner

The C.A.M.R.T.