Forensic Radiography

1. Forensic Radiography Done by: Alaa Al- Angary Noura Al- Anazi Shatha Al- Mushayt Presented by: Shatha Al- Mushayt

2. History Definition Modalities Using Medical Imaging in Forensic Science Projections Radiographer Role Outline

3. Forensic Radiology History Using x-ray to produce images was discovered by Wilhelm Roentgen in 1895. Only weeks later, the forensic use of x-ray was tested. Helped in convicting an American murderer. Weeks later, the technique was first used in UK. http://www2.le.ac.uk/departments/emfpu/imaging/brief-history

4. Definition of Forensic Radiology It is a specialized area of medical imaging using radiological techniques to assist physicians and pathologists in matters related to the law. Radiographs must be taken before dissection . Earliest photograph of roentgenography of a cadaver found by the author. http://www2.le.ac.uk/departments/emfpu/imaging/brief-history

5. Modalities General X-ray Fluoroscopy NM CT MRI Dental Identification Angiography and venography US

6. Fluoroscopy: Post-operative chest x-ray and intra-bronchial contrast material with initial tracheal stent in place . General X-ray: Shard of glass (arrows) from a broken beer bottle remain in the lung of this stabbing victim. http://www.sahha.gov.mt/pages.aspx?page=559

7.   NM: This is a nuclear scan for died person that dead in isotope environment. It is show 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. CT: Recently, more popular Why?  Time , cost Improved scan quality Some says that CT will replace other modalities in forensic radiology. http://www2.le.ac.uk/departments/emfpu/imaging/brief-history

8. CT image (a) 2 separated fractures in the frontal and temporal bone,(b) corresponding contusions Digital superimposition of a hummer with the depressed skull fracture . (PDF)The use of clinical CCT images in the forensic examination of closed head Injuries ( M.Bauer ,S. polzin , D.patzelt )   (PDF)The use of clinical CCT images in the forensic examination of closed head Injuries ( M.Bauer ,S. polzin , D.patzelt )

9. MRI: Used also in FR but has a limited role to play. Why? The strong magnetic currents required, costs Dental Radiography: for identification and ageing purposes 93% rate for identification of subjects from dental radiographs. PDF)The use of clinical CCT images in the forensic examination of closed head Injuries ( M.Bauer ,S. polzin , D.patzelt )

10. MRI: Used also in FR but has a limited role to play. Why? The strong magnetic currents required, costs Dental Radiography: for identification and ageing purposes 93% rate for identification of subjects from dental radiographs. Dental Radiography: A darkening in the crown (arrow); Tooth 32 occlusal destruction of crown. PDF)The use of clinical CCT images in the forensic examination of closed head Injuries ( M.Bauer ,S. polzin , D.patzelt )

11. Used to detect intracranial and intraventricular bleeding. It is possible that this may also be used post-mortem. Bilateral intraventricular haemorrhage : enlarged lateral ventricles with oval contours. Macrogranular choroid vascular plexuses show a large textured cohesion. Visible enlarged third ventricle with a diameter of 7-8 mm. Angiography and venography : For determining blood flow although it is not common. Cerebral angiogram demonstrates small, acute stroke (arrowhead) in internal capsule – thalamic junction. THE USE OF RADIOGRAPHY IN FORENSIC MEDICINE (Nigel Hughes and Mary Baker ) http://www.czytelniamedyczna.pl/new_medicine-92

12. Using Of Forensic Radiology Widely used in: Identification Establishing cause of death five bullets, overlying in the skull Forensic Radiology by B. G. Brogdon , M.D .

13. A. Identification To bring evidence to help confirm, determine, or eliminate the identity of both living and dead persons. Age Gender Race The comparison of ante & post mortem radiographs is one of the most accurate means of identification. Forensic Radiology by B. G. Brogdon , M.D .

14. A. Identification Age Child: by the appearance of centers of ossification for hand and wrist. Young adult: by the state of fusion of epiphyses. Race Images basically for skull. Skeletal racial Groups: Negroid – elongated cranium Mongoloid – rounded cranium Caucasoid- Head is curved at the top, not completely flat, The chin is prominent. Forensic Radiology by B. G. Brogdon , M.D .

15. A. Identification Gender Usually the 1st step in ID process. The sexual characteristics recognizable by radiography begin to appear after puberty. RT takes Images for the skull , long bones and pelvis . SKULL F, more vertical forehead M, less rounded forehead

16. A. Identification Gender Usually the 1st step in ID process. The sexual characteristics recognizable by radiography begin to appear after puberty. RT takes Images for the skull , long bones and pelvis . SKULL F, more vertical forehead M, less rounded forehead PELVIS F, larger & more round M, more oval

17. A. Identification Gender Usually the 1st step in ID process. The sexual characteristics recognizable by radiography begin to appear after puberty. RT takes Images for the skull , long bones and pelvis . LONG BONES F, shorter & thinner M, longer & thicker

18. A. Identification Gender Usually the 1st step in ID process. The sexual characteristics recognizable by radiography begin to appear after puberty. RT takes Images for the skull , long bones and pelvis . A : male pelvis. B : female pelvis

19. A. Identification Gender Usually the 1st step in ID process. The sexual characteristics recognizable by radiography begin to appear after puberty. RT takes Images for the skull , long bones and pelvis . A : male pelvis. B : female pelvis

20. B. Cause of death Foreign bodies location Demonstration of tracks Demonstration of injuries or disease Child abuse

21. Foreign bodies packages of illegal substances objects such as bullets, fragments of glass, explosives or pieces of broken needles in drug addicts in the soft tissues. The location of swallowed objects can assist in correlating time of death with possible cause of injury. foreign body (button battery) in the proximal esophagus http://www.rad-club.com/vb/showthread.php?t=26

22. Demonstration of tracks Tracks made by gun-shot wounds, stab wounds and bullet wounds Their depth & proximity to vital organs can be demonstrated by CM Cont. Foreign bodies Supine chest radiograph showing bullet (arrow) from acute gunshot wound. Forensic Radiology by B. G. Brogdon , M.D .

23. Demonstration of injuries or disease s e.g. The identification of old or multiple fractures (new # is more bright) Child abuse To identify the extent of physical injury To clarify all imaging findings that point to alternative diagnoses Sever hand fractures in young male   This fracture was caused by a twisting force or torsion at the hands of an adult caregiver. http://www.flickr.com/photos/roentgenator/1435208683/

24. Projections   digits  PA projection for bone age evaluation. skull  true AP & lat. projections the frontal sinuses &the Sella turcica can provide unique markers in ID. Entire body (for identification)  every joint must be included because orthopedic appliances or unique degenerative changes aid the ID process. Correct anatomical markers within the collimated light field is critical. Forensic Radiology by B. G. Brogdon , M.D .

25. Radiographer Role Should has a complete understanding of the technical factors ; may have to vary greatly from subject to subject. e.g. A dead individual remains may be found from early soft tissue stages to advanced skeletonization condition technique early soft tissue stages like on living subjects very fragmented, or skeletonized wide exposure latitude and sharp image detail systems http://www.eradimaging.com/site/article.cfm?ID=657&mode=ce

26. Radiographer Role Obtaining images as close as possible to ante-mortem imaging in AP/PA and lateral projections. Providing optimal detail & proper visibility of the structures. All data & identifiers are recorded on the images (date, time, & location). If any data or markers are not visible or correct, the image should be repeated. Following all confidentiality and ethical standards. http://www.eradimaging.com/site/article.cfm?ID=657&mode=ce

27. Radiographer Role Must be prepared to work under extreme environmental conditions, with any type of X-ray equipment (old piece, portable unit, C-arm, mobile CR, and CT scanners) Safety aspects Adhering to radiation safety protocols . Wear personal protective equipment when coming into contact with any body fluids exists. during imaging , Image receptors placed in plastic covers & wiped with antiseptic after use. Completed & up-to-date vaccinations for Personnel. http://www.eradimaging.com/site/article.cfm?ID=657&mode=ce

28. Radiographer Role Collection and Preservation of Evidence Radiographer needs to be familiar with certain procedures. Keep any artifacts that could become evidence. e.g. never throw away any articles of clothing. Bagged hand; do not remove the bags – done to keep evidence for gunshot residue and underneath fingernails. ask questions before removing anything that might be related to the incident. http://www.eradimaging.com/site/article.cfm?ID=657&mode=ce

29.   As radiology equipment continues to develop and more applications are discovered for its use in the field of forensics, so will the role of the radiographer and technologist. Conclusion

30. Thanks for being attentive !

31. References: http://www2.le.ac.uk/departments/emfpu/imaging/brief-history http://imagingradiationoncology.advanceweb.com/Editorial/Content/Editorial.aspx?CC=53867 http://www.forensicmag.com/articles.asp?pid=7 http://www.diagnosticimaging.com/conference-reports/ecr2009/article/113619/1386135?verify=0 http://www.eradimaging.com/site/article.cfm?ID=657&mode=ce http://www.flickr.com/photos/roentgenator/1435208683/ http://www.sahha.gov.mt/pages.aspx?page=559 Forensic Radiology by B. G. Brogdon , M.D . (PDF)The use of clinical CCT images in the forensic examination of closed head Injuries ( M.Bauer ,S. polzin , D.patzelt ) (PDF)THE USE OF RADIOGRAPHY IN FORENSIC MEDICINE (Nigel Hughes and Mary Baker ) http://www.rad-club.com/vb/showthread.php?t=26 References