10) Forensic Radiology

Question 1

Forensic radiology used in detecting

Answer 1

• Identification
• Gunshot wounds
• Nonviolent crimes
• Abuse
• Torture
• Terrorism

Question 2

Forensic radiology definition

Answer 2

• Forensic = pertaining to, connected with, or used in courts of justice or public discussion and debate
• Thus, forensic sciences apply specialized and/or technical knowledge to questions of civil or criminal law, especially in court proceedings

Question 3

Identification of the dead key concepts (two methods)

Answer 3

• Visual review of the remains (least reliable)

- Review of documentation on or in the body of certain anatomical characteristics

Question 4

Most reliable method of identification of the dead involves

Answer 4

• Documentation on or in the body of certain anatomic characteristics
• Fingerprints, dental restorations, healed fractures, surgical sutures, etc.
• Those can be compared with similar documentation prior to death

Question 5

Skull evaluation

Answer 5

• Dental arches
• Paranasal sinuses
• Mastoids
• Sella turica
• Other (brow ridge, surgical lesions, previous trauma, etc.)

Question 6

Chest evaluation

Answer 6

• Costal cartilage ossification
• Calcifications in the lungs
• Anomalies, tumors, traumatic lesions
• Sternal configuration
• Scapular configuration

Question 7

Traumatic lesions

Answer 7

• Healed fractures

- Internal fixation

Question 8

Radiology in mass casualty situations

Answer 8

• Disasters of many kinds require processing and identification of multiple victims
• Railroad and aircraft accidents
• Natural disasters
• Collapse or fire in high occupancy buildings

Question 9

Mass disasters often require

Answer 9

• Temporary morgues
• Improvised field x-ray operations
• Usually much more convenient to use preexisting, permanent hospital radiology facilities

Question 10

Radiology in mass casualty situations key concepts

Answer 10

• Initial main goal = rapid identification of the victims
• With bodies that are burned or mutilated beyond physical recognition, radiology may become the primary (and often the only) means of positive identification

Question 11

Gunshot wounds

Answer 11

• 65 murders a day in the U.S. (the highest homicide rate of any Western industrialized country)
• 70% of those murders are committed with firearms

Question 12

Gunshot wounds key concepts

Answer 12

• Determining the location of the bullet is first and foremost
• X-rays can reveal whether there are bullets of different caliber present
• X-rays 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 a bullets’ path

Question 13

Radiology in nonviolent crimes

Answer 13

• “Body packer” = smuggler who tries to carry contraband drugs (mostly cocaine) across borders in specially devised packages in the carrier’s rectum, vagina, or alimentary canal
• Typically the drug is wrapped in several layers of latex by using condoms, the fingers of surgical gloves, or toy balloons, then swallowed or inserted into the rectum

Question 14

In nonviolent crimes, radiographically one looks for

Answer 14

• Regularly shaped round or oval, slightly radiopaque foreign bodies

Question 15

Radiology of abuse

Answer 15

• Child abuse
• Spousal abuse
• Elderly abuse

Question 16

Radiologic manifestations of child abuse include

Answer 16

• Healing fractures of various ages
• Fractures at the edges of the metaphysis
• Epiphyseal and metaphyseal fractures
• Posterior rib fractures
• Compression fractures of the vertebral bodies

Question 17

If child abuse is suspected, you should request

Answer 17

• Skeletal survey

Question 18

A skeletal survey consists of

Answer 18

• AP and Lat skull
• AP views of the chest, abdomen, and pelvis
• AP views of of the long bones of the extremities, including the hands and feet
• Imaging studies are important because they may supply evidence of multiple episodes of abuse

Question 19

Child abuse key concepts

Answer 19

• Vast majority of fractures occur in patients under 3 years of age, and half of them are in infants
• The extremities are convenient “handles” by which the child can be grabbed, swung, shaken, or pulled (hence, extremity fractures are most common)

Question 20

The metaphyseal lesion of child abuse

Answer 20

• Virtually pathognomic
• Extends transversely across the extreme end of the metaphysis
• May also appear as a metaphyseal chip fracture

Question 21

Pathognomonic

Answer 21

• A sign or symptom that is so characteristic of a disease or condition, that it can be used to make a diagnosis

Question 22

Diaphyseal spiral fractures

Answer 22

• Highly suggestive of abuse, especially in the non-ambulatory child

Question 23

Transverse long bone fractures

Answer 23

• High specificity for child abuse
• Joint dislocations are rarely seen in child abuse cases
• Multiple fractures seen at different stages of healing have a very high specificity of child abuse

Question 24

Callus in diaphyseal fractures

Answer 24

• Generally forms no earlier than 5 days after a fracture, but will usually form by 14 days

Question 25

Rib fractures

Answer 25

• Highly suggestive of child abuse
• Practically never seen after resuscitative efforts in children
• Nuclear medicine scans are ideal for detecting rib fractures
• A high specificity for child abuse is found in fractures of the sternum and spinous processes of the spine

Question 26

The most common cause of death from child abuse is from

Answer 26

• Trauma to the head
• Linear skull fracture is not highly suggestive of child abuse, but the level of suspicion should increase with complex skull fractures

Question 27

Acute subdural hematoma

Answer 27

• Crescent-shaped homogeneously hyperdense extra-axial collection
• Spreads diffusely over the affected hemisphere

Question 28

Subacute subdural hematoma

Answer 28

• As the clot ages and protein degradation occurs, the density starts to drop
• At some point between 3 and 21 days (typically 10-14 days), the density will drop to ~ 35-40 HU and become isodense to the adjacent cortex, making identification potentially tricky, especially if subdural collections are bilateral

Question 29

Chronic subdural hematoma

Answer 29

• By definition, it is at least 3 weeks old

- The subdural collection becomes hypodense

Question 30

Child abuse in the abdomen key concepts

Answer 30

• The abdomen is a fairly frequent site of abusive trauma, particularly after the child becomes ambulatory
• Blunt force in the form of a fist or knee can cause severe damage to the intraabdominal viscera and is associated with a high mortality rate

Question 31

Intramural hematoma of the duodenum

Answer 31

• Most common abdominal injury seen in child abuse

- Laceration of the liver and pancreas are also common

Question 32

Spousal abuse

Answer 32

• Abuse is the single most common etiology for injury presented by women
• Accounts for more injury episodes than motor vehicle accidents, mugging, and rapes combined

Question 33

Spousal abuse key concepts

Answer 33

• The two most common causes of facial trauma in adults are MVA’s and domestic violence
• In a study of facial fractures caused by domestic violence, fractures involving the mandibular body and angle were most common

Question 34

Elderly abuse

Answer 34

• The elderly are the fastest growing age group in the U.S.
• As many individuals age, they become dependent on others
• The care givers of the elderly might be persons who are reluctant, ill prepared, or incapable of providing necessary care, leading to abuse