New bone post-processing tools in forensic imaging: a multi-reader feasibility study to evaluate detection time and diagnostic accuracy in rib fracture assessment.

PURPOSE: The aim of this multi-reader feasibility study was to evaluate new post-processing CT imaging tools in rib fracture assessment of forensic cases by analyzing detection time and diagnostic accuracy. MATERIALS AND METHODS: Thirty autopsy cases (20 with and 10 without rib fractures in autopsy) were randomly selected and included in this study. All cases received a native whole body CT scan prior to the autopsy procedure, which included dissection and careful evaluation of each rib. In addition to standard transverse sections (modality A), CT images were subjected to a reconstruction algorithm to compute axial labelling of the ribs (modality B) as well as "unfolding" visualizations of the rib cage (modality C, "eagle tool"). Three radiologists with different clinical and forensic experience who were blinded to autopsy results evaluated all cases in a random manner of modality and case. RESULTS: Rib fracture assessment of each reader was evaluated compared to autopsy and a CT consensus read as radiologic reference. A detailed evaluation of relevant test parameters revealed a better accordance to the CT consensus read as to the autopsy. Modality C was the significantly quickest rib fracture detection modality despite slightly reduced statistic test parameters compared to modalities A and B. CONCLUSION: Modern CT post-processing software is able to shorten reading time and to increase sensitivity and specificity compared to standard autopsy alone. The eagle tool as an easy to use tool is suited for an initial rib fracture screening prior to autopsy and can therefore be beneficial for forensic pathologists.

Incidental occult gunshot wound detected by postmortem computed tomography.

The body of a 59 year old woman underwent postmortem computed tomography (PMCT) examination prior to forensic autopsy, using a 256 slice multidetector row computed tomography scanner. A large left tension pneumothorax detected on the PMCT was considered to be a likely cause of death and this was confirmed at autopsy. In addition there was an unsuspected PMCT finding of a probable gunshot injury traversing the right orbit, facial bones and frontal sinus. The autopsy technique was adjusted accordingly and PMCT findings confirmed. PMCT in this case was not only diagnostic of cause of death, but also revealed retained projectile fragments of an old gunshot wound to the face. Without prior imaging such findings would have been undetected at autopsy. This case further underscores the contribution of routine PMCT examination to forensic autopsy practice.

Indicatory external findings in two cases of fatal cervical spine injury.

A fatality of an 83-year-old female experiencing acute circulatory failure as a result of a type II odontoid fracture is compared with the case of an 86-year-old female who died from delayed cardiopulmonary complications due to a lower cervical spine injury. Falls on the forehead from minor height can cause odontoid fractures especially in elderly patients, hyperextension of the neck on the other hand can lead to lower cervical spine injury with prevertebral hematoma. The latter can lead to extensive hematoma of the neck, but might be difficult to diagnose by computed tomography in the living patient. Especially in cases of elderly patients showing bruises on the forehead or extensive neck hematoma, the possibility of cervical spine fracture should be taken into account and postmortem examinations should be arranged commensurately.

Overview of clinical forensic services in various countries of the European Union.

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings. In the context of a clinical forensic examination, physical findings are recorded and biological trace material is gathered and secured. Ideally, all forensic findings are documented in a detailed report combined with photographic documentation, which employs a forensic scale to depict the size of the injuries. However, the integrity of such forensic findings depends particularly on two factors. First, the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence. Second, the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time. Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union (EU); in some states, they are not available at all. As part of the JUSTeU! (Juridical standards for clinical forensic examinations of victims of violence in Europe) project, the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz, Austria created (in cooperation with its international partner consortium) a questionnaire: the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU. Our paper provides a summary of the responses and an overview of the current situation concerning provided clinical forensic services.

Does weight force application to the lower torso have an influence on inferior vena cava and cardiovascular parameters?

OBJECTIVE: The aim of this study was to determine whether weight force application to the lower torso can lead to impairment of inferior vena cava (IVC) and cardiovascular parameters. METHODS: Using ultrasound sonography and impedance cardiography, the effects of a weight force application of 5, 10, 15, and 25 kg to the lower torso, placed in prone position, on IVC diameter and maximal blood flow, mean artery pressure, stroke volume, heart rate, cardiac index, cardiac output, oxygen saturation (SpO(2)), and acceleration index were investigated in 6 healthy volunteers. RESULTS: The following parameters showed a statistically significant correlation with the amount of weight force applied: IVC diameter: r=-0.83, P < .001; IVC maximal blood flow: r=-0.76, P < .001; cardiac index: r=-0.33, P < .05; and cardiac output: r=-0.32, P < .05. CONCLUSION: Application of moderate weight force to the lower torso can lead to major changes in IVC parameters and minor changes in cardiovascular parameters.

Integrated computer-aided forensic case analysis, presentation, and documentation based on multimodal 3D data.

Three-dimensional (3D) crime scene documentation using 3D scanners and medical imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) are increasingly applied in forensic casework. Together with digital photography, these modalities enable comprehensive and non-invasive recording of forensically relevant information regarding injuries/pathologies inside the body and on its surface. Furthermore, it is possible to capture traces and items at crime scenes. Such digitally secured evidence has the potential to similarly increase case understanding by forensic experts and non-experts in court. Unlike photographs and 3D surface models, images from CT and MRI are not self-explanatory. Their interpretation and understanding requires radiological knowledge. Findings in tomography data must not only be revealed, but should also be jointly studied with all the 2D and 3D data available in order to clarify spatial interrelations and to optimally exploit the data at hand. This is technically challenging due to the heterogeneous data representations including volumetric data, polygonal 3D models, and images. This paper presents a novel computer-aided forensic toolbox providing tools to support the analysis, documentation, annotation, and illustration of forensic cases using heterogeneous digital data. Conjoint visualization of data from different modalities in their native form and efficient tools to visually extract and emphasize findings help experts to reveal unrecognized correlations and thereby enhance their case understanding. Moreover, the 3D case illustrations created for case analysis represent an efficient means to convey the insights gained from case analysis to forensic non-experts involved in court proceedings like jurists and laymen. The capability of the presented approach in the context of case analysis, its potential to speed up legal procedures and to ultimately enhance legal certainty is demonstrated by introducing a number of representative forensic cases.

Suicidal asphyxiation with helium: report of three cases.

Helium is an inert gas that among other things is used medically to alleviate the symptoms of airway obstruction, as part of a diving mix in deep-sea diving or as balloon gas. In recent years the so-called right-to-die literature has suggested suffocation with inhaled helium as an effective and peaceful means of self-deliverance for terminally ill patients. Helium displaces oxygen and carbon dioxide and can thus lead to asphyxia. We report three cases of suicidal asphyxiation with helium gas that were examined at the Department of Forensic Medicine Vienna within three months in 2006. In all three cases, autopsy was unrewarding from the point of view of gross pathology. Special autopsy techniques and devices are required for collection of the gas from the lungs. Gas-chromatography is used to examine the gas for helium; however, this requires replacement of the carrier gas, which is itself usually helium. The fact that three people in Vienna committed suicide using this method within a short period of time, together with the abundance of detailed how-to literature on the Internet, suggests a possible future increase in the number of deaths associated with the inhalation of inert gases, particularly helium. Because of the diagnostic obstacles involved, it is necessary to rely on good death-scene investigation for situational evidence when the body is discovered.

Time related changes of T1, T2, and T2(*)(2) of human blood in vitro.

In view of a potential future use for dating hemorrhage in forensic medicine the correlation of MR relaxation parameters with time was evaluated in blood samples. A systematic relationship could be valuable for using MRI for estimating the age of hemorrhage and soft tissue hematomas particularly in clinical forensic medicine. Relaxation times T1, T2, and T2(*) of venous blood samples from 6 volunteers were measured using 3T MRI regularly up to 30 days. The time progression of the relaxation parameters was systematically analyzed and examined for possible interrelations. T2 initially decreased to a minimum, and then increased again (range 24-97ms), while T1 started with a plateau phase followed by an almost linear decrease (range 333-2153ms). T2(*) remained relatively constant during the entire investigation period. The higher the initial T2 was, the lower was its minimum, and the greater was the decrease of the associated T1. The inter- and intra-individual variability was relatively large, one reason being very likely the metabolic differences in the blood samples. The observed characteristic changes in blood samples over time measured by quantitative MR techniques add objective information in view of an estimation of the age of hemorrhage. However, in vivo studies will be needed to verify the data with respect to influencing metabolic factors.

Applicability of Greulich-Pyle and Tanner-Whitehouse grading methods to MRI when assessing hand bone age in forensic age estimation: A pilot study.

Determination of skeletal development is a key pillar in forensic age estimation of living persons. Radiological assessment of hand bone age is widely used until the age of about 17-18 years, applying visual grading techniques to hand radiographs. This study investigated whether Greulich-Pyle (GP) and Tanner-Whitehouse (TW2) grading can be equally used for magnetic resonance imaging (MRI) data, which would offer the huge benefit of avoiding ionizing radiation. In 18 subjects aged between 7 and 17 years a radiograph and an MRI scan of the hand were performed. Epiphyseal ossification of hand bones was rated by two blinded radiologists with both GP and TW2. Correlation between hand MRIs and radiographs was analyzed by linear regression and inter-observer agreement was assessed. Correlation between age estimates from MRI and radiographs was high for both GP (r(2)=0.98) and TW2 (r(2)=0.93). MRI showed a tendency to estimate age slightly lower for 14-18 year-olds, which would be favorable regarding majority age determination in case this result could be reproduced using a currently not existing reference estimation method based on MRI data. Inter-observer agreement was similar for GP in radiographs and MRI, while for TW2, agreement in MRI was lower than in radiographs. In spite of limitations regarding sample size and recruited subjects, our results indicate that the use of GP and TW2 on MRI data offers the possibility of hand bone age estimation without the need for ionizing radiation.