The use of 3D computed tomography reconstruction in medico-legal testimony regarding injuries in living victims - Risks and benefits.

ABSTRACT

Forensic pathologists are often called upon to determine the mechanism and severity of injuries in living individuals. Such expert testimony is often based solely on hand-written clinical notes. The victims' injuries may also be visualized via three-dimensional (3D) reconstruction of computed tomography (CT) images. This method has certain benefits but is not free from limitations. This paper presents two case reports. The first case is that of a female who was brought to the hospital with a knife thrust into her body. The prosecutor's questions focused on the wound channel. The information obtained from the patient's medical records was very general with many contradictory statements. A re-evaluation of the available CT scan data and a subsequent 3D reconstruction helped determine the exact course of the wound channel. The other case was that of a young male, hospitalized based on CT evidence of bilateral rib fractions, who claimed to have been assaulted by police officers. Court expert witnesses were already in possession of a 3D reconstruction showing symmetrical fractures of the patient's lower ribs with bone fragment displacement. An expert witness in radiology definitively excluded the presence of any actual fractures, and explained their apparent visibility in the three-dimensionally reconstructed image as a motion artifact. These two cases suggest that a professionally conducted 3D CT reconstruction is a very useful tool in providing expert testimony on injuries in living victims. However, the deceptive simplicity of conducting such a reconstruction may encourage inexperienced individuals to undertake it, and thus lead to erroneous conclusions.