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Hansen PL, Leth PM, Nielsen PA, Bech DM, Nielsen JB, Mørup SD, Holst AK, Bak L, Poulsen MR, Greisen PW, Hansen DL, Precht H. Optimization of Postprocessing parameters for abdominal Forensic CT scans. Forensic Sci Int Synerg 2024; 8:100478. [PMID: 38779309 PMCID: PMC11109732 DOI: 10.1016/j.fsisyn.2024.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
Aim Postmortem Computed Tomography (PMCT) is gradually introduced at forensic institutes. Image reconstruction software can increase diagnostic potential in CT by increasing distinction between structures and reduction of artifacts. The aim of this study was to develop and evaluate novel image reconstruction parameters for postmortem conditions, to increase image quality and diagnostic potential of CT scans. Method Twenty PMCT scans of deceased hereof two in severe decay were subjected to four reconstruction techniques: a standard reconstruction algorithm, the detail reconstruction algorithm and two novel algorithms based on the standard algorithm, but with different Hounsfield settings. Image quality was evaluated by visual grading analysis (VGA) by four forensic radiologist observers. Results The VGA did not prove that any of the reconstruction techniques were superior to the others. For standard and detail, the two pre-defined reconstruction algorithms, VGA scores were indiscernible and were superior to the equally indiscernible Hounsfield reconstructions on parameters translated into Sharpness and Low Contrast Resolution. The two alternative Hounsfield settings were superior with respect to Noise and Artifacts/Beam Hardening. Conclusion The study elucidates the possiblity for multiple reconstructions specialized for PMCT conditions, to accommodate the special conditions when working with the deceased. Despite the lack of clear improvements in the tested reconstructions, this study provides an insight into some of the possibilities of improving PMCT quality using reconstruction techniques.
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Affiliation(s)
| | - Peter Mygind Leth
- Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Dina Maria Bech
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | | | - Svea Deppe Mørup
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Anette Koch Holst
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Lene Bak
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Mette R. Poulsen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Dennis Lund Hansen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helle Precht
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
- Department of Radiology, Lillebaelt Hospital, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Kolding, Denmark
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2
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Suzuki S, Ohtani M, Matsuo Y, Fukuda M, Mimasaka S. Age estimation using postmortem computed tomography-based Hounsfield unit values of the palate and mandibular condyle and the Eichner classification. Leg Med (Tokyo) 2024; 69:102446. [PMID: 38640872 DOI: 10.1016/j.legalmed.2024.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
Age estimation is important in forensic investigations of unidentified human remains. This study assessed the correlation between age and Hounsfield unit (HU) values of the palate and mandibular condyle based on postmortem computed tomography (CT) and analyzed the influence of occlusal support in developing an age estimation method for Japanese individuals, including older adults. The sample consisted of a training dataset (357 cadavers) and a validation dataset (300 cadavers) that underwent postmortem CT. Three measurements were selected: the respective HU values of the palate and mandibular condyle and the Eichner classification. The correlation coefficients between age and HU values were also evaluated. Multiple stepwise regression analysis was performed to evaluate the significance of four parameters (sex, respective HU values of the palate and mandibular condyle, and the Eichner classification) for age estimation and to determine the best age estimation formula. In the validation tests, inaccuracy and bias were calculated for the groups aged ≥65 or <65 years. Significant correlations between age and HU values of the palate and mandibular condyle were observed, regardless of sex. In multiple stepwise regression analysis, all variables except sex were significantly correlated with age. The age estimation formula from the regression analysis was useful, and the validation test exhibited high accuracy, especially in older adults. The HU values of the palate and mandibular condyle and the Eichner classification are useful for age estimation in Japanese individuals.
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Affiliation(s)
- Shoken Suzuki
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan; Department of Dentistry and Oral Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Maki Ohtani
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan.
| | - Yuhei Matsuo
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan.
| | - Masayuki Fukuda
- Department of Dentistry and Oral Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Sohtaro Mimasaka
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan; Division of Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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3
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Bruch GM, Engel K, Schropp J, Grabherr S. Realistic three-dimensional imaging of injuries in forensic medicine - Survey-based method comparison of CRT and VRT. J Forensic Leg Med 2024; 103:102681. [PMID: 38588619 DOI: 10.1016/j.jflm.2024.102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE A comparison between Cinematic Rendering Technique (CRT) and Volume Rendering Technique (VRT) in cases with postmortem CT-angiography (PMCTA) was carried out. METHODS For different injuries seen in PMCTA, a VRT and a CRT image of exactly the same pathological section was generated. Two questionnaires were created, one with CRT and one with VRT reconstructions, with the same questions per 3D-image. The questionnaires were sent to forensic pathologists, lawyers and police officers. In total eleven different injuries had to be analyzed. RESULTS In total 109 questionnaires were answered fully. Of these returnees, 36 stated that they were forensic pathologists. Seventy-three people were assigned to the group of medical laypersons, in the study this group consists mainly of police officers, judges and lawyers. Between the two software programs CRT and VRT that were compared, no significant difference could be identified in any of the participating groups with regard to the assessment of the life-threatening nature of the injury images shown. When asked about the comprehensibility of pathology, there was a significant difference in favour of CRT. This advantage was apparent to named medical laypersons and to forensic pathologists. CONCLUSIONS The study showed a positive trend that CRT may be more understandable than VRT. Not only the medical laypersons, but also the forensic physicians found CRT to be beneficial.
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Affiliation(s)
- G M Bruch
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität, Munich, Germany.
| | - K Engel
- Medical Imaging Technologies, Siemens Healthcare Technology Center, Erlangen, Germany
| | - J Schropp
- Jonas Schropp Consulting, Switzerland
| | - S Grabherr
- Centre Universitaire Romand de Médecine Légale, Hôpitaux Universitaires de Genève, Université de Genève, Switzerland; Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Switzerland
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4
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Rahbani D, Fliss B, Ebert LC, Bjelopavlovic M. Detecting missing teeth on PMCT using statistical shape modeling. Forensic Sci Med Pathol 2024; 20:23-31. [PMID: 36892806 PMCID: PMC10944413 DOI: 10.1007/s12024-023-00590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/10/2023]
Abstract
The identification of teeth in 3D medical images can be a first step for victim identification from scant remains, for comparison of ante- and postmortem images or for other forensic investigations. We evaluate the performance of a tooth detection approach on mandibles with missing parts or pathologies based on statistical shape models. The proposed approach relies on a shape model that has been built from the full lower jaw, including the mandible and teeth. The model is fitted to the target, resulting in a reconstruction, in addition to a label map that indicates the presence or absence of teeth. We evaluate the accuracy of the proposed solution on a dataset consisting of 76 target mandibles, all extracted from CT images and exhibiting various cases of missing teeth or other cases, such as roots, implants, first dentition, and gap closure. We show an accuracy of approximately 90% on the front teeth (including incisors and canines in our study) that decreases for the molars due to high false-positive rates at the wisdom teeth level. Despite the drop in performance, the proposed approach can be used to obtain an estimate of the tooth count without wisdom teeth, tooth identification, reconstruction of the existing teeth to automate measurements taken as part of routine forensic procedures, or prediction of the missing teeth shape. In comparison to other approaches, our solution relies solely on shape information. This means it can be applied to cases obtained from either medical images or 3D scans because it does not depend on the imaging modality intensities. Another novelty is that the proposed solution avoids heuristics for the separation of teeth or for fitting individual tooth models. The solution is therefore not target-specific and can be directly applied to detect missing parts in other target organs using a shape model of the new target.
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Affiliation(s)
- Dana Rahbani
- Graphics and Vision Research Group (GraVis), University of Basel, Basel, Switzerland
| | - Barbara Fliss
- Institute of Forensic Medicine, University Hospital of Mainz, Mainz, Germany
| | - Lars Christian Ebert
- 3D Center Zurich, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Monika Bjelopavlovic
- Department of Prosthodontics and Materials Science, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
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Wan L, Chen J, Zhou Z, Li Z, Wang Y, Zou D, Liu N, Song F, Huang P, Zhang Z, Wang M, Xia W. The value of PMCTA in the diagnosis of coronary atherosclerosis in isolated human hearts. Forensic Sci Res 2023; 8:308-312. [PMID: 38405630 PMCID: PMC10894061 DOI: 10.1093/fsr/owad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/17/2023] [Indexed: 02/27/2024] Open
Abstract
Postmortem computed tomography (PMCT) has a limited value in investigating coronary artery disease, despite several obvious advantages over the conventional autopsy. To address this issue, postmortem computed tomography angiography (PMCTA) has been introduced into various studies, where it has been used to investigate natural and unnatural deaths involving vascular damage, occlusion, or other pathologies of the vascular system. To investigate the application value of PMCTA in the diagnosis of coronary artery stenosis in ex situ hearts, the water-based contrast media were injected into isolated hearts, scaned, and finally compared with gold standards (autopsy and histology findings of the coronary artery). This study involved 16 subjects from the Academy of Forensic Science who were suspected to have died of sudden death without traumatic injuries. Unenhanced PMCT was performed first, followed by PMCTA using a water-based contrast agent, injected into the coronary arteries of isolated hearts using a self-designed angiography device. The image data were reconstructed into three-dimensional (3D) angiography images using software in the angiography facility. The 3D images were recorded and evaluated by two radiologists and then statistically analysed. The results of PMCTA were consistent with the gold standards for the diagnosis of coronary artery stenosis (P > 0.05). However, water-based contrast media can only be used to examine the pathological changes of blood vessels, which may have limitations in the diagnosis of causes of death such as myocardial oedema. PMCTA can be used as a new method to evaluate the degree of coronary atherosclerosis in addition to traditional autopsy. The 3D reconstruction technique reveals the coronary artery lesions more objectively and vividly and provides the opportunity to re-read the data at any time. Key points The methods and parameters for coronary angiography in isolated human hearts were standardized based on the previous researcher.PMCTA in isolated human hearts is including the 3D reconstruction technique that reveals the coronary artery lesions more objectively and vividly, and provides the opportunity to re-read the data at anytime.PMCTA could only be used to examine the pathological changes of blood vessels, which might have limitations for the diagnosis of causes of death.PMCTA in isolated human hearts can be viewed as an auxiliary method for establishing the cause of death, which can provide an assessment of degree and extent of arterial stenosis and accurately help determine the abnormal location.
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Affiliation(s)
- Lei Wan
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jiemin Chen
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhilu Zhou
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Zhengdong Li
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
| | - Yahui Wang
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
| | - Donghua Zou
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
| | - Ningguo Liu
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
| | - Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ping Huang
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Maowen Wang
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
| | - Wentao Xia
- Department of Forensic Pathology, Academy of Forensic Science, Shanghai, China
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Ibanez V, Jucker D, Ebert LC, Franckenberg S, Dobay A. Classification of rib fracture types from postmortem computed tomography images using deep learning. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00751-x. [PMID: 37968549 DOI: 10.1007/s12024-023-00751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 11/17/2023]
Abstract
Human or time resources can sometimes fall short in medical image diagnostics, and analyzing images in full detail can be a challenging task. With recent advances in artificial intelligence, an increasing number of systems have been developed to assist clinicians in their work. In this study, the objective was to train a model that can distinguish between various fracture types on different levels of hierarchical taxonomy and detect them on 2D-image representations of volumetric postmortem computed tomography (PMCT) data. We used a deep learning model based on the ResNet50 architecture that was pretrained on ImageNet data, and we used transfer learning to fine-tune it to our specific task. We trained our model to distinguish between "displaced," "nondisplaced," "ad latus," "ad longitudinem cum contractione," and "ad longitudinem cum distractione" fractures. Radiographs with no fractures were correctly predicted in 95-99% of cases. Nondisplaced fractures were correctly predicted in 80-86% of cases. Displaced fractures of the "ad latus" type were correctly predicted in 17-18% of cases. The other two displaced types of fractures, "ad longitudinem cum contractione" and "ad longitudinem cum distractione," were correctly predicted in 70-75% and 64-75% of cases, respectively. The model achieved the best performance when the level of hierarchical taxonomy was high, while it had more difficulties when the level of hierarchical taxonomy was lower. Overall, deep learning techniques constitute a reliable solution for forensic pathologists and medical practitioners seeking to reduce workload.
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Affiliation(s)
- Victor Ibanez
- Forensic Machine Learning Technology Center, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Dario Jucker
- Zurich Institute of Forensic Medicine, 3D Centre Zurich, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Lars C Ebert
- Zurich Institute of Forensic Medicine, 3D Centre Zurich, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Sabine Franckenberg
- Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Zurich Institute of Forensic Medicine, 3D Centre Zurich, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Akos Dobay
- Forensic Machine Learning Technology Center, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
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7
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Di Fazio N, Scopetti M, Delogu G, Morena D, Santurro A, Cipolloni L, Serviddio G, Papi L, Frati P, Turillazzi E, Fineschi V. Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital. Diagnostics (Basel) 2023; 13:3361. [PMID: 37958256 PMCID: PMC10650777 DOI: 10.3390/diagnostics13213361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Healthcare-related homicidal cases are not novel within the medical-legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy;
| | - Luigi Papi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Emanuela Turillazzi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
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8
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Golomingi R, Dobay A, Franckenberg S, Ebert L, Sieberth T. Augmented reality in forensics and forensic medicine - Current status and future prospects. Sci Justice 2023; 63:451-455. [PMID: 37453776 DOI: 10.1016/j.scijus.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
Forensic investigations require a vast variety of knowledge and expertise of each specialist involved. With the increase in digitization and advanced technical possibilities, the traditional use of a computer with a screen for visualization and a mouse and keyboard for interactions has limitations, especially when visualizing the content in relation to the real world. Augmented reality (AR) can be used in such instances to support investigators in various tasks at the scene as well as later in the investigation process. In this article, we present current applications of AR in forensics and forensic medicine, the technological basics of AR, and the advantages that AR brings for forensic investigations. Furthermore, we will have a brief look at other fields of application and at future developments of AR in forensics.
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Affiliation(s)
- Raffael Golomingi
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Akos Dobay
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Sabine Franckenberg
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland; Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Lars Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Till Sieberth
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
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9
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Kobayashi S, Makino Y, Torimitsu S, Yamaguchi R, Chiba F, Tsuneya S, Iwase H. Age estimation by evaluating median palatine suture closure using postmortem CT. Int J Legal Med 2023:10.1007/s00414-023-02994-3. [PMID: 37074412 DOI: 10.1007/s00414-023-02994-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/14/2023] [Indexed: 04/20/2023]
Abstract
This study sought to develop an age-estimation formula to evaluate the extent of median palatine suture (MP) closure using postmortem computed tomographic (PMCT) images. The PMCT images of 634 Japanese subjects (mean age, 54.5 years; standard deviation [SD], 23.2 years) with known age and sex were examined. The degree of suture closure of the MP, anterior median palatine suture (AMP), and posterior median palatine suture (PMP) was measured and scored (suture closure score, SCS), and a single linear regression analysis was conducted with age at death. On the analysis, SCS of MP, AMP, and PMP showed a significant correlation with age (p < 0.001). The correlation coefficient of MP was higher (0.760, male; 0.803, female; and 0.779, total) than that of AMP (0.726, male; 0.745, female; and 0.735, total) or PMP (0.457, male; 0.630, female; and 0.549, total). The regression formula and standard error of estimation (SEE) of MP were calculated as Age = 100.95 × SCS + 20.51 (SEE 14.87 years) for male subjects, Age = 91.93 × SCS + 26.65 (SEE 14.12 years) for female subjects, and Age = 95.17 × SCS + 24.09 (SEE 14.59 years) for the total, respectively. In addition, another 50 Japanese subjects were randomly selected to validate the age-estimation formula. In this validation, the actual age of 36 subjects (72%) was within the estimated age ± SEE. This study showed that the age estimation formula using PMCT images of MPs was potentially useful for estimating the age of unidentified corpses.
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Affiliation(s)
- Susumu Kobayashi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
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10
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Virtopsy of severe chest compression: lungs partly herniated into the deep neck space. FORENSIC IMAGING 2023. [DOI: 10.1016/j.fri.2023.200536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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11
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Camilleri S, Swainston K, MacGregor F. A qualitative exploration of the experiences of post-mortem forensic imaging in Malta: A psychological perspective. Radiography (Lond) 2023; 29:84-89. [PMID: 36327519 DOI: 10.1016/j.radi.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study aimed to qualitatively explore the experiences of post-mortem forensic imaging on theatre and trauma radiographers from a psychological perspective at a general hospital in Malta. METHODOLOGY The study utilised purposive sampling to recruit five radiographers undertaking forensic post-mortem imaging in a general hospital in Malta. Individual face-to-face semi-structured interviews were held. Interpretative phenomenological principles and reflexivity were applied throughout the transcription and analysis phases. RESULTS Four themes were developed from the interpretive phenomenological analysis of semi-structured interviews: 'The impact of the imaging process,' 'Psychological distancing,' 'Finding meaning in work,' and 'Resource needs,' the latter comprising three subordinate themes: 'Protocols,' 'Physical resources,' and 'Psychological training.' CONCLUSION Forensic radiography is a rewarding area of practice yet one that can be complex and have a lasting psychological impact. Many factors including working close to the cadaver, a lack of appropriate training and staffing levels and a lack of evidence-based protocols were identified by participants as contributing to potential psychological stress and emotional distress. IMPLICATIONS FOR PRACTICE Exploration and evaluation of the psychological experiences of radiographers undertaking post-mortem imaging will inform the development of appropriate psychological services and reinforce the need for the appropriate application of best practice guidelines and protocols to support radiographers working on traumatic cases within forensic and general radiographic practice.
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Affiliation(s)
- S Camilleri
- Senior Radiographer, Mater Dei Hospital, Triq Dun Karm, L-Imsida, MSD 2090, Malta
| | - K Swainston
- Senior Lecturer in Psychology, School of Psychology, Newcastle University, Newcastle NE2 4DR, UK
| | - F MacGregor
- Principal Lecturer, School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX, UK.
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Bryce AJ, Dandrieux JR, Lenard Z, Chen Y, Milne ME. Veterinary forensic radiology–Development of a cost-effective and easily performed post mortem computed tomographic angiography protocol. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Hoch A, Hasler J, Schenk P, Ackermann J, Ebert L, Fürnstahl P, Zingg P, Vlachopoulos L. Registration based assessment of femoral torsion for rotational osteotomies based on the contralateral anatomy. BMC Musculoskelet Disord 2022; 23:962. [DOI: 10.1186/s12891-022-05941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Computer-assisted techniques for surgical treatment of femoral deformities have become increasingly important. In state-of-the-art 3D deformity assessments, the contralateral side is used as template for correction as it commonly represents normal anatomy. Contributing to this, an iterative closest point (ICP) algorithm is used for registration. However, the anatomical sections of the femur with idiosyncratic features, which allow for a consistent deformity assessment with ICP algorithms being unknown. Furthermore, if there is a side-to-side difference, this is not considered in error quantification.
The aim of this study was to analyze the influence and value of the different sections of the femur in 3D assessment of femoral deformities based on the contralateral anatomy.
Material and methods
3D triangular surface models were created from CT of 100 paired femurs (50 cadavers) without pathological anatomy. The femurs were divided into sections of eponymous anatomy of a predefined percentage of the whole femoral length. A surface registration algorithm was applied to superimpose the ipsilateral on the contralateral side. We evaluated 3D femoral contralateral registration (FCR) errors, defined as difference in 3D rotation of the respective femoral section before and after registration to the contralateral side. To compare this method, we quantified the landmark-based femoral torsion (LB FT). This was defined as the intra-individual difference in overall femoral torsion using with a landmark-based method.
Results
Contralateral rotational deviation ranged from 0° to 9.3° of the assessed femoral sections, depending on the section. Among the sections, the FCR error using the proximal diaphyseal area for registration was larger than any other sectional error. A combination of the lesser trochanter and the proximal diaphyseal area showed the smallest error. The LB FT error was significantly larger than any sectional error (p < 0.001).
Conclusion
We demonstrated that if the contralateral femur is used as reconstruction template, the built-in errors with the registration-based approach are smaller than the intraindividual difference of the femoral torsion between both sides. The errors are depending on the section and their idiosyncratic features used for registration. For rotational osteotomies a combination of the lesser trochanter and the proximal diaphyseal area sections seems to allow for a reconstruction with a minimal error.
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Virtopsy visualisation: mixed data gradient model for more accurate thin bone visualization in 3D rendering. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Horn-Lodewyk J, van der Merwe B, Kali GM, Munro L. Evaluating the knowledge and training of forensic pathologists and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa. Health SA 2022; 27:2014. [PMID: 36337446 PMCID: PMC9634712 DOI: 10.4102/hsag.v27i0.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Forensic radiography is an important component in forensic sciences. There seems to be a lack of recent studies in the literature on the knowledge and training of forensic pathologists and registrars performing forensic radiography at forensic pathology mortuaries in South Africa. AIM To evaluate the knowledge and training of forensic pathologists (consultants) and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa. SETTING A prospective study was conducted at a conveniently selected forensic pathology mortuary located in the Free State province of South Africa. METHOD Personnel performing forensic radiography at the selected mortuary were invited to participate in the study. An exploratory quantitative study design was used. The research tool was a self-administered questionnaire comprising open- and closed-ended questions. Four registrars and four consultants (n = 8) completed the questionnaire. RESULTS Training was only received on computed tomography (n = 1; 12.5%), the C-arm machine (n = 1; 12.5%) and the digital X-ray mobile machine (n = 1; 12.5%) Lodox on corpse positioning (n = 7; 87.5%) and setting of exposure factors (n = 2; 25%). CONCLUSION Lack of training of the personnel performing forensic radiography, at the selected mortuary was identified. Training is required in image acquisition protocols, quality control tests of the X-ray machines, setting technical factors and operation of various X-ray machines. CONTRIBUTION Training of registered radiation workers who perform forensic radiography in mortuaries is essential to produce high-quality ionising radiation images and ensure their own and other staff members' safety.
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Affiliation(s)
- Je’nine Horn-Lodewyk
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa
| | - Belinda van der Merwe
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa
| | - Gift M. Kali
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa
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Porzionato A, Macchi V, Stecco C, Boscolo-Berto R, Loukas M, Tubbs RS, De Caro R. Clinical Anatomy and Medical Malpractice-A Narrative Review with Methodological Implications. Healthcare (Basel) 2022; 10:1915. [PMID: 36292362 PMCID: PMC9601975 DOI: 10.3390/healthcare10101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
Anatomical issues are intrinsically included in medico-legal methodology, however, higher awareness would be needed about the relevance of anatomy in addressing medico-legal questions in clinical/surgical contexts. Forensic Clinical Anatomy has been defined as "the practical application of Clinical Anatomy to the ascertainment and evaluation of medico-legal problems". The so-called individual anatomy (normal anatomy, anatomical variations, or anatomical modifications due to development, aging, para-physiological conditions, diseases, or surgery) may acquire specific relevance in medico-legal ascertainment and evaluation of cases of supposed medical malpractice. Here, we reviewed the literature on the relationships between anatomy, clinics/surgery, and legal medicine. Some methodological considerations were also proposed concerning the following issues: (1) relevant aspects of individual anatomy may arise from the application of methods of ascertainment, and they may be furtherly ascertained through specific anatomical methodology; (2) data about individual anatomy may help in the objective application of the criteria of evaluation (physio-pathological pathway, identification-evaluation of errors, causal value, damage estimation) and in final judgment about medical responsibility/liability. Awareness of the relevance of individual anatomy (risk of iatrogenic lesions, need for preoperative diagnostic procedures) should be one of the principles guiding the clinician; medico-legal analyses can also take advantage of its contribution in terms of ascertainment/evaluation.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Veronica Macchi
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Carla Stecco
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Rafael Boscolo-Berto
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
| | - Ronald Shane Tubbs
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
- Department of Neurosurgery, Tulane University, New Orleans, LA 70112, USA
| | - Raffaele De Caro
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
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Robinson L, Smit C, Bernitz H. Dental radiographic superimposition: An exciting addition to the forensic odontology armamentarium. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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18
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Health Technology Assessment (HTA) of virtual autopsy through PMCT with particular focus on Italy. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Blaettler C, Kaessmeyer S, Grabherr S, Koch C, Schweizer D, Van der Vekens E. Post-mortem Computed Tomographic Angiography in Equine Distal Forelimbs: A Feasibility Study. Front Vet Sci 2022; 9:868390. [PMID: 35647108 PMCID: PMC9132589 DOI: 10.3389/fvets.2022.868390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 01/11/2023] Open
Abstract
In-depth understanding of pathophysiological processes occurring in the vasculature of the equine distal limb is of great importance to improve both diagnostic and therapeutic approaches to diseases. To gain further insights, a model allowing high-resolution 3D-visualization of the vasculature is necessary. This pilot study evaluated the feasibility of restoring vascular perfusion in frozen-thawed distal equine cadaver limbs without prior preparation using computer tomographic imaging (CT). Five frozen-thawed, radiographically normal forelimbs were perfused with a lipophilic contrast agent through the median artery and radial vein in three phases (arterial, venous, and arterial-venous combined (AVC) dynamic). For comparison, one additional limb was perfused with a hydrosoluble contrast agent. The CT-studies (16-slice MDCT, 140 kV, 200 mA, 2 mm slice thickness, 1 mm increment, pitch 0.688) were evaluated at 11 specified regions for visualization of the vasculature and presence of artifacts or anatomic variations. The protocol used in this study proved to be feasible and provided good visualization (93.1%) of vasculature with low rates of artifacts. During the different phases, vascular visualization was similar, but while filling defects decreased in the later phases, extravasation worsened in the 2 limbs where it was observed. Subjectively, the best quality of angiographic images was achieved during the AVC dynamic phase. Perfusion with hydrosoluble contrast resulted in significantly lower vascular visualization (74.0%) and higher artifact rates. This study shows that reperfusion of frozen-thawed equine distal limbs with a lipophilic contrast agent allows for high-quality 3D-visualization of the vasculature and may serve as a model for in situ vascular evaluation in the future.
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Affiliation(s)
- Chantal Blaettler
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Sabine Kaessmeyer
- Division of Veterinary Anatomy, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Silke Grabherr
- Centre Universitaire Roman (Lausanne-Geneva), University Centre of Legal Medicine (CURML), Lausanne, Switzerland
| | - Christoph Koch
- Swiss Institute of Equine Medicine, Department of Clinical Veterinary Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Elke Van der Vekens
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- *Correspondence: Elke Van der Vekens
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Wilder-Smith AJ, Yang S, Weikert T, Bremerich J, Haaf P, Segeroth M, Ebert LC, Sauter A, Sexauer R. Automated Detection, Segmentation, and Classification of Pericardial Effusions on Chest CT Using a Deep Convolutional Neural Network. Diagnostics (Basel) 2022; 12:diagnostics12051045. [PMID: 35626201 PMCID: PMC9139725 DOI: 10.3390/diagnostics12051045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 01/15/2023] Open
Abstract
Pericardial effusions (PEFs) are often missed on Computed Tomography (CT), which particularly affects the outcome of patients presenting with hemodynamic compromise. An automatic PEF detection, segmentation, and classification tool would expedite and improve CT based PEF diagnosis; 258 CTs with (206 with simple PEF, 52 with hemopericardium) and without PEF (each 134 with contrast, 124 non-enhanced) were identified using the radiology report (01/2016−01/2021). PEF were manually 3D-segmented. A deep convolutional neural network (nnU-Net) was trained on 316 cases and separately tested on the remaining 200 and 22 external post-mortem CTs. Inter-reader variability was tested on 40 CTs. PEF classification utilized the median Hounsfield unit from each prediction. The sensitivity and specificity for PEF detection was 97% (95% CI 91.48−99.38%) and 100.00% (95% CI 96.38−100.00%) and 89.74% and 83.61% for diagnosing hemopericardium (AUC 0.944, 95% CI 0.904−0.984). Model performance (Dice coefficient: 0.75 ± 0.01) was non-inferior to inter-reader (0.69 ± 0.02) and was unaffected by contrast administration nor alternative chest pathology (p > 0.05). External dataset testing yielded similar results. Our model reliably detects, segments, and classifies PEF on CT in a complex dataset, potentially serving as an alert tool whilst enhancing report quality. The model and corresponding datasets are publicly available.
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Affiliation(s)
- Adrian Jonathan Wilder-Smith
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Shan Yang
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
| | - Thomas Weikert
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Martin Segeroth
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
| | - Lars C. Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zürich, 8057 Zürich, Switzerland;
| | - Alexander Sauter
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Raphael Sexauer
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
- Correspondence: ; Tel.: +41-613-286-584
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21
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Schweitzer W, Thali M, Aldomar E. Virtopsy in a case of intrathoracic dislocation of the head of the humerus: does this imply an active defense to fall from great height? FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Henningsen MJ, Larsen ST, Jacobsen C, Villa C. Sensitivity and specificity of post-mortem computed tomography in skull fracture detection-a systematic review and meta-analysis. Int J Legal Med 2022; 136:1363-1377. [PMID: 35286468 DOI: 10.1007/s00414-022-02803-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Post-mortem computed tomography (PMCT) has been increasingly used as routine examination in forensic pathology. No recent review of the growing number of papers on the ability of PMCT to detect skull fracture exists, and original papers report sensitivities from 0.85 to 1.00. This systematic review (PROSPERO: CRD42021233264) aims to provide a meta-analysis of sensitivity and specificity of PMCT in skull fracture detection. We searched PubMed, MEDLINE and Embase for papers published between January 2000 and August 2021 reporting raw numbers, sensitivity and specificity or Abbreviated Injury Score for PMCT compared to autopsy. Papers without both PMCT and autopsy, no separate reporting of the neuro-cranium, exclusively on children, sharp trauma, gunshot or natural death as well as case reports and reviews were excluded. Two authors independently performed inclusion, bias assessment and data extraction. QUADAS-2 was used for bias assessment and a random effects models used for meta-analysis. From 4.284 hits, 18 studies were eligible and 13 included in the meta-analysis for a total of 1538 cases. All deceased were scanned on multi-slice scanners with comparable parameters. Images were evaluated by radiologists or pathologists. Intra- and inter-observer analyses were rarely reported. In summary, sensitivity of PMCT for detection of fractures in the skull base was 0.87 [0.80; 0.92] with specificity 0.96 [0.90; 0.98], and sensitivity for the vault was 0.89 [0.80; 0.94] with specificity 0.96 [0.91; 0.98]. The mixed samples are a limitation of the review.
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Affiliation(s)
- Mikkel Jon Henningsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark.
| | - Sara Tangmose Larsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
| | - Christina Jacobsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
| | - Chiara Villa
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
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Planned complex suicide combining pistol head shot and train suicide and Virtopsy examination. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2021.200485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jakobsen SR, Hansen IB, Harders SW, Thomsen AH, Pedersen CCE, Boel LWT, Hansen K. Quantitative analysis of pulmonary structures in PMCT; Stereological comparison of drowning compared to opioid-overdose cases. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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The status of forensic radiography in the Nordic Countries: Results from the 2020 IAFR questionnaire. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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What Can the Clinical Radiologist Learn from Forensic Imaging? Analogies and Differences Between Forensic and Clinical Imaging. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Malfroy Camine L, Varlet V, Campana L, Grabherr S, Moghaddam N. The big puzzle: A critical review of virtual re-association methods for fragmented human remains in a DVI context'. Forensic Sci Int 2021; 330:111033. [PMID: 34883302 DOI: 10.1016/j.forsciint.2021.111033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022]
Abstract
During a Disaster Victims Identification (DVI) mission, international protocols rely on interdisciplinary work, especially between specialists from forensic imaging and anthropology. In case of air crashes or explosions, DVI units may face thousands of fragmented human remains (FHRs). The physical re-association of FHRs and the identification process is very complex and challenging, and relies upon expensive and destructive DNA analysis. A virtual re-association (VRA) of these fragments, using Multidetector Computed Tomography (MDCT), could be a helpful tool in forensic anthropology analysis, as it could assist in reducing the number of DNA samples. However, there is no standardized protocol for including such an approach into a DVI procedure. The aim of this study was to summarize and analyze existing techniques through a systematic review and to develop a protocol for virtual re-association of FHRs, adapted to the DVI context. A keyword-based literature search was conducted, focusing on the VRA methods using MDCT imaging and 3D surface scan methodology. Reviews and primary articles, published between 2005 and 2020 in the fields of forensic anthropology, paleoanthropology, archeology, and fracture reduction surgery were sorted out. A total of 45 publications were selected and analyzed based on their content and relevance. The results show that research on the re-association of FHRs increased significantly during the last five years. Seven steps regarding the MDCT-based method for the virtual re-association of FHRs could be identified: acquisition of 3D-images, segmentation of the MDCT-data, post-processing and surface generation, identification of intact and fracture surfaces, identification and registration of matching fragments, and validation of the re-association. The literature is surprisingly sparse regarding the FHRs re-association as a forensic tool, and mainly consists in case reports, whereas validated methods were presented in archeology and surgery publications. However, we were able to adapt the MDCT-based approach for the virtual re-association of the FHRs and propose an innovative protocol for DVI missions. This protocol includes the needed details, from the acquisition of MDCT imaging to the virtual re-association of 3D models and its validation. Each step has to be fully tested, adapted and validated in future studies.
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Affiliation(s)
- Lise Malfroy Camine
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Vincent Varlet
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lorenzo Campana
- Forensic Imaging and Anthropology Unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Silke Grabherr
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Forensic Imaging and Anthropology Unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Geneva University Hospital and University of Geneva, Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Negahnaz Moghaddam
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Forensic Imaging and Anthropology Unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ibanez V, Gunz S, Erne S, Rawdon EJ, Ampanozi G, Franckenberg S, Sieberth T, Affolter R, Ebert LC, Dobay A. RiFNet: Automated rib fracture detection in postmortem computed tomography. Forensic Sci Med Pathol 2021; 18:20-29. [PMID: 34709561 PMCID: PMC8921053 DOI: 10.1007/s12024-021-00431-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 12/31/2022]
Abstract
Imaging techniques are widely used for medical diagnostics. In some cases, a lack of medical practitioners who can manually analyze the images can lead to a bottleneck. Consequently, we developed a custom-made convolutional neural network (RiFNet = Rib Fracture Network) that can detect rib fractures in postmortem computed tomography. In a retrospective cohort study, we retrieved PMCT data from 195 postmortem cases with rib fractures from July 2017 to April 2018 from our database. The computed tomography data were prepared using a plugin in the commercial imaging software Syngo.via whereby the rib cage was unfolded on a single-in-plane image reformation. Out of the 195 cases, a total of 585 images were extracted and divided into two groups labeled "with" and "without" fractures. These two groups were subsequently divided into training, validation, and test datasets to assess the performance of RiFNet. In addition, we explored the possibility of applying transfer learning techniques on our dataset by choosing two independent noncommercial off-the-shelf convolutional neural network architectures (ResNet50 V2 and Inception V3) and compared the performances of those two with RiFNet. When using pre-trained convolutional neural networks, we achieved an F1 score of 0.64 with Inception V3 and an F1 score of 0.61 with ResNet50 V2. We obtained an average F1 score of 0.91 ± 0.04 with RiFNet. RiFNet is efficient in detecting rib fractures on postmortem computed tomography. Transfer learning techniques are not necessarily well adapted to make classifications in postmortem computed tomography.
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Affiliation(s)
- Victor Ibanez
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Samuel Gunz
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Svenja Erne
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Eric J Rawdon
- Department of Mathematics, University of St. Thomas, St. Paul, Minnesota, 55105-1079, USA
| | - Garyfalia Ampanozi
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Sabine Franckenberg
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Till Sieberth
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Raffael Affolter
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Lars C Ebert
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Akos Dobay
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
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Chiba F, Inokuchi G, Hoshioka Y, Sakuma A, Makino Y, Torimitsu S, Yamaguchi R, Saitoh H, Kono M, Iwase H. Age estimation by evaluation of osteophytes in thoracic and lumbar vertebrae using postmortem CT images in a modern Japanese population. Int J Legal Med 2021; 136:261-267. [PMID: 34642821 DOI: 10.1007/s00414-021-02714-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Estimation of age at death is important in forensic investigations of unknown remains. There have been several reports on applying the degree of osteophyte formation-an age-related change in the vertebral body-for age estimation; however, this method is not yet established. This study investigated a method for age estimation of modern Japanese individuals using osteophytes measured on CT images. The sample included 250 cadavers (125 males) aged 20-95 years. The degree of osteophyte formation was evaluated as score O (0-5 points), and the degree of fusion of the osteophytes between the upper and lower vertebrae was evaluated as score B (0-2 points). Age estimation equations were developed using regression analyses with seven variables, determined by scores O and B, and the equation with the smallest standard error of estimate (SEE) was obtained when the number of vertebrae with score O ≥ 2 was used as the explanatory variable. Age estimation with SEE of about 10 years was possible even when partial vertebrae with a high degree of osteophyte formation were used, showing its potential for practical application. The cutoff value for age estimation was established using the receiver operating characteristic curve analysis, wherein good results were obtained for all variables (area under the curve ≥ 0.8). The combination of the estimation equation and the cutoff value can narrow the range of age estimates.
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Affiliation(s)
- Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan. .,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Ayaka Sakuma
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Rutsuko Yamaguchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Hisako Saitoh
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Mei Kono
- Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
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O'Donnell C, Iles L, Woodford N. Post-mortem CT lung findings at a medicolegal institute in SARS-CoV-2 RT-PCR positive cases with autopsy correlation. Forensic Sci Med Pathol 2021; 17:611-620. [PMID: 34160740 PMCID: PMC8220885 DOI: 10.1007/s12024-021-00389-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/23/2022]
Abstract
CoVID-19 is a novel viral infection with now well-established clinical radiological findings. There is limited data on post-mortem imaging. We explore the proposition that PMCT could be used as screening test. In an 11-week period, 39 deceased persons were referred for medicolegal investigation with pre-existing or subsequent nasopharyngeal swabs showing positivity on SARS-CoV-2 RT-PCR testing. All 39 had routine whole-body CT scans on admission and 12 underwent medicolegal autopsy. These cases were contrasted with 4 others which were negative on nasopharyngeal swabs despite PMCT findings suggestive of CoVID-19 pneumonia (designated false positive). Nine of the 12 autopsies showed lung histology consistent with those reported in CoVID-19 pneumonia. Typical clinical CoVID-19 lung findings on PMCT were only detected in 5 (42%). In 3 of the 4 false positive cases, lung findings showed non-COVID-19 histology but in 1, findings were identical. PMCT CoVID-19 findings in the lungs are therefore not specific and may not be detected in all cases due to obscuration by expected agonal CT findings or other pathologies that pre-dated SARS-CoV-2 infection. PMCT findings may otherwise be subtle. Although PMCT may hint at CoVID-19, we believe that nasopharyngeal swabs are still required for definitive diagnosis. Even with positive swabs, clinical CoVID-19 lung findings on PMCT are often not detected. PMCT findings can be subtle, extreme or obscured by agonal changes. Given this range of PMCT changes, the challenge for pathologists is to determine whether death has been caused by, or merely associated with, SARS-CoV-2 infection.
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Affiliation(s)
- Chris O'Donnell
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia. .,Department of Forensic Medicine, Monash University, Clayton, Australia.
| | - Linda Iles
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia.,Department of Forensic Medicine, Monash University, Clayton, Australia
| | - Noel Woodford
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia.,Department of Forensic Medicine, Monash University, Clayton, Australia
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Schweitzer W, Verster J, Aldomar E, Ebert L, Bolliger SA, Thali MJ, Ampanozi G. Forensic volumetric visualization of gunshot residue in its anatomic context in forensic post mortem computed tomography: Development of transfer function preset. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garland J, O'Connor K, Hu M, Ondruschka B, Tse R. Phlegmonous Psoas Muscle Infection Causing Sepsis and Death With Missing Postmortem Computed Tomography Scan Correlation. Am J Forensic Med Pathol 2021; 42:170-173. [PMID: 33109914 DOI: 10.1097/paf.0000000000000632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Infection of the psoas muscle is a rare pathology, which carries a high risk of sepsis and is a potential cause of death. Classic symptoms include back pain and fever and it may be diagnosed premortem on computed tomography or magnetic resonance imaging, where abscess formation may be identified as a discrete rim enhancing and low-attenuation lesion. Infections without abscess formation, such as phlegmonous infection, may be more difficult to identify however, particularly if there is absence of other nonspecific findings, such as gas bubbles. We report a case of Staphylococcus aureus phlegmonous psoas muscle causing sepsis and death with no postmortem computed tomography scan correlation, where clinical history of back pain and an unknown source of sepsis was the only prompt for psoas dissection. This case highlights a potential postmortem computed tomography blind spot in abdominal pathology and we recommend dissecting the psoas muscle if sepsis is suspected but a definitive septic focus is unable to be identified.
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Affiliation(s)
- Jack Garland
- From the Forensic and Analytical Science Service, NSW Health Pathology, New South Wales, Australia
| | - Kate O'Connor
- Department of Radiology, Auckland District Health Board
| | - Mindy Hu
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Harty MP, Gould SW, Harcke HT. Navigating the perils and pitfalls of pediatric forensic postmortem imaging in the United States. Pediatr Radiol 2021; 51:1051-1060. [PMID: 33999245 DOI: 10.1007/s00247-020-04833-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Postmortem CT is widely used in the general adult and military populations. It is used extensively in pediatric death investigations in Europe and Asia, but distinctive challenges are encountered when launching a postmortem imaging program in the United States. We describe the issues we have encountered specific to establishing a pediatric postmortem imaging service in this country and propose potential solutions.
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Affiliation(s)
- Mary P Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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A review of visualization techniques of post-mortem computed tomography data for forensic death investigations. Int J Legal Med 2021; 135:1855-1867. [PMID: 33931808 PMCID: PMC8354982 DOI: 10.1007/s00414-021-02581-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
Postmortem computed tomography (PMCT) is a standard image modality used in forensic death investigations. Case- and audience-specific visualizations are vital for identifying relevant findings and communicating them appropriately. Different data types and visualization methods exist in 2D and 3D, and all of these types have specific applications. 2D visualizations are more suited for the radiological assessment of PMCT data because they allow the depiction of subtle details. 3D visualizations are better suited for creating visualizations for medical laypersons, such as state attorneys, because they maintain the anatomical context. Visualizations can be refined by using additional techniques, such as annotation or layering. Specialized methods such as 3D printing and virtual and augmented reality often require data conversion. The resulting data can also be used to combine PMCT data with other 3D data such as crime scene laser scans to create crime scene reconstructions. Knowledge of these techniques is essential for the successful handling of PMCT data in a forensic setting. In this review, we present an overview of current visualization techniques for PMCT.
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Chatzaraki V, Ebert LC, Thali MJ, Haidich AB, Ampanozi G. Evaluation of the mediastinal-thoracic volume ratio on postmortem computed tomography. Int J Legal Med 2021; 135:1903-1912. [PMID: 33909145 PMCID: PMC8354949 DOI: 10.1007/s00414-021-02593-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
Objectives The aim of this study was to measure the mediastinal-thoracic volume ratio (CTR_VOL) on PMCT as a more accurate version of traditional CTR, in order to assess the terminal positional relationship between the heart and lungs in the different causes of death with regard to age, gender, BMI, cardiomegaly, and lung expansion. Materials Two hundred fifty consecutive postmortem cases with pre-autopsy PMCT and full forensic autopsy were retrospectively evaluated. The lungs and the mediastinum were manually segmented on the PMCT data and the correspondent volumes were estimated in situ. CTR_VOL was calculated as the ratio of the mediastinal to the thoracic volume. The volume measurements were repeated by the same rater for the evaluation of the intrarater reliability. Age, gender, body weight and height, heart weight at autopsy, and cause of death were retrieved from the autopsy reports. Presence of lung expansion was radiologically evaluated in situ. Results CTR_VOL was positively associated with age and BMI but not with gender and was higher for cardiomegaly compared to normal hearts, lower for asphyxiation-related deaths compared to cardiac deaths and intoxications, and lower for cases with lung expansion. The intrarater reliability was excellent for the calculated volumes of both lungs and mediastinum. Conclusion The results of the present study support CTR_VOL as a tool to assess the relationship between the heart and lungs in situ, which differs significantly between the studied cause of death categories. Supplementary Information The online version contains supplementary material available at 10.1007/s00414-021-02593-0.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland. .,Department of Radiology, Kantonsspital Baden, Baden, Switzerland.
| | - Lars C Ebert
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Garyfalia Ampanozi
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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Ebert LC, Seckiner D, Sieberth T, Thali MJ, Franckenberg S. An algorithm for automatically generating gas, bone and foreign body visualizations from postmortem computed tomography data. Forensic Sci Med Pathol 2021; 17:254-261. [PMID: 33905073 PMCID: PMC8119247 DOI: 10.1007/s12024-021-00363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
Post mortem computed tomography (PMCT) can aid in localizing foreign bodies, bone fractures, and gas accumulations. The visualization of these findings play an important role in the communication of radiological findings. In this article, we present an algorithm for automated visualization of gas distributions on PMCT image data of the thorax and abdomen. The algorithm uses a combination of region growing segmentation and layering of different visualization methods to automatically generate overview images that depict radiopaque foreign bodies, bones and gas distributions in one image. The presented method was tested on 955 PMCT scans of the thorax and abdomen. The algorithm managed to generate useful images for all cases, visualizing foreign bodies as well as gas distribution. The most interesting cases are presented in this article. While this type of visualization cannot replace a real radiological analysis of the image data, it can provide a quick overview for briefings and image reports.
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Affiliation(s)
- Lars C Ebert
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland.
| | - Dilan Seckiner
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland
| | - Till Sieberth
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland
| | - Michael J Thali
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland
| | - Sabine Franckenberg
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland.,Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Ferrante B, Baroni C, Muramoto C, Ribas L, Torres L, Catão-Dias J, Pinto A. Histological effect caused by contrast solution injection for post mortem computed tomography angiography in dogs. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Impact of increasing levels of adaptive statistical iterative reconstruction on image quality in oil-based postmortem CT angiography in coronary arteries. Int J Legal Med 2021; 135:1869-1878. [PMID: 33629138 PMCID: PMC8354936 DOI: 10.1007/s00414-021-02530-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/03/2021] [Indexed: 01/03/2023]
Abstract
Introduction Postmortem multi-detector computed tomography (PMCT) has become an important part in forensic imaging. Modern reconstruction techniques such as iterative reconstruction (IR) are frequently used in postmortem CT angiography (PMCTA). The image quality of PMCTA depends on the strength of IR. For this purpose, we aimed to investigate the impact of different advanced IR levels on the objective and subjective PMCTA image quality. Material and methods We retrospectively analyzed the coronary arteries of 27 human cadavers undergoing whole-body postmortem CT angiography between July 2017 and March 2018 in a single center. Iterative reconstructions of the coronary arteries were processed in five different level settings (0%; 30%; 50%; 70%; 100%) by using an adaptive statistical IR method. We evaluated the objective (contrast-to-noise ratio (CNR)) and subjective image quality in several anatomical locations. Results Our results demonstrate that the increasing levels of an IR technique have relevant impact on the image quality in PMCTA scans in forensic postmortem examinations. Higher levels of IR have led to a significant reduction of image noise and therefore to a significant improvement of objective image quality (+ 70%). However, subjective image quality is inferior at higher levels of IR due to plasticized image appearance. Conclusion Objective image quality in PMCTA progressively improves with increasing level of IR with the best CNR at the highest IR level. However, subjective image quality is best at low to medium levels of IR. To obtain a “classic” image appearance with optimal image quality, PMCTAs should be reconstructed at medium levels of IR.
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Correlation of age, sex and season with the state of human decomposition as quantified by postmortem computed tomography. Forensic Sci Med Pathol 2021; 17:185-191. [PMID: 33587253 PMCID: PMC8119255 DOI: 10.1007/s12024-021-00356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
Dead bodies exhibit a variable range of changes with advancing decomposition. To quantify intracorporeal gas, the radiological alteration index (RAI) has been implemented in the assessment of postmortem whole-body computed tomography. We used this RAI as a proxy for the state of decomposition. This study aimed to (I) investigate the correlation between the state of decomposition and the season in which the body was discovered; and (II) evaluate the correlations between sociodemographic factors (age, sex) and the state of decomposition, by using the RAI as a proxy for the extent of decomposition. In a retrospective study, we analyzed demographic data from all autopsy reports from the Institute of Forensic Medicine of Zurich between January 2017 to July 2019 and evaluated the radiological alteration index from postmortem whole-body computed tomography for each case. The bodies of older males showed the highest RAI. Seasonal effects had no significant influence on the RAI in our urban study population with bodies mostly being discovered indoors. Autopsy reports contain valuable data that allow interpretation for reasons beyond forensic purposes, such as sociopolitical observations.
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Höch A, Özkurtul O, Hammer N, Heinemann A, Tse R, Zwirner J, Henkelmann J, Fakler J, Ondruschka B. A comparison on the detection accuracy of ante mortem computed tomography vs. autopsy for the diagnosis of pelvic ring injury in legal medicine. J Forensic Sci 2021; 66:919-925. [PMID: 33512022 DOI: 10.1111/1556-4029.14677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
A detailed knowledge on the exact morphology of pelvic injuries provided crucial information in understanding the mechanisms of injury and has influence on the natural course and subsequent mortality. However, forensic medical literature investigating pelvic fractures in detail is scarce to date. This case series aims to compare the accuracy in detecting pelvic injuries using autopsy and ante mortem computed tomography (CT). Nineteen deceased patients with CT scans of pelvic fractures were included retrospectively. Pelvic injuries were independently assessed by a board-certified radiologist (R) and a board-certified trauma surgeon (T), both using the ante mortem CT scans, and by a board-certified forensic pathologist using autopsy (A) results without knowledge of the CT scan findings. No patient had died causatively from a pelvic fracture. Most injuries of the pelvis were present in the pubic rami (16/18) and sacral bone (13/18), followed by the sacroiliac joint (9/18) and iliac bone fractures (8/18). Ilium fractures (A:100%;R:67%;T:67%) and injuries of the sacroiliac joint (A:83%;R:50%;T:42%) were best detected via autopsy. The diagnosis of sacral fractures (A:19%;R:94%;T:88%) and fractures of the pubic rami (A:67%;R:96%;T:96%) were most often missed in autopsy. The results show deficits in the assessment of the pelvic injury for both CT and autopsy. Autopsy was superior in detecting injuries of the sacroiliac joint, but inferior in detecting sacral and pubic bone fractures. For an encompassing evaluation of ligamento-skeletal pelvic injuries, the complementary use of both CT and autopsy is recommended.
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Affiliation(s)
- Andreas Höch
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Orkun Özkurtul
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Niels Hammer
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.,Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Fakler
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Legal Medicine, University Hospital Leipzig, Leipzig, Germany
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Franckenberg S, Sieberth T, Frauenfelder T, Thali MJ, Ebert LC. Semiautomated robotic, CT-guided needle placement for postmortem CSF sampling – a Novel application of the Virtobot. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1875056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Sabine Franckenberg
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich Switzerland
- Institute of Forensic Medicine, University of Zurich, Zurich Switzerland
| | - Till Sieberth
- Institute of Forensic Medicine, University of Zurich, Zurich Switzerland
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich Switzerland
| | - Michael J. Thali
- Institute of Forensic Medicine, University of Zurich, Zurich Switzerland
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Chatzaraki V, Thali MJ, Ampanozi G. Diagnostic accuracy of postmortem computed tomography for bleeding source determination in cases with hemoperitoneum. Int J Legal Med 2021; 135:593-603. [PMID: 33410928 PMCID: PMC7870604 DOI: 10.1007/s00414-020-02472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
Aim The aim of this retrospective study was to determine the accuracy of postmortem computed tomography and different radiological signs for the determination of the bleeding source in cases with hemoperitoneum confirmed at autopsy. Methods Postmortem computed tomography data of consecutive cases with hemoperitoneum confirmed at autopsy were reviewed by two raters, blinded to the autopsy findings. The determination of possible bleeding sources was based on the presence of the sentinel clot sign, blood or sedimented blood surrounding an organ, intraparenchymal abnormal gas distribution, and parenchymal disruption. The bleeding source and the cause of hemoperitoneum (traumatic, surgical, natural, or resuscitation) as reported in the autopsy report were noted. The survival intervals of the deceased were calculated when information about the time of an incident related to death was available in the autopsy reports. Results Eighty-five cases were included in the study. Postmortem computed tomography showed 79% sensitivity and 92.1% specificity for the detection of the bleeding source. The sentinel clot sign was associated with surgical or natural causes of hemoperitoneum and longer survival intervals. Sedimented blood around the bleeding source was associated with resuscitation. Abnormal gas distribution within organs and combination of multiple radiological signs provided higher sensitivity. Conclusion Postmortem computed tomography provides moderate sensitivity and high specificity for determining the bleeding source in cases with hemoperitoneum. Different PMCT signs are associated with different causes of hemoperitoneum and survival intervals.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
- Department of Radiology, Kantonsspital Baden AG, Im Ergel 1, CH-5404, Baden, Switzerland.
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Garyfalia Ampanozi
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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A practical review of adipocere: Key findings, case studies and operational considerations from crime scene to autopsy. J Forensic Leg Med 2020; 78:102109. [PMID: 33596512 DOI: 10.1016/j.jflm.2020.102109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/21/2022]
Abstract
After death, the body begins decomposition, a process that starts with the breakdown of organic matter and typically leads to the complete degradation of a body. Such a process is highly affected by (micro and macro) environmental factors of intrinsic and extrinsic nature. Adipocere is a substance formed from the decomposition of adipose tissue and represents a disruption to the typical decomposition process. Such disruption causes decomposition to slow or arrest completely, placing a body into a state of preservation, and determines complications in the estimation of the time since death (Post-Mortem Interval, PMI). While several studies have been performed on the nature, the formation and the degradation of adipocere, there is still no reliable model to assess the PMI of a body exhibiting it. Case studies are an important source to aid pathologists and investigators during a case. This review presents a summary and an update on the knowledge surrounding the chemistry and the factors affecting adipocere formation and degradation, the timing and the distribution of adipocere throughout a body, and the techniques used to investigate it. Furthermore, a table of the most important case studies involving adipocere since 1950, several images and descriptions of recent cases and operational considerations for the best practice at the crime scene and autopsy are presented to be used as a reference to facilitate forensic professionals in adipocere cases.
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Bulliard J, Eggert S, Ampanozi G, Affolter R, Gascho D, Sieberth T, Thali MJ, Ebert LC. Preliminary testing of an augmented reality headset as a DICOM viewer during autopsy. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dobay A, Ford J, Decker S, Ampanozi G, Franckenberg S, Affolter R, Sieberth T, Ebert LC. Potential use of deep learning techniques for postmortem imaging. Forensic Sci Med Pathol 2020; 16:671-679. [PMID: 32990926 PMCID: PMC7669812 DOI: 10.1007/s12024-020-00307-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 01/05/2023]
Abstract
The use of postmortem computed tomography in forensic medicine, in addition to conventional autopsy, is now a standard procedure in several countries. However, the large number of cases, the large amount of data, and the lack of postmortem radiology experts have pushed researchers to develop solutions that are able to automate diagnosis by applying deep learning techniques to postmortem computed tomography images. While deep learning techniques require a good understanding of image analysis and mathematical optimization, the goal of this review was to provide to the community of postmortem radiology experts the key concepts needed to assess the potential of such techniques and how they could impact their work.
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Affiliation(s)
- Akos Dobay
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland. .,Department of Evolutionary Biology and Environmental Studies, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
| | - Jonathan Ford
- Department of Radiology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle STC 6097, Tampa, FL, 33606, USA
| | - Summer Decker
- Department of Radiology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle STC 6097, Tampa, FL, 33606, USA
| | - Garyfalia Ampanozi
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Sabine Franckenberg
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Raffael Affolter
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Till Sieberth
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Lars C Ebert
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Gascho D, Heimer J, Thali MJ, Flach PM. The value of MRI for assessing danger to life in nonfatal strangulation. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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48
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Imaizumi K, Bermejo E, Taniguchi K, Ogawa Y, Nagata T, Kaga K, Hayakawa H, Shiotani S. Development of a sex estimation method for skulls using machine learning on three-dimensional shapes of skulls and skull parts. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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49
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Uthandi D, Sabarudin A, Mohd Z, Rahman MAA, Karim MKA. Effectiveness of Post-Mortem Computed Tomography (PMCT) in Comparison with Conventional Autopsy: A Systematic Review. Curr Med Imaging 2020; 16:669-676. [PMID: 32723237 DOI: 10.2174/1573405615666190821115426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/27/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the advancement of technology, Computed Tomography (CT) scan imaging can be used to gain deeper insight into the cause of death. AIMS The purpose of this study was to perform a systematic review of the efficacy of Post- Mortem Computed Tomography (PMCT) scan compared with the conventional autopsies gleaned from literature published in English between the year 2009 and 2016. METHODOLOGY A literature search was conducted on three databases, namely PubMed, MEDLINE, and Scopus. A total of 387 articles were retrieved, but only 21 studies were accepted after meeting the review criteria. Data, such as the number of victims, the number of radiologists and forensic pathologists involved, causes of death, and additional and missed diagnoses in PMCT scans were tabulated and analysed by two independent reviewers. RESULTS Compared with the conventional autopsy, the accuracy of PMCT scans in detecting injuries and causes of death was observed to range between 20% and 80%. The analysis also showed that PMCT had more advantages in detecting fractures, fluid in airways, gas in internal organs, major hemorrhages, fatty liver, stones, and bullet fragments. Despite its benefits, PMCT could also miss certain important lesions in a certain region such as cardiovascular injuries and minor vascular injuries. CONCLUSION This systematic review suggests that PMCT can replace most of the conventional autopsies in specific cases and is also a good complementary tool in most cases.
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Affiliation(s)
- Deveshini Uthandi
- Department of Diagnostic Imaging, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Akmal Sabarudin
- Department of Diagnostic Imaging, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Zanariah Mohd
- Department of Diagnostic Imaging, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Amiruddin Abd Rahman
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
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Garland J, Ondruschka B, Stables S, Morrow P, Kesha K, Glenn C, Tse R. Identifying Fatal Head Injuries on Postmortem Computed Tomography Using Convolutional Neural Network/Deep Learning: A Feasibility Study. J Forensic Sci 2020; 65:2019-2022. [PMID: 32639630 DOI: 10.1111/1556-4029.14502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022]
Abstract
Postmortem computed tomography (PMCT) is a relatively recent advancement in forensic pathology practice that has been increasingly used as an ancillary investigation and screening tool. One area of clinical CT imaging that has garnered a lot of research interest recently is the area of "artificial intelligence" (AI), such as in screening and computer-assisted diagnostics. This feasibility study investigated the application of convolutional neural network, a form of deep learning AI, to PMCT head imaging in differentiating fatal head injury from controls. PMCT images of a transverse section of the head at the level of the frontal sinus from 25 cases of fatal head injury were combined with 25 nonhead-injury controls and divided into training and testing datasets. A convolutional neural network was constructed using Keras and was trained against the training data before being assessed against the testing dataset. The results of this study demonstrated an accuracy of between 70% and 92.5%, with difficulties in recognizing subarachnoid hemorrhage and in distinguishing congested vessels and prominent falx from head injury. These results are promising for potential applications as a screening tool or in computer-assisted diagnostics in the future.
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Affiliation(s)
- Jack Garland
- Forensic and Analytical Science Service, 480 Weeroona Rd, Lidcombe, NSW, 2141, Australia
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52 20251, Hamburg, Germany
| | - Simon Stables
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand, 1023
| | - Paul Morrow
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand, 1023
| | - Kilak Kesha
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand, 1023
| | - Charley Glenn
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand, 1023
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand, 1023.,University of Auckland Faculty of Medical and Health Sciences, 85 Park Road, Grafton, Auckland, New Zealand, 1023
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