Contribution of postmortem multidetector CT scanning to identification of the deceased in a mass disaster: Experience gained from the 2009 Victorian bushfires

Detecting missing teeth on PMCT using statistical shape modeling

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.

Marine mimicry is afoot

It is a relatively common occurrence for forensic pathologists and anthropologists to be presented with what are believed to be human remains as part of their day-to-day practice. Despite this, the literature pertaining to such challenges is not extensive, and much knowledge of this is largely based on experience. As such, we present a case of what appeared to be a severed foot located on a beach, which examination revealed was a marine animal known as a sea squirt (ascidian). While marine scientists have been aware of such mimicry, to our knowledge, this has not been previously described in the forensic pathology literature. The external examination and post-mortem CT scan revealed the nonhuman nature of the remains, and an imminent police investigation was prevented, saving time and resources. Nonhuman remains may include animals and inorganic objects, and their discovery may invoke anxiety in the finder. A timely forensic pathology or anthropology examination will assist in alleviating such concern. Forensic pathologists and anthropologists should be prepared to face a variety of presented remains and objects.

Sphenoid sinuses' volume and area analysis of Brazilian individuals' CBCTs, related to sex, age, skin color, and nutritional status using DDS-Pro™ software

The purpose of this study was to analyze the volume and area of sphenoid sinuses of Brazilian individuals' cone-beam computed tomography (CBCT) images using the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland), to assess a potential correlation to sex, age, skin color, and nutritional status, and to evaluate differences between the right and left sides. Three-dimensional volume and area measurements were made with the software using CBCT images of 113 living Brazilian individuals of both sexes (67 females and 46 males). TEM, rTEM, and R were used to assess the reproducibility of inter- and intra-examiner measurements. The measurement means were estimated with 95% confidence intervals according to sex and age group. There were no significant differences between the left and right sides for both volume and area and between the sexes and black and white individuals. Volume and area were significantly higher in 18 years or older (p < 0.05) and in individuals with normal body mass index (BMI) (p < 0.05). The obtained results do not allow indicating the use of sphenoid sinuses volume and area measurements to estimate sexual dimorphism, and the same occurred for skin color. However, such measures can help to estimate age. Further studies are suggested with a larger sample, especially for the nutritional status variable.

Anthropometric analysis of orbital and nasal parameters for sexual dimorphism: New anatomical evidences in the field of personal identification through a retrospective observational study

Orbital and nasal parameters among modern humans show considerable variation, which affects facial shape, and these characteristics vary according to race, region, and period in evolution. The aim of the study was to ascertain whether there are sex differences in the orbital and/or nasal indexes and/or the single measurements used to calculate these in a Kosovar population. The following parameters were taken into consideration: orbital height (OH), orbital width (OW), nasal height (NH), and nasal width (NW). The ratios between orbital index/nasal index (RONI) were calculated. All measurements were obtained from a population sample comprising 408 individuals. The accuracy in sex prediction was 52.86% (CI95% = 45.05%-60.67%) for NW and 64.96% for NH (CI95% = 57.50%- 72.42%). The difference between male and female indexes was statistically significant (P < 0.05). The anthropometric study revealed that only NW and NH are configured as predictors of sexual dimorphism. It could be useful to increase the number of samples to test the discriminant function in other population groups.

Knowledge and attitudes of Polish prosecutors and general Polish population in regard to post-mortem computed tomography in 2019

Post-mortem computer tomography (PMCT) is an imaging technique that is gaining popularity both worldwide and in Poland. It provides certain benefits in death investigation that a conventional autopsy is not able to, however, it has significant limitations. As PMCT and post-mortem computed angiography (PMCTA) continue to develop in this country, it is critical to become aware what people know and think about these imaging techniques, especially the prosecutors who officially order such examinations to be performed. In 2019, two concurrent surveys were administered to Polish prosecutors and general Polish population, respectively, regarding their current knowledge and opinions on PMCT. The results were collected both online and on paper, and then subjected to analysis. In total, 92 prosecutors and 227 non-prosecutors responded to the survey. The present authors observed that while prosecutors were more likely to have heard of this examination than the general public, their knowledge was often inadequate or incorrect. Conventional autopsy was still held as the gold standard in death investigation. However, a good popular sentiment towards PMCT was shown, and a desire to learn more about it - not just among prosecutors, but among the general public as well. The present authors' recommendation is that more courses and training should be organised for Polish prosecutors to compensate this knowledge gap.

3D-3D Superimposition of Pubic Bones: Expanding the Anthropological Toolkit for the Pair-Matching of Commingled Skeletal Remains

Virtual anthropology (VA) has recently produced an additional tool for the analysis of commingled remains and is based on the distance analysis between three-dimensional (3D) models of bones. To date, the pair-matching of the innominate bone through a 3D approach remains partially unexplored. Here, 44 abdominal CT scans (22 males and 22 females) were selected from a hospital database, and the pubic bones were segmented through ITK-SNAP software. The models were hollowed with Viewbox4 to minimize the amount of trabecular bone. The left pubic bones were mirrored and superimposed on the right ones, according to the smallest point-to-point difference between the two surfaces through VAM software. RMS distances between models were calculated through VAM, producing RMS values for 20 matches and 420 mismatches for each sex group. Differences in RMS distance values between matches and mismatches were investigated through Mann−Whitney tests (p < 0.05); the repeatability of the procedure was assessed through absolute and relative technical error measurement (TEM and rTEM). RMS distance values of matches and mismatches were significantly different (p < 0.01) in both groups. The method yielded optimal results with high sensitivity (100.0%) and specificity (99.8% in males, 98.8% in females) rates according to the chosen threshold. This project contributes to the research field of VA with a valuable adjunct that may bolster and strengthen the results of the current visual and osteometric methods through a multidisciplinary approach.

An osteometric and 3D analysis of the atlanto-occipital joint: An initial screening method to exclude crania and atlases in commingled remains

OBJECTIVES

The anatomical features of the atlanto-occipital joint can be potentially useful in re-associating or excluding crania to atlases in commingled remains. This study investigated whether linear measurements and the 3-dimensional (3D) surface of occipital condyles and articular facets of atlases can represent valid insights for this purpose.

METHODS

The variations among eight corresponding linear distances were analyzed in a sample of 150 individuals through six supervised machine learning techniques attempting to develop classifiers able to identify elements belonging to the same individual. Furthermore, a 3D analysis was conducted on the articular surfaces through superimpositions of 3D models of corresponding and non-corresponding crania and atlases obtained by using respectively stereophotogrammetry and laser scanning. This analysis investigated differences in terms of point-to-point distances (Root Mean Square, RMS) of superimposed 3D surfaces.

RESULTS

None of the six machine learning techniques were able to correctly detect a satisfying percentage of correspondent pairs in the overall sample by using the linear variables. The 3D analysis of the articular surfaces found RMS values over 0.53 mm only for superimposed non-corresponding surfaces, which sets a threshold value to identify 32% of incorrect pairs.

DISCUSSION

The re-association of cranium to atlas proved to be challenging and hardly possible when considering only metric variables. However, the 3D geometry of the articular surfaces represents a valid variable for this purpose and 3D analyses pave the way for an initial exclusion of incorrect re-associations, thus should not be considered as a re-association method per se, but as an exclusionary screening technique.

Strengths and Weaknesses of Non-enhanced and Contrast-enhanced Cadaver Computed Tomography Scans in the Teaching of Gross Anatomy in an Integrated Curriculum

Cadaver-specific postmortem computed tomography (PMCT) has become an integral part in anatomy teaching at several universities. Recently, the feasibility of contrast-enhanced (CE)-PMCT has been demonstrated. The purpose of this study was to identify particular strengths and weaknesses of both non-enhanced and contrast-enhanced PMCT compared to conventional cadaver dissection. First, the students' perception of the learning effectiveness of the three different modalities have been assessed using a 34-item survey (five-point Likert scale) covering all anatomy course modules. Results were compared using the nonparametric Friedman Test. Second, the most frequent artifacts in cadaver CT scans, were systematically analyzed in 122 PMCT and 31 CE-PMCT data sets to quantify method-related limitations and characteristics. Perfusion quality was assessed in 57 vascular segments (38 arterial and 19 venous). The survey was answered by n = 257/320 (80.3%) students. Increased learning benefits of PMCT/ CE-PMCT compared to cadaver dissection were found in osteology (2/3 categories, P < 0.001), head and neck (2/5 categories, P < 0.01), and brain anatomy (3/3 categories, P < 0.01). Contrast-enhanced-PMCT was perceived particularly useful in learning vascular anatomy (10/10 categories, P < 0.01). Cadaver dissection received significantly higher scores compared to PMCT and CE-PMCT in all categories of the abdomen and thorax (7/7 categories, P < 0.001), as well as the majority of muscular anatomy (5/6 categories, P < 0.001). Frequent postmortem artifacts (total n = 28, native-phase n = 21, contrast injection-related n = 7) were identified and assessed. The results of this work contribute to the understanding of the value of integrating cadaver-specific PMCT in anatomy teaching.

The big puzzle: A critical review of virtual re-association methods for fragmented human remains in a DVI context'

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.

Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters

Background

Catastrophic natural disasters and epidemics claim thousands of lives and have severe and lasting consequences, accompanied by human suffering. The Ebola epidemic of 2014–2016 and the current COVID-19 pandemic have revealed some of the practical and ethical complexities relating to the management of dead bodies. While frontline staff are tasked with saving lives, managing the bodies of those who die remains an under-resourced and overlooked issue, with numerous ethical and practical problems globally.

Methods

This scoping review of literature examines the management of dead bodies during epidemics and natural disasters. 82 articles were reviewed, of which only a small number were empirical studies focusing on ethical or sociocultural issues that emerge in the management of dead bodies.

Results

We have identified a wide range of ethical and sociocultural challenges, such as ensuring dignity for the deceased while protecting the living, honouring the cultural and religious rituals surrounding death, alleviating the suffering that accompanies grieving for the survivors and mitigating inequalities of resource allocation. It was revealed that several ethical and sociocultural issues arise at all stages of body management: notification, retrieving, identification, storage and burial of dead bodies.

Conclusion

While practical issues with managing dead bodies have been discussed in the global health literature and the ethical and sociocultural facets of handling the dead have been recognised, they are nonetheless not given adequate attention. Further research is needed to ensure care for the dead in epidemics and that natural disasters are informed by ethical best practice.

Pair-Matching Digital 3D Models of Temporomandibular Fragments Using Mesh-To-Mesh Value Comparison and Implications for Commingled Human Remain Assemblages

The mesh-to-mesh value comparison (MVC) method developed by Karell et al. (Int J Legal Med 130(5):1315-1322, 2016) facilitates the digital comparison of three-dimensional mesh geometries obtained from laser-scanned or computed tomography data of osteological materials. This method has been employed with great success to pair-matching geometries of intact skeletal antimeres, that is, left and right sides. However, as is frequently the case for archaeological materials, there are few circumstances which proffer complete skeletal remains and fewer still when considering contexts of commingling. Prior to the present research, there existed a paucity of sorting techniques for the diverse taphonomic conditions of skeletal materials found within commingled assemblages, especially regarding fragmentary remains. The present chapter details a study in which the MVC method was adapted to encompass comparisons of isolated components of bone in lieu of entire bone geometries in order to address this dearth. Using post-mortem computed tomography data from 35 individuals, three-dimensional models of 70 mandibular fossae and 69 mandibular condyles were created and then compared using Viewbox 4, to produce numerical mesh-to-mesh values which indicate the geometrical and spatial relationship between any two given models. An all-to-all comparison was used to determine if the MVC method, using an automated Trimmed Iterative Closest Point (TrICP) algorithm, could be utilized to (1) match corresponding bilateral pairs of condyles and fossae and (2) match same-sided articular correlates. The pair-matching of both the condyles and the fossae generally produced high sensitivity and specificity rates. However, the articulation results were much poorer and are not currently recommended.

New solutions for automated image recognition and identification: challenges to radiologic technology and forensic pathology

This paper outlines the history of biometrics for personal identification, the current status of the initial biological fingerprint techniques for digital chest radiography, and patient verification during medical imaging, such as computed tomography and magnetic resonance imaging. Automated image recognition and identification developed for clinical images without metadata could also be applied to the identification of victims in mass disasters or other unidentified individuals. The development of methods that are adaptive to a wide range of recent imaging modalities in the fields of radiologic technology, patient safety, forensic pathology, and forensic odontology is still in its early stages. However, its importance in practice will continue to increase in the future.

Human identification: a review of methods employed within an Australian coronial death investigation system

Whilst many identification methods have been widely described and discussed in the literature, and considered in disaster and humanitarian contexts, there has been limited reporting and evaluation of the identification methods used in domestic medico-legal death investigation contexts. The aim of this study was to evaluate the identification methods utilised at the Victorian Institute of Forensic Medicine (VIFM), which forms part of a coronial medico-legal death investigation system. The method of identification and time taken to complete the identification were reviewed for all cases admitted to the VIFM over a five-year period from 1 July 2015 to 30 June 2020. The majority, 91%, of individuals admitted to the VIFM were visually identified. The remaining 9% of cases required identification by primary methods (i.e. fingerprints, DNA or dental) or, when those methods were not possible, by secondary methods (i.e. circumstantial). Visual identifications were the timeliest, taking an average of 1.5 days, whilst primary identification methods required an average of 5 days to complete. The triaging of identification methods, dependent on the case context, body preservation, availability of ante-mortem data, legal requirements and admissibility of the method, are determined by identification coordinators within the Human Identification Service (HIS) to ensure the most appropriate and timely method is employed. This review of human identification methods provides the foundation for future analyses to compare workflow processes and improve identification methods utilised in domestic medico-legal contexts.

Potential use of deep learning techniques for postmortem imaging

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.

A simple method for the automatic classification of body parts and detection of implanted metal using postmortem computed tomography scout view

Information on medical devices embedded in the body is important in the identification of an unidentified body. Computed tomography (CT) is a powerful imaging modality; however, metallic artifacts deteriorate the image quality because of the reconstruction method. On the contrary, CT scout view is less affected by metallic artifacts compared to CT. It is a simple method to classify the body into three rough parts for postmortem CT (PMCT) scout view, and an algorithm used to detect the location of the implanted metal has been developed for personal identification in forensic pathology. Of the test images, 97% were correctly classified into the three body parts. The true-positive rate for detection of the implanted metal in the scout view was 96.5%. Therefore, our simple methods are applicable in PMCT scout views and would be particularly useful for forensic pathology.

Disaster victim identification operations with fragmented, burnt, or commingled remains: experience-based recommendations

Human-made and natural disasters can result in severely fragmented, compromised, and commingled human remains. The related disaster victim identification (DVI) operations are invariably challenging, with the state of the remains potentially precluding some identifications. Practitioners involved in these DVI operations will routinely face logistical, practical, and ethical challenges. This review provides information and guidance derived from first-hand experiences to individuals tasked with managing DVI operations with fragmented human remains. We outline several key issues that should be addressed during disaster preparedness planning and at the outset of an operation, when incident-specific strategies are developed. Specific challenges during recovery and examination of fragmented remains are addressed, highlighting the importance of experienced specialists at the scene and in the mortuary. DNA sample selection and sampling techniques are reviewed, as well as downstream effects of commingling and contamination, which can complicate reconciliation and emphasise the need for rigorous quality control. We also touch on issues that may arise during communication with families. While recommendations are provided, they are not intended as proscriptive policy but rather as an addition to the general recommendations given in the International Criminal Police Organization (INTERPOL) DVI Guide, to inform preparative discussions between government officials, judiciary, police, and forensic specialists.

Key points

A DVI operation for an incident characterised by many fragmented and otherwise compromised human remains poses specific challenges that may prolong and complicate identifications.

Specialists should be consulted at the outset to address key issues related to the aim and extent of the operation.

Specialist expertise in handling compromised human remains is indispensable at the scene, in the mortuary, during reconciliation, and for quality control.

Continuous consultation between representatives from government, the judiciary, law enforcement, the media, and various forensic specialists will prevent unnecessary delay and facilitate accurate and timely communication.

Odontological identification dental charts based upon postmortem computed tomography compared to dental charts based upon postmortem clinical examinations

Since the beginning of this century, the use of postmortem computed tomography (PMCT) in forensic autopsies has increased. In this study we examined how similar dental charts created using PMCT as a solitary examination mode were to dental charts created using the conventional method of a clinical inspection including intraoral radiographs. A total of 100 previously performed dental identification cases were retrospectively included in the study. For each case, a dental chart was created solely based upon PMCT. The PMCT based dental chart was subsequently compared with the chart created from the previous conventional identification examination. Based upon the accuracy, sensitivity and specificity values PMCT performed very well compared to the conventional method in the identification concerning presence or absence of teeth, the presence of crowns, bridges and endodontic treatments as well as the presence and types of fillings. PMCT performed poorly concerning the extension of fillings and identification of small, tooth-colored fillings. The use of PMCT is a valuable supplement to the conventional methods available for forensic odontologists and may be of great value for initial screening in mass fatalities.

Forensic odontology in DVI: current practice and recent advances

Forensic odontology frequently plays a significant role in identification of the victims of multi-fatality disasters, but not in all. It depends on adequate dental remains surviving the disaster and on the availability of dental records to be successful. This paper describes current practice in the techniques of identification in forensic odontology and outlines recent advances that are moving into the mainstream.Key PointsForensic odontology plays a key role in mass disaster victim identification (DVI) when good-quality antemortem (AM) dental records are available.Images including radiographs, computerized tomography (CT) data and three-dimensional (3D) scan data are considered more reliable AM records than written dental charts and odontograms.Interpretation, transcription and comparison of dental datasets are complex processes that should be undertaken only by trained dental professionals.The future of forensic odontology DVI techniques is likely to include the use of 3D datasets for comparison.

Baggage scanners and their use as an imaging resource in mass fatality incidents

Disaster victim identification following a mass fatality incident is focussed on identifying the deceased and returning them to their families as quickly as possible, while gathering as much information as practical to aid investigators in establishing the cause of the incident. Ante-mortem data is gathered and compared with the post-mortem data obtained in order to positively identify the deceased. This paper presents results from a study concerned with the first part of the process of identifying the deceased—the triage or Primary Survey and how this can be done without access to hospital facilities such as conventional X-ray imaging or computed tomography. In particular, this study focuses on the imaging undertaken prior to the opening of the body bag by a multidisciplinary team, and how this imaging can assist particularly when forensic anthropologists are involved in the identification process. There are several advantages to imaging the body bags before they are opened and one of the most important is safety. Thus, this paper examines the viability of using a baggage scanner as a practical resource for X-ray imaging, as many regions worldwide may not be able to access conventional imaging equipment. Baggage scanners are readily available and found in airports and various government buildings. The baggage scanner is particularly suited to this task and produces images that can be used by forensic anthropologists to distinguish between human and non-human remains, identify items of evidence and personal effects, and even perform a preliminary or partial biological profile. When considering their response plans, emergency responders should consider including baggage scanners as a contingency for screening body bags if no other imaging system is available.

Remote post-mortem radiology reporting in disaster victim identification: experience gained in the 2017 Grenfell Tower disaster

On 14 June 2017 at 00:54 h, the worst residential fire since the conclusion of the Second World War broke out in Flat 16, 4th floor of the 24-storey residential Grenfell Tower Block of flats, North Kensington, West London, UK. Seventy-one adults and children died, including one stillbirth. All victims of the Grenfell Tower disaster who died at the scene underwent post-mortem computed tomography (PMCT) imaging using a mortuary-sited mobile computed tomography scanner. For the first time, to the authors’ knowledge, the disaster victim identification (DVI) radiology reporting was undertaken remote to the mortuary scanning. Over an 11-week period, 119 scans were undertaken on 16 days, with up to 18 scans a day. These were delivered to a remote reporting centre at Leicester on 13 days with between 2 and 20 scans arriving each day. Using a disaster-specific process pathway, a team of 4 reporters, with 3 support staff members, trialled a prototype INTERPOL DVI radiology reporting form and produced full radiology reports and supporting image datasets such that they were able to provide 96% of prototype DVI forms, 99% of image datasets and 86% of preliminary reports to the DVI teams in London within one working day of image receipt. This paper describes the first use of remote radiology reporting for DVI and exemplifies how remote PMCT reporting can be used to support a DVI process of this scale.

Accuracy and reliability of virtual femur measurement from CT scan

BACKGROUND

In the application of scientific human skeletal variation in medico-legal matters, virtual anthropology is the current technique performed to examine skeleton and its body parts. Hence, this study was conducted to assess the accuracy and reliability of virtual femur measurement through intra and inter-observer error analysis, and comparison was made between the virtual and conventional methods.

METHODS

A total of 15 femora were examined with four parameters i.e. maximum length of femur (FeMl), diameter of femoral head (FeHd), transverse diameter of midshaft (FeMd) and condylar breadth (FeCb). Osteometric board and vernier calipers were employed for the conventional method, while CT reconstructed images and Osirix MD software was utilised for the virtual method.

RESULTS

Results exhibited that there were no significant differences in the measurements by conventional and virtual methods. There were also no significant differences in the measurements by the intra or inter-observer error analyses. The intraclass correlation coefficients (ICC) were more than 0.95 by both intra and inter-observer error analyses. Technical error of measurement had displayed values within the acceptable ranges (rTEM <0.08 for intra-observer, <2.25 for inter-observer), and coefficient of reliability (R) indicated small measurement errors (R > 0.95 for intra-observer, R > 0.92 for inter-observer). By parameters, FeMl showed the highest R value (0.99) with the least error in different methods and observers (rTEM = 0.02-0.41%). Bland and Altman plots revealed points scattered close to zero indicating perfect agreement by both virtual and conventional methods. The mean differences for FeMl, FeHd, FeMd and FeCb measurements were 0.01 cm, -0.01 cm, 0.02 cm and 0.01 cm, respectively.

CONCLUSION

This brought to suggest that bone measurement by virtual method was highly accurate and reliable as in the conventional method. It is recommended for implementation in the future anthropological studies especially in countries with limited skeletal collection.

Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging

The applications of forensic radiology involve both Virtopsy both studies on living people - to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass disasters.

The advantage of the virtual forensic autopsy - A new approach which could benefit forensic expertise

We aimed to assess the accuracy and advantages of postmortem CT examination and three-dimensional (3D) view of the cadaver with the Sectra Visualization Table compared to the full conventional autopsy of a forensic suicidal case. Our survey concerned unusual case of self-strangulation where a body was found in the stage of mummification with a nylon cable tie around the neck and another around the feet. The case was initially determined as a homicide, but later reconsidered a suicide based on objective scene investigation, virtual autopsy and the positions of knots. Unlike the physical autopsy in case of mummification 3D examination does not alter evidence and can revisit the body for additional investigation.

The role of forensic anthropology in disaster victim identification (DVI): recent developments and future prospects

Forensic anthropological knowledge has been used in disaster victim identification (DVI) for over a century, but over the past decades, there have been a number of disaster events which have seen an increasing role for the forensic anthropologist. The experiences gained from some of the latest DVI operations have provided valuable lessons that have had an effect on the role and perceived value of the forensic anthropologist as part of the team managing the DVI process. This paper provides an overview of the ways in which forensic anthropologists may contribute to DVI with emphasis on how recent experiences and developments in forensic anthropology have augmented these contributions. Consequently, this paper reviews the value of forensic anthropological expertise at the disaster scene and in the mortuary, and discusses the way in which forensic anthropologists may use imaging in DVI efforts. Tissue-sampling strategies for DNA analysis, especially in the case of disasters with a large amount of fragmented remains, are also discussed. Additionally, consideration is given to the identification of survivors; the statistical basis of identification; the challenges related to some specific disaster scenarios; and education and training. Although forensic anthropologists can play a valuable role in different phases of a DVI operation, they never practice in isolation. The DVI process requires a multidisciplinary approach and, therefore, has a close collaboration with a range of forensic specialists.

The value of post-mortem computed tomography of burned victims in a forensic setting

Objectives

Fire deaths are challenging fatalities for forensic pathologists, as the main question of whether death was due to the fire or not needs to be answered. In this retrospective study, we assessed whether post-mortem computed tomography (PMCT) has an added value prior to a forensic autopsy of burned victims.

Methods

From 2008 to 2016, a PMCT was performed in 50 burned corpses prior to a complete forensic autopsy. In retrospect, all 50 PMCT scans were systematically assessed by a forensically experienced radiologist, masked from the autopsy reports. Subsequently, the PMCT findings were compared with the autopsy reports.

Results

Heat fractures, contractions and destruction of extremities, subcutaneous emphysema and post-mortem gas collections were easier to detect by PMCT compared to autopsy. Alterations by penetrating and blunt trauma and the presence of foreign bodies were easy to detect by PMCT as well by autopsy. PMCT was, however, not successful in detecting signs of vitality during the fire, detection of superficial thermal injuries and to answer the main question of the forensic autopsy, which is to investigate the cause of death.

Conclusions

PMCT prior to autopsy is a valuable add-on in the post-mortem forensic investigation of burned victims for detection of hidden signs of trauma, gas collections and foreign bodies. However, since PMCT cannot answer the two main questions in forensic examination—determining the cause of death and detecting signs of vitality during the fire—it cannot replace an autopsy.

Key Points

• Post-mortem CT (PMCT) in burned victims shows hidden signs of trauma.

• Foreign bodies and gas collections can easily be detected.

• Cause of death and vitality signs cannot be assessed by PMCT.

Determining gender by taking measurements from magnetic resonance images of the patella

BACKGROUND

A key step in making a positive identification in forensic medicine is the establishment of a biological profile, which involves determining factors such as gender, age, ancestry, and stature. The goal of this study was to determine if gender could be established by taking various measurements of the patella taken from magnetic resonance imaging (MRI) images and analyzing the variations by gender.

METHODS

The sample group consisted of 220 patients (110 male and 110 female) whose patella were measured using MRI images of their left knee. Reasons for exclusion were any previous surgery, patella bipartite variation, any fracture in the patella due to trauma or findings of mass or infection. Three measurements - transverse length (TP), craniocaudal length (CC) and anteroposterior length (APP) - were taken off T2-weighted axial and sagittal MRI scans. The program SPSS (Version 21.0) was used to make a descriptive analysis, independent t-test and discriminative analysis.

RESULTS

It was found possible to determine gender with an accuracy rate of 91% for females and 87% for males. Since measurements were made individually the accuracy for gender estimation is lower than that seen in other methods.

CONCLUSION

The findings are important in that they show that it is possible to determine gender with a high degree of accuracy using just a few measurements taken from the patella.

Synergistic Role of Newer Techniques for Forensic and Postmortem CT Examinations

OBJECTIVE

The aim of this article is to provide an overview of newer techniques and postprocessing tools that improve the potential impact of CT in forensic situations.

CONCLUSION

CT has become a standard tool in medicolegal practice. Postmortem CT is an essential aid to the pathologist during autopsies. Advances in technology and software are constantly leading to advances in its performance.

Post-mortem MR angiography: quantitative investigation and intravascular retention of perfusates in ex situ porcine hearts

As the implementation of minimally invasive imaging techniques in both forensic and pathological practice increases, research in this area focuses on addressing recognised diagnostic weaknesses of current approaches. Assessment of sudden cardiac death (SCD) can be considered one such area in which post-mortem imaging still shows diagnostic weaknesses. We hypothesise that magnetic resonance imaging (MRI) with an angiographic adjunct may improve the visualisation and interpretation of cardiac pathologies in a post-mortem setting. To systematically investigate this hypothesis, selected perfusates (paraffin oil, Gadovist®;-doped physiological solution and polyethylene glycol (PEG)) were injected into the left anterior descending (LAD) artery of ex situ porcine hearts to assess the visualisation of perfusates in MRI as well as their intravascular retention over 12 h. Morphological images were acquired and quantitative T₁ maps were generated from inversion recovery data. Visualisation of vascular structure and image quality were assessed using signal-to-noise and contrast-to-noise ratios. Intravascular retention was assessed both visually and statistically using a volume of interest (VOI) approach to analyse significant changes in signal intensity in and around the filled LAD artery, as well as changes in the longitudinal relaxation time (T₁) in adjacent myocardium. In addition to presenting possible mechanisms explaining perfusate extravasation given the increased permeability of post-mortem vessels, the potential diagnostic consequences of this phenomenon and the importance of contrast stability and extended intravascular retention are discussed. In light of our findings and these considerations, paraffin oil emerged as the preferred perfusate for use in post-mortem MR angiography.

Standardized medical image registration for radiological identification of decedents based on paranasal sinuses

Image registration software is frequently used in clinical radiology, e.g., for follow-up diagnosis. To a certain extent, the radiological identification of decedents (RadID) is comparable to a clinical follow-up diagnosis, in that two datasets from different dates are compared in terms of their anatomical characteristics (e.g., paranasal sinuses) or surgical implants. Due to the increasing use of computed tomography (CT) for head examinations in clinical radiology and the increased use of postmortem CT (PMCT) in forensic imaging, the comparison of three-dimensional (3D) clinical CT (termed as antemortem CT (AMCT) in this article) and PMCT datasets for RadID is becoming increasingly practical. In particular, the comparison of paranasal sinuses in AMCT and PMCT imaging is considered a suitable and reliable modality for RadID. However, previous publications regarding RadID based on comparisons of 3D datasets have not considered the implementation of image registration to provide software-side support for RadID. This article demonstrates and evaluates the use of a standard medical image registration procedure for RadID by comparing paranasal sinuses.

Virtual anthropology - a brief review of the literature and history of computed tomography

Computed tomography (CT) has influenced numerous fields since its inception in the 1970s. The field of palaeoanthropology significantly benefited from this efficient and non-invasive medium in terms of the conservation, reconstruction and analysis of fossil human remains. Over the past decade, there has been a steady increase in the number of forensic anthropological studies incorporating virtual osteological analyses. Because of the increasing importance of these modern cross-sectional imaging techniques and the requirement for standardized parameters in forensic science, we deemed it important to outline the history and development of CT applications in these related academic areas. The present paper outlines the history of “virtual anthropology” and osteological multi-detector CT in the context of palaeoanthropology and forensic anthropology.

Stature estimation in a contemporary Japanese population based on clavicular measurements using multidetector computed tomography

The aims of this study was to assess the correlation between stature and clavicular measurements in a contemporary Japanese population using three-dimensional (3D) computed tomographic (CT) images, and to establish regression equations for predicting stature. A total of 249 cadavers (131 males, 118 females) underwent postmortem CT scanning and subsequent forensic autopsy between October 2011 and May 2016 in our department. Four clavicular variables (linear distances between the superior margins of the left and right sternal facets to the anterior points of the left and right acromial ends and between the superior margins of the left and right sternal facets to the left and right conoid tubercles) were measured using 3D CT reconstructed images that extracted only bone data. The correlations between stature and each of the clavicular measurements were assessed with Pearson product-moment correlation coefficients. These clavicular measurements correlated significantly with stature in both sexes. The lowest standard error of estimation value in all, male, and female subjects was 3.62cm (r²=0.836), 3.55cm (r²=0.566), and 3.43cm (r²=0.663), respectively. In conclusion, clavicular measurements obtained from 3D CT images may be useful for stature estimation of Japanese individuals, particularly in cases where better predictors, such as long bones, are not available.