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Forensic Radiology – Come to the Dark Side

Do you think a career in medical imaging sounds boring? Well, guess again. It is not uncommon for hospital imaging departments to get requests to image the deceased. In fact, Gene Turley, our County Coroner, was a guest speaker at our annual state radiology society conference this year. He shared many illustrative slides in a powerpoint presentation that detailed the types of patients who undergo imaging examinations post mortem. That is the topic of this article, what exactly is forensic radiography?

Answer: Conducting examinations that use ionizing radiation to gather and analyze forensic evidence constitutes forensic radiography, an academic and scientific discipline, per the American Society of Radiologic Technologists

To watch the video, click below:

Radiography is commonly used in the collection of forensic evidence and is especially useful for confirming the identity of both living and deceased subjects. It can be used for identifying pre-existing skeletal trauma, assisting in the determination and/or confirmation of the cause of death, and locating hidden foreign bodies.  Some types of foreign bodies include bullet fragments, fragments of explosives and packages of illegal substances. This is why it is important for radiographers to understand the appropriate forensic imaging protocols for each situation, as well as the legal and ethical issues involved. During my career, I have seen a variety of post mortem examinations. Bicycle riders hit by cars, minors in abuse cases and other cases that can’t be unseen. It is not a pleasant part of the job but it is fulfilling in its own way.

You see, as radiographers, we get to solve the puzzle. We are the digital sleuth on the case. We can radiograph through the body and see the broken bones. The county coroner relies on radiographers to provide clues that cannot be seen any other way. Radiographers provide much needed digital evidence that can help to solve cases. Digital evidence includes all facets of crime where evidence may be found in a digital form. It includes forensic imaging, forensic audio, video analysis, and analyzing computer files and other digital data from computer systems.

Who can be involved in forensic radiography?

There are three professions identified by the ASRT who can perform this necessary task:

  1. The traditional licensed ARRT radiographer or x-ray tech.
  2. A limited license radiographer or LXMO (limited x-ray machine operator), also licensed by the ARRT.
  3. A forensic assistant (usually an assistant to a forensic pathologist or medical examiner or forensic laboratories, including morgue assistants, laboratory clerks, and pathologists).

In every hospital I have worked over the past 16 years, these examinations occur in our main imaging department. The deceased are brought in on a gurney and usually sealed inside of what is commonly referred to as a “body bag.”  Most times the bodies are laid upon the imaging table and imaged without even opening the bag. However, there are times when only specific body parts need to be imaged… including body parts that are no longer attached. In those cases, there is no shroud to cover the object being imaged. More often than not it occurs on the evening or night shift. These are the technologists who bare the brunt of this emotionally taxing examination.

The county officials are sensitive to the fact that hospitals have more of the general public walking around during the day. Out of respect for decorum, they bring the deceased for imaging after normal hours when possible. Forensic imaging can occur in both general radiography or computed tomography. The determination lies at the request of the coroner. Sometimes entire CT scans of the body are acquired. But the day shift techs do sometimes get the same requests. It is completely random and part of the imaging technologist’s job to perform this exam. There is no more qualified person, in my opinion, to perform this exam than the licensed radiographer.

In the United States, there’s a good chance that a forensic pathologist will still cut into these corpses in search of clues about the cause of death. But technology advances mean that there are other options. Scanning the deceased with CT is commonly done in Europe, Australia, and Japan. It is slow to take hold in the United States, though a few Cheif Medical Examiner offices are leading the charge, incorporating imaging other than radiographs in their offices.

Forensic radiographers are not depicted on the tv shows…but should be.

The forensic sciences enjoy great visibility and respect among the public today. Popular television shows depict the crime laboratory as an important and exciting endeavor, and young people are choosing to study forensic science in college in unprecedented numbers. In particular, DNA analysis has revolutionized the ability of law enforcement to identify criminals and protect the innocent from wrongful prosecution, according to the National Criminal Justice Reference Service. Forensic disciplines span a large range including general toxicology, firearms/tool marks, questioned documents, trace evidence, controlled substances, biological/serological screening, fire debris/arson analysis, impression evidence (e.g., fingerprints, shoe/tire prints), blood pattern analysis, crime scene investigation, medicolegal death investigation, and digital evidence.

It should be noted that not all forensic services are performed in what is thought of as a traditional crime laboratory. Forensic services in the disciplines of digital evidence, latent prints, questioned documents, and crime scene investigation may also be provided at a site outside of the traditional crime laboratory setting by a unit composed of sworn law enforcement personnel who may or may not have scientific training.

Ultimately, they seek to solve the Cause of Death and the Manner of Death. The Cause of Death is the determining factor that brings about the Manner of Death. COD is determined through a medicolegal investigation by the coroner. There are five Manners of Death:

  1. Natural – myocardial infarction, organ failure, Alzheimer’s, etc.
  2. Homicide – a death that results from an accident or injury when the injury was intentionally caused by another person to the deceased or a person acts in such willful and wanton disregard for life that his or her actions are likely to cause death.
  3. Suicide – a death resulting from the intent by the deceased to terminate his own life by any means.
  4. Accidental – a death resulting from an accident or injury not intentionally caused by the decedent or by another.
  5. Undetermined – if the evidence as to the manner of death is unclear.

What kind of cases require forensic radiography?

According to an ASRT forensic radiography survey completed in 2008 (only available to ASRT members), the following cases require radiographic imaging:

  • Homicides
  • suicides
  • decomposed bodies
  • infant deaths
  • penetrating traumas
  • burn victims and
  • unidentified bodies
rad tech gear
Imaging occurs before the autopsy

Although they are used for a variety of purposes, skeletal surveys are commonly completed on children with suspected child abuse (living or deceased.) A skeletal survey is a systematically performed series of radiographic images that encompasses the entire skeleton or those anatomic regions appropriate for the clinical indications. The goal of the skeletal survey is to accurately identify focal and diffuse abnormalities of the skeleton.  This includes acute or healing fractures, bone lesions, evidence of metabolic bone disease or characteristics of skeletal dysplasia. It is also used to differentiate them from developmental changes and other anatomic variants that may occur in infants and children. (American College of Radiology)

A licensed radiologic technologist will have training and experience in performing radiographic examinations on infants and children. In particular, the technologist is trained to be familiar with positioning and patient restraint.  A rad tech is also trained in the measures to minimize radiation exposure to every patient. We follow a culture of ALARA which means we keep the radiation levels As Low As Reasonably Achievable to obtain a diagnostic image. The technologist should be aware of the unique circumstances created when children with suspected abuse are brought to the radiology department by caretakers, guardians, and child protective service representatives.

The case for a credentialed radiography program

There is no individual forensic radiographer career whose only job is post mortem x-rays. it is incorporated into the standard job duties of every radiographer of which they are completely capable. A credentialed, accredited school of radiography reviews medical and legal issues that surround the radiology world. They properly prepare every student for a multitude of liability issues and devote an entire class to it. Coupled with the positioning classes, radiation physics, radiation biology and a slew of other fundamental radiography classes, the graduate of a proper program becomes a vital part of yet another segment of society: the forensic radiographer.

Revealing Counterfeit Art

radiographing-forged-artwork
Image courtesy of FutureLearn.com

A lesser known use of radiography in criminal investigations is on valuable paintings. Radiographs can be used by art historians to detect whether or not a picture has been painted over an existing piece. Art forgers know that you cannot take a fresh canvas and attempt to paint an ancient image on it. You would need an ancient canvas to start with. That is why they will find less valuable but old painting to paint over the original image. A newer canvas could be debunked with a common microscope and the age would be revealed. It is common throughout history for “starving artists” could save money by painting over other people’s paintings.

Radiography as a Medicolegal Investigative Tool

  • Fingerprints: Specific imaging techniques using radiographs can uncover latent fingerprints from difficult surfaces such as plastic, biological material, and colored or printed paper.
  • Documents: Radiographs can reveal surface details in the paper as well as indentations, obliterations, alterations, and watermarks.
  • Serial Numbers: Concealed or altered serial numbers may be visualized in radiographs as well as identifying markings hidden inside the seams of clothing.
  • Bomb Detection: X-ray images provide a more detailed look at the explosive devices that also include a battery and wiring.

Additional Information: If you are curious about the career of radiography, I have written some articles on various topics:

 

Ron Jones MSRS, RT (R,CT) ARRT

Ron is huge radiology nerd. It started with Xray school at Pima Medical Institute in Mesa, AZ. He was crosstrained in CT during his Xray clinical rotations at Mesa General Hospital. Then immediately returned to school for ultrasound at Gateway Community College as he started his first job as an Xray/CT Tech. Not much later learned MRI out of necessity at his small rural hospital in Apache Junction, AZ. A decade later he found himself as a manager in a level one trauma center. Currently he is a system operations director over an entire hospital system and loves every minute of it.

16 thoughts on “Forensic Radiography – The Dark Side of Radiology

  1. In 1983, when the US Marines were killed by a suicide bomber in Beirut I was stationed in Germany with a Army field hospital. The bodies were flown to Germany and the X-ray techs, and their equipment, were sent to the airbase (Rammstein maybe?) to X-ray bodies. When they were killed many of them were asleep and only wearing boxers and their dog tags. The blast literally blew the dog tags into their body and the X-ray was used to locate the dog tag which is how some were ID’d.

    https://en.m.wikipedia.org/wiki/1983_Beirut_barracks_bombings?wprov=sfti1 https://maps.apple.com/?ll=33.829167,35.494722&q=1983%20Beirut%20barracks%20bombings&_ext=EiQpp0opIiLqQEAxlMDFDlO/QUA5p0opIiLqQEBBlMDFDlO/QUA%3D

  2. I was 18 at the time. Working one of my first rotations in the ER of a level 1 trauma center. I get called over for a chest x-ray on a patient that didn’t get a trauma alert and wasn’t in our trauma room. This should have been a clue.

    I went into the room and there was a 19 year old female that had passed away from a car accident. They wanted the chest x-ray in an attempt to figure out why she died. She had no signs of trauma, no visible bleeding, and no swelling of any kind. I placed the CR cassette under her and the MD walks into the room as I’m positioning the AMX4 tube above the patient. The MD says “well I guess you can’t get her to hold her breath”. I’ve never wanted to hurt someone so badly in life, before or since. I finished the exam quickly because I wanted away from that MD.

    I went back to the alcove where x-ray was located and spoke to the Rad Tech about my problems with it. She told me that sometimes as a way to handle a difficult situation, people make jokes. I told her that I didn’t care what he was trying to do and I didn’t care. If I saw him again that evening, it wouldn’t be a good thing for either of us.

    Trauma later ordered a lateral cervical spine and lateral head. The Rad Tech decided it was best that she handle it and told me she would take care of it.

    To this day, that event gets under my skin. I remember what the young lady looked like, where she was in the room, and where the room was in the hospital(that has since closed). I have not been in that building since February of 2000. I still feel that the MD was trash for making that comment. He was trash for even thinking it.

  3. I recently had my first pm CT. 19 year old girl died in a horrific car crash, was brought into the ER while undergoing CPR. Did the CT to evaluate the probable cause of death (hint: severe lung contusion with mass bleeding and complex head trauma).

  4. Did a clinical rotation at the University hospital which is where the county ME is. Got to do a few interesting cases. It’s certainly a different environment.

    One was a guy who was literally playing Russian roulette. FYI, he lost.

  5. This is what made me get out of the field. Dead bodies are absolutely not my thing, and I get so scared.

    For some reason, preserved scientific specimens don’t freak me out, but recently dead people do.

  6. I’ve been an x-ray tech for 28 years. I once x-rayed a guy that had jumped from a freeway overpass and then was promptly run over by an eighteen-wheeler. I literally just x-rayed a bag of parts. You could see skull, femur, and feet all on the same 14×17 film. Pretty gnarly, and no I didn’t open the bag.

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