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Any x-
x-ray is potentially forensic
Elder abuse
Images of traumatic injuries that become
evidence in criminal or civil court cases
Child abuse
Criminal investigations
Drug mules, FB search of prisoners
Analysis of adverse medical events
Paediatric Non-
Non-Accidental Trauma
In Britain:
7% of children experienced serious physical abuse at the hand of
their parents or caregivers during childhood.
Up to 55% of fatally abused children have been seen within the
previous month by a healthcare professional.
The incidence of injury sufficient to cause fracture is reported as
occurring in 6% - 55% of physically abused children depending on
age and nature of the population studied.
Non
Non--accidental Head Injury with brain injury show outcomes of 20%
mortality, severe disability in 34% and mild disability in 25% of
survivors.
Royal College of Paediatrics and Child Health, Standards for Radiological Investigations of Suspected Non-Accidental Injury, March 2008
Recommendations for
Paediatric Non-
Non-Accidental Trauma
Royal College of Paediatrics and Child Health, Standards for Radiological Investigations of Suspected Non-Accidental Injury, March 2008
Recommendations for
Paediatric Non-
Non-Accidental Trauma
Canadian Association of Radiologists Standard
for Skeletal Surveys in Children
· Skull (SXR) - AP and lateral, plus Towne's view for occipital injury.
Skull x-rays should be taken with a skeletal survey even if a CT scan
has been performed.
· AP Chest (including clavicles)
· Oblique views of the ribs (left and right)
· AP Abdomen with pelvis and hips
· Lateral spine - cervical and thoracic-lumbar
· AP Humeri
· AP Radius / Ulna
· AP Femurs
· AP Tibia/Fibula
· PA hands and AP feet
Royal College of Paediatrics and Child Health, Standards for Radiological Investigations of Suspected Non-Accidental Injury, March 2008
Recommendations for
Paediatric Non-
Non-Accidental Trauma
http://www.radiologyassistant.nl/en/43c63c41ef792
http://www.hawaii.edu/medicine/pediatrics/pemxray/v4c02.html
Coroner
Is an elected or appointed official
Not necessarily required to have any training
in science, law or medicine.
Would appoint experts to assist the Coroner’s
office in performing it’s duties.
Medical Examiner vs. Coroner
Medical Examiner
is a physician
is charged with investigation and examination
of persons dying a sudden, unexplained or
violent death.
usually a Pathologist, but not required to be
so.
It’s Not CSI
Non--x-ray methods
Non
Visual ID in recognizable individuals
Fingerprints
DNA
Radiographic Identification
Surgical implants
Comparative skeletal anatomy
Chest x-
x-ray / Thoracic Spine
Frontal Sinuses
Any comparative finding with ante mortem
images.
Implants
Comparative Anatomy
Dental Examination
Intra Oral x-
x-rays
Intra Oral x-
x-rays
Parallel Technique
The film is positioned
parallel to the long
axis of the tooth. CR
is perpendicular to the
film
The body bag will then be transferred to the pathology area for
examination and autopsy.
Secondary Survey
Tertiary Survey
• Any unique skeletal features observed by
fluoroscopy or identified at autopsy
• difficult cases which for which a
radiograph may be useful
Resources