Table Of ContentMedical Radiology · Diagnostic Imaging
Series Editors: Hans-Ulrich Kauczor · Paul M. Parizel · Wilfred C. G. Peh
Fabrice Dedouit
Kathrin Yen
Sarah Heinze Editors
Forensic
Imaging
A Practical Guide
Medical Radiology
Diagnostic Imaging
Series Editors
Hans-Ulrich Kauczor
Paul M. Parizel
Wilfred C. G. Peh
The book series Medical Radiology – Diagnostic Imaging provides accurate
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Medical Radiology – Diagnostic Imaging covers all organ systems and
addresses all modern imaging techniques and image-guided treatment
modalities, as well as hot topics in management, workflow, and quality and
safety issues in radiology and imaging. The judicious choice of relevant topics,
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Fabrice Dedouit • Kathrin Yen
Sarah Heinze
Editors
Forensic Imaging
A Practical Guide
Editors
Fabrice Dedouit Kathrin Yen
Service de médecine légale Institute of Forensic and Traffic
CHU Rangueil Medicine
Toulouse University Hospital Heidelberg
France Heidelberg
Germany
Sarah Heinze
Institute of Forensic and Traffic
Medicine
University Hospital Heidelberg
Heidelberg
Germany
ISSN 0942-5373 ISSN 2197-4187 (electronic)
Medical Radiology
ISSN 2731-4677 ISSN 2731-4685 (electronic)
Diagnostic Imaging
ISBN 978-3-030-83351-0 ISBN 978-3-030-83352-7 (eBook)
https://doi.org/10.1007/978-3-030-83352-7
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Foreword
Since about 20 years ago forensic post-mortem imaging was developed sys-
tematically at first in Bern, then in whole Switzerland and now worldwide.
Richard Dirnhofer, the father of “Virtopsy”1, summarizes the scientific devel-
opment of post-mortem imaging techniques as follows:
It was against the background of rapid technological advances in various imaging
techniques, that at the turn of the century, the academic concept of the “Virtopsy”
research programme was realized at the University of Bern in Switzerland. The aim
of this project has been to develop a minimally invasive autopsy procedure in which
evidentially relevant findings are obtained from a corpse predominantly by means of
medical imaging methods. Depending on the individual case and the specific issue
involved, this leaves, the option open to perform a conventional autopsy to acquire
further relevant facts, such as histological, toxicological and bacteriological
examinations.
The international impact of this idea has been reflected in an exponential
increase in scientific publications around the world dealing with forensic radiology.
For instance, the recently published study by M. Baglivo et al. showed a tenfold
increase in the volume of publications compared to the turn of the millennium, when
the “Virtopsy” project started.
This academic “hype” in the field of postmortem radiology has had a very posi-
tive influence on the attractiveness of radiology for the new generation of academics
in forensic medicine.
In short, the results of these numerous publications documents that postmortem
imaging is not only equal to autopsy in many respects but that this method can even
achieve better results than conventional autopsy procedures. This has also called
into question the status of conventional autopsy as the “gold standard” for obtain-
ing and recording forensic medical findings.
At the beginning of the virtopsy project, there was a confrontation between
supporters of new developments and the defenders of the classical autopsy.
This confrontation has now been resolved due to the success of Forensic
Imaging.
Forensic Imaging in living individuals is of course also useful for the
forensic examiner in different medicolegal contexts or situations as it is the
only way of documenting internal lesions in living persons.
Also in this field post-portem imaging and forensic medicine have been
very successful in the last years.
1 The term “Virtopsy” is a neologism comprising the words “virtual” and “autopsy”. It is
used for imaging in Forensic Medicine, especially post-mortem imaging (CT, MRT, sur-
face scanning, angiography).
v
vi Foreword
From the beginning on in Bern Forensic Imaging could make its success-
ful way only by the collaboration of experts in forensic medicine together
with radiologists.
Richard Dirnhofer always acknowledges the support by the former
Professor of Radiology at the University Hospital in Bern, Peter Vock.
Both radiologists and forensic practitioners have to learn their lessons
since forensic radiology is a unique subdiscipline and not only an application
of imaging in a forensic context.
It has impacts from both disciplines. Classical questions of forensic medi-
cine have to be answered by methods of forensic radiology.
And this is also the approach of this book: Collaboration between forensic
medicine and radiology. At least one of the editors is board certified both as
expert in forensic medicine and as radiologist.
This book is not an introductory book. It is based on experience and own
research in many fields of forensic radiology.
Meanwhile forensic radiology has become a standard method in forensic
case assessment and diagnostics. According to the authors, the importance of
interdisciplinary research and cooperation will further increase in the near
future.
Since forensic imaging profits from new projects and collaborations
between forensic medicine, radiology and other associated disciplines, it is
nowadays mandatory for the expert in forensic medicine to have beside his
own textbook a further one on forensic radiology, just like this one.
The table of contents covers a broad field both from forensic medicine and
radiology. For instance:
– Imaging methods
– Analogies and differences between forensic and clinical imaging
– Post-mortem changes
– Normal post-mortem imaging findings in foetuses and children
– Artefacts (Mummification, Adipocere and Artefacts)
– Forensic radiology in trauma cases (blunt, gunshot, sharp wounds)
– Asphyxia
– Child abuse
– Post-mortem CT of charred victims
– Natural death
– Post-mortem imaging in fatal hospital cases after medical interventions
The authors come from several countries and offer an up-to-date view of
the various facets of forensic radiology.
It is a pleasure for me to recommend this book not only for practitioners in
forensic medicine, but also for radiologists who are beginning to deal with
imaging in forensics: to understand the questions addressed in a medicolegal
context and being aware of the required proof of evidence of an expert opin-
ion, interpret traumatic alterations which are rarely seen in a clinical context
and being aware of post-mortem changes.
Imaging in Forensics has gained its success by the contribution of both
disciplines.
Foreword vii
It is really amazing how fast this new and unique subdiscipline has devel-
oped within the last 20 years: by communication and cooperation between
the disciplines radiology and forensic medicine and also between the insti-
tutes of forensic medicine in Europe. Forensic Imaging has given our disci-
pline a new and strong scientific direction.
I congratulate the editors and the authors. For me it was a great honour to
have been invited to write this foreword. I wish the book a great success.
December 2021 Bonn, Germany
Burkhard Madea
Preface
The rise of Forensic Imaging began around the year 2000 with the increasing
use of CT and MRI in post-mortem and later also in living forensic cases and
growing research activities in this newly developing field. Now, more than 20
years later, it seems time to present an overview of the many possibilities,
benefits and current applications of imaging in a forensic context. The book
shall introduce into forensic imaging casework and provide illustrated exam-
ples regarding typical forensic issues such as post-mortem alterations, charac-
teristic signs of violence including the highly complex and important topic of
child maltreatment, findings following accidents such as drowning or falls
from height, specific needs and pitfalls of forensic image reading and more.
The currently applied and presented imaging methods range from classical
X-rays to CT, MRI, post-mortem angiography, post-processing methods up to
3D surface scanning and 3D printing, most of them fast developing and offer-
ing technologies that perfectly support modern forensic case assessment.
Our work does not claim to be an exhaustive textbook that fully covers all
details of Forensic Imaging. We however hope it helps gaining interest in
this—from a clinical view—still “exotic” field. If it succeeds in bringing both
radiologists and forensic experts closer together and motivates to learn more,
and maybe even become an active part of the forensic imaging community, it
has fully served its objective.
Last but not least we want to cordially thank all the authors for their out-
standing contributions and the publisher Springer for excellent work and sup-
port throughout the whole creation process of the book.
Toulouse, France Fabrice Dedouit
Heidelberg, Germany Sarah Heinze
Heidelberg, Germany Kathrin Yen
ix
In Memoriam: B. G. Brogdon (1929–2014)
Prof. Byron Gilliam Brogdon—the still undisputed doyen of forensic radiol-
ogy—called for interdisciplinary collaboration between radiologists and
forensic doctors in his 1998 bestseller, Forensic Radiology, “because sharing
of interdisciplinary skills and knowledge would expand the scientific
horizon.”
This note struck a chord in my soul and mind and at the end of the last
century prompted me to establish a transdisciplinary research group at the
University of Berne to develop a minimally invasive autopsy. The project was
named “Virtopsy” and used the imaging methods CT, MRI, surface scanning,
and angiography.
In 2001, the first scientific results were presented in Interlaken on the
occasion of the DGRM annual conference. Thankfully, Gil Brogdon accepted
the invitation to be a keynote speaker. He was accompanied by his charming
wife—his “precious” Babs—who supported him all her life as a lecturer for
his scientific activities.
In his lecture, Gil Brogdon said with a wink that our project was “nihil
novum sub sole.” Because just 3 years after the discovery of X-rays, the first
corpse was examined radiologically in the USA. Against the background of
his stupendous knowledge of the literature, he also let us know that there was
already talk of a “forensic autopsy machine” in forensic scientific circles in
the early 1990s. And he also referred me to a specific paper by an Israelite
working group that made morphological comparisons between computed
tomography and autopsy findings. An illustration of his scientific modesty
was the additional remark that the head of this working group Y. Donchin was
neither a forensic doctor nor a radiologist, but an anesthetist.
Gil Brogdon spontaneously agreed to support our stringent, comprehen-
sive transdisciplinary approach to our project. Above all, he also welcomed
our cooperation with his radiological colleague and friend Prof. Peter Vock,
Director of the Institute for Diagnostic Radiology, who was the first to suc-
ceed in three-dimensional recording of the body using spiral computed
tomography. His willingness to provide support then became very concrete
when, as a reviewer of our transdisciplinary publications, he promoted and
accelerated their acceptance—also in radiological journals.
He found great pleasure in our word creation “Virtopsy.” He found this
neologism “a conveniently short but descriptive word.” He expressed his
approval for this in a congratulations when “Virtopsy” was included in
xi
