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C M Y CM MY CY CMY K
FORENSICS & CRIMINAL JUSTICE Burke
FORENSIC PATHOLOGY OF F
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FRACTURES AND E
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MECHANISMS OF INJURY
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Postmortem CT Scanning T
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Practitioners of forensic medicine have various tools at their disposal to determine cause of death, and G
today’s computed tomography (CT) can provide valuable clues if images are interpreted properly. Forensic
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Pathology of Fractures and Mechanisms of Injury: Postmortem CT Scanning is a guide for the
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forensic pathologist who wants to use CT imaging to assist in determining the mechanism of injury that might
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have contributed to death.
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Drawn from the author’s work at the Victorian Institute of Forensic Medicine, the book presents an overview A
of his experience with CT in routine casework, provides an appraisal of the literature with respect to fractures, C
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and offers suggestions for the evaluation of CT images by pathologists. He then suggests what reasonable
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conclusions can be drawn from the images, the circumstances surrounding the death, and an external
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examination of the deceased. E
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Enhanced with hundreds of CT images that clarify the text and case studies to put the material in context,
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the book begins by discussing classification of injuries and different types of fractures. It then explores the
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basics of CT. Next, the book gives a head-to-toe catalogue of various injuries and how they are represented
on a CT scan. Finally, the book explores the use of CT in difficult forensic cases such as decomposed and M
burnt remains, falls, child abuse, and transportation incidents. E
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While not intended to make a forensic pathologist an expert at CT image interpretation, the book enables
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these professionals to become familiar with the technology so they can competently use it in their practice,
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heightening the accuracy of their cause of death determinations.
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K13836 R
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FORENSIC PATHOLOGY OF
FRACTURES AND
MECHANISMS OF INJURY
Postmortem CT Scanning
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FORENSIC PATHOLOGY OF
FRACTURES AND
MECHANISMS OF INJURY
Postmortem CT Scanning
Michael P. Burke
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
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CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2012 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
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Version Date: 2011926
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Monash University
“Ancora imparo”
“I am still learning”
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Table of Contents
List of Illustrations xvii
Preface xxxi
Acknowledgments xxxiii
ἀ e Author xxxv
Introduction xxxvii
1 Introduction of Computed Tomography (CT) into Routine Forensic Pathology
Practice 1
Introduction 1
ἀ e Victorian Model 1
ἀ e Introduction of Postmortem CT 2
Current Victorian Institute of Forensic Medicine (VIFM) System 2
Decision-Making Process 2
Cause of Death 3
Family Contact Program 4
CT in Trauma 4
CT in Tissue Donation 4
Errors in CT Diagnosis by Forensic Pathologists 5
Proficiency Standard of Forensic Pathologists in Analysis of CT Images 5
CT Education for Forensic Pathologists 5
Deficiencies of CT in Routine Forensic Practice 5
Audit 6
Practical Issues in the Use of CT in Routine Forensic Practice 7
Illustrative Case Studies 7
Case Study 1: Coronary Artery Disease 7
Forensic Issues 7
Case Study 2: Hemopericardium and Aortic Dissection 8
Forensic Issues 8
Case Study 3: Ruptured Abdominal Aortic Aneurysm 9
Forensic Issues 1 0
Case Study 4: Pericardial Effusion 10
Forensic Issues 1 0
Case Study 5: Cardiomegaly 1 1
Forensic Issues 1 1
Case Study 6: Hemothorax 1 2
Case 6.1 1 2
Case 6.2 1 4
Case Study 7: Basal Subarachnoid Hemorrhage 1 4
Case 7.1 1 4
Case 7.2 14
Case Study 8: Intracerebral Hemorrhage 1 5
Case 8.1 1 5
Case 8.2 15
Case 8.3 1 5
Case Study 9: Subdural Hemorrhage 1 7
vii
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viii Table of Contents
Case 9.1: Acute Subdural Hemorrhage 1 7
Case 9.2: Acute Subdural Hemorrhage Arising from an Arachnoid Cyst 18
Case Study 10: Cerebral Infarction 1 9
Forensic Issues 1 9
Case Study 11: Hydrocephalus 2 0
Case Study 12: Pneumoperitoneum 2 0
Forensic Issues 2 0
Case Study 13: Bowel Obstruction 21
Forensic Issues 2 2
Case Study 14: Liver Disease and Ascites 2 4
Case 14.1 2 4
Case 14.2 2 4
Case Study 15: Hemoperitoneum 2 5
Forensic Issues 2 5
Case Study 16: CT in Medication Overdose 26
Forensic Issues 2 6
Case Study 17: CT in Pulmonary ἀ romboembolism 2 6
Forensic Issues 2 6
Case Study 18: Pneumonia 2 8
Forensic Issues 2 8
Case Study 19: Peritonitis and Appendicitis 2 9
Forensic Issues 3 0
Case Study 20: Air Embolism 3 0
Forensic Issues 3 0
Case Study 21: Hyoid Bone in Hanging and Neck Compression 3 0
Forensic Issues 3 1
Case Study 22: Postmortem Angiography 3 2
Forensic Issues 3 2
Case Study 23: Cautionary Cases 3 2
Case 23.1 3 2
Case 23.2 3 2
Conclusions 33
References 3 5
2 Classification of Injuries 37
Introduction 3 7
Types of Skin Injury 3 7
Abrasions 37
Lacerations 38
Bruises 4 0
Other Skin and Soft Tissue Injuries 4 1
Gunshot Injuries 4 1
Entrance Injuries 4 1
Exit Wounds 4 2
Sharp Force Injuries 4 2
Inflammation and Artifacts 4 2
Postmortem Insect Predation 4 2
ἀ e Forensic Importance of Skin Injuries 4 3
Site of Application of Blunt Force 4 3
Case Study 4 3
References 4 4
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Table of Contents ix
3 Fractures 4 5
Anatomy of Bone 4 5
Composition of Bone 4 5
Development of Bone 4 5
Remodeling of Bone 4 5
Classification of Bone 45
Fractures 4 6
Definition 4 6
Types of Fracture 4 6
Mechanisms of Fracture 4 6
Long Bone Fractures 4 6
Healing of Fractures 4 8
Complications of Fractures 5 0
Forensic Issues 5 0
Pediatric Fractures 5 2
Case Study 5 3
References 5 4
4 Computed Tomography 5 5
Introduction 5 5
Challenges in Routine CT Analysis by Forensic Pathologists 55
“Expert Interpretation” of CT Images by Forensic Pathologists 5 5
Standard of CT Analysis by the “Reasonable” Forensic Pathologist 5 5
Practical Problems Raised by the Introduction of CT into Routine Forensic Practice 5 6
Basic Principles of CT 5 6
Evolution of CT Scanning 5 6
Helical Computed Tomography (HCT) Scanning 5 7
Multidetector Computed Tomography (MDCT) Scanning 5 7
Reconstruction in CT Scanning 5 8
ἀ e Detection of Foreign Materials by MDCT 5 8
Practical Issues in CT Scanning 5 9
Spatial Resolution 5 9
Contrast Resolution 59
Conspicuity 5 9
Noise 5 9
Windowing 5 9
Artifacts in CT Scanning 5 9
Physics-Based Issues 5 9
Beam Hardening 5 9
Photon Starvation 5 9
Partial Volume Artifact 6 0
Patient- or Subject-Based Issues 60
Partial Scanning 6 0
Metal Artifact 60
Scanner-Based Issues 6 0
Ring Artifact 6 0
Helical Scanning or Reconstruction-Based Issues 6 1
Cone Beam Effects 6 1
Helical Artifacts in Multisection Scanning 6 2
Stair-Step Artifacts 6 2
Fracture Diagnosis 6 2
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