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postmortem imaging

Forensic Radiology: A Comprehensive Review for Non-Radiologist Physicians and Medical Students

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D'Arcy Little MD CCFP FCFP FRCPC,

D’Arcy Little, MD, CCFP, FCFP, FRCPC, Medical Director, Journal of Current Clinical Care and www.healthplexus.net Radiologist, Orillia Soldiers’ Memorial Hospital, Assistant Professor, Department of Medical Imaging cross-appointed to Department of Family and Community Medicine, University of Toronto, University of Toronto, Toronto, ON.

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Abstract:
Forensic radiology represents the intersection of diagnostic imaging and legal medicine, playing an increasingly vital role in modern medicolegal investigations. This review article provides an overview of forensic radiology for non-radiologist physicians and medical students, covering its historical development, clinical applications, imaging modalities, and medicolegal significance. Key applications include postmortem imaging (virtopsy), identification of deceased individuals, documentation of trauma patterns, detection of non-accidental injury in children, and evaluation of criminal evidence. As imaging technology advances and its integration into forensic pathology increases, understanding the capabilities and limitations of forensic radiology becomes essential for all physicians involved in medicolegal cases. This article aims to provide a foundational knowledge of forensic radiology principles and practices relevant to clinical medicine and legal proceedings.

Key Words: Forensic radiology, postmortem imaging, virtopsy, forensic pathology, medicolegal investigation.
Postmortem CT is the cornerstone of modern forensic radiology, offering rapid whole-body acquisition (5-15 minutes) with excellent skeletal and gas visualization, but the absence of circulation significantly limits soft tissue characterization compared to clinical imaging.
Imaging complements but cannot replace traditional autopsy because it cannot substitute for microscopic tissue examination, toxicology sampling, microbiological cultures, or detection of many disease processes like acute myocardial infarction.
Standardized skeletal surveys are critical for detecting non-accidental injury in children, with classic metaphyseal lesions and posterior rib fractures being highly specific for abuse, and follow-up surveys at 2 weeks increasing diagnostic sensitivity by 27%.
Interpreting postmortem imaging requires specialized expertise to distinguish pathological findings from normal postmortem changes like livor mortis, decomposition gas, and temperature-related density alterations that differ fundamentally from clinical imaging.
PMCT detects more rib fractures than traditional autopsy, particularly posterior and healing fractures obscured by soft tissue, making it superior for documenting thoracic trauma in child abuse cases.
Bilateral skull fractures, fractures crossing suture lines, or complex/depressed fractures in infants suggest inflicted trauma requiring greater force than typical household falls, though absence of skull fracture does not exclude severe head injury.
Three-dimensional CT reconstructions are invaluable for courtroom presentation, allowing judges and juries to understand complex injury patterns, projectile trajectories, and spatial relationships better than 2D images alone.
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Related Terms: Radiology, Forensic radiology, postmortem imaging, virtopsy, forensic pathology, medicolegal investigation
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