Alison Brough

The role of micro-computed tomography in forensic investigations☆

The use of micro-CT within forensic practice remains an emerging technology, principally due to its current limited availability to forensic practitioners. This review provides those with little or no previous experience of the potential roles of micro-CT in forensic practice with an illustrated overview of the technology, and the areas of practice in which micro-CT can potentially be applied to enhance forensic investigations.

Post-mortem computed tomography and 3D imaging: anthropological applications for juvenile remains

Anthropological examination of defleshed bones is routinely used in medico-legal investigations to establish an individual’s biological profile. However, when dealing with the recently deceased, the removal of soft tissue from bone can be an extremely time consuming procedure that requires the presence of a trained anthropologist. In addition, due to its invasive nature, in some disaster victim identification scenarios the maceration of bones is discouraged by religious practices and beliefs, or even prohibited by national laws and regulations. Currently, three different radiological techniques may be used in the investigative process; plain X-ray, dental X-ray and fluoroscopy. However, recent advances in multi-detector computed tomography (MDCT) mean that it is now possible to acquire morphological skeletal information from high resolution images, reducing the necessity for invasive procedures. This review paper considers the possible applications of a virtual anthropological examination by reviewing the main juvenile age determination methods used by anthropologists at present and their possible adaption to MDCT.

Anthropological measurement of the juvenile clavicle using multi-detector computed tomography--affirming reliability.

Currently, there is no standardized protocol for multi‐detector computed tomography (MDCT) measurement of juvenile remains. Using 33 juvenile clavicles, this paper investigates a protocol to allow MDCT measurements, comparable or supplemental with traditional osteometric measurements, to be acquired for application to previously published algorithms. The results illustrate that there is no significant difference between MDCT measurements and those taken by direct osteometric methods. By presenting such a protocol, this paper takes the first steps toward validation of the process of conversion from measurement of dry juvenile bone to MDCT compatibility and allows the forensic world to take a step forward in standardizing the way MDCT is used for forensic practice. This paper assesses the limitations and potential applications of this virtual approach and offers some suggestions for where further work might progress the conversion of these new approaches into legally admissible anthropological techniques of age estimation.

Perimortem trauma in King Richard III: a skeletal analysis

BACKGROUND Richard III was the last king of England to die in battle, but how he died is unknown. On Sept 4, 2012, a skeleton was excavated in Leicester that was identified as Richard. We investigated the trauma to the skeleton with modern forensic techniques, such as conventional CT and micro-CT scanning, to characterise the injuries and establish the probable cause of death. METHODS We assessed age and sex through direct analysis of the skeleton and from CT images. All bones were examined under direct light and multi-spectral illumination. We then scanned the skeleton with whole-body post-mortem CT. We subsequently examined bones with identified injuries with micro-CT. We deemed that trauma was perimortem when we recorded no evidence of healing and when breakage characteristics were typical of fresh bone. We used previous data to identify the weapons responsible for the recorded injuries. FINDINGS The skeleton was that of an adult man with a gracile build and severe scoliosis of the thoracic spine. Standard anthropological age estimation techniques based on dry bone analysis gave an age range between 20s and 30s. Standard post-mortem CT methods were used to assess rib end morphology, auricular surfaces, pubic symphyseal face, and cranial sutures, to produce a multifactorial narrower age range estimation of 30-34 years. We identified nine perimortem injuries to the skull and two to the postcranial skeleton. We identified no healed injuries. The injuries were consistent with those created by weapons from the later medieval period. We could not identify the specific order of the injuries, because they were all distinct, with no overlapping wounds. Three of the injuries-two to the inferior cranium and one to the pelvis-could have been fatal. INTERPRETATION The wounds to the skull suggest that Richard was not wearing a helmet, although the absence of defensive wounds on his arms and hands suggests he was still otherwise armoured. Therefore, the potentially fatal pelvis injury was probably received post mortem, meaning that the most likely injuries to have caused his death are the two to the inferior cranium. FUNDING The University of Leicester.

The scoliosis of Richard III, last Plantagenet King of England: diagnosis and clinical significance

Richard III was king of England from 1483 to 1485, after declaring his nephew, Edward V, illegitimate. On Aug 20, 1485, Richard was killed in battle with the rebel Lancastrian claimant Henry Tudor at Bosworth. His body was carried back to Leicester and buried in the Greyfriars Minor Friary, where it remained until its excavation in 2012, when it was seen to have a severe scoliosis. Famously, Shakespeare described Richard III as “hunchbacked” in his eponymous play of 1593. There has been considerable disagreement whether this “hunchback” was real or an invention of his enemies after death, with political motivations. However, the chronicler John Rous wrote around 1490 that Richard “was small of stature, with a short face and unequal shoulders, the right higher and the left lower.” This description is compatible with the presence of a rightsided scoliosis. We analysed the skeleton macroscopically for evidence of spinal curvature and related lesions. From CT 3D reconstructions of each bone, we created polymer replicas and built a model of the spine to recreate its alignment in life (fi gure, appendix). The apex of the right-sided thoracic curve noted at excavation was at vertebrae T8–T9. The Cobb angle, determined from vertical excavation photos, was 75° from the upper border of T6 to the lower border of T11. Since this was measured supine, whereas clinical angles are taken standing, we estimate the Cobb angle to have been in the range 70–90° during life. The curve was well balanced, with cervical and lumbar spines reasonably well aligned (King Moe type 3). Abnormalities of individual vertebrae (eg, wedging of vertebral end plates, lateral angulation of spinous processes, asymmetry of facet joints) were restricted to the thoracic region (appendix). The foramen magnum was normal in size and shape. The 3D reconstruction closely matches the 2D images recorded at excavation, and shows the spiral nature of the scoliosis (appendix, video). Determining the cause of Richard’s scoliosis allows us to estimate the age at which it developed, and how it may have aff ected him. Since the spinal ligaments are some of the last to decompose after death, and in this case had partly ossifi ed, the position of the vertebrae should show only minimum change from the time of burial, having been surrounded by soil. Such small change is supported by the similarity to the reconstructed model, which relied on joint morphology to determine each joint position. The absence of structural spinal abnormalities, such as hemivertebrae and unilateral bars, makes congenital scoliosis improbable. Neuromuscular causes, such as cerebral palsy, are unlikely because of the normal structure, muscle markings, and cortical thickness of the legs and hips, compatible with a normal weight-bearing gait. Skeletal changes associated with syndromes such as Marfan’s (eg, high arched palate and tall stature) were not present, and a normal foramen magnum makes a Chiari malformation unlikely. The subtle nature of the changes in vertebral anatomy suggest onset in the last few years of growth, which is compatible with adolescent onset idiopathic scoliosis, probably starting after 10 years of age. The physical disfi gurement from Richard’s scoliosis was probably slight since he had a well balanced curve. His trunk would have been short relative to the length of his limbs, and his right shoulder a little higher than the left. However, a good tailor and custom-made armour could have minimised the visual impact of this. A curve of 70–90° would not have caused impaired exercise tolerance from reduced lung capacity, and we identifi ed no evidence that Richard would have walked with an overt limp, because the leg bones are symmetric and well formed.

A minimum data set approach to post-mortem computed tomography reporting for anthropological biological profiling

Anthropological examination of bones is routinely undertaken in medico-legal investigations to establish an individual’s biological profile, particularly their age. This often requires the removal of soft tissue from bone (de-fleshing), which, especially when dealing with the recently deceased, is a time consuming and invasive procedure. Recent advances in multi-detector computed tomography have made it practical to rapidly acquire high-resolution morphological skeletal information from images of “fleshed” remains. The aim of this study was to develop a short standard form, created from post-mortem computed tomography images, that contains the minimum image-set required to anthropologically assess an individual. The proposed standard forms were created for 31 juvenile forensic cases with known age-at-death, spanning the full age range of the developing human. Five observers independently used this form to estimate age-at-death. All observers estimated age in all cases, and all estimations were within the accepted ranges for traditional anthropological and odontological assessment. This study supports the implementation of this approach in forensic radiological practice.

Postmortem computed tomography age assessment of juvenile dentition: comparison against traditional OPT assessment.

Age estimation is one of the primary demographic features used in the identification of juvenile remains. Determining the accuracy and repeatability of age estimations based on postmortem computed tomography (PMCT) data compared with those using conventional orthopantomography (OPT) images is important to validate the use of PMCT as a single imaging technique in forensic and disaster victim identification (DVI). In this study, 19 juvenile mandibles and maxilla of known age underwent both OPT and PMCT. Three raters then estimated dental age using the resulting images and 3D reconstructions. This assessment showed excellent agreement between the age estimations using the two techniques for all three observers. PMCT also offers a greater range of measurements for both the dentition and the whole human skeleton using a single image acquisition and therefore has the potential to improve both the speed and accuracy of age estimation.

Postmortem computed tomography (PMCT) and disaster victim identification

AbstractRadiography has been used for identification since 1927, and established a role in mass fatality investigations in 1949. More recently, postmortem computed tomography (PMCT) has been used for disaster victim identification (DVI). PMCT offers several advantages compared with fluoroscopy, plain film and dental X-rays, including: speed, reducing the number of on-site personnel and imaging modalities required, making it potentially more efficient. However, there are limitations that inhibit the international adoption of PMCT into routine practice. One particular problem is that due to the fact that forensic radiology is a relatively new sub-speciality, there are no internationally established standards for image acquisition, image interpretation and archiving. This is reflected by the current INTERPOL DVI form, which does not contain a PMCT section. The DVI working group of the International Society of Forensic Radiology and Imaging supports the use of imaging in mass fatality response and has published positional statements in this area. This review will discuss forensic radiology, PMCT, and its role in disaster victim identification.

The future of pediatric and perinatal postmortem imaging

The field and applications of postmortem imaging are exponentially growing. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented, as well as its use in drug mule identification. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. In this review, after a short historical review and analysis of current problems and challenges, we will try to depict the way we see the future of this subspecialty of postmortem cross-sectional imaging, including all specific situations: terminations of pregnancy, intrauterine death, sudden unexpected infant death and identification issues.

Post-mortem computed tomography and 3D imaging: Anthropological applications for juvenile remains

Anthropological examination of defleshed bones is routinely used in medico-legal investigations to establish an individual’s biological profile. However, when dealing with the recently deceased, the removal of soft tissue from bone can be an extremely time consuming procedure that requires the presence of a trained anthropologist. In addition, due to its invasive nature, in some disaster victim identification scenarios the maceration of bones is discouraged by religious practices and beliefs, or even prohibited by national laws and regulations. Currently, three different radiological techniques may be used in the investigative process; plain X-ray, dental X-ray and fluoroscopy. However, recent advances in multi-detector computed tomography (MDCT) mean that it is now possible to acquire morphological skeletal information from high resolution images, reducing the necessity for invasive procedures. This review paper considers the possible applications of a virtual anthropological examination by reviewing the main juvenile age determination methods used by anthropologists at present and their possible adaption to MDCT.