Guy N. Rutty

Targeted post-mortem computed tomography cardiac angiography: proof of concept

With the increasing use and availability of multi-detector computed tomography and magnetic resonance imaging in autopsy practice, there has been an international push towards the development of the so-called near virtual autopsy. However, currently, a significant obstacle to the consideration as to whether or not near virtual autopsies could one day replace the conventional invasive autopsy is the failure of post-mortem imaging to yield detailed information concerning the coronary arteries. To date, a cost-effective, practical solution to allow high throughput imaging has not been presented within the forensic literature. We present a proof of concept paper describing a simple, quick, cost-effective, manual, targeted in situ post-mortem cardiac angiography method using a minimally invasive approach, to be used with multi-detector computed tomography for high throughput cadaveric imaging which can be used in permanent or temporary mortuaries.

Post-mortem computed tomography angiography: past, present and future

The role of imaging has been long established in forensic practice as an adjunct to the conventional autopsy. Recently with the development of MDCT, there has been a large international push towards the development of the so called “near virtual autopsy.” Currently a large obstacle to the acceptance of “near virtual autopsies” is the failure of post-mortem imaging to yield detailed information about the coronary arteries. This is a major deficiency of post-mortem MDCT and MRI compared to conventional autopsy as standard clinical angiography relies on circulation. One possible way to overcome this is by the use of post-mortem MDCT angiography. This review paper considers the past, current and future advances in cadaver cardiac imaging which, if successful, will take radiological imaging one step closer to the widespread introduction of near virtual autopsies.

Anthropological Measurement of Lower Limb and Foot Bones Using Multi-Detector Computed Tomography

Abstract:  Anthropological examination of defleshed bones is the gold standard for osteological measurement in forensic practice. However, multi‐detector computed tomography (MDCT) offers the opportunity of three‐dimensional imaging of skeletal elements, allowing measurement of bones in any plane without defleshing. We present our experiences of the examination of 15 human lower limbs in different states of decomposition using MDCT. We present our method of imaging and radiological measurement of the bones including sex assessment. The radiological measurements were undertaken by three professional groups–anthropology, radiology, and forensic pathology–both at the site of scanning and at a remote site. The results were compared to anthropological oestological assessment of the defleshed bones. We discuss the limitations of this technique and the potential applications of our observations. We introduce the concept of remote radiological anthropological measurement of bones, so‐called tele‐anthro‐radiology and the role that this could play in providing the facility for standardization of protocols, international peer review and quality assurance schemes.

An investigation into the transference and survivability of human DNA following simulated manual strangulation with consideration of the problem of third party contamination

Abstract Amplification was performed on human DNA material transferred during a model of manual strangulation. A total of 29 separate experiments were performed using a single male offender-female victim combination to observe whether DNA was transferred both from the offender’s fingers to the victim’s neck and vice versa and to consider the period of time after the event during which the material could potentially be recovered and amplified. DNA was amplified from either the victim’s neck or the offender’s fingers for at least 10 days after the contact although it is discussed whether this is potentially due to primary contact or a secondary/tertiary transfer event. The study highlights the problem of contamination of the offender’s hands and victim’s neck with third party DNA, the presence of which could have a significant outcome for both the investigating authority and the third party.

The role of mobile computed tomography in mass fatality incidents.

Abstract:  Mobile multi‐detector computed tomography (MDCT) scanners are potentially available to temporary mortuaries and can be operational within 20 min of arrival. We describe, to our knowledge, the first use of mobile MDCT for a mass fatality incident. A mobile MDCT scanner attended the disaster mortuary after a five vehicle road traffic incident. Five out of six bodies were successfully imaged by MDCT in c. 15 min per body. Subsequent full radiological analysis took c. 1 h per case. The results were compared to the autopsy examinations. We discuss the advantages and disadvantages of imaging with mobile MDCT in relation to mass fatality work, illustrating the body pathway process, and its role in the identification of the pathology, personal effects, and health and safety hazards. We propose that the adoption of a single modality of mobile MDCT could replace the current use of multiple radiological sources within a mass fatality mortuary.

Air weapon fatalities.

AIMS: To describe characteristics of a series of people accidentally and deliberately killed by air powered weapons. METHODS: Five cases of fatal airgun injury were identified by forensic pathologists and histopathologists. The circumstances surrounding the case, radiological examination, and pathological findings are described. The weapon characteristics are also reported. RESULTS: Three of the victims were adult men, one was a 16 year old boy, and one an eight year old child. Four of the airguns were .22 air rifles, the other a .177 air rifle. Two committed suicide, one person shooting himself in the head, the other in the chest. In both cases the guns were fired at contact range. Three of the cases were classified as accidents: in two the pellet penetrated into the head and in one the chest. CONCLUSIONS: One person each year dies from an air powered weapon injury in the United Kingdom. In addition there is considerable morbidity from airgun injuries. Fatalities and injuries are most commonly accidents, but deliberately inflicted injuries occur. Airguns are dangerous weapons when inappropriately handled and should not be considered as toys. Children should not play with airguns unsupervised.

Cutting crime: the analysis of the “uniqueness” of saw marks on bone

Witness marks produced on bone by the use of saws have traditionally been examined using stereomicroscopy. The marks are typically found on the kerf wall or floor and give important information about the implement that made them. This paper describes a new approach to the analysis of witness marks left on kerf walls and floors from crimes involving dismemberment. Previously, two types of marks have been identified: deep furrows formed during the pull stroke and fine striations formed on the push stroke. These types of striation allow the class of saw to be identified, but not an individual saw. With the advent of environmental scanning electron microscopy (ESEM), insulating materials can now be examined without the need for conductive coatings to be applied. This allows materials to be examined at higher magnifications than those available with stereomicroscopy. Here we report on a new, third type of striation that is visible at higher magnifications on ESEM images. These striations are formed from the imperfections on the cutting teeth of saws and give real possibilities of uniquely identifying whether or not a particular saw was used to cause the mark. In blind trials conducted on sawing of nylon 6.6, different individual saws could be successfully identified even if different people used the saw. We discuss ways in which these results can be extended to bone and how this may assist in the investigation of the act of dismemberment.

Lack of Evidence for a Causal Relationship Between Hypoxic-Ischemic Encephalopathy and Subdural Hemorrhage in Fetal Life, Infancy, and Early Childhood

It has been asserted that hypoxic-ischemic encephalopathy (HIE) with cerebral swelling in the absence of marked trauma may be responsible for subural hemorrhage in the young. As this may have considerable implications in determining both the mechanism of death and the degree of force required to cause injury in certain cases of inflicted head injury in infancy, clarification is required. A retrospective study of 82 fetuses, infants, and toddlers with proven HIE and no trauma was undertaken from forensic institutes in Australia, the United Kingdom, Germany, Denmark, and the United States. The age range was 35 weeks gestation to 3 years, with a male to female ratio of 2:1. All cases had histologically confirmed HIE. Causes of the hypoxic episodes were temporarily resuscitated sudden infant death syndrome with delayed death (N = 30), drowning (N = 12), accidental asphyxia (N = 10), intrauterine/delivery asphyxia (N = 8), congenital disease (N = 6), aspiration of food/gastric contents (N = 4), inflicted asphyxia (N = 3), epilepsy (N = 1), dehydration (N = 1), drug toxicity (N = 1), complications of prematurity (N = 1), and complications of anesthesia (N = 1). The initiating event was not determined in 4 instances. In no case was there macroscopic evidence of subdural hemorrhage. In this study no support could be given to the hypothesis that HIE in the young in the absence of trauma causes subdural hemorrhage.

The effectiveness of protective clothing in the reduction of potential DNA contamination of the scene of crime

The use of ultra-sensitive low copy number (LCN) DNA typing allows the analysis of picogram amounts of DNA. Trace evidence accidentally left at a scene of crime (SOC) by the investigating team may be inadvertently collected and analysed, potentially leading to spurious evidence being introduced into the criminal investigation. A series of experiments were undertaken to determine the extent to which an investigator could contribute to any DNA contamination of a scene of crime under different simulated activities. Further, the degree to which any contamination was reduced by the use of commercially available protective clothing was demonstrated. Precautions that should routinely be taken at a scene of crime to reduce the risk of DNA contamination are recommended.

Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?

I have read with considerable interest the paper by N Yukawa et al concerning intraalveolar haemorrhage in infant deaths, and Professor Berry’s editorial response. I also applaud the authors’ ambition to bring some scientific objectivity to this controversial issue. The results of their investigation are extremely diYcult to interpret, however, because the authors have carried out morphometric analysis of the area of the alveolar space occupied by blood when biased by some prior knowledge of the diagnostic category of each case. The authors concede their impression that pulmonary haemorrhage is a marker of asphyxia. Armed with this preconception and the knowledge of the initial diagnosis made in a case, there is an unavoidable tendency to “select” for analysis from a microscopic field a “random” alveolus that supports the observer’s opinion. Indeed, each case was placed in an initial diagnostic category based no doubt to some extent on the subjective degree of pulmonary haemorrhage. Furthermore, we are not told how many alveoli were analysed from each case, nor whether lung tissue was sampled randomly at postmortem examination. Their data in this paper would have been more robust if each case had been assigned a diagnostic category based on criteria excluding the histology, only after blinded morphometric analysis of lung tissue. Resolution of the hypothesis that lung haemorrhage in a baby is a marker of upper airway obstruction awaits such rigorous scrutiny.