Report from the American Academy of Forensic Sciences, Fabruary 2009, Denver USA
Emily Faircloth, vice Chair of the Association of Forensic Radiographers reports on the annual meeting of the American Academy of Forensic Sciences in Denver, Colorado. 16th - 21st February 2009.
On Tuesday 17th February 2009, President Barak Obama attended Denver’s Museum of Nature and Science to "pave the way for future prosperity" by signing a $787 billion “Stimulus Bill” (the American Recovery and Reinvestment Act of 2009). At the nearby Denver Conference Centre, delegates from around the world were also looking to the future; not of the American economy, but of developments in the rapidly evolving field of forensic science.
The 61st American Academy of Forensic Sciences’ annual scientific meeting included over 500 scientific papers, breakfast seminars and workshops to send the mind reeling with inspiration. A wide range of forensic specialties were represented by delegates who convened from across the globe to present and discuss the most up to date research, current practice and developments.
The second day of the meeting started early with a workshop: “Forensic imaging – current developments and future directions”. The purpose of this morning session, attended by over 100 international delegates was to provide an overview of the developments in forensic imaging, specifically cross sectional scanning, throughout Europe and the United States.
Renowned forensic Radiologist Professor BG Brogdon opened the session with an entertaining and informative account of the historical perspectives of forensic imaging, providing an illuminating description of the first uses of radiology in the forensic setting almost immediately following the discovery of the x-ray in 1895. Further examples of the application of developing imaging modalities were described from the depiction of “Battered Child Syndrome” by the Radiologist John Caffey in 1946 which outlined the radiological presentation of physical child abuse, elder abuse findings by Burston in 1975 to the use of new imaging modalities on the reconstruction and investigation of fatalities. He concluded his fascinating presentation with the sobering but motivating message: “The sad truth is that a century after the first x-ray was introduced… in a court of law, there is no general appreciation of the extent of the radiological potential in the forensic sciences.”
The applications of CT and MRI as part of the autopsy examination were then described by Professor R Dirnhofner from the Institute of Forensic Medicine at the University of Bern in Switzerland, also known as the home of Virtopsy®. He described the vision of the “Virtobot”; a minimally invasive, integrated autopsy tool using a combination of techniques such as robot guide sampling, surface scanning, CT, angiography and biopsy. This new innovation is aimed at providing investigators, scientists, members of the court a new opportunity to explore and understand autopsy finding “at the click of a mouse”. Avid CSI viewers will have already seen an example of this technology in use, to investigate a case during an episode of this American based drama series.
Dr M Thali, also a key member of the Virtopsy® team followed to give an account to the current status, issues and development for forensic imaging in Europe. He provided a comparison of 3D reconstructed CT and MR imaging in the investigation of fatalities and provided examples of their application in the demonstration on injury and post mortem identification. Delegates were reminded that a new book entitled The Virtopsy Approach, published by CRC Press will soon be available. (ISBN: 978-0-8493-8178-2 RRP £105.00). The 5th Basic Virtopsy Course is also being held in Bern from 2nd -4th March 2009. Details of this and future course are available from www.virtopsy.com
John M Getz from the American Armed Forces Medical Examiners Office in Rockville, USA continued the theme of the virtual autopsy with advice and recommendations for initiating such a service, detailing requirements such as powerful multidetector CT tubes with maximum coverage for full body scans to meet the requirements of US military death investigations. He explained that all military fatalities went through a protocol including full body CT scanning and dental imaging. He recommended that 16 slice scanners were more than adequate for this service but that high powered CT tubes, optimum post processing software and data storage systems were paramount to maintain the high workflow encountered by the US military services.
Ballistics and blast injuries were the theme of the next presentation provided by Dr T Haracke from the American Armed Forces Institute of Pathology. The benefits and limitations of post mortem CT in ballistic, knife and blast injury evaluations were discussed with 3D CT in particular being praised for the demonstration of such injuries through several case studies. There were cautionary lessons to be learnt however: CT does not have the capacity to accurately specify metallic composition and ballistic measurement: it cannot therefore be used as the only tool to make these types of conclusions a ballistic fatality investigation. Another limitation of CT is the demonstration of multiple, co-mingled bullet tracks and vascular structures following rupture, usually best demonstrated during autopsy. However, CT angiography was described as developing onto a contributory tool in the investigation of this type of trauma. The presentation concluded with a final cautionary note on CT imaging of ballistic injury: be aware of the positioning of the body during the imaging procedure. If this does not match the position of the body at the time of shooting, bullet trajectories (pathways) can often not correlate causing potential confusion for investigators. A useful tip for the forensic radiographer to note.
Dr Barry Daly, Consultant Radiologist from the University of Maryland School of Medicine provided the penultimate presentation on the collaboration with the University and the Office of the Chief Medical Examiner of Maryland in the development of a forensic imaging program. Logistical challenges in the initiation of this service included scanner availability, departmental administration, interest from CT/MR technologists (radiographers) and co-operation with Chief Medical Examiner staff. The local CT and MR imaging autopsy protocols were then described in detail as indicated for cases involving blunt/penetrating trauma, unidentified bodies, suspected paediatric non accidental injury, suspected elder abuse, drowning, burns and unknown causes of death or where there is an opposition to the invasive autopsy procedure. An emphasis on multidisciplinary working and effective communication was sited a major factor in the success of any such program, in particular, a strong collaboration between the interpreting Radiologist and the Pathologist in the determination of the potential cause and circumstances of death.
In the concluding presentation of the morning’s workshop, the Chief Medical Examiner’s perspective to the development of forensic imaging in the United States was then provided by Dr D Fowler of the State of Maryland. This session served as a comprehensive guide in the initiation of this type of service including initial costing, installation and capacity considerations for the Medical Examiners office. With the introduction of the latest CT scanning models into the healthcare market, it was debated whether the comparatively slower (16 slice) models were just as adequate in post mortem imaging, having similar resolution capabilities.
Day three of the meeting saw the opening of the exhibit hall, where a large number of companies and international organisations were gathered to demonstrate the latest forensic innovations including radiography imaging. Among those were AribexTM who were showcasing the new Nomad Pro hand-held dental x-ray tube, which at 5.5llbs (2.5kg) in weight, is notably lighter than the original model. Minxray Inc offered portable imaging solutions for military and forensic use featuring Canon panel technology for DR imaging. Kubtec (Kub Technologies Inc) demonstrated the use of static cabinet x-ray systems for the radiography of tissue specimens, body parts and other artefacts. CRC Press provided delegates with the opportunity to view published books in this field and get the heads up on forthcoming publications. In particular, watch out for Brogdon’s Second edition on Forensic radiology which is due for release later this year. Edited by BG Brogdon, M Thali and (IAFRs own) MD Viner, it promises a comprehensive review of the history, current development and future evolvement of international forensic radiology. You heard it here first!
Radiography also had a presence in the poster section. The International Association of Forensic of Radiographers had collaborated with UK based charity Inforce to provide a poster that debated: "Experiential radiography – an effective method of training for forensic radiography?”. The poster described Kolb’s 1984 theory of the experiential learning cycle incorporating concrete experience, reflective observation, abstract conceptualisation followed by active experimentation and its application to the training of radiographers involved in mass fatality investigations. Produced by Kim Hutchings, Mark Viner & Roland Wessling, a copy of this poster can be found via this link:
http://www.inforce.org.uk/news/inforce%20news/article/43/
(Picture: from left to right)
Tania Blyth, Quinnipiac University, USA
Roland Wessling, Inforce Foundation, Cranfield University, UK
Emily Faircloth, IAFR, UK
Mark Viner, Inforce Foundation, Cranfield University & IAFR, UK
Nancy Adams, Itawamba Community College, Fulton, USA
Gerry Conlogue, Quinnipiac University, USA
Throughout the week, open breakfast and evening sessions gave me the opportunity to network with others in the forensic community and introducing some to the various applications of forensic radiography. I found these social meetings particularly useful as a first time attendee to this event; it was great to get the views of veterans in the benefits of joining the American Academy of Forensic Sciences.
The final days were filled to capacity with presentations covering the ten sections representing a wide range of forensic specialities. Forensic radiography was featured across these specialty sections which was encouraging to see. In particular, the Anthropology, Pathology and Odontology sessions contained numerous presentations covering plain film, cross sectional and dental imaging. The sheer scale of the conference centre building and a jam-packed program made it a real challenge to get to all the lectures! Fortunately, I made it to Gerry Conlogue’s pictorial tour of forensic field radiography in the aptly named “In the Trenches with MacGyver”. Some may have recognised Gerry from the TV series The Mummy Road Show featured on the National Geographic Channel.
A case study was also reported by Professor Brogdon involving the use of radiology in the identification of metacarpal fragments of a dismembered murder victim in a presentation entitled “Fingering a Murderer” showing the meticulous examination of the remains to achieve justice. There were also a number of presentations on dental imaging and its use in post mortem identification procedures in incidents around the world. I was particularly interested in the quality assurance related topics involving hand held dental x-ray tubes and their perception in the forensic community.
Saturday, the day of my departure from Denver came all too quickly and there was one last lecture marked on my timetable to attend. Nancy Adams, Clinical Coordinator for radiologic sciences at Itawamba Community College in Fulton, USA provided an overview of “Radiology Students in Morgues” which would have inspired many a student in the UK. Nancy was the first RT (radiologic technologist) to be accepted for membership to the AAFS and her dedication to the profession clearly shows.
Reflecting on a memorable (if exhausting!) week, I was thoroughly inspired that radiography had such broad coverage at this international event. From the first ever held workshop dedicated to this specialty, to exhibits, posters and numerous presentations it is clear that forensic radiology/radiography has made its mark on an international level. As Professor Brogdon identified, there is still much work to be done in convincing the courts of the range of uses of forensic radiology and radiography in the forensic setting but the forensic community of the AAFS has certainly appeared to have taken this message on board.
I would thoroughly recommend attendance for anyone at this annual event with a professional interest in forensic radiography looking to broaden their appreciation of its international use and contribution, along with other specialities to medical jurisprudence, criminalistics and death investigations. I would particularly like to thank the International Association of Forensic Radiographers for providing me with the opportunity to attend this year’s AAFS meeting and for their continued support and encouragement.
