Andi Raisyiah Akrimah Imran / C11112013

Lecture 24 : How can imaging be the value in the investigation of gunshot injuries ?
Answer :
Imaging techniques are powerful tools in forensic sciences. Medical examiners, forensic
pathologists, and anthropologists are required to interpret findings from imaging studies to further
medicolegal investigations. Often, the forensic investigator calls on the radiologist, whose
expertise might prove invaluable in forensic consultations. Radiological studies are instrumental
in medicolegal investigations involving the location of foreign bodies within the body (i.e., bullets
in gunshots).
X-ray is the most common, basic and essential imaging method used in forensic medicine.
It serves to display and localize the foreign objects in the body (such as gunshots). X-ray allows
non-invasive evaluation of important findings before the autopsy and thus selection of the optimal
strategy for dissection. Basic indications for postmortem X-ray imaging in forensic medicine
include gunshot and explosive fatalities (identification and localization of projectiles or other
components of ammunition, visualization of secondary missiles).
With time modern imaging methods, especially computed tomography and magnetic
resonance imaging, are more and more applied in forensic medicine. Their application extends
possibilities of the visualization the bony structures toward a more detailed imaging of soft tissues
and internal organs. The application of modern imaging methods in postmortem body investigation
is known as digital or virtual autopsy. Virtual autopsy (virtopsy), which involves a full-body
computed tomography and magnetic resonance imaging examination to obtain two-dimensional
and three-dimensional documentation has been proposed as an alternative to conventional autopsy
in cases when the next of kin oppose the necroscopy and as a complementary tool for better
visualization of postmortem findings. At present digital postmortem imaging is considered as a
bloodless alternative to the conventional autopsy. And during autopsy, radiological investigation
is priceless for all gunshot wound cases.
As a rule, in all gunshot wound cases it is strongly recommended that X-rays are taken. This
includes instances where the bullet is known to be in the body as well as those in which it has
allegedly exited. This relatively easy task can sometimes fail--a bullet can be overlooked even by
experienced radiologists because of "professional blinkers phenomenon". In localizing bullets, it
is important to remember that they might migrate; thus, the radiographic examination should
include the whole body. The path of the bullet can be observed as a cloud of minute metallic
particles detached from the projectile, the so-called "lead snowstorm"., or by using more
sophisticated imaging techniques such as computed tomography (CT).
The type of bullet (high or low velocity) might be deduced by the pathologist through the
different injuries detected on radiographs, whereas the determination of the type of weapon and
the distance from the target should be left to the ballistics experts. Establishing the bullet's caliber
from a radiograph should be avoided because angulation and distance from the beam can distort
the image. Radiography is useful not only to locate a projectile but also in determining whether
metallic fragments are present within the body because even verysmall fragments of a bullet's
jacket may suffice for a ballistic identification.
As summary, imaging assessment of a gunshot injury includes:
 identification of wound tracks by the presence of gas, haemorrhage, bone or metal in a linear
distribution
o directionality of fragments and bevelling of bone toward the direction of travel may establish
bullet path and help differentiate entry vs exit wound.
 localisation of projectile: orientation (tumbling) and fragments
o final location may be at a distance from the entry wound due to the tracking of bullets along
soft tissue layers, or deflection by anatomical structures (e.g. bone) - such tracking suggests
low-velocity injury
o if a projectile is not identified on available imaging, a search must be made for
 an exit wound
 projectile outside the field of view (i.e. may need further imaging)
 assessment of internal injuries including involvement of critical structures, active haemorrhage,
etc.
 consider the possibility of embolised fragments/shot pellets.
In conclusion, any diagnostic imaging examination can be considered a forensic examination, such
as gunshot injuries which often require imaging assessment, and this evaluation has both clinical
relevance (assessment of organ damage, surgical planning and prognostication), and often also
forensic implications.