The Gazette 1989

JULY 1989

GAZETTE

X-Rays and the Law

lished if the skeleton is not fully mature. Identification is not limited to humans. Figure 2 shows a radio- graph of a foot which was brought home one night by a family's dog. The skin and soft tissues had decomposed. This happened in an area where a multiple child killer had recently been convicted, but not all of the bodies had been found. The x-rays showed that the foot was not human, (probably that of a young bear), and a search for a child's corpse was not necessary. Trauma The use of radiographs in trauma is usually related to the assessment of suspected bony injury. This can occur in healthy or diseased bone and the radiologist can usually dis- tinguish these. The trauma may be direct or indirect, and can result in a complete break or, especially in children, a partial break or even bowing of a bone without a break. In children it may be possible to give an indication of the age of a fracture, as typical changes occur at various stages of healing (Fig. 3). This is not so easy in adults, as the rate of healing varies considerably from person to person. However, an experienced radiologist can usually give some estimate as to the time scale involved. It is worth mention- ing that some fractures may not be visible immediately, and require some degree of healing to have occurred before they will be seen on a radiograph. It is important to have proper viewing conditions for looking at radiographs. These are generally not present in a court- room. Glossy photographs of x-rays may be taken, but these usually involve considerable minification, which may make the abnormality difficult to see. In most areas of the body, changes occur with age. This is particularly so in the spine, which is an area commonly involved in accidents, including road traffic accidents. It is possible that an accident which does not cause a

As early as May 1896, x-ray plates were accepted in an English court when a Miss Gladys Ffoliett, a burlesque actress, sued the Nottingham Theatre Company for damages sustained in a fall, which occurred " in the line of duty". She fractured a small bone in her foot, and the x-ray evidence was accepted by the jury. In February 1896 the second x- rays taken in America were used to locate a bullet in a leg wound. The first use of x-rays as evidence in a case of medical negligence occurred in America in the same year. At that time it took many minutes to obtain a study of adequate quality. Today, high quality radiographs, as they are now more properly called, are obtained in a fraction of a second. Since their discovery in Germany in 1895, by W. C. Roentgen, x-rays have been used in many settings which have medico-legal implica- tions. These have included identifi- cation of victims of various kinds of trauma, assessment of trauma and its nature, localisation of foreign material, identification of non- accidental injury, especially in children, and assessment of normal processes within the human (and animal) body. X-rays are particularly helpful to lawyers in documenting the nature and extent of injury to the bony skeleton. Sequential studies following trauma can give an indication of how well healing is occurring and how likely it is that there will be further complications, e.g. arthritis in an adjacent joint. Studies which have been performed prior to an injury may be especially helpful for comparison. It is important that the x-ray films are accurately identified with as much information about the patient as possible and that this should be clearly legible. Photographic equip- ment which allows such information to be incorporated into the film is available. It is preferable that the technician who took the x-ray should be identifiable. The date and

time of the study, and the side of the body involved should be clearly marked. X-rays should be inter- preted by a doctor trained in radiology, because of the wide range of normal variation possible in the human body. Most radiologists have experienced cases referred to them as being abnormal, when, in fact, normal variation is the cause of the apparent abnormality. X-rays are now an extension of the clinical examination of a patient and are as valuable as the clinical findings, perhaps more so, from a legal point of view, as they provide a per- manent record which is visible to all.

By Samuel Hamilton, Consultant Radiologist, Mea th and Adelaide Hospitals, Dublin

Identification Radiographs have proved useful in identifying victims of various disasters, such as aircraft crashes and fires. While the destruction caused in these may be severe, bone or bony fragments may remain. These can be x-rayed and, where a list of known victims is available, old radiographs may be obtained for comparison with post- mortem studies. Views of the skull are helpful, as the frontal sinuses, which are air- containing spaces in the forehead, are unique for each individual (Fig. 1). Even identical twins will have different frontal sinuses. Com- parison of pre- and post-mortem studies may allow identification or, more often, exclusion of the person whose old films are available. How- ever, views of any part of the bony skeleton may be helpful in identification, as each individual is slightly different and may have characteristic features, including such things as old healed fractures or surgical changes. The age of a victim may be accurately estab-

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