The Gazette 1989

JULY 1989

GAZETTE

(nuclear medicine) and magnetic fields (magnetic resonance imaging). These modalities are all available in Ireland, although not easily accessible in some instances, due to their high cost and limited numbers. X-rays, however, still remain the basis of many of the investigations performed, and are readily available. Figure legends Figure 1. Frontal sinuses of two people are outlined, showing quite different shapes. Figure 2. Three views of an animal foot showing different bone con- figuration from man. Small bones in the toes (arrow) are more numerous. Figure 3. Left side shows fracture of the radius (arrow) in a child's wrist. Middle shows healing one month later. Right shows healed fracture at four months. Figure 4. Nail fragments (arrow- head) and skull fracture and air in the skull (arrow) are seen following suicide. Figure 5. This disturbed young girl had inserted a plastic doll into her vagina. • Family Mediation Michael Williams 14, Charleville Road, Dublin 6. Telephone: 9 7 8 4 0 2 has been admitted to the Senior Membership of the American Academy of Family Mediators ISLE OF MAN Messrs Samuel McCleery Registered Legal Practitioners in the Isle of Man, of Derbyhaven House, Derbyhaven, will be pleased to accept instructions by their resident partner Mr. S. McCleery from Irish Solicitors in the formation and administration of resident and non-resident Isle of Man Companies.

There are, however, some rare abnormalities which may mimic non-accidental injury but these can be excluded by a careful study of the whole skeleton. Foreign bodies The localisation of foreign material within the body is a situation uniquely suited to radiology. Many foreign bodies are encountered, some innocently, some through violence. Figure 4 shows the remains of the head of a nail which was fired into the skull by a nail gun, by a young man who committed suicide after killing his fiancee in a similar fashion. Some foreign bodies are swallowed by patients and others are inserted into body cavities (Fig. 5). In the case of gunshot wounds, x-rays are necessary to find the bullet fragments as they may travel a long way from the site of entry. Radiographs of an assassinated foreign diplomat in London a few years ago showed a tiny metallic sphere which had been injected into him. This had contained a potent poison, but might never have been found without the x-ray study. Non-metallic foreign bodies may also be identified and x-rays have been used to catch drug smugglers, who swa l l ow the drugs in condoms. Generally it is more difficult to see non-metallic foreign bodies, however. Diamonds do not show on x-rays because of their carbon content. In America, a lady was detained on suspicion of swa l l ow i ng a d i amond in a jeweller's. She was mistakenly x- rayed to find the missing gem and a radiograph of her abdomen showed a diamond shaped opacity! When the jeweller was told that true diamonds do not show up, the charges were quickly dropped. X-rays, which have the fascinat- ing property of being able to pass through the body, essentially un- noticed, have a useful role to play in many medico-legal situations. Their accurate i n t e r p r e t a t i on requires some expertise and a rigorous course of training. Newer modalities are now available for imaging various parts of the body. These involve the use of more sophisticated computer linked radio- graphy (computed tomography, CT or CAT scan), high frequency sound waves (ultrasound), radio-isotopes

fracture, may aggravate the changes of normal ageing. Experi- ence is required in the assessment of such areas, in order that what are natural ageing features are not misinterpreted as being directly due to injury. The radiologist can often ascertain this with a good degree of certainty. Head injuries are a particularly important medico-legal area. In the majority of cases radiographs are not of significant help in diagnosis. They will show fractures of the skull, but wi ll not give any indication of the extent of damage to the structures within the skull, principally the brain. Clinical examination of the patient is much more important in assessing brain injury, although sophisticated exami na t i on by compu t ed tomography, (a "brain scan") is helpful in the appropriate clinical setting. Many serious cases of brain injury show no skull fracture on x-ray, and the radiograph can be misleading as to the extent of injury. Conversely, many fractures which do show on x-ray are relatively innocuous. The important factor in head injury is whether or not the brain is damaged and skull x-rays may not tell this. A less common situation where x-rays may be useful is when strangulation is suspected. Views of the neck may show fractures of the hyoid bone or thyroid cartilage. These are small and are not commonly damaged in accidents. They can be damaged during post- mortem examination, making their assessment difficult, other than by radiography beforehand. Non-accidental injury In recent years the problem of non- accidental injury, or "battered baby" has become all to prevalent. The radiologist may be the first person to raise a suspicion of this as the child's injuries are often given a very plausible explanation. There are certain types of bony injury which are unlikely to occur accidentally. These include posterior fractures of ribs, fractures close to the growing ends of bones, vertebral fractures and spiral fractures of long bones. There are often injuries at different stages of healing, indicating several episodes of trauma. Minor bony injuries may not show immediately and follow- up examinations may be helpful.

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