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GAZETTE
JULY 1989
X-Rays and the Law
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-
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
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