Radiological investigation of gunshot wounds: a systematic review of published evidence

Giorgetti, Arianna; Giraudo, Chiara; Viero, Alessia; Bisceglia, Marco; Lupi, Amalia; Fais, Paolo; Quaia, Emilio; Montisci, Massimo; Cecchetto, Giovanni; Viel, Guido

doi:10.1007/s00414-019-02071-8

Cited by 32 publications

(12 citation statements)

References 85 publications

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“…Although the use of CT in gunshot wounds is frequently presented in the literature, less attention has been paid to the in situ examination of lodged projectiles. 28,31 Metal artefacts on a standard CT scale 30 may have led to a reluctance to perform CT examinations for the visualisation of bullets. Although metal artefacts from lodged projectiles, that is, the dark and bright stripes that extend over the entire image, can be considerably reduced by applying metal artefact reduction algorithms, 32 only windowing into a very high range on an ECTS allows the clear depiction of a metallic object.…”

Section: Discussionmentioning

confidence: 99%

In situ identification of Action 4, SECA and QD-PEP bullets from special police ammunitions by computed tomography

et al. 2020

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Introduction Special deformation bullets were developed for police forces to achieve a defined penetration depth (avoiding over-penetration) and a controlled energy transfer (avoiding collateral damage). This article focuses on Action 4, SECA and QD-PEP bullets. These 9 mm bullets were specially designed for controlled deformation. The characteristic slight mushrooming with a front cross-section of approximately 11.5 mm after entering a ballistic simulant was verified in ballistic tests. To achieve such slight mushrooming, the projectile’s core is hollowed. The purpose of this study was to investigate the feasibility of visualising the hollowed cores of Action 4, SECA and QD-PEP bullets using a standard clinical computed tomography (CT) scanner for non-invasive identification of these special bullets from police ammunitions. Methods First, undeformed specimens were scanned to reveal the shape of the hollowed core of each type of special bullet. Second, Action 4, SECA and QD-PEP bullets were fired towards animal cadaver models to visualise their hollow core after deformation inside biological tissue. Third, two reviewers were tasked with identifying special bullets from police ammunition (Action 4 bullets: n = 3) among 10 CT examinations of humans with lodged projectiles who were selected by the supervisor of the study. Results The CT scans of the undeformed specimens revealed the special design of the bullets’ metal core. All special bullets from police ammunitions that were fired towards an animal cadaver model demonstrated the characteristic slight mushrooming. In accordance with the CT scans of the undeformed bullets, visualisation of the individual internal cavities of the special bullets allowed the Action 4, SECA and QD-PEP bullets to be clearly distinguished. With regard to the real forensic cases, both reviewers clearly identified each of the three Action 4 bullets among all other lodged projectiles. Conclusions This study demonstrates the feasibility of identifying Action 4, SECA and QD-PEP bullets from special police ammunitions by CT. The individual shapes of the cavity inside the bullets were clearly visible on CT. In situ identification of these bullets can aid in the assessment of injuries, and since these bullets are fabricated from non-ferromagnetic metals, their clear identification allows for magnetic resonance imaging (MRI) without the risk of bullet movement inside the body due to the magnetic pull of the MRI unit. Furthermore, this approach could be of great interest to forensic investigators if patients who received gunshot wounds underwent non-operative treatments and the projectile remains in the body. Since the use of CT is also increasing for medico-legal post-mortem examinations, the identification of lodged projectiles is of interest for a virtual autopsy or ‘Virtopsy’.

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Section: Discussionmentioning

confidence: 99%

In situ identification of Action 4, SECA and QD-PEP bullets from special police ammunitions by computed tomography

et al. 2020

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“…Postmortem imaging analysis, including X-ray and computed tomography (CT), has been used to not only identify retained bullets in penetrating gunshot wounds but as an adjunctive technique to gross inspection for the determination of entrance versus exit gunshot wounds and for determining the wound pathway [11]. Comparative studies in bone have demonstrated the superiority of digital radiography versus CT and magnetic resonance imaging in detecting metallic gunshot residue particles from both fresh and cremated bone [12].…”

Section: Discussionmentioning

confidence: 99%

Radiodense bullet wipe around osseous entrance gunshot wounds

Lukefahr

Vollner

Anderson

et al. 2020

Journal of Forensic Sciences

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Bullet wipe" is the material deposited by a bullet on any surface with which it comes into contact after it is fired and may contain debris from the gun barrel, including particles of primer and metal fragments from previously fired bullets. X-ray analysis is a non-destructive method by which traces of metallic elements can be visually detected. The analysis of osseous defects for radiodense bullet wipe (RBW) assists in determining the presence or absence of perforating gunshot wounds, especially in fragmented, skeletonized remains. The aim of our current study was to determine the frequency of RBW around entrance firearms injuries that perforated bone. We prospectively analyzed entrance gunshot wounds for RBW over a three-year period using digital X-ray analysis (n = 59). We retrospectively reviewed the corresponding autopsy reports to determine the frequency of RBW by biologic sex, reported ancestry, age-at-death, location of wound, manner of death, range of fire, bullet caliber, and presence of bullet jacket. Data were analyzed by Fisher's exact test or Chi-square test with significance levels accepted at p < 0.05. RBW was present in 66% (n = 39) of examined cases. Decedent characteristics did not significantly alter RBW distribution, including biologic sex (p = 0.75), reported ancestry (p = 0.49), and age-at-death (p = 0.43). Additionally, the location of the osseous entrance gunshot wound, manner of death, range of fire, and cartridge caliber did not affect RBW detection. All cases involving non-jacketed rounds (n = 5) showed RBW (p = 0.30). To our knowledge, this study is the first to report the frequency of RBW detection from osseous entrance gunshot wounds.

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“…Key Words: bullet, gunshot, radiologic wound ballistics, postmortem computed tomography, postmortem magnetic resonance imaging, virtopsy (Am J Forensic Med Pathol 2020;41: 119-123) P ostmortem computed tomography (CT) is frequently presented as a supplementary examination to autopsy in cases of gunshot wounds. 1,2 The major strength of CT is the rapid detection and location of lodged projectiles or bullet fragments inside a cadaver. [3][4][5] Computed tomography also allows for an in situ assessment of the bullet trajectory via the detection of osseous injuries.…”

Section: Postmortem Computed Tomography and Magneticmentioning

confidence: 99%

Postmortem Computed Tomography and Magnetic Resonance Imaging of an Abdominal Gunshot Wound

Gascho

Bolliger

Thali

et al. 2020

Am J Forensic Med Pathol

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The use of postmortem computed tomography (CT) has been described in many articles concerning gunshot injuries. Postmortem magnetic resonance imaging (MRI) for better assessment of soft tissue injuries has also been mentioned in the literature, albeit much less often. The use of postmortem MRI for abdominal gunshot wounds has not been previously presented in the literature. The present case report describes the findings of an abdominal gunshot wound detected by postmortem CT and MRI, followed by an autopsy. The main imaging findings on CT were a hyperdense ring at the entrance wound, which indicated the muzzle imprint mark, a hyperdense region beneath the skin, which was suggestive of combustion residue, gas cavities surrounding the bullet path, which might be related to the temporary cavity, and a fracture of the 13th rib on the left. Magnetic resonance imaging provided a clear depiction of defects in the muscle tissue and peritoneal fat, as well as an injury to the left kidney and a large volume of blood in the abdominal cavity. Computed tomography combined with MRI provided a descriptive presentation of the intracorporeal trajectory noninvasively. Autopsy confirmed the radiologic findings but additionally revealed further relevant findings, which were not detected radiologically, such as a duodenal perforation. Autopsy also detected subendocardial hemorrhages and shock kidney, which were consistent with severe blood loss.The imaging findings and their interpretations are discussed in this case report, as well as the role of CT and MRI in the assessment of abdominal gunshot wounds compared with autopsy.

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Radiological investigation of gunshot wounds: a systematic review of published evidence

Cited by 32 publications

References 85 publications

In situ identification of Action 4, SECA and QD-PEP bullets from special police ammunitions by computed tomography

In situ identification of Action 4, SECA and QD-PEP bullets from special police ammunitions by computed tomography

Radiodense bullet wipe around osseous entrance gunshot wounds

Postmortem Computed Tomography and Magnetic Resonance Imaging of an Abdominal Gunshot Wound

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