Forensic imaging: The sensitivities of various imaging modalities in detecting skeletal trauma in simulated cases of child abuse using a pig model.

Physical child abuse is a major problem in South Africa and throughout the world, and the detection of skeletal trauma in victims of abuse may be critical in the accurate investigation of these cases. Since many of these fractures are not detected during traditional autopsy, the use of various diagnostic imaging tools is implemented in order to aid in the detection of trauma. In South Africa, Lodox (low-dose full-body X-ray) is commonly used in forensic mortuaries and the aim of this study was to assess the sensitivities of CT, X-ray and Lodox, in comparison to dry bone as the gold standard, in detecting both the number of fractures and minimum number of impacts in piglets subjected to blunt force trauma. Ten piglets were beaten with a mallet post-mortem in every region of the body. CT, X-ray and Lodox scans were taken of each piglet, after which the piglets were macerated in order to conduct an osteological analysis of the remains. The number of fractures and impacts present in each scan and on the dry bone were recorded. CT scans were the most sensitive in identifying trauma in all regions of the body, detecting 73% of fractures and 79% of impacts. X-ray and Lodox scans were less sensitive in detecting both fractures (50% and 42% respectively) and impacts (59% and 54% respectively). An assessment of the directionality of trauma was possible using dry bone and CT scans, but not when using X-rays or Lodox scans. CT scans can be used to assess skeletal trauma in suspected victims of child abuse, but the use of X-ray and Lodox scans is not recommended other than for initial screening procedures. Osteological analysis, however, is still considered the gold standard and should be performed whenever possible.