Authors Accepted Manuscript

Research in Forensic Radiology and Imaging;

identifying the most important issues

M.C. Aalders, N.L. Adolphi, B. Daly, G.G. Davis,

H.H. de Boer, S.J. Decker, J.J. Dempers, J. Ford,
C.Y. Gerrard, G.M. Hatch, P.A.M. Hofman, M.
Iino, C. Jacobsen, W.M. Klein, B. Kubat, P.M.
Leth, E.L. Mazuchowski, K.B. Nolte, C. www.elsevier.com/locate/jofri

O'Donnell, M.J. Thali, R.R. van Rijn, K. Wozniak

PII: S2212-4780(16)30098-3
DOI: http://dx.doi.org/10.1016/j.jofri.2017.01.004
Reference: JOFRI239
To appear in: Journal of Forensic Radiology and Imaging
Received date: 20 January 2017
Accepted date: 20 January 2017
Cite this article as: M.C. Aalders, N.L. Adolphi, B. Daly, G.G. Davis, H.H. de
Boer, S.J. Decker, J.J. Dempers, J. Ford, C.Y. Gerrard, G.M. Hatch, P.A.M.
Hofman, M. Iino, C. Jacobsen, W.M. Klein, B. Kubat, P.M. Leth, E.L.
Mazuchowski, K.B. Nolte, C. O'Donnell, M.J. Thali, R.R. van Rijn and K.
Wozniak, Research in Forensic Radiology and Imaging; identifying the most
important issues, Journal of Forensic Radiology and Imaging,
http://dx.doi.org/10.1016/j.jofri.2017.01.004
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 Research in Forensic Radiology and Imaging; identifying

the most important issues.

M.C. Aalders1,2, N.L. Adolphi3, B. Daly4, G.G. Davis5, H.H. de Boer6, S.J.

Decker7, J.J. Dempers8, J. Ford7, C.Y. Gerrard3, G.M. Hatch3, P.A.M. Hofman9, M.

Iino10, C. Jacobsen11, W.M. Klein12, B. Kubat13, P.M. Leth14, E.L. Mazuchowski15,

K.B. Nolte3, C. O'Donnell16, M.J. Thali17, R.R. van Rijn2,13,18#, K. Wozniak19

Department of Biomedical Physics and Engineering1, Academic Medical Center Amsterdam, the

Netherlands.

Amsterdam Center for Forensic Science and Medicine2, University of Amsterdam, Amsterdam, the

Netherlands.

Radiology-Pathology Center for Forensic Imaging3, New Mexico Office of the Medical Investigator,

Albuquerque, New Mexico, USA.

Department of Radiology4, University of Maryland, Baltimore, Maryland, USA.

Department of Pathology5, University of Alabama, Birmingham, Alabama, USA.

Department of Pathology6, Academic Medical Center, University of Amsterdam, the Netherlands.

#
Address for correspondence:
Prof. Rick R. van Rijn, MD. PhD.
Department of Radiology
Emma Childrens Hospital - Academic Medical Center Amsterdam
Meibergdreef 9
1105 AZdAmsterdam Zuid-Oost
the Netherlands
Tel: 31-20-5669111
E-mail: r.r.vanrijn@amc.uva.nl

1
2
Abstract

This paper presents the outcome of the first international forensic radiology and imaging

research summit, organised by the International Society of Forensic Radiology and Imaging,

the International Association of Forensic Radiographers, the National Institute of Justice of

the United States of America, and the Netherlands Forensic Institute. During this meeting, an

international and multidisciplinary panel of forensic scientists discussed the current state of

science in forensic radiology, and drafted a research agenda to further advance the field.

Four groups for further research focus were identified: big data and statistics, identification

and biological profiling, multimodal imaging, and visualization and presentation. This paper

describes each of these research topics and thereby hopes to contribute to the development

of this exciting new field of forensic medical science.

3
Introduction

Forensic radiology and imaging is a relatively new field within the realm of forensic science

and medicine (1). As in all new fields in medicine and science, one of the important tasks is

to establish a rigorous base of scientific evidence, which establishes forensic radiology as a

reliable, precise, and valuable source of information in medicolegal death investigations.

On November 27th 2011 the International Society of Forensic Radiology and Imaging (ISFRI)

was founded. One of the aims of this society is to encourage and develop research programs

in forensic radiology and imaging. With this in mind, the ISFRI, in conjunction with the

International Association of Forensic Radiographers (IAFR), the National Institute of Justice

(NIJ, Washington D.C., United States of America), and the Netherlands Forensic Institute

(NFI, the Hague, the Netherlands), organized a two day international forensic radiology

research summit. During this summit, held just prior to the 2016 joint annual meeting of the

ISFRI and IAFR in Amsterdam, an international and multidisciplinary panel of experts in the

field of forensic radiology and imaging discussed the current state of forensic radiological

research and created a research agenda for the coming years.

The identified research topics were divided into the four following groups: big data and

statistics, identification and biological profiling, multimodal imaging, and visualization and

presentation (fig. 1). This paper presents the consensus view of the panellists for each of the

identified research topics. We hope that this information can be used to inform both

sponsored and non-sponsored research in this emerging discipline.

Big data & statistics

Post mortem imaging must be evidence based and proven capable of yielding reliable and

precise information about the cause of death and other issues of importance for the death

4
investigation process. There has been a rapid increase in the number of publications within

the field of post mortem imaging, mostly published in journals devoted to forensic sciences

and fewer in radiology journals. Most of these studies concern adults, while paediatric

studies are more scarce (2). The existing scientific literature is, however, mostly based on

case reports and relatively small case series with a marked variability in quality and

methodology used (3). Larger and better-designed studies are therefore needed.

Priority must be given to an international agreement on diagnosis coding. This would

facilitate international cooperation on research projects and also facilitate meta-analyses

and comparisons of scientific studies. Some researchers have used the abbreviated injury

scale for coding of injuries (4). Procedures used to code diseases have been more variable.

Establishment of national and international research groups should be encouraged. The

international cooperation regarding post mortem angiography is an example of such

international cooperation (5).

Research design considerations

Some methodological issues that need to be addressed were identified. It is important that

comparisons between different methods such as autopsy and various imaging modalities are

performed double blinded. This may present a problem if the research is performed

prospectively and based on data from imaging used in the daily routine. Imaging and

autopsy findings must in these cases be collected independently, for example by recording

the autopsy data before the results of the imaging are revealed to the pathologist

performing the autopsy and by recording the radiologic data before the autopsy results are

revealed to the radiologist. However, we note that some research questions require some

level of unblinding to study, for example, how a pathologists access to imaging findings

5
prior to autopsy may affect the type of autopsy chosen (e.g., external, partial, full). When

unblinding is essential, studies must be carefully designed (e.g., using sequential unblinding)

or utilizing comparisons of findings from an unblinded study arm with a double-blinded

study arm to systematically determine the impact of unblinding.

There is a need for a strict adherence to modern epidemiological methods. Comparison with

a control group is often needed. There are only a few inter- and intra-observer variability

studies (6). Studies in this area, including studies of observers with different background

such as radiology or pathology, are needed.

Specific topics

Studies about how to use imaging in the death investigation process are needed, both

regarding forensic and clinical deaths (7, 8). This may vary depending on the medicolegal

death investigation decision process operating in the country in question. Research in this

field includes studies concerning quality, accuracy, and timeliness of imaging in the post

mortem examination process. Studies regarding the implications of introducing post mortem

imaging in the death investigation process for logistics, resources, and specialist training are

also needed (9). Post-mortem imaging has important limitations that need to be remedied

before such methods could replace autopsy (10, 11). These include poor visualization of

some pathological lesions such as coronary artery disease and the lack of microscopic

examination of tissues and organs (12). Such limitations might be remedied by adding

ancillary methods such as angiography (13) and needle tissue sampling (14), but more

studies of these methods are needed (fig. 2A &B).

The important questions that need to be answered during the forensic post mortem

investigation process are often focused on pattern of injuries and injury mechanisms rather

6
than on the individual injury diagnosis. There is a lack of studies in this important field, as

most studies focus on the individual injury rather than on injury patterns.

Imaging data used for biomechanical model building for research in injury mechanism and

force is an emerging area and a potential important research area.

Identification and Biological profiling

Biological profiling of individuals

The use of radiological imaging techniques is quickly gaining momentum in the identification

and/or biological profiling of living and deceased individuals. Especially in forensic

investigation, the biological profile of an individual generally consists of four components:

sex, age, stature, and ancestry.

In the majority of forensic cases, radiological assessment of sex is unnecessary. However in

selected cases, for instance those related to unidentified skeletal remains, the use of CT-

imaging might pose an important addition to current (forensic anthropological) methods

(15). Only a limited number of studies have explored this potential, but with promising

results. More research is needed, firstly on the precision and accuracy of radiographic

techniques, and secondly on the performance of regularly used sex estimation methods

when applied on, or adapted to, radiological techniques (16-20). The technical issues

pertaining to radiological sex estimation could be performed in any population, whereas

performance studies are limited by population specificity.

In contrast to sex estimation, the assessment of age is an often-encountered problem in

forensic cases. In living individuals (e.g. refugees), radiological analysis may provide an

7
objective method of age estimation, which can be used to corroborate testimonies or

questionable identity documents. Despite some early work, further research is needed to

evaluate the validity of current scoring techniques, to develop non-ionizing techniques (i.e.

MRI), and the application of multiple measurement sites (21). The variation in age related

features between different ancestral groups and the impact of socio-economical background

should be explored further (22-26). In deceased individuals, objective age estimation is

equally important. In suspected neonaticide, radiology may help to assess whether or not a

foetus had a viable age, which may restrict the possibility of a potential crime (fig. 3A & B).

Although clinical data on foetal age estimation is available, the use in a forensic environment

has limitations as most collections are based on older studies with a limited number of

included cases. Application of different databases or equations can lead to different

gestational age assessment, and thus to misclassification.

The estimation of stature and ancestry has limited applicability in forensic science and has

not been studied thoroughly. Adapting classical forensic anthropological methods to imaging

may eventually increase the use of forensic radiology to estimate these parameters, thereby

preventing tedious maceration and measurement techniques (16, 27-32).

Besides adopting classical biological profiling methods, radiological imaging may provide

alternative means of identification. The use of frontal sinus morphology is a good example

(33-36). Exploration and validation of alternative methods almost certainly will add to the

impact of forensic radiology in cases of unidentified remains. Another approach on

identifying an unknown corpse is forensic facial approximation. The current method often

includes highly subjective interpretative choices by the performing artist. As a result, facial

8
approximations from a single skull may differ significantly (37). This technique is therefore

generally not considered a legally recognized identification technique. Research in the use of

PMCT data and automated techniques for facial approximation, using normative soft-tissue

data obtained in living patients, may provide an opportunity to change this status-quo (38-

40).

For any forensic radiological investigation related to identification, thought has to be given

on how to present the virtual anthropological data and how to fit them into international

protocols, such as e.g. the Interpol Disaster Victim Identification forms (41, 42).

Timing of disease, trauma and death

The timing of disease, trauma, and/or death often is often pivotal in a legal context, and

forensic radiology and imaging can be an important addition to current techniques. Here a

division should be made between living and deceased victims.

In living individuals, issues such as dating bruises (43, 44), (e.g. in case of child or spousal

abuse), dating of fractures (45, 46), and dating subdural hematomas (e.g. in case of child

abuse) (47) have already received some attention (fig. 4). However, there is a general lack of

large series of patients with a known post-traumatic interval and additional research to

establish the performance of published methods is needed. The combination of radiological

techniques and non-radiological imaging techniques (e.g. spectrometry, fluoroscopy) can

provide additional insight. In the clinical context, it is often claimed that disease or trauma

can be dated by means of either visual inspection or radiological imaging, but evidence

shows that these methods are highly subjective with a high interobserver bias (48-51). Since

it is not possible to confirm fractures by gross inspection or histology in living individuals,

special attention should be given to false positive or false negative findings (52).

9
In deceased victims, the dating of lesions is related to several complicating factors. The

processes of dying and post-mortem decay may obscure the biological hallmarks of disease

or trauma, thereby negatively affecting the sensitivity and specificity of imaging techniques.

Besides some studies focussing on imaging skeletonized remains, there is little research on

the dating of fractures in various post mortem scenarios (43, 53-55).

More research should be focussed on lesions outside the traditional radiographic diagnostic

spectrum. As an example, more emphasis should be placed on physiological causes of

death such as myocardial infarction. Early studies suggest radiological imaging techniques

may provide a solution to the current problems of diagnosing myocardial infarction in the

first few hours after the onset of myocardial ischemia (56-59).

The effects of decomposition on radiological imaging parameters are insufficiently known.

Such knowledge could eventually aid in establishing the post-mortem interval (PMI) and

thereby supplement or even replace the currently used, but notoriously unrefined,

nomogram of Hensgge. Some research studies have attempted to find reliable imaging

markers to assess the PMI, but the results are highly variable and not currently applicable in

a forensic context (60-62).

Multimodal Imaging

Multi-Modal Imaging (MMI) was identified as a critical research priority for forensic science.

Traditionally, forensic investigation has relied on several imaging methods photography,

radiography, and light microscopy to document physical evidence. Ongoing improvements

in technology and developments in other fields, from physics to clinical medicine, have led to

a wide variety of new and more powerful imaging methods with potential utility for forensic

investigation. For example, CT and MRI, which are standard tools of clinical medicine, are

10
now increasingly being studied and applied in the context of medicolegal death investigation

or forensic cases requiring evaluation of living subjects (63-67). Furthermore, there has

recently been an tremendous increase in techniques related to image capture and

processing that open new possibilities for merging image information obtained by one or

more modalities over multiple length scales or at multiple points in time and visualizing the

information in new ways.

We identified four specific areas of research that will enable the forensic science community

to take advantage of both existing and emerging imaging technologies.

First, is the use of novel imaging or other analytical methods for basic research that could

improve the forensic application of more traditional imaging methods. There is a need for

further studies investigating the scientific underpinnings of specific imaging modalities and

systematically studying conditions that are unique to the forensic setting which may affect

image appearance or quality. Some examples of new research questions that could be

addressed include: what is the underlying chemical basis of the macroscopic MR contrast

observed in a particular type of injury or pathology? What is the chemical basis of post-

mortem changes that affect CT or MR image quality? What are the histological correlates of

specific macroscopic imaging findings?

Second, is translating novel imaging or analytical methods (not routinely used in forensic

investigation) into the forensic setting. Research in this area may include the development of

optimized techniques or devices, such as portable imaging devices designed specifically for

use at crime scenes, as well as the evaluation of existing imaging technologies for new

forensic applications.

Third, is combining macroscopic imaging methods to identify regions-of-interest with

microscopic or molecular techniques that provide a more detailed picture. As an example,

11
traditional MR or CT could be combined with MR or CT microscopy to image selected ex vivo

tissues or in situ regions-of-interest with enhanced spatial resolution (68). Other techniques

capable of providing enhanced detail include optical spectroscopies and spectral imaging,

mass spectroscopy, Magnetic Resonance Spectroscopy (MRS) and Magnetic Resonance

Spectroscopic Imaging (MRSI), optical microscopy (histology, immunofluorescence, etc.), and

electron microscopy (fig. 5A&B). Practical research questions include how best to identify

regions-of-interest (autopsy or imaging, and which imaging modality) and what investigative

value microscopic or molecular methods can provide (improved accuracy, specificity,

quantification).

Fourth, is synthesizing and displaying image data from multiple modalities in new and more

powerful ways (69, 70). Potential topics of research in this area include new methods for

merging images, 3D and 4D displays, including animation to display changes in time, length

scale (i.e., zooming), or viewing angle, interactive images that link to additional images or

non-imaging data, and virtual reality (66, 71-73).

Visualization & Presentation

The visualization and presentation of data differ depending on the user of the data. The

users described specifically in this paper are the radiologist, pathologist, and courts. The

caveat to using data is that the quality of the data is dependent on the quality of the image.

Image quality and consistency of image output are driven by four distinct cohorts: personnel

who acquire the image, acquisition protocol, interpretation methodology, and the end user

of the data.

Personnel

12
Traditional autopsy and radiology differ in important ways. Autopsy examination of a body

requires that the body be present for examination. The pathologist may take photographs to

record certain observations on or within the body, but the pathologist is unlikely to take

detailed photographs of the entire body surface, and even less likely to record all the

internal findings with photographs. In contrast, radiological data have the advantage of

being available for review at any time following acquisition of the data. Archiving methods

and recall of radiologic imaging must be considered when using imaging that was acquired at

an earlier point in time; especially if the imaging is used to answer fundamental research

questions or new queries that arise concerning the scan. Image quality and the options

available to correct problems depend on the hardware and software used to scan the body

and the protocols selected by the personnel acquiring data. The personnel acquiring image

data are quite literally the first-line of defence in terms of identifying and potentially

correcting quality problems that arise before, during and immediately after imaging.

Therefore, personnel acquiring the images must possess an understanding of how the

software and hardware of the scanner affect overall image quality. There are two types of

personnel who will likely acquire imaging at a forensic institution: radiologic technologists

trained in the specific imaging modality or morphology/autopsy technicians who are trained

on-the-job. Radiologic technologists would presumably have more facility at troubleshooting

problems that arise in image acquisition, but would an autopsy technician with general

training be adequate at troubleshooting for most problems? Future research should be

focussed on evaluating the key strengths and limitations of each type of personnel in the

forensic setting.

Acquisition protocol

13
The protocol for acquiring images affects image quality, and research is needed to determine

the ideal acquisition protocols for both living and deceased individuals. Imaging protocols for

living patients in the clinical setting are well defined. However, imaging protocols are not

defined for performing radiologic imaging on living patients that have forensically significant

circumstances (e.g. assault, attempted strangulation, etc.). Further, the condition of the

body of a deceased subject (cold, decomposed, mummified, burned) may require protocol

modifications not typically encountered in the clinical setting.

Interpretation methodology

Research comparisons between different methods such as autopsy and various imaging

modalities need to be performed with appropriate blinding and controls. But the question

remains, at what point should radiologists and pathologists work together, sharing data and

interpretations, as they work toward determining the cause of death and the various

parameters related to the cause of death, such as injuries, patterns of injury, etc.? How is

interpretation of images best performed in daily practice?

Radiological images are ultimately used by radiologists, pathologists, and the legal system.

Research questions concerning the application of images by these end users include how the

legal system will utilize forensic radiology. How does one combine radiological images and

pathology images to best present findings to others, such as families or the court? This

aspect will be explored in greater detail below.

How radiologic images are presented to the radiologist affect the radiologists ability to

interpret, reformat, and manipulate the images. This ultimately affects their ability to

14
accurately diagnose disease and injuries and provide adequate consultation to a pathologist.

Finally, how do autopsy findings inform examination and interpretation of radiological

images? Similar questions concern a pathologists use of radiological images. How does

radiological imaging impact the performance of an autopsy? To put the question quite

simply, which combination of examinations is the new gold standard; autopsy alone,

radiologic imaging alone, or a combination of autopsy and radiologic imaging?

Findings versus Interpretation versus Scenarios

The presentation of evidence in court has developed according to legal precedent and

custom. No study has determined what types of scientific evidence are most effective in

providing reports or testimony for court. Similarly, there has been no research to determine

if 2D and 3D reconstructions of findings from a modality such as CT are more or less

comprehensible and more or less unfairly prejudicial compared to standard courtroom

illustrations (e.g., photographs, diagrams, mannequins, etc.) when viewed by potential jurors

(fig. 6A-C). Some early work has shown that a group of attorneys surveyed prefers 3D

reconstructions and color-coded CT images accompanied by written report because this was

cost-effective and most easily understood (74). Research concerning the presentation of

evidence can assess usefulness of autopsy images, radiology images, and three-dimensional

models, as well as comparing utility of one type of evidence versus another type.

For example, future studies could compare detailed reproductions (whether images or 3D

models) versus simplified models. Simplification raises questions concerning judgments on

what detail is removed or added to the image or model. At which point does raw data

become a requirement for creating objective reconstructions of the data by a third party?

15
Is there a place for animation in court? Law will determine this in some way, for example,

does the animation truly and accurately reflect findings of the examination of the body?. At

what point does animation cross over from objective (rotation of a body) to subjective

(reproduction of occurrence)? With respect to this issue, the rapid developments within the

field of Augmented Virtual Reality (AVR) could be a topic for research. As an example,

imagine that crime scene investigators make a 3-dimensional recording of a room where a

body was found, allowing the judge or jury to virtually be in the room and see what the

investigators saw at the death scene in three dimensions. Should the scene be shown as the

investigators saw it, without any alteration? Would it e.g. be appropriate, after seeing the

unaltered image, to highlight spots of blood for the court to see? Will it be possible for a

juror to look out a virtual window and see a car with a certain license plate parked in the

driveway, as witnesses claim was present? At this point, there is no consensus on what

imaging methods are appropriate, let alone what would be needed to apply advanced virtual

reality innovations.

Human Perception

Human perception affects image interpretation, whether the images are radiologic or

photographic recordings from autopsy. Physicians practicing forensic medicine do courts and

themselves a disservice if they do not acknowledge that forensic practice is a special

category of medical practice. Acquiring history precedes even the acquisition of images for

radiological interpretation. Some attorneys have called for limiting or eliminating the history

available to forensic physicians in an attempt to avoid inappropriate or confirmation bias,

but this approach to preventing what the attorneys consider a potential problem betrays a

16
misunderstanding of sound medical practice. Research could be done into what kind of

information is essential to making accurate diagnoses and the errors that can occur when

appropriate information is withheld (75, 76). The legal system has a different set of research

questions as an end user recipient of radiologic imaging, i.e., should the legal system,

consisting of individuals without relevant training, be given raw image data directly from

imaging modality to interpret and reformat? The call to restrict access to information for

experts should not be one sided. Should attorneys be expected to understand data and

images without inappropriate bias?

The question is how should we be operating in a system that seeks to avoid confirmation

bias?

Conclusion

This paper presents the results of the first international forensic radiology summit. The

research topics presented are, by the attending experts, felt to currently be the main

research topics in our field for the years to come. During the meeting the attendees agreed

that in order for research to succeed, two general issues should be addressed: 1) the need

for national and international collaborative research groups and 2) the need for research

funding. Collaborative research groups foster adequate sample sizes and multidisciplinary

teams that include individuals with scarce expertise. The Technical Working Group Post-

mortem Angiography Methods (TWGPAM), is an example of international cooperation

regarding post mortem angiography (5). The lack of adequate research funding is ubiquitous

for forensic radiological research, especially for post-mortem radiology. In many countries

the field does not fit in the research agenda of major funding bodies, such as the National

Institutes of Health (NIH) and The EU Framework Programme for Research and Innovation,

17
Horizon 2020. In recent years, the US National Institute of Justice has sponsored several

forensic radiology projects; however, the need for funding currently exceeds the supply even

in the US. We hope that this publication will play an instrumental role for funding bodies,

both on a national as well on an international level, in advancing forensic radiologic

research.

Acknowledgements

The authors would like to thank Mrs. H. Waltke, Mrs. D. McLeod-Henning, Mrs. D.M. Weiss,

and Mrs. H. Barcus (the Office of Investigative and Forensic Sciences, National Institute of

Justice, Washington, USA) and Prof. A. van Asten, MSc. PhD. (Netherlands Forensic Institute)

for their support in organizing this first international forensic radiology research summit.

18
Legend to figures

Figure 1. Mindmap showing the four main groups for future research and examples of

individual research topics.

Figure 2. Post mortem CT of a donor of the Amsterdam Body Donation Program

(Faculty of Medicine, University of Amsterdam). The CT shows several

hypodense lesions in the liver and an enlarged right adrenal gland (A). Post

mortem CT Angiography of the same donor shows rim enhancement of

multiple hepatic metastases (B).

Figure 3. Three dimensional reconstruction of a foetal skeleton of a unknown child. The

corpse was hidden and found by accident (A). Femoral length measurement of

the right femur on the 3D dataset shows the foetal age to be in keeping with a

gestational age of 38.9 weeks (SD 2.1 week) (according to J.L. Scheuer et al.)

(77).

Figure 4. A combination of bruise modelling and spectroscopy as used for dating

bruises (44).

Figure 5. Proton magnetic resonance spectroscopy (1H-MRS) at 1.5 T showing the

metabolites present in an antelope brain, comparing post-mortem intervals of

1 day (A) and 6 days (B).

19
Figure 6. The use of postmortem CT with skin reconstruction (A) and bone

reconstruction (B) compared to a crime scene photo (c) as it can be used to

illustrate injury in a less prejudicial way (scan obtained as part of Utility of

Postmortem X-ray Computed Tomography (CT) in Supplanting or

Supplementing Medicolegal Autopsies National Institute of Justice (NIJ 2010

DNBXK205)).

20
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highlights

Four groups for further research focus were identified: big data and statistics,
identification and biological profiling, multimodal imaging, and visualization and
presentation. This paper describes each of these research topics and thereby hopes to
contribute to the development of this exciting new field of forensic medical science.

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The author has requested enhancement of the downloaded file. All in-text references underlined in blue are linked to publications on ResearchGate.