Short Article

Challenges and Rewards of Forensic Radiology

Today it is hard to flip through television stations without passing a crime drama. Many now concentrate on the forensic aspect – evaluating evidence through the application of scientific techniques. Because of its mostly factual foundation, forensic evidence holds up well under court scrutiny, often as the voice of the deceased who cannot speak for themselves. A forensic examination can be a satisfying part of the radiology, but it usually isn't what a new student entering the field anticipates.

The role of forensic radiography

According to the National Institute of Justice, “Forensic science plays a vital role in the criminal justice system by providing scientifically based information through the analysis of physical evidence.”1 Forensic biology tends to get top billing in crime shows because DNA testing can be instrumental both in identifying perpetrators and in exonerating the innocent. However, this is only one area of forensics. Others include:

  • Anthropology
  • Controlled substances
  • Dentistry/odontology
  • Glass fracture analysis
  • Impression and pattern evidence
  • Pathology
  • Toxicology
  • Trace evidence

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Although it sometimes involves live subjects, forensic radiography generally falls into the pathology or medicolegal death investigation category. The objective is to use ionizing radiation to aid in determining if a crime has occurred, or to support the identification of circumstances surrounding death (cause and manner) of a crime.

The order for forensic imaging generally comes from the medical examiner. However, it must be admitted into evidence by the judge presiding over the case. Judge Owen E. Lefevre was the first to do so in 1896, by admitting radiographs as evidence in a malpractice case over which he presided for the District Court of Denver. Judge Lefevre established the precedent of admissibility that "a skilled operator, operating with adequate equipment under proper conditions, had produced the particular image."2

Forensic radiography degree programs do not currently exist in the United States, and certificate programs are rare. The work is considered a random and routine part of the radiology team's job. Exams are generally performed according to the facility's regular protocols, with a registered technologist taking the X-ray or CT images, and a radiologist interpreting the pictures. However, a forensic examination may be completed by a limited X-ray machine operator (LXMO), or a forensic assistant.3 In keeping with Lefevre’s precedent, exams may take place at the medical examiner’s office, or as is more often the case, in a physician’s office, outpatient imaging center, or hospital.

Forensic exams can be unexpected and unforgettable

Authorities, sensitive to the impact on a waiting room full of live patients, may attempt to send forensic exams at night. Depending on the urgency of the case and the radiology department’s hours, however, that is not always possible. A human remains pouch (HRP or “body bag”) may show up at any time during regular hours.

The technologist, in theory, is meant to handle it with the same decorum as any other study. In reality, it can be a bit more jarring. In a forensic exam, the radiology team is looking for clues as to what happened – bullet fragments, remnants of explosive devices, broken bones, or any other evidence that helps to establish circumstances. In some scenarios, remains can be manipulated into position and imaged without breaching the HRP.

Other times, such as when only a specific body part is to be imaged, the radiologist is not so lucky. The experience can result in a disturbing experience cannot be “unseen.” Utmost adherence to infection controls is also essential. The Society of Radiographers codified such guidelines in the Health and Safety section of their May 2014 Guidance for Radiographers Providing Forensic Radiography Services document, stating "The protocol should address appropriate precautions to minimize any risks of cross-infection during radiography for forensic purposes."4

You might think homicide and suicide cases, trauma, burns, decomposed bodies, and infant deaths would be the worst of it. Not necessarily. A skeletal survey in a case of suspected child abuse generally involves a series of images depicting the entire skeletal structure, possibly with a concentration on specific anatomical areas. The story that acute and healed fractures, bone lesions, dysplasia, and developmental abnormalities tells can be among the very hardest forget.

Is it worth it?

The radiology team does not get to pick and choose – they ethically and professionally take exams as ordered. Even if they could, most would not be deterred by the darker side of forensic studies. Part of the reason is the same curiosity that drives the popularity of forensic crime dramas on television. Wanting to see a mystery solved is human nature. For the radiology team, it can be invigorating to provide information that leads to that conclusion.

In addition, every forensic case involves real people – loved ones searching for answers or victims deserving of justice. It can be incredibly rewarding to provide the information that identifies a victim, or helps a family find closure in the “how,” if not the “why.” It may also get a child out of a dangerous situation and into protective care.

Ideally, in the future radiology programs will devote more attention to student training in the legal importance of forensic exams, as well as dealing with the emotional issues surrounding this area of radiology. Hopefully, popular television will further illuminate the role of forensic radiography in providing vital evidence. Until then, technologists and radiologists remain the unsung but crucial force behind many solved mysteries.


  1. Forensic Sciences. National Institute of Justice. June 24, 2019.
  2. The State of Forensic Radiography in the United States. American Society of Radiologic Technologists. June 24, 2019.
  3. Forensic Radiography Educational Framework. American Society of Radiologic Technologists. June 24, 2019.
  4. Guidance for Radiographers providing Forensic Radiography Services. Society of Radiographers. June 24, 2019.