Disaster victim identification: new applications for postmortem computed tomography

Abstract:  Mass fatalities can present the forensic anthropologist and forensic pathologist with a different set of challenges to those presented by a single fatality. To date radiography has played an important role in the disaster victim identification (DVI) process. The aim of this paper is to highlight the benefits of applying computed tomography (CT) technology to the DVI process. The paper begins by reviewing the extent to which sophisticated imaging techniques, specifically CT, have been increasingly used to assist in the analysis of deceased individuals. A small scale case study is then presented which describes aspects of the DVI process following a recent Australian aviation disaster involving two individuals. Having grided the scene of the disaster, a total of 41 bags of heavily disrupted human remains were collected. A postmortem examination was subsequently undertaken. Analysis of the CT images of all body parts ( n  = 162) made it possible not only to identify and side differentially preserved skeletal elements which were anatomically unrecognizable in the heavily disrupted body masses, but also to observe and record useful identifying features such as surgical implants. In this case the role of the forensic anthropologist and CT technology were paramount in facilitating a quick identification, and subsequently, an effective and timely reconciliation, of body parts. Although this case study is small scale, it illustrates the enormous potential for CT imaging to complement the existing DVI process.     

The contribution of DNA to the disaster victim identification (DVI) effort

As part of the disaster victim identification (DVI) response to the 2009 Victorian bushfires disaster, a number of scientific disciplines contributed to the human identification process--forensic pathology, anthropology and odontology, as well as fingerprinting and DNA profiling. The DNA laboratory received 182 post-mortem (PM) samples from 120 DVI cases and 236 reference samples corresponding to 163 missing persons (and two non-DVI cases). DNA analysis yielded full DNA profiles for 102 DVI cases and 190 ante-mortem (AM) samples (relating to all 163 missing persons), respectively. Subsequent comparison of DNA profiles, through direct and kinship matching, resulted in the submission of 76 DNA reports to the DVI Reconciliation Centre which assisted in the identification of 67 deceased. This paper describes the contribution of DNA analysis towards the DVI response to the 2009 Victorian bushfires disaster.     

Dealing with allelic dropout when reporting the evidential value in DNA relatedness analysis

A method is suggested that allows the use of loci that have shown allelic dropout in kinship analysis as used for disaster victim identification (DVI) and missing person work (MP). This approach uses an extension of a previously published approach to modelling allelic dropout. This method may salvage some information in cases where allelic dropout is hindering DVI or MP work particularly in reconciliations involving a large number of bodies and pedigrees. It should not replace the pursuit of more complete DNA profiles by the normal rework process for such samples.     

Dealing with allelic dropout when reporting the evidential value in DNA relatedness analysis

A method is suggested that allows the use of loci that have shown allelic dropout in kinship analysis as used for disaster victim identification (DVI) and missing person work (MP). This approach uses an extension of a previously published approach to modelling allelic dropout. This method may salvage some information in cases where allelic dropout is hindering DVI or MP work particularly in reconciliations involving a large number of bodies and pedigrees. It should not replace the pursuit of more complete DNA profiles by the normal rework process for such samples.     

Major incident response: collecting ante-mortem data

The Asian tsunami of 26 December 2004, which devastated coastal parts of more than 10 countries in and around the Indian Ocean caused over 200,000 casualties. People from more than 58 nationalities were amongst the victims and subsequently an international effort for disaster victim identification (DVI) was set up, coordinated by Interpol. DVI teams from more than 20 countries took part in the identification process which, because of the complexity of the situation, had to be conducted in an internationally agreed upon procedure. Standard operating protocols of post-mortem (PM) procedures were established for fingerprinting, forensic pathology, forensic odontology and DNA profiling and were crucial in the quality of the entire DVI process of the quickly decomposing bodies. A very important and underestimated part of the DVI process is the gathering of the ante-mortem (AM) data of the persons reported missing in their home countries. In the wake of this tsunami event it appeared to be even more problematic as entire families had died and information was difficult to obtain. As dentistry proved to be the most valuable identification mean--up to 85% of the cases--the AM dental records proved to be crucial elements for DVI. Standard operating protocols (SOP) were again established as to who, where, when and what information had to be collected by the dentists by the AM teams abroad. Transcribing the AM dental information by experienced forensic odontologists was another crucial element in the whole identification procedure as the information had to be loaded into the DVI System International (Plass Data, Holbaek, Denmark) for comparison with incoming PM data. The Interpol DVI Standing Committee thus recommends that forward planning, adequate funding, international cooperation and standardisation are essential to guarantee an effective response to any major mass disaster of this kind in the future.     

Attitudes,Perceptions, and Preferences of Individuals from Temuco (Chile) About Denture Marking

Denture marking (DM) helps identify edentulous people with different methods. Analyzing perceptions and attitudes of denture wearers would enable understanding of the practical aspects, an analysis still absent in South America. Fifty‐three individual candidates for removable dentures were instructed on disaster victim identification (DVI) and the usefulness of DM for this purpose. They were physically shown eight DM systems and a questionnaire to which they responded by highlighting preferences in those systems. Although 98.11% did not know that dentures could be marked, only 9.43% denied interest in some type of DM. The 90.57% would mark their dentures with some system, preferring the inclusion of QR codes or a micro SIM card. The proven weaknesses of DVI and propensity for disaster mean this community in Chile is an opportunity to implement DM systems. Obstacles may come not from patients but from their dentists, educational institutions, or a lack of public policies.     

Maggot development during morgue storage and its effect on estimating the post-mortem interval

When insect evidence is obtained during autopsy, forensic entomologists make decisions regarding the effects of low-temperature (-1 degrees C to 4 degrees C) storage of the body and associated insects when estimating the post-mortem interval (PMI). To determine the effects of storage in a morgue cooler on the temperature of maggot masses, temperatures inside and outside of body bags containing a human cadaver and porcine cadavers (seven replicates) were measured during storage. Temperatures remained significantly higher (p<0.05) inside of the body bags relative to the cooler, and remained at levels sufficient for maggot feeding and development. If the assumption that no insect development takes place during preautopsy refrigeration is made, potential error rates in PMI estimation of 8.6-12.8% occur. The potential for blow fly larvae to undergo significant development while being stored in the morgue is a possibility that forensic entomologists should consider during an investigation involving samples collected from autopsy. Case and experimental evidence also demonstrate that substantial tissue loss can occur from maggot feeding during morgue storage.     

Mortuary operations in the aftermath of the 2009 Victorian bushfires

On the day of the 2009 Victorian bushfires the Victorian Institute of Forensic Medicine activated its emergency plan. Within 48 h a temporary body storage facility was constructed adjacent to the existing mortuary. This temporary facility had the capacity to store up to 300 deceased persons. Pathologists, anthropologists, odontologists, police and mortuary assistants responded from all around Australia, New Zealand and Indonesia. The existing forensic mortuary and staff were divided into two areas: DVI (disaster victim identification) and "routine operations". A high priority for the mortuary was to ensure the casework of the "routine" deceased persons (those cases which were not related to the bushfires) was handled concurrently and in a timely manner. On admission each set of victim remains was given both a Coroner's case number in addition to the DVI number allocated at the scene. The case was CT scanned, examined by a pathologist, an anthropologist, and odontologist and in some instances a fingerprint expert. Where possible a DNA sample was taken. All processes, samples, labels and paperwork underwent a quality assurance check prior to the case completion. Regular audits were conducted. All of post mortem examinations were completed within 20 days of admission. Occupational health and safety issues of the staff were a high priority; this included correct manual handling, infection control and psychological debriefings. During the operation it was found that some remains were contaminated with asbestos. Procedures were set in place to manage these cases individually and each was isolated to reduce the risk of exposure by staff to asbestos. This overall mortuary operation identified a number of significant challenges, in particular the management of multiple parts of human remains for one individual. A new procedure was developed to ensure that all human remains, where possible, were reconciled with identified deceased persons prior to the release to the funeral director. It also highlighted the need to have well documented plans in place including plans for temporary mortuary facilities.     

Use of multislice computed tomography in disaster victim identification--advantages and limitations

After a mass fatality incident (MFI), all victims have to be rapidly and accurately identified for juridical reasons as well as for the relatives' sake. Since MFIs are often international in scope, Interpol has proposed standard disaster victim identification (DVI) procedures, which have been widely adopted by authorities and forensic experts. This study investigates how postmortem multislice computed tomography (MSCT) can contribute to the DVI process as proposed by Interpol. The Interpol postmortem (PM) form has been analyzed, and a number of items in sections D and E thereof have been postulated to be suitable for documentation by CT data. CT scans have then been performed on forensic cases. Interpretation of the reconstructed images showed that indeed much of the postmortem information required for identification can be gathered from CT data. Further advantages of the proposed approach concern the observer independent documentation, the possibility to reconstruct a variety of images a long time after the event, the possibility to distribute the work by transmitting CT data digitally, and the reduction of time and specialists needed at the disaster site. We conclude that MSCT may be used as a valuable screening tool in DVI in the future.     

The collapse of an Italian cemetery into the sea: Forensic approach to human remains identification

On February 22nd, 2021, a landslide on the Italian coast caused the collapse of an old cemetery. About 370 coffins tumbled and more than 200 fell into the sea. 333 groups of unidentified human remains were found: 140 decomposed bodies and 193 bags of commingled skeletal remains. The Medical Staff of Legal and Forensic Medicine was involved for analyzing the remains in order to identify and bury them. The remains involved belonged to people who died between the end of the XIX century and 2017; all were interesting by advanced transformative phenomena. For the identifications, new forms, based on the Interpol DVI ones, were created. Information was collected by relatives through a specific antemortem form. Relatives’ information and post-mortem data were compared: 19 body were identified thanks to secondary methods (like object in the bury, dresses, medical devices). 147 bone samples (long bones and teeth) were collected for the genetic analysis. Among the 77 relatives eligible for a genetic comparison, 66 gave consent to DNA swab for collection and genetic typing. Currently, after 48 samples DNA analysis (STRs and Y-polymorphism) 12 remains were identified, 21 presented a profile suitable for comparison but without attribution, and 7 did not return a comparable profile caused by stochastic effects. 31 subjects have been identified and the genetics analysis are still in progress. The Cemetery collapse shows that every disaster requires a tailored approach.     

Victim of a dictatorial regime: identification of Mr. Roberto Gomensoro Josman

Forensic cases are ideal to test osteological techniques developed by physical anthropologists. Forensic anthropology is a scientific discipline that applies population-based standards to individual skeletal remains. Many complex techniques are used in an attempt to make a positive identification. Several of these techniques, specifically digital video superimposition and DNA, were used to identify the victim in this case. The purpose of this paper is to describe anthropological techniques used to identify the remains of an unknown person who was later identified as Mr. Roberto Gomensoro Josman, the victim of a Uruguayan dictatorial regime. Mr. Gomensoro Josman disappeared after authorities of the Uruguayan dictatorial government (1973-1984) arrested him. Six days later an unknown body was found floating in Lake Rincon del Bonete. The corpse was found tied with wire and weighted with three large stones used to keep the body submerged. An autopsy was performed and the body was buried as an unknown person in the grave identified as number 10936 of Tacuarembo Cemetery. On December 2002 the Peace and Justice Service asked the local judge to authorize the exhumation of the remains. The exhumed body was headless. An investigation revealed that the local medical examiner who had autopsied the remains on March 1973 had retained the victim's skull in his office. Osteological analysis indicated the victim was a white male in his 20s. Four good quality photographs of Mr. Gomensoro who was known to be missing were compared with the skull. To confirm the identification from the video a DNA analysis was carried out comparing the victim with relatives. DNA typing confirmed the results of the earlier identification.     

Investigation of Different Ways in Which the CODIS 7.0 May be Used in Mass Disaster Identification

DNA analysis is a key method for the identification of human remains in mass disasters. Reference samples from relatives may be used to identify missing persons by kinship analysis. Different methods of applying the CODIS in disaster victim identification (DVI) were investigated. Two searches were evaluated: (i) relating family relatives to a pedigree tree (FPT) and (ii) relating unidentified human remains to a pedigree tree (UPT). A joint pedigree likelihood ratio (JPLR) and rank were calculated for each search. Both searches were similar in average JPLR and rank. In exceptional cases, namely the existence of a mutation different from the CODIS model, a nonbiological father, a mistake in STR, or incorrect profile association, the UPT search returned one true rank, whereas the FPT search returned no results. This paper suggests a novel strategy to overcome these limitations and increase efficiency in conducting identification of mass disaster victims.     

Conceiling the cadaver in masonry and cement

Encasing with concrete and/or bricks are relatively rare forms of hiding or disposing of a body; criminologically, cases of this kind are often treated as "matters involving a missing person" at first. The article describes the circumstances and findings of 2 cases in which bodies were encased with concrete. Under the aspects of reconstruction it is of importance that bodies may be preserved quite well in concrete, which allows not only identification of the victim but also determination of the cause of death even after a prolonged post-mortem interval, the more so as occasionally tools used for committing the offense are also encased together with the body.     

Identification of decomposed human remains by deoxyribonucleic acid (DNA) profiling

After routine methods failed to establish positive identification of a decomposed homicide victim, deoxyribonucleic acid (DNA) typing techniques using blood from the victim and putative parents of the victim were used. This is the first report in the literature of a case using DNA fingerprinting in a "parentage" context to establish identity of unidentified, decomposed human remains.     

The identification of a dismembered human body: a multidisciplinary approach

A criminal case was directed to a multidisciplinary forensic team for identification, concerning a victim whose head, having two gunshot wounds, had been separated by a sharp instrument and was recovered 6 months later. The purpose of this research was to determine the sex and age of the victim for human identification. Primarily, macroscopic examination of the skull, tooth, and DNA analysis was conducted for sex determination. A rough assessment of age was made from the skull based on anthropological findings, however a more definitive result of age estimation was determined utilizing dental morphology. The dental data showed an age range of 32-37 from the mineral examination and the formulation of microscopic measurements. The results obtained from the skull and dental analysis matched with the physical characteristics of the victim's body, the known personal data of this person, and with the superposition of the photos gathered by a formal request. Besides, the result of DNA profiling of the victim showed male gender and direct relationship with the victim's presumed wife and daughter. Generally, research on human identification consists of sex and age determination. The sex characteristics can be precisely proved from DNA tests. However, age can be estimated by skeletal, and dental analysis. In this case the performed sex and age analysis lead the research to the selective matching of the missing person's identity.     

Drugs as markers in identification. Detection of melperon (Buronil) in an adipoceratous corpse

The body of a 76-year old female pensioner was recovered from the Danube as adipoceratous torso after the person had been missing for almost two years. Identification first of all based on comparing postmortem and radiological findings which revealed correspondence of numerous features. The missing woman had been receiving long-term drug therapy of melperone (active substance of the neuroleptic Buronil) in doses of 25 mg three times daily. Combined gas chromatography and mass spectrometry succeeded in detecting the characteristic mass fragment of melperone in the adipoceratously transformed bone marrow of the water-logged corpse; in the remaining soft tissues outside the bones the concentration was below detection range. The reported case exemplifies that demonstration of low drug levels resulting from therapeutic ingestion can contribute to the identification of extensively decomposed bodies and to the correct relating of severed parts.     

DNA profiling of disaster victim identification in Trenggalek shipwreck case

DNA analysis is one of the primary methods of identification in DVI practices. The external environment of a mass disaster often results in severe fragmentation, decomposition and intermixing of the remains. However, DNA profiling still can be achieved even on cases involving partial, severely decomposed remains. This report shows the DNA profile of shipwreck victims using identifiler plus marker from tissue sample exposed to environmental conditions.     

The identification of Linda Agostini. The significance of dental evidence in the Albury ‘Pyjama Girl’ case. A case report

The discovery in 1934 of the badly burned, pyjama clad body of a young woman protruding from a roadside culvert near Albury, N.S.W., led to one of the largest investigations in the history of Australian crime. Two simple errors, made by a local dentist with no previous experience in forensic odontology called by the police to examine the teeth of the victim, resulted in a delay in identification for 10 years. This paper examines the background of the odontological evidence which ultimately led to the identification of the victim and the conviction of the offender.     

A study on the standard for forensic anthropologic identification of skull-image superimposition

By means of X-ray photography tests were made of 224 (100 males and 124 females) volunteer Chinese adults of Han nationality to study the related regular patterns of superimposed projection of face landmarks onto the skull. On the basis of these tests, the present article reveals from a forensic anthropology angle the related regular patterns of plane projection of the human face with its skull. Study shows that there exist a strict individual identity and exclusiveness in relation between the human face and skull. The related regularity of displacement of face landmarks appears in projection of the skull with the human head at different photographic positions and angles. On the basis of this discovery, 52 indexes in 4 groups were established as a standard for judging the identification of a skull's body origin by means of skull-image superimposition. Based on forensic anthropology, the technique has raised to a great extent the credibility of unknown skull identification. In the past 8 years, 89 unknown skulls have been identified with their body origins which provided important and accurate evidence for the solution of murders with dismembered bodies, skeletonized bodies, and unidentified dead bodies.