Radiographers – Think You’re Not in Forensic Imaging? Think Again.

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Educate yourself for the possibility of being a witness in a criminal investigation.

By Dr. Michaela Davis, Winston Churchill Research Fellow, Assistant Professor UCD School of Medicine and Medical Science, and Diagnostic Radiographer Assistant. 

Although you might not carry the actual title of “forensic radiologist,” there is a possibility that at some point in your career as a radiologic technologist, you will have a role in a criminal investigation.

Radiographers and radiologic technologists, by the nature of their work, capture and view images that tell a clinical story. Sadly, the story that is revealed is sometimes a cruel one of neglect or possible abuse of a child. These images have the potential to be used as evidence.

When radiographers become part of the forensic imaging chain of evidence

In these cases, a radiographic image that was requested to assist with clinical care decisions unexpectedly becomes evidence in a court of law, and you now have a role in forensic radiology.

Additionally, conversations and observations you had with the patient or their carers also might become evidence. Should you find yourself in this situation, it is important that you follow the protocol and child protection guidelines within your department.

image of waist-below of a child in a dress with teddy bear with text "Radiology's Role in Identifying Child Abuse"
Understand your potential role in a forensic examination, and prepare yourself by reviewing the common pitfalls.

I am an English-trained radiographer currently working in academia within the Republic of Ireland. Previously, I was a magistrate for 12 years in the United Kingdom where I presided over adult criminal court, and child and family court, hearing a variety of cases. Based on my experience, I know that the “chain of custody” – which will include your image capture and patient interactions – is often the weak link in a criminal case.

Keep in mind that in a criminal case, the burden of proof falls to the prosecution to prove “beyond all reasonable doubt.” I have seen firsthand how defense lawyers can create reasonable doubt around an event based on evidence. At times, the source of the event in question was the action of an unwitting radiology professional.

The role of radiology in forensics

The goal of a criminal investigation is to correctly interpret the facts, reconstruct the events, and understand what happened – often in the face of varying accounts of what took place. An important part of this is to establish an “evidential chain” or “chain of custody” that refers to the chronological and careful documentation of evidence to establish its connection to an alleged crime.

How does this apply to radiographers? As a radiographer or radiologic technologist, you might capture or review an image that is inconsistent with the age and ability of the child; or inconsistent with the history of injury. Injuries or fractures in various stages of healing; or spiral or metaphyseal fractures, could be cause for concern. Alternatively you may observe a bruise or other injury on the child – such as a belt or strap mark, or cigarette burn – that seems suspicious.

The evidence also could be an act that you observe. A child might shrink from a parent or caregiver, or display fear in his or her presence. My colleague witnessed a parent aggressively slamming a child against the X-ray chest stand.

Another possibility is a disclosure of abuse from the child or carer to the radiographer. This is a very delicate situation and one where an ill-informed rad tech can unwittingly destroy this critical evidence and contaminate the evidential chain or chain of custody. Remember that law professionals are trying to build up a picture of the child’s life – almost like a jigsaw puzzle – and you as radiographer might hold a critical piece.

Radiographers: What to do if you suspect criminal activity  

Imaging a child with a suspected non-accidental injury or physical abuse can be a very emotional event and bring up a series of emotions in the radiographer. However, it is crucial that the radiographer remains professional and does not act as “judge and jury”. It is important that the radiographer listens to the child and takes contemporaneous notes.

It is also important that the radiologic technologist does not question the child. Children need to be interviewed by trained specialists. A radiographer who starts to question the child can contaminate the chain of custody/ evidential chain. In addition this can start the clock ticking in terms of commencing the investigation, giving police less time to collect any evidence.

Another point to bear in mind is that, in a courtroom, the radiographer’s initial questioning of the child could be interpreted by the defense barrister as coaching. This is another possible way that a radiographer could contaminate the evidence.

examples of marks from instruments a radiographer may see - belt buckle, belt, looped cord, stick/whip, fly swatter, coat hanger, board or spatula, hand/knuckles, bite marks, saucepan, paddles, hairbrush, spoon
The source of injuries are not always obvious. In the image above, the unmarked image in the first row is indicative of being hit with a looped cord. In the third row, the unidentified image on the left is the result of a bite mark, and the injury on the right is caused by a hair brush.
Image Credit: Cole Dempsey

If you see a suspicious injury on a child – or if a child offers that someone has hurt them – never ask “who” caused the injury. For example, never pose the question, “did your mother or father do this to you?”  If you do this, you will have contaminated the evidential chain. A defense attorney will propose that you coached the child – introducing the element of “doubt” into the evidence presented.

Instead ask, “how did this happen?” It is important to let a child speak freely and to believe him or her if they share information about possible abuse.

Thorough note keeping is essential in forensic radiology

Within a very short time of the disclosure – immediately is ideal – record the conversation in as much detail as possible. Your notes may well become your witness statement in a court of law.

Use the child’s exact wording when writing your notes. If the child swore, use those words. Also record your observations – without interpretation. For example, do not say, “the child was upset.” Instead, write down what you observed. For example, “the child was crying.”

After completing your notes, sign and date them.  Contact the referring clinician with your suspicions. If they are not available, contact the A&E department.

Ideally, your notes should be signed by another healthcare professional who can act as a witness to the events. The witness should not be someone who reports to you, nor a student. In this case, an astute barrister may raise the possibility of the power imbalance between the professional and the student, and suggest implications of it on the witness statement.

Pass on your notes as soon as possible to a fellow clinician who is also treating the child, and/or a social worker.

I stress to rad techs the importance of capturing your observations as soon as possible because a lapse in time is another area where a defense lawyer can introduce the possibility of doubt. If you see other patients before you write your notes, or go a long period of work without eating or without adequate sleep, the barrister may pose the prospect that your memory was clouded and not reliable at the time you finally recorded your observations. 

Common pitfalls that weaken the forensic imaging chain of evidence

It is crucial to demonstrate “traceability” and “continuity” of the evidence from the time it is collected at the crime scene to its presentation in the courtroom. In our example, the “crime scene” is your X-ray imaging room.

If the chain of custody is not properly maintained, the value of the evidence can be challenged or even disregarded. This is why the chain of custody is often called the weak link in a criminal investigation.

Here are some common pitfalls that can weaken the evidence brought before a court:

  • A non-specialized interviewer questioning the child in a leading way
  • Not listening to what the child has to say; and interpreting events
  • Not realizing what is evidence, and therefore not managing it properly
  • Poor documentation of the events and your observations
  • Adding your interpretation of the facts to your witness statement
  • Delay in documenting the incident
  • Multiple people handling the evidence with no clear traceability
  • Lost material images, notes, or witness accounts
  • Delay in passing on the material

Radiographers have moral and ethical obligation – and possibly a legal one

Identifying cases of neglect or abuse is often the result of multiple pieces of information coming together. These can include observations by numerous people such as a teacher or neighbor, as well as radiographers, nurses or physicians. Without your piece of the puzzle, the abuse might not come to light.

A tragic example is the case of Victoria Climbie who died at 8 years old in 2000 in London after years of sustained abuse. An investigation revealed 14 missed opportunities for social workers, healthcare providers, and others to have intervened if they had properly recorded and shared evidence of the abuse.

The strongest message I want to convey to you is never ever do nothing. Radiographers, radiologic technologists, and radiologists have a moral and ethical obligation to document and report suspicions of neglect or abuse. And in some countries, like the Republic of Ireland, this is also a legal responsibility.

In Ireland, there is an offense of “reckless endangerment” that requires “a person with authority or control over a child or over an abuser not to intentionally or recklessly endanger the child by leaving or placing them in a situation of substantial risk of serious harm or sexual abuse.” A person guilty of an offense under this section is subject to a fine or to imprisonment for a term not exceeding 10 years, or both.

Understand your potential role in a forensic examination

I hope this information has helped you understand the potential role you might play in a forensic examination. Radiographers are not here to be judge nor jury. Our role is to image the child to help answer a specific clinical question and/or produce evidence – such as your observations when interacting with a child – for an investigation. By acting with integrity, care, and professionalism throughout a forensic examination, you can help ensure that the information you observe and record can be admissible for court purposes.

Resources:
  • Child Protection Issues, Professional Responsibilities: An International Perspective
  • 6 Mar 2014European Congress of Radiology 2014
  • Is Child Protection Within The Clinical Environment The Sole Responsibility of the Clinician? 1 Dec 2014 Radiography Ireland18(5):2-5
  • A Study to Investigate the Ability of A&E Nurses in Pediatric Hospital to Detect Markers of Non-Accidental Injury in Children 1 Jan 2011180:6
  • Forensic Radiography and Non Accidental Injuries in Children; 1 May 2012Radiollogi Bilten29(1):29-32
  • Blog: How to Become a Forensic Imaging Technologist

Michaela Davis, PhD, Msc, Bsc (Hons), Cert Ed,  DCR (R ), is a Diagnostic Radiographer by profession and now works as an Assistant Professor within the Republic of Ireland. She is also a Winston Churchill Research Fellow. Dr. Davis delivered a presentation on this topic at ECR 2019.

Read the blog on Pediatric Imaging Techniques.

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