1
|
Puntonet J, Gorgiard C, Soussy N, Soyer P, Dion E. Body packing, body stuffing and body pushing: Characteristics and pitfalls on low-dose CT. Clin Imaging 2021; 79:244-250. [PMID: 34139609 DOI: 10.1016/j.clinimag.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/01/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Because of availability and low radiation dose level, low dose computed tomography (CT) is now commonly used to identify illicit in corpore drug transportation. This review illustrates the most common CT findings of in corpore drug transportation and describes complications due to in corpore drug transportation, with a special emphasis on low dose CT. Major information such as number of packets, exact location and aspect of packets must be assessed. Radiologist must be aware of the imaging characteristics of "in corpore" illicit drug transportation, and should know situations that may alter drug smugglers management.
Collapse
Affiliation(s)
- Julien Puntonet
- Department of Radiology - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, F-75006 Paris, France.
| | - Charlotte Gorgiard
- Université de Paris, F-75006 Paris, France; Medicolegal Department - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, 75001 Paris, France
| | - Nicolas Soussy
- Université de Paris, F-75006 Paris, France; Medicolegal Department - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, 75001 Paris, France
| | - Philippe Soyer
- Université de Paris, F-75006 Paris, France; Department of Radiology- Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France
| | - Elisabeth Dion
- Department of Radiology - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, F-75006 Paris, France
| |
Collapse
|
2
|
Aissa J, Bölke E, Sawicki LM, Appel E, Thomas C, Heusch P, Sedlmair M, Krzymyk K, Kröpil P, Antoch G, Boos J. Noise insertion in CT for cocaine body packing: where is the limit of extensive dose reduction? Eur J Med Res 2018; 23:59. [PMID: 30526681 PMCID: PMC6284291 DOI: 10.1186/s40001-018-0356-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/29/2018] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate the detection rate and image quality in CT-body-packer-screening at different radiation-dose levels and to determine a dose threshold that enables a reliable detection of incorporated body packs and incidental findings with a maximum of dose saving. Materials and methods We retrospectively included 27 individuals who underwent an abdominal CT with automated exposure control due to suspected body packing. CT images were reconstructed at different radiation-dose levels of 50%, 10, 5% and 1% using iterative reconstructions. All 135 CT reconstructions were evaluated by three independent readers. Reviewers determined the presence of foreign bodies and evaluated the image quality using a 5-point ranking scale. In addition, visualization of incidental findings was assessed. Results A threshold of 5% (effective dose 0.11 ± 0.07 mSv) was necessary to correctly identify all 27 patients with suspected body packing. Extensive noise insertion to a dose level of 1% (0.02 ± 0.01 mSV) led to false-positive solid cocaine findings in three patients. Image quality was comparable between 100 and 50%. The threshold for correct identification of incidental findings was 10% of the initial dose (effective dose 0.21 ± 0.13 mSv). Conclusions Our results indicate that dose of abdominal CT for the detection of intracorporeal cocaine body packets can be markedly reduced to up to 5% of the initial dose while still providing sufficient image quality to detect ingested body packets. However, a minimum effective dose of 0.21 mSv (10% of initial dose) seems to be required to properly identify incidental findings.
Collapse
Affiliation(s)
- Joel Aissa
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Elisabeth Appel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Christoph Thomas
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Philipp Heusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Martin Sedlmair
- Computed Tomography, Siemens Healthineers GmbH, Forchheim, Germany
| | - Karl Krzymyk
- Computed Tomography, Siemens Healthineers GmbH, Forchheim, Germany
| | - Patric Kröpil
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.,Department of Radiology, BG Klinikum Duisburg gGmbH, 47249, Duisburg, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Johannes Boos
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| |
Collapse
|
3
|
Gohmann RF, Heckner F, Uschner D, Katharina Kuhl C, Daniel Reinartz S. Body Pushers: Low-Dose CT, Always the Best Choice? A Study of the Diagnostic Performance of CT Scout View. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojrad.2017.72013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
4
|
Systematic Evaluation of Radiation Dose Reduction in CT Studies of Body Packers: Accuracy Down to Submillisievert Levels. AJR Am J Roentgenol 2016; 206:740-6. [PMID: 26866340 DOI: 10.2214/ajr.15.15374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to systematically evaluate the accuracy of abdominal CT performed at different radiation dose levels for the detection of body packs in human cadavers, in comparison with the accuracy of abdominal radiography. MATERIALS AND METHODS In this study, differing numbers of body packs (range, 0-20) were placed in the alimentary tract of human cadavers and then underwent imaging with abdominal radiography and with CT performed at different radiation dose levels (ranging from the standard abdominal CT dose to the technical minimum dose). Depiction of body packs on abdominal radiographs and on each CT scan was assessed by two independent blinded radiologists, and the accuracy of detection of body packs was calculated. The radiation dose associated with abdominal radiography was measured, and the effective radiation dose associated with CT was estimated. RESULTS The mean (± SD) effective radiation dose for abdominal radiography was 1.4 ± 0.3 mSv, whereas the mean effective dose of CT ranged from 0.1 to 9.6 mSv. Interobserver agreement for body pack detection was moderate (κ = 0.51) for abdominal radiography and good (κ = 0.72-0.85) for CT. In a per-body pack analysis, abdominal radiography depicted 42% of the body packs with a sensitivity of 71% and a specificity of 100%. When performed at radiation dose levels of 0.6 mSv or greater, CT correctly detected all body packs. In per-person analysis, the sensitivity and specificity of CT for the correct detection of at least one body pack per cadaver was 100% for all radiation dose levels. CONCLUSION CT performed at a dose of 0.6 mSv can be used for the detection of body packs. With a sensitivity and specificity of 100%, CT is superior to abdominal radiography in terms of reliability, associated radiation dose, and accuracy of detection.
Collapse
|
5
|
Low-tube voltage 100 kVp MDCT in screening of cocaine body packing: image quality and radiation dose compared to 120 kVp MDCT. ACTA ACUST UNITED AC 2015; 40:2152-8. [DOI: 10.1007/s00261-015-0464-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Laberke PJ, Fornaro J, Kim SK, Blum S, Augsburger M, Alkadhi H, Wildermuth S, Hausmann R, Leschka S. Dual-energy CT behavior of heroin, cocaine, and typical adulterants. Forensic Sci Med Pathol 2015; 11:20-8. [PMID: 25566768 DOI: 10.1007/s12024-014-9643-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the dual-energy CT behavior of cocaine and heroin and of typical adulterants, and to evaluate the elemental composition of pure cocaine and heroin compared with cocaine and heroin in bodypacks. METHODS Pure heroin and pure synthetic cocaine samples, eight different adulterants, and in each case ten different bodypacks containing cocaine or heroin, were imaged at 80, 100, 120, and 140 kVp in a dual source CT system at two different degrees of compression. Two radiologists, blinded to the samples, measured the attenuation. The dual-energy index (DEI) was calculated. We performed atomic mass spectrometry for the elemental analysis of pure cocaine, pure heroin, and heroin and cocaine in bodypacks, and 140 kVp in a dual-source CT system. RESULTS Inter- and intra-observer agreement for attenuation measurements was good (r = 0.61-0.72; p < 0.01). The cocaine bodypacks had a positive DEI of 0.029, while the pure drugs and the heroin bodypacks had a negative DEI (-0.051 to -0.027). Levamisole was the only substance which expressed a positive DEI of 0.011, while the remaining adulterants had negative DEIs ranging between -0.015 and -0.215. Atomic mass spectrometry revealed a concentration of tin in the cocaine bodypack that was 67 times higher than in the pure synthetic cocaine sample. CONCLUSIONS The different DEIs of bodypacks containing cocaine and heroin allow them to be distinguished with dual-energy CT. Although the material properties of pure cocaine, pure heroin, or common drug extenders do not explain the differences in DEI, tin contamination during illicit natural cocaine production may be a possible explanation.
Collapse
Affiliation(s)
- Patrick J Laberke
- Institute of Legal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland,
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Body packers on your examination table: How helpful are plain x-ray images? A definitive low-dose CT protocol as a diagnosis tool for body packers. Clin Radiol 2014; 69:e525-30. [DOI: 10.1016/j.crad.2014.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022]
|
8
|
Grimm J, Wudy R, Ziegeler E, Wirth S, Uhl M, Reiser MF, Scherr M. Differentiation of heroin and cocaine using dual-energy CT—an experimental study. Int J Legal Med 2014; 128:475-82. [DOI: 10.1007/s00414-014-0980-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/13/2014] [Indexed: 01/08/2023]
|
9
|
Abdul Rashid SN, Mohamad Saini SB, Abdul Hamid S, Muhammad SJ, Mahmud R, Thali MJ, Flach PM. Walking on thin ice! Identifying methamphetamine "drug mules" on digital plain radiography. Br J Radiol 2014; 87:20130472. [PMID: 24472728 DOI: 10.1259/bjr.20130472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the sensitivity, specificity and accuracy of identifying methamphetamine (MA) internal payloads in "drug mules" by plain abdominal digital radiography (DR). METHODS The study consisted of 35 individuals suspected of internal MA drug containers. A total of 59 supine digital radiographs were collected. An overall calculation regarding the diagnostic accuracy for all "drug mules" and a specific evaluation concerning the radiological appearance of drug packs as well as the rate of clearance and complications in correlation with the reader's experience were performed. The gold standard was the presence of secured drug packs in the faeces. RESULTS There were 16 true-positive "drug mules" identified. DR of all drug carriers for Group 1 (forensic imaging experienced readers, n = 2) exhibited a sensitivity of 100%, a mean specificity of 76.3%, positive predictive value (PPV) of 78.5%, negative predictive value (NPV) of 100% and a mean accuracy 87.2%. Group 2 (inexperienced readers, n = 3) showed a lower sensitivity (93.7%), a mean specificity of 86%, a PPV of 86.5%, an NPV of 94.1% and a mean accuracy of 89.5%. The interrater agreement within Group 1 was 0.72 and within Group 2 averaged to 0.79, indicating a fair to very good agreement. CONCLUSION DR is a valuable screening tool in cases of MA body packers with huge internal payloads being associated with a high diagnostic insecurity. Diagnostic insecurity on plain films may be overcome by low-dose CT as a cross-sectional imaging modality and addressed by improved radiological education in reporting drug carriers on imaging. ADVANCES IN KNOWLEDGE Diagnostic signs (double-condom and halo signs) on digital plain radiography are specific in MA "drug mules", although DR is associated with high diagnostic insecurity and underreports the total internal payload.
Collapse
Affiliation(s)
- S N Abdul Rashid
- Department of Radiology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | | | | | | | | | | | | |
Collapse
|
10
|
Scherr MK, Peschel O, Grimm JM, Ziegeler E, Uhl M, Geyer LL, Reiser MF, Wirth S. Low-dose CT in body-packers: delineation of body packs and radiation dose in a porcine model. Forensic Sci Med Pathol 2014; 10:170-8. [PMID: 24443143 DOI: 10.1007/s12024-013-9522-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare low-dose computed tomography (CT) with standard CT and conventional radiography (CR) regarding delineation of body packs and radiation dose. METHODS Nine samples of illicit drugs including cocaine, heroin, and hashish were positioned in the rectum of a 121.5 kg pig cadaver. Each sample was scanned on a 64-row MDCT with 120 kV: one standard modulated pelvic protocol (STD), and without modulation at 80 mA (LD80), 30 mA (LD30), and 10 mA (LD10). Additionally, conventional abdominal anterior-posterior radiographs (77 kV and 106 ± 13 mA) were taken. Body pack characteristics (wrapping, content, shape) were rated independently by two radiologists and summarized to a delineation score from 0 to 9 with scores ≥6 representing sufficient delineation. Mean delineation scores were calculated for CR and CT protocols. These were additionally differentiated for readings in soft tissue (S), lung (L), user defined, variable window settings (V), and in cumulative window evaluation including all the other window settings (SLV). Effective doses were calculated (mSv). RESULTS The CR delineation score was insufficient (3.1 ± 2.5; 2.4 ± 0.3 mSv). For CT, the SLV window setting performed best (p < 0.01). Its score significantly (p < 0.01) declined with decreasing effective radiation doses: STD (8.8 ± 0.5; 10.6 mSv), LD80 (8.2 ± 0.7; 2.6 mSv), LD30 (6.8 ± 1.3; 1.0 mSv), and LD10 (4.6 ± 1.9; 0.3 mSv). Thus, LD30 was the protocol using the lowest but sufficient dose. Moreover, for LD30 further differentiation between the particular window settings resulted in scores of 6.4 ± 1.3 (L), 6.3 ± 1.2 (V), and 3.1 ± 1.0 (S). CONCLUSIONS With appropriate window settings, low-dose CT at 30 mA allowed for sufficient body-pack delineation below the dose of CR, which itself performed insufficient.
Collapse
Affiliation(s)
- Michael K Scherr
- Department of Clinical Radiology, Ludwig-Maximilians-University Munich, Nussbaumstreet 20, 80336, Munich, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
11
|
[Legal considerations regarding radiological examinations of bodypackers ordered by police officers]. Unfallchirurg 2013; 116:92-4. [PMID: 23325160 DOI: 10.1007/s00113-012-2285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 28-year-old woman was arrested for body packing. One pack was removed from her vagina by the forensic pathologist. She was referred by the police to an emergency surgical department to obtain a radiological examination of the abdomen in order to rule out the presence of further packs in the intestines. In the case of a negative result it would not be necessary to be kept under arrest. For this reason the woman agrees to the examination. The surgeon in the emergency department refused to perform an examination involving radiation exposure to a young woman without any medical indications according to the German X-Ray Ordinance § 23 subsection I. Generally a physician can refuse to perform examinations ordered by state authorities; however, the provision of expert testimony in legal proceedings by a judge, a state attorney or a high ranking police officer makes collaboration mandatory in accordance with § 75 of the German penal code of procedures. However, any relevant harm caused by the examination must be excluded with a very high degree of certainty.
Collapse
|
12
|
Ziegeler E, Grimm JM, Wirth S, Uhl M, Reiser MF, Scherr MK. Computed tomography scout views vs. conventional radiography in body-packers - delineation of body-packs and radiation dose in a porcine model. Eur J Radiol 2012; 81:3883-9. [PMID: 23017196 DOI: 10.1016/j.ejrad.2012.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/22/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare abdominal computed tomography (CT) scout views with conventional radiography regarding radiation dose and delineation of drug packages in a porcine body-packer model. MATERIALS AND METHODS Nine samples of illicit drugs packed in ovoid plastic containers were consecutively placed in the rectum of a 121.5 kg pig cadaver. Antero-posterior and lateral scout views were obtained at 120 kVp and 80 mA, 150 mA and 200 mA, respectively, using a 64-row MDCT. Scout views were compared with conventional abdominal antero-posterior radiographs (77 kV and 106 ± 13 mAs). Visibility of three body pack characteristics (wrapping, content, shape) was rated independently by two radiologists and summarized to a delineation score ranging from 0 to 9 with a score ≥ 6 representing sufficient delineation. Mean delineation scores were calculated for each conventional radiography and single plane scout view separately and for a combined rating of antero-posterior and lateral scout views. RESULTS Even the lowest single plane scout view delineation score (5.3 ± 2.0 for 80 mA lateral; 0.4 mSv; sensitivity=44%) was significantly higher than for conventional radiographs (3.1 ± 2.5, p<0.001; 2.4 ± 0.3 mSv; sensitivity=11%). Combined reading of antero-posterior and lateral scout views 80 mA yielded sufficient delineation (6.2 ± 1.4; 0.8 mSv; sensitivity=56%). CONCLUSIONS All CT scout views showed significantly better delineation ratings and sensitivity than conventional radiographs. Scout views in two planes at 80 mA provided a sufficient level of delineation and a sensitivity five times higher than conventional radiography at less than one third of the radiation dose. In case of diagnostic insecurity, CT can be performed without additional logistical effort.
Collapse
Affiliation(s)
- Edvard Ziegeler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstraße 20, 80336 Munich, Germany.
| | | | | | | | | | | |
Collapse
|