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Walking on thin ice! Identifying methamphetamine "drug mules" on digital plain radiography
S N Abdul Rashid1, S B Mohamad Saini, S Abdul Hamid
1Department of Radiology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia.
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.
Insights
Digital radiography (DR) is a useful tool for detecting methamphetamine (MA) internal payloads in drug mules, though it has limitations. Further training and cross-sectional imaging like CT can improve diagnostic accuracy for these cases.
Area of Science:
- Radiology
- Forensic Imaging
- Toxicology
Background:
- Internal concealment of drugs, particularly methamphetamine (MA), poses significant challenges in forensic medicine.
- Plain abdominal digital radiography (DR) is a common initial imaging modality for suspected drug mules.
Purpose of the Study:
- To retrospectively evaluate the sensitivity, specificity, and accuracy of plain abdominal digital radiography (DR) in identifying internal methamphetamine payloads in individuals.
- To assess the impact of reader experience on the diagnostic performance of DR for detecting drug packets.
Main Methods:
- Retrospective analysis of 59 supine digital radiographs from 35 individuals suspected of carrying internal MA drug containers.
- Evaluation of diagnostic accuracy, radiological appearance of drug packs, clearance rates, and complications.
- Comparison of performance between experienced and inexperienced readers, with fecal drug pack recovery serving as the gold standard.
Main Results:
- Experienced readers (Group 1) achieved 100% sensitivity, 76.3% specificity, and 87.2% accuracy. Inexperienced readers (Group 2) showed 93.7% sensitivity, 86% specificity, and 89.5% accuracy.
- Interrater agreement was fair to very good (0.72-0.79).
- DR identified specific signs (double-condom and halo signs) but was associated with diagnostic insecurity and underreporting of the total internal payload.
Conclusions:
- Plain abdominal DR is a valuable screening tool for methamphetamine body packers, despite limitations in diagnostic certainty.
- Low-dose CT and enhanced radiological education are recommended to improve the detection and reporting of internal drug payloads.
- Specific radiographic signs exist, but overall diagnostic insecurity necessitates further investigation with cross-sectional imaging.
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