Visualization and material-based differentiation of lodged projectiles by extended CT scale and the dual-energy index

Computed tomography (CT) scans of gunshot wounds and their high sensitivity in detecting osseous lesions has often been reported in the literature. However, studies concerning in situ examinations of lodged projectiles with CT to determine the ammunition used are lacking. Projectile visualizations are hampered in standard CT due to the presence of metal artifacts and the limited range of Hounsfield units (HU). The use of special reconstruction algorithms can overcome these limitations. For instance, using extended CT scale (ECTS) reconstruction supports detailed visualizations of metallic objects. In addition to projectile visualizations, X-ray attenuation measurements (CT numbers) of metallic objects can be used to differentiate materials in CT. This study uses real forensic cases to demonstrate that-depending on the degree of deformation-a detailed visualization of lodged projectiles using ECTS can provide useful information regarding the ammunition used and allows accurate caliber measurements. Independent from the degree of deformation, the in situ classification of bullets, even fragmented bullets, according to their metallic components is feasible by dual-energy index (DEI) calculations. The assessment of a lodged projectile with CT images provides useful information on the case; thus, a close examination of lodged projectiles or bullet fragments should be a part of the overall radiological examination for cases of penetrating gunshot wounds.