A Diagnostic Algorithm for Reconstructing the Direction of Gunshots Using OsiriX and Maya in Living Patients: A...

Background/Objectives: Gunshot wounds in living patients present significant challenges from both a clinical and a forensic perspective. Understanding the exact trajectory of a bullet is crucial not only for guiding treatment but also for providing reliable documentation in legal settings. This work introduces a practical diagnostic workflow that combines OsiriX (V. 14.1.1), a DICOM viewer with advanced 3D tools, with Autodesk Maya, a modeling platform used to recreate the external shooting scene. Methods: CT scans obtained with multidetector systems were analyzed in OsiriX using a structured, seven-step process that included multiplanar reconstructions, 3D renderings, and region-of-interest tracking. The reconstructed trajectories were then exported to Maya, where they were integrated into a virtual model of the shooting scene to correlate internal findings with the incident's external dynamics. Results: The workflow allowed precise identification of entry and exit points, reliable reconstruction of bullet paths, and effective 3D visualization. While OsiriX provided detailed information for clinical and radiological purposes, the use of Maya enabled simulation of the external scene, improving forensic interpretation and courtroom presentation. The procedure proved reproducible across cases and compatible with emergency timelines. Conclusions: The combined use of OsiriX and Maya offers a reproducible and informative method for analyzing gunshot wounds in living patients. This approach not only supports surgical and diagnostic decisions but also enhances the forensic value of radiological data by linking internal trajectories to external shooting dynamics. Its integration into trauma imaging protocols and forensic workflows could represent a significant step toward standardized ballistic documentation.