Impact of discrepancies in radiological interpretation on forensic report outcomes: A retrospective study

In the evaluation of forensic cases, misinterpretations of radiological imaging can directly affect not only patients' diagnostic and therapeutic processes but also judicial proceedings. This retrospective study aimed to investigate the impact of radiological re-evaluations on forensic report outcomes.

Between July 2023 and March 2025, a total of 365 forensic cases that underwent radiological evaluation were retrospectively reviewed. For radiological examinations performed in the emergency department (plain radiography or computed tomography), interpretations made by our radiology specialist and the corresponding forensic reports were reviewed retrospectively. X-ray images requested in the emergency department that lacked a radiologist report and were evaluated by emergency physicians were subsequently interpreted by our radiology specialist; this cohort was defined as an "X-ray interpretation" group. Computed tomography (CT) images requested in the emergency department that were initially reported via teleradiology were subsequently reinterpreted by our radiology specialist; this cohort was defined as the "CT interpretation" group.

Following interpretations performed by our radiologist, changes in the conclusion section of forensic reports were observed in 35.3% of cases. The rate of changes in forensic report conclusions was statistically significantly higher in the "CT interpretation" group (47.8%) than in the "X-ray interpretation" group (34.2%). The likelihood of modifications in forensic report outcomes was significantly greater in cases involving three or more injury sites. The most frequent cause of error was the misinterpretation of bone fractures (84.5%), predominantly affecting the craniofacial and upper extremity regions. In fracture assessment, false-positive findings were more commonly identified on plain radiographs (73.8%), whereas false-negative findings were more frequently encountered on computed tomography scans (59.5%).

These findings demonstrate that radiological misinterpretations, particularly in the assessment of bone fractures, can significantly influence forensic report outcomes and, consequently, judicial processes. This study underscores the necessity of involving trauma-experienced radiologists in forensic imaging and highlights the importance of effective interdisciplinary collaboration between radiology and forensic medicine.