Abstract
The present research aims to analyze and reflect upon the evolution of Legal Radiological Sciences, with focus on the synergic interaction between Forensic Radiology and the Judicial System, discussing the inherent tension regarding the radiological technique application and the necessity of linguistic description and enlightenment adequate to the Judicial scope.
Keywords: Medicine, Law, Language, Legal Radiological Sciences, Medical Radiology, Judicial Science
1. Introduction
The first scientific interactions between radiology and court-related matters were limited to image production for identifying foreign bodies, without comprehending the elaboration of complex radiological reports. Initially, medical applications did not have such terminology, despite its implicit existence. The term “forensic”, used as justification for the inclusion of radiological sciences as important Legal Medicine allies, restricted the reflections upon the being, the way of being, and the Forensic Radiology means of production [1].
Part of this essential tension intensified when medical radiology was established as a specialty dedicated to research, reflection, and application of ionizing and non-ionizing radiations for medical treatment diagnosis through images. However, in 1985 Medical Radiology became administratively and theoretically ramified regarding methodology. Currently, radiological technique professionals operate this equipment [1].
In the theoretical texts, an administrative layer has been notably formed by reflex of medical models (article 12 in Law 7.394, from 1985), from 1950 with the enactment of Law number 1.234, from the same year. However, it lacked both technical development and investment in research and extension, resulting in an absence of relevance in the study of language, contrasting to what occurred in Law or Medicine studies. In other words, the mere operation of radiological techniques, without the due abstraction of the limits of symptom figurations in the potential clinical diagnoses - an essential factor for the complete validation of methodological ramifications - solely undervalues the technique [1].
The tension between technique and the necessity, yet political, for describing and clarifying the meaning of words has become the emergent paradigm. On the one hand, there is medical knowledge, which contains a complex, objective, and abstract linguist reflection upon its procedures. On the other hand, Law, which has several disciplines focused on the meaning of the words, such as judicial semiotics and philosophy, through language, for being a social memory in the affirmation of collective will. The third element in this tension is philosophy itself, with linguistic and subjective universes, expressed through words. Such elements justify the necessity of rupture with the dominant paradigms, considering the apparent structural, epistemological, and methodological emptying, on behalf of the emergent paradigm adequately named Legal Radiological Sciences [1].
2. Legal Radiological Science Aspects
2.1 Historical Aspects
The birth of Forensic Radiology is directly connected to the X-ray discovery by the German physicist Wilhelm Conrad Röntgen (1845-1923), in 1895. After experiments with the vacuum tube, Röntgen discovered that a paper containing barium platinocyanide became fluorescent when exposed to the rays originating from the ampoule. In 1896, one year after his discovery, there was a crime in the United States in which X-ray was essential. The radiological examination of the victim’s jaw, killed by a firearm, revealed the authorship of the murder due to the presence of the lead projectile in the exposed bone structure [2].
Before this event, Brogdon (1998) and Brecher (1969) report that the interaction between Forensic Radiology and Justice also occurred in Montreal, Canada, three days before Röntgen’s correspondence to the scientific society of Würzburg. The report:
George Holder fired his gun against the leg of Tolson Cunning. Several attempts were made to locate the projectile, but all resulted in misfortunes. The wound was healed, but Mr. Cunning persisted with the symptomatology. By request of the victim’s doctor, a Physics professor from McGill University, James Cox, performed radiography in the extremity of the wound. The complete material was made available at a Physics amphitheater, and, after 45 minutes of exposure, the “photography” showed a flattened projectile, “enclosed” between the tibia and the fibula. Tolson Cunning then underwent surgical intervention.
The X-ray discovery was a milestone in modern medicine, providing significant advances and avoiding unnecessary mutilations. Marie Curie and her daughter Irene Joliot-Curie were pioneers in the use of mobile X-rays in the war field, contributing to mutilation avoidance. Nevertheless, the numerous accidents and deaths related to irresponsible exposure to X-rays propelled research on the effects of radiation on the matter. At first, radiological examinations were considered “supernatural manifestations” [3, 4].
Several intellectuals from various fields of human knowledge became interested in the discoveries, among them Dr. Fovau D’Courmelles, director of the American X-ray Journal at the time, who stated that the capability of identifying fractures in burned or mutilated people, in addition to visual recognition, allowed to discover their identity through X-rays. In courts, however, most magistrates demonstrated skepticism towards radiological examinations, arguing that: “It is as if they offered us the picture of a ghost” [5, 6, 7].
In Brazil, there is no consensus about the first researchers to perform radiological examinations, since they worked concomitantly. Therefore, it is practically impossible to precisely determine which scientist inaugurated the method in the country. Reports range from Dr. Alfredo Brito, from Bahia, including Dr. Silvia Ramos, from São Paulo, to Dr. Francisco Pereira Neves, from Rio de Janeiro [7, 8, 9].
It is important to highlight that the first radiological equipment in Brazil was imported by doctor Carlos Pereira Pires at the end of the nineteenth century. At this time, the lack of electric energy and medical technologies complicated the analysis and examination quality. In 1897, during the War of Canudos in Brazil (November 1896 - October 1897), doctor and professor Alfredo Brito performed radiological examinations on the battlefield, locating firearm projectiles in the wounded. Around 98 radiography and radioscopies were performed in this period [5, 10, 11].
It is also vitally important to reinforce that the nineteenth-century cosmovision regarding radiology, although it is considered a science nowadays, did not have a consolidated application in Criminal Sciences. The evolution of Forensic Radiology in Brazil not only followed the technological and scientific development in medicine but also and above all, in Legal Medicine [8, 9, 11].
The first work on Legal Medicine, attributed to Gonçalves Gomide by Oscar Freire and Flamínio Fávero, in 1814, is noteworthy. At this time, two scientific centers arose in Brazil, in Bahia and Rio de Janeiro. In Bahia, the Medical Legal School was founded, which included the intellectuals Raimundo Nina Rodrigues (1894-1906), Estácio de Lima (full professor in 1965), and Oscar Freire de Carvalho (professor from 1914 to 1923). In Rio de Janeiro, there were the illustrious professors Ferreira de Abreu, Afrânio Peixoto, and Tenner de Abreu. Therefore, the development of Criminal Sciences follows the advancement of crime execution methods, which explains the institutionalization and officialization of criminal expertise in Brazil [7].
Especially in the twentieth century, Brazilian radiology experienced a transformation due to the arrival of various Brazilian doctors and scientists coming from Europe, bringing new research, methods, and equipment. The apex of this development occurred with the discovery of the new abreugraphy method, developed by the doctor Manuel Dias de Abreu (1894-1962) - indicated to the Nobel Prize of Medical Physiology in 1946. This method was used for detecting tuberculosis victims through chest X-rays. By the end of the 1940s, there were the first initiatives for the institutionalization and regulation of the activity performed by radiological technique professionals, aiming to better respond to governmental specificities regarding the use of radiation on human beings, and also to grant complete education to such professionals. The first course created with this end was at Hospital das Clínicas, in São Paulo, in March 1951. During the course, the government issued the first legislation of the area, law number 1.234/50 [10].
Only 55 years later, on October 29, 1985, Law 7.394/85 is issued, originating from bill number 317/1975, by deputy Gomes de Amaral and with great contribution from Mr. Jair Pereira, then president of the Association of Radiology Technicians of Goiás State (ATREGO) and vice president of the Federation of the Associations of Radiology Technicians in Brazil (FATREB)[11].
The Decree SVS/MS number 453, from June 1, 1998, deals with the approval of technical regulation that establishes the Basic Guidelines for Radiological Protection in Medical and Dental Radiodiagnosis, establishing the guidelines for X-ray diagnosis all over the country. In 2019, with the necessity for improvement in radiological protection, following technological evolution and replacing the mentioned Decree, the RDC3 number 330 was formulated and issued by the Ministry of Health, the National Agency of Sanitary Vigilance, and the Collegiate Directorate. Subsequently, it was revoked by RDC number 611 in 2022, which establishes the sanitary requirements for the organization and the functioning of diagnostic or interventionist radiological services and regulates the control over medical, occupational, and public exposure as a result of the use of diagnostic or interventionist radiological technologies.
Currently, Legal Radiology does not have indoctrination in the Brazilian judicial system, not even in judicial systems related to the Councils that regulate both medical specialties and professional practice of technicians and technologists in radiology. In a way, this conceptual absence justifies the present text and, in other aspects, eventually hinders its application in the practical and theoretical fields, making it necessary to establish, before whatever reflections, the disciplinary and theoretical-practical limits of Legal Radiology education in Brazil.
From the conceptual point of view, Legal Radiology can be defined as the branch of Medical Radiology specialty that proposes establishing new knowledge about the understanding, legitimation, superimposition, and application of radiological-judicial knowledge over the phenomena composed in the judicial, social, philosophical, cultural and technical fields, which, in turn, surpass the scientific legitimacy scope of Medical Radiology itself.
2.2 Ontological Aspects
The suffix that composes the term, when applied in combination with each big field of knowledge, indicates the intention of this discipline in establishing new knowledge, with its innovative methodology, subspecializing the objects contained in the main trunk. Legal Medicine and Legal Odontology are good examples. In this case, the suffix legal indicates that the development of scientific objects obeys judicial questioning, without harming essential points in the primary branches. Nevertheless, the term forensic intends to prove something to someone simply by making it public, not being conceptually adequate to comprehend every problem presented in this text.
Figure 1 - Composition of the suffixes forensic and legal.
If we use an extended application of the suffix legal, we will start reflecting upon the knowledge already established in Medical Radiology, although under forensic, judicial, and social perspectives, even if some general terminology could be comparable to Legal Medicine.
Brogdon, B. G. (2011) does not define Legal Radiology, only Forensic Radiology, understanding it as “the medical specialty of applied radiology to help respond to questions that arise in the Law field”, attributing its arousal not to the overcoming of scientific facts, but to the availability of high-cost equipment in pathological researches. Michael J. Thali, Richard Dirnhofer, and Peter Vock (2009) define Radiology through its investigation techniques, inaugurating the term Virtopsy, a hybrid word that combines the terms “virtual” and “autopsy”, denominating the combination derived from “autopsy” (autos - own) and opsomei, that is, to see with one’s own eyes.
The first division proposed for Legal Radiology is the disciplinary one, in which the main trunk is divided into three other branches: firstly, the forensic one, applying its techniques of radiodiagnosis in Medical, Veterinarian, Dental, and Industrial Radiology; secondly, Jucial Radiology, reflecting upon and operating normative constructions of ethical, administrative, civil, penal, occupational, social security, and environmental nature; lastly, Social Radiology, with inter and multidisciplinary composition, as occurs in the contact between religion and medicine [2].
It is important to note that the longer the distance of the analyzed object from its original branch, the more interdisciplinary its employed terms and multidisciplinary its employed methods will be, demanding the participation of other professionals for a legitimate observation of the object. Nonetheless, the analysis method remains the same: the forensic method.
Forensic Radiology is responsible for applying diagnosis techniques through medical images to essentially judicial phenomena. In short, it is the method of elaboration and analysis of evidence in the systematic and logical construction of forensic reports.
On the other hand, Judicial Radiology comprehends and transcends ethical, moral, bioethical, normative, and procedural knowledge that originates from superimpositions between the patients’ and the radiological and terminological professionals’ rights and duties.
Social Radiology, in turn, aims to reflect upon and analyze the religious, cultural, and artistic relations derived from the intersection between men and their geographical and social surroundings, as well as anatomopathological, epidemiological, historical, and paleontological matters, with direct or indirect interference in the application of radiological techniques.
Regardless of the Legal Radiology branch, the division by object is related to the interaction between individuals and surroundings or institutions. In other words, events subject to study that occur in the Social Radiology scenario are analyzed by the Forensic Radiology tools, and its conflicts are solved in Judicial Radiology, being limited to the interactions that fit in the attributive articles of Resolution number 02, from May 02, 2012, by National Council of Radiology Technicians (CONTER) [5].
It is also possible to categorize Legal Radiology into historical periods: The first historical period (1895-1985) that comprehends what we now understand as one of the big branches of Legal Radiology Sciences, is represented by the former Legal Radiology discipline, also confused with Legal Medicine, due to the absence of theoretical and professional ground, as demonstrated before. The referred period comprehends from 1895, the year of X-ray discovery as a medical application to the law promulgation of Medical Radiology Technicians, 1985. Although several Legal Medicine publications have been made during this period, Forensic Radiology, due to a certain intellectual “elite” that included journalists and magistrates, believed that X-rays were some sort of magic ritual.
The second period emerged with the subdivision of the medical radiology analysis method and the creation of a professional class. Even though there was a professional class in radiological techniques and their legitimacy in the operation of equipment that emits ionizing radiation, it still lacked to establish conceptual bases that would underlie clinical thought in the application of techniques comprehensively, independently from Legal Medicine knowledge. This perpetuated the confusion with the previous period.
The discipline of Legal Radiology begins after the promulgation of the radiology technicians law (1985) and intensifies in 2012 with Resolution number 02/2012 – CONTER for technologists, which in its first chapters recuperates the text from Law 7.394/85, but does not comprehend the remaining articles, hence demanding a combined reading. What applies to technicians also applies to technologists and vice-versa. The referred Resolution includes, in Article 3, Forensic Radiology as a radiodiagnosis branch, attributing to the technician the right to perform in the area, as well as the technologist [2].
Some initiatives from private educational institutions have played a significant role in the development of the profession in Brazil. The first one was the Forensic Radiology Course created by the Medical Radiology technologist Mr. Antônio Silvestre, in 1994, in partnership with Universidade da Bahia. The second one was the Forensic Radiology Course in the Permanent Education School in Hospital das Clínicas, in São Paulo, besides the graduate course in Image Diagnosis with a focus on Forensic Radiology, in Faculdade Logo, in Nova Goiânia, Goiás, Brazil.
In the public domain, there is Project PISA5- Image Platform in the Autopsy Room, in partnership with the Pathology Department of the Medical School from Universidade de São Paulo, the Radiology Institute from Hospital das Clínicas, and the Capital’s Death Verification Service. Equipped with Computed Tomography, Ultrasonography, Magnetical Resonance, and Virtangio equipment, under the supervision of Professor Doctor Paulo Hilário Nascimento Saldiva and Professor Doctor Cláudia da Costa Leite, and directed by Professor Doctor Maria Concepcion Gracia Otaduy. There is also the Forensic Radiology Department from the Medical Legal Institute of Belo Horizonte, Minas Gerais, headed by Mr. Leanderson de Sá, among other initiatives throughout the country and South America.
Although this historical division could have been distinct in Brazil and the world, it was not necessary, for, in both cases, the events developed simultaneously after Röntgen’s x-ray discovery in 1895.
2.3 Technical Aspects
Differently from other parts of the world, where terminological subdivisions occurred from Virtopsy or virtual autopsy modalities, forensic investigation techniques of Legal Radiological Sciences are divided into internal, external, and minimally invasive, using ionizing or non-ionizing radiation. This results in a non-exhaustive array of investigative radiological techniques.
The internal investigation techniques include antemortem or post-mortem radiography; antemortem or post-mortem computed tomography, with other applications such as computed microtomography, computed angiotomography (Virtangio), multi-energy (double energy), spectroscopy through magnetic resonance, volumetric inverse geometry and C-arm plan. Antemortem or post-mortem magnetic resonance is also present, with applications in magnetic microresonance, magnetic angioresonance, and spectroscopy through magnetic resonance. Furthermore, there is antemortem or post-mortem ultrasonography, and antemortem or post-mortem cintilography [1].
The external techniques include manual measurements, and photogrammetry, with applications in stereophotogrammetry and surface scanners through 3D laser.
The minimally invasive autopsy (MIA) techniques can be guided by ultrasonography, computed tomography, laparoscopy, or multimodal. We can also include oral autopsy and sanitary autopsy.
These techniques compose the set of investigation methods used in Legal Radiological Sciences, allowing the detailed analysis of forensic cases, both internally and externally, in a minimally invasive way, when possible.
Conclusion
Hitherto, it is possible to highlight two possible causes for the structural, epistemological, and ethical emptying. The first one is characterized as the “critique of indolent reason”, which criticizes a lazy, slow, and at the same time self-centered reason, due to the lack of manipulation in the conceptual universe and for not providing the students with minimal critical thinking. The second cause would be the devaluation of intersectional linguistic diversity. The insensitivity regarding such plurality may result in the discredit of fundamental expectations of Medicine and Law studies, questioning the legitimacy of the doctors’, lawyers’, judges’, or radiologists’ functions.
Paradoxically, it is within this perspective that judicial relations are vitiated that the transformation project arises as a “marginalized elite” delirium, creating the idea that detaining our wishing for change would be synonymous with being marginalized: marginalized judge, marginalized professor, marginalized lawyer marginalized doctor, marginalized student, and marginalized expert. These characters were marginalized in the sense of concentrating social interaction practices as grounds for their reflections.
References
[1] SILVA, W. L. O regime jurídico da radiologia legal. Dissertação (Mestrado em Direito Médico) — Universidade Santo Amaro, São Paulo, 2023. URI http://dspace.unisa.br/handle/123456789/2486.
[2] DA LUZ SILVA, W.; SIQUEIRA DIAS, R.; SILVESTRE FIGUEIREDO DOS SANTOS, A. Ciências Radiológicas Legais. RECISATEC - Revista Científica Saúde e Tecnologia - ISSN 2763-8405, [S. l.], v. 2, n. 10, p. e210182, 2022. Disponível em: https://recisatec.com.br/index.php/recisatec/article/view/182. Access in: 23 Mar. 2023.
[3] BROGDON, B. G. et al. Radiologia Forense. 1ª ed. Florida, EUA: Editora CRC Press LLC, 1998.
[4] THALI, Michael J.; DIRNHOFER, Richard; VOCK, Peter. Abordagem Virtopsy: Escaneamento e Reconstrução Óptica e Radiológica em Medicina Forense. 1ª ed. Florida, EUA: Editora CRC Press LLC, 2009. Disponível em: https://doi.org/10.1201/9780849381898.
[5] ALVES, B. M. C., Fortes, M. L., Fernandes, M., Almeida, L., & Alves, R. F. N. C. (2015). Investigação Radiológica em Ciências Forenses: Proposta de Pós-graduação (Trabalho de conclusão de curso).
[6] VALE, S. (2009). Pequena história da radiografia. Contemporânea, 7(3), 58–67.
[7] CARVALHO, H. V. et al. Lições de Medicina Legal. 3ª ed. São Paulo: Saraiva, 1965.
[8] CROCE, D. & JÚNIOR, D. C. (2017). Manual de medicina legal.
[9] FRANÇA, G. V. Direito Médico. 13ª ed. Rio de Janeiro: Forense, 2016, p. 503-504.
[10] OLIVEIRA, J. (2014). Forensic Radiology - History, applications and the job market. http://conter.gov.br/site/noticia/profissao-rx.
[11] FURTADO, G. V. et al. Radiologia Forense e sua atuação: uma breve história. Environmental Smoke, v. 1, n. 2, p. 110-119, 2018.