Digital dental radiography speeds mass casualty victim identification

Terrible tragedies involving multiple victims can overwhelm the ability of forensic medical examiners to identify mass casualties in a timely, accurate manner. Turning to digital dental radiography over film may be the solution.

Dr. Scott R. Firestone, a dentist in the Suffolk County, NY, Medical Examiner's Office, documented the advantages of digital radiography in mass casualty incidents in a paper published in the current issue of the Journal of Homeland Security and Emergency Management (Vol. 1: No. 4, Article 408).

Using conventional film radiography can be both time-consuming and fraught with complications, according to Firestone. Faster turnaround and increased productivity are the most important advantages digital radiography can bring to the table during mass disaster dental identification.

"The time factor helps to alleviate the number one cause of inadequate radiographs - operator error," he said.

During mass fatality incidents, time pressure can lead to a "good-enough" operating philosophy. With digital radiography, the chance of producing a less then perfect set of radiographs is minimized, Firestone said.

Examiners first used digital dental radiography following the crash of TWA Flight 800 off Long Island, NY, in July 1996, in spite of general skepticism among many forensic odontologists who feared digital images would not be admitted in courts of law.

"We proved the naysayers wrong," Firestone said. "There is now case law established for admitting digital images in court proceedings."

Since then, digital radiography has become the gold standard in mass disaster identification.

The armed forces dental identification units now use it instead of film. The dental identification unit at Dover Air Force base used digital radiography after Sept. 11, 2001, to identify casualties from the flights that crashed in Pennsylvania and at the Pentagon. It is now an integral part of the portable morgue used by FEMA's Disaster Mortuary Response Team in mass disaster responses.

Digital radiography was not used following the World Trade Center incident even though its advantages include instant imaging, automation of the x-ray template, simplicity of retakes, staff acceptance, higher system usage, and elimination of film development, according to Firestone.

"In my opinion, there are no technical or legal reasons why digital radiography should not be the standard method of producing dental radiographs of victim identification," he said.