Medical Imaging Comparison for Personal Identification: A Primer for Forensic Practitioners

Comparative medical imaging is a well-established scientific method of personal identification that utilizes concordant anatomical features observed in antemortem and postmortem medical images. As access to antemortem medical imaging and digital image archives has expanded, radiographic comparison has become an increasingly important component of medicolegal death investigations. Despite its widespread use, many medicolegal practitioners receive limited formal training in comparative medical imaging. This paper provides a practical primer on radiographic comparison for personal identification. Common imaging modalities encountered in forensic casework, including conventional radiography, dental radiography, computed tomography (CT), cone beam computed tomography (CBCT), and magnetic resonance imaging (MRI), are reviewed with emphasis on image acquisition and characteristics, limitations, and comparative considerations. Frequently utilized anatomical regions, common comparative features, and methodological considerations are also discussed. Accurate radiographic identification requires not only the recognition of concordant anatomical features but also the appropriate interpretation of explainable differences arising from biological, radiographic, and postmortem factors. This paper provides foundational guidance intended to assist practitioners in conducting scientifically defensible radiographic comparisons and highlights the need for greater incorporation of comparative medical imaging training within forensic curricula.