Development and feasibility of a 3D whole-body protocol with integrated surface documentation in a mobile cone-beam CT system for applications in forensic imaging and disaster victim identification

Development and feasibility of a 3D whole-body protocol with integrated surface documentation in a mobile cone-beam CT system for applications in forensic imaging and disaster victim identification | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and feasibility of a 3D whole-body protocol with integrated surface documentation in a mobile cone-beam CT system for applications in forensic imaging and disaster victim identification Dominic Gascho, Anastasiia Parii, Felix Ginzinger, Herbert Biber, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9540776/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: Postmortem computed tomography plays an important role in modern forensic investigations, particularly in disaster victim identification, where flexible and deployable imaging solutions are required. However, the use of whole-body postmortem computed tomography remains limited by the infrastructure demands of conventional computed tomography systems. This study aimed to develop and evaluate a standardized whole-body imaging protocol for a mobile cone-beam computed tomography system. A dedicated protocol was established in collaboration with the manufacturer through an iterative development process, including dose modulation, infrared tracking, and automated image stitching. The finalized protocol was applied in ten forensic cases. Sequential acquisitions along the longitudinal body axis were combined into a single dataset, while simultaneously acquired optical images were used for photogrammetric surface reconstruction. Results: Whole-body imaging was successfully achieved in all cases, providing continuous anatomical coverage from head to feet. Skeletal structures and implanted devices were clearly visualized, with adequate soft tissue depiction for general assessment. Image stitching enabled seamless integration of sequential scans without relevant artifacts. Surface reconstruction was feasible in all cases, although mesh quality was limited by the camera system. In addition, the system enabled rapid acquisition of conventional radiographs and targeted high-resolution imaging of selected regions. Conclusions: Mobile cone-beam computed tomography enables feasible whole-body postmortem imaging with integrated surface documentation. The combination of whole-body imaging, targeted acquisitions, radiographic imaging, and simultaneous surface documentation represents a versatile approach for forensic workflows and may be particularly valuable in disaster victim identification scenarios. Further technical refinements and larger studies are warranted. Postmortem CT Cone-beam CT Mobile CT Forensic radiology Disaster victim identification 3D surface documentation Photogrammetry Virtual autopsy Virtopsy Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Background Since its introduction, the Virtopsy concept has evolved into a multidisciplinary imaging approach combining cross-sectional imaging, three-dimensional (3D) surface documentation, and advanced post-processing techniques for comprehensive postmortem examination (Thali et al., 2003 ; Khmara et al., 2024 ; Solomon et al., 2025b ). It offers the advantages of non-invasive whole-body documentation, permanent digital archiving, repeatable image review, and improved visualization of skeletal trauma, gas collections, and foreign bodies (Gascho, 2025 ; Zou et al., 2024 ). Within this framework, several studies have demonstrated the practical forensic value of postmortem computed tomography (PMCT), particularly for rapid whole-body assessment, improved fracture detection, and visualization of gas collections that may be difficult to identify during conventional autopsy (Solomon et al., 2025a). PMCT enables non-invasive visualization of internal structures, facilitates the detection of traumatic injuries, and supports the radiological identification of decedents, particularly in the context of disaster victim identification (DVI), where flexible and deployable imaging solutions are required (Brough et al., 2015a ). In mass fatality incidents, imaging may substantially improve victim processing by assisting triage, localization of foreign bodies or implants, documentation of injuries, and comparison with antemortem radiological records (Brough et al., 2015b ; Filograna et al., 2023 ). In complex DVI scenarios involving fragmented, burnt, or commingled remains, radiological imaging can further support sorting procedures, anatomical assessment, and multidisciplinary reconciliation workflows (de Boer et al., 2020 , 2019 ). In addition, recent operational analyses have highlighted that successful DVI responses depend not only on technical capability, but also on deployable, scalable, and logistically feasible systems that can be integrated into challenging post-disaster environments (Adamovic et al., 2023 ). In addition to internal imaging, 3D surface documentation of the body has gained increasing importance, as it allows for the assessment and correlation of external injuries with internal findings (Villa, 2017 ). The combined acquisition of radiological and optical surface data is therefore considered an ideal approach in forensic imaging (Thali et al., 2005 ; Buck et al., 2007 ; Villa et al., 2017 ). Dedicated low-cost systems such as multi-camera photogrammetry setups in combination with clinical CT scanners have been developed to enable comprehensive whole-body documentation (Kottner et al., 2017 , 2021 ). However, the widespread implementation of such approaches remains limited by the high costs and infrastructure requirements of conventional CT systems, including specialized power supply, cooling systems, and extensive radiation shielding. To address these limitations, an alternative imaging solution has been explored by dedicating a mobile cone-beam CT system ( ImagingRing ) originally developed for image-guided radiotherapy and surgical applications (Roeder et al., 2023 ). The system features an ultra-large gantry bore of approximately 121 cm, independently movable X-ray source and detector arms, and supports non-isocentric imaging with flexible field-of-view (FOV) configurations. In contrast to conventional CT scanners, the ImagingRing operates with standard electrical power supply and an integrated air-cooling system, significantly reducing infrastructure requirements. Furthermore, the system is equipped with integrated stereoscopic RGB camera systems mounted in both the gantry and detector, enabling simultaneous acquisition of optical image data. Despite these advantages, the ImagingRing was not originally designed for whole-body postmortem imaging. In particular, the limited coverage along the longitudinal axis necessitates the development of dedicated acquisition strategies, such as sequential scanning and image stitching, to enable complete body coverage. To date, no standardized protocol for postmortem whole-body imaging using this system has been established. The aim of this study was therefore to develop and implement a standardized whole-body PMCT protocol for the ImagingRing , including longitudinal image stitching and simultaneous photogrammetric surface acquisition. Furthermore, the feasibility of this protocol was evaluated in a series of real forensic cases, with particular focus on workflow, image quality, and applicability for forensic investigations. 2. Methods and Materials 2.1. Study Design and Case Selection This study represents a technical feasibility study evaluating a postmortem whole-body CT protocol developed for a mobile cone-beam CT system. The protocol was established in close collaboration with the system manufacturer through an iterative development process over several months. During this period, both the acquisition workflow and system functionalities were progressively refined, including the implementation of dose modulation and infrared (IR) tracking to improve scan alignment and stitching performance. Following this development phase, the finalized protocol was applied in a pilot series of 10 forensic cases. No specific inclusion criteria were defined apart from a body weight below 120 kg, which was limited by the load capacity of the prototype examination table. Case inclusion was additionally dependent on the availability of the deceased within the routine workflow of the Institute of Forensic Medicine. 2.2. Imaging System All examinations were performed using the mobile cone-beam CT system ImagingRing (medPhoton GmbH, Salzburg, Austria). The system features a large gantry opening (121 cm), independently movable X-ray source and detector arms, and it supports non-isocentric imaging allowing flexible acquisition geometries (Fig. 1 ). Iso-centric imaging was used for the whole-body protocol, and reconstructions were performed with a large field of view (LFOV) of 500 mm in diameter. The system operates with a standard electrical power supply and does not require dedicated cooling infrastructure, enabling flexible deployment in non-clinical environments. In addition to radiological imaging, the system is equipped with integrated stereoscopic RGB camera systems located in both the gantry and the detector arm, allowing simultaneous acquisition of optical image data. 2.3. Development of the Whole-Body CT Protocol As the ImagingRing system was not originally designed for whole-body postmortem imaging, a dedicated acquisition protocol was developed in collaboration with the manufacturer. The protocol is based on sequential cone-beam CT acquisitions along the longitudinal axis of the body. Prior to CT acquisition, whole-body topograms (anterior-posterior and lateral) were obtained to define the scan range from head to feet. The final whole-body dataset was generated by performing multiple overlapping scans, which were subsequently combined into a single dataset using an infrared-aided image stitching approach that was specifically developed and implemented for this system. To improve spatial alignment between sequential scans, tracking markers were used and detected by the system’s infrared tracking functionality. The protocol underwent iterative optimization during the development process. Initial acquisitions were performed without dose modulation, resulting in prolonged scan times due to x-ray heat management. Subsequently, dose modulation was implemented, allowing for a more efficient acquisition workflow while maintaining sufficient image quality. 2.4. Imaging Procedure In all cases, a 120 kV full-body CT scan from head to feet was performed using the described protocol. The deceased were positioned supine on a custom-built radiolucent examination table designed to allow longitudinal movement of the imaging system. The CT acquisition consisted of sequential 360° cone-beam scans with overlapping fields of view. The final reconstructed datasets corresponded to LFOV whole-body acquisitions derived from stitched multi-slice datasets. In addition to cone-beam CT imaging, optical images were simultaneously acquired during gantry rotation using the detector-integrated camera system. Image frames were automatically recorded from the live camera streams at predefined intervals during sequential whole-body acquisition. A total of 798 color images (1280 × 720 pixels, 24-bit) were used for photogrammetric reconstruction. The captured image set was processed using photogrammetric reconstruction software (Agisoft Metashape, Agisoft LLC, St. Petersburg, Russia) to generate a three-dimensional textured surface model and polygon mesh of the body surface. For retrospective objective geometric descriptors of mesh complexity and spatial resolution, the exported surface model (OBJ format) was analyzed using MATLAB (MathWorks, Natick, MA, USA). Quantitative descriptors included total number of vertices, number of faces, and mesh edge-length statistics. 3. Results 3.1. Feasibility of Whole-Body Imaging Whole-body postmortem cone-beam CT imaging using the developed protocol was successfully performed in all 10 cases ( Table ). The pilot cohort comprised six male and four female decedents with a mean age of 68 years (range 35–87 years). Complete anatomical coverage from head to feet was achieved in every examination without the need for protocol interruption or modification. Depending on body size, up to 10 sequential scan positions were required. The sequential acquisition workflow with subsequent automated image stitching enabled reconstruction of continuous whole-body datasets without relevant misalignment artifacts at the junctions between adjacent scan segments. Individual scan segments required approximately 60–68 s irradiation time, while final automated reconstruction and stitching required approximately 15 s, depending on the number of scan positions. The total workflow time for a complete whole-body examination was approximately 10–15 min for an average-sized adult decedent. 3.2. Image Quality The finalized whole-body protocol was performed using a LFOV acquisition mode at 120 kVp with automatic dose modulation. Reconstructed images were generated with an isotropic voxel size of approximately 1.2 mm (pixel spacing 1.228 × 1.228 mm; slice thickness 1.228 mm). The reconstruction field of view was 470 mm with a matrix size of 470 × 422 pixels. Images were exported in Hounsfield unit format for multiplanar reconstruction and 3D post-processing. The reconstructed datasets provided consistent visualization of the entire skeletal system in all cases. Bone structures were clearly delineated across the full body length, and metallic implants were reliably detected and well visualized (Fig. 2 ) . Maximum-intensity projection allowed intuitive 3D visualization of skeletal anatomy and implant positioning. The stitching of sequential acquisitions resulted in a coherent 3D dataset without visible discontinuities, supporting the technical feasibility of the developed protocol. A CTDI vol of approximately 12 mGy was recorded, indicating a moderate dose level for postmortem whole-body cone-beam CT acquisition. Lung and soft tissue structures were adequately visualized, allowing for anatomical orientation and assessment of major organ systems. While image characteristics reflect the nature of cone-beam CT acquisition, the overall soft tissue contrast was considered moderate for forensic evaluation. For further imaging in cases of unclear findings, additional region-specific scans using dedicated protocols from the device’s standard protocol library can be performed, effectively circumventing this limitation. 3.3. Photogrammetric Surface Reconstruction A representative photogrammetric mesh reconstructed from 798 color images consisted of 479,625 vertices and 956,926 faces. The mean and median unique edge lengths were approximately 2.8 mm and 2.2 mm, respectively, indicating moderate surface mesh resolution. The reconstructed body surface provided adequate depiction of general external anatomy, body contour, and positioning. Fine surface details were limited, and reconstruction artifacts were mainly observed in adjacent non-target structures such as the examination table and peripheral regions. The textured surface model enabled additional visual documentation of external features complementary to the radiological dataset (Fig. 3 ). 4. Discussion This study demonstrates the feasibility of performing postmortem whole-body imaging using a mobile cone-beam CT system with a dedicated acquisition protocol. By combining sequential scanning and image stitching, continuous whole-body datasets could be generated in all cases, enabling comprehensive radiological assessment. A key aspect of this work is the successful implementation of a standardized whole-body protocol on a system that was not originally designed for this purpose. The use of longitudinally overlapping acquisitions and automated stitching allowed for complete anatomical coverage of the entire body. This approach expands the potential applications of mobile cone-beam CT systems in forensic imaging (Sarment and Christensen, 2014 ). The image quality achieved using the 3D whole body protocol was sufficient for forensic purposes, particularly with regard to the visualization of skeletal structures and implanted devices. In addition, soft tissue structures were adequately depicted, allowing for general anatomical assessment. The observed image characteristics are consistent with cone-beam CT acquisition and reflect the balance between image quality, acquisition time, and system design. Compared with fan-beam CT, cone-beam CT systems generally offer high spatial resolution for osseous structures and metallic foreign bodies, but lower soft tissue contrast due to increased scatter radiation, beam-hardening effects, and detector-related noise. Previous comparative studies have shown that fan-beam CT remains superior for low-contrast detectability and soft tissue differentiation, whereas cone-beam CT may provide advantages in geometric detail (Lechuga et al., 2016 ; Lustermans et al., 2024 ). Previous postmortem forensic studies have shown that cone-beam CT can represent a valuable complementary imaging modality, particularly for skeletal trauma assessment, radiological identification, and localization of metallic foreign bodies or projectiles, where reduced metal artefacts and high spatial resolution may be advantageous (Sarment and Christensen, 2014 ; von See et al., 2009 ). However, fan-beam CT remains the reference standard for comprehensive whole-body postmortem imaging and for the evaluation of subtle internal pathology or soft tissue findings relevant to cause-of-death assessment (Coty et al., 2018 ). Against this background, the ImagingRing offers several practical advantages compared to fan-beam CT systems. The ability to operate using standard electrical infrastructure, combined with reduced requirements for cooling and installation, enables flexible deployment in environments where conventional CT scanners are not available. This may be particularly relevant in the context of DVI or in resource-limited settings, where the ImagingRing enables comprehensive visualization of fragmented remains and supports the assessment of commingled human material ( Fig. 4 ). While the generation of 3D whole-body datasets requires sequential acquisition and is therefore time-consuming, the system also allows for rapid acquisition of conventional radiographic images across the entire body. These radiographs may provide a fast initial overview and support targeted decision-making in forensic workflows. Future developments, including the implementation of stitching approaches for two-dimensional whole-body reconstructions, may further enhance rapid assessment capabilities. In addition, region-specific radiographs can be acquired using non-isocentric imaging, allowing targeted evaluation of selected anatomical areas. In addition, the system enables the conventional application of cone-beam CT in forensic odontology (Issrani et al., 2022 ). In addition to radiological imaging, the simultaneous acquisition of optical image data represents a particularly noteworthy feature of this system. The integrated camera systems enabled photogrammetric surface reconstruction without requiring additional acquisition time or separate hardware setups. Although the resulting 3D surface models were limited in resolution and texture quality, this study demonstrates the fundamental feasibility of combined radiological and optical whole-body documentation within a single compact system. The ability to acquire both datasets simultaneously has the potential to streamline workflows and improve the documentation of injuries and other forensic findings (Kottner et al., 2017 ). To the best of our knowledge, this feasibility study represents the first integrated and simultaneous acquisition of radiological cross-sectional data and optical 3D surface data using a single mobile platform for postmortem whole-body imaging. Previous multimodal systems combining X-ray imaging with optical modalities have primarily been developed for preclinical bioimaging applications, such as simultaneous CT/optical tumor imaging or fluorescence-enhanced micro-CT systems, rather than forensic whole-body documentation (Ju et al., 2019 ; Luo et al., 2024 ). The forensic approach of simultaneous CT and optical has the potential to fundamentally advance forensic documentation, which is particularly significant for complex forensic scenarios and the identification of disaster victims (DVI), where rapid, comprehensive and on-site data collection is of crucial importance. Disaster victim identification increasingly relies on radiological methods as an adjunct to conventional forensic examination. International position statements and INTERPOL reporting frameworks emphasize the growing role of radiography and postmortem CT for documentation, triage, identification, and detection of forensic findings in mass fatality incidents (Rutty et al., 2018 ). In recent years, CT-based workflows have become progressively integrated into large-scale identification operations. However, access to fixed fan-beam CT infrastructure remains limited in many disaster scenarios. Following the 2011 Great East Japan Earthquake and tsunami, no CT imaging could be implemented during the identification process despite the scale of the incident, mainly because of logistical constraints, distributed mortuary sites, and limited deployability of conventional systems (Iino and Aoki, 2016 ). These experiences underline the need for mobile and infrastructure-light imaging solutions. Within this context, the present mobile cone-beam CT platform may offer a complementary approach where rapid deployment, lower infrastructure requirements, and on-site imaging availability are priorities. While image quality and soft-tissue contrast remain below state-of-the-art fan-beam CT systems, the ability to generate whole-body volumetric datasets directly at the point of care or recovery may provide substantial practical value in selected forensic and disaster settings. Several limitations of the 3D whole body protocol must be considered. First, the study is based on a relatively small number of cases and does not include a systematic quantitative evaluation of image quality or diagnostic accuracy. Second, the surface reconstruction quality was limited by the characteristics of the integrated camera systems, which were not originally designed for high-resolution photogrammetry. Further optimization of camera hardware, lighting conditions, and reconstruction algorithms is therefore necessary. Third, the acquisition workflow relies on sequential scanning and post-processing steps such as image stitching, which may introduce additional complexity compared to single-pass whole-body CT systems. Future developments, including the implementation of a helical scan mode, may further simplify the workflow, improve automation, and reduce acquisition times. Another limitation is that the pilot cohort was not specifically composed of dedicated DVI scenarios. Instead, heterogeneous routine postmortem cases were intentionally used to assess technical feasibility under realistic forensic conditions. Future studies should evaluate the system specifically in larger disaster victim identification scenarios and mass-fatality workflows. 5. Conclusion Postmortem whole-body imaging using a mobile cone-beam CT system is feasible and allows for comprehensive radiological assessment. The developed protocol enables complete anatomical coverage through sequential acquisition and image stitching. In addition to 3D whole-body imaging, the system supports targeted high-resolution acquisitions and conventional radiographic imaging, providing a versatile approach for forensic workflows. The simultaneous acquisition of radiological and optical surface data further enables integrated forensic documentation within a single system and may be particularly valuable in DVI scenarios. Further technical refinements and larger studies are warranted to fully evaluate its potential in forensic practice. Abbreviations 3D Three-dimensional AP Anterior-posterior CT Computed tomography CTDI vol Computed tomography dose index volume DVI Disaster victim identification FOV Field of view IR Infrared LFOV Large field of view MRI Magnetic resonance imaging MSCT Multislice computed tomography PMCT Postmortem computed tomography Declarations Ethics approval As part of the forensic medical service and supporting legal inquiries, the scientific investigation met ethical standards and secured a no-objection declaration from the competent ethics committee (KEK-ZH-Nr. 2015-0686). All procedures performed in this study involving humans were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication All authors have approved the final version of the manuscript for submission. Funding This study was supported by the Emma Louise Kessler Grant, University of Zurich, awarded to D.G. References Adamovic, N., Howes, L.M., White, R., Julian, R., 2023. Understanding the challenges of disaster victim identification: perspectives of Australian forensic practitioners. Forensic Sci. Res. 8, 107–115. https://doi.org/10.1093/fsr/owad020 Brough, A.L., Morgan, B., Rutty, G.N., 2015a. The basics of disaster victim identification. Journal of Forensic Radiology and Imaging 3, 29–37. https://doi.org/10.1016/j.jofri.2015.01.002 Brough, A.L., Morgan, B., Rutty, G.N., 2015b. Postmortem computed tomography (PMCT) and disaster victim identification. Radiol med 120, 866–873. https://doi.org/10.1007/s11547-015-0556-7 Buck, U., Naether, S., Braun, M., Bolliger, S., Friederich, H., Jackowski, C., Aghayev, E., Christe, A., Vock, P., Dirnhofer, R., Thali, M.J., 2007. 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Forensic imaging of projectiles using cone-beam computed tomography. Forensic Science International 190, 38–41. https://doi.org/10.1016/j.forsciint.2009.05.009 Zou, D.-H., Liu, Y.-Y., Liu, N.-G., Chen, Y.-J., 2024. Virtopsy: Development and Application in Forensic Practice. Journal of Forensic Science and Medicine 10, 343. https://doi.org/10.4103/jfsm.jfsm_154_24 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviewers invited by journal 01 May, 2026 Submission checks completed at journal 30 Apr, 2026 First submitted to journal 29 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9540776","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635394760,"identity":"6e84f82b-4307-4370-a749-8ab75b2b0c20","order_by":0,"name":"Dominic Gascho","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDCCAyBkAGEzMzDY8IBZjA0MMEGCWtKI0wIHQC2HGQhq4TvenXi4oMCOQd79+MPPBRXnZcynHWCT/LmDQd4chxbJM2c3HJ5hkMxgeCbHWHrGmds8MrcT2CQkzzAY7mzArsXgRu6GwzwGBxgMG3LYmHnbbvNISAO1GLYxJBgcIKSl//kzoJZzEC2JxGiRl0gwA2o5ANFyEI8WsF94DJJ5DCTeGEvznEkGaklstmxskzDcgEML3/HezZ95/tjJyfenP/zMU2FnLyGdfPDmzzYbeVy2wAAPkgJQpDBI4FcPAvINhNWMglEwCkbBCAUAVYBXhp+bKHQAAAAASUVORK5CYII=","orcid":"","institution":"University of Zurich","correspondingAuthor":true,"prefix":"","firstName":"Dominic","middleName":"","lastName":"Gascho","suffix":""},{"id":635394761,"identity":"518c7ffc-6c9c-4ef7-8e70-46f9ad443f54","order_by":1,"name":"Anastasiia Parii","email":"","orcid":"","institution":"medPhoton GmbH","correspondingAuthor":false,"prefix":"","firstName":"Anastasiia","middleName":"","lastName":"Parii","suffix":""},{"id":635394762,"identity":"c9c0b30b-09b8-4959-9c40-23f6430eb9ba","order_by":2,"name":"Felix Ginzinger","email":"","orcid":"","institution":"medPhoton GmbH","correspondingAuthor":false,"prefix":"","firstName":"Felix","middleName":"","lastName":"Ginzinger","suffix":""},{"id":635394763,"identity":"423f29cd-e8a1-4a39-a2dd-85270ea495b0","order_by":3,"name":"Herbert Biber","email":"","orcid":"","institution":"medPhoton GmbH","correspondingAuthor":false,"prefix":"","firstName":"Herbert","middleName":"","lastName":"Biber","suffix":""},{"id":635394764,"identity":"8c9a71f4-e90b-4c22-9743-1221fbf6aac1","order_by":4,"name":"Heinz Deutschmann","email":"","orcid":"","institution":"medPhoton GmbH","correspondingAuthor":false,"prefix":"","firstName":"Heinz","middleName":"","lastName":"Deutschmann","suffix":""},{"id":635394766,"identity":"bb38691b-af46-4789-88dc-cb38bc759d6f","order_by":5,"name":"Michael Thali","email":"","orcid":"","institution":"University of Zurich","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Thali","suffix":""},{"id":635394767,"identity":"b23e8104-a600-4127-956a-c56f4d7693df","order_by":6,"name":"Philipp Steininger","email":"","orcid":"","institution":"medPhoton GmbH","correspondingAuthor":false,"prefix":"","firstName":"Philipp","middleName":"","lastName":"Steininger","suffix":""}],"badges":[],"createdAt":"2026-04-27 11:09:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9540776/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9540776/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108974557,"identity":"84571a30-1b1c-417e-86f8-46a1f1144cbc","added_by":"auto","created_at":"2026-05-11 10:52:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16477464,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eImagingRing\u003c/em\u003e system with key components. The mobile cone-beam CT system comprises an X-ray source, flat-panel detector, integrated detector-mounted camera system, gantry-mounted cameras, and an infrared (IR) tracking system. A tablet interface is used for system control. The setup enables simultaneous acquisition of radiological and optical data.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-9540776/v1/1563d6f2f81593649d6c128c.png"},{"id":108974555,"identity":"fcc58d8d-11d3-40c2-bd8c-b427f8ff64c4","added_by":"auto","created_at":"2026-05-11 10:52:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13880699,"visible":true,"origin":"","legend":"\u003cp\u003eWhole-body volume renderings demonstrating the developed imaging protocol. The upper row shows an adult case with clearly visualized skeletal structures and medical implants. The lower row depicts a pediatric case from the test series, illustrating the applicability of the protocol across different body sizes. Multiple viewing angles highlight consistent image stitching and continuous whole-body reconstruction.\u003c/p\u003e","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-9540776/v1/84aad026de4fe30bae9e5b2c.png"},{"id":108974558,"identity":"69bf5517-3945-4363-b397-8b7b2809c244","added_by":"auto","created_at":"2026-05-11 10:52:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":60894341,"visible":true,"origin":"","legend":"\u003cp\u003eSimultaneously acquired optical surface documentation generated from the integrated camera system during whole-body cone-beam CT acquisition. Left: polygon mesh reconstruction with inset showing surface geometry detail. Right: textured surface model with inset demonstrating color surface information. The models provide complementary external documentation in addition to the radiological dataset.\u003c/p\u003e","description":"","filename":"Fig.3.png","url":"https://assets-eu.researchsquare.com/files/rs-9540776/v1/776f921976db27a3db6f49fc.png"},{"id":108974556,"identity":"fb07e33f-4a1c-4b52-bde4-9e8d340a4f01","added_by":"auto","created_at":"2026-05-11 10:52:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":45750091,"visible":true,"origin":"","legend":"\u003cp\u003eExample of postmortem imaging in a disaster victim identification (DVI) context. The left image shows a three-dimensional surface reconstruction of a fragmented body, while the right image displays the corresponding volume-rendered CT dataset. Metallic implants are clearly visualized and can be highlighted, facilitating localization for retrieval and enabling comparison with antemortem radiological data.\u003c/p\u003e","description":"","filename":"Fig.4.png","url":"https://assets-eu.researchsquare.com/files/rs-9540776/v1/1a52343ef1fef33ae4aed16a.png"},{"id":109067282,"identity":"0501643d-4b86-4845-8770-a6916535a5d6","added_by":"auto","created_at":"2026-05-12 09:31:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":105373793,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9540776/v1/88c21d9a-c6fb-4918-b994-ae9371b83235.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and feasibility of a 3D whole-body protocol with integrated surface documentation in a mobile cone-beam CT system for applications in forensic imaging and disaster victim identification","fulltext":[{"header":"1. Background","content":"\u003cp\u003eSince its introduction, the Virtopsy concept has evolved into a multidisciplinary imaging approach combining cross-sectional imaging, three-dimensional (3D) surface documentation, and advanced post-processing techniques for comprehensive postmortem examination (Thali et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Khmara et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Solomon et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2025b\u003c/span\u003e). It offers the advantages of non-invasive whole-body documentation, permanent digital archiving, repeatable image review, and improved visualization of skeletal trauma, gas collections, and foreign bodies (Gascho, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zou et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Within this framework, several studies have demonstrated the practical forensic value of postmortem computed tomography (PMCT), particularly for rapid whole-body assessment, improved fracture detection, and visualization of gas collections that may be difficult to identify during conventional autopsy (Solomon et al., 2025a).\u003c/p\u003e \u003cp\u003ePMCT enables non-invasive visualization of internal structures, facilitates the detection of traumatic injuries, and supports the radiological identification of decedents, particularly in the context of disaster victim identification (DVI), where flexible and deployable imaging solutions are required (Brough et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015a\u003c/span\u003e). In mass fatality incidents, imaging may substantially improve victim processing by assisting triage, localization of foreign bodies or implants, documentation of injuries, and comparison with antemortem radiological records (Brough et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2015b\u003c/span\u003e; Filograna et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In complex DVI scenarios involving fragmented, burnt, or commingled remains, radiological imaging can further support sorting procedures, anatomical assessment, and multidisciplinary reconciliation workflows (de Boer et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In addition, recent operational analyses have highlighted that successful DVI responses depend not only on technical capability, but also on deployable, scalable, and logistically feasible systems that can be integrated into challenging post-disaster environments (Adamovic et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to internal imaging, 3D surface documentation of the body has gained increasing importance, as it allows for the assessment and correlation of external injuries with internal findings (Villa, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The combined acquisition of radiological and optical surface data is therefore considered an ideal approach in forensic imaging (Thali et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Buck et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Villa et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Dedicated low-cost systems such as multi-camera photogrammetry setups in combination with clinical CT scanners have been developed to enable comprehensive whole-body documentation (Kottner et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, the widespread implementation of such approaches remains limited by the high costs and infrastructure requirements of conventional CT systems, including specialized power supply, cooling systems, and extensive radiation shielding.\u003c/p\u003e \u003cp\u003eTo address these limitations, an alternative imaging solution has been explored by dedicating a mobile cone-beam CT system (\u003cem\u003eImagingRing\u003c/em\u003e) originally developed for image-guided radiotherapy and surgical applications (Roeder et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The system features an ultra-large gantry bore of approximately 121 cm, independently movable X-ray source and detector arms, and supports non-isocentric imaging with flexible field-of-view (FOV) configurations. In contrast to conventional CT scanners, the \u003cem\u003eImagingRing\u003c/em\u003e operates with standard electrical power supply and an integrated air-cooling system, significantly reducing infrastructure requirements. Furthermore, the system is equipped with integrated stereoscopic RGB camera systems mounted in both the gantry and detector, enabling simultaneous acquisition of optical image data. Despite these advantages, the \u003cem\u003eImagingRing\u003c/em\u003e was not originally designed for whole-body postmortem imaging. In particular, the limited coverage along the longitudinal axis necessitates the development of dedicated acquisition strategies, such as sequential scanning and image stitching, to enable complete body coverage. To date, no standardized protocol for postmortem whole-body imaging using this system has been established.\u003c/p\u003e \u003cp\u003eThe aim of this study was therefore to develop and implement a standardized whole-body PMCT protocol for the \u003cem\u003eImagingRing\u003c/em\u003e, including longitudinal image stitching and simultaneous photogrammetric surface acquisition. Furthermore, the feasibility of this protocol was evaluated in a series of real forensic cases, with particular focus on workflow, image quality, and applicability for forensic investigations.\u003c/p\u003e"},{"header":"2. Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design and Case Selection\u003c/h2\u003e \u003cp\u003eThis study represents a technical feasibility study evaluating a postmortem whole-body CT protocol developed for a mobile cone-beam CT system. The protocol was established in close collaboration with the system manufacturer through an iterative development process over several months. During this period, both the acquisition workflow and system functionalities were progressively refined, including the implementation of dose modulation and infrared (IR) tracking to improve scan alignment and stitching performance.\u003c/p\u003e \u003cp\u003eFollowing this development phase, the finalized protocol was applied in a pilot series of 10 forensic cases. No specific inclusion criteria were defined apart from a body weight below 120 kg, which was limited by the load capacity of the prototype examination table. Case inclusion was additionally dependent on the availability of the deceased within the routine workflow of the Institute of Forensic Medicine.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Imaging System\u003c/h2\u003e \u003cp\u003eAll examinations were performed using the mobile cone-beam CT system \u003cem\u003eImagingRing\u003c/em\u003e (medPhoton GmbH, Salzburg, Austria). The system features a large gantry opening (121 cm), independently movable X-ray source and detector arms, and it supports non-isocentric imaging allowing flexible acquisition geometries (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Iso-centric imaging was used for the whole-body protocol, and reconstructions were performed with a large field of view (LFOV) of 500 mm in diameter. The system operates with a standard electrical power supply and does not require dedicated cooling infrastructure, enabling flexible deployment in non-clinical environments. In addition to radiological imaging, the system is equipped with integrated stereoscopic RGB camera systems located in both the gantry and the detector arm, allowing simultaneous acquisition of optical image data.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Development of the Whole-Body CT Protocol\u003c/h2\u003e \u003cp\u003eAs the \u003cem\u003eImagingRing\u003c/em\u003e system was not originally designed for whole-body postmortem imaging, a dedicated acquisition protocol was developed in collaboration with the manufacturer. The protocol is based on sequential cone-beam CT acquisitions along the longitudinal axis of the body. Prior to CT acquisition, whole-body topograms (anterior-posterior and lateral) were obtained to define the scan range from head to feet. The final whole-body dataset was generated by performing multiple overlapping scans, which were subsequently combined into a single dataset using an infrared-aided image stitching approach that was specifically developed and implemented for this system. To improve spatial alignment between sequential scans, tracking markers were used and detected by the system\u0026rsquo;s infrared tracking functionality. The protocol underwent iterative optimization during the development process. Initial acquisitions were performed without dose modulation, resulting in prolonged scan times due to x-ray heat management. Subsequently, dose modulation was implemented, allowing for a more efficient acquisition workflow while maintaining sufficient image quality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Imaging Procedure\u003c/h2\u003e \u003cp\u003eIn all cases, a 120 kV full-body CT scan from head to feet was performed using the described protocol. The deceased were positioned supine on a custom-built radiolucent examination table designed to allow longitudinal movement of the imaging system. The CT acquisition consisted of sequential 360\u0026deg; cone-beam scans with overlapping fields of view. The final reconstructed datasets corresponded to LFOV whole-body acquisitions derived from stitched multi-slice datasets.\u003c/p\u003e \u003cp\u003eIn addition to cone-beam CT imaging, optical images were simultaneously acquired during gantry rotation using the detector-integrated camera system. Image frames were automatically recorded from the live camera streams at predefined intervals during sequential whole-body acquisition. A total of 798 color images (1280 \u0026times; 720 pixels, 24-bit) were used for photogrammetric reconstruction. The captured image set was processed using photogrammetric reconstruction software (Agisoft Metashape, Agisoft LLC, St. Petersburg, Russia) to generate a three-dimensional textured surface model and polygon mesh of the body surface. For retrospective objective geometric descriptors of mesh complexity and spatial resolution, the exported surface model (OBJ format) was analyzed using MATLAB (MathWorks, Natick, MA, USA). Quantitative descriptors included total number of vertices, number of faces, and mesh edge-length statistics.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Feasibility of Whole-Body Imaging\u003c/h2\u003e \u003cp\u003eWhole-body postmortem cone-beam CT imaging using the developed protocol was successfully performed in all 10 cases (\u003cb\u003eTable\u003c/b\u003e). The pilot cohort comprised six male and four female decedents with a mean age of 68 years (range 35\u0026ndash;87 years). Complete anatomical coverage from head to feet was achieved in every examination without the need for protocol interruption or modification. Depending on body size, up to 10 sequential scan positions were required. The sequential acquisition workflow with subsequent automated image stitching enabled reconstruction of continuous whole-body datasets without relevant misalignment artifacts at the junctions between adjacent scan segments. Individual scan segments required approximately 60\u0026ndash;68 s irradiation time, while final automated reconstruction and stitching required approximately 15 s, depending on the number of scan positions. The total workflow time for a complete whole-body examination was approximately 10\u0026ndash;15 min for an average-sized adult decedent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Image Quality\u003c/h2\u003e \u003cp\u003eThe finalized whole-body protocol was performed using a LFOV acquisition mode at 120 kVp with automatic dose modulation. Reconstructed images were generated with an isotropic voxel size of approximately 1.2 mm (pixel spacing 1.228 \u0026times; 1.228 mm; slice thickness 1.228 mm). The reconstruction field of view was 470 mm with a matrix size of 470 \u0026times; 422 pixels. Images were exported in Hounsfield unit format for multiplanar reconstruction and 3D post-processing.\u003c/p\u003e \u003cp\u003eThe reconstructed datasets provided consistent visualization of the entire skeletal system in all cases. Bone structures were clearly delineated across the full body length, and metallic implants were reliably detected and well visualized (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Maximum-intensity projection allowed intuitive 3D visualization of skeletal anatomy and implant positioning. The stitching of sequential acquisitions resulted in a coherent 3D dataset without visible discontinuities, supporting the technical feasibility of the developed protocol. A CTDI\u003csub\u003evol\u003c/sub\u003e of approximately 12 mGy was recorded, indicating a moderate dose level for postmortem whole-body cone-beam CT acquisition. Lung and soft tissue structures were adequately visualized, allowing for anatomical orientation and assessment of major organ systems. While image characteristics reflect the nature of cone-beam CT acquisition, the overall soft tissue contrast was considered moderate for forensic evaluation. For further imaging in cases of unclear findings, additional region-specific scans using dedicated protocols from the device\u0026rsquo;s standard protocol library can be performed, effectively circumventing this limitation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Photogrammetric Surface Reconstruction\u003c/h2\u003e \u003cp\u003eA representative photogrammetric mesh reconstructed from 798 color images consisted of 479,625 vertices and 956,926 faces. The mean and median unique edge lengths were approximately 2.8 mm and 2.2 mm, respectively, indicating moderate surface mesh resolution. The reconstructed body surface provided adequate depiction of general external anatomy, body contour, and positioning. Fine surface details were limited, and reconstruction artifacts were mainly observed in adjacent non-target structures such as the examination table and peripheral regions. The textured surface model enabled additional visual documentation of external features complementary to the radiological dataset (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study demonstrates the feasibility of performing postmortem whole-body imaging using a mobile cone-beam CT system with a dedicated acquisition protocol. By combining sequential scanning and image stitching, continuous whole-body datasets could be generated in all cases, enabling comprehensive radiological assessment.\u003c/p\u003e \u003cp\u003eA key aspect of this work is the successful implementation of a standardized whole-body protocol on a system that was not originally designed for this purpose. The use of longitudinally overlapping acquisitions and automated stitching allowed for complete anatomical coverage of the entire body. This approach expands the potential applications of mobile cone-beam CT systems in forensic imaging (Sarment and Christensen, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The image quality achieved using the 3D whole body protocol was sufficient for forensic purposes, particularly with regard to the visualization of skeletal structures and implanted devices. In addition, soft tissue structures were adequately depicted, allowing for general anatomical assessment. The observed image characteristics are consistent with cone-beam CT acquisition and reflect the balance between image quality, acquisition time, and system design. Compared with fan-beam CT, cone-beam CT systems generally offer high spatial resolution for osseous structures and metallic foreign bodies, but lower soft tissue contrast due to increased scatter radiation, beam-hardening effects, and detector-related noise. Previous comparative studies have shown that fan-beam CT remains superior for low-contrast detectability and soft tissue differentiation, whereas cone-beam CT may provide advantages in geometric detail (Lechuga et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Lustermans et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Previous postmortem forensic studies have shown that cone-beam CT can represent a valuable complementary imaging modality, particularly for skeletal trauma assessment, radiological identification, and localization of metallic foreign bodies or projectiles, where reduced metal artefacts and high spatial resolution may be advantageous (Sarment and Christensen, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; von See et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). However, fan-beam CT remains the reference standard for comprehensive whole-body postmortem imaging and for the evaluation of subtle internal pathology or soft tissue findings relevant to cause-of-death assessment (Coty et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAgainst this background, the \u003cem\u003eImagingRing\u003c/em\u003e offers several practical advantages compared to fan-beam CT systems. The ability to operate using standard electrical infrastructure, combined with reduced requirements for cooling and installation, enables flexible deployment in environments where conventional CT scanners are not available. This may be particularly relevant in the context of DVI or in resource-limited settings, where the \u003cem\u003eImagingRing\u003c/em\u003e enables comprehensive visualization of fragmented remains and supports the assessment of commingled human material \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). While the generation of 3D whole-body datasets requires sequential acquisition and is therefore time-consuming, the system also allows for rapid acquisition of conventional radiographic images across the entire body. These radiographs may provide a fast initial overview and support targeted decision-making in forensic workflows. Future developments, including the implementation of stitching approaches for two-dimensional whole-body reconstructions, may further enhance rapid assessment capabilities. In addition, region-specific radiographs can be acquired using non-isocentric imaging, allowing targeted evaluation of selected anatomical areas. In addition, the system enables the conventional application of cone-beam CT in forensic odontology (Issrani et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn addition to radiological imaging, the simultaneous acquisition of optical image data represents a particularly noteworthy feature of this system. The integrated camera systems enabled photogrammetric surface reconstruction without requiring additional acquisition time or separate hardware setups. Although the resulting 3D surface models were limited in resolution and texture quality, this study demonstrates the fundamental feasibility of combined radiological and optical whole-body documentation within a single compact system. The ability to acquire both datasets simultaneously has the potential to streamline workflows and improve the documentation of injuries and other forensic findings (Kottner et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). To the best of our knowledge, this feasibility study represents the first integrated and simultaneous acquisition of radiological cross-sectional data and optical 3D surface data using a single mobile platform for postmortem whole-body imaging. Previous multimodal systems combining X-ray imaging with optical modalities have primarily been developed for preclinical bioimaging applications, such as simultaneous CT/optical tumor imaging or fluorescence-enhanced micro-CT systems, rather than forensic whole-body documentation (Ju et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Luo et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The forensic approach of simultaneous CT and optical has the potential to fundamentally advance forensic documentation, which is particularly significant for complex forensic scenarios and the identification of disaster victims (DVI), where rapid, comprehensive and on-site data collection is of crucial importance.\u003c/p\u003e \u003cp\u003eDisaster victim identification increasingly relies on radiological methods as an adjunct to conventional forensic examination. International position statements and INTERPOL reporting frameworks emphasize the growing role of radiography and postmortem CT for documentation, triage, identification, and detection of forensic findings in mass fatality incidents (Rutty et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In recent years, CT-based workflows have become progressively integrated into large-scale identification operations. However, access to fixed fan-beam CT infrastructure remains limited in many disaster scenarios. Following the 2011 Great East Japan Earthquake and tsunami, no CT imaging could be implemented during the identification process despite the scale of the incident, mainly because of logistical constraints, distributed mortuary sites, and limited deployability of conventional systems (Iino and Aoki, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). These experiences underline the need for mobile and infrastructure-light imaging solutions. Within this context, the present mobile cone-beam CT platform may offer a complementary approach where rapid deployment, lower infrastructure requirements, and on-site imaging availability are priorities. While image quality and soft-tissue contrast remain below state-of-the-art fan-beam CT systems, the ability to generate whole-body volumetric datasets directly at the point of care or recovery may provide substantial practical value in selected forensic and disaster settings.\u003c/p\u003e \u003cp\u003eSeveral limitations of the 3D whole body protocol must be considered. First, the study is based on a relatively small number of cases and does not include a systematic quantitative evaluation of image quality or diagnostic accuracy. Second, the surface reconstruction quality was limited by the characteristics of the integrated camera systems, which were not originally designed for high-resolution photogrammetry. Further optimization of camera hardware, lighting conditions, and reconstruction algorithms is therefore necessary. Third, the acquisition workflow relies on sequential scanning and post-processing steps such as image stitching, which may introduce additional complexity compared to single-pass whole-body CT systems. Future developments, including the implementation of a helical scan mode, may further simplify the workflow, improve automation, and reduce acquisition times. Another limitation is that the pilot cohort was not specifically composed of dedicated DVI scenarios. Instead, heterogeneous routine postmortem cases were intentionally used to assess technical feasibility under realistic forensic conditions. Future studies should evaluate the system specifically in larger disaster victim identification scenarios and mass-fatality workflows.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003ePostmortem whole-body imaging using a mobile cone-beam CT system is feasible and allows for comprehensive radiological assessment. The developed protocol enables complete anatomical coverage through sequential acquisition and image stitching. In addition to 3D whole-body imaging, the system supports targeted high-resolution acquisitions and conventional radiographic imaging, providing a versatile approach for forensic workflows. The simultaneous acquisition of radiological and optical surface data further enables integrated forensic documentation within a single system and may be particularly valuable in DVI scenarios. Further technical refinements and larger studies are warranted to fully evaluate its potential in forensic practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e3D\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Three-dimensional\u003c/p\u003e\n\u003cp\u003eAP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Anterior-posterior\u003c/p\u003e\n\u003cp\u003eCT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Computed tomography\u003c/p\u003e\n\u003cp\u003eCTDI\u003csub\u003evol\u003c/sub\u003e Computed tomography dose index volume\u003c/p\u003e\n\u003cp\u003eDVI\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Disaster victim identification\u003c/p\u003e\n\u003cp\u003eFOV\u0026nbsp; \u0026nbsp; \u0026nbsp;Field of view\u003c/p\u003e\n\u003cp\u003eIR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Infrared\u003c/p\u003e\n\u003cp\u003eLFOV\u0026nbsp; \u0026nbsp;Large field of view\u003c/p\u003e\n\u003cp\u003eMRI\u0026nbsp; \u0026nbsp; \u0026nbsp;Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eMSCT\u0026nbsp;\u0026nbsp;Multislice computed tomography\u003c/p\u003e\n\u003cp\u003ePMCT \u0026nbsp;Postmortem computed tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eAs part of the forensic medical service and supporting legal inquiries, the scientific investigation met ethical standards and secured a no-objection declaration from the competent ethics committee (KEK-ZH-Nr. 2015-0686). All procedures performed in this study involving humans were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eAll authors have approved the final version of the manuscript for submission.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Emma Louise Kessler Grant, University of Zurich, awarded to D.G.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAdamovic, N., Howes, L.M., White, R., Julian, R., 2023. Understanding the challenges of disaster victim identification: perspectives of Australian forensic practitioners. Forensic Sci. Res. 8, 107\u0026ndash;115. https://doi.org/10.1093/fsr/owad020\u003c/li\u003e\n \u003cli\u003eBrough, A.L., Morgan, B., Rutty, G.N., 2015a. The basics of disaster victim identification. Journal of Forensic Radiology and Imaging 3, 29\u0026ndash;37. https://doi.org/10.1016/j.jofri.2015.01.002\u003c/li\u003e\n \u003cli\u003eBrough, A.L., Morgan, B., Rutty, G.N., 2015b. Postmortem computed tomography (PMCT) and disaster victim identification. Radiol med 120, 866\u0026ndash;873. https://doi.org/10.1007/s11547-015-0556-7\u003c/li\u003e\n \u003cli\u003eBuck, U., Naether, S., Braun, M., Bolliger, S., Friederich, H., Jackowski, C., Aghayev, E., Christe, A., Vock, P., Dirnhofer, R., Thali, M.J., 2007. Application of 3D documentation and geometric reconstruction methods in traffic accident analysis: With high resolution surface scanning, radiological MSCT/MRI scanning and real data based animation. 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Forensic Sci. Res. 5, 191\u0026ndash;201. https://doi.org/10.1080/20961790.2020.1751385\u003c/li\u003e\n \u003cli\u003eFilograna, L., Manenti, G., Micillo, A., Chirico, F., Carini, A., Gigliotti, P.E., Floris, R., Malizia, A., Oliva, A., 2023. Post-mortem imaging: A tool to improve post-mortem analysis and case management during terrorist attacks. Forensic Imaging 34, 200551. https://doi.org/10.1016/j.fri.2023.200551\u003c/li\u003e\n \u003cli\u003eGascho, D., 2025. VIRTual autOPSY\u0026mdash;applying CT and MRI for modern forensic death investigations. Front. Radiol. 5. https://doi.org/10.3389/fradi.2025.1557636\u003c/li\u003e\n \u003cli\u003eIino, M., Aoki, Y., 2016. The use of radiology in the Japanese tsunami DVI process. Journal of Forensic Radiology and Imaging, Special Issue: Papers from the ISFRI Conference 2015 4, 20\u0026ndash;26. https://doi.org/10.1016/j.jofri.2015.12.006\u003c/li\u003e\n \u003cli\u003eIssrani, R., Prabhu, N., Sghaireen, M.G., Ganji, K.K., Alqahtani, A.M.A., ALJamaan, T.S., Alanazi, A.M., Alanazi, S.H., Alam, M.K., Munisekhar, M.S., 2022. Cone-Beam Computed Tomography: A New Tool on the Horizon for Forensic Dentistry. International Journal of Environmental Research and Public Health 19. https://doi.org/10.3390/ijerph19095352\u003c/li\u003e\n \u003cli\u003eJu, Q., Luo, S., Chen, C., Fang, Z., Gao, S., Chen, G., Chen, X., Gu, N., 2019. Single-Irradiation Simultaneous Dual-Modal Bioimaging Using Nanostructure Scintillators as Single Contrast Agent. Advanced Healthcare Materials 8, 1801324. https://doi.org/10.1002/adhm.201801324\u003c/li\u003e\n \u003cli\u003eKhmara, N., Baumeister, R., Schweitzer, W., Thali, M., Ampanozi, G., 2024. Virtopsy concept around the world: Institute-based survey of worldwide forensic postmortem imaging. Forensic Imaging 37, 200595. https://doi.org/10.1016/j.fri.2024.200595\u003c/li\u003e\n \u003cli\u003eKottner, S., Ebert, L.C., Ampanozi, G., Braun, M., Thali, M.J., Gascho, D., 2017. VirtoScan - a mobile, low-cost photogrammetry setup for fast post-mortem 3D full-body documentations in x-ray computed tomography and autopsy suites. Forensic Sci Med Pathol 13, 34\u0026ndash;43. https://doi.org/10.1007/s12024-016-9837-2\u003c/li\u003e\n \u003cli\u003eKottner, S., Schulz, M.M., Berger, F., Thali, M., Gascho, D., 2021. Beyond the visible spectrum \u0026ndash; applying 3D multispectral full-body imaging to the VirtoScan system. Forensic Sci Med Pathol 17, 565\u0026ndash;576. https://doi.org/10.1007/s12024-021-00420-x\u003c/li\u003e\n \u003cli\u003eLechuga, L., Weidlich, G.A., Lechuga, L., Weidlich, G.A., 2016. Cone Beam CT vs. Fan Beam CT: A Comparison of Image Quality and Dose Delivered Between Two Differing CT Imaging Modalities. Cureus 8. https://doi.org/10.7759/cureus.778\u003c/li\u003e\n \u003cli\u003eLuo, J., Zhu, H., Janjua, R.A., Ji, W., Zhang, R., Liang, J., He, S., 2024. Dual-Modal Fluorescent Hyperspectral Micro-CT for Precise Bioimaging Detection. Progress in Electromagnetics Research 181, 73\u0026ndash;80. https://doi.org/10.2528/PIER24121305\u003c/li\u003e\n \u003cli\u003eLustermans, D., Fonseca, G.P., Taasti, V.T., van de Schoot, A., Petit, S., van Elmpt, W., Verhaegen, F., 2024. Image quality evaluation of a new high-performance ring-gantry cone-beam computed tomography imager. Phys. Med. Biol. 69, 105018. https://doi.org/10.1088/1361-6560/ad3cb0\u003c/li\u003e\n \u003cli\u003eRoeder, F., Fastner, G., Fussl, C., Sedlmayer, F., Stana, M., Berchtold, J., J\u0026auml;ger, T., Presl, J., Schredl, P., Emmanuel, K., Colleselli, D., Kotolacsi, G., Scherer, P., Steininger, P., Gaisberger, C., 2023. First clinical application of image-guided intraoperative electron radiation therapy with real time intraoperative dose calculation in recurrent rectal cancer: technical procedure. Radiat Oncol 18, 186. https://doi.org/10.1186/s13014-023-02374-6\u003c/li\u003e\n \u003cli\u003eRutty, G.N., Alminyah, A., Apostol, M., Boel, L.W., Brough, A., Bouwer, H., O\u0026rsquo;Donnell, C., Fujimoto, H., Iino, M., Kroll, J., Lee, C.T., Levey, D.S., Makino, Y., Oesterhelweg, L., Ong, B., Ranson, D., Robinson, C., Singh, M.K.C., Villa, C., Viner, M., Woodford, N., Watkins, T., Wozniak, K., 2018. Positional Statement: Radiology Disaster Victim Identification Reporting Forms: Positional statement of the members of the Disaster Victim Identification working group of the International Society of Forensic Radiology and Imaging; Journal of Forensic Radiology and Imaging 15, 4\u0026ndash;7. https://doi.org/10.1016/j.jofri.2018.10.003\u003c/li\u003e\n \u003cli\u003eSarment, D.P., Christensen, A.M., 2014. The use of cone beam computed tomography in forensic radiology. Journal of Forensic Radiology and Imaging 2, 173\u0026ndash;181. https://doi.org/10.1016/j.jofri.2014.09.002\u003c/li\u003e\n \u003cli\u003eSolomon, N., Elifritz, J., Adolphi, N.L., Decker, S.J., Filograna, L., Kroll, J.J.F., Gascho, D., Thali, M.J., Gosangi, B., Sanchez, H., Revzin, M.V., Sinusas, A.J., 2025a. Postmortem CT: Applications in Clinical and Forensic \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Medicine. 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Forensic Sci. 50, JFS2004290-15. https://doi.org/10.1520/JFS2004290\u003c/li\u003e\n \u003cli\u003eThali, M., Yen, K., Schweitzer, W., Vock, P., Boesch, C., Ozdoba, C., Schroth, G., Ith, M., Sonnenschein, M., Doernhoefer, T., Scheurer, E., Plattner, T., Dirnhofer, R., 2003. Virtopsy, a New Imaging Horizon in Forensic Pathology: Virtual Autopsy by Postmortem Multislice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI)\u0026mdash;a Feasibility Study*. J. Forensic Sci. 48, 1\u0026ndash;18. https://doi.org/10.1520/JFS2002166\u003c/li\u003e\n \u003cli\u003eVilla, C., 2017. Forensic 3D documentation of skin injuries. Int J Legal Med 131, 751\u0026ndash;759. https://doi.org/10.1007/s00414-016-1499-9\u003c/li\u003e\n \u003cli\u003eVilla, C., Flies, M.J., Jacobsen, C., 2017. Forensic 3D documentation of bodies: Simple and fast procedure for combining CT scanning with external photogrammetry data. Journal of Forensic Radiology and Imaging 10, 47\u0026ndash;51. https://doi.org/10.1016/j.jofri.2017.08.003\u003c/li\u003e\n \u003cli\u003evon See, C., Bormann, K.-H., Schumann, P., Goetz, F., Gellrich, N.-C., R\u0026uuml;cker, M., 2009. Forensic imaging of projectiles using cone-beam computed tomography. Forensic Science International 190, 38\u0026ndash;41. https://doi.org/10.1016/j.forsciint.2009.05.009\u003c/li\u003e\n \u003cli\u003eZou, D.-H., Liu, Y.-Y., Liu, N.-G., Chen, Y.-J., 2024. Virtopsy: Development and Application in Forensic Practice. Journal of Forensic Science and Medicine 10, 343. https://doi.org/10.4103/jfsm.jfsm_154_24\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"egyptian-journal-of-forensic-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejfs","sideBox":"Learn more about [Egyptian Journal of Forensic Sciences](http://ejfs.springeropen.com)","snPcode":"41935","submissionUrl":"https://submission.springernature.com/new-submission/41935/3?","title":"Egyptian Journal of Forensic Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Postmortem CT, Cone-beam CT, Mobile CT, Forensic radiology, Disaster victim identification, 3D surface documentation, Photogrammetry, Virtual autopsy, Virtopsy","lastPublishedDoi":"10.21203/rs.3.rs-9540776/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9540776/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePostmortem computed tomography plays an important role in modern forensic investigations, particularly in disaster victim identification, where flexible and deployable imaging solutions are required. However, the use of whole-body postmortem computed tomography remains limited by the infrastructure demands of conventional computed tomography systems. This study aimed to develop and evaluate a standardized whole-body imaging protocol for a mobile cone-beam computed tomography system. A dedicated protocol was established in collaboration with the manufacturer through an iterative development process, including dose modulation, infrared tracking, and automated image stitching. The finalized protocol was applied in ten forensic cases. Sequential acquisitions along the longitudinal body axis were combined into a single dataset, while simultaneously acquired optical images were used for photogrammetric surface reconstruction.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWhole-body imaging was successfully achieved in all cases, providing continuous anatomical coverage from head to feet. Skeletal structures and implanted devices were clearly visualized, with adequate soft tissue depiction for general assessment. Image stitching enabled seamless integration of sequential scans without relevant artifacts. Surface reconstruction was feasible in all cases, although mesh quality was limited by the camera system. In addition, the system enabled rapid acquisition of conventional radiographs and targeted high-resolution imaging of selected regions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMobile cone-beam computed tomography enables feasible whole-body postmortem imaging with integrated surface documentation. The combination of whole-body imaging, targeted acquisitions, radiographic imaging, and simultaneous surface documentation represents a versatile approach for forensic workflows and may be particularly valuable in disaster victim identification scenarios. Further technical refinements and larger studies are warranted.\u003c/p\u003e","manuscriptTitle":"Development and feasibility of a 3D whole-body protocol with integrated surface documentation in a mobile cone-beam CT system for applications in forensic imaging and disaster victim identification","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 10:52:48","doi":"10.21203/rs.3.rs-9540776/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T11:20:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124933246510111505263880213057964775737","date":"2026-05-05T07:50:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281174997740679548228224762305376377560","date":"2026-05-01T16:19:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-01T05:35:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-30T05:48:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Journal of Forensic Sciences","date":"2026-04-29T14:47:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"egyptian-journal-of-forensic-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejfs","sideBox":"Learn more about [Egyptian Journal of Forensic Sciences](http://ejfs.springeropen.com)","snPcode":"41935","submissionUrl":"https://submission.springernature.com/new-submission/41935/3?","title":"Egyptian Journal of Forensic Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8f7a33ef-245d-4aac-bdc9-eaa16fd5175a","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T11:20:46+00:00","index":16,"fulltext":""},{"type":"reviewerAgreed","content":"124933246510111505263880213057964775737","date":"2026-05-05T07:50:03+00:00","index":14,"fulltext":""},{"type":"reviewerAgreed","content":"281174997740679548228224762305376377560","date":"2026-05-01T16:19:57+00:00","index":13,"fulltext":""},{"type":"reviewersInvited","content":"4","date":"2026-05-01T05:35:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-30T05:48:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Journal of Forensic Sciences","date":"2026-04-29T14:47:51+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T10:52:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 10:52:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9540776","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9540776","identity":"rs-9540776","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}