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The comparison of pre- and postmortem radiographs as a method of identification of unknown human remains is well established in the forensic and radiologic literature. Identification can be based on a single bony feature when there is evidence of prior surgery, trauma or unusual anatomic variation. We present a case in which a positive identification was made using bony changes in the skull secondary to prior surgery for correction of unilateral lambdoid craniosynostosis. The unusual radiographic appearance of the bony defect initially raised the question of trauma and foul play.

The use of radiographs as a means of identification of unknown remains is a well-established method as performed by radiologists, forensic anthropologists, or pathologists. We devised a test to determine whether the degree of radiographic and medical knowledge of a film interpreter correlates with the degree of accuracy in making comparisons of radiographic unknowns. Three groups considered to be distinctly different in their level of medical knowledge and radiographic interpretive skills were chosen to evaluate forensic identification cases. Although all three groups identified a majority of cases correctly, none were completely accurate. The group with training in radiographic interpretation performed significantly better. Our study supports the need for trained interpreters in cases of forensic identification.