Research Article

International Journal of Forensic Science & Research

3D CT Cinematic Rendering: Transforming Forensic Imaging with Enhanced

Visualization for Skeletal Trauma Analysis
Walter M Wallner-Essl1*, Johannes A R Pfaff1 and Jochen Grimm2

*
Correspondence:
1
Department of Neuroradiology, Christian Doppler Medical Center, Dr. Walter M. Wallner-Essl, MD, Forensic Imaging Group,
Paracelsus Medical University, Salzburg, Austria.
Department of Neuroradiology, Christian Doppler Medical
Forensic Imaging Group, Department of Neuroradiology, Christian
2 Center, Paracelsus Medical University, Austria, Phone: +43 (0)5
Doppler Medical Center, Paracelsus Medical University, Salzburg, 7255-56107, Fax: +43 (0)5 7255-39198.
Austria.
Received: 07 Oct 2024; Accepted: 20 Nov 2024; Published: 29 Nov 2024

Citation: Wallner-Essl WM, Pfaff JAR, Grimm J. 3D CT Cinematic Rendering: Transforming Forensic Imaging with Enhanced
Visualization for Skeletal Trauma Analysis. Int J Forens Sci Res. 2024; 1(1): 1-5.

ABSTRACT
Cinematic rendering (CR) is an innovative imaging technique that has emerged as a powerful tool in forensic
radiology, offering enhanced visualization capabilities for the analysis of skeletal trauma. This article explores the
application of CR in the setting of forensic imaging in skeletal injury and its impact on the field of skeletal trauma
analysis. The study discusses the advantages of CR over traditional imaging methods and presents a comprehensive
overview of the techniques, materials, and results associated with its application. The results indicate that CR has
the potential to revolutionize forensic imaging, providing forensic experts with a highly accurate and detailed
depiction of skeletal trauma for improved forensic analysis.

Keywords traditional methods, and its impact on the field. CR's ability to
Cinematic rendering, Forensic imaging, Skeletal trauma, create immersive 3D renderings aids in understanding injury
Visualization, Forensic analysis. patterns, especially in complex cases. Its interactivity allows real-
time exploration of trauma sites, aiding event reconstruction. CR
Abbreviations could revolutionize forensic communication in court, conveying
CT: Computed Tomography, CR: Cinematic Rendering, 3D: Three- complex findings effectively [1-6].
Dimensional, XR: X-Ray, MRI: Magnetic Resonance Imaging,
VR: Volume Rendering, MPR: Multi-Planar Reconstruction. The Radiologic 3D Cinematic Rendering Technique combines
radiological data and advanced visualization algorithms to create
detailed 3D representations. The technique follows a workflow,
Introduction beginning with high-resolution imaging data acquisition followed
Forensic imaging is vital for analyzing skeletal trauma and by segmentation, and rendering to produce accurate models. This
determining injury cause, manner, and timing. Traditional method finds applications in medical education, surgical planning,
techniques like X-Ray, CT, and MRI have limitations in depicting and clinical presentations, enhancing diagnostic accuracy,
complex injuries. Cinematic rendering (CR) has emerged as a treatment planning, and communication.
promising method, offering photorealistic 3D visualization of
anatomy and pathology. Unlike traditional imaging methods that The purpose of this article is to explore the potential of CR in
generate images based on X-ray attenuation or signal intensity, transforming forensic imaging and assess its impact on the
CR utilizes advanced algorithms to simulate the interaction of analysis of skeletal trauma. By examining the advantages and
light with anatomical structures, resulting in visually striking capabilities of CR over traditional radiological techniques, we can
and realistic representations. This article explores CR's potential gain insight into the potential benefits it offers to forensic experts
in transforming forensic imaging, examining its advantages over and the field as a whole. CR's ability to produce photorealistic
Int J Forens Sci Res, 2024 Volume 1 | Issue 1 | 1 of 5
3D renderings of skeletal trauma holds significant promise. By Visualization Capabilities Surpassing Traditional Imaging
providing a more immersive and detailed visualization, CR allows Methods
forensic experts to better understand the injury patterns and In the field of radiology, the advancements in imaging technology
characteristics. This enhanced visualization aids in the accurate have paved the way for innovative visualization techniques that
identification and characterization of skeletal injuries, even in enhance the interpretation and communication of medical imaging
cases involving complex fractures or subtle trauma that may be data. Among these techniques, CT cinematic rendering and volume
challenging to interpret using conventional imaging methods alone rendering are prominent methods utilized for the visualization of
[7-11]. Despite its advantages, CR has limitations. Computational anatomical structures and pathologies. While both approaches
complexity may hinder real-time visualization, and accuracy in aim to improve the visualization of CT scans, they differ in their
representing structures can be imperfect due to factors like noise underlying principles and the visual information they provide.
and limitations in resolution. Interpretation could be subjective,
impacting standardization. Accessibility might be limited due CT Cinematic Rendering
to specialized hardware and software requirements. Ongoing CT cinematic rendering is a relatively new technique that
research aims to address these challenges, potentially leading to leverages advanced algorithms and computational power to create
broader adoption of CR in clinical practice. highly realistic visualizations from CT scan data. By simulating
the interaction of light with tissues, cinematic rendering produces
In summary, CR's potential in transforming forensic imaging visually immersive images that closely resemble real-world
for skeletal trauma analysis is explored. Its advantages over appearances. It captures fine details such as surface textures,
traditional methods and photorealistic 3D visualization offer shading, and subtle changes in tissue density, resulting in lifelike
a promising avenue for improved accuracy. The article delves renderings that aid in the understanding and interpretation of
into methodologies, results, and discussions surrounding CR's anatomical structures. CT cinematic rendering provides enhanced
application in skeletal forensic imaging, presenting its capabilities depth perception, allowing for interactive exploration of the
and potential impact. scanned anatomy from multiple angles and perspectives (Figure
1,2).
Methods and Materials
Imaging Technique Volume Rendering
At our institution, all postmortem CT exams are performed Volume rendering, on the other hand, is a well-established
according to a standardized protocol (Table 1) using a 128-slice technique used in CT imaging for visualizing volumetric data. It
multidetector CT Somatom Definition AS (Siemens Healthineers involves the direct rendering of the raw voxel data obtained from
AG, Erlangen, Germany). The acquired data is reconstructed into CT scans, using transfer functions and rendering algorithms to
axial bone and soft tissue images with a slice thickness of 0.6 mm. transform the data into a 3D representation. By assigning color
Sagittal and coronal reformations are stored at a slice thickness of 1 and opacity to different tissue densities, volume rendering enables
mm. More complex reconstructions (oblique or curved planes, 3D the visualization of internal structures and highlights anatomical
VR Reconstructions, etc.) can be extracted from the stored thin- abnormalities. It provides insights into the spatial relationships
slice images later if needed. This protocol can be flexibly adapted and distribution of tissues within the volume, aiding in the
to specific research questions or regions can be supplemented or detection and characterization of pathologies. Volume rendering
selectively investigated. offers flexibility in adjusting the transparency and color mapping,
allowing radiologists to optimize the visualization for specific
Post-processing Techniques for Cinematic Rendering diagnostic purposes. Compared to traditional imaging methods
We utilized dedicated workstations equipped with the Cinematic such as volume rendering and surface rendering, 3D cinematic
Rendering package for image reconstruction. This product is rendering offers a transformative visual experience. By simulating
commercially available and is used by us for image reconstruction the interaction of light with different tissues and materials within
purposes. Image rendering was performed using syngo.via version the human body, it creates visually stunning renderings that
8.7 and the syngo.via Enterprise Browser (Siemens Healthineers, closely resemble the actual anatomical structures. The resulting
Erlangen, Germany). The initial raw datasets, as discussed in images exhibit lifelike textures, shadows, and reflections, enabling
the imaging technique section, were imported into the program clinicians to gain a deeper understanding of the complex spatial
to perform subsequent reconstructions such as MPR (Multi- relationships and anatomical variations. Despite its numerous
Planar Reconstruction), VRT (Volume Rendering Technique), or benefits, it is important to acknowledge certain limitations of 3D
Cinematic Rendering with optimal display and quality. cinematic rendering. The computational complexity and time-
consuming nature of generating highly realistic renderings can

Table 1: Post mortem Computed Tomography Scan Protocol.

Reference Tube Care Dose 4D / Care Rotation time
Region Tube Voltage (kVp) Field of View (mm) Collimation (mm) Pitch factor
current (mA) kV (s)
Head and Neck 120 350 on / off 300 40x0.6 0.35 1
Body and extremities 120 500 on / on 128x0.6 0.35 1

Int J Forens Sci Res, 2024 Volume 1 | Issue 1 | 2 of 5

impact workflow efficiency, particularly in time-sensitive clinical Multidimensional Exploration of Skeletal Trauma
scenarios. Validation and verification against gold standard The enhanced visualization capabilities of 3D cinematic rendering
imaging techniques are crucial to ensure accuracy and reliability. facilitate a more thorough examination and understanding of spatial
Moreover, the interpretation of cinematic rendering images may relationships within a forensic scene. This multidimensional format
be subjective and dependent on the expertise and experience of the allows investigators to explore different angles, aiding in better
user, necessitating ongoing efforts for standardization and training. reconstruction and visualization of the crime scene, identifying
patterns, and conveying complex forensic findings in court.

In the forensic context, visualizing skeletal trauma is crucial for

reconstructing events, determining the cause of death, and expert
testimony. Traditional methods like 2D radiographs and CT scans
have limitations in representing the complex three-dimensional
nature of trauma and spatial relationships. 3D cinematic rendering
captures fractures, dislocations, and foreign objects, offering a
comprehensive view of trauma. An advantage is its interactive
exploration, allowing forensic experts to dynamically rotate, zoom
in, and examine the trauma site. This aids in understanding spatial
relationships, fracture patterns, bone fragments, and soft tissue
damage. Such exploration assists in reconstructing the sequence
of events, determining the cause and manner of death (Figure 3-5).

Figure 1: Multiple fractures of the midface as well as the fronto-temporo-

parietal skull cap with significant emphasis on the frontal bone, within the
context of a severe blunt force traumatic brain injury. In the upper row, the
reconstructions of cinematic rendering are shown, which, in comparison
to the reconstructions of VRTs in the lower row, depict the fractures in
much more detail and clarity. Overall, cinematic rendering provides a
much more realistic visual impression.

Figure 3: Cinematic rendering of an extensive cranial brain injury with

multiple impression fractures of the frontal bone. Dorsal view through the
cranial vault towards the frontobase.

Figure 2: Extensive osseous destruction of the entire skeletal system

with deformation of the bony thorax, spine, extremities, and cranial vault,
resulting from a suicide attempt by jumping in front of a train. On the left
Figure 4: Same case as in Figure 3: Cinematic rendering of extensive
side, the VRT (Volume Rendering Technique) reconstruction, and on the
impression fractures of the left parietal cranial vault. Ventral view.
right side, the cinematic rendering.

Int J Forens Sci Res, 2024 Volume 1 | Issue 1 | 3 of 5

 This realism enhances event recreation and visualization in
forensic investigations. Dynamic, multidimensional visualizations
allow exploration of various angles, aiding in reconstructing the
sequence of events, identifying potential causes, and determining
the manner of death. This realistic approach also improves
evidence presentation in court, resulting in more compelling and
accurate forensic findings (Figure 6,7).

Figure 5: Multifocal fractures of the trunk with bilateral series rib

fractures, transsection and dislocation of the thoracic spine, as well as
multiple avulsion fractures of the right-sided lumbal transverse processes.
The conventional CT images on the left side and in the middle can only depict
the fractures in one plane or at one location. The cinematic rendering on the
right side represents the multiple fractures in their entirety and complexity.

Highly Realistic Visualizations with Cinematic Rendering

The advantage of 3D cinematic rendering in forensic imaging lies
in its lifelike precision when recreating evidence. By incorporating
the aforementioned realistic lighting, shadows, and textures, the Figure 7: Cinematic rendering from dorsal (left) and ventral (right) views:
rendered images closely mimic the actual crime scene or object, Multifocal skeletal injuries resulting from a rollover trauma caused by an
aiding in understanding spatial relationships, identifying patterns, excavator. Right-sided series rib fractures, disruption of the left iliosacral
and drawing conclusions about evidence. joint, fracture of the upper and lower pubic rami on the left, fracture
of the lower pubic ramus on the right, fracture of the right acetabulum,
distal femur fracture on the right with significant dislocation and mid-
shaft fracture of the right fibula and tibia with 180-degree torsion (note
the misrotated right foot).

Results
The systematic pictorial review conducted on the application of
cinematic rendering (CR) in skeletal trauma analysis revealed
several significant findings. These findings highlight the
advantages of CR over conventional imaging and rendering
methods and underscore its potential for transforming forensic
imaging practices.

One key finding is that CR provides superior visualization

Figure 6: Left side, lateral view: Cinematic Rendering of a subtle fracture capabilities compared to traditional imaging techniques. By
of the petrous bone with a delicately delineated fracture and fracture- leveraging advanced algorithms and rendering techniques, CR
related occlusion of the external auditory canal. generates highly detailed and realistic visualizations of skeletal
Right side, lateral view: Cinematic Rendering of the normal anatomy of trauma. These visualizations surpass the limitations of conventional
the petrous bone with well-defined external auditory canal. imaging methods, such as computed tomography (CT) and
Thick arrows: Tracheal tube. magnetic resonance imaging (MRI), in terms of their ability to
Int J Forens Sci Res, 2024 Volume 1 | Issue 1 | 4 of 5
accurately depict complex skeletal injuries. The enhanced level analysis, and ultimately facilitating justice through robust forensic
of detail and accuracy offered by CR enables forensic experts to evidence.
identify and assess skeletal injuries with unprecedented precision.
Furthermore, CR allows for interactive exploration of the trauma References
site from various angles. Forensic experts can manipulate the 1. Spies AJ, Steyn M, Prince DN, et al. Can forensic
rendered images and examine the trauma scene from different anthropologists accurately detect skeletal trauma using
perspectives. This interactive feature of CR contributes to a radiological imaging? Forensic Imaging. 2021; 24: 200424.
comprehensive understanding of the injury pattern by providing a
2. Obertova Z, Leipner A, Messina C, et al. Postmortem imaging
multi-dimensional view of the trauma site.
of perimortem skeletal trauma. Forensic Sci Int. 2019; 302:
Another notable finding is that CR enables the creation of highly 109921.
realistic visualizations. The photorealistic nature of CR-generated 3. Dappa E, Higashigaito K, Fornaro J, et al. Cinematic rendering
images enhances the comprehension of complex forensic findings - an alternative to volume rendering for 3D computed
for both experts and non-experts, including legal professionals. The tomography imaging. Insights Imaging. 2016; 7: 849-856.
highly detailed and visually engaging nature of CR visualizations 4. Eid M, De Cecco CN, Nance JW Jr, et al. Cinematic Rendering
facilitates effective communication of findings in the courtroom. in CT: A Novel, Lifelike 3D Visualization Technique. AJR
This improved communication of findings enhances the impact Am J Roentgenol. 2017; 209: 370-379.
and credibility of forensic evidence, potentially influencing legal 5. Soyer P. Cinematic rendering: When virtuality comes true.
outcomes. Diagn Interv Imaging. 2019; 100: 465-466.
6. Johnson PT, Schneider R, Lugo-Fagundo C, et al. MDCT
Conclusion
Angiography With 3D Rendering: A Novel Cinematic
The incorporation of CR in forensic imaging offers numerous
advantages. Its ability to produce photorealistic 3D renderings Rendering Algorithm for Enhanced Anatomic Detail. AJR
enhances the spatial comprehension of skeletal trauma, leading to Am J Roentgenol. 2017; 209: 309-312.
improved accuracy in injury identification and characterization. 7. Berger F, Ebert LC, Kubik-Huch RA, et al. Application of
CR also enables the visualization of subtle fractures and complex Cinematic Rendering in Clinical Routine CT Examination of
injury patterns that may be challenging to interpret using traditional Ankle Sprains. AJR Am J Roentgenol. 2018; 211: 887-890.
imaging methods alone. Moreover, the interactive nature of CR 8. Rowe SP, Fritz J, Fishman EK. CT evaluation of
allows for real-time manipulation and exploration of the trauma musculoskeletal trauma: initial experience with cinematic
scene, providing valuable insights into injury dynamics and rendering. Emerg Radiol. 2018; 25: 93-101.
possible mechanisms. 9. Rowe SP, Zinreich SJ, Fishman EK. 3D cinematic rendering
of the calvarium, maxillofacial structures, and skull base:
Cinematic rendering represents a significant advancement
preliminary observations. Br J Radiol. 2018; 91: 20170826.
in forensic imaging for the analysis of skeletal trauma. Its
enhanced visualization capabilities, coupled with its ability to 10. Chu LC, Rowe SP, Fishman EK. Cinematic rendering of skin
accurately depict complex injury patterns, make it a valuable and subcutaneous soft tissues: potential applications in acute
tool for radiologists and forensic experts in their analysis and trauma. Emerg Radiol. 2019; 26: 573-580.
interpretation. With further development and integration into 11. Boven J, Boos J, Steuwe A, et al. Diagnostic value and forensic
routine forensic practice, CR has the potential to revolutionize relevance of a novel photorealistic 3D reconstruction technique
the field, improving the accuracy and reliability of skeletal trauma in post-mortem CT. Br J Radiol. 2020; 93: 20200204.

© 2024 Wallner-Essl WM, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

Int J Forens Sci Res, 2024 Volume 1 | Issue 1 | 5 of 5