'It's quite morbid with all the gunshot injuries'
As Ireland's first forensic radiologist, Dr Ferdia Bolster is used to looking for clues in murder victims, writes Wayne O'Connor
Deep within the bowels of the emergency department at Dublin's Mater Hospital is a radiology unit that doubles up as a forensic lab. It looks innocuous but is used to help those fighting crime. Think of hit TV shows like Bones, CSI and Cold Case Files and you are on the right track.
In the hours after a killing, the victim's body will typically remain at a crime scene for investigators to carry out crucial tests. They will do ballistic analysis, check for blood splatter and do a series of forensic checks before the body is removed.
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Previously, most bodies were taken to the Office of the State Pathologist for further analysis and an autopsy. Now, thanks to advanced technology, the bodies will first make their way to the Mater Hospital in a specially adapted ambulance to be studied by a leading radiologist.
Dr Ferdia Bolster is not a normal radiologist. As well as carrying out clinical work at the hospital, as patients come and go from its state-of-the-art radiology unit, Dr Bolster works as a forensic expert.
He leads a team specialising in the scanning of bodies to identify traumas, fatal injuries, bullets, knives and other objects that may have entered a victim's body during the course of a gruesome killing.
"It is quite a morbid thing," Dr Bolster told the Sunday Independent. "It does linger and stay with you so it does take some getting used to."
He graduated from UCD in 2006 before pursuing a career in radiology - diagnosing and treating injuries and medical conditions with imaging techniques such as CT (computerised tomography) scanning, X-rays and MRI (magnetic resonance imaging).
In 2014, he was looking to improve his skill set when he spoke to Professor Barry Daly, the director of forensic radiology at the University of Maryland in the US. Dr Bolster realised forensic imaging was not something that was done in Ireland at the time so he embarked on a scholarship programme to learn how his work could help those fighting crime.
"It is definitely new and novel in Ireland," he said. "There are a few other radiologists who have done some post-mortem imaging on an ad hoc basis. It has been done as well in Tallaght and the Midlands but we have a more formalised process here in the Mater Hospital and I would be considered a forensic radiologist with formal training, which is unique to the Irish system."
Dr Bolster returned to Ireland in 2016 after two years in the US, when the number of shootings linked to gangland crime and the Hutch-Kinahan feud was at its height.
"The most common one that we do is the gunshot injuries - the ballistic injuries," he said. "I have been sitting watching TV on a Saturday evening when I got a notification on my phone saying there had been a shooting with confirmed injuries in west Dublin. Then I got a phone call about an hour later from the State Pathologist. When my phone was ringing, I knew the person had died and I would be doing a CT scan that evening or the following morning, depending on how long they wanted to keep the body at the scene.
"When a body is on the way to Whitehall, to the Office of the State Pathologist in north Dublin, they will stop here in the Mater Hospital to get the CT scan in advance of their autopsy.
"Most recent high-profile cases of gunshot injuries in the past two years have had forensic imaging done here as part of their autopsy procedure.
"The main initial question that the Office of the State Pathologist has is 'Can we identify if there are any bullets within the body and where they are located?' It helps them retrieve them at the time of autopsy. We can help them try to determine the course of the bullet, which is what they try to do at autopsy also, and any injuries that may have been inflicted that can be attributed to death."
Despite the surge in shootings and an increased workload in recent years, Dr Bolster seldom knows who he is scanning or why they have been killed.
"These bodies get a completely anonymised medical record number. It doesn't matter to me who they are. The only thing we ask for is an identification number," he added.
"I have no personal interest in who the individual may be and usually only find out by reading newspapers subsequently. I don't think you should let that cloud your judgement and it is not of major interest. My interest is in what the CT adds to the autopsy and what the pathologist wants me to be able to tell them, rather than judging why somebody may have been shot."
The body is brought to the hospital's emergency department and put through a CT scanner. The State Pathologist does not have a scanning unit so a clinical unit is used when it is not occupied by patients.
As well as helping pathologists and gardai to identify victims of shootings and murders, Dr Bolster has helped experts to identify the remains of missing persons and worked with the National Museum of Ireland to identify a hundreds-year-old human skull.
In other cases he has worked with coroners to rule out foul play following the discovery of a body. He has also analysed the victims of car crashes to determine causes of death.
After a body is scanned, Dr Bolster and his team are able to render a 3D image of the remains and explain anomalies and injuries and unearth any other irregularities. Internationally this has been used to help juries in murder trials.
"One of the advantages is that this 3D interpretation is easy for pathologists and laypeople to understand. So if you are presenting evidence it has been shown that the jurors are happy to look at these 3D images, just as if they were watching CSI," he said.
"There are scenarios that cannot be detected at autopsy that we can uncover. There are certain cases where officials are happy to sign the death certificate based on the CT scan and toxicology investigation."
There are many advantages of using a CT scan ahead of an autopsy. They are less intrusive and destructive, and they are also deemed acceptable in cultures and religions where autopsies are forbidden.
However, Dr Bolster admits that efficiencies could be enhanced to help pathologists and gardai further. Internationally, many pathologists would have scanners and similar equipment in their labs, but that is not the case in Ireland.
He said that if that happened here he could analyse the scans from his office in the Mater Hospital without any need for the bodies to be brought to him.
"Here it is more confined by the fact we have a clinical scanner so if somebody has a stroke or there is an emergency the body will be waiting in the ambulance. Patients always get priority. If the person being scanned is deceased there is no rush but there are limitations with access to scanners," said Dr Bolster.
"In an ideal world you would have a scanner in Whitehall and the images would be analysed here with the HSE's national integrated medical imaging service. Using that, I can review all the CT scans done around the country if necessary."