title: "Drug mules" as a radiological challenge: sensitivity and specificity in identifying internal cocaine in body packers, body pushers and body stuffers by computed tomography, plain radiography and Lodox.
abstract: OBJECTIVE
  The purpose of our study was to retrospectively evaluate the specificity, sensitivity and accuracy of computed tomography (CT), digital radiography (DR) and low-dose linear slit digital radiography (LSDR, Lodox(®)) in the detection of internal cocaine containers.
  
  
  METHODS
  Institutional review board approval was obtained. The study collectively consisted of 83 patients (76 males, 7 females, 16-45 years) suspected of having incorporated cocaine drug containers. All underwent radiological imaging; a total of 135 exams were performed: nCT=35, nDR=70, nLSDR=30. An overall calculation of all "drug mules" and a specific evaluation of body packers, pushers and stuffers were performed. The gold standard was stool examination in a dedicated holding cell equipped with a drug toilet.
  
  
  RESULTS
  There were 54 drug mules identified in this study. CT of all drug carriers showed the highest diagnostic accuracy 97.1%, sensitivity 100% and specificity 94.1%. DR in all cases was 71.4% accurate, 58.3% sensitive and 85.3% specific. LSDR of all patients with internal cocaine was 60% accurate, 57.9% sensitive and 63.4% specific.
  
  
  CONCLUSIONS
  CT was the most accurate test studied. Therefore, the detection of internal cocaine drug packs should be performed by CT, rather than by conventional X-ray, in order to apply the most sensitive exam in the medico-legal investigation of suspected drug carriers. Nevertheless, the higher radiation applied by CT than by DR or LSDR needs to be considered. Future studies should include evaluation of low dose CT protocols in order to address germane issues and to reduce dosage.
authors.affiliation: Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland. patricia.flach@irm.uzh.ch
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flach
authors.forename: Steffen G
authors.initials: SG
authors.lastname: Ross
authors.forename: Garyfalia
authors.initials: G
authors.lastname: Ampanozi
authors.forename: Lars
authors.initials: L
authors.lastname: Ebert
authors.forename: Tanja
authors.initials: T
authors.lastname: Germerott
authors.forename: Gary M
authors.initials: GM
authors.lastname: Hatch
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.forename: Michael A
authors.initials: MA
authors.lastname: Patak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003042:Cocaine / Q000032:analysis*; D003415:Crime / Q000517:prevention & control*; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis*; D006801:Humans; D013287:Illicit Drugs / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection / Q000379:methods*; D013557:Switzerland; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014195:Travel; D055815:Young Adult
chemical_list: D013287:Illicit Drugs; D003042:Cocaine