and specific for electric current trauma. Absence of these specific changes in a biopsy specimen does not mitigate against a diagnosis of electric shock torture, and judicial authorities must not be permitted to make such an assumption. Unfortunately, if a court requests a petitioner alleging electric shock torture to submit to a biopsy for confirmation of the allegations, refusal to consent to the procedure or a negative result is bound to have a prejudicial impact on the court. Furthermore, clinical experience with biopsy diagnosis of torture-related electrical injury is limited, and the diagnosis can usually be made with confidence from the history and physical examination alone. suspension torture. In the acute period, oedema, fluid collection on and around the shoulder joint, lacerations and haematomas of the rotator cuffs can be observed by ultrasound. Re-examination with ultrasound and finding that the evidence in the acute period disappears over time strengthen the diagnosis. In such cases, MRI, scintigraphy and other radiological examinations should be carried out together, and their correlation should be examined. Even without positive results from other examinations, ultrasound findings alone are adequate to prove suspension torture. (c) Computerized tomography This procedure is, therefore, one that should be done in a clinical research setting and not promoted as a diagnostic standard. In giving informed consent for biopsy, the person must be informed of the uncertainty of the results and permitted to weigh the potential benefit against the impact upon an already traumatized psyche. CT is excellent for imaging soft tissue and bone. However, MRI is better for soft tissue than bone. MRI may detect an occult fracture before it can be imaged by either routine radiographs or scintigraphy. Use of open scanners and sedation may alleviate anxiety and claustrophobia, which are prevalent among torture survivors. CT is also excellent for diagnosing and evaluating fractures, especially temporal and facial bones. Other advantages include alignment and displacement of fragments, especially spinal, pelvic, shoulder and acetabular fractures. It cannot identify bone bruising. CT with and without intravenous infusion of a contrast agent should be the initial examination for acute, sub-acute and chronic central nervous system (CNS) lesions. If the examination is negative, equivocal or does not explain the survivor’s CNS complaints or symptoms, proceed to MRI. CT with bone windows and a pre- and post-contrast examination should be the initial examination for temporal bone fractures. Bone windows may demonstrate fractures and ossicular disruption. The pre-contrast examination may demonstrate fluid and cholesteatoma. Contrast is recommended because of the common vascular anomalies that occur in this area. For rhinorrhea, injection of a contrast agent into the spinal canal should follow a temporal bone. MRI may also demonstrate the tear responsible for leakage of the fluid. When rhinorrhea is suspected, a CT of the face with soft tissue and bone windows should be performed. Then a CT should be obtained after a contrast agent is injected into the spinal canal. (a) Rationale for biopsy There has been extensive laboratory research measuring the effects of electric shocks on the skin of anaesthetized pigs.b,c,d,e,f,g This work has shown that there are histologic findings specific to electrical injury that can be established by microscopic examination of punch biopsies of the lesions. However, further discussion of this research, which may have significant clinical application, is beyond the scope of this publication. The reader is referred to the footnote references for additional information. Few cases of electric shock torture of humans have been studied histologically.h,i,j,k Only in one case, where b H. K. Thomsen and others, “Early epidermal changes in heat and electrically injured pigskin: a light microscopic study”, Forensic Science International, vol. 17 (1981), pp. 133-143. c Ibid., “The effect of direct current, sodium hydroxide and hydrochloric acid on pig epidermis: a light microscopic and electron microscopic study”, Acta Pathol. Microbiol. Immunol. Scand, vol. 91 (1983), pp. 307-316. d H. K. Thomsen, “Electrically induced epidermal changes: a morphological study of porcine skin after transfer of low-moderate amounts of electrical energy”, dissertation (University of Copenhagen, F.A.D.L., 1984), pp. 1-78. e T. Karlsmark and others, “Tracing the use of torture: electrically induced calcification of collagen in pigskin”, Nature, vol. 301 (1983), pp. 75-78. f Ibid., “Electrically induced collagen calcification in pigskin: a histopathologic and histochemical study”, Forensic Science International, vol. 39 (1988), pp. 163-174. g T. Karlsmark, “Electrically induced dermal changes: a morphological study of porcine skin after transfer of low to moderate amounts of electrical energy”, dissertation, University of Copenhagen, Danish Medical Bulletin, vol. 37 (1990), pp. 507-520. h L. Danielsen and others, “Diagnosis of electrical skin injuries: a review and a description of a case”, American Journal of Forensic Medical Pathology, vol.12 (1991), pp. 222-226. i F. Öztop and others, “Signs of electrical torture on the skin”, Treatment and Rehabilitation Center Report 1994 (Human Rights Foundation of Turkey), vol. 11 (1994), pp. 97-104. j L. Danielsen, T. Karlsmark, H. K. Thomsen, “Diagnosis of skin lesions following electrical torture”, Rom. J. Leg. Med., vol. 5 (1997), pp. 15-20. k H. Jacobsen, “Electrically induced deposition of metal on the human skin”, Forensic Science International, vol. 90 (1997), pp. 85-92. (d) Magnetic resonance imaging MRI is more sensitive than CT in detecting CNS abnormalities. The time course of CNS haemorrhage is divided into immediate, hyperacute, acute, sub-acute and chronic phases and CNS haemorrhage has ranges that correlate with imaging characteristics of the haemorrhage. Thus, the imaging findings may allow estimation of the timing of head injuries and correlation to alleged incidents. CNS haemorrhage may completely resolve or produce sufficient haemosiderin deposits for the CT to be positive even years later. Haemorrhage in soft tissue, especially in muscle, usually resolves completely, leaving no trace, but, in rare cases, it can ossify. This is called heterotrophic bone formation or Myositis ossificans and is detectable with CT. 2. Biopsy of electric shock injury Electric shock injuries may, but do not necessarily, exhibit microscopic changes that are highly diagnostic 62