Walking on thin ice! Identifying methamphetamine "drug mules" on digital plain radiography

The purpose of this study was to retrospectively evaluate the sensitivity, specificity and accuracy of identifying methamphetamine (MA) internal payloads in "drug mules" by plain abdominal digital radiography (DR). The study consisted of 35 individuals suspected of internal MA drug contain...

Full description

Saved in:

Bibliographic Details
Published in:	British journal of radiology Vol. 87; no. 1036; p. 20130472
Main Authors:	Abdul Rashid, S N, Mohamad Saini, S B, Abdul Hamid, S, Muhammad, S J, Mahmud, R, Thali, M J, Flach, P M
Format:	Journal Article
Language:	English
Published:	England The British Institute of Radiology 01-04-2014
Subjects:	Adult Animals Cross-Sectional Studies Drug Trafficking - prevention & control Female Forensic radiology special feature: Full paper Humans Male Methamphetamine Middle Aged Radiographic Image Enhancement Radiography, Abdominal - methods Retrospective Studies Sensitivity and Specificity Tomography, X-Ray Computed - methods
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	The purpose of this study was to retrospectively evaluate the sensitivity, specificity and accuracy of identifying methamphetamine (MA) internal payloads in "drug mules" by plain abdominal digital radiography (DR). The study consisted of 35 individuals suspected of internal MA drug containers. A total of 59 supine digital radiographs were collected. An overall calculation regarding the diagnostic accuracy for all "drug mules" and a specific evaluation concerning the radiological appearance of drug packs as well as the rate of clearance and complications in correlation with the reader's experience were performed. The gold standard was the presence of secured drug packs in the faeces. There were 16 true-positive "drug mules" identified. DR of all drug carriers for Group 1 (forensic imaging experienced readers, n = 2) exhibited a sensitivity of 100%, a mean specificity of 76.3%, positive predictive value (PPV) of 78.5%, negative predictive value (NPV) of 100% and a mean accuracy 87.2%. Group 2 (inexperienced readers, n = 3) showed a lower sensitivity (93.7%), a mean specificity of 86%, a PPV of 86.5%, an NPV of 94.1% and a mean accuracy of 89.5%. The interrater agreement within Group 1 was 0.72 and within Group 2 averaged to 0.79, indicating a fair to very good agreement. DR is a valuable screening tool in cases of MA body packers with huge internal payloads being associated with a high diagnostic insecurity. Diagnostic insecurity on plain films may be overcome by low-dose CT as a cross-sectional imaging modality and addressed by improved radiological education in reporting drug carriers on imaging. Diagnostic signs (double-condom and halo signs) on digital plain radiography are specific in MA "drug mules", although DR is associated with high diagnostic insecurity and underreports the total internal payload.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0007-1285 1748-880X
DOI:	10.1259/bjr.20130472