Low-Dose Computed Tomography for the Detection of Cocaine Body Packs: Clinical Evaluation and Legal Issues

Purpose: To discuss the juridical basis for CT examinations of cocaine body packers and to evaluate the clinical implementation of a tube current reduction-based low-dose CT protocol. Materials and Methods: A literature search was performed to discuss the legal basis regarding the problem, the procedures, the potential harm and the proportionality. Retrospective evaluation of 8 patients who had undergone a low-dose CT scan (body mass index < 25 kg/m(2) 30 mAs; > 25 kg/m(2) 60 mAs) during the time period from February until October 2009 in order to exclude or to assess remaining cocaine body packs was approved by the institutional review board. The detectability and condition of the body packs were analyzed. Effective doses were calculated. Results: German jurisdiction does not distinguish between plain film X-ray and CT examinations. Both plain film X-ray and CT examination require a judicial warrant. However, examination results might still remain valid if a warrant was not requested. In 8 examinations (30 mAs n =3, 60 mAs n = 5, mean BMI 25.9 +/- 3.2.) a total of 34 body packs were correctly identified. The mean density of the body packs was 74.4 +/- 31.9 HU (range 17 - 154 HU) with a cocaine content between 22.5% and 72.8%. The mean estimated radiation dose was 2.23 +/- 0.72 mSv. Conclusion: Although medical legal aspects do not specify the diagnostic procedure to be performed, the high diagnostic accuracy and applied radiation dose reduction could establish low-dose CT as the method of choice for detecting cocaine body packs, thereby potentially avoiding future legal problems.