The computed tomography scanning machines at Inova Alexandria Hospital are typically used to diagnose strokes, blood clots and other internal injuries. But recently the hospital utilized its CT scanners for an unconventional purpose: to examine the skulls of deceased children who have gone unidentified for years. Over the past year, the National Center for Missing & Exploited Children joined forces with the radiology department at Inova to help unlock the mysteries behind three such cold cases, plus that of one adult. ¶ “It’s already a horrible story by the time the skull gets here,” says Joe Mullins, a forensic imaging specialist at NCMEC, a nonprofit based in Alexandria. “Opening up a little box and pulling out the skull of a 7- or 8-year-old who has been found in the woods is tough. But someone’s got to do it, so we use our powers for good to help find missing children and help give them their names back.”

Mullins’s job seems straight out of “Bones” or “CSI.” He uses Adobe Photoshop to reconstruct what the victim looked like, building virtual layers of muscle and skin based on the person’s presumed ancestry and age. A technology called FreeForm modeling allows him to feel the work he’s doing on the computer screen as if it were clay, via a joysticklike arm called a Phantom. The image is then distributed on flyers and to the media in hopes of sparking recognition among the victim’s acquaintances.

But to do facial reconstruction, Mullins first needs to have the skull digitized with a CT scan, which can produce three-dimensional images using X-ray and computer technology. Mullins has been employing this method — CT scan, FreeForm and Photoshop — for about five years. He knows of only two or three other forensic artists in the world who use it. Most forensic artists reconstruct skulls using molding clay as a stand-in for soft tissue.

Although she has never used the technology, Barbara Anderson, a forensic artist with the California Department of Justice, thinks it is especially valuable in cases where the skull is old and fragile, because the specimen receives less handling.

“I think it’s allowing people to do things they’ve never been able to do before with cold cases,” she says. “Only time will tell if it will replace clay.”

Mullins and Anderson both cite the expense of the software as the reason that more forensic artists haven’t gone digital. But just because the technology seems more sophisticated, it’s not necessarily better, Anderson says.

“Your success is all vested in the artist’s ability, 100 percent,” Anderson says. “You can have the best tools in the world, but if your artist doesn’t take the time to understand the case and the bones, you’re not going to get a good likeness.”

Getting creative

For years, Mullins used the CT scanner at the Smithsonian’s National Museum of Natural History, where the machine is normally devoted to examining artifacts such as mummies, dinosaur bones and Stradivarius violins. There, physical anthropologist David Hunt analyzed skulls to find out the victim’s ancestry, general health and any identifying details. But Hunt’s machine broke a little more than a year ago, so NCMEC had to get creative when authorities in Provincetown, Mass., sent in the skull of the “Lady in the Dunes,” a murder victim whose body was discovered on a Cape Cod beach in 1974. Mullins couldn’t start the facial reconstruction without a CT scan.

That’s where Inova Alexandria came in. John Rabun, the executive vice president of NCMEC, contacted a longtime professional friend, Christine Candio, the chief executive of Inova Alexandria.

“We felt that if in any small way we could help identify this poor woman and bring closure to her family, that would be an honor,” Candio says. The Provincetown police department released the new “Lady in the Dunes” image in May 2010. The case is still unsolved.

The hospital’s CT clinical coordinator, Robert Winters, says that his department was thrilled about the project. “The whole team was like, ‘I want to see it and be part of it.’ ”

The Smithsonian’s CT machine has since been repaired, so NCMEC is back to doing scans there. But officials at NCMEC are hoping that the partnership with the hospital will inspire law enforcement offices around the country to work with local medical centers to do CT scans. That way, the images could be sent to Mullins and he could begin the digital reconstruction immediately. In the bigger picture, a streamlined process could help law enforcement solve all kinds of cold cases, not just those of children.

“It could help out the thousands of other skulls — just in the U.S. — that are sitting in medical examiner’s offices on a shelf and nobody knows what to do with them,” Mullins says.

A small part of the job

Skull reconstruction is a small part of Mullins’s job. He spends much of his time on age progressions: taking a photo of a child who has been missing for more than two years and creating an image of what he or she would look like now. Often he uses pictures of the child’s siblings and parents to imagine the most accurate rendering. He also has the sobering task of taking morgue photos of children and, as he puts it, “bringing them back to life digitally,” so their image can be released to the media.

Mullins, who has a degree in fine art and graphic design from James Madison University, handles all of the center’s skull reconstructions. Among his cases was that of a unidentified woman whose body was found in 2006 in a shallow grave near Los Angeles. The police commissioned a sketch, which was done by photographing the skull, having it analyzed by a medical examiner or forensic anthropologist and handing over the information to an artist. The sketch circulated for two years with no results.

“If it’s a case where no new leads have come in and [the police] hear we have this new technology, they’ll send us a skull to redo,” Mullins says. “It’s after they’ve exhausted all of their resources. I’m not out on the scene, like on TV shows.”

He received the skull in 2008 and sent it to Hunt at the Smithsonian. Hunt determined that the remains belonged to a female of Hispanic and African American heritage who was in her late teens or early 20s, in good health and with healthy teeth.

“If she’d had a huge fracture or a deviated septum or crazy teeth, that’s great for a forensic artist because it is something that will translate into the soft tissue,” Mullins says.

That wasn’t the case for this skull, but Hunt did give Mullins another clue: He said her nose looked like Dionne Warwick’s. (Hunt often gives Mullins celebrity comparisons.)

Narrowing the possibilities

Sometimes Hunt can look at a skull and immediately know the ancestry, he says, but other times it’s not so easy. In those cases, measuring the skull helps him narrow down the possibilities.

Starting with the CT image of the skull and Hunt’s advice, Mullins began using Photoshop to rebuild the woman’s face. The projection and width of the nose, the projection of the ears, the location of the eyebrows and even an estimate of the hairline —“all of that information about the soft tissue of the face is etched into the skull,” Mullins says.

Mullins uses formulas for calculating the placement and measurement of facial features based on a person’s ancestry.

Hunt and Mullins can’t determine a person’s weight just from a skeleton. But sometimes the remains are accompanied by items of clothing, which can hint at the victim’s weight.

The digital reconstruction took about a week. Law enforcement officers released the new image at a public meeting in June 2008. A city councilman saw the image and told the police it might be Stephanie Quezada, who disappeared in 2005 at age 20. A flyer with her picture on it had been hanging in his office for years.

Four months later, DNA results confirmed that the skull was that of Quezada.

Of the 30 or so digital reconstructions that NCMEC has done over the last five years, Quezada’s is the only cold case that has been solved using the new technology. But Mullins is optimistic that there will be more successes.

“Hope is what gets me out of bed every day to come to work,” he says. “If I didn’t have hope, I couldn’t do my job.”