A Diagnostic Algorithm for Reconstructing the Direction of Gunshots Using OsiriX and Maya in Living Patients: A Forensic Radiology Approach

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

I have checked the current form of the paper and I see it is considerably better. It is a nice, short contribution and I can predict it will be cited among the specialists in the field. However, there are a few things I would like the authors to make. These are all necessary changes, and they must be incorporated prior to final acceptance.

1) ZIP code should be used for all affiliations

2) line 94, documentation

3)Figure 1, please capitalize the different words of the workflow, as in the text, for consistency

4)Figure 2, "one of the shooters" (add the)

5) line 321, delete full stop prior to [10].

Comments on the Quality of English Language

Language-wise, although the English is intelligible, I think it is quite clear that the authors are not native speaker, and I strongly recommend they have the paper read by a professional translator or by a native colleague prior to final submission. This will make a great difference.

Author Response

The file is attached

Author Response File: Author Response.pdf

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

Thank you for the revison version . This version is acceptable

Author Response

the file is attached

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I have read this paper with interest and I indeed see some merit, however, a few changes have to be made prior to publication. 

Line 10: should Radiology Department be Radiology Division?

If this is a different department, then it should be spelled out as a separate affiliation

Line 12: the correct name is Marche Polytechnic University, please replace it

Line 278: please delete “About….applicability” so that the sentence starts from Beyond.

Line 386: Just write “not needed” to avoid repetition

Line 389: replace I with We, because there are multiple authors.

This article presents an innovative workflow integrating clinical software (OsiriX) and 3D modeling (Maya). However, the originality would be better demonstrated by more explicitly comparing this methodology with already published protocols for forensic trajectory reconstruction (e.g., Riva et al., Int J Legal Med, 2021).
I suggest adding a table or paragraph comparing the present algorithm with pre-existing methods (PMCT-based, 3D Slicer, Blender, etc.), highlighting specific advantages and limitations.
1. Statistical Analysis
The Results section reports descriptive data (times, angles, forensic utility) but no statistical analysis. At least a quantitative summary (mean, standard deviation, range, ICC) should be added to strengthen the reliability of the method.
2. The use of Autodesk Maya is original but poorly explained technically. It is unclear how the data transfer occurs (e.g., coordinate system, metric scale, alignment with anthropometric models).
I suggest describing in detail the import/export process (STL or DICOM 3D format, metric calibration) and whether the reconstruction in Maya is quantitatively consistent with the OsiriX data.
3. Clinical vs. Forensic Relevance
The work oscillates between clinical and forensic purposes, but does not clarify the application priority.
It would be necessary to define whether the primary objective is clinical use (support for the surgeon) or forensic use (evidentiary documentation), as the requirements for accuracy and validation differ.

Author Response

In attached the reply to reviewer 1 

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

This manuscript presents an interesting 7-step diagnostic algorithm for analyzing gunshot wound direction from MDCT data in living patients, combining OsiriX for internal modeling with Autodesk Maya for external scene simulation.  While the authors claim this method is reproducible and holds high utility for forensic work, I have significant concerns about the study's methodology and conclusions.

My primary concern lies with the claims of reproducibility and validation in forensic aspect. The number of cases(10) is too small to claim about the method's reliability. Furthermore, the study lacks rigorous statistical validation.

Secondly, the use of Autodesk Maya to depict shooter and victim positions moves from reconstruction to speculation is over interpretation. A CT scan can only reveal the internal trajectory relative to the patient's supine position on the scanner. It cannot, by itself, be used to determine the external dynamics of the shooting scene.

Finally, the work is clearly framed as a study on Living Patients but in the Institutional Review Board Statement, it clearly states that consent was obtained from the relatives of the deceased. This is an inconsistency that raises a question about the reliability of the data

 

Author Response

In attached the reply to reviewer 2

Author Response File: Author Response.docx