The Ongoing Utility of Historical Military Photofluorographs—Tools to Identify Fallen US Soldiers From Past Wars as Cross-Validated by DNA and Dental Data in 180 Cases

Introduction Mass chest X-ray formed a routine part of induction processes to the US armed forces in the 1940-1950s for tuberculosis screening. Today, the skeletal structure recorded in these medical miniature films serves to identify these same soldiers. In the US military’s accounting/repatriation setting, chest radiograph comparisons have grown to be a primary identification mechanism alongside DNA and dental records. Identifications are now routinely conducted with contributions from miniature radiographic films. This article reviews the miniature radiographic film as an identification tool and provides the first evaluation of findings (180 cases) against gold standards of DNA and dental analyses for the very same cases. Materials and Methods This article reviews both miniature film photofluorographs and the standardized chest radiograph comparison (CXR) protocol employed by the Defense POW/MIA Accounting Agency (DPAA) for identification. Additionally, all DPAA cases (2010-2025) where radiographic CXR resulted in a match result (280) were reviewed for additional DNA and/or dental record findings, providing 180 cases where dual-modality result existed to cross-validation test the radiographic analyses. Results For 172 DNA cases, there was no instance of disagreement between the chest radiograph result and the independently acquired Armed Forces DNA Identification Laboratory’s DNA result. For 8 dental cases reporting a positive match result, the CXR identity finding was identical (both evidence lines identified the same person). To be conservative, we assume that the next future CXR case to be conducted using miniature films will yield an erroneous result, thereby setting a positive predictive value for radiographic comparison of 99.4% (=180 correct results/181 total decisions). Conclusions Miniature chest radiographs provide useful identification-relevant information. DPAA casework provides a rare circumstance to evaluate the accuracy of miniature film radiograph comparisons across a large sample, as multiple independent and parallel lines of analysis exist for single cases. Evaluation of these cases (180 in total) reveals that the military miniature films supply the same name associations that DNA and forensic odontology provide. The positive predictive value is high (99.4%), conservatively assuming the next case to be an incorrect one. This confirms the value of the miniature chest film and CXR methods, when DNA and dental records alone are unable to provide definitive answers.