Postmortem computed tomography (CT) is a medical imaging technique used to examine the body of a deceased individual after death. It is a non-invasive imaging procedure that allows forensic pathologists/forensic radiologist to view her body's anatomy and diagnose pathology without dissection. Postmortem CT has numerous applications, including diagnosis of traumatic injuries and natural disease. Postmortem CT is often referred to as "virtual autopsy" or "virtopsy."

A forensic radiologist is a radiologist with sub specialization in medicolegal image interpretation. Particularly, regarding postmortem examinations. A forensic radiologist has the education and experience to recognize postmortem artifacts and can gauge the postmortem change on an examination to identify the expected limitations on interpretation related to those artifacts. Additionally, a forensic radiologist has experience of radiologic/pathologic correlation. This is a necessary tool which facilitates collaboration between the radiologist and medicolegal death investigators.

It is important for individuals who interpret forensic imaging examinations to have the appropriate education and/or experience required for this role. Inaccurate interpretations have serious medicolegal consequences.

Postmortem computed tomography (CT) works on the same principles as conventional clinical CT scans. It involves the use of X-rays and advanced computer technology to create detailed images of the internal structures of the deceased individual's body.

Numerous research projects and studies have validated the utility of PMCT. In fact, PMCT has been proven to be superior to autopsy for some injuries such as skeletal trauma. This is particularly helpful in cases of blunt force trauma. Furthermore, the absence of injuries on PMCT can be powerful for ruling out foul play in other types of cases such as presumed natural deaths, suicidal hangings, and overdose deaths.

Numerous studies have shown that in many cases PMCT is as reliable as traditional autopsies. (Note: Forensic institutes in Europe, Australia and Japan have been using PMCT in their daily routine for many years – a few major US centers have been doing so as well and the trend is now catching up nationwide.)

Postmortem CT is noninvasive, efficient, preserves the body, and images can be documented and stored indefinitely. 3D representations of the body can be generated to enhance visualization and understanding of complex injuries, allowing for powerful demonstrative aids. Postmortem CT has been proven to be especially useful in diagnosis and documentation of pathology related to blunt force trauma, natural disease, and ballistic injuries. Furthermore, the negative predictive value of atraumatic postmortem CT findings in nonsuspicious cases of hanging, drowning and overdose can improve efficiency in busy medical examiner's offices.

Applications for PMCT include but are not limited to:

• Blunt Force Trauma

• Natural Deaths

• Overdose

• Penetrating Trauma

• Ballistic Trauma

• Unidentified Bodies

• Falls

• Elder & Domestic Partner Abuse

• Decomposition

• Charred Remains

• Infectious Disease Death

• Unknown Cause of Death

• Pediatric Deaths

• Demonstrative Tool (Cross-sectional images, 3D, and Volume renderings)

PMCT is a tool available to medical investigators that can be used according to the needs of their office. In some cases, postmortem CT is utilized as the primary examination to evaluate all cases as a triage mechanism to direct decedents to full autopsy or external examination. Other centers utilize postmortem CT as a secondary examination for specific indications such as homicidal or medical malpractice.

• Noninvasive procedure which does not involve body dissection. This preserves the bodies integrity and can be less emotionally distressing for the family.

• Respect for cultural or religious beliefs. PMCT provides an alternative means of investigation of the body without violating cultural or religious practices, ensuring that the deceased is treated with respect and in accordance to the families beliefs.

• Time efficiency. Postmortem CT is quicker to perform than conventional autopsy, which can help expedite the investigative process. This can allow families to receive information about cause of death in a more timely fashion, allowing for respect of the grieving process and timely facilitation of funeral arrangements.

• Digital documentation of examination findings can be helpful as a reference tool for genetically related family members to share with other medical professionals, if necessary.

CT scanners are now very affordable:

• Remanufactured CT scanners are now available starting $199,999 (1)

• New CT scanners are now available starting $379,999 (2)

Note:

(1) Includes 1-year service contract, ForensicPACS (Year 1) and Forensic Applications Specialist Training.

(2) Includes 2-year service contract, ForensicPACS (Year 1)and Applications Specialist Training – Limited Offer.

PMCT is a validated noninvasive, efficient, and cost-effective tool that is complementary, and in some cases, can be used as an adjunct to conventional autopsy. Ultimately, the decision to implement PMCT in your office should be based on a thorough assessment of the factors mentioned above and a careful evaluation of its potential benefits and limitations in your specific setting.

If you have questions about how PMCT can benefit your office, reach out to the forensic radiology group for consultation.

PMCT is a valuable tool that can enhance forensic investigations, but it does not threaten the jobs of forensic pathologists. Instead, it complements their expertise and contributes to a more comprehensive and well-informed approach to determining the cause of death. The collaboration between forensic pathologists and forensic radiologists is crucial in using PMCT effectively and ensuring that the best possible information is available to support justice and truth-seeking in forensic cases.

PMCT is used as an ancillary test - it does not affect examination findings any more so than any other ancillary test (toxicology, vitreous testing), it is just MORE information.

Defending PMCT interpretation to an attorney is no different than defending interpretation of postmortem cultures, or toxicology, or vitreous testing, or histology.  It is just a test used and interpreted by the pathologist, to their skill level, like any other test or tool.  

PMCT doesn't threaten findings, it actually helps prevent mistakes when calling the cause of death. 

For example, if the pathologist sees something on the PMCT that does NOT correlate well to the history given or the circumstances.

PMCT is a trigger to autopsy that otherwise wouldn't be there.

(ie, coming into triage planning on calling an elderly decedent's cause "COPD" given the circumstances and history, but then seeing hemoperitoneum on the PMCT - this is a trigger to autopsy, to tease out if the hemoperitoneum is from CPR injury, or hemorrhagic pancreatitis, or ruptured artery, etc).  This is just additional info that wouldn't otherwise be there without the PMCT, and would be missed without the PMCT.  Another example is pneumonias, which are frequently caught on PMCT and otherwise would have been missed on an external case.  In summary - rather than threatening findings, it prevents you from calling a wrong cause of death.

Postmortem CT increases efficiency and ultimately brings down costs.

Benefit of time is on the pathologist AND the decedent's family, allowing for quicker processing of death certificates.

Benefit of time is on the autopsy technician - each case external led and not autopsied is less time cleaning, less autopsy tables required for use that day, and overall, less burnout.

Most CT scanners used in Coroner and Medical Examiners are operated by medical death investigators and/or autopsy technicians.

Our Forensic Applications Specialists are here to help you with your CT operation.

Medical death investigators and/or autopsy technicians are trained to operate the CT scanners.

If you can’t afford and/or can’t justify having your own CT scanner – do not despair:

1- Speak with your local hospital / imaging center – to have decedents scanned at their facility.

2- Get a copy of the decedents CT scans (images) on either a DVD/CD/USB.

3- Download them via a broker (software) to Forensic Radiology Group (FRG).

4- Receive a forensic radiology findings report back.

Minimum space required: 9’ x 15’

Most CT vendors thinking is geared toward the CT clinical market not toward the forensic market – for effective advice talk to your forensic CT experts at ADS.

CT Trailers are available & specifically designed for forensic use!

NO – whole-body x-ray only gives you a static 2D image which is not enough for non-invasive autopsy results.

On the other hand, CT scanners provide:

• 2D whole-body x-ray imaging – similar to whole-body x-ray systems.

PLUS, the following imaging modalities that allow for PMCT/ non-invasive autopsy:

• 3D Images

• Cross-Sectional Images

• Volume Acquisition

• Multiplanar Reconstruction (MPR)

Big difference in trauma deaths:

In an MVA external, rather than saying "there are multiple fractured ribs and a skull fracture", if you had a PMCT you can be more detailed on the injuries "there are fractures of left ribs 2-5 posteriorly, calvarial and basilar skull fractures, subdural hematomas, intraventricular hemorrhage, and hemoperitoneum".  You can't see that level of detail on an X-ray.

Forensic Radiology Group (FRG) offers courses geared specifically to forensic pathologists to allow them to get a better understanding of CT images.

FRG also offers a series of services including Forensic Radiology Report readings, Identifications, Consulting, and more.