Advanced Radiologic Imaging Technology in Forensic Pathology

A study funded by the U.S. Department of Justice examines the use of post-mortem computed tomography (PMCT) in lieu of autopsy in cases of fatal trauma. A report on the study, "Utility of Postmortem X-ray Computed Tomography (CT) in Supplanting or Supplementing Medicolegal Autopsies", states that past studies have provided inconsistent feedback on the usefulness of PMCT as a substitute for autopsy. "Some studies have shown that there are injuries seen by PMCT that are not detected by autopsy, indicating that PMCT is likely useful as an autopsy adjunct," wrote the authors. "Previously performed studies were limited by small study populations, large variation in postmortem interval, differences in study protocols, differences in who interpreted the scans and how injuries were scored."

In this study, conducted by Sarah L. Lathrop, DVM, Ph.D. and Kurt B. Nolte, M.D. with the office of the Medical Investigator in Albuquerque, New Mexico, a large centralized, statewide medical examiner office was utilized over a period of four years to evaluate 174 blunt-force injury deaths, 205 firearm deaths, 65 pediatric (5 years and younger) trauma deaths, and 460 drug-poisoning deaths. In each case, a full autopsy was performed, as well as a complete PMCT, with the pathologist and radiologist blinded to the other's findings.

The report explains: "Injuries detected and described by autopsy and PMCT were compared in consensus conferences attended by radiologists and pathologists who had not been involved in the original cases. Conference attendees decided if each injury was a match between autopsy and PMCT, a category 1 miss (should have been seen but was not) or a category 2 miss (was not seen but would not expect to see it given location/resolution)."

The study found that there was strong agreement between autopsy and PMCT in assigning the cause of death. More injuries were detected using PMCT in blunt-force and firearm cases, while autopsy detected more injuries in pediatric trauma and drug-poisoning cases.

"Comparison of autopsy to PMCT revealed neither modality is perfect, but both independently allow correct assessment of severity of injuries and cause of death," the report's abstract concludes.

You can read the full report here.
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