Early Experience With Postmortem CT Imaging

Postmortem computed tomography (PMCT) is a procedure fairly unfamiliar to many US radiologists. We embarked on a collaboration between the department of radiology and the medical examiner's office (MEO) with the purpose of introducing PMCT into the autopsy workflow and the goal of assisting forensic pathologist decision-making regarding the need for autopsy in determining cause of death.

Establishing this service involved coordination, education, and extensive planning involving numerous professionals volunteering their time and effort. For the last 2 years, PMCT has been performed on cases requested by the MEO. Two emergency radiologists issued double-read reports detailing the PMCT findings, and the MEO completed a report detailing the PM examination process, which always included an external examination and often included an autopsy. Shared documentation summarized decedent and case information (eg, medical history), radiology primary findings and impressions, and the pathology report findings (including autopsy conclusions, when performed).

As of July 2024, 116 PMCT examinations have been performed, of which 64 (55.2%) underwent formal autopsy, 2 (1.7%) received limited autopsy, and 50 (43.1%) had no subsequent autopsy performed. MEO conducted external exam only when PMCT findings were conclusive for the cause of the death, demonstrating that CT had a role in supplanting the need for an autopsy. Indications for PMCT included Rule out trauma, assess extent of trauma, and family/religious objection. The manner of death for these cases was classified as accident, homicide, natural, suicide, traffic related, or undetermined.

PMCT can be a valuable service to decedent families as well as to forensic pathologists who often operate in a limited resource environment. We anticipate that PMCT will become a standard discipline in forensic analysis. This service can often reduce the need for traditional autopsy and provides the potential to honor cultural sentiments and religious needs surrounding traditional autopsy. Establishing such a service requires the co-operation of many stakeholders, sometimes across institutional boundaries. PMCT broadens the experience of the radiologist and provides the potential for collaborative research and educational opportunities between radiology and the MEO. Lessons learned from this study may be useful for other jurisdictions implementing PMCT.