Medico-legal considerations in post-mortem imaging data: governance, ethics, and evidential use

Post-mortem imaging, in particular CT (PMCT), is increasingly used for death investigation in England and Wales, yet unlike "live" clinical imaging, this data falls outside traditional health-record legislation, creating uncertainty around data ownership, access rights, and disclosure obligations. This review examines the current data governance landscape surrounding post-mortem imaging data, identifying critical gaps requiring national guidance. We explore fundamental questions of data control between coroners and commercial service providers, noting how the absence of standardized frameworks has resulted in substantial regional variation in practice. Key challenges include inconsistent approaches to data storage, whether on clinical or dedicated PACS systems, varying data-retention periods, and disparate policies for third-party access by researchers, legal teams, and bereaved families. The evolving role of radiologists as expert witnesses in coronial and criminal proceedings presents additional complexities, particularly regarding who is best placed to explain imaging findings in court. We propose recommendations including national standards for data governance, standardized contractual frameworks clarifying data-controller relationships, protocols for secure storage and access controls, and defined competencies for radiologists presenting evidence in legal settings. Establishing robust governance foundations for post-mortem imaging data is essential to ensure this technology serves the public interest effectively, while maintaining legal defensibility and ethical integrity.