Cutting-Edge Forensics Utilizes CT Imaging for Autopsies

According to findings presented in November 2007 at the annual meeting of the Radiological Society of North America (RSNA) held in Chicago, IL, USA, CT autopsy has the potential to replace traditional autopsy in determining the cause of certain accidental deaths.

"CT is a sensitive imaging tool for detecting injuries and cause of death in victims of blunt trauma,” commented Barry Daly, M.D., professor of radiology at the University of Maryland School of Medicine (Baltimore, MD, USA). "When there are major injuries, such as those resulting from a motor vehicle accident, CT may provide enough information to enable a conventional autopsy to be avoided altogether.”

All states in the United States are required by law to perform an autopsy in cases of sudden and unexplained deaths. Of the 8,000 such deaths referred to the chief medical examiner of the state of Maryland last year, approximately one-half required full autopsy.

CT autopsy was found to compare favorably to conventional autopsy in several ways. In cases of suspicious death, the noninvasive procedure does not damage or destroy vital forensic evidence, as can happen during a traditional autopsy. Moreover, CT can be used in situations where autopsy may be prohibited by religious or cultural beliefs. CT autopsy is significantly less expensive than conventional autopsy and can be performed in a fraction of the time. A forensic medical examiner requires several hours to conduct a full autopsy, while multi-detector (MD) CT scanning and interpretation can be completed in approximately 30 minutes.

In Dr. Daly's study, 20 autopsies were performed using whole-body MDCT at the University of Maryland Medical Center. Interpretations of the CT scans by two radiologists were compared with the findings of a conventional autopsy performed on each body by state forensic medical examiners. Included were 14 victims of blunt trauma and six victims of a penetrating wound made either by a knife or ballistic weapon.

In all 14 blunt trauma cases and five of the six penetrating wounds, CT effectively identified the cause of death. The radiologists and forensic medical examiners evaluated the CT findings as comparable to conventional autopsy in 13 of the 14 blunt trauma cases and as a helpful adjunct in five of the six penetrating wound cases. In the study, CT was able to localize rapidly all 26 major ballistic fragments recovered from the victims during conventional autopsy.

"Autopsy is mandatory in deaths involving gunshot wounds, but CT can serve as a powerful adjunct to the conventional exam,” Dr. Daly said. "Performing CT imaging first may speed up a conventional autopsy, especially when it comes to locating ballistic fragments, which are so important to criminal investigations.”

Furthermore, CT was found to be more sensitive than traditional autopsy in detecting air embolism, a frequently unidentified significant contributing factor in fatal trauma.
Whereas CT has previously been used in autopsies of American soldiers and in a few countries outside the United States., the technology is only now generating strong interest within the U.S. forensic community.

"Although these preliminary results are promising, more research is needed to show that CT could be widely used within the U.S. medical examiners system,” Dr. Daly concluded.


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University of Maryland School of Medicine