The Evaluation of Computerised Tomography for its use in Forensic Pathological Investigations
thesisposted on 2011-05-16, 09:32 authored by Amanda Jane Jeffery
The prospect of an autopsy examination of a loved one is often upsetting for relatives. Despite public perceptions of pathologists, many doctors entering histopathology training do not aspire to undertake autopsy examinations. As many pathologists cease autopsy work following completion of training and the option of an autopsy-light curriculum of UK pathology training is proposed, the future of autopsy practice is unclear. A few research groups, worldwide, have started investigating expansion of the role of post-mortem imaging. The replacement of invasive autopsies by post-mortem imaging is proposed by some as a socially acceptable solution to future autopsy service provision. The benefits of post-mortem computed tomography (PMCT) have been championed but few authors have taken a more critical approach. This thesis critically examines the capabilities of PMCT in the fields of mass fatality investigation and ballistics/projectile deaths. It assesses its ability to replace the invasive components of a forensic post-mortem and the acceptance of such a procedure by the end users of the report. PMCT provides valuable additional information which informs and enhances the autopsy examination. It can form part of the permanent medico-legal record which can be revisited long after body release. The images produced have great potential to revolutionise the demonstration of injuries to end users including HM Coroners, the police, and other legal professions and more importantly lay jurors. PMCT is particularly valuable in the investigation of mass fatalities. It is also of great assistance in the investigation of projectile trauma both as part of the autopsy examination and as a terminal ballistics research tool. Whilst PMCT has a lot to offer death investigations, there are still areas where it cannot compete with the autopsy examination. This is particularly true of certain soft tissue abnormalities. With standard PMCT, vascular abnormalities such as traumatic defects, thrombosis and atherosclerosis cannot be reliably detected as circulating contrast media cannot be seen. Parenchymal defects in organs and cartilage, including penetrating wound tracks cannot be reliably discerned in all cases. At present, PMCT cannot provide all of the answers that the police and legal profession have come to expect from autopsy examinations. The legal profession is not ready to accept the current uncertainties that surround a technique that is very much in its infancy. Therefore, it is unlikely that PMCT will replace the autopsy as the gold standard in suspicious death investigation in the near future. It may have the potential to replace the invasive component of some coronial autopsies in particular some road traffic deaths. It does have great potential as a pre-autopsy screening tool and as a valuable adjunct.