Evaluation of Computed Tomography as a Screening Test for Death Inquest

Abstract

The Japanese method of inquest, which depends mostly on external examinations, may misdiagnose a considerable number of accidental deaths and suicides as death by disease. We conducted computed tomography (CT) scans of 80 cases for which police concluded death by disease or natural causes based on police investigations into the circumstances and results from external examinations. The cause of death was clearly determined by CT scan in 17 of 80 cases. Ten cases underwent autopsy after the police suspected criminality based on results of the CT examinations. The results suggest CT scan may be a tool for preventing a number of overlooked crimes and accidents in Japan. However, it cannot be a perfect tool for discerning between death by disease and other causes of death without cooperation from the investigative agencies and subsequent forensic examinations such as autopsy and toxicological tests.

Three-dimensional visualization of composite fillings for dental identification using CT images

“…Post-mortem CT imaging is a useful tool for forensic diagnosis in general, and it is now being introduced into the field of forensic odontology. [2][3][4] If composite resins could be visualized accurately on reconstructed CT images in cases where it is difficult to detect them by external investigations alone, this would aid more accurate dental identification.…”

An autopsy case of an elderly man with myelodysplastic syndromes in which postmortem computed tomography showed massive splenomegaly

“…Examination of this case suggests that PMCT may provide valuable information for determining the true cause of death of elderly with several critical diseases. However, PMCT has several limitations that may prevent review of PMCT findings alone from confirming the direct and/or underlying cause(s) of death [13,17].…”

“…Japan is no exception, where the death investigation system is currently in the developmental stage [13,14]. If external examination indicates the possibility of death due to external causes is low, determination of probable cause of death is performed by review of the patient's medical history.…”

Trial investigation of post-mortem non-invasive transnasal endoscopy

“…The National Police Agency reports that 37 cases from 1997 to 2009 were likely murders, but not identified as such. Computed tomography (CT) imaging has recently been introduced to improve the accuracy of superficial post-mortem examinations [1,2]. Reports indicate that post-mortem CT imaging is especially effective in detecting blunt trauma [2,3].…”

“…The cause of death for over 80% of the cases involving unnatural death is currently based solely on superficial post-mortem examinations. Most administrative regions in Japan have unique procedures for death inquests [1]. The determination of criminality in a case is generally based solely on the results of non-invasive superficial post-mortem examinations.…”