The criminal justice system's considerations of so-called near-virtual autopsies: the East Midlands experience

Jeffery, Amanda; Raj, Vimal; Morgan, Bruno; West, Kelly N.; Rutty, Guy N.

doi:10.1136/jclinpath-2011-200008

Cited by 23 publications

(8 citation statements)

References 12 publications

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“…PMCT was better at detecting trauma and clinically significant soft-tissue haemorrhage, and autopsy was better at detecting pulmonary thromboembolism and respiratory disease. This outcome is consistent with previous reports,22, 23 and supports our belief that the new gold standard for post-mortem investigation is PMCT (with targeted coronary angiography) followed by autopsy.…”

Section: Discussionsupporting

confidence: 93%

Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study

et al. 2017

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SummaryBackgroundEngland and Wales have one of the highest frequencies of autopsy in the world. Implementation of post-mortem CT (PMCT), enhanced with targeted coronary angiography (PMCTA), in adults to avoid invasive autopsy would have cultural, religious, and potential economic benefits. We aimed to assess the diagnostic accuracy of PMCTA as a first-line technique in post-mortem investigations.MethodsIn this single-centre (Leicester, UK), prospective, controlled study, we selected cases of natural and non-suspicious unnatural death referred to Her Majesty's (HM) Coroners. We excluded cases younger than 18 years, known to have had a transmittable disease, or who weighed more than 125 kg. Each case was assessed by PMCTA, followed by autopsy. Pathologists were masked to the PMCTA findings, unless a potential risk was shown. The primary endpoint was the accuracy of the cause of death diagnosis from PMCTA against a gold standard of autopsy findings, modified by PMCTA findings only if additional substantially incontrovertible findings were identified.FindingsBetween Jan 20, 2010, and Sept 13, 2012, we selected 241 cases, for which PMCTA was successful in 204 (85%). Seven cases were excluded from the analysis because of procedural unmasking or no autopsy data, as were 24 cases with a clear diagnosis of traumatic death before investigation; 210 cases were included. In 40 (19%) cases, predictable toxicology or histology testing accessible by PMCT informed the result. PMCTA provided a cause of death in 193 (92%) cases. A major discrepancy with the gold standard was noted in 12 (6%) cases identified by PMCTA, and in nine (5%) cases identified by autopsy (because of specific findings on PMCTA). The frequency of autopsy and PMCTA discrepancies were not significantly different (p=0·65 for major discrepancies and p=0·21 for minor discrepancies). Cause of death given by PMCTA did not overlook clinically significant trauma, occupational lung disease, or reportable disease, and did not significantly affect the overall population data for cause of death (p≥0·31). PMCTA was better at identifying trauma and haemorrhage (p=0·008), whereas autopsy was better at identifying pulmonary thromboembolism (p=0·004).InterpretationFor most sudden natural adult deaths investigated by HM Coroners, PMCTA could be used to avoid invasive autopsy. The gold standard of post-mortem investigations should include both PMCT and invasive autopsy.FundingNational Institute for Health Research.

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Section: Discussionsupporting

confidence: 93%

Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study

et al. 2017

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“…Only two of the three lesions described in the autopsy were detected by conventional imaging. Moreover, only the first method detailed the format and vitality of the edges of the lesions, consistent with related studies 11,12. The left scapular lesion was not detected by PMCT.…”

Section: Discussionsupporting

confidence: 88%

Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case

Zerbini¹,

Silva²,

Ferro³

et al. 2014

Clinics

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OBJECTIVE:The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound.METHOD:Comparison between the findings of different methods: autopsy and postmortem computed tomography.RESULTS:In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography.CONCLUSIONS:Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations.

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“…Computed tomography (CT) imaging has been used as an adjunct in post-mortem practice for over 27 years [1] and has reached a stage in its development in autopsy practice such that Jeffery et al [2] recently suggested that it should be used in all forensic death investigations [where ''forensic'' in the United Kingdom is confined to the investigation of suspicious or homicide death and does not include other medico-legal autopsies, many of which will be found to be natural causes (so called ''routine'' cases)]. Despite this, and the growing literature within this field, a significant obstacle in the acceptance and widespread introduction of so called ''near virtual'' or ''minimally invasive'' autopsies, relates to the diagnosis of cardiac death and the failure of current post-mortem imaging to yield detailed information concerning the coronary arteries.…”

Section: Introductionmentioning

confidence: 99%

Targeted cardiac post-mortem computed tomography angiography: a pictorial review

Rutty¹,

Saunders²,

Morgan

et al. 2011

Forensic Sci Med Pathol

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With the introduction of targeted coronary artery angiography to post-mortem computed tomography (PMCT) it is now possible to assess the coronary arteries and left ventricle after death without, case dependent, the necessity to undertake an invasive autopsy. The purpose of this pictorial review is to act as a walk through aid memoire and educational learning document for radiologists and pathologists alike who may be new to the use and interpretation of targeted PMCT angiography. By using an example scanning protocol, which uses both positive and negative (air) contrast mediums, this pictorial review provides a systematic approach to vessel and ventricular assessment that is based upon clinical cardiac angiography but adapted to PMCT.

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The criminal justice system's considerations of so-called near-virtual autopsies: the East Midlands experience

Cited by 23 publications

References 12 publications

Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study

Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study

Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case

Targeted cardiac post-mortem computed tomography angiography: a pictorial review

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