An image of sudden death

Abstract

Cross-sectional imaging such as computed tomography (CT) is an essential investigative modality in clinical medical practice. Since early 2005 the Victorian Institute of Forensic Medicine has utilised a mortuary located CT scanner to routinely scan all deceased persons and suspected human remains admitted through the Victorian Coronial system. CT has been successfully integrated into the death investigative process, primarily in conjunction with autopsy but also when objection to autopsy is lodged by next of kin, together with external examination. In both streams of investigation, CT has proven itself to be of value. When autopsy is scheduled, the pathologist is able to inspect the body internally on a workstation with a view to planning the autopsy, providing insight into potential findings and assisting in anatomical areas where dissection is difficult such as the skull base and pelvis. The CT images can also be viewed retrospectively when the autopsy has raised a point of concern or there is need for clarification. Where objection to autopsy is encountered, CT is used by the pathologist in concert with other provided information to ascertain if there are any suspicious findings and provide a probable cause of death. CT scanning can also be useful in identification and aging of the deceased especially when the body is severely disfigured or decomposed. Cross sectional techniques for interrogation of the deceased are not limited to CT. Magnetic resonance imaging and ultrasound are also being studied in several centres. It is inevitable that CT and these other radiological techniques will become standard practice in investigation of the deceased primarily in the forensic arena although there is increasing interest in application to hospital-related deaths that fall outside coronial jurisdiction.