Managing transformational change: Implementing cross-sectional imaging into death investigation services in the United Kingdom

Abstract

In general, healthcare is constantly re-building to provide better, quicker, more dependable services and care and, as a result, change is an inevitable part of our professional lives. The process of death investigation is no different. Traditionally the ‘true’ cause of death can only be determined by an invasive autopsy. Considered the ‘gold standard’ investigation, this highly specialised surgical procedure consists of a thorough examination of the corpse, evaluating the contribution of any natural disease or injury identified to the cause and manner of death. It involves the processes of external and internal examination, supplemented with laboratory investigations when required, followed by reconstruction of the body. However, a radical adjunct or alternative to the traditional autopsy has now been developed, challenging the concept of the ‘gold standard’, using the ‘so-called’ minimally invasive radiological autopsy. This approach uses post-mortem computed tomography (PMCT) and/or post-mortem magnetic resonance (PMMR) imaging, possibly supplemented with angiography, pulmonary ventilation, needle biopsy and, where available, surface scans of corpses. When combined with an external examination this innovative translation of clinical radiological imaging provides fresh insights and a new horizon for death investigation worldwide. In the beginning there was considerable doubt, resistance and uncertainty concerning the use of cross-sectional imaging in autopsy practice from the global medical community. Nevertheless, time has seen change in death investigation practices across the world, and a growing number of centres are investigating and instigating PMCT and PMMR into autopsy practice, including Japan, Australia, United States and parts of Europe (Denmark, Germany and Switzerland to name only a few) [1–9]. Recently practitioners and researchers from around the world united with the formation of the International Society of Forensic Radiology and Imaging (http://www.isfri.net/ last visited October 2014) which included the launch of the first dedicated journal for this specialist area of work, the Journal of Forensic Radiology and Imaging (http://www.jofri.net/ last visited October 2014). Despite these international developments, and some local enthusiasts, the forensic, pathology, criminal justice system and radiology communities in the United Kingdom (UK) have, in general, been slow to use post-mortem cross-sectional imaging. Possible reasons include unawareness of its potential, financial concerns, lack of experience and lack of educational opportunities. However, it has been questioned by UK practitioners within the forensic press whether, in terms of the adoption of imaging technology, the world is running before it can walk [10].