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SA 8 - Forensic and post-mortem imaging

Thursday, March 2, 16:00 - 17:30 Room: G Session Type: State of the Art Symposium Topics: General Radiology, Medico-legal Digital Evaluation: Open Digital Evaluation for this Session Moderator: P. A. M. Hofman (Maastricht/NL) Add session to my schedule In your schedule (remove)

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Chairman's introduction

P. A. M. Hofman; Maastricht/NL

Learning Objectives

1. To update delegates on the role of radiologists in post-mortem and forensic radiology.
2. To update delegates on the radiology in death investigations.
3. To discuss the role of various imaging modalities.
4. To highlight areas where further research is required.

Abstract

Radiology has always played a role in forensic and death investigations but only after the introduction of high-resolution cross-sectional imaging techniques both forensic and clinical postmortem radiology are evolving into a new subspeciality. There are two application fields: court procedures or law enforcement and the clinical use as a quality assurance or teaching tool. In all these cases, imaging can be an independent examination and the combination with an external examination, an autopsy and toxicological examination will provide more comprehensive information on the cause and manner of death and disease processes. The questions in a forensic setting will differ from a clinical setting but in both applications the level of expertise of the interpreter will determine the quality of the examination. It is, therefore, essential that radiologists are involved in these procedures. As in all new applications of imaging techniques it is important to establish a scientific basis, which positions forensic and postmortem radiology as a reliable method. The last decade many studies have been publishes but there are still many issues that need to be addressed. This includes pathologies that are difficult visualize. Another important question that needs to be answered during a forensic examination deals with injury patterns, and injury mechanisms and most research has been focused on individual injury rather than on injury patterns. Also the timing of injury and the time of death are important forensic issues that are still challenging for imaging. Therefore, more and larger studies are needed to establish a scientific basis.

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Introduction to post-mortem radiology

T. Ruder; Zurich/CH

Learning Objectives

1. To understand the potential role of post-mortem imaging and forensic imaging.
2. To discuss the different imaging techniques and protocols for post-mortem imaging.
3. To learn about the typical imaging findings and pitfalls.
4. To discuss relevant legal issues related to forensic radiology.

Abstract

Over the last 20 years, forensic radiology underwent tremendous growth and today, pre-autopsy post-mortem CT or MR are standard practice in many countries worldwide. Imaging is used for personal identification, documentation of injury, as evidence in court and for research and teaching in forensic sciences. The aim of this lecture is to provide an introduction to the field of forensic radiology and entice radiologists to get involved in this growing sub-speciality area. The lecture includes a discussion about the role and the potential of radiologic imaging in forensic medicine; a description of imaging modalities used in post-mortem imaging such as CT, CTA and MR; an outline of minimum standards for image acquisition in post-mortem forensic radiology; a review of current applications of cross-sectional imaging in forensic death investigations, including forensic identification, documentation of injury, disease and death; a note on legal aspects and peculiarities of reading, reporting and presenting findings in forensic radiology.

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Post-mortem imaging: a pathologist's perspective

D. Ranson; Melbourne/AU

Learning Objectives

1. To understand the potential role of post-mortem imaging in relation to pathology.
2. To become familiar with relevant questions in a death investigation.
3. To discuss the contribution of imaging to a death investigation.

Abstract

PMCT is completely integrated with Coroners’ death investigation procedures in Melbourne and this has been associated with a halving of the autopsy rate over the past 15 years. In Australia, the reliance on PMCT as a death investigation tool is becoming firmly established. The historical background to this change in death investigations and the medical, social and legal advantages that have accrued will be explored. We believe that considering autopsies to be the main medical tool (or the ‘gold standard’) of medico-legal death investigation is an outdated approach today. Unfortunately, legislation is often focused on these traditional approaches and this has influenced some of the case law that has emerged following family objections to autopsy. These views have also driven the academic and community debate that seeks to address the question as to whether PMCT can replace autopsy. We believe this approach is fundamentally flawed and it should be replaced by a consideration of how PMCT can provide part of the evidence base that helps identify what are procedures are appropriate in a particular death investigation. This paper outlines the benefits that arise when you analyse the medico-legal death investigation process and re-engineer it so that PMCT, autopsy, 24-hour toxicology, 24-hour DNA, fast electronic access to medical records, scene photography/video and early external examinations are seen as equally valuable tools in the death investigation. The way in which these various modalities are chosen by the legal investigator (coroner) in partnership with forensic pathologists in Melbourne will be explored.

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Paediatric forensic post-mortem radiology

R. R. van Rijn; Amsterdam/NL

Learning Objectives

1. To learn about the role of imaging in child abuse.
2. To discuss the different imaging techniques and protocols in paediatric forensic radiology.
3. To discuss relevant legal issues related to paediatric forensic radiology.

Abstract

Postmortem radiology is mostly focussed on imaging of foetuses and neonates. However, in recent years it has found its way into the field of forensic medicine. The advantage of post-mortem imaging is the fact that imaging can be reviewed indefinitely and images can easily be shared between experts. Using post-processing techniques imaging findings can be used as illustrations for laymen in forensic reports. This lecture will present legal cases and the advantage and limitations of post-mortem imaging.

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Post-mortem CT and MRI: imaging techniques

A. Persson; Linköping/SE

Learning Objectives

1. To learn about quantitative MRI and temperature independent imaging.
2. To learn about DECT in post-mortem imaging.
3. To learn about advanced visualisation techniques in post-mortem and forensic radiology.
4. To understand areas where further research is needed.

Abstract

Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. The diagnostic accuracy of postmortem imaging for various types of findings are depending of the imaging acquisition technique that has been used. Only recently quantitative post-mortem magnetic resonance imaging (PMMRI) technique has been introduced. A particular quantitative MRI sequence feasible for simultaneous quantification of T1 and T2 relaxation times as well as proton density (PD) can be used to quantify and characterize post-mortem tissue. This technique has the potential to reduce the temperature dependents in PMMRI examinations. Another promising imaging technique is postmortem dual-energy computed tomography (PMDECT). This technique enables to some extent quantification and determination of soft tissues and other foreign materials in the body. These new quantification techniques lay the foundation for new advanced visualization techniques and the use of big data, machine learning tools and radiomics in future forensic radiology.

Panel discussion: What should be the focus of future research?

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Chairman's closing remarks

P. A. M. Hofman; Maastricht/NL

Learning Objectives

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Abstract

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