Imaging & Oncology - Society of Radiographers

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{ 66 } Is the autopsy dead? Guy Rutty, Bruno Morgan { 66 } IMAGING & ONCOLOGY 2013
The gold standard for the investigation of sudden unexpected death throughout the world is considered the invasive autopsy, although the word ‘autopsy’ itself does not imply nor require an invasive component to the investigation as many might think. “Public and political interest grew in the notion of the noninvasive radiological autopsy in the UK” Several different systems have been put forward previously as alternatives to the invasive autopsy (referred to from now onwards as simply the ‘autopsy’), although none has managed to gain sufficient interest to challenge the autopsy’s position 1 . However, there has been steady growing international interest in the potential role of cross–sectional imaging as an adjunct or alternative to the autopsy. The reasons for this include the approach being more acceptable to religious and cultural groups, more acceptable to grieving relatives, the potential to yield greater diagnostic information particularly in trauma related deaths and the production of a permanent, auditable record of the deceased 2 . In 2012 two documents were released which allowed the United Kingdom to take the next step forward in considering a realistic alternative to the invasive autopsy for the investigation of both natural and unnatural death. The first was the joint collegiate document from the Royal College of Radiologists and Royal College of Pathologists, which provided a statement on standards for medico-legal post-mortem cross-sectional imaging in adults. This document stated that both Colleges agreed that cross-sectional imaging could be used instead of an invasive autopsy, but went on to issue guidance for the circumstances when such imaging could be considered and the roles of the radiologists and pathologists involved. It included an example protocol for the use of post-mortem computed tomography 3 . The second document, provided to the Department of Health, supported the views of the Colleges and put forward proposals for the introduction of a national post-mortem cross-sectional imaging service within the National Health Service 4 . What had led to the production of these two documents and where do we go now? HISTORY The majority of autopsies undertaken throughout the UK today are medico-legal enquiries. Radiological imaging has been part of medicolegal autopsy practice since 1896 when x-rays were first used as an adjunct to assist the investigation of a firearm related homicide 5 . Shortly after this, the use of x-rays became established in the investigation of medico-legal skeletal trauma and became accepted as a form of evidence both within the civil and criminal courts. As early as 1898 the capacity to assist with the identification of an individual was realised although it was not until 1949 that radiographs were used solely for the identification of the victims of a mass fatality incident 6 . Despite the widespread use of radiographs in autopsy practice, and the early use of computed tomography (CT) in medico-legal practice, first in the living in 1977 7 , and then in the dead in 1983 8 , it was not until Donchin et al’s work in 1994 that it was proposed IMAGING & ONCOLOGY 2013 { 67 }
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2013
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CONTENTS 4 EDITORIAL 5 FOREWORD 6 P
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FOREWORD { 5 } I am honoured to hav
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Concerns about high attrition from
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Student support and assessment Ther
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appraisal process seemed to be a wo
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In January 2008, the radiotherapy s
Page 15 and 16: confirmed on the morning of Monday
Page 17 and 18: Figure 5: Technicians working on th
Page 19 and 20: Elekta’s Versa HD System Sets Ne
Page 21 and 22: Radiotherapy treatment planning and
Page 23 and 24: days would have improved target cov
Page 25 and 26: However, the tools and equipment av
Page 27 and 28: ARIA ® Oncology Information System
Page 29 and 30: For many years mammography has play
Page 31 and 32: part of the process and then prefer
Page 33 and 34: grey zone because little thickness
Page 36 and 37: { 36 } Radiography and Research: A
Page 38 and 39: thinking and leadership, lifelong l
Page 40 and 41: Where are we headed? We have alread
Page 42 and 43: { 42 } State-of-the-art Nuclear Car
Page 44 and 45: particle moves approximately 1mm an
Page 46 and 47: Perfusion (‘relative’) images i
Page 48 and 49: and the challenges of utilising it
Page 50 and 51: { 50 } XRadiology IT: moving on fro
Page 52 and 53: Downloadable data will be personal
Page 54 and 55: ‘off-the-shelf’ solutions, and
Page 56 and 57: { 56 } Funding and Commissioning is
Page 58 and 59: provide courses and had to meet cer
Page 60 and 61: to be a high priority for Foundatio
Page 62 and 63: { 62 } Radiology in Haiti: Challeng
Page 64 and 65: The plan Once home, word spread qui
Page 68 and 69: “In the UK the autopsy rate is re
Page 70 and 71: the dead, and reporting the subsequ
Page 72 and 73: { 72 } Blast Imaging: the Bastion e
Page 74 and 75: “The off-shift radiographers are
Page 76 and 77: “Primary fragmentation includes b
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