NIJ Advocates for CT Scans to Assist Forensic Pathologists

By: Seth Augenstein
ROCKAWAY, NJ – About 2.6 million people die in America each year. That results in an annual load of 500,000 post-mortem examinations. It’s well documented that there aren’t enough forensic pathologists—with some estimates showing the U.S. has only half of the staffing that’s really required for the caseload.
But implementing new imaging technologies, especially computed tomography (CT) scanning, in medical examiners’ offices could potentially be a game changer, according to a new publication by the National Institutes of Justice.
“There is a tremendous need to develop and implement advanced methods that could not only enhance autopsies diagnostically but also help combat this shortfall and reduce workloads,” write the authors, from the NIJ’s Office of Investigative and Forensic Sciences.
Already the use of CT in and around autopsies is regular in Europe, Japan and Australia, they write. The three-dimensional images produced by multiple X-ray images show nuances of trauma and other pathology within a single image, they write.
For instance, a CT scan shows injuries in the bodies of burn victims or big car crashes, enabling a better examination of cause and manner of death—without the need for a lengthy “gross autopsy,” they add.
But in the United States, the technology has not caught on in morgues. CT is costly to buy and maintain. Other logistical problems include temperature controlled environments, having other appropriate infrastructure, and hiring the right personnel with the right expertise to handle the tools. Not least of all includes the need for research to demonstrate its value to pathologists, and the criminal justice system, write the experts.
Instead some of the agencies have begun embracing Lodox imaging technology—which purports to offer full-body scans with lower radiation doses in about 13 seconds.
That system may be fast and less expensive, and show big features like bone fractures near the surface of the skin, as well as projectiles, and implants, writes the NIJ. But the CT scans are more detailed, they add.
“CT technology allows physicians to better visualize areas that are harder to dissect, visualize vessels (including stenosis, occlusion, and ruptures) and stab wounds using radio-opaque dyes, and estimate the volume of hemorrhages,” they explain.
Hiring radiologists would thus streamline the operations at medical examiners’ offices nationwide.
“Some of the offices’ cases might then be resolve quickly through imaging, thus realizing significant time savings,” they write.
Currently four agencies have CT capabilities in-house: the Armed Forces Medical Examiner’s Office in Delaware; the Chief Medical Examiner’s Office in Maryland; the New Mexico Office of the Medical Investigator; and the Los Angeles County Coroner/Medical Examiner. In the Maryland office, the tool is used in about half of all cases, and a radiologist works alongside the medical examiner.
Two endeavors are currently underway to gauge the value of CT scans for the forensic pathologists of the U.S. Research funded by the NIJ is currently underway at the University of New Mexico Health Sciences Center, in conjunction with that state’s medical examiner’s office. Another collaboration is international, between the NIJ and the Netherlands Forensic Institute; together they created the International Forensic Radiology Research Summit, or IFRRS. What began as a memorandum of understanding between the two countries in 2011 resulted in a two-day meeting in Amsterdam in May 2016 involving 40 researchers from 11 nations. (The next meeting is planned for May 10 to 12 in Melbourne, Australia, this year.)
If the cost and other hurdles are overcome, many benefits would come with more CTs, according to the NIJ authors. Some religious and cultural groups who object to autopsies may be satisfied with non-invasive images. The images may be more palatable to judges and juries than gory autopsy photos. Quicker work would be realized on some cases. And more thorough death investigations would come from the in-depth visualizations, they add.
“The use of advanced imaging techniques offers agencies a way to reduce the number of gross autopsies needed, address the shortage of forensic pathologists, decrease the number of biohazard exposures, honor our nation’s diverse cultural traditions and, most importantly, increase the amount of diagnostic information that is captured and retained electronically,” they write.
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