Can forensic pathologists diagnose pulmonary thromboembolism on postmortem computed tomography pulmonary angiography?

Postmortem computed tomography (CT) scanning is a routine examination in the medicolegal death investigation of every deceased person admitted to the Victorian Institute of Forensic Medicine. Pulmonary CT angiography is a standard clinical investigation for suspected pulmonary thromboembolism. To the best of our knowledge, a study of postmortem CT pulmonary angiography has not been previously reported in the English-speaking forensic literature. We present our findings on 13 cases of suspected massive pulmonary thromboembolism where forensic pathologists assessed postmortem CT pulmonary angiography, which were then correlated with conventional postmortem examinations.

Different conditions and strategies to utilize forensic radiology in the cities of Melbourne, Australia and Berlin, Germany.

Forensic radiology has become a common modality in many forensic practices around the world. Here, we report and compare the usage patterns in the cities of Melbourne, Australia, and Berlin, Germany, using 16 multislice scanners in two large forensic facilities with both machines integrated in the mortuary. While in Melbourne all bodies receive a full body computed tomography (CT) scan resulting in nearly 5,000 scans per year, the situation differs in Berlin where approximately 250 state prosecutor sanctioned cases are scanned per year. While in Melbourne the CT scanner is an integral element of the process of determining whether further examinations will follow, in contrast in Berlin all cases proceed to autopsy irrespective of the findings from the CT scan. While pathologists in Berlin receive on site training to use the CT scanner by a highly experienced forensic pathologist who has previously been involved in the Virtopsy(®) program in Switzerland, training of pathologists in Melbourne is multifaceted. A radiologist with extensive experience in the forensic environment is employed part time at the institute in Melbourne and provides radiology lectures including topics such as postmortem artifacts, regional anatomy, and neuroradiology. CT is gaining acceptance as a useful modality for presenting information to the courts and juries, as well as providing an easily accessible platform to review cases and initiated research projects.

Routine CT scan combined with preliminary examination as a new method in determining the need for autopsy.

CT scanning is an intrinsic component of the workup of all admissions to the Victorian Institute of Forensic Medicine. Using a new system of preliminary examination a decision is made by the coroner as to whether or not an autopsy should occur following consultation with a forensic pathologist. This study examines 318 consecutive cases for the month of July 2010 where the deceased had a preliminary examination including a CT scan which was primarily interpreted by a forensic pathologist. Findings relate to the age and sex of the deceased, the value of CT scanning, pathologist variability in advising an autopsy examination as well as the input from our sessional radiologist. A breakdown of natural versus unnatural death is provided. Overall the process is effective in developing interaction between the medical and legal elements at the VIFM in efforts to process admissions in the most suitable manner.

Thermoregulation during mild exercise at different circadian times.

Eight healthy subjects exercised at 90watts on a cycle ergometer on four occasions, at times close to the minimum, maximum rate of rise, maximum, and maximum rate of fall of their resting core temperature. The duration of exercise was determined by the time taken for the core (rectal) temperature to reach an equilibrium value. Forearm skin blood flow and temperature were measured regularly during the exercise, as were heart rate and ratings of perceived exertion. Sweat loss was calculated by weighing the subjects nude before and after the exercise. The rise of heart rate was not significantly different at the four times of exercise, though the rating of perceived exertion was greatest at 05:00 h. Resting core temperatures showed a significant circadian rhythm at rest (the timing of which confirmed that exercise was being performed at the required times), but the amplitude of this rhythm was decreased significantly by the exercise. The initial rate of rise of core temperature, and the total rise from the resting to the equilibrium value, were both inversely proportional to resting temperature. The time-course of the rise was accurately described by a negative-exponential model, but this model gave no evidence that the kinetics of the equilibration process depended upon the time of day. The thermoregulatory responses to the rise in core temperature--the amount of total sweat loss and rises in forearm skin blood flow and temperature--differed according to the time of exercise. In general, the responses were significantly greater at 17:00h compared with 05:00h, and at 23:00 h compared with 11:00 h. The results accord with predictions made on the basis of previous work by us in which core temperature rhythms have been separated into components due to the endogenous body clock and due to the direct effects of spontaneous activity. The results are discussed in terms of the ecological implications of the differing capabilities of humans to deal with heat loads produced by spontaneous activity or mild exercise at different phases of the circadian rhythm of resting core temperature.

Post mortem sampling of the bladder for the identification of victims of fire related deaths.

In a coronial setting a deceased person must be formally identified. It is difficult to identify a deceased person when their physical features are disrupted and identification by visual means cannot occur. In the absence of visual identification, the confirmation of identity of a deceased person relies on the scientific comparison of information obtained post mortem with ante mortem information. The ante mortem information may include dental and medical records, fingerprints, and DNA profiling. For cases involving incinerated remains, this traditionally requires the collection of blood, muscle or bone samples from the deceased (depending on the severity of the burns) for DNA analysis and subsequent comparison to a reference sample for kinship determination. Following on from work conducted during the DVI response to a plane crash in Papua New Guinea in 2011, a study has been performed examining the viability of utilising material obtained from bladder swabs in deaths associated with fires. Twenty-eight cases were analysed during 2012 with deaths occurring in motor vehicle and aviation accidents, as well as house fires, homicides and from self-immolation. Bladder and conventional (blood, muscle or bone) samples were subjected to DNA analysis and compared. Our findings demonstrate that the bladder samples all gave DNA of sufficient quality for DNA profiling. This easily obtained sample (when available) can be now recommended in the scientific identification process of fire affected deceased persons.