Improving and Evaluating Computed Tomography and Magnetic Resonance Imaging in the Investigation of Fatalities Involving Suspected Head Trauma

As submitted by the proposer: Recent studies comparing Post-Mortem Computed Tomography (PMCT) Imaging and Autopsy, by our Center and others, suggest that combining methods enhances the reliability of injury detection. For example, in a recently completed double-blinded study comparing PMCT and Autopsy in trauma cases, the number of unique injuries detected by combining Autopsy and PMCT findings was 20-40% greater than the number of injuries detected by either Autopsy or PMCT alone. Autopsy is a well-established method, widely regarded as the gold standard for death investigation, for legal purposes and to evaluate and improve clinical diagnosis. The possibility of improving injury detection reliability, by 20% or more, suggests that Autopsy + PMCT may someday be adopted as the new gold standard. In the meantime, many questions remain to be addressed. When comparing Imaging and Autopsy findings, how is “agreement” best defined, what is the reason for “disagreement,” and what are its implications? Is discordance worrisome, suggesting that neither Imaging nor Autopsy is performed with sufficient reliability or consistency? Or is discordance reassuring, demonstrating that Imaging and Autopsy each reliably provide unique information, resulting in a more comprehensive examination overall? If the addition of PMCT and/or Post-Mortem Magnetic Resonance (PMMR) imaging improves the reliability of death investigation, in which cases should it be used? Our over-arching hypothesis is that the use of Advanced Radiological Imaging and Autopsy will result in death investigations that are demonstrably more comprehensive and reliable, and will someday be adopted as the gold standard in cases for which complete injury documentation has legal importance, such as suspected abuse, medical malpractice, or workplace injury. We propose to systematically evaluate the accuracy of previous PMCT findings in cases of Blunt Force Injury and Pediatric Trauma, to better define the causes and implications of observed discordance between PMCT and Autopsy. Guided by these findings, we propose to improve the radiological assessment of fatal trauma, through improvements in PMCT reporting methods, and by adding PMMR, which is more sensitive than CT for identifying brain injuries. Finally we propose to study the impact of these improvements on the reliability of injury identification and cause of death determinations, by evaluating the use of Imaging and Autopsy in the investigation of fatalities involving suspected head trauma (Blunt Force Injury and Pediatric Trauma). The long-term goal is helping to define best practices for effective and efficient integration of Advanced Radiological Imaging into the practice of Forensic Pathology. Note: This project contains a research and/or development component, as defined in applicable law. ca/ncf