Interpretation of postmortem head computed tomography for non-traumatic in-hospital deaths by non-radiologists: a preliminary study

SpringerPlus, Jul 2016

Purpose Postmortem computed tomography (PMCT) has recently become important to clarify the cause of death in forensic medicine. It has also been proven to be useful for in-hospital deaths to a certain extent when interpreted by radiologists. However, accuracy of the interpretations of PMCT by non-radiologists remains to be elucidated. Nevertheless, they are often required to write death certificates based on the findings of PMCT in the absence of radiologists in Japan. We compared the interpretations of postmortem head CT (PMCT-H) by non-radiologists with the autopsy findings. Methods This study included 13 patients who underwent both brain dissection at autopsy and PMCT between June 2011 and December 2014. All cases were non-traumatic in-hospital deaths. Interpretation of PMCT was performed by the clinicians in charge of the patients, not by radiology experts. Results The patients were first examined with PMCT and then autopsies were performed. Ten out of 13 cases were confirmed to have no lesions in the cranial cavity by both PMCT-H and autopsy. Two cases were diagnosed with intracranial hemorrhage (intracerebral and/or subarachnoid hemorrhage) and one with recurrent malignant lymphoma by both the clinicians and the pathologists. Intracranial hemorrhages were thought to be the direct causes of mortality of the two patients, and recurrent malignant lymphoma was considered to be one of the cardinal findings of the cancer death. There were no discrepancies between PMCT-H and autopsy findings. Conclusions The interpretations of PMCT-H by non-radiologists were completely the same as the autopsy findings regarding the non-traumatic in-hospital deaths in this study. It is premature to draw a definitive conclusion at present, but PMCT-H might be as effective as autopsy not only for those lesions described above but also for no remarkable changes in the brain. There has been no report on such a comparison. We believe further verification of the validity of interpretation of PMCT by non-radiologists is worthwhile in terms of death certificates made out in the absence of radiology experts and pathologists.

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Interpretation of postmortem head computed tomography for non-traumatic in-hospital deaths by non-radiologists: a preliminary study

Araki et al. SpringerPlus Interpretation of postmortem head computed tomography for non-traumatic in-hospital deaths by non-radiologists: a preliminary study Asuka Araki 0 Noriyoshi Ishikawa 0 Saki Takami 0 Nahoko Ishikawa 0 Chika Amano 2 Haruo Takeshita 1 Riruke Maruyama 0 0 Department of Organ Pathology, Shimane University School of Medicine , 89-1 Enya, Izumo, Shimane 693-8501 , Japan 1 Autopsy Imaging Center, Shimane University Hospital , 89-1 Enya, Izumo, Shimane 693-8501 , Japan 2 Department of Pathology, Matsue Red Cross Hospital , 200 Horomachi, Matsue, Shimane 690-8506 , Japan Purpose: Postmortem computed tomography (PMCT) has recently become important to clarify the cause of death in forensic medicine. It has also been proven to be useful for in-hospital deaths to a certain extent when interpreted by radiologists. However, accuracy of the interpretations of PMCT by non-radiologists remains to be elucidated. Nevertheless, they are often required to write death certificates based on the findings of PMCT in the absence of radiologists in Japan. We compared the interpretations of postmortem head CT (PMCT-H) by non-radiologists with the autopsy findings. Methods: This study included 13 patients who underwent both brain dissection at autopsy and PMCT between June 2011 and December 2014. All cases were non-traumatic in-hospital deaths. Interpretation of PMCT was performed by the clinicians in charge of the patients, not by radiology experts. Results: The patients were first examined with PMCT and then autopsies were performed. Ten out of 13 cases were confirmed to have no lesions in the cranial cavity by both PMCT-H and autopsy. Two cases were diagnosed with intracranial hemorrhage (intracerebral and/or subarachnoid hemorrhage) and one with recurrent malignant lymphoma by both the clinicians and the pathologists. Intracranial hemorrhages were thought to be the direct causes of mortality of the two patients, and recurrent malignant lymphoma was considered to be one of the cardinal findings of the cancer death. There were no discrepancies between PMCT-H and autopsy findings. Conclusions: The interpretations of PMCT-H by non-radiologists were completely the same as the autopsy findings regarding the non-traumatic in-hospital deaths in this study. It is premature to draw a definitive conclusion at present, but PMCT-H might be as effective as autopsy not only for those lesions described above but also for no remarkable changes in the brain. There has been no report on such a comparison. We believe further verification of the validity of interpretation of PMCT by non-radiologists is worthwhile in terms of death certificates made out in the absence of radiology experts and pathologists. Postmortem computed tomography; Head; Non-radiologist; In-hospital death; Autopsy Background In accordance with decreasing autopsy rate in almost every country, the postmortem imaging has gradually become important as an alternative to autopsy in elucidating the cause of death. In Japan, since Ezawa et al. (2003 ) advocated autopsy imaging (Ai) as the term equivalent to postmortem imaging, it has been prevailing rapidly. Japan has overwhelmingly the highest number of CT scanners per capita in the world (almost three times the number in the United States in 2009) (OECD 2011) and clinicians can easily utilize them as a postmortem imaging device. However, compared to prevalence of CT scanners, the number of radiologists is insufficient (lowest among OECD countries) (Nakajima et  al. 2008) . Many clinicians in Japan often encounter situations where no radiologists are available, and if the cause of death is unclear but autopsy cannot be done, they have to interpret PMCT by themselves (Ikeda et al. 2009) before writing a death certificate. The role of postmortem imaging has been widely discussed in literature regarding non-violent adult deaths (Roberts et al. 2003; Weustink et  al. 2009; Patriquin et  al. 2001; Ros et  al. 1990; Thali et  al. 2003) . One large study showed the accuracy of postmortem imaging as compared with autopsy by meticulous method (Roberts et  al. 2012) . In recent years, even PMCT-angiography (PMCTA) has been in use as to enhance the quality of PMCT ( Busardò et  al. 2015 ). However, such expensive methods are unlikely to apply to practical settings in small to middle-sized hospitals where the radiology workforce is insufficient. Furthermore, we must emphasize that the pathology workforce in Japan is also insufficient as compared with other countries: almost one-fifth of that of the USA per capita (The Japanese Society of Pathology 2003) . In order to understand and record the postmortem conditions of patients, almost all inpatients that died in Shimane University Hospital have been examined with unenhanced PMCT since June 2011. Taking advantage of this situation, we are currently elucidating the accuracy of postmortem imaging for non-traumatic inhospital deaths interpreted by non-radiolog (...truncated)


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Asuka Araki, Noriyoshi Ishikawa, Saki Takami, Nahoko Ishikawa, Chika Amano, Haruo Takeshita, Riruke Maruyama. Interpretation of postmortem head computed tomography for non-traumatic in-hospital deaths by non-radiologists: a preliminary study, SpringerPlus, 2016, pp. 978, Volume 5, Issue 1, DOI: 10.1186/s40064-016-2653-z