The ground swell of postmortem computed tomography in Japan: the harbinger of widespread use of autopsy imaging?
Patients taken to the emergency room (ER) by ambulance with
cardiopulmonary arrest on arrival and confirmed dead are generally
classified as unusual death. The cause of death is then confirmed by
medical examiners in those areas having medical examiner system (MES).
However, MES is limited to 5 major cities in Japan due to lack of funds
and limited number of specialists. In fact, 85% of the Japanese
population live in areas without MES. In ERs of areas without MES,
physicians have to prepare a death certificate for the local police with
an attestation of death cause.
It is difficult to detect the cause of death by superficial
inspection alone. However, classical autopsies have been decreasing in
number. As an alternative method to objectively identify or presume the
cause of death, postmortem imaging examinations have been recently
proposed in some countries [1, 2]. In Japan, postmortem computed
tomography (PMCT) has been widely applied for three major roles [3, 4]:
1) screening the cause of death, 2) screening candidates for autopsy, and
3) guidance and/or supplemental information for autopsy. We distributed
questionnaire sheets, regarding the use of PMCT, to 183 major ERs in
Japan. Of these, 67% responded and we found that 89% of the respondents
use PMCT. This high rate is likely because the number of CTs in Japan is
greater than 10,000 units, constituting more than one-third of those in
world wide.
In Japan, the new term Autopsy imaging (abbreviated as Ai, to
differentiate from AI which signifies Artificial Intelligence) was
proposed by pathologists, comprehensive of postmortem CT and MRI [5]. The
significance and usefulness of Ai is gradually increasing in the fields of
Radiology, Forensic Medicine, and Emergency Medicine in Japan. We are
hoping to accumulate more images and autopsy data to ensure Ai diagnosis
based on pathologic correlation.
References
1) Bisset RAL, Thomas NB, Turbull IW, Lee S. Postmortem examinations
using magnetic resonance imaging: four year review of a working service.
BMJ 2002; 324: 1423-1424
2) Thali MJ, Kathrin Y, Schweitzer W, et al. Virtopsy, a new imaging
horizon in forensic pathology: virtual autopsy by postmortem multislice
computed tomography (MSCT) and magnetic resonance imaging (MRI) ¯ a
feasibility study. J Forensic Sci 2003; 48: 386-403
3) Shiotani S, Kohno M, Ohashi N, et al. Non-traumatic postmortem
computed tomographic findings of the lung. J Forensic Sci Int 2004; 139:
39-48
4) Hamano J, Shiotani S, Yamazaki K, et al. Postmortem computed
tomographic (PMCT) demonstration of fatal hemoptysis by pulmonary
tuberculosis radiologic-pathologic correlation in a case of rupture of
Rasmussen's aneurysm-. Radiat Med 2004; 22: 120-122
5) Ezawa H, Yoneyama R, Kandatsu S, Yoshikawa K, Tsujii H, Harigaya
K. Introduction of autopsy imaging redefines the concept of autopsy: 37
cases of clinical experience.
Pathol Int 2003; 53: 865-873
Seiji Shiotani
Chief, Department of Radiology, Tsukuba Medical Center
Yuichi Hamabe
Director, Department of Trauma and Critical Care, Tertiary Emergency
Medical Center, Tokyo Metropolitan Bokutoh Hospital
Noriyoshi Ohashi
Director, Department of Critical Care and Emergency Medicine, Tsukuba
Medical Center
Hidefumi Ezawa
Chief Pathologist, Section of Clinical Oncology, the Research Center
Hospital for Charged Particle Therapy, the National Institute of
Radiological Science
Competing interests:
None declared
Competing interests:
No competing interests
29 May 2006
Seiji Shiotani
Chief
Yuichi Hamabe, Noriyoshi Ohashi, and Hidefumi Ezawa.
Department of Radiology, Tsukuba Medical Center, Tsukuba, Japan, 305-8558
Rapid Response:
The ground swell of postmortem computed tomography in Japan: the harbinger of widespread use of autopsy imaging?
Patients taken to the emergency room (ER) by ambulance with
cardiopulmonary arrest on arrival and confirmed dead are generally
classified as unusual death. The cause of death is then confirmed by
medical examiners in those areas having medical examiner system (MES).
However, MES is limited to 5 major cities in Japan due to lack of funds
and limited number of specialists. In fact, 85% of the Japanese
population live in areas without MES. In ERs of areas without MES,
physicians have to prepare a death certificate for the local police with
an attestation of death cause.
It is difficult to detect the cause of death by superficial
inspection alone. However, classical autopsies have been decreasing in
number. As an alternative method to objectively identify or presume the
cause of death, postmortem imaging examinations have been recently
proposed in some countries [1, 2]. In Japan, postmortem computed
tomography (PMCT) has been widely applied for three major roles [3, 4]:
1) screening the cause of death, 2) screening candidates for autopsy, and
3) guidance and/or supplemental information for autopsy. We distributed
questionnaire sheets, regarding the use of PMCT, to 183 major ERs in
Japan. Of these, 67% responded and we found that 89% of the respondents
use PMCT. This high rate is likely because the number of CTs in Japan is
greater than 10,000 units, constituting more than one-third of those in
world wide.
In Japan, the new term Autopsy imaging (abbreviated as Ai, to
differentiate from AI which signifies Artificial Intelligence) was
proposed by pathologists, comprehensive of postmortem CT and MRI [5]. The
significance and usefulness of Ai is gradually increasing in the fields of
Radiology, Forensic Medicine, and Emergency Medicine in Japan. We are
hoping to accumulate more images and autopsy data to ensure Ai diagnosis
based on pathologic correlation.
References
1) Bisset RAL, Thomas NB, Turbull IW, Lee S. Postmortem examinations
using magnetic resonance imaging: four year review of a working service.
BMJ 2002; 324: 1423-1424
2) Thali MJ, Kathrin Y, Schweitzer W, et al. Virtopsy, a new imaging
horizon in forensic pathology: virtual autopsy by postmortem multislice
computed tomography (MSCT) and magnetic resonance imaging (MRI) ¯ a
feasibility study. J Forensic Sci 2003; 48: 386-403
3) Shiotani S, Kohno M, Ohashi N, et al. Non-traumatic postmortem
computed tomographic findings of the lung. J Forensic Sci Int 2004; 139:
39-48
4) Hamano J, Shiotani S, Yamazaki K, et al. Postmortem computed
tomographic (PMCT) demonstration of fatal hemoptysis by pulmonary
tuberculosis radiologic-pathologic correlation in a case of rupture of
Rasmussen's aneurysm-. Radiat Med 2004; 22: 120-122
5) Ezawa H, Yoneyama R, Kandatsu S, Yoshikawa K, Tsujii H, Harigaya
K. Introduction of autopsy imaging redefines the concept of autopsy: 37
cases of clinical experience.
Pathol Int 2003; 53: 865-873
Seiji Shiotani
Chief, Department of Radiology, Tsukuba Medical Center
Yuichi Hamabe
Director, Department of Trauma and Critical Care, Tertiary Emergency
Medical Center, Tokyo Metropolitan Bokutoh Hospital
Noriyoshi Ohashi
Director, Department of Critical Care and Emergency Medicine, Tsukuba
Medical Center
Hidefumi Ezawa
Chief Pathologist, Section of Clinical Oncology, the Research Center
Hospital for Charged Particle Therapy, the National Institute of
Radiological Science
Competing interests:
None declared
Competing interests: No competing interests