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Autopsy work is currently principally used in the UK to derive a cause of death and/or investigate the pathologies leading to death on the instruction of a medicolegal authority.1 Traditionally, this has involved a variable degree of opening the body, direct observation, tissue sampling and special tests (histology, microbiology, toxicology, etc), generally termed an invasive autopsy.2
At the start, it is fully accepted that those practising forensic pathology, where a full autopsy and a wide range of ancillary tests, will generate a very high degree of confidence in the autopsy findings. However, society does not request this level of confirmation with regard to community and hospital deaths—unless there is a medicolegal/criminal issue under consideration.
It is also accepted that medically certified causes of death have an appreciable error rate with missed significant diagnoses when compared with a full invasive autopsy.3 Given that it would be impractical to subject every single death in this country to a full invasive/forensic autopsy, a pragmatic balance needs to be sought for society. A clinical impression formed over a period of time, variably supported by antemortem tests, remains sufficient for natural hospital and community/general practitioner cause of death certification.
Non-invasive postmortem CT scan radiology autopsy review (PM-CT) in the last 10 years has been increasingly used in the UK, mainly on an episodic relative-request basis, rather than as a tool applied to all mortuary cases.4 Some work on the accuracy of such studies has been performed, and it has been seen that non-invasive and minimally invasive autopsy methods may serve as an adjunct or alternative to conventional autopsies. They are more acceptable to relatives, but are less accurate than the reference standard (ie, a full open/invasive autopsy with fully histology and other tests).5
The use of PM-CT requires a slightly …