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New Journal ...
A new Journal dedicated to a holistic and evidence based approach to forensic medicine has recently been launched by Humana Press. 'Forensic Science, Medicine, and Pathology', edited by Prof. Guy Rutty, Dr Roger Byard, Dr Michael Tsokos and Ashraf Mozayani is available in print and online. The first issue contains an excellent overview of 'Controversies in paediatric forensic pathology', as well as interesting articles on the 'pathology of whiplash maculopathy and retinopathy', and a 'mechanistic hypothesis for eye injury in infant shaking'. Subscription information is available at www.humanajournals.com. Shaken Baby Syndrome Recently in the news in the UK, find links to relevant websites and read several articles recently published in the BMJ (328:719,720,754 and 766 27th March 2004)
Forensic entomology ... There has been a couple of 'special edition' journals featuring forensic entomology articles, which may be of interest to readers. These include the Forensic Science International Vol 120 (2001) (www.elsevier.com/locate/forsciint - accessible for subscribers to www.sciencedirect.com). More recently Aggrawal's Internet Journal of Forensic Medicine and Technology (5(1) 2004) has repeated the format with some fantastic articles. These can be freely accessed at www.geradts.com/~anil/ij/indexpapers.html or the mirror site www.beneeke.com/maggots.html. Happy reading!
Post Mortem Magnetic Resonance Imaging (CT/MRI)
In recent years there has been increasing interest in the use of MRI for the diagnosis of disease and injury in the dead, in order to ascribe a cause of death. The UK government has declared its interest in this application on several occasions, particularly following the damaging organ and tissue retention 'scandals' of recent years, including those involving Alderhey and Bristol hospitals. BMA News (Saturday April 13th 2002) ran a front page headline 'Post mortem MRI scans could drain vital resources' following the government' declaration of interest, but highlighted the lack of human and financial resources available to undertake such imaging and interpretation. A full body MRI costs in the region of £1000 - considerably more than a conventional autopsy. The following week a further story ran on page 6 'MRI moves could cut the scalpel out of autopsies', and quoted Dr Ian Roberts of Oxford as saying that pathologists had ' ... lost the PR battle', referring to the poor image that pathologists and the use of autopsy had in the minds of the general public. The UK government have recently advertised a contract tender for investigation of the use of MRI autopsies, a contract worth £750,000. One of the main criticisms of the use of MRI as an alternative to conventional autopsy is the lack of validation of this imaging technique. MRI post mortem examinations had previously been reported in the fields of neuropathology and paediatrics where it has had mixed results. Alderstein et al (2003) compared MRI with autopsy in perinatal cases and were disappointed. In particular, as had been previously reported, MRI was not good at detecting major malformations such as cardiac anomalies. They calculated the positive predictive value of MRI for detecting such malformations as 80%, and concluded that although 15% more families consented to an MRI autopsy only, a normal MRI did not equate to a normal baby, and that parents giving consent for an MRI post mortem only needed to be given that information. In Manchester, UK, a team investigated the use of MRI autopsies in Coroner's cases (Bisset et al 2002). They had access to a private scanner, paid for by the local Jewish community, and reported 53 cases. Of these only 6 cases received both an MRI scan and a full post mortem. The remaining cases were given a cause of death based on the medical notes and the MRI scan. The short paper showed that MRI was not able to accurately assess ischaemic heart disease - the most common cause of death in this country. However, they concluded that the use of MRI was a credible alternative to autopsy, stating that doctors only accurately certify the cause of death in 31-75% of cases, and that MRI autopsies were at least as good as that! Not surprisingly, this paper resulted in a flurry of responses and letters, all criticising the lack of validation and the inability of the technique to identify the most common cause of death. A team led by Dr Roberts at Oxford has since reported on a further 10 cases (Roberts et al 2003). They concluded that the MRI was unable to;
In addition changes associated with decomposition, such as gas formation in the biliary tree, caused immense interpretative problems for radiologists. It was found that those radiologists with experience of interpreting post mortem images were no better than inexperienced colleagues in such cases, and it is recommended by the team that MRI autopsies are carried out within 24 hours of death. This obviously has immense resource implications. Most of the literature comments on the utility of MRI post mortems as an adjunct to full autopsy, and Benbow and Roberts (2003 pp. 417-423) provide an interesting overview of other autopsy adjuncts, such as needle autopsies etc. However, Thali and his team in Switzerland have been carrying out MRI and multi-slice CT examinations in forensic cases, including victims of gunshot wounds. They have developed an imaging research programme 'Virtopsy' and have published a great deal of papers highlighting the ability to image features of wounds and carry out post-image processing in 3D. The future of the autopsy seems to be under threat, but the overwhelming evidence suggests that it is still the 'gold standard' in diagnosis, and that the use of imaging techniques will remain the preserve of an autopsy adjunct rather than a replacement. References
Virtopsy,
a New Imaging Horizon in Forensic Pathology: A
High-Speed Study of the Dynamic Bullet-Body Interactions produced by Grazing
Gunshots with Full Metal Jacket and Lead Projectiles. Analysis of
Patterned Injuries and Injury-Causing Instruments with Forensic 3D-CAD supported
Photogrammetry (FPHG): An Instruction Manual for the Documentation Process. ‘Morphological
Imprint’: Determination of the Injury-Causing Weapon from the Wound Morphology
using Forensic 3D/CAD Photogrammetry (FPHG) New Horizons
in Forensic Radiology: The 60-Second "Digital Autopsy"; Charred Body:
Virtual Autopsy with Multi-slice Computed Tomography and Magnetic Resonance
Imaging. Forensic
Radiology with Cross-Section Modalities: Spiral CT Evaluation of a Knife Wound
to the Aorta. High-Speed
Documented Experimental Gunshot to a "Skull-Brain Model" and
Radiological Virtual Autopsy. The Dynamic
Development of the Muzzle Imprint by Contact Gunshot: The
"Skin-skull-brain model": a new instrument for the study of gunshot A study of the
morphology of gunshot entrance wounds, in connection with their dynamic
creation, utilizing the "skin-skull-brain model". A
"skin-skull-brain model" for the biomechanical reconstruction of blunt Body models in
forensic ballistics: reconstruction of a gunshot injury to Improved
Vision in Forensic Documentation: Forensic, 3DICAD-Supported Photogrammetry of
Bodily Injury External Surfaces, Combined with Volumetric Radiologic Scanning of
Bodily Injury Internal Structures to Provide More Leads and Stronger Forensic
Evidence Matching tire
tracks on the head using forensic photogrammetry. Observation
and identification of metabolites emerging during postmortem decomposition of
brain tissue by means of in situ 1H-magnetic resonance spectroscopy.
The clinical application of MRI to cardiovascular pathology is covered in a BMJ review (Vol 329 11th Dec 2004 pp. 1386-1389)..
Artist Jose Perez has a unique 'take' on medics, and an exhibition at the National Library of Medicine in the USA showcases his paintings of different professions. Compare his vision of the obstetrician and the pathologist!
Online Forensic Medicine Journal ... Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology This on-line journal contains some fantastic articles and case-studies, as well as a regular undergraduate section and makes for fascinating reading. Visit it today ! Prof. Aggrawal also has several other forensic related sites, including his 'Popular Forensic Medicine page', and 'Forensic Toxicology page'.
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Forensicmed.co.uk book store T-shirt store © www.forensicmed.co.uk. Richard Jones forensicmed.co.uk , all rights reserved ; this page or any part thereof may not be duplicated without the express written permission of the copyright owner. This site aims to provide educational resources for medical students in the fields of forensic pathology, clinical forensic medicine, forensic psychiatry and forensic science. All illustrations used are believed to be in the public domain, and royalty free. However, if this is not the case, and you are the copyright holder, I apologise, and will remove the relevant illustrations if required.
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