MINI-SYMPOSIUM: NON-INVASIVE RADIOLOGICAL AUTOPSY

Exchanging information:current United Kingdomdevelopments in theinfrastructure to supportpost-mortem imagingPhilip Webster

AbstractThrough joint working across the Home Office, Ministry of Justice and

Department of Health the United Kingdom (UK) has developed a single

programme of research and development in the field of less invasive

autopsy, forensic and mass fatality imaging. By supporting research and

development within these fields the UK has developed an outline for

a national core training programme in this field along with the develop-

ment of the National Forensic Image Management System (FiMag). This

symposium paper is a brief overview of this development.

Keywords computed tomography; Disaster Victim Identification; FiMag;

less invasive autopsy; MRI; post-mortem

Introduction

Through joint working across the Home Office, Ministry of

Justice and Department of Health the United Kingdom (UK) has

developed a single programme of research and development in

the field of less invasive autopsy, forensic and mass fatality

imaging. The work is led by the National Clinical Lead for

Imaging through the National Imaging Board which oversees all

developments in Imaging across the NHS. With representation

from radiology, radiography, pathology (forensic and non-

forensic autopsy), defence medical services, anthropology and

odontology this work stream is part of the Department of Health

National Imaging Board. The remit of the group is to:

� Evaluate and expand the current practice and application of

two and three dimensional imaging

� Consider existing and ‘imminent’ research

� Recognize the opportunities of modern data transfer

techniques

� Joint working with the defence medical services

� Coordination and development of a national approach

The Forensic and Disaster Imaging work programme is designed

to cover all aspects of this specialist area, share current practice

and knowledge, provide a coordinated approach to research and

development and link developments into the NHS infrastructure.

There are four main areas of research covered by the pro-

gramme which include:

Philip Webster HDCR DMS Dip CIMMBA is the Imaging Technical Lead for the

Department of Health, London, UK. Conflicts of interest: none declared.

DIAGNOSTIC HISTOPATHOLOGY 16:12 578

1. Oversight of the less invasive autopsy research

2. Education and training in Disaster Victim Identification

3. Operational processes and data transfer for both less inva-

sive autopsy and forensic imaging

4. Imaging techniques and advances in computed tomography

(CT) digital image manipulation.

The remainder of this article will focus on two current devel-

opments; the training support developments of the less invasive

autopsy programme and the infrastructural support develop-

ments for mass fatality related imaging.

History

Following the London bombings in 2005 the UK wide resilience

programme was established to provide an imaging response

using conventional 2D imaging and fluoroscopy. This response

has been extended to include the provision of CT scanning.1

Having established access to mass fatality CT scanning and

the potential information gained from cross sectional imaging it

was recognized that specialist radiological skills would comple-

ment the radiographic service provided to the examining

pathologist. In essence to create an imaging team common to

hospital practice. This has been further enhance by the devel-

opment of the worlds first dedicated Forensic Imaging computer

system, FiMag, which follows the principles of radiology infor-

mation systems and provides an integrated record of body

recovery, imaging and identification data.2

Approach to training

To facilitate the development of expertise across all disci-

plines involved in post-mortem imaging a comprehensive

training programme has been developed. The components

are:

� Creation of a validated case archive of Magnetic Resonance

Imaging (MRI) and CT images correlated with conventional

autopsy findings

� Development of reference index of normal post-mortem

radiological appearances

� Development of standardized training material

� Training facilities linked to clinical educational

establishments

As part of the development of a national training programme

a core training curriculum has been proposed. Designed to

provide expertise in both less invasive and Forensic techniques

and findings, the curriculum covers core skills and detailed

imaging presentations (Table 1). The training is based on

a common approach to secure data recording, storage and

transfer which will integrate with Hospital Radiology and

Pathology Systems and is based on the UK Forensic Imaging

Management system (FiMag). The system consists of a Master

Record Database collecting recovery, radiography, mortuary,

pathology, odontology, anthropology and radiology datafields

with four data capture modules.

Overview of the FiMag system

The FiMag system arose from Home Office sponsored research

undertaken at the East Midlands Forensic Pathology Unit,

Leicester and subsequent development of a CT based mass

� 2010 Published by Elsevier Ltd.

The national training programme core curriculum forless invasive and forensic imaging

C Ethics

C Consent

C Health & safety

C Imaging techniques

C Equipment

C Time based imaging artefacts

C Presentation in adults and children

C Assessment and relevance of previous medical history

C Research findings and sources of reference

C Imaging findings

B Vascular

B Solid tissue

B Gas

B Calcification

B Parenchyma changes

C Anatomical review

B Brain

B Thorax

B Abdomen

B Spine

B Pelvis

B Extremities

C Specialist evaluation of cardiac and lung anatomy and pathology

C Application and technique of minimally invasive techniques

The programme is made up of four modules offering

Techniques 20%

Case based training 60%

Systems and administration processes 10%

Common audit tools 10%

Table 1

MINI-SYMPOSIUM: NON-INVASIVE RADIOLOGICAL AUTOPSY

fatality image and reporting system. Taking into account the

requirements of the professionals the data capture systems have

been designed to collect information gathered at all stages of the

recovery and identification process. The integrated database and

image storage combine to form the full identification and inves-

tigative record.

As part of each system a containerized Specialist Support Unit

(SSU) is deployed close to the scene inner cordon and provides

dedicated office environment allowing specialists to record and

update information and view/manipulate radiographic images,

including 3D reconstruction. From the SSU specialist Disaster

Victim Identification (DVI) officers, pathologists, odontologists,

anthropologists and radiographic specialists can both review the

information and communicate in real time with the examining

pathologists and other team members through live audio and

video data links either on site or utilizing remote

communications.

The system modules are:

1. Body recovery. Using ruggedized handheld tablet computers

the DVI recovery teams record and photograph details of the

DIAGNOSTIC HISTOPATHOLOGY 16:12 579

recovery of every body or fragment simultaneously creating

the unique system record (Case) for tracking throughout the

system, using electronic forms based on the current stan-

dards used across the UK. Each entry records the detail of

location, team members and unique reference number of the

item. Images of the recovery scene are captured and recorded

against the case using the tablet’s built in camera and

software.

2. Body movement. Movement of the body or fragment is

tracked around the different locations at the incident using

specialized handheld Cases Tracking Units (CTU). Each CTU

captures the location of the case prior to movement, the time

of transfer and arrival at the new destination in the recovery

workflow. Locations are set up dependant on the type and

scale of incident. The system also records who carried out

the movement, providing complete audit and tractability of

any Case in real time.

3. Radiology imaging data capture. Capturing the images from

the Multi-detector CT (MDCT) scanner or from conven-

tional X-ray equipment the images are stored as part of the

Master Case Record. The captured images are then used to

create a virtual 3D reconstruction of the body bag contents

without opening it, assisting in the location of any poten-

tially hazardous objects within the sealed body bag prior to

examination. Once stored in FiMag the images are imme-

diately available for review by the onsite pathologists and

DVI teams. Capable of storing very large amounts of data

from any electronic source (a MDCT Scan is approximately

1 Gb) the system provides the ability to securely transfer the

images to specialists across the UK and other countries to

assist in identification.

4. Mortuary examination. Within the mortuary area the system

provides voice and real-time video links to the specialist

teams based in System Support Unit or remote from the

incident. Video images are captured by an overhead video

camera with zoom facility controlled by the team located in

the SSU. A head camera unit worn by the examining

pathologist captures images in pathologist’s field of vision

and includes two way audio communications with the SSU.

The audio communication and video feeds are used by

a team member in the SSU to assist in the completion of

identification forms and are all recorded as part of the Master

Case Record. Specially designed to operate in mortuary

conditions a high definition large screen monitor in the

mortuary providing 3D images of the body or fragment in the

body bag that can be remotely manipulated by a member of

the DVI team in the SSU assisting the pathologist during the

examination.

Designed to support operations in harsh environments the FiMag

equipment is built to be deployed rapidly in robust specialist

modular units allowing the service to be located in close prox-

imity to the mortuary and Imaging services. This includes the

ability to operate and be maintained remotely if deployed in the

restricted inner cordon.

Summary

Through the National Clinical Lead for Imaging and the

National Imaging Board the United Kingdom is investing in

� 2010 Published by Elsevier Ltd.

MINI-SYMPOSIUM: NON-INVASIVE RADIOLOGICAL AUTOPSY

research, training and service development related to the less

invasive autopsy, forensic and mass fatality imaging. For

a Civil Contingency national response the UK is a world

leader in this area and our task is to ensure sustainability

through training and ongoing education. For less invasive

autopsy techniques we are preparing for when the science is

right. A

DIAGNOSTIC HISTOPATHOLOGY 16:12 580

REFERENCES

1 Rutty GN, Robinson CE, BouHaidar R, Jeffery AJ, Morgan B. The role of

mobile computed tomography in mass fatality incidents. J Forensic Sci

2007; 52: 1343e9.

2 Rutty GN, Robinson C, Morgan B, Black S, Adams C, Webster P. Fimag:

the United Kingdom disaster victim/forensic identification imaging

system. J Forensic Sci 2009; 54: 1438e42.

� 2010 Published by Elsevier Ltd.