Non-invasive post-mortem examination
One of the roles of a coroner is to determine the cause of death and decide whether the circumstances of the death need further investigation.
In almost two thirds of cases a doctor who knew the person in life can tell the coroner a cause of death and so no further medical investigation will then be needed. However in over a third of cases the coroner will need to ask a doctor to examine the body after death and provide an opinion to help the coroner determine the cause of death. That examination after death is known as a “post-mortem examination”.
The coroner looks at the circumstances of the death and decides whether or not a post-mortem examination is needed and if so what type of examination is most appropriate. A coroner’s post-mortem examination will be independent and is carried out by a doctor of the coroner’s choice. In Lancashire and Blackburn with Darwen areas around 1800 post-mortem examinations are carried out each year.
The Royal Preston Hospital non-invasive post-mortem service
The Lancashire and Blackburn with Darwen coroners Service aims to put bereaved families at the centre of the coronial process and recognises that after the death of a loved one it can be distressing to learn that an invasive post mortem examination might be required. Examination of a body in this way is also against the core beliefs of some faith communities.
A new collaboration between Lancashire County Council, the Lancashire Teaching Hospital NHS Trust and a private scanning provider, iGene London Ltd has allowed us to develop an innovative service where all non-suspicious deaths will now, initially, be investigated by scanning and so, in the majority of cases, an invasive autopsy will not be needed.
Non-invasive post mortem examinations
Traditionally, most post-mortem examinations have been carried out by a pathologist and have involved an “invasive autopsy that is opening and examining the body internally and examining and weighing the internal organs. However recent advances in computerised scanning means that internal examinations can now be carried out using a scanner that produces digital images that are then looked at by a doctor without needing to open the body.
This is called enhanced computerised tomography or ‘CT scanning’. Specialist doctors (Consultant Radiologists) interpret the CT images and are able to provide a cause of death in over 90% of cases without the need for a traditional autopsy.
This type of post-mortem examination, based on CT scanning, is known as a “non-invasive post mortem examination”.
When and where the examination will take place
A non-invasive post-mortem will usually be performed within 48 hours of death or sooner if there are particular reasons to speed up the process. The scanning will take place at a specialist CT scanning facility that has been built at the mortuary at the Royal Preston Hospital.
What the process will involve
All the staff involved in the non-invasive post-mortem examination will be NHS employees. NHS staff will deal with the bodies in the mortuary, prepare the bodies for scan, undertake the scan and report on the scans.
A specially trained NHS anatomical pathology technologist (‘APT’) will receive the body at the mortuary along with a written report from the coroner’s office giving the brief circumstances of the death. The APT will conduct an external examination and take photographs if necessary before preparing the body for scanning.
A NHS Consultant Radiologist will examine the scan images and consider all of the other available information before providing a report to the coroner on the cause of death. Where the CT scan procedure reveals a medical cause of death an invasive autopsy will therefore, usually, have been avoided.
iGene London Ltd will arrange the respectful transfer of the body to and from the Royal Preston Hospital mortuary, provide the CT scanning equipment and manage the secure storage of the scan images and other data.
Need for surgery
Part of the non-invasive post-mortem involves scanning the blood vessels to look for abnormalities. To do this a small amount of dye has to be introduced into the coronary arteries by making two small incisions.
In up to 10% of cases the radiologist may be unable to give a cause of death after the CT scanning procedure. In those cases the coroner may need to ask a pathologist to conduct a limited or full invasive autopsy examination.
When the coroner will know the cause of death
Where the CT scan procedure reveals a medical cause of death this will usually be provided to the coroner on the same day that the scan is conducted, in a full radiology report. In most cases the coroner will receive the report within two days of the death.
If a partial or full traditional invasive autopsy conducted by a pathologist is required, then there will be a delay to establishing the medical cause of death.
Bereaved relatives are entitled to have a copy of that post-mortem report and you should ask the coroner’s Officer if you wish to have a copy.
Pathologists will still play an important role in assisting with difficult cases by providing additional evidence for the coroner’s inquiry and possible inquest.
Where the evidence from the scanning does not reveal a cause of death the coroner may then, where necessary, ask a pathologist to conduct a limited or full invasive post-mortem.
Where there is any suggestion of criminal conduct or neglect leading to the death it is likely that a full invasive post-mortem will be requested at the outset.
The advantages of the new service
A non-invasive approach will be preferred by many people who have a personal or religious objection to an invasive examination of the body.
The post-mortem results will now be available to the coroner more quickly than with a traditional invasive autopsy.
The use of Consultant Radiologists to report the cause of death is a more efficient use of consultant time.
Pathologists are in short supply, and this new system will also release their valuable skill set to assist in diagnosing serious conditions in the living.
Images from the non-invasive post-mortem will be securely stored and can be reviewed later if required, something which is not possible after cremation and is impracticable after burial if a traditional invasive autopsy has been conducted.
The disadvantages of scanning PMCT
The use of a scanning technique may not avoid the need for an invasive autopsy if the CT scan does not identify the cause of death. In up to 10% of cases an invasive autopsy will still be required
In some situations post-mortem by CT scanning is not as good as a traditional invasive autopsy in establishing cause of death – for example where there has been pulmonary embolism (clots in lungs).
Need for consent to a post-mortem examination
By law, the coroner is not required to obtain the consent of the bereaved to a post-mortem examination of any type. But you will be informed by the coroner's Officer what type of post-mortem is to be undertaken and the coroner will give you the reason for his or her decision if you ask to know this.
Wherever possible, the coroner’s office will, on request, tell you when the examination is to be performed.
As with the previous invasive autopsy service, the new service will be paid for from the Local Authority’s coronial budget at no charge to the bereaved.
The cost to the Local Authority of this radiologist led CT post-mortem scanning service will be the same as previously for the traditional invasive autopsy service.
Presence or representation at the scanning
The bereaved can be represented by a doctor of their choice at any post-mortem examination (invasive or non-invasive), although this is not normally necessary. You would have to pay any fee the doctor may charge.
If you choose to be represented you should advise the coroner straight away. The coroner’s office will then tell you when and where the examination will happen.
Arranging a second post-mortem examination
If you remain concerned about the cause of death, you can arrange for a separate, additional post-mortem examination. This would be at your own expense, once the coroner has released the body.
If you have queries, or object to the decision to hold a post-mortem examination or carry out additional examination of tissue, you should let the coroner’s office know as soon as possible so your wishes can be considered.
If there is no post-mortem at all
If the coroner decides not to request a post-mortem examination, and you think there should be one, you should discuss this with the coroner’s office.
In all cases the final decision about a post-mortem examination and any other tests is the responsibility of the coroner.
If you have any further questions please contact the coroner’s Officer:
Preston: 01772 524740
Chorley: 01257 247756/247757
Lancaster: 01524 516353
Blackburn: 01254 734116
Burnley: 01282 804539/804508