Post-Mortem CT: How Radiology Is Rewriting the Autopsy

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Dr. Kalpana Kanal, PhD

Professor and Director, Diagnostic Physics Section, Department of Radiology • University of Washington

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In this 12-minute clip, host Chris St. John revisits his conversation with Dr. Kalpana Kanal, Professor and Director of the Diagnostic Physics Section at the University of Washington, to spotlight one of the most striking threads from her full interview: the use of CT imaging in forensic pathology. Postmortem CT gives investigators a way to examine the body in detail without a scalpel, and Dr. Kanal explains why that matters.

The highlights cover how imaging can reduce the need for invasive autopsies, what postmortem CT adds to death investigation, and the value these cases bring to medical education. If this clip catches your interest, the full conversation is in EP 15, Radiation Optimization: Dr. Kanal’s Legacy with the Dose Index Registry.

Host

Chris St. John

Host, Rethink Imaging • Imalogix

Featured Guest

Dr. Kalpana Kanal, PhD

Professor and Director, Diagnostic Physics Section, Department of Radiology • University of Washington

Watch the Episode

Key Takeaways

CT imaging has a growing role in forensic pathology, giving pathologists and medical examiners a non-invasive way to examine the body after death.
Postmortem CT can reduce reliance on invasive autopsies, which matters for families, for workload, and for cases where a traditional autopsy is declined or impractical.
Imaging is changing how death investigation works, with CT findings adding a layer of documentation that complements the pathologist’s exam.
These cases carry real teaching value: postmortem imaging gives trainees a way to connect imaging findings with anatomy and cause of death.

Full Transcript

Kalpana Kanal Transcript

After playing such an integral role in DIR’s early days, you have since stepped back from the initiative. What kind of led to that decision, and where are you focused now, um, on your research and your professional work?

[00:31:42] Kalpana Kanal: Yeah. So I got, uh, I got very fortunate to become a trustee, a diagnostic medical physics trustee for the American Board of Radiology. And I had to step back from the ACR because it was really difficult to manage both those leadership positions. Um, the ABR trustee role is pretty demanding of time, uh, but it’s a very fulfilling role as well. So I’ve been doing that since 2017, uh, and that’s why I stepped back from DIR. I mean, I’m still involved with, uh, ACR. We’re still trying to write some, uh, papers. I’m very much talk to all the leadership there now as well, but I’m not actively involved. Right now, my focus has been, in terms of work, has been on a very interesting new path that not a lot of people in physics are, which is forensic CT. So what that is is basically using CT. So you’re leveraging technology to determine cause of death or trauma or whatever is going on in a cadaver. So instead of imagine here, instead of doing an autopsy, if you could have that cadaver or that dead person go through a CT and you can figure out what is the cause of death, um, and don’t have to cut open the body, that is significant. Yeah. So I’ve been working on this for the last six, seven years. So my chairman, doctor Dushan Sawhney, when he came to, uh, University of Washington and he was talking about his some one of some of his, um, far thinking ideas and his vision, Um, this whole world of forensics CT totally resonated with me, and I just went with it. And he gave me his blessing to move forward with it over here at University of Washington. So we started working on this. And we have to today, we have scanned about more than 50 cadavers on our Siemens CT scanner. You can do it on any CT. It’s just that our Siemens CT scanner is right one floor over our medical examiner’s office. And we have scanned, um, one fifty, one 60 of them. And, uh, in about forty five to fifty percent of the cases, an autopsy was not needed because the CT gave them the answer to the reason for the cause of death or the trauma or whatever the reason might be. And these are cadavers that come you know, decedents as well, it’s called, uh, from suicide, trauma, accident, um, you know, natural death, stuff like that. And that has been a fascinating fascinating, uh, pathway that I have taken. And I’ve presented, uh, at 8PM. I presented, uh, because I want people to be aware of this. In America, here in The US, not a lot of sites do this. Um, but outside America, a lot of sites do it. Japan does it. Australia does it. There’s England that does it. Um, and why not here? I mean, just imagine the impact on community if you do not have to cut up a cadaver. Right? Uh, think about the cultural um, and emotional sentiments that people have and saying, you know, my relative suffered enough, and now you wanna cut them open. Right? I wouldn’t want that for my relative. So I think it’s gonna have a far reaching effect. We we are publishing on it right now. It’s in the process of being published. Um, I’ve given several talks at physicist meetings to bring awareness. And, like, the main common question I get is why not. Right? Why aren’t we doing it more in The US? And I think it is an issue of billing and things like that for anything because radiologists have to read these images. Mhmm. We we work with our pathology pathologists on doing this. So we have established this program here, and we did such a great job of convincing our medical examiner colleagues that, uh, we helped them buy a CT scanner, which is gonna be installed in the medical examiner’s office in a couple of months. And then they’re going to have every cadaver go through it. For my project, we did selective, right, because we didn’t have the bandwidth. But now imagine the whole new world opens up. The other reason this is this is great using technology, but from a ME perspective, there’s a shortage of forensic pathologists. So there aren’t a lot of people available to do autopsies. They’re backed up for days. So using technology to help, why not? Right? Yeah. So this is something I have been very interested in for the last four, five years, and that’s what I’ve been working on to establish a forensic program here at University of Washington. Very, very interesting to me.

[00:36:08] Chris St John: Can I can I just ask? I’m I’m so curious. So, I mean, obviously, it’s it’s there’s there’s there’s different cadavers coming in, and maybe you have clues of like, when it comes to selecting protocols for these cadavers, um, is it is it is it always full body scans? Is it case by case? Like, I’m I’m kind of curious about how you approach this.

[00:36:38] Kalpana Kanal: Correct. So we, um, we had the same questions when we got started. And, um, I think we have now worked so much in it that it’s getting more fine tuned that, excuse me, the forensic pathologist who order these CTs from the medical examiner’s office actually give us guidelines. They say, you know, we are interested in the pelvic area. So can you just run a pelvic CT? Or we are interested in chest abdomen, pelvis? Or we are interested in in the head? So now we are actually moving away from doing whole body, and that’s actually good because the scanner, if you’re doing whole body Right. You’re heating up the scanner. You know, you’re you’re creating tons of images, which no one is necessarily gonna look at.

[00:37:18] Chris St John: And you’re like, how many slices do you have to go through for a full body scan?

[00:37:23] Kalpana Kanal: A lot. So, you know, it also depends what slice sickness you’re reading at. So we have now actually worked so well with our program and our medical examiner’s office that now they give us guidelines. They say, okay. For this cadaver, you know, say it was a medic, uh, a car accident, so it’s an MVA, we suspect there’s trauma in this area, can you do a CT here or we suspect this is going on. There’s a lot of conversation going on between the forensic pathologists and our radiologists. They get some guidance, um, and so we are now more focused in what we do. And we also actually do conferences every other month, I think it is, or every month, um, where kind of like an M and M conference where we are looking at these cases, and we are talking it’s so interesting because you’re talking the radiologist is talking, hey. Here is a finding on the CT, and then the, uh, forensic pathologist is putting their gory images with the blood and gore and anatomy, which now you’re used to seeing and you’re trying to correlate the two, right, which is so fantastic. Um, so they learn a lot from our radiologists, and our radiologists learn a lot from the forensic pathologists. What are their needs? What are they looking for? And I would say we are a good example of the success, uh, for someone who’s trying to establish the program. As I said, there are other programs. Uh, one in, um, Albuquerque, OMI at University of New Mexico is a very well established program for years. They they, um, scan every cadaver that comes over there. Um, so, you know, we are learning from other people, and I think we have been very successful in in doing this. And I hope to, you know, see more happening in the future. And then you can apply this to education, right, medical student education. You don’t need to cut up bodies to look at anatomy. You can look at images, CT images, and see what it looks like and things like that. So there’s a limitless potential for taking this to any other area you want to.

[00:39:20] Chris St John: And so I I can’t I can’t help but wonder with you and your background in, you know, dose optimization now working on oh, god. Forensic CT. Forensic CT. So, um, you know, your your past experience with DIR now working in forensic CT, have you like, do you have any observations about dose or image quality that you kind of picked up while working with cadavers?

[00:39:50] Kalpana Kanal: The the one thing is that dead people images look look very different than live people. Right? There’s no blood flow. And the more if you’re further away from that, your imaging, it’s gonna look different. So I know that the dose is not a concern. They’re dead.

[00:40:02] Chris St John: Right. Yeah.

[00:40:03] Kalpana Kanal: Right? Yeah. So you’re not worried about optimizing dose. Right. But at the same time, you’re not overexposing them either. Uh, we we are, um, really focused more on the radiologists and what image quality they want. Right?

[00:40:16] Chris St John: So

[00:40:16] Kalpana Kanal: we haven’t really tweaked our protocols because we use automatic tube current modulation, Um, and the radiologists have been happy with it. They haven’t told us to tweak anything because, again, it’s hard for them anyway to look and relearn what anatomy looks like in a dead person because there’s no blood flow and things like that. Um, and that’s what they are focused on. They’re not focused on dose or anything. So that’s not even come up. But we might do some projects with our residents in the near future to look at, you know, all the 50 patients we have done so far. What has been the dose? Curious. Right? If there was a three hundred pounder or a hundred pound patient, what is our range of doses for these cadavers? And is our radiologists who are reading these are so far seem to be okay with image quality? They haven’t told us to increase the dose. Um, so it’s a different question. The focus is more on, you know, are we finding what we need to find with the physio physiological changes in cadavers because they are not alive more than worrying about dose. Yeah. Yeah. For sure. Is a little different.

[00:41:22] Chris St John: Yeah. I yeah. I I I wasn’t thinking that you were focused on dose, but I was just curious about, yeah, like, what your approach was when it came to

[00:41:33] Kalpana Kanal: protocol, and we’re using this. We probably tweaked up our dose a little bit because we we were not worried about harming anyone. So maybe 20%, which is not significant. Um, um, and so we really haven’t deep dived, if you will, into the dose aspect of these 50 or so we have done so far. But that is something we’re looking starting to look at now that our program is getting a little bit more established. We can now start looking at research projects along all these data that we have.

[00:42:04] Chris St John: That’s that is way more interesting. I mean, it not that it wouldn’t be interesting, but you you had me just, like, sucked in for a minute.

[00:42:13] Kalpana Kanal: Yeah. It’s been the response I’ve received at any audience. I’ve I’ve presented this to physicists. I’ve presented I’ve presented this to technologists. Our paper is getting published in JCAT. It should be coming out soon. I have had that response. This is so interesting. Why don’t we do it? Well, yeah, why don’t we do it, it, right, in The US? So it’s a question of billing and time and, uh, you know, the radiologist getting compensated to read these images.

[00:42:40] Chris St John: Yeah. Absolutely. But, I mean, wouldn’t I mean, someone performing an autopsy, like, there’s there’s billing and stuff involved in all of that as well. Um, but yeah. No. It’s it’s it’s fascinating to hear, and it just makes so much sense.

[00:42:54] Kalpana Kanal: Totally. That’s what I say.

[00:42:56] Chris St John: It’s just like, oh, yeah. Sure. Um, honest okay. So, um, that is, like, such a, like, incredibly interesting place to leave things, but I want to because we’re hitting about the forty five minute mark, so I don’t wanna eat up any more of your time. But is are there any questions or, like, follow ups about the forensic CT that you’d like me to ask or prompt so you can address anything else that’s on your mind that you wanna get out? Um,

[00:43:29] Kalpana Kanal: I think I kind of already said about the challenges and Yeah. You know, that why not why aren’t we all doing this? So I think I’ve covered it. Yeah.

[00:43:38] Chris St John: Cool. You can

[00:43:39] Kalpana Kanal: do another podcast in a in a year with more.

[00:43:42] Chris St John: Yeah. Absolutely. Um, and we can yeah. That I mean, we’re you’re you are now on the hook for that. So

[00:43:48] Kalpana Kanal: Okay. That’s fine. Totally.

[00:43:51] Chris St John: But, yeah, in that case, um, I’m gonna I’m just gonna say a little sentence to throw into the end of the episode, and then we can debrief for a half second, and then I’ll let you go.

[00:44:02] Kalpana Kanal: Okay. Sounds good.

[00:44:04] Chris St John: Cool. So I’m just gonna say that is beyond fascinating. Doctor Kanal, thank you so so much for joining us today on Frame by Frame. It’s been an absolute pleasure having you.

[00:44:16] Kalpana Kanal: Thank you so much, Chris. That was a lot of fun. I I didn’t realize that we have a formal podcast going on here. It was like a conversation, so I really enjoyed it. Thank you very much.

[00:44:25] Chris St John: Good. Thank you so much. Um, alright.

Questions from This Episode

What is postmortem CT?
Postmortem CT is the use of computed tomography to examine a body after death, sometimes called virtual autopsy or virtopsy. It produces detailed cross-sectional images of bones, organs, and foreign objects without any incision. Medical examiners and forensic pathologists use it to document findings and guide or supplement the physical exam.
Can CT imaging replace a traditional autopsy?
Not fully, and that is not the goal Dr. Kanal describes. CT is strong at showing fractures, hemorrhage, and foreign bodies, but some causes of death still require tissue examination. The practical shift is that imaging can reduce how often a full invasive autopsy is needed and make the ones that happen more targeted.
Why does postmortem CT matter for medical education?
Postmortem cases let trainees compare imaging findings directly against known outcomes, which is rare in clinical practice. That feedback loop sharpens interpretation skills and deepens understanding of anatomy and pathology. Dr. Kanal points to this as one of the underappreciated benefits of bringing radiology into death investigation.