Rethink Imaging

EP 40 • March 19, 2026

45% Fewer Autopsies: How Postmortem CT Is Changing Death Investigation in the U.S.

Featured Guest

Dr. Jonathan Medverd, PhD, DABR

Chief of Radiology, Harborview Medical Center; Associate Professor of Radiology • University of Washington

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Postmortem CT is already running in real programs, not waiting for someday. Dr. Kalpana Kanal, Director of Diagnostic Physics at the University of Washington, and Dr. Jonathan Medverd, Chief of Radiology at Harborview Medical Center, join the show to share how a collaboration between UW radiology and King County’s Medical Examiner Office grew from a pilot into a working clinical pathway. Since July 2022, the program has scanned 184 decedents.

The results carry weight. In roughly 45% of cases, CT findings were enough to determine cause of death without a traditional autopsy, and early validation cases, including a precise read of a ruptured aorta, were confirmed at autopsy. The conversation is candid about what it took to get there: aligning two different governance structures, working through IT firewalls between hospital PACS and county systems, funding a scanner, building trust between radiology and pathology, and operating without a billing code for postmortem imaging.

Kanal and Medverd also talk through the wider stakes, from cultural and religious alternatives for families who object to invasive autopsy, to reduced pathologist exposure to infectious disease and embalming chemicals, to clearer courtroom communication, to the cost gap when a complex autopsy can run past $2,500. Looking forward, they describe a forensic radiology rotation for senior residents and a longer-term vision for a fellowship that combines radiology and forensic pathology as the pathology workforce tightens.

Host

Chris St. John

Host, Rethink Imaging • Imalogix

Featured Guest

Dr. Jonathan Medverd, PhD, DABR

Chief of Radiology, Harborview Medical Center; Associate Professor of Radiology • University of Washington

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Key Takeaways

A postmortem CT program run jointly by UW radiology and the King County Medical Examiner has scanned 184 decedents since July 2022.
In about 45% of cases, CT findings determined cause of death without a traditional autopsy, with early imaging diagnoses confirmed at autopsy.
The hard part was operational, not just clinical: aligning two governance structures, connecting hospital PACS to county systems through IT firewalls, funding a scanner, and building trust across specialties.
The U.S. lacks a billing code (CPT) for postmortem imaging, which limits how widely programs like this can be adopted.
Postmortem CT offers practical benefits beyond efficiency, including cultural and religious alternatives to invasive autopsy, lower pathologist exposure to infection and chemicals, clearer courtroom evidence, and lower cost when complex autopsies exceed $2,500.

Full Transcript

[00:00:00] Jonathan Medverd: It was the very first case that I looked at, and I sent up an unfortunate bicyclist that got hit by a car at speed and obviously died. And that was the first postmortem CT that I looked at in this arrangement. And I’m used to looking at very banged up people, being a trauma radiologist here at a level one trauma center. And this case was kind of a Uber on that, essentially. Broken bones, a lot of, uh, trauma, We’re here

[00:00:43] Chris St John: We’re here because we’re curious about medical imaging or have a hunger to learn more. What can we learn from each other, and how should we prepare to tackle the challenges ahead? I’m Chris St. John, and join me today as we rethink imaging, a podcast by Imologix. Welcome to the show. Welcome back to Frame by Frame Rethink Imaging. Today, actually, by popular demand, we have doctor Kalpana Kanal back with us, the director of diagnostic physics and imaging physics residency program at UW. Doctor Kanal led the ACRCT Dose Index Registry as vice chair and chair. Since 2017, she has served as the ABR’s diagnostic medical physics trustee. And joining us as well is doctor Jonathan Medford, the chief of radiology at Harborview Medical Center and associate professor of emergency trauma and radiology at UW. Doctor Mevers specializes in emergency trauma, body, and musculoskeletal imaging, focusing on optimizing imaging workflows and image guided procedures. Thank you so much for joining us on Frame by Frame to you both.

[00:01:52] Jonathan Medverd: Thank you. Happy to be here.

[00:01:54] Kalpana Kanal: Thank you.

[00:01:55] Chris St John: And so when I sent by popular demand, what I meant was doctor Kunal and I originally recorded an episode on the dose index registry. And at the end, she let me know that she’s been working on something something different, this post mortem CT. And we got a lot of feedback from folks, and we wanted to do an episode where we really dive into it rather than just covering it. And so for the listeners who are new to the postmortem CT, not to the, but to postmortem CT, could y’all give me, like, a little bit of an elevator pitch for the project? What is the problem you set out to solve? How does your collaboration work? And where does the program stand today?

[00:02:36] Kalpana Kanal: We started this work actually almost six years ago, and the goal that we had was to leverage technology to help with cadaver imaging so we can determine using CT, the cause of death. Do we really need to do an autopsy on every cadaver to determine the cause of death? Right? Because that’s really what reason we do autopsies. So that is one reason. Can we leverage technology and assist our forensic pathologists in making that diagnosis and helping them using the CT. The other concern also is in the forensic pathology world, there’s a shortage of, um, professionals, um, going into that field. You know? Who wants to do autopsies as part of your career? I think so that there’s been a significant drop in their numbers, and I feel that CT could then help again fill some of that gap and the lack of, uh, staffing that they’re going to encounter as fewer and fewer professionals go into forensic pathology. I’ll let doctor Medved comment on the collaboration.

[00:03:39] Jonathan Medverd: The collaboration has been truly wonderful from a professional standpoint as well as a operational, uh, glide standpoint. Harborview is county owned hospital, and the county also has a whole different bureaucracy, different office that, uh, involves the medical examiner’s office. And it just so happens that both our hospital campus and the medical examiner are on the same campus. They’re basically, uh, in our Outpatient Building, radiology, has 3rd Floor and the medical examiner’s on the 2nd. Um, I didn’t even know that before this relationship started because we were that separate. However, given mutual interests and mutual goals, we’ve really developed a tight bond and have worked to overcome many hurdles to get this collaboration and program together. The relationship has grown with time. The trust is built with time, and the realization of synergies between the imaging sciences in our department and the forensic science knowledge and expertise in the medical examiner’s office has really, uh, mutually come to light over time. I can say with great gratification that one plus one is more than two in this particular relationship.

[00:05:12] Chris St John: Can you take us into that a little bit? Like, what was that first moment where you noticed that one plus one was more than two? Right? Like, did you have a moment where you were like, oh, this is really gonna change how we investigate debts? Like, what did you see on the scan? How did you steer the case? Or how did it steer the case? Was there, like, one particular moment for you?

[00:05:35] Jonathan Medverd: To tell you the truth, Chris, it was the very first case that I looked at. In the early days, the, uh, we were we were not doing consecutive cases. We were doing selected cases by the medical examiner, and they sent up an unfortunate bicyclist that got hit by a car at speed and obviously died. That was the first postmortem CT that I looked at in this arrangement. And I’m used to looking at very banged up people, being a trauma radiologist here at a level one trauma center. And this case was kind of a Uber on that, essentially. Um, a lot of broken bones, a lot of trauma, but and that could be picked out very quickly. But then I saw, Mary also had, you know, a chest full of blood and and things like that. And with more examination and leaning on skills I have from the living, I hypothesized that this person’s aorta had, uh, ruptured, and that was the, uh, cause of their death. And in those early days, we were doing autopsies as well. So there was that one to one correlate, the RadPath correlate, and it was, uh, confirmed not just that the aorta ruptured, but at the location I had predicted. And I saw then the power that, okay, we could have maybe prevented a traditional autopsy in this case by using the CT, and it’s gone from there.

[00:07:07] Chris St John: That’s pretty cool. I mean and so how many cases have you scanned so far?

[00:07:12] Kalpana Kanal: Well, couple of weeks ago, we have scanned about hundred and eighty four cases. We started on 07/18/2022, so we’re coming up on upload anniversary. So we scanned, as I said, about hundred and eighty four cases. And if you want the analysis, I would say about forty five percent of those cases, we did not have to do an autopsy on. The CT gave us significant results and said, you know what? Here’s a diagnosis. Doctor Medved had confirmed diagnosis, but the pathologist didn’t need to do an autopsy for at least forty five percent of those cases.

[00:07:47] Chris St John: Joe, y’all were finding, like, potentially, you have to distinguish between the iatrogenic and the natural actual causes when you’re reading these images. Right?

[00:07:58] Jonathan Medverd: That’s a difficult question. Anatomy is anatomy, but interpretation of living versus deceased individuals has been a definite learning curve. We’re building our experience on the artifacts. Common things become common even in, uh, dead people. Gas is, uh, difficult to interpret sometimes. Uh, when is there too much gas because of trauma or disease? Uh, when is gas, um, just because of natural decomposition? That really becomes an art because some people die in a 70 degree room and other people die in a 40 degree sidewalk. And the trajectory that they take is much different. With trauma, oftentimes, a traumatic rib fracture looks different than a, let’s say, a CPR fracture related to CPR. So that what did the accident cause versus what did the attempted resuscitation cause. Usually, you can tell the difference because just like in the living, it’s pattern recognition. Typical patterns usually will draw out And particularly when neighboring patterns all fit a story, then, uh, you you can become more confident. I hope that answers the question.

[00:09:25] Chris St John: So it’s so cool. And so as y’all are preparing to transition from the pilot, uh, into a full service, what operational hurdles do you anticipate running into?

[00:09:36] Kalpana Kanal: I think we have kind of already passed the hurdle point because as we speak, the CT scanner is being installed in the MA office right now, this week. It arrived on Monday. The operational hurdles, you know, just to kind of reiterate, for this whole project get started, we had to figure out initially who the players are, who do we talk to, who are the decision makers on the pathology side, are there people interested on the radiology side. So when I started this with my other physicist colleague, David Zamora, we started six years ago. We started at the main campus, and we had to figure out who are the pathologists? Who do I need to talk to? Are they even interested in forensic imaging? Those were all the hurdles we worked out. Now as we came to Harborview and the ME office saw the value of this, the hurdles to work out was the money. Where do we get the money for the scanner? How do we support the staff that’s reading the t’s, the radiologist? What else do we need the money for? Right? Do we need money to support the whole program? How do we do the training? How do we set up our day to day? When do we do huddles for the radiologists to look at the scans and figure things out? Those are the type of operational hurdles we are working out now. Where do we store our images? How do we connect with UW being a different entity, a university setting, hospital trial level one trauma setting, and King County being governed. It’s a government agency. Right? So just the way things are done on both sides are different, and how do we do that? So one thing we have done is we do a touch base meeting every month to talk about our issues and hurdles and getting over them. And we’ve been doing that for more than a year to get ready for the CT scanner that arrived yesterday.

[00:11:22] Chris St John: You have to have some sort of complex understanding between UW and the King County ME office. Right? What was the process of coming to that understanding like, and what would you suggest for others who are looking to streamline a similar process?

[00:11:39] Jonathan Medverd: I think step one has to be the relationship. Uh, without the relationships that we’ve built here, I do not think we’ve been we would be able to be where we’re at. And relationships sort of, in my mind, becomes an umbrella term, you know, for trust. Through that relationship, we’ve learned to trust each other. We’ve, uh, honed a common vision. Are there facets of that vision that radiology looks a little bit differently on than the medical examiner? Sure. Our needs, our strengths are both different. Our our needs are different, but but we both kind of have the goal to get to the same horizon. So that’s good. So I I think you need to meet the people in your neighborhood, so to speak, you know, in quotes, and come to common vision or at least common goal and then work on it coming to a common vision. And then you gotta get to the nitty gritty. I wish if I were to do this again, I would come up with a more of a formal business pro form a right up front. There is data out there from our experience from there’s more mature centers like a very well known one in New Mexico that have, uh, published on some of the operations, some of the expenses, some of the savings, and group could use that to to model and translate to their environment and their unique situation, so to speak, and hopefully understand better the time and resource investment that are needed. I mean, with us, we were volunteering, and we were following a goal, a dream, a vision, whatever you wanna call it. And it would have been nice to be able to keep our bosses, uh, do well, not to keep to inform our bosses going into it what the possible range of expectations were to be. And so if I were to do it again, I I would do a napkin perform. It doesn’t need to be a formal thing, but get a sense there. Try to use, uh, litter to have ideas to mimic other experiences. And then, I guess, to come full circle, the the relationship is key. If if you don’t have a collaborator on the other side, certainly, what I’ve learned, this is we need both the push and the pull in the same direct you know, going towards the same goal. If there was friction, I I’m not sure how we would have fared, but there was very little friction. We worked together to eliminate friction.

[00:14:20] Kalpana Kanal: And I could add to that, if I may add to that. Uh, having a commitment from whatever, you know, your leadership is and going into this with a commitment that there would be money to run the operation, right, and to set up the program. I think for any entity who wants to get into that, commitment should be there. Because you don’t wanna get halfway through the process and then realize that there is no money to support the program. So I think that is what I would also highly recommend anyone who wants to get into this to do is sit down with your leadership, people who do the money and get a commitment that we’re gonna support the program. We are fortunate that we have this wonderful understanding. And even though we are not making any money right now, we have the potential to do this, you know, as a consulting to make maybe do consulting in the future when it’s set up and, you know, establish a revenue stream. But we are doing it because we care and we are passionate about this project because we think it’s impacting the community. It’s making a lot of impact. And at some point, CT might also show up in the court system. Right? When a medical examiner goes does a testimony in a court case, instead of looking at gory images, they can look at CT images. So much better for not biasing the jury. Right? It’s much better than looking at blood and gore. So I think there’s so much of an impact I feel on public, on community, on public health. That’s why I got into it. You know? I didn’t get into it because I’m making money. Right? I’m making no money. I’m a physicist. I’m not even a radiologist. Don’t have value here. I don’t have any value. Really, the passion of what to bring to the world, to the community. And it’s very, very common outside The US, so why not here?

[00:16:00] Chris St John: Absolutely. I mean and I feel like that community element, it goes into people’s it touches them in their belief systems a lot of times. Right? Like, haven’t y’all done some cases where you can do a CT instead of an autopsy for for religious objections. Right?

[00:16:18] Kalpana Kanal: Absolutely. We had some cases, and I don’t remember the exact number, but we have had cases where the family objected to an autopsy. And we said, okay. We have a CT, which is okay. We have a CT, which is noninvasive, and we’ll still get the answers we want. And I think that has been significantly helpful to family and the community that we can still get the answer we want without cutting open the body. So it’s definitely from a cultural point of view, uh, emotional sentiment point of view, religious point of view, significant to have this alternate option to an autopsy.

[00:16:54] Jonathan Medverd: In some circumstance, the, uh, medical examiner gets requests from, uh, families for, uh, sometimes religious, sometimes other preference reasons that, uh, they don’t want a body disturbed. And while they don’t advertise that per se, they do want to honor those requests when the circumstances of the death allow it. For example, in a very straightforward, not many questions about the cause and manner of death, They might do that, but, uh, their hands might be tied if there’s particularly suspicious circumstances surrounding a death where even in the face of a request to not disturb the body, they might feel compelled to do a full autopsy nonetheless. Be uncomfortable with CT only. Anything with a police investigation, uh, usually gets a, uh, a traditional autopsy, uh, just to have the maximum information for whatever official investigation is going on. When it can work, it’s, uh, comforting for families, and they’re very appreciative to avoid the either the thought or the sight of body being disturbed.

[00:18:14] Chris St John: Good. So if y’all wouldn’t mind a a slight little pivot, I feel like you hinted a little bit at, uh, a future post mortem CT fellowship. Are there are there core skills and rotations that you would wanna build into the curriculum

[00:18:29] Kalpana Kanal: for that? So this is something I’ll I’ll comment on, and then I’ll have Don put on his, uh, radiologist hat and comment on. I’ll I’ll put on my business hat. So this is something I really am interested in because I feel that we are interested, the radiology side. The pathology side is interested. Why don’t we train people to do both? We want this field to expand and grow and become popular. You need the radiologist and you need the pathologist. So having a fellowship where it could be a pathologist learning on the about the radiology side besides what they learn or having a radiologist learn about the pathology side because they are already learning the radiology. So kind of combining the two, to me, would be fantastic. The solution to the problem where they can use both their expertise to grow this. Because this is, you know, what we are seeing with only the 184 we have done has such an impact. So imagine doing this every day on every cadaver. So from my very naive non MD point of view, I think, why not? We should have a fellowship that will actually be a new area of study and where we would combine the radiology principles and the pathology principles to to grow it. And I’ve told John I’d like to do this before I retire, so we only have three or four years to do this, John. So that’s my take on it, but I’ll let John comment from his radiologist hat.

[00:19:58] Jonathan Medverd: Thank you, doctor Khanal. You covered most of it. There are advantages to knowing postmortem CT interpretation that, uh, benefits living interpretation. The way I’ve come to view it is that, uh, reading postmortem CT really adds a new facet, a new way to understand CT in the living and vice versa. They really do complement each other. I came into this, obviously, having two decades experience as a radiologist for for the living and learned as I went the rules, so to speak, of, uh, post mortem CT. I think that, uh, in a fellowship, you know, more of an educational program rather than a school of hard knocks is preferred, and, uh, that is something that we now will have the opportunity to someday do. And and I think we both have a passion to try to fulfill that. There’s certainly a need for this work in our state and other states. There’s a shortage of forensic, uh, pathologists. There’s no shortage of deaths. A fellowship to help, uh, inform a well trained and competent people in possibly a new future for, uh, forensic investigation is something that I think we’re gonna be doing. Maybe not tomorrow, but, uh, maybe next month.

[00:21:23] Kalpana Kanal: And we have made a small step in that direction, Grit, by establishing doctor Medvedev and I have established a forensic radiology rotation in our department, and that will be on for our senior residents, our five years. So they’re done with all their, you know, all their they’re getting ready to graduate. And we’re gonna try it out this November, and doctor Medved and I actually wrote the content of that rotation. And at least on paper, we still have to work on making it happen, and we worked and partnered with our ME, doctor Lacey, who’s been very supportive of this whole work with us and is very, very excited about doing that rotation where we envision our resident with help with the reading of the postmortem CT under doctor Medward and other attending guidance, as well as go and shadow the medical examiner office pathologist and see how things happen on their end. And I think it’s gonna make for a very interesting rotation. I wanna do it, and I’m not even qualified. I’m not a but it just seems so interesting to me, right, that they would learn something they haven’t learned in the four years that they’ve been here as a resident to read cadaver exams under the expertise of the attendings like doctor Medford. And then also look at the other side of the coin, the ME side. And and I think it’s gonna make for a fantastic rotation. It’s gonna be a one month rotation, and we’re hoping we’ll have, you know, people it’s an elective. They don’t have to sign up for it. But we will have a first taste of that in November or so this year, and I think that will give us some good experience in seeing what works, what doesn’t work, and how we can then build to make or to create rotations in that fellowship, a one year long fellowship. So I think we’ve already taken a tiny step towards a fellowship, and I’m sure we get a learn a lot from that experience.

[00:23:16] Chris St John: Yeah. And so this is forgive my naivete if this is a silly question. Right? But these are full body scans. So isn’t that a unique and interesting opportunity for folks who are learning to read these images?

[00:23:29] Jonathan Medverd: We certainly can scan from, uh, head to toe. And in fact, with homicides, we do from the very top of the head to the to to the end of the big toe. For most, uh, postmortem CTs, though, we do, uh, head, neck, and torso and then a portion of the legs. Usually, the the thighs and knees and maybe a little bit into the lower leg. That’s just easier that way from a scanning perspective. And oftentimes, if there’s no question in the ex the far lower extremities, then it’s easy to do. We would maybe decide, uh, how much to scan beyond that standard, uh, based on the death scene investigation and the questions the medical examiner might have in their head.

[00:24:18] Chris St John: Yeah. And so, I mean, in those forty something percent of cases, postmortem CT alone was sufficient reducing autopsies. Are there any traits or any tells initially that might hint that a CT will be enough off the bat?

[00:24:35] Jonathan Medverd: When the death investigation is pretty clear, an empty road, a car is found, uh, that hit a tree with, uh, one occupant that is now deceased. Uh, simple story. No question of foul play in those you know, maybe the person’s drunk, uh, and and had a good reason to lose control or something like that. In those situations, a CT often can do a great job making an inventory of traumatic injuries and, uh, very likely point to the cause of, uh, death amongst those, uh, injuries or or maybe a combination of those injuries leading to death. That kind of a case might be a good candidate to, uh, do a virtual autopsy, so to speak, avoid the traditional autopsy. You can combine that information with drug and alcohol testing of urine and blood, etcetera, etcetera. It really is circumstance by circumstance.

[00:25:40] Chris St John: You mentioned earlier, you know, you have to figure out where you’re storing these images, how you’re storing these images. How are you storing and sharing these DICOM datasets between hospital packs and the and the medical examiner’s office?

[00:25:54] Kalpana Kanal: Right now, we are storing all our images in our radiology packs, and the medical examiners can access images on EPIC, which is, you know, EPIC, which is the whole patient management system. And also continuing forward when they buy their scanner, which is currently being installed, the agreement between us is that they would still send our images, their images to radiology packs. So it would still store everything in our packs. It’s not that expensive now, storage of images, so we can we can afford to let that come to us. And then they would still have access to EPIC. And then some of them are also faculty in, uh, pathology department, so they have UW email. So they have the potential of, uh, logging into our PACS system anywhere and being able to access images as well. And for now, I think that’s gonna work really well between both partners, us having it on PACS. And we also do a every other month forensic radiology conference where we go through cases. So doctor Mediter will log in to PACS. He’ll throw up the cases on the computer, on the monitor, and there’s pathologists and radiologists and physicists in the room, and we are looking at interesting They have the option there too as he points out interesting things, um, that they’re interested in. They can go look in EPIC as well. They can always come and visit us in the radiology reading room. It’s not that far. I think the biggest aims of doing this project is we are they’re right across the street from Harborview. So it’s not like you have to travel miles. In five minutes, I can be in doctor Lacey’s office or he can be in doctor Medworth’s office. Very, very convenient. And I think so far, that’s the plan we have of storing the images than having them access of via EPIC.

[00:27:45] Jonathan Medverd: I might just add, uh, thank you to our, uh, radiology department chairman who has supported us in the use of our department’s PAC storage. His support and, uh, has been pivotal to getting this, uh, program off the ground. He let us know that we didn’t have to worry about, uh, money or time or, uh, uh, cost of the PAC storage in that regard. And, uh, for that, we’re all very thankful.

[00:28:14] Kalpana Kanal: And may I also add with respect to a question you asked earlier about hurdles? So, yes, saving it in our PACS, but we are University of Washington PACS network, and they are King County network. So we had to get people on both sides, our IT, their IT. And initially, you know, just trying to figure out who the players are. You know? Someone is not responding, they would come to us. I just recall that this is one of the hurdles that you need to also think about if you’re working with two different entities. Even though what, uh, doctor Meguid said that, great, we can use our packs and thanks to our chairman, but we still have to make it happen. So the hurdles were the IT team. Both IT teams trying to talk to each other, making sure they’re available. All of that were also hurdles that we had to overcome, and now things are finally smooth. But initially, there was some rough waters to navigate, you know, till we figured out who’s the IT person we need to talk to. Are we all their needs? Are they meeting our needs? Firewalls, access. You know, it it’s always dealing with IT is all those issues that you have to think about.

[00:29:19] Chris St John: Absolutely. I was going to perhaps make a a joke. I respect the IT teams of the world, but I guess I will also say it is unsurprising that that was one of your hurdles. And I say that with respect to all of the IT workers out there. I respect and appreciate what you do. Also, I am unsurprised to hear that. It’s complicated. Things are complicated.

[00:29:41] Kalpana Kanal: And thank god they know more thing about it because we sure don’t. So this is very common in Japan, UK, Australia. They scan econeri cadaver in Japan. Why can’t we do this in The US? I mean, we are already seeing with the very small data that the number of cadavers we have scanned the benefits. So why is it, uh, such a hurdle? Right? Sure doctor Medved will comment on that, uh, from his perspective. From my perspective, I think, you know, just initially to figure out all the relationships and who’s doing what to get a program started as a hurdle. But I also think the biggest issue in my perspective is billing. We can’t make any money out of this unless there is a billing code. Right? So how can we bill and make money? A lot of these other places like Japan, the government supports the whole forensic center. Maybe we need to look at that from that perspective. In America, here in The US, we only have two or three centers who are doing this a lot. But the rest of us, maybe some of us are doing it, some not so much. It’s getting a little bit more popular in the medical examiner offices, but I think the main hurdle from a radiology side who I feel are the experts in reading a CT is the billing. Why would a radiologist dedicate all their time to doing this if they can’t count it towards RVUs or get paid for it from billing perspective or even a professional fee? We are doing it now because we wanna get the program started. Right? But I don’t expect doctor Medvedev to read this indefinitely without, you know, pro fees or or billing for our postmortem CTs. It’s still time on the scanner. So I think that’s the one challenge in America and I which we I hope we can overcome in the next few years as this gets more popular.

[00:31:27] Jonathan Medverd: I would agree with that, Kalpana. Absence of a billable code for postmortem CT or postmortem MRI for that matter is definitely a strong contributor to why postmortem imaging is not a big practice here in The US. I will say, though, that since we are in such a infant stage at this point, it’s a real opportunity to build something that benefits the society and and isn’t just a potential profit chasing vehicle. If we can struck backwards from the need back to, uh, the service, hopefully, we can find an efficient way to meet this ever and and, you know, an endless stream of decedents with a always challenged resource pool. And so figuring it out in an efficient way in this day and age where everything costs too much, it seems, is a real, uh, opportunity for our society, I think.

[00:32:35] Kalpana Kanal: From a benefit perspective, we have only been talking about diagnosis. Right, doctor Medvedev? But the other benefit would be in cases with diseases and, uh, infectious diseases where you don’t have to cut up a body and expose the pathologist to it. Right? The CT could be very helpful. COVID. During COVID. Right? If we could do a CT, which we did to determine COVID. Similarly, for cadavers, right, instead of opening it up and getting exposed using this technology from that path for now. Nothing in diagnosis, but how can we help in world problems? You know, infectious diseases, we don’t want our personnel to be exposed to that. So using the CT and sort of cutting open your body and being exposed to chemicals, I think, though, one of the cases that we had here in King County, one of the pathologists got back to me and said, CT diagnosed a ruptured anterobrovascular aneurysm in an embalmed case where they did not have to do autopsy and expose the pathologist to chemicals to toxic chemicals. If you open applications. We are focusing on diagnosis and cause of death, but there are so many advantages to the population, to the pathologist from doing the CT and not, you know, opening the so there’s a world and population impact. As doctor Medvedev said, we have to approach it maybe from that angle and see how we can make this more popular or advertise it, if you will, that, hey. Why are we not doing the school stuff? Right? It is cool.

[00:34:07] Jonathan Medverd: Yeah. I think this will inherently take off because it’s a hybrid model. It combines imaging with traditional forensic science. It’s less expensive. If savings are similar to the 45% avoidance of autopsy that we found so far, that savings can be directed into other resources, whether that be more imaging or staffing services or, uh, needs on the ground.

[00:34:37] Kalpana Kanal: Yeah. You meant cost, and I’m just gonna one more comment real quick. A complex autopsy, uh, costs around $2,500. Routine autopsy costs around $1,900, and external is about $900. Um, so you can just think if you don’t have to do a complex autopsy with the $2,500 and do a CT instead, right, there might be potential cost savings too. So you can even think from a economic and financial point of view how this would help whoever is doing it, basically.

[00:35:10] Chris St John: Let’s say a mid sized county wanted to replicate your model tomorrow. What would step one be for them, and what rookie mistakes would you tell them to watch out for?

[00:35:19] Kalpana Kanal: When we started, uh, really, the first step was figuring out the players on both sides. Who do I talk to on pathology side? Who is a medical examiner? What is the optic death investigation service processes? There are different depending on whether it happens in the hospital. Does it happen in the field? Dave and I, my colleague, uh, David Zamora, the medical physicist, and I have figured all this out. And I think that first step is, okay. I wanna do this. Okay. Let me find the players too. What is the plan, and where’s the money coming from? Because whatever you say, I think if you do not have a plan for the future to have money and resources, it’s gonna fall apart very quickly. Right? So I think we really have to start with just figuring out who the players are. Who do I talk to? Are they gonna be interested in this? What the point of radiology is interested in and pathology is not? Right? If the ME is not interested, there’s no point for us being interested. So I think finding your players, like minded people, is the first conversation you have. And I had, like, these two or three meetings with these really smart people on both sides, uh, that I didn’t know, but I had to bring together to the table and have a conversation about this, including our chairman, of course, doctor Sani, who presented the vision of the department. So I think the first point to me would be to any hospital would be, you know, figure out who the players are, have a conversation, and then take it from there.

[00:36:46] Jonathan Medverd: I agree. There needs to be a vision and a plan, but, really, everything needs to start with a relationship. With that can come trust and the opportunity to build towards a shared vision. And then, also, I think one needs at least a backup napkin pro form a. You need to know a little bit about costs, a little bit about expenses, a little bit about where your pain would be if volunteerism can’t carry the full day. So, um, coming up with a pro form a to understand how to fill at least basic needs of each side would be useful. Luckily, we built a very strong collaboration, very trusting relationship, so we’ve been able to touch through that. But before getting in, it is good to test how deep the water is for you.

[00:37:43] Kalpana Kanal: And, John, we wrote the vision statement within couple of months of starting on this. So doctor Sahani, myself, and Dave wrote this six years ago. Uh, we have an actual vision statement on this project. So we started right away, and I think that brings clarity to what we wanna do. Um, we have come a really long way. I have to say how proud I am of the team and all of us who are involved in the collaboration and everyone being so involved and interested. And I can’t thank the medical examiner office enough for being supportive of radiology who wants to do this. And, of course, my partner here in crime, doctor Medved, who so many hours reading the postpartum CT along with other, uh, of two or three radiologists we have that are reading, you know, on his own time. We are not getting professional fee for that, but he believes in the same message. And he believes in this, and so we are we are doing this. Uh, and we are doing great so far.

[00:38:40] Chris St John: The way that y’all talk about it, it is inspiring. It’s that’s genuine. It is passionate people speaking passionately about things they are passionate about is always going to inspire others for that little bit of poetry for me using the same word over and over again. But thank you very much. Well, I think that is as good of a place as any to wrap up, uh, this conversation today. I don’t wanna keep y’all any longer. But doctor Medved, doctor Kunal, thank you both so much for coming in and joining us today on Frame by Frame. It has been it’s been a delight because you’re passionate people speaking passionately about the things you’re passionate about, and so thank you.

[00:39:21] Kalpana Kanal: Thank for giving us an opportunity to talk about this project that we are very passionate about, and I hope the vision I have is if I know that this takes on in The United States, then we do more and more about of this in the country to benefit, you know, humanity.

[00:39:40] Jonathan Medverd: Thank you for inviting us. It’s been a fun time meeting you.

[00:39:44] Chris St John: Rethink imaging is brought to you by Imalogix. Here, you’ll find engaging interviews with thought leaders, experts, and patients sharing stories that showcase the transformative power of medical imaging. To discover how Imologix is rethinking imaging in health care, visit imologix.com. Be sure to subscribe to Rethink Imaging on Apple Podcasts, Spotify, or wherever you listen. And from all of us here at Emalogix, thanks for tuning in.

Questions from This Episode

What is postmortem CT, and can it replace an autopsy?
Postmortem CT is a CT scan of a decedent used to help determine cause of death. In the program Dr. Kanal and Dr. Medverd describe, imaging findings were sufficient to avoid a traditional autopsy in roughly 45% of cases. It does not replace autopsy in every case, but it can resolve many, and imaging diagnoses in early validation cases were confirmed when autopsy followed.
What stands in the way of postmortem CT being adopted more widely in the U.S.?
The biggest structural barrier is billing. There is no CPT code for postmortem imaging, so programs run without a clear reimbursement path. On top of that, programs have to solve operational problems like connecting hospital and county IT systems, funding scanner access, aligning two governance structures, and building trust between radiology and pathology.
What are the benefits of postmortem CT beyond cost and efficiency?
It gives families a cultural or religious alternative when they object to invasive autopsy. It reduces pathologist exposure to infectious disease and toxic embalming chemicals. It can improve communication in court by using diagnostic imaging in place of graphic photographs. And it supports forensic investigation while a complex autopsy can cost more than $2,500 per case.