...A forensic pathologist like me who has had minimal exposure to CT images and their interpretation has a lot to learn from this book. After reading this book, I started ordering CT in much more cases than I used to previously. In many of these cases, I was rewarded with unusual and unexpected findings which helped me opine better. This book will be a useful companion to me, and I would strongly recommend it to all forensic clinicians and pathologists...
Forensic Pathology of Fractures and Mechanisms of Injury: Postmortem CT Scanning, 1st Edition, by Michael P. Burke. Hard Bound, 11" x 8.5" x 0.7”.
CRC Press LLC, 2000 Corporate Blvd., N.W., Boca Raton, Florida 33431, Phone - 1(800)272-7737, Fax - 1(800)374-3401. Publication Date December 6, 2011. 273 pages, ISBN-10: 1439881480; ISBN-13: 978-1439881484 (alk. paper). Price: $189.95.
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Traditionally the forensic pathologists have used dissection and observation of lesions to determine cause of death. The book under review provides insights into a new tool that has become available only recently - the computed tomography (CT). It serves as a guide for the forensic pathologist who wants to use CT imaging to assist in determining the mechanism of injury that might have contributed to death.
The book is drawn from the author’s work at the Victorian Institute of Forensic Medicine [VIFM]. It presents an overview of his experience with CT in routine casework, provides an appraisal of the literature with respect to fractures, and offers suggestions for the evaluation of CT images by pathologists. The author suggests what reasonable conclusions can be drawn from the images, the circumstances surrounding the death, and an external examination of the deceased.
The book is illustrated with hundreds of CT images that clarify the text and case studies to put the material in context. It begins by discussing classification of injuries and different types of fractures. It then explores the basics of CT. A head-to-toe catalogue of various injuries is provided and also how they are represented on a CT scan. Finally, the book explores the use of CT in difficult forensic cases such as decomposed and burnt remains, falls, child abuse, and transportation incidents.
Use of Postmortem CT sometimes can obviate the need of a complete postmortem altogether. This is helpful if there is, say, a religious or some other objection to a complete autopsy [eg highly infective body], or if organ harvesting is contemplated. Take this case study for example, which the author gives at page 141. A 30 y old intoxicated man fell approximately 5 m from a balcony onto a concrete car parking area, and died. The body was sent for medicolegal examination to VIFM. The external examination showed a laceration to the occiput, and abrasions over the right upper back and right lumbar region. There were no injuries to suggest an assault. Normally one would have then proceeded for internal examination by cutting up the dead body. But the author then did a postmortem CT, which showed no fractured skull, intracranial hemorrhage or cervical spine injury. The CT examination of the chest showed a fracture of right scapula, right ribs and massive right hemothorax. These findings were sufficient to opine upon the cause of death. The coroner was informed of these findings, and he did not order any further examination of the dead body. This not only saved much time and effort for the pathologist, but also unnecessary mutilation of the dead body and accompanying distress to the relatives.
A number of similar cases have been described throughout the book. I read many of them and each one was instructive in itself.
A forensic pathologist like me who has had minimal exposure to CT images and their interpretation has a lot to learn from this book. After reading this book, I started ordering CT in much more cases than I used to previously. In many of these cases, I was rewarded with unusual and unexpected findings which helped me opine better. This book will be a useful companion to me, and I would strongly recommend it to all forensic clinicians and pathologists.
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