Dr Chris O’Donnell is a necro-radiologist. In layman’s terms, he’s a scanner of the dead.
O’Donnell is the man behind the Victorian Institute of Forensic Medicine’s use of radiation-based computer tomography (CT) scans to determine how people die.
It’s a growing alternative to the traditional autopsy. And sometimes, it does a better job of discovering the cause of death.
“There’s a condition called pneumothorax, for example, which is where you have a collapsed lung,” O’Donnell said.
“That’s quite a difficult diagnosis for a pathologist to make but it’s very, very easy on the basis of CT.”
Of the 35,000 to 40,000 people that die every year in Victoria, 7000 end up at the city mortuary under the Coroner’s Court.
Their deaths are usually the result of something traumatic, such as suicide, car crashes, work accidents and sometimes homicide.
But by far the largest group is the category of “sudden unexpected death”. In those cases, the cause of death is a little trickier to determine.
It’s up to the medical forensic team, and ultimately a coroner, to determine how these people died. In the past, all these bodies would be autopsied – an invasive, but often necessary, process to find the cause of death.
But now the figure is close to 50 per cent, because CT scans are often sufficient for a pathologist to accurately determine how someone died. For many families, the thought of an autopsy on their loved one adds to their trauma, so the scans are a huge relief.
Victoria has one of the most comprehensive libraries of these scans in the world because the technology has been in use since 2005. As Victorian Institute of Forensic Medicine head pathologist Dr Linda Iles points out, this makes it “an enormous opportunity for research”.
It also means if there are any questions about circumstances of death in the future, the scans are retrievable for further investigation.
O’Donnell was responsible for acquiring the first permanent CT scanner, something which very nearly didn’t happen.
“Of course, money was the problem, but the Bali bombing [of 2002] changed everything,” he said.
“One of the issues in the Bali bombing was there were no fridges so bodies were just left out, decomposing. It was a very unfortunate situation. There was a lot of delay, and families were very upset.”
A plan to use a CT scanner to identify victims in a mass disaster was set out. It was put to the test after Black Saturday.
“Our plan, which we didn’t know whether it would work, did work amazingly well,” O’Donnell said.
Since then, all Australian states have installed CT scanners in their mortuaries, and they are considered central to the function of forensic investigations and coroners courts across Australia.
CT scanning also saves resources. A mortuary technician takes around 15 minutes to complete a CT scan, including paperwork.
In contrast, an autopsy would always take over an hour and can take up to four hours. Today, all mortuary technicians are trained in CT scanning, and scan up to 20 bodies in an evening.
Even if a CT scan can’t determine the cause of death, it still plays an important role in the investigative process.
CT scans clearly show areas at the top of the spine and lower pelvis, areas harder to assess using autopsy. They are excellent for showing air pockets in the body.
Scans are often used in evidence for inquests held in the coroners court, O’Donnell said, and they’re particularly good for juries in criminal trials.
“Judges will often not want juries to see the autopsy pictures because they’re confronting with blood and so forth,” he said.
“Whereas the pictures that I can produce through CT, using workstation graphics, are much more acceptable and understandable. I think as well, because it’s not blood and gore, and people aren’t sort of turning away”
Such is Victoria’s love of scanning the deceased, a magnetic resonance imaging (MRI) scanner is being installed at the Institute of Forensic Medicine – with O’Donnell again propelling this Australian-first development.
MRI scans take more detailed images of smaller areas, so are good for imaging the heart and the brain.
“MRI is amazingly good for children and babies,” O’Donnell said.
Once installed, the MRI machine will be used with the concept of “one room, two doors” to scan both the living and the deceased – using different tables, of course.
In the case of the living, MRI scans of victims who have survived family violence assaults can be used in court as evidence, particularly in cases of strangulation where there are no obvious signs of injury.
“Neck compression, that can be a very difficult thing for clinicians to understand and work out, whereas MRI is very, very good in that area,” O’Donnell said.
“So we will be wanting to use the MRI scanner in living persons who have had episodes of assault or injury. We want to try and document those.”
When asked what he enjoys most about the work, O’Donnell points to the strength and purpose of the teamwork.
“Everyone’s working to a single goal. It’s very collegiate … I’m absolutely accepted as an equal. We all work together. So I love that teamwork thing to try and get to an answer.”
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