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

What if nearly half of traditional autopsies could be avoided without sacrificing diagnostic certainty? In this episode of Rethink Imaging, host Chris St John speaks with Dr. Kalpana Kanal, Director of Diagnostic Physics at the University of Washington, and Dr. Jonathan Medverd, Chief of Radiology at Harborview Medical Center, about building one of the most advanced postmortem CT programs in the United States. Together, they share how a cross-campus collaboration between radiology and the medical examiner’s office has scanned 184 cases to date, avoided autopsy in approximately 45% of them, and demonstrated how virtual autopsy can improve efficiency, reduce costs, respect religious objections, and enhance forensic investigations. This conversation explores clinical validation, operational hurdles, PACS integration, billing challenges, and the long-term vision for forensic radiology fellowships in the U.S.

Postmortem CT is not theoretical. It is operational and growing.

In this episode of Rethink Imaging, Dr. Kalpana Kanal and Dr. Jonathan Medverd share the real-world story behind launching a collaborative forensic imaging program between the University of Washington and King County’s Medical Examiner Office. What began as a pilot project six years ago has evolved into a structured clinical pathway that has scanned 184 decedents since July 2022.

The results are striking. In roughly 45% of cases, CT findings were sufficient to determine cause of death, eliminating the need for traditional autopsy. In early validation cases, imaging diagnoses including precise identification of a ruptured aorta were confirmed at autopsy, demonstrating strong radiologic-pathologic correlation.

Beyond clinical accuracy, the episode dives into the operational realities: aligning two different governance structures, navigating IT firewalls between hospital PACS and county systems, securing funding for scanner installation, building trust between specialties, and operating without a billable CPT code for postmortem imaging. The conversation is candid about volunteerism, resource constraints, and the importance of leadership commitment before launching similar programs.

The broader implications are significant. Postmortem CT offers cultural and religious alternatives for families who object to invasive autopsy. It reduces pathologist exposure to infectious diseases and toxic embalming chemicals. It may improve courtroom communication by replacing graphic imagery with diagnostic imaging. And it opens the door to cost efficiencies, particularly when complex autopsies can exceed $2,500 per case.

Looking ahead, Dr. Kanal and Dr. Medverd discuss developing a forensic radiology rotation for senior residents and the longer-term vision of a dedicated fellowship combining radiology and forensic pathology expertise. As forensic pathology faces workforce shortages nationwide, hybrid training models may become essential.

This episode reframes postmortem CT not as a niche innovation, but as a scalable systems solution with implications for public health, forensic science, radiology training, and healthcare economics.

What You’ll Learn:

How postmortem CT can replace traditional autopsy in ~45% of cases
The radiologic-pathologic validation process behind virtual autopsy
Operational hurdles when partnering between hospital and county systems
How PACS, DICOM storage, and EMR access were structured across entities
The billing and CPT code gap limiting U.S. adoption
Cultural and religious considerations in death investigation
Cost comparisons between CT and complex autopsy
Why forensic radiology fellowships may represent the next evolution

Chapters:

[00:00] The First Postmortem CT Case That Changed Everything
[05:35] Radiology–Medical Examiner Collaboration in Practice
[12:07] 184 Cases and a 45% Autopsy Avoidance Rate
[18:00] Diagnostic Challenges: Decomposition vs. Trauma
[23:29] Building a Forensic Radiology Rotation
[29:19] IT, PACS, and Cross-Entity Data Sharing
[32:35] Why Billing Codes Are Holding the U.S. Back
[34:37] Cost Comparisons and Public Health Impact
[36:46] How Counties Can Replicate the Model