Forensic Pathology Round Table Discussion
In the run-up to this year’s Laboratory Medicine Conference (LMC) held at the end of July 2013, the Department of Forensic Medicine and Toxicology at the University of Cape Town (UCT), together with Lodox Systems, hosted a Round Table Discussion. The title of the discussion was: The significance of new imaging technologies for forensic pathology – A South African and international perspective on the application of imaging technology in investigations of (mainly) suspicious deaths. The discussion was led by Professor David Fowler, Chief Medical Examiner from Baltimore, Maryland, USA. Also on the panel were Dr Linda Liebenberg, Salt River Mortuary, Ms Vonita Thompson, Director of Forensic Pathology Services in the Western Cape, Ms Margie Orford, Crime Novelist, and Mr Pieter de Beer, CEO of Lodox Systems.
Lodox in The Western Cape
Lodox Systems has been involved with the Forensic Pathology Services (FPS) in the Western Cape since 2006 when the Statscan full-body X-ray scanners, already in service at the two teaching hospitals linked to UCT, elicited interest from forensic pathologists because of their potential usefulness in pre-autopsy imaging. Two South African mortuaries, both based in Cape Town, adopted this technology for medical imaging in September 2007.
Forensic Pathology: USA and South Africa
Prof. Fowler explained that the state of forensic pathology in the USA was not all that different from that in the Western Cape. He pointed out that “technology that other doctors have been using for the past 20 – 30 years is only now becoming available for forensic pathologists”. This is the model for most of the world, except for Europe which is very resource-rich. South Africa is generally under-resourced in terms of facilities and skilled human resources. Mr Pieter de Beer, CEO of Lodox Systems, suggested that “technology must bridge that gap, making what we do with the limited resources more efficient and effective”.
Dr Linda Liebenberg from UCT echoed the sentiment, stating that one of the biggest frustrations for forensic pathologists was “knowing about existing technology but that it is not available to forensic pathologists”. According to Dr Liebenberg, the reason forensic pathology does not often have access to the same equipment other doctors in other specialities have is because “forensic pathology is the stepchild of medicine”.
Many of the death statistics for Maryland, USA, are fairly similar for the Western Cape, South Africa: about 10 000 cases per year are processed; the majority of homicides are young males; motor vehicle accidents are fairly common. However, in the Western Cape approximately 30% of the cases are homicides. One of the major differences between the USA and South Africa is that it takes very much longer to complete case reports in South Africa, mainly because of the bottleneck in toxicology examinations which are outsourced to another department.
The Value of Technology in Forensic Pathology
A medical facility such as that in Maryland costs approximately $1.70 per citizen; this is not a large tax burden, but the reason forensic pathology is under-resourced is because “dead people don’t vote”. The public has largely had the image of a forensic pathologist as someone who investigates only homicides. Yet homicide is only a small proportion of the examinations conducted. Just as important are cases of sudden and unexpected death. Any information on sudden deaths as a result of diseases needs to be properly documented so this can be fed back into the health system to inform public health policies and strategies for a country so that appropriate interventions can be put in place to protect the living.
Mr de Beer highlighted the benefits of having a Lodox full-body X-ray scanner in a medical facility. This technology is still unique. There is no equivalent system on the market that is able to image a full body, 1800 mm x 700 mm, in a single acquisition in 13 seconds at an image quality equivalent or sometimes better than a conventional digital X-ray system. The cost benefits are obvious: a full-body image becomes available to a medical practitioner in less than two minutes. Any other system will take at least 30 minutes to produce a similar sized image. When time is money, it is clear which system is more efficient. Mr de Beer suggested that spending a bit of money now on technology will result in huge cost-savings and benefits in the next few years.
To find out more, watch some of the footage on our YouTube channel: