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Gil Brogdon Honorary Lecture

Prof. Hirotaro Iwase

Chiba University/The University of Tokyo, Japan

HONORS / ACTIVITIES 

Young Researcher’s Award of the Japanese Society of Legal Medicine

 

MEMBERSHIPS

The Japanese Society of Legal Medicine

 

EDUCATION 

1993, Doctor of Medicine, The University of Tokyo, Tokyo, Japan

 

1994-1995

Graduate Student

Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo.

 

RESIDENCY 

Resident, Physician 1993- 1994

Toshima Metropolitan Hospital

Tokyo, Japan

 

Career

2013-

Professor

Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo (Concurrent post)

 

2003-
Professor

Department of Legal Medicine, Graduate School of Medicine, Chiba University

 

2001-2003

Research Associate
Pulmonary and Critical Care, Department of Medicine, The University of Chicago

 

2000-

Associate Professor

Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo

 

1999-2000

Lecturer

Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo

 

1995-1999

Associate

Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo

 

 

Postmortem Imaging in Japan

 

This lecture will introduce the history of death investigation and postmortem imaging in Japan.

Japan was dominated by samurai until the latter half of the 19th century and was strongly influenced by Chinese politics and culture. Medical science and death investigation were also influenced by China. If the cause of death was not clear, the cause of death or criminality, was determined from external findings and the context of the dead body, rather than a scientific determination of the cause of death by autopsy. The defeat of China by England in the Opium Wars forced Japan to adopt European technology to protect Japan from foreign aggression. Japan abandoned samurai domination to establish a European-style country. In both medicine and a death investigation system they followed Europe, and started to determine the cause of death by autopsy.

However, the autopsy rate in Japan did not improve because the government did not allocate enough budget to determine the cause of death by autopsy. Continuing the 800-year-old Chinese method of cadaveric examination to determine criminality and performing an autopsy only when a crime was suspected, helped to keep Japan’s autopsy rate low and was still maintained in modern Japan. In this way, Japan’s death investigation system was a unique system in which old Chinese methods and the new European methods were mixed. Since the autopsy rate was low, there was a relatively high possibility of overlooking a crime. As a result, many forensic scientists called for an improvement in the Japanese death investigation system. The incorporation of national universities in 2004 was an opportunity to change the death investigation system. Until then, due to a shortcoming in the law, the police had to ask a national university to perform forensic autopsies free of charge. Incorporation made it legally possible to charge the police for the cost. However, due to the precedential principle of officials, dissection was continued free of charge even after the national universities were incorporated. A mobile CT scanner changed that. By introducing mobile CT in postmortem examinations on a trial basis, it was possible to show the differences in the cause of death diagnosed from an external examination of a corpse and the cause of death determined by CT. It became widely known, also to the public, that there was a problem with Japan’s death investigation system. The Japanese government was forced to respond. After 2006, universities could earn an income when performing an autopsy, and two new laws on the death investigation system were formulated and enacted. As a result, the financial situation of universities’ department of forensic medicine improved, and more than 30 of the 80 departments now have CTs. As a result, a hybrid type of forensic scientist emerged, such as a radiologist/forensic pathologist, such as Drs. Hyodo, Makino, and Yoshida. CT and MRI in the field of forensic medicine are now used to assess not only a corpse but also injuries of living people.

Thus, with the development of forensic imaging, another movement has taken place in Japan. This is a movement called autopsy imaging (Ai). The word Ai was conceived by a novelist and doctor, and was popularized in novels and TV dramas. The medical community advocated that clinicians should also perform Ai as a method of avoiding police intervention in the medical field, so Ai became popular for postmortem imaging performed by clinicians. Because Ai was considered a way to eliminate police and forensic medicine investigation, the postmortem imaging tests performed by clinicians did not link up with investigations conducted by forensic pathologists. Although there are many instances where autopsy findings and the interpretation of imaging differed and imaging overlooked criminality, there is no feedback to the interpretation doctor. Thus, Ai performed by clinicians can promote a situation where crime may still be overlooked.

Designated Lecture

​Dr. Yohsuke Makino​​

The University of Tokyo, Japan

Education

2009 – 2013 the Degree of Doctor of Philosophy (Medicine)
Department of Legal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan

2001 – 2007 Doctor of Medicine

The University of Tokyo, Tokyo, Japan

 

Certification

2016- Forensic pathologist certified by the Japanese Society of Legal Medicine
2013- Radiologist certified by the Japan Radiology Society

Career History

April 2017 – today  Associate Professor
Department of Forensic Medicine, The University of Tokyo, Tokyo, Japan

July 2019 – December 2019 Postdoctoral Fellow
Department of Pathology, University of New Mecico, Albuquerque, NM, USA

June 2014 – April 2017 Lecturer
Department of Forensic Medicine, The University of Tokyo, Tokyo, Japan

October 2013 – June 2014 Assistant Professor
Department of Legal Medicine, Chiba University, Chiba, Japan

April 2013 – September 2013 Researcher
Department of Legal Medicine, Chiba University, Chiba, Japan

April 2009 – March 2013 Senior Resident, Radiology
April 2012 – March 2013 Department of Radiology, Chiba University Hospital
April 2010 – March 2012 Department of Radiology, Kanto Central Hospital
April 2009 – March 2010 Department of Radiology, Chiba University Hospital

April 2007 – March 2009 Junior Resident
April 2008 – March 2009 The University of Tokyo Hospital
April 2007 – March 2008 Keio University Hospital
 

Awards

 

2018 Certificate of Merit, RSNA 2018, the 104th scientific assembly and annual meeting

2018 Young Researcher’s Award of Japanese Society of Legal Medicine
2015 Bronze Medal, The 51st Autumn Assembly of the Japan Radiological Society

2013 Student Poster Forum Award, The 97th Congress of the Japanese Society of Legal Medicine

2012 Most viewed JRS electronic exhibit during ARRS 2012 annual meeting, 2012 American Roentgen  Ray Society

2011 Gold Medal, The 70th Annual Assembly of the Japan Radiological Society

Current situation of postmortem forensic imaging in Japan

 

In Japan, there are no clear standards for reporting unnatural deaths. Besides, the reported bodies will be investigated by police to see if they are involved in the crimes, and only if criminality is suspected, forensic autopsies are performed in the university’s forensic medicine laboratories. As a corollary, the autopsy rate for unnatural deaths in Japan is very low.

After Prof. Iwase’s mobile CT experiments, many cases of unnatural death overlooked by police were discovered in the latter of 2000s, and this became a social problem. CT has attracted national attention as a means of improving the death investigation system in Japan. A new law on the medico-legal system was enforced in 2013, establishing a system that allows police to perform autopsies and postmortem imaging for the decedents that are not strongly suspected of being criminal. 

Then what happened? Unfortunately, and unexpectedly, autopsy rate for unnatural deaths did not increase after new law enforcement. CT is now carried out at public expense in many areas of the nation under the law, and many unnatural deaths are being investigated by CT, instead of increasing autopsies. It can be said Japan has independently formed a cause of death investigation system utilizing postmortem CT. However, this does not provide a fundamental solution to the death investigation problems. Under the surface of the water, various problems related to postmortem CT death investigations are occurring.

This lecture will explain the current postmortem forensic CT situation in Japan and introduce what kind of efforts are being made to solve the problems.

Dr. Wataru Gonoi

The University of Tokyo, Japan

Work history:

Apr, 2021 – Present Lecturer / Deputy Director, The University of Tokyo Hospital Radiology

Apr, 2018 – Present Invited Associate Professor, Graduate School of Medicine, Osaka University Legal Medicine (additional post)

Apr, 2020 – Mar, 2021 Assistant Professor / Medical Director, Radiology, The University of Tokyo Hospital

Apr, 2012 – Mar, 2020 Assistant Professor, Radiology, The University of Tokyo Hospital

Oct, 2017 – Mar, 2018 Invited Lecturer, Graduate School of Medicine, Osaka University Legal Medicine (Additional Post)

Apr, 2008 – Mar, 2009 Residency (Specialist Trainee), Radiology, Kanto Medical Center NTT EC, Tokyo, Japan

Apr, 2007 – Mar, 2008 Residency (Specialist Trainee), Radiology, The University of Tokyo Hospital

Apr, 2006 – Mar, 2007 Residency, The University of Tokyo Hospital

Apr, 2005 – Mar, 2006 Asama General Hospital, Nagano, Japan Residency

 

Education:

Radiology and Biomedical Engineering Apr, 2008 – Mar, 2012The University of Tokyo Graduate School of Medicine (received Ph.D.)

Apr, 2001 – Mar, 2005 The University of Tokyo Faculty of Medicine  (received M.D.)

Apr, 1999 – Mar, 2001The University of Tokyo College of Arts and Sciences

 

Awards:

May, 2019 Japanese Society of Abdominal Radiology Bayer Encouraging Award

Sep, 2017 Japanese Society of Emergency Radiology Image Interpretation Session 2nd Prize 

Apr, 2017 Japanese Radiology Society Research grant from Japan Radiological Society supported by Bayer

Oct, 2015 Japan Radiological Society ACADEMIC EXHIBITION: GOLD MEDAL

Apr, 2015 Japanese Society of Abdominal Radiology (JSAR) BAYER ENCOURAGING PRIZE

Apr, 2015 Japan Radiology Society CYPOS AWARD 《BRONZE MEDAL》

Sep, 2014 The Asian Oceanian Society of Radiology 《BRONZE PRIZE》 of SCIENTIFIC EXHIBITION

Apr, 2014 Japan Radiological Society CYPOS AWARD: SILVER MEDAL (3rd Award) 

Apr, 2013 Japanese Society of Radiology ITAI AWARD (1st Award) 

Sep, 2012 Japan Radiological Society ACADEMIC EXHIBITION: GOLD MEDAL (1st Award)

May, 2012 The University of Tokyo Medical Association PRIZE IN MEDICINE (1st)

Jan, 2011 Radiology, The University of Tokyo AWARD of EXCELLENCE

Oct, 2010 Japanese Society for Magnetic Resonance in Medicine PRESIDENTIAL AWARD

 

Main Research Fields:

Postmortem imaging

Pancreatic ductal anomaly

Colorectal liver metastasis

COVID-19 pneumonia

Normal aging in the brain

Experience of postmortem CT in in-hospital death in Japan

Postmortem imaging (PMI) is a relatively new imaging technique that reveals the cause of death and pathological state of corpses by using radiological modalities such as computed tomography (CT) (postmortem CT) and magnetic resonance imaging (MRI) (postmortem MRI). The Japanese Medical Accident Investigation System implemented in October 2016 recognizes the usefulness of PMI which is expected as a means of investigating the cause of death and possibly complements conventional autopsy. Subsequently, the basic law to promote causes of death investigation was implemented in April 2020. At medical institutions in Japan, a movement to perform postmortem CT images at the time of death is accelerating for cases of a questionable cause of death. At present, however, interpretation of PMI has not yet been fully standardized in many organs and diseases. To properly utilize PMI, it is essential to optimize the imaging method and to establish an interpretation standard. In PMI, radiological findings change dynamically depending on the elapsed time after death. Many findings that should be interpreted as abnormal in antemortem images can be normal in PMI. So, clinicians need to know the various pitfalls in postmortem images. Since the rate of conventional anatomy is getting less and less, the significance of PMI is increasing rapidly. When encountering in-hospital deaths, it is recommended to perform postmortem CT to confirm the cause of death, to avoid medical disputes and promote its resolution, regardless of whether or not a conventional autopsy is scheduled. In this lecture, I would like to introduce some basic postmortem CT findings that we experienced in the settings of in-hospital death.

Invited Lecture

Dr. Heon Lee

Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea

EDUCATION

Graduate;

Mar 1986- Feb 1993. Medical School, Jeonbuk National University

Mar 1994- Feb 1998. Graduate School, Jeonbuk National University

 Postgraduate;

Mar 1993 – Feb 1994. Rotating internship in Jeonbuk National University Hospital

Mar 1994 – Feb 1998. Radiology residency in Jeonbuk National University Hospital

 Research fellowship (Mentor: U. Joseph Schoepf MD);

Mar 2007- Feb 2008.

Department of Radiology, Division of Cardiovascular imaging

Medical University of South Carolina (MUSC),

265 NT, 169 Ashley Avenue, Charleston, SC 29425 USA

 Visiting professor (Invited by U. Joseph Schoepf MD);

Jan 2020- July 2020.

Department of Radiology, Division of Cardiovascular imaging

Medical University of South Carolina (MUSC),

Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC 29425 USA.

Short term education for MPMCTA

(Invited by Docteur Silke Grabherr, MD, PhD);

May 31 to June 6 2014

Centre Universitaire romand de medicine legale,

Ru du Bugnon 21,CH-1011 Lausanne, Switzerland.

 Post-Mortem CT Interpretation Short Course;

25-28 July, 2017

the Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.

PRESENT POSITION

Professor of Radiology

Division of cardiovascular imaging

Soonchunhyang University Hospital Bucheon, Republic of Korea.

Consultant radiologist

National forensic service (NFS) Korea, Republic of Korea.

OFFICE ADDRESS & TELEPHONE;

 170 Jomaru-ro Wonmi-gu, Bucheon, Gyenggi 420-767 Korea

TEL; 82.32.621.5853 (Office)

FAX; 82.32.6216.5874 (Office)

Mobile: 82.10.3658.0121.  E-MAIL: acarad@naver.com

LICENSURE/CERTIFICATION

 License of Korean Medical Association (1993)

Board-Certificated, Diagnostic Radiology, Korea (1998)

 SOCIETY MEMBERSHIP;

Member of Korean Society of Radiology

Member of Korean Society of Cardiovascular Imaging

Member of Asian Society of Cardiovascular Imaging

 BIOGRAPHY, Heon Lee MD, PhD.

Heon Lee MD, PhD is a tenured professor in the department of radiology at Soonchunhyang University Hospital Bucheon and a consultant radiologist of National Forensic Service (NFS) Korea.

In 1993, he earned his medical degree from Jeonbuk National University College of Medicine in Jeonju, South Korea and he became a certified radiologist by the Korean board of Radiology in 1998.

After completion of one year fellowship training of cardiovascular imaging at Medical University of South Carolina in Charleston SC, Unites States in 2007, he served as the director of the radiology department at Seoul Medical Center, and then moved to Soonchunhyang University College of Medicine in 2011 as an associate professor.

His main scientific interest is non-invasive cardiovascular imaging, especially using advanced CT and MRI techniques for the diagnosis of cardiovascular diseases and injuries for both clinical and forensic purposes.

Currently, he has been involved in many research projects with NFS Korea, including the application of postmortem CT/CT angiography in death investigation and the development of automated injectors and contrast agents for postmortem use.

Postmortem CT and CT angiography: Current Role in Korea.

 

With the introduction of modern imaging into forensic investigation in recent years, postmortem cross-sectional imaging, especially CT and CT angiography, has gained increasing popularity worldwide in the field of death investigation.

Meanwhile, in Korea, the first CT scanner dedicated for postmortem examination was installed at the National Forensic Service (NFS) Seoul institute in June 2013. About a year later, in August 2014, the first postmortem CT (PMCT) angiography was performed. Since then, two additional CT systems have been used in two NFS regional institutions as a pre-autopsy imaging tool for death investigation, performing more than 4,000 PMCT examinations annually nationwide. These CT techniques have been served for pre-autopsy screening for potential pathologies, guiding subsequent autopsy dissection to the target area, and identifying lesions that are difficult or even impossible to detect during conventional autopsy dissection. The longstanding partnership between radiologists and forensic pathologists in Korea has helped to implement a head-to-head comparison between imaging findings and autopsy results, and these direct radiological-pathological comparison has provided excellent learning tools and opportunities to address a wide variety of challenging forensic and medico-legal questions.

This lecture introduces our experience in PMCT and PMCT angiography, which is being performed as pre-autopsy procedures in Korea, and their roles of answering various forensic questions in the investigation of deaths from various causes such as trauma, natural disease, and medical errors.

Prof. Rick R. van Rijn

Department of Radiology and Nuclear Medicine Emma Children’s Hospital

graduated as a medical doctor at the Erasmus Medical University Rotterdam in 1994, he obtained his PhD at the same university in 1998. In 2002 he finished his training as a radiologist, at the Erasmus Medical Center, Rotterdam, and the Academic Medical Center, Amsterdam.

Since 2003 he works a paediatric radiologist at the Emma Children’s Hospital – AMC Amsterdam. As of 2010 he also holds a part-time position at the department of Forensic Medicine, Netherlands Forensic Institute. In June 2014 he was appointed as professor of forensic radiology with an emphasis on forensic paediatric radiology.

He’s is a founding member of the Dutch Expertise Center of Child Abuse and has held/holds several positions in professional societies amongst others chair of the International Society of Forensic Radiology and Imaging, chair of the scientific committee of the Dutch Society of Forensic Medicine, and general secretary of the European Society of Paediatric Radiology.

He has published >200 publications, many on child abuse imaging, wrote a book on forensic aspects of paediatric fractures, edited two paediatric radiology books, and several book chapters.

He is an editorial board member of European Radiology, Pediatric Radiology, Journal of Forensic Radiology and Imaging, BJR, and the Dutch Journal of Medicine.

Meet Expert Session (film interpretation)

Prof. Naoya Takahashi​

Niigata University, Japan

Qualifications

1993 – Present     Japanese Board Certified Radiologist

2009 – 2020         Chair of the Japan Society of Autopsy imaging

2014 – Present     Representative of Japan Radiological Society

 

Membership in scientific organizations

1988 – Present     Regular member of Japan Radiological Society

1990 – Present     Regular member of the Japanese Society of Nuclear Medicine

1993 – Present     Member of the Japanese College of Radiology

2001 – Present     Corresponding member of the Radiological Society of North America

2007 – Present     Corresponding member of the European Society of Radiology

2008 – Present     Regular member of the Japan Society of Autopsy imaging

2009 – Present     Regular member of the Japanese Society of Legal Medicine

 

Working Experience

October 1, 2013 – Present              Professor of Niigata University

April 1, 2002 – September 31, 2013             Chair of the department, Department of Diagnostic Radiology, Niigata City General Hospital

July 1, 2000 – March 31, 2002       Chief of the department, Department of Radiology, Tsubame Industrial Injury Hospital 

April 1, 1997 – June 30, 2000         Staff of the department, Department of Radiology, Shool of Medicine, Niigata University 

April 1, 1995 – March 31, 1997       Department of Radiology, Niigata City General Hospital

 

Residency Training Experience

May 1, 1988 – March 31, 1991        Niigata University Hospital

 

Graduate Education

April 1, 1991 – March 31, 1995      Graduate School of Medicine, Niigata University    

              Took the degree of Doctor of Philosophy in medicine (Radiology)

 

Medical Education

April 1, 1982 – March 31, 1988       School of Medicine, Niigata University

              Took the degree of Doctor of Medicine

Dr. Chris O’Donnell​

Victorian Institute of Forensic Medicine, Australia