With many South African children falling victim to abuse, a new study has highlighted the valuable contribution post-mortem imaging can make in assessing the injuries suffered by children suspected to have been fatally abused.
Believed to be the first of its kind in South Africa, the study was conducted by senior lecturer in Diagnostic Radiography, Aladdin Speelman, for his doctoral thesis titled: Post-Mortem Computed Tomography in the Assessment of Fatal Child Abuse.
Speelman is among the hundreds of graduates who are being capped during CPUT’s Summer Graduation.
According to the study, there has been a worldwide decline in autopsy rates due to cultural and religious objections to the conventional autopsy and clinicians have had to find alternative ways to establish the cause of death.
It states that the increased application of post-mortem imaging in forensic pathology has resulted in researchers exploring the suitability of both post-mortem Computed Tomography (PMCT) and post-mortem Magnetic Resonance Imaging (PMMRI) to establish the cause of death, determine injuries sustained and whether this imaging modality can replace the autopsy in certain cases.
Speelman said skeletal injuries identified with diagnostic imaging is often the only evidence that a child is a victim of abuse.
“SA has a high rate of child abuse and child homicides and the many social dimensions thereof do not get the attention it deserves. Radiographers have a greater role to play in stemming this social anomaly. Research studies such as this can highlight the valuable contribution advanced imaging modalities such as PMCT can make in the diagnosis and management of child abuse.”
He said PMCT has an even greater advantage compared to conventional diagnostic imaging options as a full body can be scanned in less than one minute giving a broad overview of the child’s injuries often with great resolution.
“I was aware that internationally there has been steady growth in using advanced cross-sectional imaging in forensic medicine. This move has not yet started in forensic institutes in SA and hence my decision to test this modality in a sample of suspected fatally abused children.”
Thirty children, all younger than 18 years with a history of suspected fatal child abuse or sudden unexplained death, underwent a whole-body PMCT examination using a 64 slice Computed Tomography (CT) scanner, followed by a forensic autopsy. All PMCT studies were reviewed independently by two paediatric radiologists.
“To my knowledge this was the first study of its kind conducted in South Africa particularly involving children only. I sincerely appreciate the excellent guidance received from my two supervisors and the two paediatric radiologists who assisted me with the interpretation of the PMCT images. These two paediatric radiology experts were based in the United Kingdom and The Netherlands. Thanks to technology, their expert opinions could be obtained without any hassles.”
The study’s conclusions include that PMCT should serve as an adjunct examination to forensic autopsies of children whose demise was due to suspected fatal abuse, irrespective of the initial manner of death.
“PMCT must therefore be routinely employed as a supplementary examination to the forensic autopsies in the assessment of suspected fatal child abuse,” it states.
Speelman said it was quite a challenge juggling the academic workload, administrative duties and collecting data and writing up the results.
“All PMCT scans were conducted after work so not to interfere with my undergraduate duties and also not to interfere with the normal CT scans scheduled at the research site. So, when a child met the inclusion criteria, I had to drive after work to the research site, which is a good 20 km away from the Bellville Campus. The three months of study leave also assisted me in consolidating my results and writing of my thesis.”
Speelman’s supervisors were Prof Penelope Engel-Hills, Adjunct Professor and former Acting Dean of the Faculty of Health and Wellness Sciences, and Prof Lorna J. Martin, Head of Division, Forensic Medicine and Toxicology, Faculty of Health Sciences, University of Cape Town.
“I think I have grown tremendously on a professional and disciplinary level. In addition, I also gained significant transdisciplinary knowledge in that I had learnt a lot about the science and application of forensic medicine (including the forensic autopsy) and PMCT imaging which is a fairly new field in radiology. I think the greatest joy I derived from completing this doctoral degree was knowing that my work met the scientific rigour of multi-disciplinary international examination, and in such a particularly new and emerging field. “
Written by Ilse Fredericks
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