Steffen Ross

• MD
• Spital Männedorf

Background Post-mortem imaging has been suggested as an alternative to conventional autopsy in the prenatal and postnatal periods. Noninvasive autopsies do not provide tissue for histological examination, which may limit their clinical value, especially when infection-related morbidity and mortality are suspected. Methods We performed a prospectiv...

Water buffaloes and cattle differ considerably with respect to the anatomy of the head. As a result, captive bolt stunners often fail to reliably produce adequate loss of consciousness in water buffaloes and, thus, do not fulfill animal welfare requirements. The goal of the present study was to assess and validate a new stunning device for water bu...

Stock management of the Swiss water buffalo livestock results in the slaughtering of about 350 animals per year. As the stunning of water buffaloes still is an unresolved issue, we investigated the terminal ballistics of currently used perforating stunning devices. Cartridge fired captive bolt devices, handguns and a bullet casing gun were tested i...

Cross-sectional imaging, such as computed tomography, has been increasingly implemented in both historic and recent postmortem forensic investigations. It aids in determining cause and manner of death as well as in correlating injuries to possible weapons. This study illuminates the feasibility of reconstructing guns in computed tomography and give...

Chapter 19: Postmortem and Forensic Magnetic Resonance Imaging SUMMARY: Magnetic resonance imaging (MRI) is a technique used in biomedical imaging and radiology to visualize internal structures of the body. Because MRI provides excellent contrast between different soft tissues, the technique is especially useful for diagnostic imaging of the brain...

Chapter 19: Postmortem and Forensic Magnetic Resonance Imaging SUMMARY: Magnetic resonance imaging (MRI) is a technique used in biomedical imaging and radiology to visualize internal structures of the body. Because MRI provides excellent contrast between different soft tissues, the technique is especially useful for diagnostic imaging of the brain...

Purpose: The purpose of this study was to evaluate the feasibility of diagnosing fatal pulmonary thromboembolism (PTE) with unenhanced postmortem computed tomography (PMCT). Materials and methods: Twelve cases with autopsy confirmed PTE and matched controls (n=19) were retrospectively examined for PTE signs on PMCT. The following variables were...

Objective: Postmortem computed tomography angiography (PMCTA) has thus far been used on only recently deceased bodies. Therefore, it is crucial to evaluate the potential of PMCTA in decomposed bodies. The aims of this study were (I) to evaluate the feasibility of PMCTA, (II) to describe the artifacts of PMCTA and (III) to compare different contrast...

The purpose of this study was to evaluate the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) to examine fetuses from an anatomical collection for the investigation and visualization of teratological malformations and other possible causes of death.

The aim of this study was to evaluate the diagnostic criteria and to identify the radiological signs (derived from known radiological signs) for the detection of aortic dissections using postmortem computed tomography (PMCT). Thirty-three aortic dissection cases were retrospectively evaluated; all underwent PMCT and autopsy. The images were initial...

Purpose: The purpose of this study was to compare postmortem computed tomography with forensic autopsy regarding their diagnostic reliability of differentiating between pre-existing cerebral edema and physiological postmortem brain swelling. Materials and methods: The study collective included a total of 109 cases (n=109/200, 83 male, 26 female,...

Purpose In forensic investigations, crime scene reconstructions are created based on a variety of three-dimensional image modalities. Although the data gathered are three-dimensional, their presentation on computer screens and paper is two-dimensional, which incurs a loss of information. By applying immersive virtual reality (VR) techniques, we pr...

The authors present a simulation-based ultrasonographic (US) training tool that can help improve the understanding of spatial relationships in US. Use of a game controller to simulate a US probe allows examination of different virtual three-dimensional (3D) objects. These 3D objects are either completely artificial simple geometric objects (eg, sph...

Objectives In recent years, different systems for gesture control of medical devices have been presented. Today, low-cost gesture control systems are commercially available. In this article, we present a plugin for the OsiriX medical image viewer, which operates the viewer using finger gestures. Materials and Methods We use a device called the Lea...

Whole-body postmortem computed tomographic (CT) angiography is a promising new development in forensic radiology that has the potential to improve vascular and soft-tissue imaging beyond levels currently achievable with unenhanced postmortem CT. Postmortem access to the vascular system and injection of contrast medium are different from those steps...

Forensic radiology is a new subspecialty that has arisen worldwide in the field of forensic medicine. Postmortem computed tomography (PMCT) and, to a lesser extent, PMCT angiography (PMCTA), are established imaging methods that have replaced dated conventional X-ray images in morgues. However, these methods have not been standardized for postmortem...

Forensic radiology is a new subspecialty that has arisen worldwide in the field of forensic medicine. Postmortem computed tomography (PMCT) and, to a lesser extent, PMCT angiography (PMCTA), are established imaging methods that have replaced dated conventional X-ray images in morgues. However, these methods have not been standardized for postmortem...

Objective Cerebral swelling is a typical finding on postmortem computed tomography (PMCT). Detection of pre-existing brain edema despite normal postmortem changes is merely based on visual judgment, dependent on the investigator׳s experience, as there are no standards yet. The purpose of this study was to evaluate the diagnostic reliability in diff...

Objective. To evaluate the diagnostic benefit of real-time elastography (RTE) in clinical routine. Strain indices (SI) for benign and malignant tumors were assessed. Methods. 100 patients with 110 focal breast lesions were retrieved. Patients had mammography (MG), ultrasound (US), and, if necessary, MRI. RTE was conducted after ultrasound. Lesions...

To assess the value of dual-energy computed tomography (DECT) and an iterative frequency split-normalized metal artefact reduction (IFS-MAR) algorithm compared to filtered back projections (FBP) from single-energy CT (SECT) for artefact reduction in internally fixated humeral fractures. Six internally fixated cadaveric humeri were examined using SE...

In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospecti...

PURPOSE To assess the value of monoenergetic extrapolations from dual-energy computed tomography (DECT) and standard filtered back projections (FBP) from single-energy computed tomography (SECT) compared to a new iterative frequency split-normalized (IFS) metal artifact reconstruction (MAR) algorithm for artifact reduction in internally fixated hum...

We present a case of a postmortem finding of bone marrow edema in postmortem magnetic resonance imaging (PMMR) indirectly induced by a bullet, which barely missed the bone of a 92year old man found kneeling in front of his bed of a tidy apartment. Additionally, a selective postmortem computed tomography angiography (PMCTA) of the left leg was perfo...

We sought to determine the effect of postmortem ventilation in combination with a suction pump in cases showing penetrating trauma to the chest with haemo- and/or pneumothorax, for better evaluation of the lungs in postmortem computed tomography (PMCT). The study included 6 subjects (1 female, 5 male; age 32-67years) with a penetrating gunshot or s...

We present a case where multi-phase post-mortem computed tomography angiography (PMCTA) induced a hemorrhagic pericardial effusion during the venous phase of angiography. Post-mortem non-contrast CT (PMCT) suggested the presence of a ruptured aortic dissection. This diagnosis was confirmed by PMCTA after pressure controlled arterial injection of co...

The single Hochdorf burial was found in 1887 during construction work in the Canton of Lucerne, Switzerland. It dates from between 320 and 250 BC. The calvarium, the left half of the pelvis and the left femur were preserved. The finding shows an unusual bony alteration of the skull. The aim of this study was to obtain a differential diagnosis and t...

Objectives First, to evaluate humeral fracture patterns created by torque and transverse force, to test the breaking force required and evaluate maximum force applied by volunteers; second, to apply the results of these experiments and review relevant literature to three clinical cases of spiral humeral shaft fracture during police arrest with cont...

We report a case of unusual intracranial gas distribution after fatal blunt force trauma to the chest. After a first cursory review of the post-mortem computed tomography (PMCT) images, the intracranial gas collection was misinterpreted as intraarterial air embolism. A second, more thorough review of the findings revealed an exclusive intra-thecal...

We report a case of unusual intracranial gas distribution after fatal blunt force trauma to the chest. After a first cursory review of the post-mortem computed tomography (PMCT) images, the intracranial gas collection was misinterpreted as intraarterial air embolism. A second, more thorough review of the findings revealed an exclusive intra-thecal...

a b s t r a c t Background: Laryngeal tubes (LT) as opposed to endotracheal tubes (ET) appear to be relatively rare in the medico-legal caseload of the Institute of Forensic Medicine of the University of Zürich(IFMZ). They contain possible relevance for medicolegal casework: they significantly differ from ET in that a LT's lower end correctly resid...

We present a case of a ruptured abdominal aortic aneurysm (AAA) with ambiguous accessory findings on post-mortem computed-tomography (PMCT), post-mortem magnetic resonance (PMMR) imaging, and PMCT-angiography (PMCTA) suggestive of thoracic aortic dissection. The diagnosis of ruptured AAA was confirmed by autopsy; however, there was no aortic dissec...

The famous La Tène burial site of Münsingen Rain in Switzerland was discovered in 1904. The individuals were dated by horizontal stratigraphy to 420 - 240 BC. One of the 77 individuals showed an alteration of the bone, so the skull, the left humerus with scapula and the right femur were retained. The aim of this study was to reconsider a different...

Purpose The purpose of this pictorial essay was to retrospectively evaluate the specificity, sensitivity and accuracy of computed tomography (CT), digital radiography (DR) and low-dose linear slit digital radiography (LSDR, Lodox) whlist emphasizing on radiological signs and pitfalls in the detection of internal cocaine containers. Methods Institut...

Purpose State of the art routine work of legal medicine is incremental facilitated by unenhanced post-mortem computed tomography (PMCT) with little information about the vasculature due to a lack of contrast. Lately established PMCT-Angiography (PMCTA) is performed in order to provide precise display of vascular and tissue lesions. Vascular patholo...

A case of a 54 year old man with unknown medical history suddenly collapsing with cardiac arrest. Post mortem MRI (PMMR) revealed T1 hyperintense material in the pulmonary trunk, a soft tissue edema of the right lower limb, a T2-hyperintense area in the myocardial septum and a patent foramen ovale (PFO). These imaging findings were confirmed by aut...

The aim of this study was to determine the sensitivity and specificity of postmortem whole-body MRI for typical injuries resulting from traumatic causes of death. Forty cases of accidental death were evaluated with postmortem whole-body MRI. Imaging was conducted according to a standard protocol, and each examination had an average duration of 90 m...

BACKGROUND With the increasing use of imaging technologies during surgeries and autopsies, new control methods for computer systems are required to maintain sterility. We developed a system which provides hand gesture based, hands-free interaction both for 2D cross sectional images as well as with a 3D volume renderer. CONCLUSION Our system, made...

The study of fossils permits the reconstruction of past life on our planet and enhances our understanding of evolutionary processes. However, many fossils are difficult to recognize, being encased in a lithified matrix whose tedious removal is required before examination is possible. The authors describe the use of multidetector computed tomography...

To determine the potential of minimally invasive postmortem computed tomographic (CT) angiography combined with image-guided tissue biopsy of the myocardium and lungs in decedents who were thought to have died of acute chest disease and to compare this method with conventional autopsy as the reference standard. The responsible justice department an...

Postmortem imaging has gained prominence in the field of forensic pathology. Even with experience in this procedure, difficulties arise in evaluating pathologies of the postmortem lung. The effect of postmortem ventilation with applied pressures of 10, 20, 30 and 40 mbar was evaluated in 10 corpses using simultaneous postmortem computed tomography...

Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image-guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE) on whole-body unenhanced pmCT, pmCTA, and image-guid...

To assess the reliability of computed tomography (CT) numbers, also known as Hounsfield-units (HU) in the differentiation and identification of forensically relevant materials and to provide instructions to improve the reproducibility of HU measurements in daily forensic practice. We scanned a phantom containing non-organic materials (glass, rocks...

Lundström C, Persson A, Ross S, Ljung P, Lindholm S, Gyllensvärd F, Ynnerman A. State-of-the-art of visualization in post-mortem imaging. APMIS 2012; 120: 316–26. Autopsies constitute a valuable feedback to the healthcare chain to achieve improvements in quality of care and cost effectiveness. This review describes post-mortem imaging, which has em...

There are conflicting results with regard to the use of catheter-based techniques for continuous paravertebral block. Local anaesthetic spread within the paravertebral space is limited and the clinical effect is often variable. Discrepancies between needle tip position and final catheter position can also be problematic. The aim of this proof-of-co...

The objective of this study was to explore the perception of the legal authorities regarding different report types and visualization techniques for post-mortem radiological findings. A standardized digital questionnaire was developed and the district attorneys in the catchment area of the affiliated Forensic Institute were requested to evaluate fo...

Computed tomography (CT) and magnetic resonance (MR) imaging have become important elements of forensic radiology. Whereas the feasibility and potential of CT angiography have long been explored, postmortem MR angiography (PMMRA) has so far been neglected. We tested the feasibility of PMMRA on four adult human cadavers. Technical quality of PMMRA w...

The purpose of our study was to retrospectively evaluate the specificity, sensitivity and accuracy of computed tomography (CT), digital radiography (DR) and low-dose linear slit digital radiography (LSDR, Lodox(®)) in the detection of internal cocaine containers. Institutional review board approval was obtained. The study collectively consisted of...

For the past 10 years, medical imaging techniques have been increasingly applied to forensic investigations. To obtain histological and toxicological information, tissue and liquid samples are required. In this article, we describe the development of a low-cost, secure, and reliable approach for a telematic add-on for remotely planning biopsies on...

PURPOSE State of the art routine work of legal medicine is incremental facilitated by unenhanced postmortem computed tomography (PMCT). Still there is little information of the vasculature due to a lack of contrast. Lately established PMCT-Angiography (PMCTA) is performed in order to provide precise display of vascular and tissue lesions. Standard...

Keyboards, mice, and touch screens are a potential source of infection or contamination in operating rooms, intensive care units, and autopsy suites. The authors present a low-cost prototype of a system, which allows for touch-free control of a medical image viewer. This touch-free navigation system consists of a computer system (IMac, OS X 10.6 Ap...

With the increasing use of medical imaging in forensics, as well as the technological advances in rapid prototyping, we suggest combining these techniques to generate displays of forensic findings. We used computed tomography (CT), CT angiography, magnetic resonance imaging (MRI) and surface scanning with photogrammetry in conjunction with segmenta...

We present a case of an individual who stabbed himself through the heart with a large knife. Post mortem computed tomography (CT) and CT-angiography were used to assess the stab channel and to reconstruct the sequence of events. After penetrating injuries to the chest, both the intra-thoracic organs and the injury causing instrument may shift (e.g....

A major concern with the use of continuous peripheral nerve block is the difficulty encountered in placing the catheters close enough to the nerves to accomplish effective analgesia. The aim of this study was to investigate if a self-coiling catheter would remain close to the sciatic nerve once introduced through needles placed under ultrasound gui...

Blood aspiration is a significant forensic finding. In this study, we examined the value of postmortem computed tomography (CT) imaging in evaluating findings of blood aspiration. We selected 37 cases with autopsy evidence of blood in the lungs and/or in the airways previously submitted to total-body CT scanning. The CT-images were retrospectively...

Ultrasound-guided techniques are increasingly used in anaesthetic practice to identify tissues beneath the skin and to increase the accuracy of placement of needles close to targeted structures. To examine ultrasound's usefulness for dilatational tracheostomy, we performed ultrasound-guided tracheal punctures in human cadavers followed by computer-...

Paravertebral regional anaesthesia is used to treat pain after several surgical procedures. This study aimed to improve on our first published ultrasound-guided approach to the paravertebral space (PVS) and to investigate a possible discrepancy between the needle, catheter, and contrast dye position. In 10 cadavers, we conducted 26 ultrasound-guide...

The benchmark first edition of Forensic Radiology, published in 1998, was a milestone in the forensic community — a bestseller throughout the world and a standard reference for practitioners and educators alike. Like its predecessor, Brogdon’s Forensic Radiology, Second Edition covers the entire scope of radiological applications in the forensic sc...

PURPOSE To retrospectively evaluate the specifity and sensitivity of multi-detector computed tomography (CT), digital radiograph (DR) and low-dose linear slit digital radiography (LSDR, Lodox®) in the detection of incorporated cocaine containers. METHOD AND MATERIALS Institutional review board approval and governmental permission was obtained. The...

As an Alpine country, Switzerland has not only a thriving mountaineering tourist industry, but also many mountaineering casualties. At the request of the state attorney, most of the victims undergo only an external inspection without autopsy. One of the main tasks of the forensic pathologist under these circumstances is the correct identification o...

Although postmortem imaging has gained prominence in the field of forensic medicine, evaluation of the postmortem lung remains problematic. Specifically, differentiation of normal postmortem changes and pathological pulmonary changes is challenging and at times impossible. In this study, five corpses were ventilated using a mechanical ventilator wi...

Although postmortem CT suffices for diagnosing most forms of traumatic death, the examination of natural death is, to date, very difficult and error prone. The introduction of postmortem angiography has led to improved radiologic diagnoses of natural deaths. Nevertheless, histologic changes to tissues, an important aspect in traditional examination...

Determination of the manner of death in case of intraoral firearm wounds can be a challenge, especially if the circumstances of the incident are unclear and crime scene investigation is inadequate. It is a well-known fact that the mouth is one of the selected sites for suicide with firearms. Homicidal shooting through the mouth is said to be rare,...

Recently, the field of forensics has experienced a rapid increase in the use of modern cross-sectional imaging in forensic investigations. We examined the value of post-mortem computed tomography (CT) imaging relative to autopsy for distinguishing aspiration into the lungs from airways, from lung alterations due to other causes, and for identifying...

The aim of the study was to examine the clinical forensic findings of strangulation according to their ability to differentiate between life-threatening and non-life-threatening strangulation, compare clinical and MRI findings of the neck and discuss a simple score for life-threatening strangulation (SLS). Forensic pathologists classified a continu...