A Decade of Postmortem Imaging Is Quietly Transforming Paediatric Autopsy Practice

When two paediatric radiologists published a short commentary in 2015 under the Latin motto “mortui vivos docent” — the dead teach the living — postmortem imaging in children was a fragmented, largely ad hoc enterprise. Ten years later, Owen J. Arthurs of Great Ormond Street Hospital for Children and Rick R. van Rijn of Amsterdam University Medical Centers and the Netherlands Forensic Institute have returned to the pages of Pediatric Radiology to take stock of that decade, and the picture they describe is one of remarkable, if uneven, transformation. Their new commentary, published in September 2026, traces how fetal and paediatric postmortem imaging has moved from scattered local practice to a field with international task forces, standardized protocols, multi-society endorsement and, increasingly, a defined place in clinical care.

The central premise of the field has not changed: imaging the dead can answer questions that matter enormously for the living. When a fetus dies in utero, when a newborn succumbs shortly after birth, or when a child dies unexpectedly, families and clinicians want answers. Conventional autopsy has long been the gold standard, but consent rates for full autopsy have fallen across much of the world, driven by religious and cultural concerns, emotional distress and simple unfamiliarity with the procedure. Less-invasive alternatives that use imaging — chiefly postmortem computed tomography and postmortem magnetic resonance imaging — promise a way to recover diagnostic information while respecting families’ wishes. That promise, the commentary argues, has come substantially closer to reality over the past ten years.

The turning point came in organizational form. In 2016, the European Society of Paediatric Radiology convened a dedicated postmortem imaging task force, building on an earlier questionnaire-based survey that had revealed how inconsistent practice was across European centres. That survey, published in 2014, documented wide variation in whether imaging was offered at all, which modalities were used, and how results were reported. The task force gave the field a focal point: a standing group of experts who could translate scattered research findings into practical, consensus-based guidance. The commentary’s authors, who have led much of this effort, frame the past decade as the story of what happened once that structure existed.

The most tangible products of that structure are the protocols. In 2019, a joint working group of the European Society of Paediatric Radiology and the International Society for Forensic Radiology and Imaging published the first standardized protocol for paediatric postmortem computed tomography, specifying how scans should be acquired in children of different sizes and ages. More recently, the task force has turned to magnetic resonance imaging, publishing a referral template for fetal and neonatal postmortem imaging in 2024, a full clinical protocol for fetal and neonatal postmortem MRI in 2025, and, in 2026, recommendations for standardized structured reporting of those examinations. Reporting guidance for perinatal and paediatric postmortem CT followed a parallel track, published in Insights into Imaging in 2024.

Standardized reporting deserves particular emphasis because it addresses one of the field’s most stubborn problems. An imaging study is only as useful as the report that follows it, and early adopters of postmortem MRI found that radiologists described findings in wildly different ways, making it difficult to compare results across centres or to accumulate the evidence base needed to convince coroners, pathologists and funders. The 2026 structured reporting recommendations aim to fix this by defining what must be documented, in what order and with what terminology, so that a postmortem MRI report from Amsterdam can be read and trusted in London, Toronto or Melbourne. It is the kind of unglamorous infrastructure work that rarely makes headlines but determines whether a technique becomes routine or remains a curiosity.

The evidence base itself has grown in parallel. One of the decade’s most influential studies, the DRIFT trial published in The Lancet Child & Adolescent Health in 2018, compared chest radiographs with computed tomography for detecting rib fractures in children and provided diagnostic accuracy data that directly inform how skeletal injury should be assessed after death. Other work has pushed into more sophisticated territory: diffusion-weighted postmortem MRI of the fetal brain has been used to help time perinatal deaths, a question with real forensic and medico-legal significance, while feasibility studies have explored multiparametric mapping and spectroscopy approaches that quantify the biochemical changes tissues undergo after death. These quantitative techniques remain largely research tools, but they hint at a future in which postmortem imaging does more than mirror autopsy — it measures things autopsy cannot.

Geography, however, remains a limiting factor. A 2023 survey of North American practice found that paediatric postmortem imaging is used far less consistently there than the European literature might suggest, and a companion European survey published the same year examined the fragile funding streams that support the work. Postmortem imaging often falls between budgetary stools: it is not routine diagnostic imaging with a living patient, nor is it always funded as part of forensic or medico-legal investigation. The commentary is candid that reimbursement and sustainable financing are now among the biggest obstacles to wider adoption, perhaps bigger than any technical question about image quality or diagnostic accuracy.

The institutional response has been to widen the coalition. In 2026, a multi-society statement on implementing paediatric and fetal postmortem imaging into clinical practice was issued jointly by the European Society of Paediatric Radiology, the Society for Pediatric Radiology, the Latin American Society of Pediatric Radiology, the Asian and Oceanic Society for Pediatric Radiology, the World Federation of Pediatric Imaging and the International Association of Forensic Radiographers. That breadth matters. It signals that the field is no longer a European project but a global one, and it gives radiologists, pathologists, coroners and health administrators on multiple continents a common reference point when they argue for local services.

Technology continues to move as well. Among the developments highlighted in the commentary’s own journal is early experience with photon-counting detector CT in paediatric postmortem imaging, a detector technology that offers higher spatial resolution and improved tissue contrast at comparable or lower radiation exposure than conventional CT. For a field whose credibility depends on detecting small, subtle findings — a hairline rib fracture, a tiny intracranial haemorrhage, a subtle malformation — such hardware advances could meaningfully shift diagnostic performance. The commentary also notes the publication of a comprehensive textbook on postmortem imaging of the fetus and child in 2025, consolidating a decade of accumulated knowledge into a single reference for practitioners entering the field.

Where does the field go from here? The commentary’s implicit answer is that the scientific groundwork has largely been laid and the remaining battles are organizational: funding, service implementation, training and the slow work of convincing legal systems and bereaved families that imaging can stand alongside — or in some cases replace — conventional autopsy. For early pregnancy loss, less-invasive autopsy approaches have already been shown to offer families answers where a full autopsy would be declined. The decade since “mortui vivos docent” has not eliminated the need for pathologists, and few in the field claim it should; instead, imaging has become a complementary tool that can guide autopsy, replace it when families refuse it, and extract information from bodies that must otherwise go unexamined. The dead, it turns out, teach the living best when the living build the systems to listen.

Subject of Research: Paediatric and perinatal postmortem imaging

Article Title: 10 years of paediatric and perinatal postmortem imaging: where are we now?

Article References: Arthurs, O. J., & van Rijn, R. R. (2026). 10 years of paediatric and perinatal postmortem imaging: where are we now?. Pediatric Radiology. https://doi.org/10.1007/s00247-026-06795-9

Image Credits: AI Generated

DOI: 10.1007/s00247-026-06795-9

Keywords: postmortem imaging, paediatric radiology, perinatal autopsy, postmortem MRI, postmortem CT, ESPR task force, less-invasive autopsy, fetal imaging, forensic radiology, structured reporting, photon-counting CT, Pediatric Radiology