This summary recounts the evolution of my career and my involvement in postmortem imaging. In 1991, after graduating from university, I began working at a university hospital and a cancer center, where I spent 8 years. Seven of those 8 years were dedicated to my role as a radiologist and respiratory physician, engaging in imaging diagnosis (CT, MRI, ultrasound, bronchoscopy), treatment (chemotherapy, radiation therapy), and terminal care for lung cancer patients. Whenever a hospitalized patient passed away, I would recommend a pathological autopsy to the family. This practice allowed me to frequently compare antemortem (living) imaging findings with autopsy findings (radiologic-pathologic correlation). One of those 8 years I spent as an anesthesiologist in the operating room and conducted cardiopulmonary resuscitation managements in the emergency room (ER).　 What I learned regarding physiology, biochemistry, and pharmacology through my work experience in the fields of pulmonology and anesthesiology, not only anatomical and pathological studies as a radiologist, became the base knowledge for me in writing later research papers.

In 1999, I was transferred to Tsukuba Medical Center Hospital (TMCH), an emergency hospital where postmortem CT (PMCT) has been systematically performed for the first time in Japan since 1985 when the hospital was established. The purpose of the PMCT was to screen for causes of death in patients who were brought to the ER in cardiopulmonary arrest (CPA), were resuscitated, but subsequently died in the ER. (In Japan, the number of forensic pathologists is low, and the autopsy rate remains very limited.)

Upon my transfer to TMCH, I discovered a substantial archive of PMCT image data in the film reading room. Though emergency and critical care physicians referred to this valuable dataset as “a treasure trove”, they were too busy to analyze it.  Therefore, I began analyzing the accumulated data and reported in 2000 that the PMCT findings could be classified into three main categories: cause of death, postmortem changes, and resuscitation-induced changes. At that time, I read Dr. Brogdon’s book “Forensic Radiology” published in 1998, which mainly focused on postmortem plain radiographs with limited descriptions regarding PMCT and postmortem MRI (PMMRI). TMCH also had an autopsy center within its facilities where forensic pathologists conducted autopsies on unusual deaths. I started to perform PMCT and PMMRI on bodies prior to autopsy, and presented the results of radiologic-pathologic correlation at conferences.

In 2006, a mystery novel involving postmortem imaging as a clue to solve problems became a bestselling novel in Japan; since then, the usefulness of postmortem imaging and the term ‘Autopsy imaging’ used in the novel have become widely known among public beyond medical professionals.

In 2015, I was transferred to my current hospital (equipped with 100 beds), where PMCT was already being performed on patients with CPA in the ER and sudden death cases among hospitalized patients. Currently, I am working with my role of in-hospital medical safety surveys, in addition to my primary role as a director of radiology department.  I also I receive police inquests to inspect unusually deceased bodies. I perform PMCTs every few days in the evening between 17:00 and 24:00, and PMMRIs in some cases. The number of PMCTs has been especially increasing in Japan (60,000 cases in 2018 compared to 20,000 cases in 2012) though the autopsy rate has been remaining low. Further advancement in postmortem image interpretations, as well as distribution of the knowledge, will be of substantial help for death-cause detection in unusual deaths.