Building Forensic Radiology Capacity in Saudi Arabia: A Narrative Review of Postmortem Imaging Pitfalls, Medicolegal Governance, and a Competency-based Fellowship Blueprint Aligned with International Standards

Abstract Postmortem computed tomography (PMCT) has become a central modality in contemporary medicolegal death investigation, providing noninvasive whole-body assessment and durable, reviewable documentation. Despite its diagnostic advantages, PMCT interpretation is inherently complex due to postmortem physiological changes and technical artifacts that may mimic antemortem pathology. Misinterpretation of these findings can influence cause-of-death determination and introduce medicolegal uncertainty. In Saudi Arabia, the use of PMCT is increasing; however, there is currently no dedicated, structured fellowship focused on advanced PMCT interpretation within forensic practice. This study presents a narrative review of PMCT-focused forensic imaging literature, synthesizing evidence on diagnostic performance, recurrent interpretive pitfalls, and medicolegal implications. High-risk areas – including dependent hypostasis, intravascular postmortem clotting, and gas redistribution – are identified as key sources of diagnostic vulnerability requiring specialized expertise. International standards emphasize competency-based training and structured reporting to ensure interpretive reliability. Within the Saudi context, ethical, cultural, and practical constraints surrounding conventional postmortem examinations highlight the potential role of PMCT as a minimally invasive alternative. However, this increased reliance on imaging further amplifies the need for specialized training and governance frameworks. This study proposes a competency-based forensic radiology fellowship centered on PMCT interpretation, aligned with international standards and adapted to Saudi medicolegal workflows. By linking high-risk interpretive pitfalls to defined competencies, assessment strategies, and governance mechanisms, the proposed model aims to improve diagnostic accuracy, strengthen medicolegal defensibility, and support sustainable workforce development.