DOCSLIB.ORG

Virtopsy: Emerging Frontier in Forensics

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Virtopsy: Emerging Frontier in Forensics Review Article DOI: 10.18231/2455-1732.2017.0017 Virtopsy: Emerging frontier in forensics Mamta Malik1, Rakesh K. Mishra2,*, Kanwalpreet Kaur3, Sanjeev Laller4, Vijay Kumar5 1,4Reader, 2Post Graduate, 3Lecturer, 5Dental Surgeon, 1,4Dept. of Oral Medicine and Radiology, 2Dept. of Forensic Medicine & Toxicology, 3Dept. of Conservative and Endodontics, 1,4PDM Dental College & Research Institute, Bahadurgarh, Haryana, 2Santosh Medical College, Ghaziabad, Uttar Pradesh, 3BJS Dental College, Ludhiana, Punjab, 5Oscar Multispecialty Hospital and Trauma Center Rohtak, Haryana, India Corresponding Author: Email: [email protected] Abstract It is long back that the autopsy procedures were invented and till now the same age old technique for autopsy are being used, though in the other fields of Forensic Medicine, there is rapid growth and advancement in the procedures performed and technology employed. Virtopsy is one step towards this end. Virtopsy came from virtual autopsy, which is a scalpel free procedure of autopsy carried out using modern medical, imaging and measuring technology. The technique could offer an alternative to the standard invasive procedure that upsets many families and is prohibited by some religion. With the help of this paper an effort is made to discuss a few points in the field of Forensics. Keywords: Virtopsy, Virtual autopsy, Forensics, Autopsy. Introduction been done in the procedures performed and technology Forensic science is the branch of medicine which employed in autopsy procedure. Virtopsy is one step aims for the documentation of medical and other towards this end which came from virtual autopsy, forensic findings in living and deceased persons, for the which is a scalpel free procedure of autopsy wherein police and the judiciary system. As we know that death modern medical, imaging and measuring technology is an inevitable part of everyone’s life, but sometimes are used such that there is no need of any dissection of for furtherance of law scientific examination of bodies the body for opening the body cavities or dissection of after death becomes mandatory to find out the reasons the different organs of the body.(2-4) for death. The contribution of Forensic science Virtopsy versus autopsy: Term autopsy was derived involving ten disciplines (which include Criminalistics, from Greek words as autos (self) and opsomei (I will engineering science, general, jurisprudence, see) – “To see with one's own eyes”. Whereas virtopsy odontology, pathology/biology, psychiatry and or "virtual autopsy" was derived from the words behavioral science, questioned documents, toxicology “virtual” (Latin: virtus: effective) which means useful, and physical anthropology) in achieving this is efficient and good‟ and elimination of autos ie, self thus appreciable.(1,2) leading to the scientific word virtopsy.(1,4) The term autopsy often referred to as “medico- Conventional Autopsy procedure involves invasive legal autopsy” or “medicolegal necropsy” is thought to body opening through incisions and dissection – the be the most important forensic tool to know the cause traditional means of postmortem investigation in of death, and therefore it is even called “the expertise of Humans and with the same time one have to consider expertises”. The conventional autopsy procedure where the sentiment of the relatives of the deceased, who are whole surface of the body as well as all the body always upset and usually against conventional cavities are explored to record the findings or is body autopsies. On the other hand virtopsy is a minimally dissection or mutilating techniques which is objected by invasive or noninvasive emerging technology in the the emotional aspects of the victim’s relatives as they field of Forensic medicine which incorporates imaging know these mutilation forms of autopsies. But most technology wherein radiologists and forensic clinicians importantly the need to know the cause of death and reflect documentation of the body in the observation of identification of an unknown deceased individual and the anatomical structures through computed also may help the law enforcement overrules this tomography (CT), magnetic resonance (MRI) and emotional involvement and justify the autopsy micro radiology devices. Thus there is no need of any procedure. Therefore, the families and relatives of the dissection of the body for opening the body cavities or victim often remain in a conflicting situation with the dissection of the different organs of the body and also forensic examiners and are usually not in favor of keep sentiments, cultural and religious beliefs of autopsy. Even some religious and cultural beliefs also patient’s family members.(1,4-6) stand against the autopsy procedure. An example is Background of virtopsy: It was in the nineties when observed in religious strands, such as Judaism, where it Richard Dirnhofer, former Director of Forensic is not permitted to undergo the process of autopsy. To Medicine, at the Institute of Forensic Medicine of the overcome, this rapid growth and advancement have University of Bern, Switzerland, started working on the Santosh University Journal of Health Sciences 2017;3(2):54-56 54 Rakesh K. Mishra et al. Virtopsy: Emerging frontier in forensics characteristics of the human body (observation of the vehicles with high stability and accuracy, (vi) anatomical structures) in a concrete, objective and non- Angiography – post-mortem heart-lung machine: it is invasive protocol created a new discipline in autopsy, done to se intravascular and intra-articular display for named as “Virtopsy”, which was a virtual project of small as well as longer circulatory system, to analyze autopsy and anatomy of body was observed and individual body organs, vascular injury leakages and to examined through computed tomography (CT), estimate quantity of stenosis, (vii) Programmable magnetic resonance (MRI) and micro radiology biopsy – contamination-free sampling: by this the body devices. The same research was then continued by his fluids can be examined for toxicological purpose successor, Michel Thali (the forensic pathologist and without contamination and requires less manpower, project manager for virtopsy) and his colleagues at the (viii) Ultrasound Technology: done to produce pictures University of Berne's Institute of Forensic Medicine, of anatomical structures like cardiac evaluation, Switzerland who said "If you are doing an autopsy, you tumours, abscesses, vascular structures, solid organ are always destroying the 3-D geometry of the body". assessment, and pregnancy etc, (ix) Animations in Using this cross-section imaging technique, it is Forensic Pathology: this helps the forensic pathologists possible to document the same findings in a to process complex evidence in animated series to noninvasive way. Idea of “all in one research area” was communicate for juries in a clear-cut and easy mode so proposed encouraging virtopsy as a promising field that jury can easily understand the justifications and with clear and controlled procedure. Virtopsy procedure observations, and (x) Photography: Digital imaging start from surface documentations carry on with CT technique is used for photography because provides it scanning and fallowed with image-controlled sampling provides exact image record of the crime scene along for histological, bacteriological and toxicological with it show present physical evidence.(2-4,7-11) examination.(2-4,7) Applications of virtopsy: Virtopsy technique is used in Imaging techniques of virtopsy: A two dimensional multiple number of forensic situations/science, such as view of the particular object is given by a photograph. thanatological investigations; carbonized and putrefied Same way, if photograph of a wound is taken, it will body identifications; mass disaster cases; age give the position, as well as length and breadth of the estimation; anthropological examinations and skin wound but cannot display the depth of the wound. So lesion analyses.(3) for determination of the depth, a three dimensional a. Cause of death in drowned cases is diagnosed by view of the wound is essential to understand the actual CT images by giving information about the dimensions. In autopsy dissection is done to get this volume, density, size of the lungs and the amount three dimensional view but same can be done without of liquid observed.(3,12) the use of scalpel in virtopsy by using combination of b. Human identification is possible in mass disaster imaging modalities.(4) cases as CT images ease in data collection on the So virtopsy involves combination of the different disaster field.(3,13) technologies of medical imaging as well as other c. In forensic odontology branch, respiratory technologies used in other field of science. An insight obstruction by foreign body is best differentiated into the future of forensic is visualized by the emerging by virtopsy using CT and MRI images as compared involvement of advanced imaging technology that can to conventional autopsy where it is difficult to enhance or even in the future may be an alternative to know the exact depth of obstructed foreign conventional forensic examination. It relies on certain body.(3,14) fundamental techniques of imaging which include (i) d. Personal identification is possible by Computed Tomography (CT) – for three-dimensional superimposition and comparing AM imaging and analysis of autopsy findings including orthopantomograms and PM reconstructed gross tissue injury and pathologic gas collections, CT panoramic
Load more

Recommended publications
  • Spring Programme 2011
    Faculty of Radiologists Royal College of Surgeons in Ireland Combined Spring Meeting 8th & 9 th April 2011 Venue: Castlemartyr Hotel, Co. Cork. Programme Faculty of Radiologists, Royal College of Surgeons in Ireland CPD Credits Awarded: 5 Royal College of Radiologists credits are applied for. Friday 8 th April 2011 3.30-4.30pm Registration 4.30-5.30pm Stroke in 2011, Moderator: Dr. Ian Kelly, Waterford Regional Hospital 4.30-5.00pm Acute Stoke Imaging. Dr Noel Fanning, Cork University Hospital, Cork 5.00-5.30pm Stroke: A clinical perspective. Dr. George Pope, John Radcliffe Hospitals, Oxford 5.30-6.30pm Moderator: Dr. Adrian Brady, Dean, Faculty of Radiologists Belfast to Bosnia and Autopsy to Virtopsy Dr. Jack Crane, State Pathologist, NI 8pm Dinner Saturday 9 th April 2011 8.30-9.00am Registration 9.00-10.00am Liver hour. Moderator: Dr John Feeney, AMNCH, Dublin 9.00-9.30am Liver imaging pre metastatectomy. Dr. Peter MacEneaney, Mercy University Hospital, Cork 9.30-10.00am Parenchymal and focal liver biopsy - when and how. Dr Stephen J Skehan St Vincent's University Hospital, Dublin 10.00-11.00am Paediatric Hour. Moderator: Dr. Stephanie Ryan, The Children’s University Hospital Temple Street, Dublin 10.00-10.30am Paediatric Abdominal Emergencies. Dr Eoghan Laffan, The Children’s, University Hospital Temple Street, Dublin 10.30-11.00am Non Accidental Injury. Dr Conor Bogue, Cork University Hospital, Cork 11.00-11.30am Tea/Coffee Break and Poster Exhibition 11.30-12.30pm MSK Hour. Moderator: Dr Orla Buckley, AMNCH, Dublin 11.30-12.00pm Image guided joint interventions.
    [Show full text]
  • Virtopsy and Living Individuals Evaluation Using Computed
    Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging Giuseppe Lo Re, MD, Sergio Salerno, MD, Maria Chiara Terranova, MD Antonella Argo, MD, Antonio Lo Casto, MD, Stefania Zerbo, MD, and Roberto Lagalla, MD The applications of forensic radiology involve both Virtopsy both studies on living people À to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass disasters. Semin Ultrasound CT MRI 40:67-78 © 2018 Elsevier Inc. All rights reserved. Introduction also preserving evidence in an undisturbed state. Diag- nostic imaging plays a pivotal role in the preliminary he applications of forensic radiology (FR) involve both evaluation in the “safety screening” prior to forensic À T studies on living people and cadavers to demonstrate assessment of the remains; thus, preventing dangers to bone age, search for foreign bodies, such as voluntary injec- the workers who handle the corpses, or in case of infec- tion of drug ovules or surgical sponges accidentally forgot- tion surveillance, such as pulmonary tuberculosis, con- ten, to assess gunshot wounds, to evaluating injuries by road firmed by CT examination before autopsy.16-18 accidents and cases of violence or abuse (both in adults and Although the costs and availability of CT scanners and 1-3 in children).
    [Show full text]
  • New Phase in Forensic Odontology
    International Journal of Dental and Health Sciences Review Article Volume 02,Issue 06 VIRTOPSY: NEW PHASE IN FORENSIC ODONTOLOGY Yogish.P 1, Asha Yogish 2 1.Assisstant Professor in Department of Oral Pathology and Microbiology, Sharavathi Dental College and Hospital, Shivamogga. 2.Postgraduate student in Department of Oral Medicine and Radiology, Coorg Institute of Dental Sciences, Virajpet. ABSTRACT: Nowadays, technological advances are becoming more and more important in forensic sciences. Yet autopsy is still one of the very traditional methods. This also applies for dental autopsies, in which visual, photographic and radiological evidences are collected. Virtual Autopsy appears as a helpful and complementary tool for dental and medical cadaveric examination. Using high-tech radiological approaches, Virtual Autopsy may provide, through images, an efficient and more accurate view on the individual case. This critical review aims to update on the origin, applications of virtopsy and also the role of dentists in this field. Keywords: Autopsy; Radiology; Forensic Odontology INTRODUCTION: Death is an inevitable part of life and at psychiatry and behavioural science, few occasions scientific examination of questioned documents, toxicology and bodies after death becomes mandatory. physical anthropology. Modern day investigations have reached a point of sophistication interconnecting Forensic pathology is a discipline of the involvement of many different Forensic science which deals with disciplines to serve problems including pathologic and
    [Show full text]
  • Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings
    Utility of Postmortem Autopsy via Whole- Body Imaging: Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings Jang Gyu Cha, MD1 Dong Hun Kim, MD1 Objective: We prospectively compared whole-body multidetector computed Dae Ho Kim, MD2 tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy Sang Hyun Paik, MD1 findings. Jai Soung Park, MD1 Materials and Methods: Five cadavers were subjected to whole-body, 16- Seong Jin Park, MD1 channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radi- Hae Kyung Lee, MD1 ologist classified the MDCT and 3.0T MRI findings into major and minor findings, Hyun Sook Hong, MD1 which were compared with autopsy findings. 3 Duek Lin Choi, MD Results: Most of the imaging findings, pertaining to head and neck, heart and 4 Kyung Moo Yang, MD vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to 4 Nak Eun Chung, MD autopsy findings. The causes of death that were determined on the bases of 4 Bong Woo Lee, MD MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of 4 Joong Seok Seo, MD five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direc- Index terms: tion of external force. MRI was effective in evaluating and tracing the route of a Computed tomography (CT) metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. Magnetic resonance (MR) Whole-body imaging Conclusion: A postmortem MDCT combined with MRI is a potentially powerful Forensic autopsy tool, providing noninvasive and objective measurements for forensic investiga- DOI:10.3348/kjr.2010.11.4.395 tions.
    [Show full text]
  • Virtopsy Working on the Future of Forensic Medicine
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by RERO DOC Digital Library Leitthema Rechtsmedizin 2007 · 17:7–12 M.J. Thali1 · S. Ross1 · L. Oesterhelweg1 · S. Grabherr1 · U. Buck1 · S. Naether1 · DOI 10.1007/s00194-006-0419-6 C. Jackowski1 · S.A. Bolliger1 · P. Vock2 · A. Christe2 · R. Dirnhofer1 Online publiziert: 30. Dezember 2006 1 Center of Forensic Imaging, Institute of Forensic Medicine, University, Bern © Springer Medizin Verlag 2006 2 Institute of Diagnostic Radiology, University Hospital, Bern Virtopsy Working on the future of forensic medicine In recent times, few fields have witnessed 3D Photogrammetry-based This allows for a more detailed surface such impressive progress as imaging optical scanning documentation compared to 3D recon- methods and radiology: digital data ac- structions based on high resolution CT quisition and post-processing of images The standard for the documentation of in- data. have revolutionized the practice of imag- juries in forensic medicine is still photog- The color information is acquired us- ing and radiology and have determined a raphy with exact measurements. Howev- ing the Tritop software that combines dig- growing interest in this field on the part er, the photographic process reduces a 3D ital photography of the surface from many of other medical professions. The applica- wound to a 2D level in the same way as different angles into 3D color information tion of imaging methods for non-invasive classical x-ray documentation. of the object that can be correctly matched documentation and analysis of relevant Using the TRITOP/ATOS III (GOM, on the digital 3D surface model using cod- forensic findings in living and deceased Braunschweig, Germany) system the col- ed and uncoded markers placed on the persons has lagged behind the enormous ored 3D surface can be documented via object.
    [Show full text]
  • Virtopsy, Does It Become an Essential Necessity in Bahrain?
    MOHAMMED FATHI SHARAF MEDICOLEGAL EXAMINER DIRECTORATE OF FORENSIC SCIENCE MINISTRY OF INTERIOR VIRTOPSY IS VIRTUAL AUTOPSY VIRTUS :useful , AUTOS : self efficient and good OPSOMEI: I will see TO SEE WITH ONE’S OWN EYES THE IMAGING TECHNIQUES 3-D surface scan Multi-slice computed tomography (MSCT) Magnetic resonance imaging (MRI) Magnetic resonance imaging spectroscopy CT guided needle biopsy Post-mortem angiography(virtangio) ADVANTAGES OF DISADVANTAGES OF VIRTOPSY VIRTOPSY Non- destructive Virtopsy is a very costly procedure. Requires a special well equipped place Non- invasive with well trained radiologists and Rapid technicians. Cannot distinguish all the Digitally storable pathological conditions. Tele-forensics Cannot give the infection status. Observer-independent Difficult to differentiate antemortem or the post-mortem wounds. Acceptance by relatives Difficult to appreciate the post- and religious mortem artefacts. communities. The physiological senses of the pathologist are restricted. Virtopsy in living subjects Matching inflicting weapon and injury. Strangulation and estimation of risk of death. Body packing. EFFECTIVNESS OF VIRTOPSY Virtopsy has about 80% concordance with cause of death identified with conventional autopsy. VIRTOPSY AND LEGAL ISSUES Clean bloodless forensic images give neutral fact- based verdict and are easy to appreciate. No juridical validity (yet). CAN WE RELY ONLY ON THE EXTERNAL EXAMINATION OF CORPSES? In cases where there is extensive medical history or the circumstances around the death are well documented, an external autopsy may be all that is needed. (Carpenter and Tait) Aim of The medico legal autopsy Identifying the deceased. Documenting the injuries. Ascertaining whether the injuries found were inflicted before or after death. Collecting samples and trace materials on the victim.
    [Show full text]
  • Virtual Autopsy Using Imaging: Bridging Radiologic And
    Eur Radiol (2008) 18: 273–282 DOI 10.1007/s00330-007-0737-4 FORENSIC MEDICINE Stephan A. Bolliger Virtual autopsy using imaging: bridging Michael J. Thali Steffen Ross radiologic and forensic sciences. A review Ursula Buck Silvio Naether of the Virtopsy and similar projects Peter Vock Abstract The transdisciplinary re- addition, is also well suited to the Received: 26 March 2007 Revised: 25 June 2007 search project Virtopsy is dedicated to examination of surviving victims of Accepted: 16 July 2007 implementing modern imaging tech- assault, especially choking, and helps Published online: 18 August 2007 niques into forensic medicine and visualise internal injuries not seen at # Springer-Verlag 2007 pathology in order to augment current external examination of the victim. examination techniques or even to Apart from the accuracy and three- offer alternative methods. Our dimensionality that conventional project relies on three pillars: three- documentations lack, these techniques dimensional (3D) surface scanning for allow for the re-examination of the . S. A. Bolliger (*) M. J. Thali the documentation of body surfaces, corpse and the crime scene even S. Ross . U. Buck . S. Naether Centre for Forensic Imaging and and both multislice computed tomog- decades later, after burial of the corpse Virtopsy, Institute of Forensic raphy (MSCT) and magnetic reso- and liberation of the crime scene. We Medicine, University of Bern, nance imaging (MRI) to visualise the believe that this virtual, non-invasive Buehlstrasse 20, internal body. Three-dimensional or minimally invasive approach will 3012 Bern, Switzerland e-mail: [email protected] surface scanning has delivered re- improve forensic medicine in the Tel.: +41-31-6318411 markable results in the past in the 3D near future.
    [Show full text]
  • Imaging in Forensic Radiology: an Illustrated Guide for Postmortem Computed Tomography Technique and Protocols
    Forensic Sci Med Pathol (2014) 10:583–606 DOI 10.1007/s12024-014-9555-6 REVIEW Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols Patricia M. Flach • Dominic Gascho • Wolf Schweitzer • Thomas D. Ruder • Nicole Berger • Steffen G. Ross • Michael J. Thali • Garyfalia Ampanozi Accepted: 10 March 2014 / Published online: 11 April 2014 Ó Springer Science+Business Media New York 2014 Abstract Forensic radiology is a new subspecialty that Introduction has arisen worldwide in the field of forensic medicine. Postmortem computed tomography (PMCT) and, to a les- Postmortem cross-sectional imaging, including computed ser extent, PMCT angiography (PMCTA), are established tomography (CT) and magnetic resonance imaging (MR), imaging methods that have replaced dated conventional has been an established adjunct to forensic pathology for X-ray images in morgues. However, these methods have approximately a decade, and the number of scientific not been standardized for postmortem imaging. Therefore, studies on postmortem imaging has increased significantly this article outlines the main approach for a recommended over that short time span [1–4]. standard protocol for postmortem cross-sectional imaging The first postmortem CT (PMCT) was reported in the late that focuses on unenhanced PMCT and PMCTA. This 1970s in a case of fatal cranial bullet wounds [5]. This report review should facilitate the implementation of a high- was followed by numerous publications and even dedicated quality protocol that enables standardized reporting in books on forensic imaging [6–14]. At the turn of the mil- morgues, associated hospitals or private practices that lennium, the Virtopsy project was founded at the Institute of perform forensic scans to provide the same quality that Legal Medicine of the University of Berne in Switzerland.
    [Show full text]
  • Drowning—Post-Mortem Imaging Findings by Computed Tomography
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by RERO DOC Digital Library Eur Radiol (2008) 18: 283–290 DOI 10.1007/s00330-007-0745-4 FORENSIC MEDICINE Andreas Christe Drowning—post-mortem imaging findings Emin Aghayev Christian Jackowski by computed tomography Michael J. Thali Peter Vock Abstract The aim of this study was to the lung resulted in hypodensity of the Received: 20 February 2007 Revised: 29 June 2007 identify the classic autopsy signs of blood representing haemodilution and Accepted: 20 July 2007 drowning in post-mortem multislice possible heart failure. Swallowed Published online: 29 August 2007 computed tomography (MSCT). water distended the stomach and du- # Springer-Verlag 2007 Therefore, the post-mortem pre- odenum; and inflow of water filled the autopsy MSCT- findings of ten paranasal sinuses (100%). All the drowning cases were correlated with typical findings of drowning, except . A. Christe (*) P. Vock autopsy and statistically compared Paltau’s spots, were detected using Institute of Diagnostic Radiology, with the post-mortem MSCT of 20 post-mortem MSCT, and a good cor- University Hospital, Freiburgstrasse, non-drowning cases. Fluid in the air- relation of MSCT and autopsy was 3010 Bern, Switzerland ways was present in all drowning found. The advantage of MSCT was e-mail: [email protected] cases. Central aspiration in either the the direct detection of bronchospasm, Tel.: +41-31-6322111 trachea or the main bronchi was haemodilution and water in the para- Fax: +41-31-6323224 usually observed. Consecutive bron- nasal sinus, which is rather compli- A.
    [Show full text]
  • The Virtopsy®: Imaging Technology Transforms the Classic Autopsy
    The Virtopsy®: Imaging Technology Transforms the Classic Autopsy David McClintock, M.D. Fellow, Pathology Informatics Massachusetts General Hospital Pathology Informatics 2011 Meeting Disclosures • No disclosures Pathology Informatics 2011 10/27/2 2 011 Autopsy – Historical Notes • Postmortem dissections have occurred for centuries – Ancient Egypt, Mesopotamia embalming, mummification – Ancient India, Greece enhancing understanding of anatomy and disease – 1700s re-emergence of post-mortem study • “Modern autopsy” in medical training and clinical education – Popularized by Osler at end of 19th century – Students expected to attend and perform autopsies as part of their training Pathology Informatics 2011 10/27/2 3 011 The Rise and Fall of the Autopsy • Early in 20th century, the medical autopsy was considered central to: – Clinical education – Medical research – Professional development of a physician • 20th century medical autopsy rates – Steady increase 1900s - 1960s worldwide, then gradual decline to present – 40-50% drop in autopsy rate over past 30 years Pathology Informatics 2011 10/27/2 4 011 Decline of the Traditional Autopsy From: Burton, JL and Underwood, J. Clinical, educational, and epidemiological value of autopsy. Lancet 2007; 369: 1471–80 . Pathology Informatics 2011 10/27/2 5 011 Decline of the Traditional Autopsy • USA overall – Early 1990s: ~19% – Early 2000s: ~11% • USA Academic Centers – Early 1990s: ~36% – Early 2000s: ~23% From: Stawicki, SP, et. al. Postmortem use of advanced imaging techniques: Is autopsy going
    [Show full text]
  • A Practical Guide to Virtual Autopsy: Why, When And
    A Practical Guide to Virtual Autopsy: Why, When and How Laura Filograna, MD, PhD,* Luca Pugliese, MD,* Massimo Muto, MD,* Doriana Tatulli, MD,* Giuseppe Guglielmi, MD,† Michael John Thali, MD,z and Roberto Floris, MD, PhD* Postmortem imaging is considered a routine investigative modality in many forensic institu- tions worldwide. Because of its ability to provide a quick and complete documentation of skeletal system and major parenchymal alterations, postmortem computed tomography (PMCT) is the imaging technique most frequently applied in postmortem forensic investiga- tions. Also postmortem magnetic resonance has been implemented in postmortem setting, but its use is mostly limited to focused analysis (eg, study of the heart and brain). PMCT presents some limits in investigating “natural” deaths, particularly related to its poor ability in differentiating soft tissue interfaces and in depicting vascular lesions. For this reason, PMCT angiography has been introduced. A major limitation of these postmortem imaging techniques is the absence of body samples for histopathologic, toxicologic, or microbiolog- ical analysis. This limit has been overcome by the introduction of postmortem percutaneous biopsies. The aim of this review is to provide a practical guide for virtual autopsy, with the intent of facilitating standardization and augmenting its quality. In particular, the indications of virtual autopsy as well protocols in PMCT examinations and its ancillary techniques will be discussed. Finally, the workflow of a typical virtual autopsy and its main steps will be described. Semin Ultrasound CT MRI 40:56-66 © 2018 Elsevier Inc. All rights reserved. Introduction 1896 these imaging methods entered the courtrooms in the United States and the United Kingdom as evidence for inves- urrently, imaging techniques are considered a routine tigations related to cases of gunshot wounds.
    [Show full text]
  • Can Virtual Autopsy with Postmortem CT Improve Clinical Diagnosis of Cause of Death? a Retrospective Observational Cohort Study in a Dutch Tertiary Referral Centre
    Open Access Research BMJ Open: first published as 10.1136/bmjopen-2017-018834 on 16 March 2018. Downloaded from Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre Lianne J P Sonnemans,1 Bela Kubat,2,3 Mathias Prokop,1 Willemijn M Klein1,4 To cite: Sonnemans LJP, ABSTRACT Strengths and limitations of this study Kubat B, Prokop M, et al. Objective To investigate whether virtual autopsy with Can virtual autopsy with postmortem CT (PMCT) improves clinical diagnosis of the ► This study investigated the diagnostic performance postmortem CT improve clinical immediate cause of death. diagnosis of cause of death? for clinical cause of death determination by use of Design Retrospective observational cohort study. Inclusion A retrospective observational postmortem CT and takes into account the added criteria: inhospital and out-of-hospital deaths over the age of cohort study in a Dutch tertiary value over clinical diagnosis alone. 1 year in whom virtual autopsy with PMCT and conventional referral centre. BMJ Open ► The immediate cause of death (ie, direct cause of autopsy were performed. Exclusion criteria: forensic cases, 2018;8:e018834. doi:10.1136/ death) was the main outcome rather than the prima- bmjopen-2017-018834 postmortal organ donors and cases with incomplete scanning ry cause of death (ie, underlying cause of death or procedures. Cadavers were examined by virtual autopsy with Prepublication history for basic illness) as from a clinical point of view, diagno- ► PMCT prior to conventional autopsy. The clinically determined this paper is available online.
    [Show full text]