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 is still one of the very traditional methods. This also applies for dental , 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 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 physiologic changes of a establishing reasons for death. The body before and after death wherein contribution of Forensic science in autopsy plays a significant role which achieving this is noteworthy. deals with establishing the circumstance leading to death by scientific Forensic Science is an area of examination of the whole surface of the specialization that can be used in a body as well as body cavities.[1] judicial setting and involves principles and procedures for the systematic The main aim of this review article is to application of knowledge involving update on the origin, applications of collection of data through observation virtopsy and also the role of dentists in and experimentation thus leading to this field. recognition and formulation of a HISTORY OF AUTOPSY problem. It involves 10 disciplines which Greek Erasistratus and include Crimanilistics, engineering Herophilus dissected cadavers to study science, general, jurisprudence, the working of organs and nerves.[2] It odontology, pathology/biology, was in 1700 when Giovanni Morgagni –

*Corresponding Author Address: Dr Yogish.P Email: [email protected] Yogish.P et al, Int J Dent Health Sci 2015; 2(6):1548-1555 the founder of today's autopsy wrote a legal purposes was seen in the forensic book on “The seats and causes of practice since 1896.[7] Disease" investigated by anatomy and published it in 1761 in which he Martin and Arroio showed the described 700 autopsies that he applicability of post-mortem performed. Susequently Matthew Baillie, radiographic techniques in order to in 1793 wrote a textbook on Morbid identify bodies through comparative [8] Anatomy of the Human Body and its analysis of the cranial sinuses. Besides, accompanying atlas, 6 years later.[2] In numerous cases were reported in which 1800, William Osler who taught liver, heart, brain and bone injuries were medicine placed autopsy at the centre investigated radio graphically revealing of the medical education.[3] the possible death cause. Furthermore, X-ray examinations were valuable to AUTOPSY VS VIRTOPSY perform guided autopsies based on the acquired skeletal information. More The etymology of “autopsy” refers to the specific in detecting(healing) bone doctor examining a body, and the union fractures, which in many cases are of the terms “autos” and “psia” meaning indistinguishable during traditional [4] “own” and “view” respectively. The autopsy.[8] A new autopsy technique traditional internal autopsy procedure consists of the internal examination of consists of body mutilating techniques. death bodies using computed Due to the emotional aspects of the tomography (CT) and magnetic victim’s relatives, their knowledge of resonance imaging (MRI), without these mutilation forms the major opening the body or body parts. Besides, [5] objection against autopsies. The it allows the reconstruction of a 3D view arguments justifying the autopsy, of the analyzed cadaver. This procedure namely the need to know the cause of was called “Virtopsy.[9] death or the identity of an unknown deceased individual overrules this The term Virtopsy coined by Thali M.. et emotional involvement. Therefore, the al is created from the terms Virtual and families and relatives of the victim often Autopsy where Virtual is derived from remain in a conflicting situation with the the latin word “Virtus” which means forensic examiners.[6] Parallel to that, „useful, efficient and good‟ and some religious and cultural aspects elimination of autos ie, self thus leading represent relevant objections for the to the scientific umbrella Virtopsy. autopsy procedure. Based on these Virtopsy is a transdisciplinary technology objections, and in an attempt to that combines Forensic medicine, ameliorate the autopsy results, pathology, radiology, image processing, alternative aids in diagnosing the cause physics and biomechanics.[10] Because of death were developed. One of these is the dentition contains multiple radiological imaging. Its use for medico- identifiers teeth often play a major role

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Yogish.P et al, Int J Dent Health Sci 2015; 2(6):1548-1555 in human identification processes. analysis concluded that the effective These processes allow for dental relative to the use of placebo was about identification: 2.1 (95% confidence interval 1.5-3.0) [5]. The basic effect of bupropion is to The comparison between post mortem elevate the levels of dopamine in the (PM) and ante-mortem (AM) data, the brain. Increase in the levels of dopamine development of dental PM victim are associated with the use of nicotine, profiles and the dental DNA so the use of bupropion mimics the use [11] techniques. of nicotine. This mechanism helps to quit tobacco faster relatively then other The collection of all PM dental data is drugs. Also it helps in maintaining the indispensable for dental identification. diet and weight of the patient. Some These are obtained by direct visual studies have also suggested that the observation and related recording of the conjugation of bupropion and nicotine available evidence. Additional patch is more effective than either of information is collected after them being used alone [6]. photographic and radiographic imaging of the dentition and the oral cavity. In Another important drug very commonly certain cases the PM photographic and used in the treatment of tobacco abuse radiological exam is difficult because the is Clonidine. Clonidine has been widely access to the oral cavity is hindered (e.g. used in opium and alcohol withdrawal bodies in rigor mortis condition).In but recent studies suggest its efficacy in contrast to the classical dental autopsy tobacco withdrawal as well [7]. Also drug the virtual autopsy process allows dental named nortriptyline can also be used in identification in an accurate and quick the tobacco cessation therapy but only way without damaging the body to as a second line therapy. access the available dental data. Dental age estimation methods based on tooth Imaging techniques was supported by development can be applied during the the creation of organizations like the virtual autopsy, allowing the examiner to Institute of Forensic Medicine include or exclude individuals based on (Denmark), the Victorian Institute of age related victim lists.[12] Pathology (Australia), the Society of Imaginological Autopsy (Japan) and the ORIGIN AND MECHANISMS Headquarters of Medical Examinations of the Armed Forces of the United States Drugs Aiding in Cessation: The most of America.[13] In the nineties, the common line of drugs indicated to be Institute of Forensic Medicine of the aiding in tobacco cessation are the anti- University of Bern, Switzerland, began to depressants. Amongst the majority, the document on the characteristics of the basic drug used is Bupropion human body in a concrete, objective and Hydrochloride. A placebo trial of non-invasive way. This resulted in the bupropion was conducted and the 1550

Yogish.P et al, Int J Dent Health Sci 2015; 2(6):1548-1555 creation of a new discipline, denoted as is performed using the GOM “Virtopsy”, a virtual project of TRITOP/ATOSIII® system (GOM®, autopsy.[14] In this context, the concept Braunschweig, Germany).[15] The TRITOP of the objective and noninvasive portion is based on photogammetry, documentation of the body consists in therefore digital images are taken by a the observation of the anatomical Nikon D2X® camera (Nikon Corp.®, structures through computed Tokyo, Japan) and submitted wirelessly tomography (CT), magnetic resonance to the main system.[15] Through these (MRI) and micro radiology devices. images the photogammetry calculates Specific software (e.g. Tera Recon the position of the body and the texture Aquarius NET®, Foster City, California, of the surface model. The surface United States of America) allowed for 3D scanning is performed by the ATOS reconstructions of the computed component, and it is based on the tomography images from the observed principle of triangulation. The sensor structures. Another part of the head has one camera on each side and a documentation concerns the body projection unit in the middle, the images surface recording, performed by forensic taken are transferred to the computer photogrammetric and 3D optical and the 3D surface points are calculated. scanning.[13] Due to the need of getting The whole procedure to scan for quick and accurate information about example both jaws with high image forensic cases, international researches quality takes, depending on the used increasingly indicate Virtual Autopsy as a protocol, around 1 minute. Aiming the useful tool for forensic exams. Ebert et management and organization of the al. specified that 3D reconstructions Virtual Autopsy data, several software made the examination processes more packages are implemented during the efficient and could be carried out and data acquisition. Such as the navigation interpreted by a single specialized software for Muti-slice CT analysis and examiner.[15] the TRITOP/ATOS® software for surface scanning and photogammetry. These Aiming the CT exam, the body can packages are controlled remotely by the remain wrapped in an artifact-free body Virtopsy Control Centre – VCC® bag and several exam protocols can be (PROFACTOR Gmbh®, Steyr-Gleink, chosen considering the area to be Austria), the main single software which analyzed. For soft tissue investigation sets all the robotic positions, guides the the magnetic resonance is the best operator and stores the entire patient’s choice due to its dependence from the information. Another complementary hydrogen molecules. The internal image system is the Virtopsy Robot Control – collection is carried out on radiological VRC® (PROFACTOR Gmbh®, Steyr-Gleink, units, e.g. the Leonardo® workstation Austria), which is responsible for (Siemens Medical Solutions®, Erlangen, executing the commands related to Germany).[16] The external examination 1551

Yogish.P et al, Int J Dent Health Sci 2015; 2(6):1548-1555 mobile tools, such as the robotic arms structure was performed with combined which perform scanning procedures.[15] computed tomography and magnetic resonance imaging. In conventional APPLICATIONS autopsy examinations the greatest difficulty is to predict the depth of the The Virtual Autopsy can be applied in a foreign body. The virtual autopsy broad number of forensic situations, provides this information accurate and such as thanatological investigations; clear. Health professionals must be carbonized and putrefied body aware of these complementary exams identifications; mass disaster cases; age because over 90% of these emergency estimation; anthropological cases were misdiagnosed.[19] examinations and skin lesion analyses. Another specific odontological In drowned bodies the CT information application for the Virtual Autopsy is on about the volume, density, size of the the comparison between AM and the amount of liquid observed orthopantomograms and PM in them is helping in diagnosing the reconstructed panoramic overviews of cause of death.[17] cranial CT images. This way PM dental Cases of firearm projectile injuries are evidences can easily be related to the often difficult to examine because either AM data of the expected missing person. sometimes the bullet is not in the body, Birngruber et al. reported a positive or diverted by an anatomical structure, identification case based on the or it can be in unknown body parts. superimposition of post-mortem CT Therefore, knowing the location of the reconstructed images on ante-mortem projectile before the autopsy is radiographies.[20] performed facilitates the examination.[18] Dedouit et al. stressed the importance of In mass disaster cases Dirnhofer et al. the presence of dentists in the forensic describe for human identification identification team in particular to purposes the use of adapted vehicles determine the age of charred bodies. In with imaging machines allowing for PM traditional medical examinations the data collection on the disaster field. The decomposition of the body is a limiting author states that mobile CT imaging factor for age assessments. Therefore, could provide a high level of positive the author cites the performance of identifications.[13] dentists to examine dental and anthropological data.[21] In the odontology field, Oesterhelweg et al. describe a case where the victim was Studies on restorative materials are also struck by respiratory obstruction from a related on the virtual technique. foreign body (food bolus). The Through the analysis of the restoration differentiation of the obstructive materials density, Jackowski et al.

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Yogish.P et al, Int J Dent Health Sci 2015; 2(6):1548-1555 performed pioneering researches on insufficient data base when compared Odontology in Virtual Autopsy. These to conventional autopsy. authors expressed in Hounsfield Units the different density of restoration 2. It exhibits dilemma in differentiating materials, such as composites, ante mortem/postmortem artifacts; temporary fillings and ceramics, by ultra- color changes and establishment of high-resolution CT imaging.[12] infection status. Furthermore, the author verified the 3. Occasionally small tissue injury may be course of restoration materials under missed.23 high temperatures by CT images, simulating a fire mass disaster.[22] CONCLUSION:

BENEFITS AND PITFALLS Virtual autopsy emerges as a useful tool for forensic investigations. Its main Advantages benefits are related to the improved 1.It is a Scalpel free non invasive imaging collection of data compared to the technology. traditional technique. The feasibility of visualizing 3-D anatomical structures 2.It is digitally storage over years or thoroughly, in real time, without decades and even transferrable over the damaging the body is an important gain. web for second opinion. The absence of contamination from cadaver’s substances is an additional 3.It is an ethical evolution which serves advantage. The main objection observed better acceptance for the relatives of the in the application of virtual autopsy, is its deceased and also by certain religious support to be performed in less ustoms where incisions are not developed countries, in which high- recommended after death. technological imaging devices are not easily feasible for scientific purposes. 4.Since there is no mutilation of the However, as any other new trend in body no hazard of infections from the science, the virtual autopsy is still blood or other tissue fluids. developing and getting space among the 5. It is less time consuming and body can commonly used methods. This review be released immediately after the allows concluding that the virtual scanning. autopsy favours the development of forensic autopsies and stresses the role Disadvantages of forensic Odontologists in this field.

1. It is not possible to distinguish all the pathological conditions with this technique and it is associated with

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Yogish.P et al, Int J Dent Health Sci 2015; 2(6):1548-1555 REFERENCES:

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