What is autopsy?
Autopsy refers to a highly specialized surgical procedure that includes a thorough examination of a corpse to determine the cause and manner of death. The word “autopsy” denotes “to see with own eyes”. During the autopsy, a forensic doctor will examine the remains inside and out, removing internal organs for testing if necessary and collecting samples of tissues or bodily fluids such as blood (Badam, R.K. et al, 2017). Manifestly, such a method would cause irreparable harm to the corpse and might cause ethical conflicts related to cultural and religious beliefs. For example, Islam and Judaism have the objection towards autopsy as it believes that bodily intrusion violates the sanctity of keeping the human body complete (Burton, E.C. & Collins, K.A., 2012). Also, in some cultures, such as China, “causing the body incomplete” can be seen as extremely disrespectful to the remains.
However, there are often cases that conducting autopsy is required and necessary, especially when someone dies in a suspicious, unusual, or unnatural way. Sometimes, in order to explore the cause of death and clarify the nature of the injury, the time when the injury occurred, or the cause of the injury, in addition to the conventional incision, additional incision exploration is required. As for the family of the remains, it is unbearable to experience additional “harm”, some of them will choose not to perform an autopsy (Vile J., 2020). However, this will make it difficult to find out the cause of the death of their loved ones.
Here comes the question:
Is there a way that could have less physical dissection on the corpse?
The new technology “Virtopsy” has made such wishes possible. “Virtopsy” is a term extracted from two words “virtual” and “autopsy”. It employs automobile imaging methods that are used in clinical medicines such as computed tomography (CT) and magnetic resonance imaging (MRI). These tools have already been widely accepted and applied in the process of autopsy among many developed countries (K. B. Tejaswi, 2020).
Autopsy imaging diagnosis can not only assist in the issuance of death certificates, help forensic doctors explain the cause of death more clearly and accurately, but also assist forensic doctors in anatomical work, such as quickly confirming the location of shrapnel in the corpse, thereby greatly shortening the dissection time. It can also be used as a screening method to determine whether the intervention of the police is needed (Staicu, A. et al, 2020). With its help, many criminal facts hidden behind seemingly normal deaths have been revealed.
One case is that, in Hokkaido, Japan, the hospital admitted a two-year-old boy who suffered a cardiac arrest and lost consciousness. His mother said that the boy fainted when he accidentally hit his head against the wall. After the rescue was declared invalid, the doctor performed a CT examination on the boy’s body. Although there were no obvious injuries on the body, a CT scan showed abnormal damage to his heart, liver, and spleen. Based on these findings, the police decided to conduct a judicial dissection of the boy. The autopsy results showed that he was abused and beaten during his lifetime, and eventually died of hemorrhage combined with a pancreatic injury.
However, as CT and MRI still cannot completely replace the surgical autopsy, in the recent years, there is a new trend that integrating 3D surface scanning imaging techniques into the autopsy imaging diagnosis (Staicu, A. et al, 2020). It can map the external surface of the body, records, and documents the 3D image of the body surface area in detail.
The process of virtopsy are as follows:
Step 1. The virtual autopsy performs a 3D scan on the surface of the corpse to record the damage to the corpse.
Step 2. CT scans are performed every 1 millimeter on average to record significant protrusions and injuries of bones and organs.
Step 3. MRI scans are used to record soft tissue damage and organs. The small structure of the deceased can also be visualized by angiography.
Step 4. All the results are integrated, and a three-dimensional virtual corpse is presented on the computer for inspection.
Along with the angiography and endoscopy, the new “virtopsy” now has tremendous advantages compared to conventional autopsies. For example, the fractural lines can be noticed, and primary and secondary traumas can be visualized. All the information of the corpse can be preserved in the form of data for a long time, even after the corpse is cremated, it can be repeatedly inspected, which ensures the quality and credibility of the inspection report (Badam, R.K, et al., 2017). At the same time, it avoids anatomy thus preventing the corpse from poison, bacteria, or virus pollution which maybe threaten the safety of forensic doctors.
Virtual autopsy provides a clear presentation of complex skull fractures
However, in practical applications, although a virtual autopsy has obvious advantages in the examination of bones and vascular system, it also has a fatal flaw, that is, the physiological senses of an anatomical pathologist like smell, texture, and color are restricted as there is no direct contact with the dead body of the victim. It cannot effectively reflect the color of tissues and mucous membranes of the internal organs (Staicu, A. et al, 2020). Apart from this, according to Sina, the total cost of a complete set of equipment is close to 2 million dollars, such a high cost of virtual autopsy equipment is also one of the limitations for widely applying virtopsy globally (Sina, 2020).
Due to such limitations, it is predicted that in the near future, virtual autopsy still cannot completely substitute the conventional autopsy, instead, it will play an active role in interdisciplinary cooperation between traditional forensic dissection and imaging technology.
In conventional autopsy, forensic doctors still use the most traditional scalpel, oral description, and photographic records. Therefore, in the long term, the focus should be placed on constantly updating and integrating advanced technologies for inspection instruments that can help improve the efficiency and accuracy of forensic work.
After a large number of cases are verified, targeted local autopsy based on the results of imaging examinations may be a more promising alternative to surgical autopsy.
Sources:
Badam, R.K., Sownetha, T., Babu, D.G., Waghray, S., Reddy, L., Garlapati, K. and Chavva, S., 2017. Virtopsy: Touch-free autopsy. Journal of Forensic Dental Sciences, 9(1), p.42.
Burton, E.C. and Collins, K.A., 2012. Religions and the Autopsy. Medscape News and Perspective.
John R. Vile, 2020. Autopsies And Treatment Of The Dead. [online] Available at: <https://www.mtsu.edu/first-amendment/article/906/autopsies-and-treatment-of-the-dead> [Accessed 8 October 2020]
Tejaswi, E., 2020. Virtopsy (Virtual Autopsy): A New Phase In Forensic Investigation. [online] PubMed Central (PMC). Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826044/> [Accessed 8 October 2020].
Staicu, A., Albu, C., Popa‐Stanila, R., Chiriac, L., Boitor‐Borza, D., Bondor, C., Kovacs, T., Caracostea, G., Rotar, I.C., Turcu, R.F. and Simon, S., 2019. Potential clinical benefits and limitations of fetal virtopsy using high‐field MRI at 7 Tesla versus stereomicroscopic autopsy to assess first trimester fetuses. Prenatal diagnosis, 39(7), pp.505-518.
