Dr Manoj Kumar Pathak
Professor & Head, Department of Forensic Medicine,
IMS, BHU

Virtopsy – The Future Of Conventional Autopsy

Virtopsy is a bloodless and minimally invasive procedure to examine a body for cause of death. It utilizes imaging techniques (CT and MRI), photogrammetry, and 3D optical-measuring techniques to get a reliable, accurate, geometric presentation of all findings (the body surface as well as the interior). The technique is being used in many countries like Switzerland, US, UK, Malaysia, Singapore, and Japan.

The conventional procedure in post-mortem examination is dissection, interpretation, and cataloguing. The data obtained from this examination is then compiled, and the forensic experts arrive at a conclusion. The dead body is then handed over for the last rites to be performed. However, if the forensic expert wants to reconsider his/her decision over the previously gathered data, it may be difficult and not feasible. The possible mutilation involved in the conventional autopsy often leaves the grieving family disturbed. Thus, the family of the deceased declares a negative consent for autopsy procedure on a sentimental basis. Certain religious groups such as the Jews, Muslims, and Jehovah’s witnesses do not completely accept conventional autopsy procedures. These pitfalls of a conventional autopsy led to the genesis of virtopsy.

History

In the late 1990s, a high-profile homicide case in Switzerland demanded an accurate forensic opinion. The impressions of the skull of the victim had to be matched with a most likely murder tool. The extensive work followed in this arena focusing on an objective method of forensic analysis, which would minimally disturb the skull of the victim. Radiographic methods were used to forensically analyze the victim’s remains, which aided the legal judgment. This instance is commonly heralded as the birth of virtopsy.

Examination of the dead

In 2003, a 3000-year-old mummy was subjected to virtopsy methods to find out the manner of death, cause of death, and identification of the deceased. Virtopsy methods were ground breaking in that they established a new high-tech toolbox into morphological investigation aspects of modern forensic pathology. Since virtopsy is non-invasive, it is less traumatic for surviving family members, and may not violate religious taboos against violating bodily integrity.

Examination of the living

Non-invasive imaging is also conducted in living or surviving subjects, but as that has been the main clinical application of CT and MR imaging to begin with, its use in medicolegal investigation of the living is not as ground breaking as using them for investigation of death. Nevertheless, a number of applications that may be regarded as specific for medicolegal imaging applications in the living have found attraction for virtopsy-derived methods:

Matching weapon or injury-causing agent and injury. The application of 3D surface documentation of injuries for the benefit of medicolegal reconstruction must be accredited to Brueschweiler et al. (2003).

Strangulation and estimation of risk of death. The first paper documenting systematic application of MRI to survivors of strangulation for the benefit of forensic medicine was published by Yen et al. in 2005.

Body-packers. According to a paper of the virtopsy group, CT scanning may be more suitable to body-packer identification than conventional or plain abdominal X-rays.

Virtopsy has four cornerstones, namely, (a) three-dimensional (3D) surface scanning 3D/computer-aided design photogrammetry; (b) multi-slice computed tomography (MSCT); (c) magnetic resonance imaging (MRI); and (d) MRI spectroscopy.

3D surface scanning 3D/computer-aided design photogrammetry. It is the science of making measurements using photographs. A number of different photographs are taken from different angles and are analyzed by TRITOP/ATOS II system (GOM, Braunschweig, Germany) software. This software uses high-speed imaging and remote sensing to construct a 3D comprehensive image of the surface features of the deceased.

Multi-slice computed tomography (MSCT). It features the hard-tissue architecture in multiple sections. It aids in the identification of any changes in the same.

Magnetic resonance imaging (MRI). It features the condition of the soft tissue. It aids in the identification of any changes in the same. MSCT and MRI together help in differentiation of the adjacent structures.

Magnetic resonance imaging spectroscopy. It provides the biochemical picture of the deceased. It uses metabolites in the brain emerging from post-mortem decomposition to give an accurate time of death.

Micro-computed tomography. Special cases require modifications of the above-mentioned techniques. The Institute of Medical Physics in Erlangen, Germany, developed a scanner to image a 3D volume with an isotropic resolution ranging from 10 to 100 µm. This scanner is sensitive to examine samples of diameters ranging from 4 to 40 mm.

Magnetic resonance microscopy. In-vitro studies on eyeballs were anatomically imaged. After this, eyeballs were paraffin embedded, and sections of 6 µm were cut and stained with hematoxylin and eosin.

Practice of virtopsy

Virtobots. In this era of robotics, virtopsy is not to be left behind. It uses an all-in-one machine called virtobot, which integrates the four imaging modalities mentioned above to practice virtopsy. This machine will allow combined surface and body volume data acquisition within a single 3D space, making present-day data fusion techniques dispensable.

Virtomobile. Virtobot is a gigantic machine, making its utility in the sites of mass disaster futile. This leads to the requirement of a more compact device for the practice of virtopsy. Thus, virtomobile was conceived. It is a version of a virtobot mounted on a trailer, which can be easily transported to the site of disaster.

Benefits of virtopsy

  • It can be done in highly infected dead bodies, or those with radioactive exposure.
  • The dissection of body is minimal, thus providing a more humanitarian approach.
  • It is preferred by family members due to its non-invasive nature.
  • It saves time and data, which can be stored indefinitely.
  • Opinions are more observer-independent and less subjective.
  • It can be used to complement standard autopsies and increase the quality of autopsies.
  • It permits additional analysis on the same body by other forensic pathologists, i.e., should allegations creep up in the future, second or third opinions can be sought even years later.
  • Visualization tools increase the quality and efficiency of forensic methods.
  • Infections and health hazards for forensic experts can be reduced.
  • Unlike a traditional autopsy, a virtopsy does not destroy the human tissues.
  • This can be an important tool in medical teaching.
  • The developers of the virtopsy method do not envision the procedure as a replacement for traditional autopsy but as a tool to be used in cases where dissection of the body is not feasible or where forensic evidence is particularly hard to visualize.

Outlook

Virtual autopsy should replace the conventional method of post-mortem examination. The mental anguish suffered by relatives of the deceased due to mutilation of the corpse can be prevented by virtual autopsy.

It should be provided to at least district headquarters of every state or should be at least done in all 29 states of the country.

The conventional post-mortem method is not the proper dignified way, and is violation of human rights; so human right activists should raise their voice on this pertinent issue to the government.

Virtual autopsy provides a ready-to-compare and reference data whenever the need arises; as post-mortem report is in a digital form, there are less chances of manipulation of data.

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