Virtual autopsy can give coroners greater insight into cause of death
The scalpel isn’t going anywhere. Traditional autopsy for death from natural causes or suspicious circumstances is still the approach favoured by coroners and pathologists across the world.
However, certain technologies have the power to enhance the results of any autopsy.
Virtopsy is the trademarked name for a Swiss company using a multidisciplinary virtual approach to autopsy which uses laser surface scanning, 3D photogrammetry, computed tomography (CT), and magnetic resonance imaging (MRI) to create a detailed forensic report in an non-invasive manner for both the living and the dead.
Virtopsy is just one company using this consolidated approach but similar virtual methodologies are being used elsewhere.
“The big advantage to this kind of medical imaging is that it’s non-destructive,” explains Jonathan McNulty, head of teaching and learning and diagnostic imaging programmes at the UCD School of Medicine and Medical Science.
“Whether a death is by natural causes or suspicious, once the pathologist takes out the scalpel, they’re damaging the body. When a full post mortem is done and a report filed to the relevant authorities, it is hard to get a second opinion as the body has been destroyed through the autopsy.
“If you scan the remains from head to toe beforehand though, you can visualise a huge amount of pathology on it, and you always have that data set.”
Virtual autopsy methods are particularly useful for certain causes of death, including where there is major trauma, like with a gunshot wound.
“Where there is trauma from head to toe, the pathologist will already have a standard procedure in an autopsy – look at the heart, brain, liver etc. But one can’t look at every bone in the body or the detailed nature of fractures.
“If you do a post mortem CT scan, you won’t miss anything. You may not always find the cause of death, but you’ll have a more accurate and detailed report.”
In other cases, such as natural deaths caused by cardiac abnormalities, sometimes virtual imaging won’t pick up on the details and it is better to look at the heart physically rather than virtually.
Likewise, a technique such as magnetic resonance imaging would – for obvious reasons – not be advisable to use on someone who had suffered a major trauma from an explosion where a lot of metallic debris could potentially still be in the body.
Virtopsy consolidates existing technologies that are more frequently used on living patients.
But it has the potential to compliment traditional methods and allow for a more comprehensive coronary report.
Use of this technology in Ireland, however, is carried out on an “ad hoc” basis, according to McNulty. “In other countries, they would have dedicated forensics institutes,” he says.
“Unfortunately the Irish state pathology service is operating out of temporary facilities. There are plans to build a new forensic and legal medicine centre. Here in UCD we have some facilities, and are brought in on occasion to assist with certain unsolved cases, to take advantage of the expertise at our end.
“We work quite closely with state services and An Garda Síochána – on everything from forensic anthropology, forensic imaging, X-rays, and CT scans. On occasion we would be brought in but the state pathologists are well trained.”
Varying international legal systems may value “virtual” evidence such as this differently. Used in Ireland would there be unique legal parameters for evidence found between a virtual and traditional autopsy?
“Every jurisdiction is different but in a court of law, all the same principles would apply – continuity of evidence, validity, interpretation of images, or a pathologist’s report,” says McNulty.
“Where it is being used regularly, it is generally well accepted by the courts, but there are usually full consultation processes which bring in barristers, state pathologists and the DPP, to make sure everyone is fully briefed.”
Not everyone is as enthusiastic about it at this point. Given the fact that Virtopsy – the trademarked company – isn’t delivering anything new and even at that is only available to a fraction of the world’s population who might need it, is it little more than an exercise in marketing?
Combination of equipment
“There are at least six billion people in the world who have no access to this kind of technology even while alive to diagnose problems like stroke,” says Prof Martin Leahy, scientific director at the National Biophotonics and Imaging Platform Ireland.
“In Ireland if you have a stroke, you would have to be very lucky to arrive at the hospital with this combination of equipment (MRI-CT), which could quickly tell whether you had a bleeding or thrombotic stroke, and then for correct treatment to be applied within the maximum time of approximately four hours which would not only save the life but retain almost a full quality of life.
“Although the technology will likely go down in price, the real cost is in the human resource required to operate the device and that is problematic particularly because of the use of hazardous radiation.
“Therefore technology developers and even very large companies are currently turning the vast market which will never be served by these expensive technologies. The future is intrinsically safe, fit-for-purpose health technologies which have a low cost of ownership.”