A new look at virtual autopsies
Using computed tomography (CT) scans for autopsies is not new. This kind of exam is routinely practiced in several countries (read this for example). But except for some autopsies of American soldiers, this technology is not really used in the U.S. This might change now that the Radiological Society of North America (RSNA) says that CT autopsy has the potential to replace conventional autopsy in determining the cause of certain accidental deaths. Not only a CT scan of the whole body is considerably cheaper than a conventional autopsy, it doesn't damage the bodies, and it's much faster -- 30 minutes compared with several hours using knives. But read more...
You can see above a picture showing arrows pointing to "some of the multiple skull and facial bone fractures resulting from fatal blunt trauma to the head." (Credit: University of Maryland School of Medicine) You can find other pictures in this other RSNA's news release which also contains a link to a short video clip (10 seconds, 4.73 MB) carrying the title "Multiple skull fractures are demonstrated in a decedent following major trauma sustained in a motor vehicle accident."
This study was led by Barry Daly, M.D., professor of radiology at the University of Maryland Medical Center in Baltimore, which published its own news release about it.
But let's look at the first RSNA news release to see how CT whole body scan could be useful. "CT autopsy compares favorably to conventional autopsy in several ways. In cases of suspicious death, the noninvasive procedure does not damage or destroy key forensic evidence, as can happen during a conventional autopsy. In addition, CT can be used in situations where autopsy may be prohibited by religious or cultural beliefs. CT autopsy is considerably less expensive than conventional autopsy and can be performed in a fraction of the time. A forensic medical examiner requires several hours to conduct a full autopsy, while multi-detector CT scanning and interpretation can be completed in about 30 minutes."
And here are some comments from Barry Daly. "'Autopsy is mandatory in deaths involving gunshot wounds, but CT can serve as a powerful adjunct to the conventional exam,' Dr. Daly said. 'Performing CT imaging first may speed up a conventional autopsy, especially when it comes to locating ballistic fragments, which are so important to criminal investigations.' In addition, CT was more sensitive than conventional autopsy in identifying air embolism, an often undetected important contributing factor in fatal trauma."
The research team presented its conclusions at the RSNA annual meeting (RSNA 2007) which was held on November 25–30, 2007, in Chicago, Illinois. The title of their presentation was "Utility of Whole Body CT Imaging Autopsy in a US State Chief Medical Examiner’s Investigation of Traumatic Death: Initial Experience" and here is a link to the abstract.
In the study, 20 autopsies were performed using whole-body high-resolution multi-detector CT (MDCT) imaging technology. Here are some of the results they obtained. "Interpretations of the CT scans by two radiologists were compared with the results of a conventional autopsy performed on each body by state forensic medical examiners. Included were 14 victims of blunt trauma and six victims of a penetrating wound made either by a knife or ballistic weapon. In all 14 blunt trauma cases and five of the six penetrating wounds, CT accurately identified the cause of death. The radiologists and forensic medical examiners evaluated the CT findings as comparable to conventional autopsy in 13 of the 14 blunt trauma cases and as a helpful adjunct in five of the six penetrating wound cases. In the study, CT was able to localize rapidly all 26 major ballistic fragments recovered from the victims during conventional autopsy."
And here is the conclusion the researchers delivered at the RSNA meeting. "Early experience suggests that MDCT imaging autopsy shows promise as a sensitive tool for the detection of major injuries and cause of death after accidental blunt trauma. In non-accidental traumatic death, MDCT can be a valuable adjunct to mandatory autopsy for detection of injuries and ballistics."
Sources: Radiological Society of North America news release, November 27, 2007; and various websites
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