Virtopsy: Is It Feasible?

by Andrea Campbell

(photo left:Jensen Larson/Discovery Health: TV Guide site)

If only the world of television was closer to reality or even on the horizon of probability, examinations for evidence and especially the cause of death would be so much easier. Take for example, the autopsy. This is a grueling, back-breaking process calling for much determination, the correct tools, and years of knowledge. Breaking skin with cutting tools, using saws to split through cartilage and bone is a difficult, highly specialized and tedious task. If it could only be done in a high-tech manner such as what we see on television shows such as Bones and CSI—with detailed scans and video images of what lay inside—so, can it?

Virtopsy Up for Opinion

According to an article for Newswise from Johns Hopkins Hospital, high-tech “Virtopsies” are not total reality and the more traditional physical examination of autopsy is ‘still the gold standard for determining cause of death’ experts claim. “The latest virtual imaging technologies–including full-body computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, X-ray and angiography are helpful, they say, but cannot yet replace a direct physical inspection of the body’s main organs.”

Pathologist Elizabeth Burton, M.D., deputy director of the autopsy service at Johns Hopkins, reiterates that traditional autopsies to determine how and why someone died are less frequently performed, but the original methodology is still the basic process used. According to an article written in the January online Annals of Internal Medicine by Burton, along with Johns Hopkins clinical fellow, Mahmud Mossa-Basha, M.D., they offer their own opinion as to why the numbers of conventional autopsies have steadily declined over the past decade and why, despite this drop, the virtopsy is unlikely to properly replace it anytime soon.

Autopsy Drawbacks

A recent German study using the conventional method of both autopsy and imaging, versus just virtopsy, showed that the diagnoses using both techniques together netted more accuracy then just the virtual version alone which failed to find almost double the new diagnoses as the conventional version.

Problematic Concerns of Both

"Medical problems most commonly missed or not seen by autopsy included air pockets in collapsed lungs (which could have impeded breathing) and bone fractures, and the most common diagnoses missed by imaging were heart attack, pulmonary emboli and cancer,” says Burton. She believes that imaging results can also create question because most tissue examples need to be physically examined for analysis. Costs may also be prohibitive as imaging equipment costs hundreds of thousands of dollars and full-body CT scans for example can run about $1,500 each, which, when added to device purchasing and maintenance fees, make vitropsy an awfully expensive option.

One of the positive reasons for imaging usage on the other hand, are that the body can remain closed; and Virtopsy detects internal bleeding, and hidden fractures hard to find in a traditional autopsy. And it is also best at something like following bullet trajectories in gunshot victims, where the track is easiest to follow from the unique image perspective.

“Steady progress in imaging technology is refining conventional autopsy, making it better and more accurate,” says Mossa-Basha, a clinical fellow in neuroradiology at Johns Hopkins. “Physicians really need to be selective and proactive—even before a critically injured patient in hospital dies—in deciding whether an autopsy is likely to be needed and, if so, whether to approach the family in advance. Only in this way do we ensure that we are using the latest scanning devices appropriately during autopsy and when it is most effective in producing the most accurate-as-possible death certificates.”

For additional information, visit the National Institutes site at: http://www.nlm.nih.gov/visibleproofs/galleries/technologies/virtopsy.html

Source:

http://www.hopkinsmedicine.org/doctors/results/directory/profile/6976979/Elizabethburton?setsize=10&dbase=main spec_disease=Anatomic%20and%20Clinical%20Pathology

For some interesting real life cases on autopsy and the subsequent evidence, visit:

http://www.nlm.nih.gov/visibleproofs/galleries/cases/index.htm

Photos: Lifelog.it, Brooklyn Museum