CT Scanning Technology Moves From Hospital to Morgue to Enable Autopsies Without the Scalpel

Imagine on an episode of CSI where instead of a human body being sliced up with a scalpel and saw, the cadaver is wheeled into a machine that produces a three-dimensional image of its interior for the medical personnel to view. While the scene might not offer quite the visual drama, the scenario is neither science fiction nor the fantasy of some television script writer. In fact, it is the idea behind the virtual autopsy.

With the advent of three-dimensional reconstruction techniques of the human body, viewing the interior of living organs is a reality. So much so, that the surface rendering of the skeleton, muscle and tendon can produce a model of the body with sufficient detail to be used in anatomical studies and the training of physicians. Performing the same service on the deceased allows a more accurate and simpler approach to autopsy.

A number of software programs are already available that can produce three-dimensional computer images of the body. Programs such as 3-D Doctor and Voxar 3D Express take the output from the same computed tomography imaging machine found in any hospital and converts the two-dimensional slices into a three-dimensional image.

Why Virtual Autopsies Are Important

There are a number of reasons to consider the virtual autopsy as an important new tool in forensic medicine. In 2004, an estimated 94 percent of the deaths reported in this country did not result in an autopsy. State laws concerning autopsy differ, and coroners may be required to perform them only in cases of suspicious death.

Many times the problem is economic. The standard autopsy costs $4,000 to $5,000, whereas a virtual autopsy can cost between $900 and $1000. Many times religious and cultural traditions consider autopsy an unwarranted desecration of the body. Additionally, in many countries, it is customary to bury the body within a day of death, which may preclude an autopsy. In smaller jurisdictions or more remote locations, where a forensic investigator is not present or available, a CT scan can be performed and stored for later evaluation or transmitted to a coroner in another location.

First Instance of Virtual Autopsy

One of the earliest virtual autopsies took place in Sweden in 2004 on an infant that died while being examined with a laryngoscope. An autopsy was unable to determine the cause of death, but a pre-autopsy CT scan revealed a puncture of the voice box that led to a collapsed lung. As the staff attempted to re-inflate the lung, a second puncture penetrated the heart. A review of the CT scan showed the needle path, solving the mystery.

In Switzerland, virtual autopsy or Virtopsy , a combination of CT and MRI, is performed at the University of Berne's Institute of Forensic Medicine, in collaboration with the Institute of Diagnostic Radiology. It has become a standard technique. In the United States, Armed Forces Institute of Pathology medical personnel scan the bodies of soldiers killed in Iraq and Afghanistan not only to determine cause of death, but also to gather data to improve body armor.

The development of CT devices especially designed for virtual autopsies may not be far off. Currently, the emphasis is on visualization devices. At a conference in 2005 at the Royal Australian and New Zealand College of Radiology, Silicon Graphics Inc. (SGI) indicated that it has been instrumental in revolutionizing crime scene investigation techniques in Italy.

There Are Drawbacks

Using CT images in virtual autopsy does have some drawbacks. CT is very good at showing bone and metal, but different soft tissues often look similar in a CT image. CT scanners also have a tendency to overheat or burn out when the volume of scans is high, as it might be during warfare or natural disaster.

One thing we do not have to worry about with CT autopsies is radiation, which has been a concern since the technology's inception. A typical CT scan exposes patients to radiation approximately 100 times that of a standard chest x-ray and 10 times that of a mammography. According to the latest figures by the Millennium Research Group, CT device sales are expected to increase to $18.5 billion by 2012. CT is still the imaging method of choice in cardiac and cancer follow-up, but as other, less damaging devices become available this advantage may erode with time. At the same time, we can expect that innovation will increase resolution while reducing exposure times and radiation dosage.

In any case, the use of CT on the non-living does not present a hazard except to radiology personnel which can be avoided with radiation shielding. With no restrictions, extended times and increased radiation levels may be used to increase resolution or definition. Further development of imaging devices for forensic evaluation will, in the future, be a positive revenue source for aging CT facilities in hospital and radiology offices, as well as an increasingly important addition to the forensic investigator.

Nerac Inc. is a global research and advisory firm for companies developing innovative products and technologies. Nerac Analysts deliver custom assessments of product and technology development opportunities, competitor intelligence, intellectual property strategies, and compliance requirements through a proven blended approach to custom analysis: review of technical knowledge, investigation of intellectual property, and appraisal of business impacts. Nerac deploys analysts in diverse disciplines to help clients discover new applications, serving as a catalyst for new thinking and creative approaches to business problems or identifying strategic growth opportunities. On the web at http://www.nerac.com

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