Virtopsy

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Virtopsy is a virtual alternative to a traditional autopsy, conducted with scanning and imaging technology. The name is a portmanteau of "virtual" and "autopsy" and is a trademark registered to Richard Dirnhofer (de), the former head of the Institute of Forensic Medicine of the University of Bern, Switzerland. [1] [2]

Contents

The term “virtual” in this context apparently is meant in both the modern and original senses. Virtual's Latin root word “virtus” (virtue) implies the qualities of capability, efficiency, effectiveness and objectivity. However, some proponents propose to replace traditional autopsy with this approach. [3] "Virtual" also has the sense of "digital" or refers to virtual reality respectively.

Based on Dirnhofer's claim, virtopsy fully satisfies the requirement that medical forensic findings provide “a complete and true picture of the object examined”. [4] Furthermore, virtopsy also achieves the objective “that the pathologist’s report should ‘photograph’ with words so that the reader is able to follow his thoughts visually”. [5]

Concept

Forensic pathology is a field within which physicians are mainly preoccupied with examining what initially are victims of possible, suspected or obvious violence that ultimately die. Clinical forensic medicine essentially does the same but with living victims; traffic medicine and age determination are applications that are not, strictly speaking, restricted to clinical forensic medicine in that general practitioners, pediatricians, and other specialists also provide services for such requests.

As examinations typically are performed under the legal and task restraints of investigative authorities such as courts, prosecutors, district attorneys or police, there are constraints as to cost, time, objectivity and task specification depending on local law.

The most relevant step is adequately documenting findings. Virtopsy employs imaging methods that are also used in clinical medicine such as computed tomography (CT), magnetic resonance imaging (MRI). [6] Also, 3D surface scanning typically used in automotive industry is being employed to integrate body surface documentation with 3D scene or tool scans. The choice of methods is further supplemented with 3D imaging-guided biopsy systems [7] and post mortem angiography. [8]

CT is well suited to show foreign objects, bone and air or gas distribution throughout the body, whereas MRI sequences are strong in detailing organ and soft tissue findings. A comprehensive analysis of both surface and deep tissue findings may require fusion of CT, MRI and 3D surface data. [9]

Resulting data can be archived and reproduced without loss, [10] analysed elsewhere, or distributed to specialists for technically demanding analysis.

Autopsy still produces both different and ancillary findings compared to virtopsy results so that currently, virtopsy is not a generally accepted method to entirely replace autopsies. [11] In fact, the first scientific study detailing the results of comparing postmortem CT scanning with conventional autopsies was conducted by a team from Israel and was published 1994. [12] Their conclusion already had been that single methods were not as useful to maximize on yielding as many findings as possible as the combination of scanning and autopsy were.

Terms

The term “Virtobot” is a trademark also registered to Prof. R. Dirnhofer. It describes a multi-functional robotic system. [7]

The Virtangio machine is a device that is trademarked to Prof. R. Dirnhofer [13] and manufactured by Fumedica . [14]

Usage of Greek words in the context of examining deaths may not withstand the test of falsification that spearheaded the virtopsy idea to begin with, but, in fact, usage of existing and creation of new neologisms may have to be reconsidered. [15]

Operative aspects

The Virtopsy project started as a research project that was initiated at the end of the twentieth century by Prof. Richard Dirnhofer, and now covers both applied methods and research. Virtopsy contains applied research into various methods of high-tech imaging with the goal to introduce them into the practice of forensic pathology. [6]

With Prof. Michael Thali as operative head of the group, the virtopsy research team operates out of the Institute of Forensic Medicine at the University of Zurich, Switzerland since early 2011. [16]

Examination of death

The idea to conduct virtual autopsy is not new. In 2003, the British Museum contacted the University of Bern's Institute of Forensic Medicine in Switzerland for their virtopsy to do autopsy on a 3000-year-old mummy named Nesperennub without compromising the body. [17] While manner of death, [6] cause of death, [6] time of death, [18] [19] identification of deceased and a range of practical and reconstructive applications are obviously related to medicolegal investigation of death, virtopsy methods were ground breaking in that they have established a new high-tech toolbox into both research and practice 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. [20]

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, their 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:

Technology

The technology currently used for conducting a “virtual autopsy” comprises

Virtopsy objectives

The virtopsy idea was generated to yield results along a comprehensive number of performance indicators:

Success

Virtopsy methods have helped to solve a range of cases that would have been difficult or impossible to solve otherwise. [24] While academically, case-reports tend to be looked down on by medical faculty, they can expand the existing experience by significant contributions.

Advantages

This method offers the following advantages:

Disadvantages

Best practice

The National Research Council in the USA, as part of its proposals for reforms in the forensic sciences, has proposed virtopsy as “Best Practice” for the gathering of forensic evidence [www.ncjrs.gov/pdffiles1/nij/grants/228091.pdf].

In addition, the International Society of Forensic Radiology and Imaging was founded in 2012 with the aim of enabling a continuous exchange of research results among its members and developing quality standards for the techniques employed .

A Technical Working Group Forensic Imaging Methods was founded in 2005 by Michael Thali and Richard Dirnhofer. It aims to promote an increasingly internationally standardised approach.

Furthermore, a TTechnical Working Group Postmortem Angiography Methods was founded in 2012 to promote best practice. Under the direction of the University Hospital of Lausanne and comprising nine European institutes of forensic medicine, it is developing reliable, standardized methods and guidelines for conducting and assessing postmortem angiographic examinations [www.postmortem-angio.ch].

Virtopsy project leading house

Institutes contributing to the Virtopsy project

Institutes, districts or countries conducting post-mortem scanning

Films

Books and journals

Related Research Articles

<span class="mw-page-title-main">Magnetic resonance imaging</span> Medical imaging technique

Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body. MRI does not involve X-rays or the use of ionizing radiation, which distinguishes it from computed tomography (CT) and positron emission tomography (PET) scans. MRI is a medical application of nuclear magnetic resonance (NMR) which can also be used for imaging in other NMR applications, such as NMR spectroscopy.

<span class="mw-page-title-main">Positron emission tomography</span> Medical imaging technique

Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, regional chemical composition, and absorption. Different tracers are used for various imaging purposes, depending on the target process within the body.

<span class="mw-page-title-main">CT scan</span> Medical imaging procedure using X-rays to produce cross-sectional images

A computed tomography scan is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or radiology technologists.

<span class="mw-page-title-main">Radiology</span> Branch of Medicine

Radiology is the medical specialty that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography, but today it includes all imaging modalities, including those that use no ionizing electromagnetic radiation, as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.

<span class="mw-page-title-main">Medical imaging</span> Technique and process of creating visual representations of the interior of a body

Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging also establishes a database of normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of removed organs and tissues can be performed for medical reasons, such procedures are usually considered part of pathology instead of medical imaging.

<span class="mw-page-title-main">Autopsy</span> Medical examination of a corpse

An autopsy is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death; or the exam may be performed to evaluate any disease or injury that may be present for research or educational purposes. The term necropsy is generally used for non-human animals.

<span class="mw-page-title-main">Angiography</span> Medical imaging technique

Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performed by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy.

In medical or research imaging, an incidental imaging finding is an unanticipated finding which is not related to the original diagnostic inquiry. As with other types of incidental medical findings, they may represent a diagnostic, ethical, and philosophical dilemma because their significance is unclear. While some coincidental findings may lead to beneficial diagnoses, others may lead to overdiagnosis that results in unnecessary testing and treatment, sometimes called the "cascade effect".

<span class="mw-page-title-main">Post-mortem interval</span> Time that has elapsed since a person has died

The post-mortem interval (PMI) is the time that has elapsed since an individual's death. When the time of death is not known, the interval may be estimated, and so an approximate time of death established. Postmortem interval estimations can range from hours, to days or even years depending on the type of evidence present. There are standard medical and scientific techniques supporting such an estimation.

<span class="mw-page-title-main">Virtual colonoscopy</span> Medical imaging of the colon

Virtual colonoscopy is the use of CT scanning or magnetic resonance imaging (MRI) to produce two- and three-dimensional images of the colon, from the lowest part, the rectum, to the lower end of the small intestine, and to display the images on an electronic display device. The procedure is used to screen for colon cancer and polyps, and may detect diverticulosis. A virtual colonoscopy can provide 3D reconstructed endoluminal views of the bowel. VC provides a secondary benefit of revealing diseases or abnormalities outside the colon.

<span class="mw-page-title-main">Neuroimaging</span> Set of techniques to measure and visualize aspects of the nervous system

Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Increasingly it is also being used for quantitative research studies of brain disease and psychiatric illness. Neuroimaging is highly multidisciplinary involving neuroscience, computer science, psychology and statistics, and is not a medical specialty. Neuroimaging is sometimes confused with neuroradiology.

<span class="mw-page-title-main">Pineal gland cyst</span> Medical condition

A pineal gland cyst is a usually benign (non-malignant) cyst in the pineal gland, a small endocrine gland in the brain. Historically, these fluid-filled bodies appeared on 1-4% of magnetic resonance imaging (MRI) brain scans, but were more frequently diagnosed at death, seen in 4-11% of autopsies. A 2007 study by Pu et al. found a frequency of 23% in brain scans.

<span class="mw-page-title-main">Incidental medical findings</span>

Incidental medical findings are previously undiagnosed medical or psychiatric conditions that are discovered unintentionally and during evaluation for a medical or psychiatric condition. Such findings may occur in a variety of settings, including routine medical care, during biomedical research, during post-mortem autopsy, or during genetic testing.

<span class="mw-page-title-main">PET-MRI</span>

Positron emission tomography–magnetic resonance imaging (PET–MRI) is a hybrid imaging technology that incorporates magnetic resonance imaging (MRI) soft tissue morphological imaging and positron emission tomography (PET) functional imaging.

Computational human phantoms are models of the human body used in computerized analysis. Since the 1960s, the radiological science community has developed and applied these models for ionizing radiation dosimetry studies. These models have become increasingly accurate with respect to the internal structure of the human body.

<span class="mw-page-title-main">Magnetic resonance imaging of the brain</span>

Magnetic resonance imaging of the brain uses magnetic resonance imaging (MRI) to produce high quality two-dimensional or three-dimensional images of the brain and brainstem as well as the cerebellum without the use of ionizing radiation (X-rays) or radioactive tracers.

A medical animation is a short educational film, usually based around a physiological or surgical topic, that is rendered using 3D computer graphics. While it may be intended for an array of audiences, the medical animation is most commonly utilized as an instructional tool for medical professionals or their patients.

<span class="mw-page-title-main">Forensic radiology</span>

Forensic radiology is the discipline which comprises the performance, interpretation and reportage of the radiological examinations and procedures which are needed in court procedures or law enforcement. Radiological methods are widely used in identification, age estimation and establishing cause of death. Comparison of ante mortem and post mortem radiographs is one of the means of identification. The scanning of baggage, vehicles and individuals have many applications.

A digital autopsy is a non-invasive autopsy in which digital imaging technology, such as with computerized tomography (CT) or magnetic resonance imaging (MRI) scans, is used to develop three-dimensional images for a virtual exploration of a human body.

<span class="mw-page-title-main">Paleoradiology</span> Study of archaeological remains through the use of radiographic techniques

Paleoradiology is the study of archaeological remains through the use of radiographic techniques, such as X-ray, CT and micro-CT scans. It is predominately used by archaeologists and anthropologists to examine mummified remains due to its non-invasive nature. Paleoradiologists can discover post-mortem damage to the body, or any artefacts buried with them, while still keeping the remains intact. Radiological images can also contribute evidence about the person's life, such as their age and cause of death. The first recorded use of paleoradiology was in 1896, just a year after the Rōntgen radiograph was first produced. Although this method of viewing ancient remains is advantageous due to its non-invasive manner, many radiologists lack expertise in archeology and very few radiologists can identify ancient diseases which may be present.

References

  1. ↑ "VIRTOPSY - wirtschaft.ch - trademarks - Universität Bern Institut für Rechtsmedizin (IRM) Prof. Dr. R. Dirnhofer, Direktor Bern - Trademark no. P-491277 - Application no. 04728/2001". wirtschaft.ch. Retrieved 2013-08-28.
  2. ↑ "Home". virtopsy.com.
  3. ↑ Richard Dirnhofer; Peter J. Schick; Gerhard Ranner (2010). Virtopsy - Obduktion neu in Bildern. Wien, Austria: Manzsche Verlags- und Universitaetsbuchhandlung. ISBN   978-3-214-10191-6.
  4. ↑ E. von Hofmann
  5. ↑ Schwarzacher
  6. 1 2 3 4 5 Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, Schroth G, Ith M, Sonnenschein M, Doernhoefer T, Scheurer E, Plattner T, Dirnhofer R (2003). "Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)--a feasibility study". J Forensic Sci. 48 (2): 386–403. doi:10.1520/JFS2002166. PMID   12665000.
  7. 1 2 3 4 Ebert LC, Ptacek W, Naether S, Fürst M, Ross S, Buck U, Weber S, Thali M (2010). "Virtobot--a multi-functional robotic system for 3D surface scanning and automatic post mortem biopsy". Int J Med Robot. 6 (1): 18–27. doi:10.1002/rcs.285. PMID   19806611. S2CID   41263796.
  8. 1 2 Grabherr S, Djonov V, Friess A, Thali MJ, Ranner G, Vock P, Dirnhofer R (2006). "Postmortem angiography after vascular perfusion with diesel oil and a lipophilic contrast agent". American Journal of Roentgenology. 187 (5): W515-23. doi:10.2214/AJR.05.1394. PMID   17056884.
  9. ↑ Thali MJ, Braun M, Buck U, Aghayev E, Jackowski C, Vock P, Sonnenschein M, Dirnhofer R (2005). "Virtopsy--scientific documentation, reconstruction and animation in forensic: individual and real 3D data based geo-metric approach including optical body/object surface and radiological CT/MRI scanning". J Forensic Sci. 50 (2): 428–42. doi:10.1520/JFS2004290. PMID   15813556.
  10. ↑ Aghayev E, Staub L, Dirnhofer R, Ambrose T, Jackowski C, Yen K, Bolliger S, Christe A, Roeder C, Aebi M, Thali MJ (2010). "Virtopsy - the concept of a centralized database in forensic medicine for analysis and comparison of radiological and autopsy data". J Forensic Leg Med. 15 (3): 135–40. doi:10.1016/j.jflm.2007.07.005. PMID   18313007.
  11. 1 2 O'Donnell C, Woodford N (2008). "Post-mortem radiology--a new sub-speciality?". Clin Radiol. 63 (11): 1189–94. doi:10.1016/j.crad.2008.05.008. PMID   18929036.
  12. ↑ Donchin Y, Rivkind AI, Bar-Ziv J, Hiss J, Almog J, Drescher M (1994). "Utility of postmortem computed tomography in trauma victims". J Trauma. 37 (4): 552–5. doi:10.1097/00005373-199410000-00006. PMID   7932884.
  13. ↑ "Virtangio - wirtschaft.ch - trademarks - Forim-X AG c/o Prof. Dr. Richard Dirnhofer Bern - Trademark no. 602006 - Application no. 51685/2010". wirtschaft.ch. Retrieved 2013-08-28.
  14. ↑ "Folders - postmortem-angio". Postmortem-angio.ch. Retrieved 2013-08-28.
  15. ↑ Ampanozi G, Ruder TD, Thali MJ (2012). "Autopsy, necropsy, and necrotomy: if used, why not correctly?". Am J Forensic Med Pathol. 33 (2): e6. doi:10.1097/PAF.0b013e3182092bf9. PMID   21224734. S2CID   33631896.
  16. ↑ "Gestochen scharfe Diagnosen: Der neue Direktor des Instituts für Rechtsmedizin setzt auf digitale Technik als Ergänzung zum Skalpell - Übersicht Nachrichten". NZZ.ch. 28 August 2013. Retrieved 2013-08-28.
  17. ↑ "Bringing ideas to life: Making virtual autopsy a reality - The Edge Malaysia". Infovalley.net.my. 2010-06-07. Retrieved 2013-08-28.
  18. ↑ Ith, Michael and Bigler, Peter and Scheurer, Eva and Kreis, Roland and Hofmann, Lucie and Dirnhofer, Richard and Boesch, Chris (2002). "Observation and identification of metabolites emerging during postmortem decomposition of brain tissue by means of in situ 1H-magnetic resonance spectroscopy". Magnetic Resonance in Medicine. 48 (5): 915–920. doi: 10.1002/mrm.10294 . PMID   12418008. S2CID   7670211.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ↑ Scheurer E, Ith M, Dietrich D, Kreis R, Hüsler J, Dirnhofer R, Boesch C (2005). "Statistical evaluation of time-dependent metabolite concentrations: estimation of post-mortem intervals based on in situ1H-MRS of the brain". Journal of Magnetic Resonance Imaging. 18 (3): 163–172. doi:10.1002/nbm.934. PMID   15578674. S2CID   36862603.
  20. ↑ "Digital autopsy: Replacing scalpels with scanners". Gizmag.com. 27 August 2013. Retrieved 2013-08-28.
  21. ↑ W. Brueschweiler and M. Braun and R. Dirnhofer and M.J. Thali (2003). "Analysis of patterned injuries and injury-causing instruments with forensic 3D/CAD supported photogrammetry (FPHG): an instruction manual for the documentation process". Forensic Science International. 132 (2): 130–138. doi:10.1016/s0379-0738(03)00006-9. PMID   12711193.
  22. ↑ Yen, Kathrin Thali, Michael J and Aghayev, Emin and Jackowski, Christian and Schweitzer, Wolf and Boesch, Chris and Vock, Peter and Dirnhofer, Richard and Sonnenschein, Martin (2012). "Strangulation signs: Initial correlation of MRI, MSCT, and forensic neck findings". Journal of Magnetic Resonance Imaging. 22 (4): 501–10. doi: 10.1002/jmri.20396 . PMID   16142698.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ↑ Flach PM, Ross SG, Ampanozi G, Ebert L, Germerott T, Hatch GM, Thali MJ, Patak MA (2005). ""Drug mules" as a radiological challenge: sensitivity and specificity in identifying internal cocaine in body packers, body pushers and body stuffers by computed tomography, plain radiography and Lodox". Eur J Radiol. 81 (4): 501–510. doi:10.1016/j.ejrad.2011.11.025. PMID   22178312.
  24. ↑ Ruder TD, Germerott T, Thali MJ, Hatch GM (2011). "Differentiation of ante-mortem and post-mortem fractures with MRI: a case report". Br J Radiol. 84 (1000): e75-8. doi:10.1259/bjr/10214495. PMC   3473468 . PMID   21415297.
  25. ↑ "Corpus Alienum captured in Post Mortem Computed Tomography, death due to an accidental ingestion of "Momos (Dumpling)"". sciencedirect. 2022-06-01. Retrieved 2022-11-11.
  26. ↑ Deepali Jena (Oct 17, 2022). "Virtual Autopsy | Giving dignity to the Dead". indiatoday.in. New Delhi: India Today . Retrieved 2023-04-02.
  27. ↑ N. Ohashi (1989). "Diagnosis of the causes on CPAOA cases: usefulness and problems of postmortem CT". KANTO J. Jpn. Assoc. Acute Med. (in Japanese). 10: 24–25.
  28. ↑ "Institute of Forensic Medicine". Sdu.dk. 2012-09-24. Retrieved 2013-08-28.
  29. ↑ "Visible Proofs: Forensic Views of the Body: Galleries: Media: Medical examiners at work". Nlm.nih.gov. 2010-12-14. Retrieved 2013-08-28.
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