Tuesday, January 22, 2019

All deaths should be audited to find preventable causes: Virtual autopsy may provide the answer

The All India Institute of Medical Sciences (AIIMS), New Delhi and ICMR are collaborating on a project to conduct virtual autopsies, as reported in TOI, Jan 20, 2019. The head of the Forensics Department at AIIMS said that they have already set up a digital X-ray machine to conduct autopsy of the deceased with bone injuries or fractures caused after an accident. He further said that in virtual autopsy, the deceased’s records are available in digital format and thus it permits additional analysis by other forensic pathologists on the same body; second or third opinion even after years if some allegations crop up in the future.

The word “autopsy” is Greek in origin. It is derived from “autos” (self) and “opsomei” (I will see), which means “to see with one’s own eyes”.

Virtual autopsy has also been called “virtopsy” by Thali et al (Leg Med (Tokyo). 2007 Mar;9(2):100-4); it originates from the Latin word “virtus”, which means “useful, efficient and good”. They deleted “autos” to eliminate its subjectivity and combined the two terms virtual and autopsy thereby coining the term “virtopsy”.

Virtual autopsy, therefore, is an alternative to traditional autopsy.

It has been called touch-free autopsy (J Forensic Dent Sci. 2017;9(1):42) as it employs imaging methods that are routinely used in day to day practice such as CT (whole body or limited) and magnetic resonance imaging (MRI). CT guided postmortem biopsies can be added for histopathological and genetic correlations. Hence, it can identify details that may have been missed on conventional autopsy.

CT scan is a superior tool to conventional autopsy in identifying entry and exit pattern of wounds (fracture patterns), pathological gas collections and gross tissue injury. Postmortem MRI is highly sensitive, specific, and mainly used for assessing soft tissue injuries, neurological/non-neurological trauma, contusions, and hematomas (J Forensic Dent Sci. 2013;5(2):146-8). A comprehensive analysis of both surface and deep tissue findings may require fusion of CT, MRI and 3D surface data.

All deaths should be self-audited to look for preventable causes. Virtual autopsy can be done in no time; it leaves no scar being non-invasive and can be the answer in finding the cause in unexplained deaths. This is necessary to prevent similar future episodes in the community. It is also the answer for most medicolegal disputes.

Virtual autopsy is an established practice in many western countries such as Switzerland.

The IMA had issued a Virtual Autopsy Draft Statement, when I was the National President, IMA as follows: “IMA is for establishing virtual autopsies at clinical level for non-medicolegal cases (whole body CT, whole body MRI, postmortem angio, molecular autopsy).”

Since the Govt. has started thinking along the lines of virtual autopsy, in every death, the family should be given an option for virtual biopsy with/without mini FNAC/tissue biopsy.  And informed refusal must be noted.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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