Virtual autopsy will be a reality: An IMA success story

New Delhi: AIIMS Delhi and Indian Council of Medical Research have joined hands to work on a technique for post-mortem without dissecting the body and it is likely to be functional within the next six months, Health Minister Dr Harsh Vardhan said in Rajya Sabha Tuesday. India will be the first country to start “virtual autopsy” in the South-East Asian region.

During my presidential tenure at the Indian Medical Association in 2017, we suggested and asked for virtual autopsy to be included in all post-mortems. We even suggested this to be included in the private sector to find out the unexplained cause of death, in routine cases and in all cases where the relatives are not satisfied with the treatment.

We thank Dr Harsh Vardhan for taking up this issue. Virtual autopsy includes post death whole body CT with or without post death MRI and post death genetics blood tests. I recall having discussed this with Dr Harsh Mahajan to have one CT machine dedicated for postmortems.

The virtual autopsy is cost and time effective as it takes less than 30 minutes to complete one autopsy as against two-and-half hour in normal post-mortem. The ICMR has provided INR 5 crore to AIIMS for this purpose and the process is in an advance stage for getting a CT machine.

Way back in 1979-83, we used to do mini post-mortems in every unexplained case of death in MGIMS Sewagram, that used to take less than five minutes. We used to do brain, heart, lungs, kidney, muscle, spleen and live needle biopsies in such cases.

Click the links below for more information.

http://blogs.kkaggarwal.com/2017/01/in-every-death-give-an-option-for-virtual-autopsy-ima/

https://www.business-standard.com/article/pti-stories/ima-for-virtual-autopsy-to-find-cause-in-unexplained-deaths-117010501159_1.html

https://www.indiatoday.in/pti-feed/story/ima-for-virtual-autopsy-to-find-cause-in-unexplained-deaths-851910-2017-01-05

https://drugtodayonline.tumblr.com/post/155434229723/have-option-for-virtual-autopsy-in-every

Dr KK Aggarwal

Padma Shri Awardee

President 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

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