Virtopsy and the Traditional Autopsy
Could autopsies of the future be performed without ever having to touch a scalpel to the body?
- History of the Autopsy
- The Traditional Autopsy
- Developing the Technology, What is Virtopsy?
- Virtopsy Applications
- Works Cited
Though highly unpleasant for the general public to think about, autopsies hold an important place in our society, providing a crucial link between the deceased and that which killed them. Like an anonymous person once said, “There's nothing like an autopsy for prognosis” (Contributed by Dean H. Garrison, Jr). With the help of forensic pathologists who make their living dissecting the dead, much knowledge can be gleaned from those who were once living. As with many areas of science and medicine, post-mortem examination and forensic pathology has never been, and indeed still isn't, perfect. As the knowledge and skills of scientists and doctors gradually expands, so too does the techniques and tools used in the areas there related to their work. Such is the case, many would say, with the autopsy. At many times a long and tedious procedure, with the help of new technology like the Virtopsy, forensic pathologists may soon be finding themselves with a lot shorter process to determine the cause of death in many cases.
History of the Autopsy
The post-mortem examination as we know it today, like many things, is not one with a history that can be attributed to any single individual, but rather to an entire host of people, along great span of time, possibly longer than we can imagine.
In Babylonian society in 1500 BC, Babylonian priests would dissect and examine the livers of a domestic sheep, a practice known as today “haruspicy”. They would become credited with performing the first known examples of post-mortem examination, information from the dead. Haruspicy will be practiced for some time before it falls out of favor, but the seeds of something greater will have already become implanted into many minds.
Greeks would form a large portion of the people who would make contributions to forensic pathology. Herophilus (born ca 335 BC) was the first to perform autopsies to learn more about how the human body worked. He is especially noted for his discoveries about the brain and nervous system (however, his writings have become completely lost) (Faqs.org). Erasistratus (304 BC), another Greek, also made some significant contributions. He is said to be the father of physiology, due to his work on human cadavers and the conclusions he made based upon his dissections (such as the idea that the brain is the center of intelligence, not the heart). And later, the findings from the Greek physician Galen's (130 AD) theatrical vivisections of Barbary Apes would become extended to man, and for the next 1300 years be the standard in European anatomy and medicine.
Andreas Vesalius, though also cutting into bodies for the appeasement of a crowd, was the first anatomist to seriously challenge Galen's findings (1514-1564). By stripping away layers of tissue, he was able to get a more detailed look into the human anatomy. His findings were published in “De Fabrica Corpora Humani”, the first known comprehensive textbook of anatomy.
Eventually, Giovanni Bathista Morgagni would draw a link from post-mortem findings to symptoms of clinical patients, and therefore ensure for the first time that autopsies would be major contributors to medical science in understanding diseases. But it was Karl Rokitansky who was responsible for ensuring that forensic pathology became an independent branch of medicine, thanks in part to the some 30,000 autopsies he performed, and more than 70,000 he oversaw during his lifetime (Eterna Pathology Service). Later, Rudolf Virchow, with his introduction of the cellular concept of disease, would bring the scientific knowledge needed to ensure that it was thereby essential.
The Traditional Autopsy
The traditional autopsy is a time intensive and extremely messy procedure. After a complete examination of the external surfaces of the body, during which not only the appearance of the individual is recorded, but any and all wounds and injuries, the body is cut open, in most cases with a long bladed scalpel. The incision runs from shoulder to shoulder, meeting in the mid chest region, and extending down to the pubic area (creating a Y-shape). The skin is then pulled back, exposing the bones and internal organs. In order to examine the internal organs, the ribcage needs to be removed. This is done by cutting the cartilages that join the ribs to the breastbone, and, depending on the preference of the pathologist, this can be done with a scalpel, saw, or other instrument. The organs are then removed and looked at individually, until each has been examined and/or a cause of death can be determined.
Developing the Technology, What is Virtopsy?
The idea for non-invasive autopsying first came about in the 1990's, with the development of a technique called forensic photogrammetry. Forensic photogrammetry is the method of taking pictures, especially at crime scenes, so that 3D measurements can be taken from them later. For example, by using photogrammetry, a crime scene investigator could look back at pictures taken at the place of a murder and be able to determine the exact measurements of most (if not all) of the critical spots in the room (such as the space between blood spatter, distance between the body and a piece of furniture, etc.).
As in the case of many new technologies, virtual autopsies were born of a pressing need. Due to a string of high profile murders in Switzerland, a skull indentation in a victims skull was needed to be compared to a possible murder weapon with a great amount of certainty. Therefore, it was suggested that the observer-independent documentation of a victim's outer surface be combined with the observer-independent documentation of his/her inner surface.
Using a combination of optical measuring techniques, photogrammetry, and other 3D imaging technologies (such as CT and MRI scanning), a geometrically accurate representation of the body, both interior and exterior, can be projected upon a screen and manipulated without ever having to take a scalpel to the body of the victim. The computer generated body can then be stored in a database to be reexamined at later dates long after the actual body has been taken away (A.J. Patowary)
With the Virtopsy technique, a scalpel never has to touch the victim's body as it is being examined (a plus for those of the Jewish or Muslim religion who are strongly against autopsies due to the laws that they break). Layers of tissue and muscle can be removed much like turning pages of a book, so deeper and deeper layers can be looked at and studied. In this way, bullet paths, stab wound patterns, skull indentations and other forensic evidence can be carefully examined without worry of crucial evidence being destroyed. During a traditional autopsy for example, emboli- obstructive air bubbles trapped inside blood vessels, most likely due to a wound of some sort – may become destroyed as soon as a pathologist's scalpel hits the vein or organ it is therein contained (destroying crucial evidence) (Popular Science). In addition, water and blood present in the lungs is much easier to detect with Virtopsy. It’s also quicker; a Virtopsy takes as little as 30 minutes to perform whereas a traditional autopsy can take anywhere from a two hours to half a day.
Despite these facts, Virtopsy cannot tell you the color of organs (important when trying to find inflammation), tell you what kind of tumor is present (if one is present at all), or detect leaks in blood vessels. It also cannot tell the difference between pre and post death wounds (or artifacts found in the body post death), cannot distinguish between all pathological conditions, and may miss some smaller tissue wounds that a medical examiner would notice. The expense is something that can’t be missed, however. One system can cost as much as $2 million to set up. Especially in the private sector, not many organizations have that much money to spare for new technology, when the old methods work just as well. Not to mention the fact that in court systems, juries may have a harder time believing digital evidence as opposed to the real thing, due to the fact that it could have been tampered with a little more easily.
The traditional autopsy is what many would call the “golden standard” of forensic pathology, and it’s highly unlikely that Virtopsy will ever completely replace this, even if all the short-comings were to be worked out. For many hundreds of years pathologists have been using their hands to examine forensic evidence, and no amount of computer technology is liable to replace it. It is clear though that Virtopsy is to eventually become a crucial part of the modern forensic pathologist’s job, not as a substitute of, but as an added tool to the traditional scalpel form of autopsying.
A.J. Patowary, “Virtopsy: One Step Forward In The Field Of Forensic Medicine - A Review” http://www.jrank.org/health/pages/32863/autopsy.html
Answers.com “Biography: Erasistratus”, http://www.answers.com/topic/erasistratus
Catherine Bosley, “Virtopsy: autopsy without the scalpel”, http://www.telegraph.co.uk/expat/expatnews/6654975/Virtopsy-autopsy-without-the-scalpel.html
Eterna Pathology Service “HISTORY OF THE AUTOPSY- It all began with Anatomy” http://eternapathology.com/HistoryoftheAutopsy.html
Eugene Lisci, “Photogrammetry in Forensics Introduction”, http://www.hgexperts.com/article.asp?id=5220
Faqs.org, “Herophilus Biography”, http://www.faqs.org/health/bios/67/Herophilus.html
In-Sung Yoo, “Autopsy Minus the Scalpel” http://www.usatoday.com/tech/news/techinnovations/2004-03-22-autopsy-usat_x.htm
Popular Science, Volume 265, “Why Give A Dead Man A Body Scan?” pages 50-57, 112-113.
Sanjay A. Pai , “Autopsy”,http://www.jrank.org/health/pages/32863/autopsy.html
Richard Dirnhofer, MD, Christian Jackowski, MD, Peter Vock, MD, Kimberlee Potter, PhD and Michael J. Thali, MD, “VIRTOPSY: Minimally Invasive, Imaging-guided Virtual Autopsy” http://radiographics.rsna.org/content/26/5/1305.full