Review Paper,

Implementation of Virtual Autopsy in Forensic Medicine

Kangana Aggarwal(Student), Amit* Chauhan(Assistant Professor), Dr. S.K
Shukla(Head of Department)

Amity Institute of Forensic Sciences, Amity University,Sector-125 (Noida) Uttar

Pradesh, INDIA- 201313

Corresponding author- Kangana Aggarwal

Email id- kanganaaggarwal.17@gmail.com

Contact Details- +91-9811256389

ABSTRACT

Dead bodies are frequently encountered at the scene of crime and it is essential to determine
the cause of death, manner of death and to find any injury or disease present on the body. [1]
For this purpose, highly trained and qualified surgeons are appointed to conduct post-mortem
on the cadaver. Since many social communities do not permit this as it violates their ethical
and religious values, therefore causing the hindrance in solving the particular case. To
overcome this drawback a new technique has been introduced called virtual autopsy also
known as Virtopsy. With the help of this technique we can figure out minute details on
different parts of the body where even radiological rays cannot reach. It will help in better
understanding of the deceased person and can be used in various medico-legal cases.

Key words: Radiology, imaging, virtual, autopsy, dead bodies, techniques, pathologist

INTRODUCTION

In past few decades forensic science has came across many innovations and advancement in
terms of techniques and methodologies. One of the recent invention in clinical autopsy is of
virtual autopsy. Virtual autopsy is an autopsy conducted virtually. Virtual autopsy is also
referred as Virtopsy which is derived from the Latin word virtus, which means, “useful,
efficient, and good.”[2]It helps in obtaining the information which cannot be obtained through
a standard autopsy. Moreover, it does not require a scalpel to examine the corpse. Different
techniques are used to obtain a 3-Dimensional view of the cadaver hence helping in better
examination and aids in giving a better opinion or conclusion. It can be massively used as an
alternative to conventional autopsy and it would not upset the family of the deceased and also
secures religions sentiments.

The idea of virtual autopsy was developed by Richard Dirnhofer, former Director of Forensic
Medicine, Berne, which was then continued by Michel Thali and his colleagues at the
University of Berne’s Institute of Forensic Medicine situated in Switzerland. [3] In1990s the
Institute of Forensic Medicine started it in the collaboration with the Scientific Service of the
City Police of Zurich.[4] The aim was to document the surfaces of objects and bodies in a
three-dimensional view. After the century, the Institute of Forensic Medicine began it in
collaboration with the institutes of Diagnostic Radiology and Neuroradiology of the
University of Bern. The ultimate aim of this new research project called Virtopsy was to
detect forensic findings in dead bodies using radiological techniques such as CT and MRI and
to compare these with the data obtained by standard autopsy.

The Virtopsy was initially begun with the surface documentation by 3D photogrammetry
which was based on optical surface scanning, CT and MRI.

Over the period of time, it was developed and other methods such as post-mortem biopsy and
angiography were implemented on it.[5] It was not a success in the initial phase but after
sometime its importance was realised among the radiologists and pathologist and teaching of
courses on the use of the Virtopsy methods began in 2006.

It can be useful in the countries where crime rate is huge and is constantly increasing day by
day like India, and other countries. It can help in giving reports in few minutes rather than
hours. In this way, it will not only help in obtaining the internal findings but will also help in
increasing the pace of judiciary to serve justice of the respective country. This can be the
most important change in the daily routines of many pathologists, radiologists, scientists, etc.
This emerging technique has gained some popularity recently and people around the world
are curious to find out more about its significance.

IMAGING TECHNIQUES

Presently, forensic imaging comprises of cross-sectional techniques i.e. CT, MSCT,

MicroCT, MR microscopy, MRs, MRI etc, which are combined with minimally invasive
techniques such as post-mortem angiography and biopsy, and 3D photogrammetry which is
based on optical surface scanning.[6] These methods are described briefly below.
 1. COMPUTED TOMOGRAPHY (CT)

Computed tomography is the most frequent used imaging tool in forensic pathology apart
from X-ray. With modern scanners, 2D and 3D reconstructions based on slice thicknesses of
0.5 mm are possible and have become routine standards. Apart from the examination of the
soft tissues, the main advantage is in the detection and depiction of foreign ingredients,
fracture lines, gas and fluid accumulations, etc. It can also show calcifications and vessels
easily. Since it is difficult to evaluate the size vessel occlusion or a vascular rupture,
therefore, for this post-mortem angiography is used.

2. MULTISECTION CT

CT was performed on a four– or six–detector row scanner. Whole-body scans were

performed with a collimation of 1 or 1.25 mm which provides 1200 axial images with a
section thickness of 1.25 mm and an increment of 0.7 mm in soft-tissue and osseous kernels.
For areas of special forensic importance which includes special fracture systems, teeth,
foreign bodies, etc additional raw data were acquired with a collimation of 0.5 mm and
0.625-mm-thick sections were calculated. Acquisition time was approximately 10 minutes.

3. MICRO-CT

In special situations, bone-tissue specimens were examined on a micro-CT system which was
developed and built at the Institute of Medical Physics in Erlangen, Germany. This scanner
can image a 3D volume with an isotropic resolution ranging from 10 to 100 μm. The system
allows the examination of samples with diameters ranging from 4 to 40 mm.

4. MR MICROSCOPY

MR microscopic studies were performed at room temperature on a Bruker DMX

spectrometer (Bruker Biospin MRI, Billerica, Mass) coupled to a wide-bore magnet operating
at 9.4 T (400 MHz for protons).For instance, formalin-fixed eyeballs were washed in
phosphate-buffered saline solution, blotted dry, and then placed in a 25-mm glass tube filled
with Fluorinert prior to imaging. 3-dimensional anatomic images were acquired with a fat-
suppressed rapid acquisition with relaxation enhancement (RARE) T1-weighted imaging
sequence (repetition time msec/echo time msec = 200/8, number of signals acquired = 16,
acquisition time = 9.5 hours). Voxels were typically 78 μm in size.

5. MAGNETIC RESONANCE IMAGING

Although CT is the method which shows foreign bodies, fractures and gas, though it is
bounded by certain restrictions which are related to the assessment of soft tissues and internal
organs. In comparison to MRI,MRI can depict soft-tissue injuries and pathologies very
clearly. Being non-ionizing in nature, it is also the imaging method of choice when
examining living victims of assault, such as in the cases of manual strangulation.

6. MAGNETIC RESONANCE SPECTROSCOPY (MRS)

Magnetic resonance spectroscopy (MRS) is another useful technique in Virtopsy which helps
in determining the metabolic concentrations in the tissues and also helps in estimating the
time of death. MR microscopy is a micro-imaging technique which is also used to study the
soft tissue injuries like retinal haemorrhage, etc.

7. POST MORTEM BIOPSY

The word postmortem biopsy has the part ‘bios’ which is from the ancient Greek meaning
‘life’ and is therefore, not applicable for a post-mortem method, this terminology has
established itself in forensic pathology in analogy to biopsies performed in clinical medicine.
With a biopsy gun, samples of organs of interest or specific pathologies seen at CT or MRI,
and can be taken and examined through histological preparations. Tissue and fluid samples
can be collected for toxicological and microbiological examinations.

8. 3 D PHOTOGRAMMETRY-BASED OPTICAL SURFACE SCANNING

With a surface-scanning unit, which projects a fringe pattern onto a surface and is recorded
with the help of two cameras, a 3D image can be obtained using special software. Digital
photography of the surface from various angles can then be added to the data, thus enabling a
true color 3D surface reconstruction. This very accurate documentation, which depends on
the applied resolution, can document structures less than 1 mm in size.

APPLICATIONS OF VIRTUAL AUTOPSY

In Virtopsy, there is the combination of the technologies of 3D imaging techniques and 3D

surface scan which records and documents the 3D image of the body surface area in detail.

The first step in performing a Virtopsy involves the preparation of the cadaver for imaging. It
is accomplished by placing small disks by the personnel along the exterior of the body, so
that the surface scan and the interior scans could be aligned easily. These disks mark points
are used for obtaining the images into a single cohesive image. Virtibot which are robotic
machine helps in accomplishing this task.[7] Therefore, making the results of Virtopsy more
standardized and accurate.The markers are used by the computer processors to calibrate the
exterior scan of the cadaver and then matches with the internal imaging processes.

After the placing of markers by the virtibot, it creates a 3D color model of the dead body. The
scanner utilizes stereoscopic cameras to capture the color image along with, the projector is
used to cast a mesh pattern on the body. These cameras have a resolution of 0.02 mm. The
robot moves over the body creating a 3D image and the total time taken in this process is
about 10s.

After the surface scan, the body is brought to the CT and MRI station which is usually
double-covered inside a blue bag through which X-rays pass. It is done in order to prevent
any contamination, then the body is laid on the sliding table of the CT, MRI, and MRS
equipment simultaneously. The bag will remain closed while the body is scanned both the
sides. It is mainly done to respect privacy of the dead, to maintain hygiene and to remain
undisturbed by any non-forensic background person present inside the room. The body then
undergoes a CT scan which is a procedure that finishes in 20 s and acquires up to 25,000
images; each image is a slice or cut through the body. Then, the corpse is also subjected to
MRI and MRS scans. The information from the interior and surface scans are stored in
powerful computers where in data are combined, further rendered using computer-aided
drafting-style programs and ultra-powerful graphics processors. In a short span as 10 min a
detail images of bone and tissue are reconstructed using those computers, from the data
which represents thin X-ray slices of the body. Different tissues, foreign materials and bodily
substances absorb the scanner's X-rays in different amounts and the different absorption
levels are presented into a 3D visual of different colors. The computer can also assign the
density differences of any color, but this is usually standardized as blue for air pockets, beige
for soft tissues, red for blood vessels, and white for bones. A pathologist is not bounded by
any restriction to peel through the layers of virtual skin and muscle with just a click of the
computer mouse.

Pathologists and radiologists can depict and study the different patterns. At the same time,
images can be manipulated up and down and rotated at various angles, providing instant
flexibility that is absent in conventional autopsy. After analysis of the 3D model, internal
and* surface scans, a needle biopsy can be done if internal body samples are needed. Virtibot,
when used, alleviates the need to expose someone's hand under the CT scan to extract the
biopsy. All the data scanned are then captured and saved on compact discs.

The Virtual Autopsy can be applied in a wide number of fields in forensic sciences, such as
thanatological investigations; carbonized and putrefied body identifications, mass disaster
cases, age estimation, skin lesion analyses etc[8]

For instance, in the cases of drowned bodies, the CT information about the volume, density,
size of the lungs and the amount of liquid observed in them which can help in diagnosing the
cause of death.

Similarly in cases of firearm projectile injuries which are often difficult to examine because
either sometimes the bullet is absent in the body, or diverted by an anatomical structure, or it
can be in unknown body parts. Therefore, knowing the location of the projectile before the
autopsy is performed facilitates the examination.

Even in the cases of odontology field, Oesterhelweg described a case where the victim was
struck by respiratory obstruction from food bolus. The differentiation of the obstructive
structure was performed with combined CT and MRI. In conventional autopsy examinations
the greatest difficulty is to predict the depth of the foreign object. The virtual autopsy
provides this information with full accuracy and clarity. Another specific odontological
application for the Virtual Autopsy is on the comparison between AM orthopantomograms
and PM reconstructed panoramic overviews of cranial CT images. This way PM dental
evidences can easily be related to the AM data of the expected missing person. Birngruber
reported a positive identification case based on the superimposition of post-mortem CT
reconstructed images on ante-mortem radiographies.

Dedouit stressed the importance of the presence of dentists in the forensic identification team
in particular to determine the age of disfigured bodies. Other studies also relate the role the
forensic Odontologist on age estimations. Through the CT analysis of the Australian bushfire
victims, the forensic experts obtained substantial information for human identification based
on age estimation techniques.

Studies on restorative materials are also related on the virtual technique. Through the analysis
of the restoration materials density, Jackowski performed pioneering researches on
Odontology in Virtual Autopsy. These authors expressed in Hounsfield Units the different
density of restoration materials, such as composites, temporary fillings and ceramics, by
ultra-high-resolution CT imaging. Furthermore, the author verified the course of restoration
materials under high temperatures by CT images, simulating a fire mass disaster.

FEASIBILITY OF VIRTUAL AUTOPSY

Virtual autopsy is feasible upto a great extent as it provides 3D illustration which are easy to
interpret and easily accessible. It allows a digital re-examination of the body and even of
putrefied corpse decades later. It takes much less time (almost in few seconds) than the
traditional autopsy and hence gives better diagnosis by providing respect to religious
sentiments. These make it a reliable technique to get forensic records. The results provided
are highly sensitive, specific and accurate. [9] It is non-invasive and non-destructive in nature.
It simplifies the work as it identifies the identity, detects foreign bodies and easy
demonstration for the court of law.

Though it has many modifications but it does has its own loopholes which needs to be fixed
such as the lack of physiological senses of anatomical pathologist like touch, feel, texture and
smell senses.[10] The concerned personnel are restricted as there is no direct contact with the
dead body. Hence, making it is less feasible in the underdeveloped and developing countries.

FUTURE ADVANCEMENT AND BENEFITS

At present, there are only few institutions in the world who have recognized the feasibility
and possible impact of cross-sectional imaging in post-mortem investigation and that have
invested efforts in its implementation. For example, the Office of the Armed Forces Medical
Examiner (Washington, DC; Dover, Del), the Institute of Forensic Medicine (Copenhagen,
Denmark), and the Victorian Institute of Pathology (Sydney, Australia) have already installed
their own CT scanners, and in Japan, the Society for Autopsy Imaging was founded in 2003.
In future, the use of CT technology will become more widespread at distinguished institutions
of forensics and pathology.

Even robotic machine called Virtobot will use all the techniques by fusing surface and body
volume data acquisition within a single 3D space. Robotic arms will do a precise and
automatic placement of injection tools or biopsy needles.[11]
 Recent developments in MR imaging technology such as whole-body or parallel imaging
(total imaging matrix) will also significantly reduce examination times for forensic MR
imaging examinations, which can still require 3 hours or more per corpse.

If other countries also take initiative to adapt this technology then it can be proved to be a
milestone in the field of forensic science.

CONFLICT OF INTEREST- Nil

SOURCE OF FUNDING- Self

ETHICAL CLEARANCE- Not required

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