Performance of an autopsy is “…the single most informative, most instructive, most revealing, most important and mostly costly procedure in the practice of medicine, not merely in the dollars and the cents needed for its proper performance, but most costly from the inescapable fact that every autopsy is carried out at the cost of human life, whether death was the result of natural disease or violence” Dr. Lester Adelson a forensic pathologist once summed up the concept of an autopsy. The autopsy has been used to further medicine and our own understanding. Why has this once great practice faded? What killed the desire to further our understanding of the human body? Are we becoming complacent and feel that we have reached the end of our understanding?
I think imaging and pathology are always going to be linked, to what extent remains to be seen. Virtopsy is a great supplementary tool to the traditional autopsy. Will it replace the traditional autopsy completely? I'm not sure. Will it change the way cases are approached? Absolutely. It's not just a simple CT scan and then you're done as many people say. It is very meticulous series of analyses involving multiple imaging modalities (CT, MR, and laser scanning) as well as selected biopsies and biochemical panels. While I recognize that it's a major concern for pathologists that radiologists are going to think that the pathologists are suddenly unnecessary, I don't think it's a legitimate concern. As Michael said, there are things that a normal autopsy picks up that can't be seen in imaging. However, wouldn't it be better if we were smarter about our traditional approach because we were informed by the imaging? We do this in surgery all the time with image guided pre-operative planning. Simple X-ray can't pick up the detail that CT or MR can even in the deceased. Yes, the big concern is the matter of access to the resource & funding but I think as proof of concept is established more here in the US that you will see more and more ME's offices using advanced imaging in the course of their normal case procedure. As a very wise pathologist pointed out to me during autopsy, the traditional autopsy hasn't changed much in hundreds of years. It's about time that technology helps serve as an additional tool as it does in the rest of clinical medicine. If for no other reason but long term digital evidence preservation, Virtopsy is a very useful tool to the ME. Not only can you preserve the data but you can also "share" or collaborate on that autopsy much like is routinely done in clinical telemedicine. I'd be very cautious against throwing the concept or practice out altogether. Regardless, it will be interesting to see where it goes.
I think this question is similar to 'Ebooks vs. traditional books - which will endure'. I personally feel that virtopsy is a really great tool in pathology to allow a re-evaluation of the autopsy later at court (as the data is stored & you can get a 2nd opinion relatively quickly). However, when you perform a normal autopsy the human eye & nose might detect stuff much better than any CT could detect (as clinical CT is also still limited in resolution).
I see virtopsy more as a complementary method - it's not either or, but more an 'and' that would be ideal. We'll see how the technology evolves, but future pathologist will be have to be well trained in radiology as well as in 'classical' pathology...
I am sure that it adds to the performance, but logistically for this to make a difference in the forensic environment in the United States there has to be governmental funding. Across the county the landscape is mixed between the style of a Coroner and Medical Examiner systems. Demand Verses Cost not “what is right” over “what will help the quality” is the bigger issue. I honestly do not see this making an impact in the field of forensics in the United States for another 20-30 years.
I think imaging and pathology are always going to be linked, to what extent remains to be seen. Virtopsy is a great supplementary tool to the traditional autopsy. Will it replace the traditional autopsy completely? I'm not sure. Will it change the way cases are approached? Absolutely. It's not just a simple CT scan and then you're done as many people say. It is very meticulous series of analyses involving multiple imaging modalities (CT, MR, and laser scanning) as well as selected biopsies and biochemical panels. While I recognize that it's a major concern for pathologists that radiologists are going to think that the pathologists are suddenly unnecessary, I don't think it's a legitimate concern. As Michael said, there are things that a normal autopsy picks up that can't be seen in imaging. However, wouldn't it be better if we were smarter about our traditional approach because we were informed by the imaging? We do this in surgery all the time with image guided pre-operative planning. Simple X-ray can't pick up the detail that CT or MR can even in the deceased. Yes, the big concern is the matter of access to the resource & funding but I think as proof of concept is established more here in the US that you will see more and more ME's offices using advanced imaging in the course of their normal case procedure. As a very wise pathologist pointed out to me during autopsy, the traditional autopsy hasn't changed much in hundreds of years. It's about time that technology helps serve as an additional tool as it does in the rest of clinical medicine. If for no other reason but long term digital evidence preservation, Virtopsy is a very useful tool to the ME. Not only can you preserve the data but you can also "share" or collaborate on that autopsy much like is routinely done in clinical telemedicine. I'd be very cautious against throwing the concept or practice out altogether. Regardless, it will be interesting to see where it goes.
Regarding this question, here's a recent press release on "Traditional autopsies still better than 'virtopsies' "
http://www.health24.com/news/Surgery_Operations/1-949,72347.asp
Just to add my two cents - try to look for extremly small subpleural hemorrages during virtual autopsy....
Sayın meslektaşlarım; Virtopsi minör patolojileri tanımlamada çok yararlı. Bununla beraber ölüde tetkik yaptırmada klinisyenlerin çekincesini gidermek lazım. Bu sebeple üstünlük yada zayıflık tartışması yerine virtopsi genelleştirmek için de uğraş vermemiz gerek. Saygı ile.
I guess I am confused, If I found an extremely small sub pleural hemorrhage, will that change the fact the patient was in a Car Accident and the blunt force trauma caused vascular damage causing exsanguination ? Or will it add to further the diagnosis to give an in depth look at the extent of the injuries. My ultimate point is that Virtual Autopsies could replace but cost for the process to take over will take time. I feel that it will most definitely add and enhance the quality and uniformity of the autopsy process. Historically it is far more beneficial to view with ones own eyes, than to chase shadows of speculation.
Yasar : O sanal Otopsi ve inceleme süreci için yararlı bir araç olabilir olacağını, katılıyorum. Bu tam vücut röntgen (ki ABD'de sınırlı kullanılıyor) converstation düşüncelerinizi için teşekkür ederiz arasında kullanılan bir çok simular şekilde kullanılabilir.
This is a great question , but its answer lies in why are we performing the dissection , or the autopsy ,, if its for an underlying pathology , postmortem examination , even for teaching anatomy then autopsy of a real cadaver is needed and is necessary for the completion of the understanding of human body , nowadays with the emergence of non invasive imaging techniques aided in the visualization of the human body with more details ...gave a new update for teaching and visualizing the human body .....the essence of autopsy vs virtual autopsy lies in the aim of the examination and who is conducting it
forensic team ....will need traditional autopsy to properly identify the cause of death and state of organs
anatomists...will benefit from traditional as well as virtual autopsy ....as we can start by traditional autopsu and preserve the dissected parts either in solutions or pictures ....that can help students
for students .....virtual autopsy is enough as it will show them the items required and labelled in clear very efficient pictures, for those who need more data they should turn to traditional autopsy ...so both are needed but according to the situation
This is a real nice discussion! In my eyes it is the wrong approach to see it as a competition between classic autopsy and virtopsy. Speaking for forensic pathology, post mortem CT is a powerful screening / documentation tool which helps to prioritize cases for classic autopsy and gives the pathologist vital information to tailor the autopsy procedure. If you add up post mortem CT angiography, pmMRI and pm biopsy, you will gain in many cases more information than with classic autopsy alone.
Small subpleural hemorrhage? You will see it in pmCTA and pmMRI.
The other question is how many pathologies are missed with classic autopsy???
Think of mediastinal emphysema, small pneumothoraces, air embolism or vascular leaks in deaths after surgical interventions.
Another thing, the declining autopsy numbers worldwide are making the statistics about the causes of death to a guesswork. Virtopsy could have a significant impact on public health, just by the possibility to examine cases which would otherwise never been dissected. How many hidden homicides would come to light if every corpse gets a CT scan before the burial???
The financial requirements for dedicated pmCT and pmMRI machines are high, no doubt. It is on the pathologic/forensic/radiologic community to spread the word and to convince the state authorities that this is not a fancy high tech game, but a substantial new tool to get information which would be otherwise lost.
I can underline the comments of the colleagues. It's not the question what is better or can a Virtopsy replace the traditional autopsy. It can't so far as several examples show - CT subdural haemorrhage - autopsy braqin fever ! f. e. pmCT is a very usefull addtional tool to get informations before autopsy and to document it.
this has been a nice discussion on virtual autopsy and traditional autopsy.
First of all both have their own advantages and disadvantages.
the traditional autopsy can go in the intricacies of any disease pathology, trauma.
We in our experience observes that many a times in cases of accidents the CT or radio logical analysis fell short in identifying hemorrhages or internal damages. this gets identified in the traditional autopsy.
moreover the cost and expertise in identifying on the radiological basis is tougher due to postmortem changes occurring in body and causing artefact in various ways.
Though Virtual autopsy is having many merits but it cannot be an alternative to the traditional autopsy in the modern context also.
As the science is evolving so are the number of medicolegal and pathological autposies are rising.
lets be better not competing with each other but rather supporting in the manner to aid in administration of justice, future treatment.
I still believe both has its merit in current state of life. However, am of the opinion that the traditional autopsy is still the gold standard hence i firmly plead that clinicians and others in medical field should not neglect the traditional autopsy in any case attended if need be. Who knows if one couldnt pick/access the lesions correctly because of the macroscopic nature may be lucky to see the pathological lesions on traditional approach.Most times, this is always the case-radiological basis done and not clear enough - full of suspicious hence could not just say this is that or the other. Traditional autopsy gives a better approach for typing the lesion as tissue biopsy or samples if fluid are taking for analysis(histology or cytology) as the case may be.
- Badges
- Science topic
- Similar topics
- Biological Science
- Anatomy