Bloodless Virtual Autopsies

The National Fatwa Committee is studying the feasibility of virtual autopsy before proclaiming an edict on its implementation here in Malaysia (The Star, April 7, 2006).

This method uses computerised CT Scan that eliminates the need for physical incisions on dead bodies to ascertain the cause of death.

The following article from the San Francisco Chronicle might shed some light on the matter:-

By Benjamin Pimentel, Chronicle Staff Writer

For many people of different faiths, cutting up a corpse to figure out how a person died is an invasive, even offensive, procedure.

In some cases, as with Muslims and Jews, autopsies may violate their religious laws.

But technology companies are stepping in with a more acceptable alternative to traditional autopsies, using sophisticated scanning and three-dimensional computer systems.

Silicon Graphics Inc. manager Afshad Mistri demonstrated one such system on a recent morning in Mountain View, standing in front of a theater screen displaying the fuzzy image of a woman who was killed in a car accident in Sweden.

Another SGI engineer moved the cursor across the corpse, revealing the next layer, an image of the woman's skeleton clearly showing her broken bones.

"Now you are starting to see the bone structure," Mistri said. "Let's zoom in on the skull area. ... You can easily see areas of interest. The data is right there. ... Her jaw is very badly mashed. ... Cause of death was a broken neck."

"No one wants a family member autopsied," Mistri, SGI's senior manager of advanced visualization, said. "If you've got a grandmother who is 94 years old and she dies of old age, why go through the trauma?"

The rules on when a body must undergo an autopsy vary by country and legal jurisdiction. In California, Hank Greely, a professor of law at Stanford University said, coroners are required by law to investigate suspicious deaths. The process could include performing autopsies.

Advances in 3-D computing and computerized tomography, or CT-scans, which use special X-ray equipment to create a detailed cross-sectional view of a body part, combined with the arrival of massive memory and processing power, have led to the rise over the past five years of virtual autopsy technology.

SGI uses its Silicon Graphics Prism visualization system powered by Itanium 2 processors and 32 gigabytes of main memory to create an interactive display of a corpse.

Using a mouse, an engineer can examine the inside of a body or turn it at different angles, providing a detailed examination without having to cut open the body.

Rapid advances in computing and scanning technologies, led by such firms as SGI, Siemens and General Electric, since the late 1990s are paving the way for growing use of virtual autopsies in forensic and even military purposes:

-- The U.S. Armed Forces Institute of Pathology's virtual autopsy program, which uses technology from Agfa and General Electric, has scanned about 800 bodies of Americans, including troops killed in action in Iraq and other war zones, in hopes of using the information to develop more effective body armor and other means to reduce casualties.

-- SGI CEO Bob Bishop last week sent a letter to Louisiana Gov. Kathleen Blanco citing a new computer visualization system the company recently set up with the Lafayette Economic Development Authority and the University of Louisiana at Lafayette that could be used for virtual autopsies to help identify bodies of hurricane victims.

-- In countries like Sweden and Switzerland, medical examiners routinely use virtual autopsies to complement findings from traditional autopsies.

-- The technology is also gaining acceptance in Australia, where early this month religious groups and legal experts met with medical professionals and technologists to tackle the future of 3-D postmortems.

The two-day conference in Sydney underscored the growing role of technology in making postmortems more acceptable to religions that have strict rules on how to treat their dead.

For example, in the Jewish faith, every part of a deceased person's remains must be buried, including the blood. Islam requires the immediate burial of a dead person, which becomes a problem for a traditional autopsy, which can take several days.

"The burial practice of Islam and Judaism are not greatly different," said Graham Segal, a barrister-at-law and chairman of the Sydney conference. "We are both compelled to bring about quick burial. There is a need therefore to treat the body with respect. There is a concept, particularly in Jewish law, that the way in which you treat the deceased is part of the function of the way in which you treat the living. It engenders respect for life as a concept."

Segal, who is Jewish, said that even beyond religious tradition people simply don't want their loved ones subjected to autopsies.

"The autopsy process is felt by many people, quite outside of any religious perspective, as being something that runs contrary to the manner in which they want to see their loved ones dealt with," he said.

Virtual autopsies also help lower postmortem costs. Mistri of SGI said a regular autopsy costs about $4,500 to $5,000, compared with about $900 to $1,000 for a virtual autopsy. Autopsies are generally paid for by the legal jurisdiction, such as a county, that is requiring the procedure.

In Sweden, virtual autopsies have helped solve medical puzzles and criminal investigations.

Dr. Anders Persson, director of the Center for Medical Image Science and Visualization at Sweden's Linkoping University, cited the case of a 6-month-old boy who died during an operation after his heart was punctured during the procedure.

"The traditional autopsy couldn't figure out how this had happened," he said in an interview. "But we solved it with a CT exam."

Anders Ynnerman, a professor at the university's science and technology department, said a virtual autopsy helped shed light on the death of a Swedish man who was shot during an encounter with police.

The man had taken his family hostage in a small town. During the confrontation with police, one of the officers fired his gun, killing the man. A virtual autopsy revealed a deformed bullet as well as fragments of lead under the man's skin. Together with the angle of the shots, the information showed that the bullet hit the man indirectly.

"The bullet had ricocheted off some metal object and then unfortunately hit the young man," Ynnerman said. "The police officer actually fired a warning shot, but unfortunately killed the guy."

The police officer was acquitted, although the family of the man who was killed has appealed, Ynnerman added.

In the military campaigns in Iraq and Afghanistan, which have led to hundreds of casualties, the U.S. military is turning to virtual autopsy technology to come up with better ways of protecting soldiers in the field.

Since November 2004, the U.S. Armed Forces Institute of Pathology's virtual autopsy program has been scanning bodies, including soldiers killed in action, at Dover Air Force Base in Delaware and the data is being sent to the armed forces medical examiner.

"The ultimate objective of virtual autopsy is to preserve the lives of soldiers, sailors, airmen and Marines in battle ... understanding what kind of casualties occurred and using that information to prevent future ones from happening," said John Getz, virtual autopsy program manager of the Department of Defense's mortality surveillance division.

"We can just collect every type of injury that occurs in the field and have a further understanding of what happened," he added.

He declined to elaborate on how the military could use the information collected from the scanning of bodies. Mistri said the information could help manufacturers make better body armors.

"People just get stacks and stacks of body armor and it's given to the manufacturers and they say, 'Go fix it,' " he said. "And (the manufacturer) is sitting there, scratching his head, saying, 'I have no idea if the explosion came from the bottom, top, side.' So now he is looking at the entire three-dimensional data and saying, 'This was a back explosion. This is how a person was not wearing his body armor correctly. Or we need three more straps to make it more tight.' "

Bishop, SGI's CEO, said virtual autopsies could play an important role in identifying the dead in natural and man-made disasters, including the recent hurricanes that devastated the Gulf states and the war in Kosovo, where mass graves are still being uncovered.

"That work is still continuing even in Kosovo" he said.

The growing acceptance of virtual autopsies is due in part to the emergence of a new generation of doctors and medical examiners who, unlike their predecessors who spent most of their careers looking at two-dimensional X-ray images, grew up in the world of 3-D visualization. Mistri calls them the Nintendo Generation.

Among them is Dr. Michael Thali of the Institute of Forensic Medicine at the University of Bern in Switzerland, who is considered a pioneer in the field and whose group coined the term "Virtopsy" to refer to the technology.

He said 3-D visualization has helped explain medical data and findings even to nonexperts, particularly in court cases.

"The classical approach is still to look at slices in 2-D," he said. "But I think the 3-D visualization is becoming more and more important to visualize the findings in 3-D. In our area dealing with forensic radiology, where you have to present your findings not to medical doctors but to the people in courts with no medical backgrounds, it's very useful that you can visualize or demonstrate your findings in 3-D."

For Segal, the Australian barrister, virtual autopsy has helped debunk what some see as a chasm between technology and religion.

"Some people take the perspective that there's science and there's religion and the two will never meet," he said. "I don't share that view. ... Technology is often a friend of religion."