Yussufs Dissertation

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A Comparative analysis of the usefulness of
virtopsy over the conventional autopsy
BSc (Hons) Forensic Science
Undergraduate major project
By Yussuf Mohamed

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Abstract:
The aim of this study was to compare and describe in detail the usefulness of
imaging modalities in conducting post mortem examinations. Imaging in autopsy and
forensic investigations has become well publicized and has been used increasingly
to document fractures, injury patterns and pin pointing foreign bodies. The preferred
imaging technique used is computed tomography (CT) due its high sensitivity, cost
effectiveness and speed. Virtopsy is capable of creating both two and three
dimensional images which are objective and can be stored away for a long period of
time and assessed over and over again. Firstly, an introduction to autopsy and a
background to how virtopsy was came about was described. The advantages and
the disadvantages of the two techniques were highlighted and a few of the
techniques involved in post mortem imaging i.e. CT, angiography, ultrasound and
biopsy were reviewed. Two case reports were analysed and the findings of virtopsy
and autopsy examinations were correlated. The information acquired led to the
notion that virtopsy should not replace the classic autopsy but rather act as an aide-
de-camp. A brief overview of the two techniques is described and conclusion and
references provide further value to this study.

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Acknowledgements:
First and foremost I would like to thank God for guiding me and helping me remain
steadfast throughout my life and especially during my studies and giving me the
strength to remain focused on my goals.
I would like to thank my parents, friends and relatives for sharing their wisdom with
me and always motivating me to do better. I have a very deep appreciation for my
father who has not only inspired me to become a very hardworking and determined
student, but has also been a role model and a person that I can always look up to,
and for that I am grateful.
I would also like to thank my supervisor Kyprianos Georgiou for continuously
supporting and guiding me from the moment he was appointed my supervisor. I am
extremely grateful for the care and dedication and willingness to always help that he
has shown, not only for my dissertation but also for my academic studies in general
which in turn has helped me gain a great amount of confidence.
I owe a huge thank you to Dr. Rahul Pathak as none of this would have been
possible had he not helped me in deciding on this topic and also for his continuous
support throughout my degree and feedback he provided whilst I was carrying out
this dissertation.
Finally, I would like to thank Dr. Lata Gauatam, my personal tutor, for guiding me,
always helping no matter what and offering me priceless advice from the start of my
first year and throughout the duration of my degree.

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Contents page:
Description Page number
Abstract
Acknowledgements
List of figures
1. Literature review 6
2. Introduction 9
3. Methodology 12
4. Advantagesanddisadvantages 13
4.1 Advantages 13
4.2 Disadvantages 15
5. Componentsof virtopsy 16
5.1 Computedtomography(CT) 16
5.2 Angiography 17
5.3 Biopsy 19
5.4 Ultrasound 20
6. Case 1: A rare case of suicide bygunshotwithnasal entryassessedbyclassical autopsy,post-
mortemcomputedtomography(PMCT) andpost-mortemmagneticresonance imaging
(PMMR) 21
6.1 Case history 21
6.2 PMCT results 22
6.3 PMMR results 24
6.4 Autopsyresults 27
6.5 Discussion 27
7. Case 2: Virtopsy:CTand MR imagingof a fatal headinjurycausedbya hatchet:A case report
29
7.1 Case History 29
7.2 CT results 30
7.3 MRI results 31
7.4 Autopsyresults 32
7.5 Discussion 32
8. Discussion 33
9. Future trends 34
10. Conclusion 34
11. References 35

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List of Figures:
Fig1. Arterial andvenouspost mortemCTangiographyof the thorax and abdomen.Coronal post
mortemmaximumintensityprojectionsobtainedafterarterial (a) andvenous (b) injectionsof
contrast mediumshowadetaileddepictionof the thoracoabdominal vasculature.Note thatarterial
enhancementdecreasesduringthe 15-minute interval betweenthe twoinjections,whichallows
almostdistinctlyseparate imagingof the arteriesandveins.(Rossetal.2014)
Fig2. Post-mortemimaging-guidedbiopsy,leftlateral 3DCT image clearlydepictsabiopsyneedle
that wasinsertedintothe brainthrougha hole boredintothe skull.The linearblue objectonthe left
side of the image representsametallicpartof a denture (Dirnhoferetal.2006)
Fig3. (a) PMCT imagesinsagittal withbone window and(b) axial planeswithsofttissue window
showingthe projectile track(dashedredarrow) andthe projectile inposteriorcranial fossa (black
arrow).Note the pneumocephalusasindicatedbythe white ‘x’andthe leftsubduralhematoma
(blackarrow head) causingmidline shifttothe right(Abdul Rashidetal.2013)
Fig4 (a) PMCT image insagittal plane with3Dreconstructionshowingthe final positionof the
projectile (whitearrow).Dental artefactsare alsodemarcatedbythe blue metal signal with(b)
autopsyphotographof the projectile inthe leftoccipitallobe asindicatedbythe yellow arrow head
(Abdul Rashidetal.2013)
Fig5 (a) FLAIR PMMR image inaxial planes(dashedblue arrow) with(b) autopsycorrelationshowing
the projectile pathwaythroughthe leftparietal lobeandthe leftsidedsubdural hematoma(Abdul
Rashidetal. 2013)
Fig6. The 600-g hatchetfoundat the crime scene (Ampanozietal.,2010).
Fig7. Three-dimensional reconstructionof the post-mortemcomputedtomographicimagingdata.
(a) Multiple fracture lines(arrows)withshatteredbone fragments(arrowheads)atthe anteriorside
of the skull.(b) Fracture lines (arrows)atthe posteriorside of the skull.Note thatthe primary
hatchet-blowwoundisshownbythe line.(c) Multiplebone fragmentsenteringthe braincavity
(arrows) (Ampanozi etal.,2010)
Fig.8 Hatchetwoundson the skull.Three-dimensional reconstructionof post-mortemcomputed
tomographicimagingdata.Arrowsindicate flakingonthe acutely-angledside,andarrowheads
indicate the absence of flakingonthe obtusely-angledsideof the wound(Ampanozi etal.,2010)
Fig.9. (a) Computedtomography(CT),(b) T2weightedmagneticresonance imaging(MRI),and(c)
autopsyimages.Note thatthe lefthemispherebraininjury(arrows)andthe occipital trauma
(arrowheads) are clearlyobservableinMRIand autopsyimagesbutnotwell differentiated(circle) in
the CT image (Ampanozi etal.,2010)
Fig10. Hatchet-blowtothe posteriorside of the skull.(a) Autopsyphotoand(b) three-dimensional
computedtomography(CT) reconstruction.Notethatthe small bone fragments(flaking) observable
inthe CT images(arrows) are notobservable inthe autopsyphoto(possiblyremovedduringscalp-
removal) (Ampanozi etal.,2010)

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1. Literature review:
A number of studies (Dirnhofer et al., 2006), (Perju-Dumbravă et al., 2010) have
been carried out leaning towards a new approach when it comes to carrying out
autopsies. A majority of these studies have gravitated towards the idea that post-
mortem imaging should replace the classic autopsy. A number of published articles
and journals have highlighted how useful virtopsy is in odontology (Cha et al., 2010)
and anthropology (Mallett, Blythe and Berry, 2014).
As per Brogdon, there has been no broad appreciation for the capability of radiology
in forensic science (Brogdon, 1998). His comment fashioned attention to the fact that
virtual imaging might be of incredible use with regards to carrying out post mortem
examinations. Prof. Thali, Vock and Dirnhofer from the University of Bern in
Switzerland, decided to act upon this and in turn launched the virtopsy project. The
purpose of this project was to implement modern imaging technologies into present
day forensic practice. These techniques comprised of three dimensional
photogrammetry and surface scanning to document injuries. In 2002, Thali et al.
coined the expression ‘virtual autopsy’ (Thali et al. 2000)
A study was done by Thali et al. to survey whether the evolution of imaging methods
had made it likely to build up an eyewitness autonomous and reproducible forensic
appraisal utilizing multi-slice computed tomography (MSCT) and magnetic
resonance imaging (MRI) for the documentation and examination of gunshot
wounds. The bodies of eight gunfire casualties were examined by MSCT and MRI;
the information of these imaging systems were post-prepared, reasoned and
afterward interrelated with the discoveries of conventional post-mortem examination.
The entire shot made complex skull cracks and cerebrum wounds, (such as, wound
channels and profound bone fragments) and these were evidently shown utilizing
both MRI and CT as part of a distinctive point of interest. CT and MRI additionally
demonstrated an indispensable response to the gunfire by showing air emboli in the
heart and veins. Gunfire deposits inside and beneath the skin were likewise seen
(Thali et al. 2003)
After conducting the study, Thali et al. concurred with Brogdon and settled on the
fact that; the more forensic pathologists and radiologists bring together their
knowledge in the area of forensic radiology, investigative efforts would be improved,
and would be able to expand forensic horizons. Thali et al. concluded that more
research was needed to be conducted pertaining to the use of CT and MRI in post
mortem cases, in order to analyse these imaging techniques in forensic medicine
(Thali et al. 2003)
After performing the study on the eight gunshot victims, Thali et al further came to
the conclusion that radiological methods of MSCT and MRI poses the potential to be
introduced in the not too distant future as a ‘‘virtual autopsy’’ instrument. (Thali et al.,
2003)

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The first forensic use of CT was a report on the course of action of a shot injury to
the head by (Wullenweber et al, 1977). On account of the deficient picture quality,
resolution and poor post-processing results in the early years. Just a couple of
studies concentrated on relating pathologic discoveries of after death CT with
forensic post-mortem autopsy results (Donchin et al., 1994).
Various authors’ opinions differ on whether or not virtopsy should replace the
conventional autopsy. According to Miller, post mortem imaging will certainly not
replace the diagnostic information acquired from a conventional autopsy (O’Reilly,
2014)
Prof. Dirnhofer contends that sooner rather than later 3D matching could get to be as
normal in courts as DNA matching. Virtopsy can possibly displace the traditional
autopsy one day, he believes that it will be a step by step process, similar to DNA
investigation, which slowly replaced blood group analysis (Honigsbaum, 2013)
Honigsbaum in 2013, via a published article, addressed the question of whether or
not the introduction of virtopsy would spell the end of the traditional autopsy.
Honigsbaum in this case questions the ability of virtual imaging to see through bone,
skin and soft tissue in order to detect certain cases such as bullet fragments that are
easily overlooked by conventional pathologists using only a scalpel and the human
eye. Honigsbaum goes into detail on how virtopsy works and what it encompasses
and comes to the belief that virtual imaging would be able to detect bullet fragments
in soft tissue.
Patowary, 2008 acknowledges the significance of using radiology to discover certain
diseases after death, but settles that radiology is incapable of replacing the
conventional autopsy. Patowary suggests that the differences in the ante-mortem
radiological findings as well as the post-mortem findings demand further in-depth
study. In addition, there may be post-mortem artefacts and it may not be probable to
differentiate between the ante-mortem and the post-mortem phenomenon which is
only conceivable by naked eye examination and many a time by histopathological or
histochemical means alone (Patowary, 2008).
Various articles and journal (published and not published) supporting the utilization
of cross-sectional imaging in post mortem examination has to date focused on
trauma related death, including head damage (Yen et al., 2007), neck harm because
of hanging or strangulation, suffocating, (Levy et al., 2007) haemorrhage from
cracked inner organs or vessels, and in addition the way and impacts of infiltrating
shots on the internal organs and bone (Jeffery et al., 2008).
The importance of this imaging in non-traumatic death is as of late, still being
discovered, (Shiotani et al., 2004) yet in the event that the impact of such imaging on
clinical practice is rehashed, then there is the a plausibility for CT and MRI to
substitute for autopsy in situations of sudden and unforeseen demise (Rutty, 2007).
It might, for instance, be an answer for the pathologist and coroner where there is

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complaint relating to autopsy by families on ethical and moral grounds or where
labour assets restrict the capacity to perform a post-mortem examination. CT
scanning can likewise can be utilized for picture guided biopsy of organs or mass
injuries, when post-mortem examination is not concurred or arranged, especially
when histological material is required by the pathologist (Aghayev et al., 2007).

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2. Introduction:
The principal motivation behind forensic medicine is to report, contemplate, and clear
up medical discoveries in both the living and the dormant individuals comprehensibly
for court presentation. In perished persons, the principle objectives are to decide the
cause and manner of death, to assess the essentialness of the sustained wounds,
and to build up a measurable forensic recreation in light of the discoveries. The
documentation of forensic pathologic discoveries is still transcendently in light of the
same autopsy strategies and conventions that have been utilized for centuries. The
most usually utilized apparatuses are a surgical tool, verbal depiction, and routine
two-dimensional photography (Lundberg, 1998.) Forensic discoveries are in this
manner reported in an unintentionally subjective way. For a long time, the use of
imaging strategies for objective non-destructive documentation of relevant forensic
discoveries has fallen a long way behind the specialized improvement of the imaging
techniques themselves. There are just a couple of reading material accessible that
are associated with forensic radiology, a large portion of which focuses on routine
radiography, but does not discuss fresher cross sectional imaging methods, for
example, computed tomography (CT) and magnetic resonance imaging (MRI) in
subtle element. The tragic truth is that a century after the principal x-beam was
presented as proof in a court of law, there is no broad appreciation as regards to the
potential of radiology in forensic sciences (Brogdon, 1998)
An autopsy is a very expert surgical method that comprises of a comprehensive
examination of a corpse to decide the reason and method for death and to evaluate
any damage or infection that exists. Virtopsy is a word joining "virtual" and "autopsy"
and utilizes imaging techniques that are routinely utilized in clinical medicine, for
example, computed tomography (CT), magnetic resonance imaging (MRI) and
miniaturized scale radiology with an end goal of examination and to determination of
the reason for passing (Tejaswi, 2013). Virtopsy likewise includes 3D body surface
documentation by means of forensic photogrammetry and 3D optical scanning. The
resulting information set envelops high-determination 3D colour encoded
documentation of body surface and 3D volume documentation of inside of the body
(Dirnhofer et al., 2006). The radiological imaging methods, for example, CT and MRI
have accomplished gigantic advances in the previous decades (Balfe and Ehman,
1998). The after death CT and MRI examinations have as of now been presented in
the field of post mortem diagnostics. The inquiry has emerged over and over of
whether these new virtual examination procedures can supplant or upgrade the
conventional autopsy (Bolliger et al., 2005). Although; forensic sciences were
enhanced by the presentation of new imaging strategies, amid scientific post-mortem
examinations, the reason for death continues to be explored by way of conventional
techniques; by dismembering, describing and recording (Cha et al., 2010).
The forensic autopsy is not only a demonstration of anatomical dismemberment. It
joins an extensive variety of master examinations involving histology, microbiology,
toxicology, organic chemistry, DNA investigation, dentistry, human sciences,

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evidence gathering, and photography (Brogdon, 1998). Radiographic examination
utilizing plain films and fluoroscopy has for quite a while been utilized to archive
fractures, especially in those zones not without difficulty seen during standard
dissection, and the restriction of outside material, such as projectile fragments.
Arrangement of individual example contact radiographs (cervical spine, hyoid bone,
larynx, and ribs), confinement of unusual gas accumulations (pneumothorax and air
embolism), and recognizable proof of the deceased are other applications frequently
utilized by pathologists. (O'Donnell and Woodford, 2008)
It was recommended that the standard post-mortem examination, today regularly
taboo by relatives or not recognized by religions, may be substituted by non-
obtrusive imaging documentation and, when obligatory, by possibly intrusive
imaging-guided tissue testing and by angiography to address vascular inquiries. The
digitally accomplished information could be re-counselled at any point when new
inquiries emerge or could be sent to different specialists for a brief moment
conclusion. The idea of target, non-obtrusive documentation of the body surface for
legal purposes emerged in the mid-1990s with the change during the time spent
improving making maps or scale drawings from photos (Dirnhofer et al, 2006)
On a basic level, all clinical use of radiologic techniques can likewise be utilized for
forensic purposes. Diagnostic imaging is still underused in criminology, mainly
because of unawareness of its potential and the absence of educating and
experience (Kleinman, 1990).
The whole reason for the Virtopsy venture was to accept this new approach by
efficiently looking at the radiologic and surface scanning discoveries with those
obtained at conventional autopsy. The new strategy ought to have the capacity to
figure out if demise was the aftereffect of regular causes, mischance, suicide, or
crime. The necessities on radiological post-mortem examination were to be
indistinguishable with those of customary medico-legal post-mortem examination, in
particular to report and depict the accompanying five legal important focuses:
1) Atrium mortis (i.e., a pathophysiological recreation and clarification of the
reason for death).
2) Relevant forensic findings in the bones, tissues, and organs.
3) Vital responses illustrating the succession of harm and death: in scientific
obsessive examinations, the inquiry whether an injury was acquired before or
after death is regularly an essential matter. The response to this inquiry lies
with discoveries that just happen with intact circulation (e.g., deadly
haemorrhage, air and fat embolism, cutaneous emphysema) and respiration.
These discoveries are termed "forensic vital responses."
4) Based on Points I–III, reconstruction of injuries with regard to force,
biomechanics, and dynamics.
5) Recapitulation and perception of the atria mortis conceivable to both laymen
and specialists in a courtroom, in this way taking into account target

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assessment of medicolegal reports and fair appreciation about a specific
case. (Yen, 2003)
In Virtopsy, there is blend of the advances of medical imaging methods and
additionally different innovations utilized as a part of other field of science.
 3-D surface scan utilized as a part of the automobile designing is utilized
to delineate the exterior of the body. It gives and records the three
dimensional picture of the body surface region in points of interest.
 Multi-slice computed tomography (MSCT)
 Magnetic resonance imaging (MRI) – which pictures the inside of the body
for gathering of the considerable number of information in points of
interest in respects of state of various organs. One can look at the part of
the body cut by cut in various planes as per the necessity of the
circumstance. Aside from these, utilizing the magnetic resonance imaging
spectroscopy, time since death can likewise be assessed by measuring
metabolites in the mind, developing amid posthumous decay. The
specimens for histopathological examination if required can be gathered
all the more correctly utilizing CT guided needle biopsy. After death
angiography is utilized to envisage the cardiovascular framework
(Patowary, 2008)
The objective of this study is to assess the value of CT and MR imaging as analytic
devices for their utilization in routine forensic examination of deceased persons and
to research the potential advantages and confinements of the imaging strategies in
correlation with autopsy and further talk about whether it ought to supplant the
customary post-mortem autopsy.
First of all, this study will present the history and background of virtopsy. It, will aid in
further understanding what virtopsy is and how it continues to progress in its use to
back up conventional autopsy findings. Secondly, this study will demonstrate the
different techniques involved in virtopsy i.e. CT, MRI, Angiography, biopsy and
ultrasound technology. Finally, the study will also highlight the advantages and
disadvantages of both techniques as they both have drawbacks although there are
many benefits hence the reason of both techniques being popular in supporting
evidence in crimes. A case study is also demonstrated to highlight the usefulness of
both techniques and aid in their comparison. Further evidence portraying which
technique is better suited for post-mortem examination will be analysed relating to
how these techniques are capable of giving important information to examiners.

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3. Methodology:
Previously published data will be reviewed primarily through the university library
using a range of information sources such as academic and commercial abstracts,
bibliographic databases, and Internet search engines i.e. google scholar, science
direct, NCBI, Wiley online library and PubMed.
Keywords used:
Post mortem imaging, virtopsy, autopsy, virtual imaging, imaging autopsy, scalpel
free autopsy, post mortem radiology, post mortem CT, post mortem MRI.
This study aims to describe in detail the imaging modalities used in virtopsy and
highlight their uses along with their drawbacks and advantages. Case reports
whereby both conventional autopsy and virtual imaging has been conducted will be
used to compare the usefulness of the two techniques and which one is best suited
for forensic investigation of corpses.
The information acquired from previously published literature will be used to help
summarize the two techniques and also provide potential areas for further research.

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4. Advantages and disadvantages:
4.1 Advantages:
Firstly, it is a surgical blade free non-intrusive imaging procedure so no danger of
diseases from the blood or other tissue fluids. It likewise implies that it doesn't
require endorsement from relatives on the grounds that the carcase is not the
slightest bit mangled. (Thali, Dirnhofer and Vock, 2009) The non-dangerous nature
of post mortem imaging takes into consideration a predominant examination of
hugely pulverized bodies (e.g. hit by train or burnt bodies); examination of risky body
territories for customary dissection, for example, the pelvis or the neck, a body can
be scanned completely with no danger of diseases e.g. tuberculosis (Zimmermann,
2011)
It can be digitally put away for quite a while and can be even transferrable over the
web for a specialist second opinion (Sharma et al., 2015). The capacity to do
rehashed examinations of the generated pictures makes virtopsy especially
charming as the assessing doctor can return, reassess, and re-sanction (counting
three-dimensional reproductions) the same data without losing any of the significant
pathologic data everlastingly (Stawicki et al., 2008) This thus permits a computerized
re-assessment of the body and a likely crime e.g. instances of a retrial or all over
again evidentiary hearings. Since the condition of the body can be inspected at
whatever time after the liberation of the crime scene, interment or rot of the body
even years after the fact will have no impact on revaluating virtopsy information as
exhumations will regularly be unnecessary (Zimmermann, 2011)
Presently, many people treat the body as the only representation of the departed, the
representation of the deceased individual’s life. Autopsy abolishes this great symbol.
Some family and religious conditions may necessitate definite time limits for autopsy,
or limit it to external examination. It should be remembered that autopsy, unless
legally required, is strictly forbidden within some major religions i.e. Islam and
Judaism. In many cultures, not only Islam, autopsy is considered to be damaging,
invasive and discourteous towards the corpse. Virtopsy negates a number of these
issues as it is non-invasive and time efficient so can be widely accepted by these
cultures (Mohammed and Kharoshah, 2014)
A basic advantage of after death cross-sectional imaging of the body before autopsy
is the capacity to document the whole body in situ. In accomplishing this, the
discoveries might be assessed, before any deviations in the position of the organs
and tissues unfold. This is primarily noteworthy for discoveries such as, mediastinal
movement and pneumothorax, additionally for pleural radiation. It is likely that both
the appearance and the number of these discoveries will be changed amid the
segment of the thoracic cavity, even before they have been perceived and
evaluated. This may clarify a portion of the contrasts amongst post-mortem
examination and radiologic examinations (Aghayev et al., 2008)

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Post mortem imaging has various favourable advantages over autopsy alone. It
yields high resolution exhaustive pictures of the body, and additionally, areas that
may not be readily available to the prosecutor. Post mortem imaging permits
documentation of abnormalities and wounds without the tissue obstruction forced by
an autopsy (Nolte et al., 2011). What's more, the picture orientation (planes) and
relative complexity of various tissues can be controlled to better envision diverse
sorts of pathology. Three dimensional (3D) picture developments are additionally
conceivable with the appropriate programming (Nolte et al., 2011). A few late studies
have thought about the utilization of post mortem imaging with autopsy in injury
assessment. There were variable agreements between autopsy and CT findings,
and CT was able to detect many injuries that were not found at autopsy (CH, 2013)
After death imaging, specifically 3D picture development, has high potential value in
court, in that it would give "bloodless" and effortlessly reasonable representations of
injuries (Nolte et al., 2011).
Since CT can be done rapidly, it is particularly valuable in emergency trauma
circumstances, demonstrating any anomalies in mind structure including cerebrum
swelling, or bleeding emerging from burst aneurysms, haemorrhagic stroke (a
cracked vein), and head injury. (Asbury, 2011)
Notwithstanding when autopsy is to be performed, pre-autopsy CT allows the
pathologists to arrange parts of the procedure in advance by identifying plausible
dangers, for example, tuberculosis or sharp metallic articles; unequivocally
pinpointing foreign bodies, for example, slug pieces; and once in a while,
prognosticate the need to approach the closest relative and coroner preceding
autopsy concerning particular organ and tissue maintenance. This relates particularly
to the brain; an organ requiring amplified formalin fixation for ideal neurotic appraisal
(O'Donnell and Woodford, 2008)

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4.2 Disadvantages:
There are a few restrictions when it comes to post mortem imaging, for example, its
insufficiency to become aware of every likely situation of death (Mahesh and Kumar,
2015) Even though CT and MRI are transcendently invaluable in traumatic injury
documentation, foreign body imaging and identifying gas accumulations are less
exact with some common ailment procedures, for example, cardiovascular disease
(CH, 2013)
Irrefutably, the general autopsy offers what any imaging strategies is yet to be able
to do; because of constrained tissue resolution by current scanning modalities and
the powerlessness to show organ colours. The pathologist can abuse the utilization
of their tangible modalities amid the autopsy. They can see colours and palpate to
acknowledge contrasts in compositions. For instance, a pathologist might have the
capacity to identify sub-periosteal bleeding around a hairline rib fracture which the
radiologist can't because of restrictions in picture orientation (Koo, 2010).
Beyond question, an unlimited number of clinical radiologists will have practically
zero involvement in comprehension of post mortem pictures and the injuries
ordinarily found in a forensic setting. In like manner, most currently, practising
forensic pathologists will have minute or no practice in the elucidation of cutting edge
imaging amid post-mortem examination. In this setting, after death, radiology will
require experience and training (O'Donnell and Woodford, 2008)
Although crushing traumatic wounds might be obvious on imaging post-mortem
examination, reasons of death as a consequence of specific therapeutic conditions
e.g. metabolic scatters may evade even the most significant imaging methods.
Likewise certain errors from imaging antiquities on post mortem CT/MRI studies are
as yet still being investigated, and the effect has not been elucidated totally (Stawicki
et al. 2008)
Unfortunately, distinct respectably minor yet critical discoveries can be "missed" on
imaging analysis; a problem that is less inclined to happen as cutting edge radiologic
procedures keep ondeveloping and their accuracy increases.

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5. Components of virtopsy:
Less intrusive autopsy is a procedure that comprises of all non-obtrusive (e.g. outer
examination of the body, placental histopathology, metabolic testing, hereditary
testing, x-beam examination, CT and MRI examination) or negligibly intrusive (e.g.
biopsies) constituents of after death examination, with the exception of open
dismemberment for direct interior examination of the instinctive organs, to which the
vast majority of people would question. Metabolic and hereditary testing can be
frequently performed on effortlessly acquired tissues like skin, muscle or placenta, or
from blood spots. It is possible that histological examination of most interior organs
can be performed by percutaneous or endoscopic strategies, however such
procedures require further acceptance (Thayyil, 2010)
Below is a list of the various techniques used in post-mortem imaging and a
description of what they are and how they work.
5.1 Computed tomography CT for 3D imaging:
CT was brought about in the early seventies as the first imaging system allowing a
perspective of within the human body without dismemberment. This innovation
utilizes unique x-ray equipment to get three-dimensional anatomical pictures of bone,
delicate tissues and air in the whole body, including the head. An x-ray emitter is
pivoted around a patient. It quantifies the beams' intensities from various points. For
cerebrum imaging, various X-ray shafts are passed through the head at various
edges. Extraordinary sensors measure the amount of radiation that is consumed by
various tissues. At that point, a PC uses the distinctions in X-ray assimilation to
create cross-sectional pictures or "cuts" of cerebrum called "tomograms" (Asbury,
2011)
CT utilizes the same strategy as radiography uses to deliver x-rays. However, to get
transverse pictures of body areas, the tube pivots around the longitudinal hub of the
body, transmitting radiation from angular positions through the body from numerous
edges. X-rays are retained by 'radiographic density' of tissues. (Payne-James,
Busuttil and Smock, 2003)
The primary criminological use of CT, was a record of the pattern of a gunshot
wound to the head by Wullenweber et al in 1977. Because of restricted picture
quality, resolution and weak post-handling results in the beginning, just a number of
researchers (Donchin et al. 1994 and Schumacher et al. 1983) correlated pathologic
revelations at full-body after death CT with routine post-mortem examination
discoveries. All the same, the presentation of spiral CT by Kalender et al in 1989,
which opened the entryway for three-dimensional information accomplishment and
handling, did not definitively upsurge the attention of scientific researchers to this
new methodology (Dirnhofer et al. 2006)
Post mortem CT outputs are exhaustively utilized as part of scientific cases and
traumatic wounds, fundamentally in mass fiascos as a screening system and for
casualty identification. Skeletal wounds can be competently shown in the court and
to lay persons by 3D volume rendering methods. (Thayyil, 2010)

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5.2Angiography
Post mortem angiography is being utilized increasing in forensic medicine, and
specialists, and researchers a part of the Virtopsy project in Bern, Switzerland have
been actively occupied with achieving suitable and negligibly intrusive strategies for
this reason, the primary exploration started in 2004. In 2005, Jackowski et al
reported preliminary findings of another strategy of less intrusive whole body post
mortem CT-Angiography. The idea of these analyses was to perform a PMCTA that
resembled clinical CT-Angiography conditions. With the idea of these propositions
came the thought of making a "post mortem circulation", which would allow perfusion
of the body (Grabherr, 2009)
Unenhanced post mortem imaging was considered to be insufficient in perception of
vascular pathology and was constrained to the exhibition of major vessel wounds
(Shiotani et al. 2004 and Aghayev et al. 2005). For the post mortem angiography an
unmistakable differentiation medium is perfused by means of various sections to
vessels by a modified heart-lung machine and a perfusion set. The small and also
the large circulatory framework may be shown venally or arterially (Aghayev et al.
2005)
After death angiography has its difficulties as various post mortem phenomena make
troublesome the utilization of clinically affirmed contrast operators and keeping in
mind the end goal to defeat this disadvantage a negligible intrusive angiography
procedure utilizing an iodinated contrast agent and multi-cut CT was utilized by
Jackowski et al. in 2005.
With the introduction of multi-detector CT into after death examinations and the
objective to improve the PMCT by contrast agents, new research began with the
point of joining PMA with PMCT. For example, in clinical practice, CT-angiography
(CTA) is the most broadly utilized technique as a part of the disclosure and
localization of clinically dynamic haemorrhages of an obscure source (Kennedy et al.
2010). It is likewise the method of choice for the assessment of coronary conduit
ailment in acute and chronic cases (Deo and Albert, 2012)
The 3D reproduction of CT angiograms has conveyed to light points of interest and
rendered promising estimations that were already not in any case imagined. The all-
around informed use with respect to after death angiography will change the
assessment of the vascular framework and enhance the nature of post mortem
anatomic, pathologic, and forensic analyses (Grabherr et al. 2007). This strategy has
figured out how to make radiant three-dimensional perception of stenosis,
impediment, or minor vessel injuries for scientific purposes, furthermore the entire
blood vessel framework in a minimally intrusive design as longed for.
Disappointingly, later phases of rot forbid a systemic, negligibly intrusive
angiographic examination for two reasons: the spoiled and powerless vessels of the

SID: 1340713 Page 18 of 43
digestive tract and pancreas can't withstand the required infusion pressures
(Jackowsk et al. 2005), and the rotted gas inside the vascular framework causes
filling imperfections (Thali et al. 2003)
Fig 1. Arterial and venous postmortem CT angiography of the thorax and abdomen.
Coronal postmortem maximum intensity projections obtained after arterial (a) and
venous (b) injections of contrast medium show a detailed depiction of the
thoracoabdominal vasculature. Note that arterial enhancement decreases during the
15-minute interval between the two injections, which allows almost distinctly
separate imaging of the arteries and veins. (Ross et al. 2014)

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5.3 Biopsy
As of today, neither CT nor MRI can give tissue data on a cellular level in a non-
obtrusive way, too diatom identification, DNA, bacteriological, chemical toxicological
and other particular tissue examinations are inconceivable utilizing radiology.
Interestingly, insignificantly obtrusive removal of tissue probes is an everyday routine
in clinical medicine. Aghayev et al. suggested that after death less obtrusive tissue
testing utilizing needle biopsies under CT direction may altogether improve the
capability of virtual autopsy. The reason for this study was to test the utilization of a
clinically endorsed biopsy needle under MSCT direction for post mortem tissue
inspection (Aghayev et al. 2007)
Various authors concur that needle examinations are an insufficient substitute for
traditional post-mortem examination, yet they considered it as a significant
instrument when assent for full post-mortem examination was not acquired (West
and Chomet, 1957) (Baumgart et al., 1994) (Foroudi et al., 1995). On numerous
occasions some researchers have reopened the interest for post mortem tissue
examination, depicting its advantages in correlation with ordinary autopsy
(Underwood et al., 1983 and Huston et al., 1996)
A majority of the researchers honing needle examinations, recognized the battle in
acquiring samples from sought after organs or their parts, which made the analytic
steadfastness of the strategy poorer than that of routine autopsy (West and Chomet,
1957), (Foroudi et al. 1995), (Guerra et al., 2001) and (Underwood et al. 1983) In
2001 Farina et al. were the first group of researchers who connected an imaging
technique i.e. ultrasonography, to get tissue samples in forensic medicine (Farina et
al., 2002)
The thought to utilize CT guidance for post mortem tissue examining was created
with the development of CT and its introduction to forensic medicine. In the previous
couple of years, various publications have showed up in the literature highlighting the
unwavering quality of CT as a documentation, representation and investigation
apparatus in legal medication (Thali and Vock, 2003), (Aghayev et al. 2005) and
(Donchin et al. 1994). CT at present is the most habitually utilized technique for
direction of biopsy needles. Fig 2 below shows a post mortem picture guided biopsy.
This method doesn’t just takes into account tissue samples to be gotten, but,
additionally samples of blood, urine for toxicology and DNA examinations (Thali et
al., 2003)
The primary advantage of after death biopsy examination, effectively brought up by
Terry, 1955 is the negligibly obtrusive expulsion of tissues of organ. Tissue testing by
needle requires a great deal less time than customary examination (Terry, 1995).
This is of extraordinary use when a tissue test is required promptly after death and
when posthumous dissection is deferred for various days either as an aftereffect of
weight of work or statutory occasions (Slack et al. 1973). Basic tissues, e.g. the liver,
might be succeptible to quick after death autolysis. As indicated by Aranda et al., an
imperitive situation for enhanced histological specimens is abbreviated after death
interval (Aranda et al. 1998)

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Biopsies significantly bring down the danger of contamination to the scientific
pathologist and funeral home orderlies included, this is vital, particularly in instances
of bio terrorism (Lucas, 1993). A toxicological examination of the acquired body
fluids i.e. blood, urine and cebrospinal fluid is additionally a diagnostic probability
(Dirnhofer, 2003)
Fig 2. Post-mortem imaging-guided biopsy, left lateral 3D CT image clearly depicts a
biopsy needle that was inserted into the brain through a hole bored into the skull.
The linear blue object on the left side of the image represents a metallic part of a
denture (Dirnhofer et al. 2006)
5.4 Ultrasound Technology
Ultrasounds are being used in numerous clinical circumstances; what’s more, it is fit
for producing pictures of anatomical structures like cardiovascular assessment,
tumours, abscesses, vascular structures, strong organ evaluation, and pregnancy,
and that’s only the tip of the iceberg (Mahesh and Kumar, 2015).
The likelihood of utilizing ultra sounds to help as a part of after death examination
might be utilized to asses’ different organs, pleural effusions and pleural air,
cardiovascular and pericardial variations from the norm and skeletal wounds. A little
number of autopsy reports have utilized ultrasounds; this innovation may offer
supplementary backing in noting scientific inquiries relating to precarious processes
of reason for death (Mahesh and Kumar, 2015)

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6. Case 1: A rare case of suicide by gunshot with nasal entry
assessed by classical autopsy, post-mortem computed
tomography (PMCT) and post-mortem magnetic resonance
imaging (PMMR)
The following case report done by Abdul Rashid et al. 2013 presents a rare case of a
suicide by gunshot through the nose with classical autopsy, post-mortem computed
tomography (PMCT) and post-mortem magnetic resonance (PMMR) findings.
Suicidal shooting through the nose is vastly uncommon. In cases of suicide by
firearms some valuable facts are the position of entry wound, the route of the internal
projectile path and the circumstances of death. Post-mortem imaging plays an
important role in the analysis of gunshot fatalities prior to autopsy. Plain radiographs
can be utilized to document fractures and pinpoint projectiles (Oehmichen, Meissner
and König, 2001) This study demonstrates these points in a case of a suicidal
gunshot through the nose by conducting a post-mortem assessment by means of
classical autopsy, PMCT and PMMR.
6.1 Case history:
A 52-year-old man was found unconscious flat on his back by a passer-by in a
forest. His wife had reported him missing earlier that day. The man had a history of
depression. Paramedics were called to the scene and their first discovery was a
wound on the face. Upon moving the body they discovered a small calibre weapon
(Semiautomatic Astra Cub.22 short, 6.35 mm) under the man’s body. The guns
safety was not on and a single unfired bullet was found in the gun chamber along
with a brass casing found at the scene. A CT scan of the man’s head was done on
arrival to the emergency department which in turn displayed a left subdural
hematoma with a metallic foreign body in the left posterior cranial fossa, suspicious
for a bullet. Surgery was not performed due to the man’s condition, and he passed
away 8 hours later.
A preliminary forensic inspection at the hospital showed a V-shaped wound above
the left nostril with some ragged blood crusted and dark red to black edges. The
circumstances of death and CT findings revealed the nasal wound to be the entry
wound. Gun powder was also detected on the nasal wound, confirming the entry
point. There was no exit wound. Two relatively small fresh scrapes and an orbital
haematoma were noted over the right nostril. Small abrasions were also seen on the
forearms, hands and on the middle of the right leg.

SID: 1340713 Page 22 of 43
SRT test for gunpowder residue was positive on both hands. No suicide note was
found at the scene, but based on the state of affairs of death; the investigators
alleged that he could have been a casualty of suicide.
6.2 PMCT Results
PMCT examination of the skull and neck uncovered an entrance gunshot wound in
the left nostril. The projectile tract passed through the left nasal passage and
crossed the left frontal lobe (Fig 3a). Millimetre-sized bone fragments were found in
the path through which projectile travelled. Blood was seen in both the maxillary and
ethmoid sinuses. The bullet bounced back on the inner table of the left frontal skull
and progressed through the left cerebral hemisphere from anterior to posterior (Fig
3b) PMCT did not detect a fracture on the left frontal bone, nor did it show an exit
wound. The ultimate position of the bullet was above the left tentorium (Fig 4a)

SID: 1340713 Page 23 of 43
Fig 3. (a) PMCT images in sagittal with bone window and (b) axial planes with soft
tissue window showing the projectile track (dashed red arrow) and the projectile in
posterior cranial fossa (black arrow). Note the pneumocephalus as indicated by the
white ‘x’ and the left subdural hematoma (black arrow head) causing midline shift to
the right (Abdul Rashid et al. 2013)

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Fig 4 (a) PMCT image in sagittal plane with 3D reconstruction showing the final
position of the projectile (white arrow). Dental artefacts are also demarcated by the
blue metal signal with (b) autopsy photograph of the projectile in the left occipital
lobe as indicated by the yellow arrow head (Abdul Rashid et al. 2013)
6.3. PMMR Results
The bullet route was observed crossing the left frontal and parietal lobe resulting in
an irregular, cavitary defect in the brain tissues. There was associated hyper-intense

SID: 1340713 Page 25 of 43
signal noted along this tract, observed on both the FLAIR and T2W imaging, in
keeping with cortical contusion and edema (Fig 5a). Both the basal ganglia and
thalami displayed high signal on T1W images and low signal on both T2W and
FLAIR imaging, in keeping with normal post-mortem changes. Additionally, pivotal
lesions were also present in the left caudate nucleus, left basal ganglia, left cerebral
peduncle and both frontal and temporal lobes. Left subdural hematoma with
subarachnoid haemorrhage causing midline shift to the right was evident.
Pneumocephalus in the left frontal region was also evident. The projectile was noted
in the left posterior cranial fossa and causing metallic (susceptibility) artefact to the
surrounding tissues.

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Fig 5 (a) FLAIR PMMR image in axial planes (dashed blue arrow) with (b) autopsy
correlation showing the projectile pathway through the left parietal lobe and the left
sided subdural hematoma (Abdul Rashid et al. 2013)

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6.4 Autopsy Results
A conventional autopsy was done 36 hours after death. The wound on the left side of
the nose alluded to the point where the bullet entered. Gun powder residue was
found on the nasal wound during the autopsy. A bullet impression part with a small
amount of metal abrasion was detected on the inner table of the left frontal
skull.There were no skeletal fractures observed in this area. A marginally deformed
bullet could be seen resting on the left occipital lobe (Fig 4b). The left side of the
brain exhibited severe damage, with a subdural hematoma and brain edema (Fig 5b)
6.5 Discussion
Gun powder particles confirmed the presence of an entry wound. This was backed
up by CT imaging discovering a bullet in the brain. Suicide by gunshot through the
nose is exceptionally uncommon, with only two described cases in literature (Lee
and Opeskin, 1995) and (Rafailov et al. 2008)
In this case, there was no history of prior suicidal attempt, suicidal ideation, history of
personal enemies or suicidal note found at the scene and the histories of depression,
firearm at the scene, lack of defensive injuries were all indicative of death by suicide
rather than homicide.
PMCT and PMMR visibly demonstrated the bullet location, wound tract and damage
to the skull and brain prior to autopsy. PMCT is advantageous in discovering the
path of a projectile through the body (Thali et al. 2003) and (Andenmatten et al.
2008).
CT is superior to MRI in the forensic documentation of bone injury. Consequently
PMCT is exceptional in demonstrating the osseous entry and exit wound as well as
the bullet. Alternatively, PMMR excels in its fantastic expression of soft tissues (Thali
et al. 2003). Anatomy of the bullet area and brain structures is well observed on MRI.
Nevertheless, as a result of the metal-induced artefacts, the bullet was not
visualized.
Post-mortem imaging has numerous benefits compared to the conventional autopsy
because of its limitless storage of the scanned data with the prospect of 2D and 3D
reconstruction even years after the initial documentation, virtual dissection in varying
planes and separation and reproducibility (Thiex, Thron and Uhl, 2004).
This case exemplifies that PMCT and PMMR are capable of answering several
significant forensic questions in a complex gunshot fatality. Imaging demonstrated
the fracture patterns/osseous injury, bone fragmentation, brain contusion, laceration
and edema as well as the projectile tract and location in 2D and 3D. Though, PMCT,

SID: 1340713 Page 28 of 43
in contrast to autopsy has some limitations, it was incapable of detecting soot or
gunpowder residue, it could not fully portray the dermal entry/exit wound alterations
without high resolution surface scanning and didn’t offer direct access to the bullet, a
regular occurrence with small calibre, low energy weapons. Additionally, it also turns
out to be less precise with high velocity and/or multiple gunshot zones particularly in
the chest and abdomen (Abdul Rashid et al. 2013)
In this case, post-mortem imaging acted more as an adjunct to conventional autopsy
in gunshot fatality related cases as autopsy is mandatory due to its medico-legal
implication.

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7. Case 2: Virtopsy: CT and MR imaging of a fatal head injury
caused by a hatchet: A case report
Hatchet hits to the human skull on numerous occasions result in tragic wounds.
Ampanozi et al. presents an instance of manslaughter by hatchet blow that was
liable to CT, MRI, and autopsy examination. Skull discontinuity, break lines, and
brain injuries were shown prior to autopsy. A hefty portion of the hatchet particular
attributes (chipping, pounding, shattering, and crack lines) portrayed in literature
were seen in the post mortem imaging of this case.
A great deal of reconstructive inquiries come to fruition when managing such a case.
A forensic pathologist was called upon to clarify the cause and manner of death, the
number of hits to the skull, the angle of impact and the sort of weapon utilized. CT
turned out to be an exceptionally valuable device in the examination and
comprehension of skull cracks and wounds (Oesterhelweg et al. 2007). Likewise,
various publications have depicted that MRI empowers reliable imaging of delicate
tissues and brain tissues that can be connected to traditional autopsy (Yen et al.
2007) and (Thali et al. 2003).
In various cases, routine autopsies are not fruitful in totally recording fine cracks of
the skull e.g. facial bones. Autopsies are likewise not able to convey three-
dimensional data on the dissemination of bone parts inside the brain; this data is
exceptionally important with regards to recreating a fatality (Oesterhelweg et al.
2007).
7.1 Case History:
A lady was struck by her life partner with a hatchet (Fig 6) and hence passed away
as an aftereffect of the wounds forced on her head. The cadaver was taken to the
Institute of Forensic Medicine at the University of Bern and was inspected utilizing
CT and MRI before leading an ordinary post-mortem examination.

SID: 1340713 Page 30 of 43
Fig 6. The 600-g hatchet found at the crime scene (Ampanozi et al., 2010).
7.2 CT results
Various skull breaks and an excess of bone parts were seen around and in the
inside of the cranial cavity (Fig 7) Disintegration and shattering was apparent
alongside a few bone sections which had all the earmarks of being forced in at the
weapons entry point, symbolizing a staggering effect (Fig 7c). On examination of the
obtuse and angled sides of the kerfs, chipping was seen on the acute angled side
and an absence of chipping was noted either side of each wound (Fig 8) Fracture
lines identified on the skull generally extended over the limits of the injury (Fig 7 an
and b)
Fig 7. Three-dimensional reconstruction of the post-mortem computed tomographic
imaging data. (a) Multiple fracture lines (arrows) with shattered bone fragments
(arrowheads) at the anterior side of the skull. (b) Fracture lines (arrows) at the
posterior side of the skull. Note that the primary hatchet-blow wound is shown by the
line. (c) Multiple bone fragments entering the brain cavity (arrows) (Ampanozi et al.,
2010)

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Fig. 8 Hatchet wounds on the skull. Three-dimensional reconstruction of post-
mortem computed tomographic imaging data. Arrows indicate flaking on the acutely-
angled side, and arrowheads indicate the absence of flaking on the obtusely-angled
side of the wound (Ampanozi et al., 2010)
7.3 MRI results
Brian damage as an aftereffect of injury are best noted utilizing MRI examination
(Yen et al. 2007). Fig 9 depicts CT, MRI, and autopsy examination pictures of an
indistinguishable part of the cerebrum. X-ray examination demonstrated dynamic
brain injury and haemorrhage, and delivered a hyper-intense sign in the front and
parietal territories of the left hemisphere (Fig 9) moreover, a hematoma was noted
(Fig 9) in both MRI and autopsy.
Fig. 9. (a) Computed tomography (CT), (b) T2 weighted magnetic resonance imaging
(MRI), and (c) autopsy images. Note that the left hemisphere brain injury (arrows)
and the occipital trauma (arrowheads) are clearly observable in MRI and autopsy
images but not well differentiated (circle) in the CT image (Ampanozi et al., 2010)

SID: 1340713 Page 32 of 43
7.4 Autopsy results
Post-mortem examination was led a day after CT and MRI were finished. Post-
mortem examination of the trauma area affirmed the revelations of the two imaging
modalities Fig 10 (a) and (b) outline the skull breaks as seen utilizing CT imaging
and au optically via autopsy. CT imaging was built up to be prevalent in deciphering
the exact amount of fragments and the event of flaking in bone injuries. The
cerebrum wounds noted at autopsy concurred with MRI discoveries.
Fig 10. Hatchet-blow to the posterior side of the skull. (a) Autopsy photo and (b)
three-dimensional computed tomography (CT) reconstruction. Note that the small
bone fragments (flaking) observable in the CT images (arrows) are not observable in
the autopsy photo (possibly removed during scalp-removal) (Ampanozi et al., 2010)
7.5 Discussion:
After death imaging has no ifs ands or buts formed into a valuable methodology in
criminological examination. Not just does it encourage pre-post-mortem examination
and documentation in trauma cases, yet offers in depth information relating to the
direction of blows in ear-splitting and dull object trauma as highlighted in the case
above, it not just empowers pre-examination diagnosis and documentation of trauma
(Thali et al. 2003) and (Oesterhelweg et al. 2007)
For the case outlined above, CT examination of the injuries created by the hatchet
demonstrated various unique elements (chipping, crushing, shattering and cracks).
Besides, MRI allowed nitty gritty comprehension of the cerebrum injury creating
results that could be compared with autopsy results.

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8. Discussion:
It has been widely contended that advances in diagnostic technology have rendered
the classical autopsy redundant especially when innovation can be utilized to give
results and answers that are required from customary autopsy. For instance, the
ordinary post-mortem examination has been challenged by the introduction of virtual
post-mortem examination (Delaney and Gallagher, 2005).
O'Donnell and Woodford report that it is exceptionally far-fetched that cross-sectional
imaging will supplant the traditional autopsy at any point in the near future; rather it
might be utilized as a supplement. With regards to comprehending a couple of the
most imperative issues in forensic pathology, CT and MRI might be utilized as a part
of request to stay away from post-mortem in spite of considerable impediments.
Cross sectional imaging is not by any stretch of the imagination fit for noting each
inquiry relating to forensic examination however is fit for helping pathologists, by
providing data that may aid finding answers (O'Donnell and Woodford, 2008)
It has been debated that virtopsy can eventually supplant the routine examination
because of the high level of determination connected with 3D reproduction (Lavis,
2005). Be that as it may, this final offer has been tested by Roberts et al. by leading
a study contrasting the utilization of MRI autopsy and conventional autopsy. In this
study, 10 MRI examinations were done in instances of non-forensic unforeseen adult
deaths. Four radiologists were requested that report their disclosures on each of the
10 cases. Nonetheless, just on one case did every one of the four radiologists figure
out how to touch base at the same reason for death as the customary autopsy, and
in four cases none of the radiologists figured out how to stick point a precise reason
for death (Roberts et al. 2003)
A study done at Nottingham University whereby 70 patients were analysed utilizing
MRI to have endured anterior circulation stroke disorder did not go to the same
reason for death dictated by autopsy examination. Post-mortem examinations done
reported that just 49/70 of the patients were correctly diagnosed, 6 were
misdiagnosed and a further 15 misclassified (Allder et al. 1999)
In another comparative pilot study as portrayed over, the conclusions were that
radiological examinations gave certain subtle elements which were not discovered
amid the autopsy and the autopsy gave certain points of interest that were not clear
from radiological examinations (Lechner et al 2006)
On the off chance that imaging is to supplant post-mortem in routine practice, it must
have the capacity to analyse vascular diseases and coronary heart disease
specifically, as this is the commonest reason for death found at post-mortem
examination (Roberts et al., 2011). In past studies of post-mortem examination
radiology correlation, it has been shown that conventional cross-sectional imaging
can distinguish coronary calcification however can't asses’ stenosis or impediment of
the arteries (Weustink et al 2009). Consequently, missed findings of coronary heart

SID: 1340713 Page 34 of 43
diseases are recurrent. The high quality of post mortem angiography will help in
reducing the number of misdiagnoses further inciting the usefulness of virtual
autopsy.
The two cases described above clearly highlight the usefulness of post mortem
imaging and recognize it as a valuable tool in forensic medicine. The advantages
associated with post mortem imaging greatly out-weigh its drawbacks. Post mortem
imaging is not capable of answering all forensic questions associated with various
deaths but provides a prized alternative in determining manner of death when
permission for conventional autopsy is not granted by family members of a deceased
person. CT scans are capable of providing accurate information pertaining to manner
and cause of death and may well be used as a pre-screening technique prior to
autopsy. This in turn will aid in reducing the number of unnecessary autopsies. The
two cases above strongly veer to the fact that autopsy still has a big role to play
when it comes to post mortem examinations as it is capable of discovering
information that is not found using imaging modalities.
9. Future trends:
A large number of Coroners autopsies are performed to a poor standard – not
meeting RCPath guidelines, and well below acceptable ‘forensic’ standard
Future development of autopsy services aims to:
 Reduce the number of “unnecessary” Coroners’ autopsies
 Improve the quality of autopsies that are performed.
The future of the Coroner’s autopsy
The virtopsy venture is surely encouraging. The implementation of routine
posthumous CT would essentially lessen the quantity of "unnecessary" post-mortem
examinations. This thus will enhance the nature of post-mortem examinations.
Imaging findings will help in determination of whether or not dismemberment will be
required offering light to any anomalies and what pathological examination might be
required.
A high extent of post-mortems are of low quality with no means for audit/review.
Imaging gives a changeless record that will uncover pathologists' blunders.
Utilization of routine CT in traumatic demise’s would give better information than
dissection about fractures and other injuries.
Practical issues:
Access to reasonable imaging facilities, exchange of the bodies to the facilities,
staffing the administration, technique for case determination (assuming any), ),
storing and transferring the data, giving a radiology report inside the time span that
might be valuable to the Coroner, obscure percentage reduction in full post-mortem
examinations.

SID: 1340713 Page 35 of 43
Financial issues:
Determining the cost of a service and how this will be funded (family, religious
organisation, Coroner, other).
Supremacy issues:
Training radiologists and pathologists, assessing their competence (diploma of post-
mortem imaging?), audit of performance and continuing professional development.
The virtopsy projects goal was to incorporate current imaging modalities such as CT,
MRI, 3D surface scanning and photogrammetry into the routine of forensic
examinations (Thali et al. 2003). These techniques offer great detail when it comes
to documenting and illustrating evidence but they have a tendency taking up time. In
order to tackle this issue, a model of a robotic system that automated tasks that were
either tedious or necessitated high precision within the area of forensic imaging. The
Virtobot, was developed at the Institute of Forensic Medicine in Bern, Switzerland in
2007 (Ebert et al. 2010). It was able to conduct 3D surface scans utilizing an optical
surface scanner and CT guided placement for biopsy purposes (Ebert et al., 2014)
10.Conclusion:
The aim of this study was to highlight the usefulness and effectiveness of post
mortem imaging as compared to traditional autopsy and it is clear from the cases
explained above that CT is the preferred imaging technique when it comes to 2D and
3D analysis of bone injuries, gas accumulations and tissue injury. CT scanning time
is relatively fast depending on the breadth and capacity to be covered. MRI evidently
had great success in demonstrating soft tissue injury. The techniques of
documenting forensic discoveries in this study are mainly objective and scalpel free,
this in turn will lead to further developments in forensic pathology. In conclusion,
there are many advantages to post mortem imaging but traditional autopsy is
considered the gold standard for post mortem investigations hence the reason why it
should not be replaced by post mortem imaging, rather it be used as an adjunct to
aid in post mortem investigations, agreeing with O’Donnell and Woodford. Further
research must be carried out when it comes to post mortem imaging by attempting to
implement imaging modalities in complicated deaths such as drowning and asphyxia
to further enhance the validity of the technique. In the midst of it all, autopsy rates
are decreasing for a number of reasons and virtual autopsy provides a suitable
alternative for obtaining more information for further research.

SID: 1340713 Page 36 of 43
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 Ampanozi, G., Ruder, T., Preiss, U., Aschenbroich, K., Germerott, T.,
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