Introducing the Virtopsy, a Variant of the Catopsy Theme

In two recent notes (see: Reinventing the Autopsy: CT Imaging as a Routine Part of the Procedure; Additional Discussion About Reinventing the Autopsy), I proposed that the classic autopsy could and should frequently be initiated with a total-body CT scan followed by selective tissue biopsies to confirm the initial CT impressions as well as to harvest tissue for tissue banks. I labeled this new approach to the post-mortem examination as the catopsy. It seems that a parallel approach on this same general theme is also being discussed: the virtopsy or virtual autopsy. In this latter case, the post-mortem examination is "bloodless" and limited to a various medical imaging modalities without any tissue sampling. Below is an excerpt of a relevant article (see: Virtopsy: the virtual autopsy):

Multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI), when used with 3-D imaging technology, create vivid images of the interior of the human body. Dr. Richard Dirnhoter and Dr. Michael Thali and their team of specialists at the University of Bern's Institute of Forensic Medicine, Switzerland are using these new imaging technologies to develop "Virtopsy"—a bloodless and minimally invasive "virtual autopsy" procedure to examine bodies for causes of death. Virtopsy detects internal bleeding, bullet paths, and hidden fractures hard to find in a traditional autopsy. The MSCT and MRI aid in picturing fracture patterns, bone and missile fragmentation, brain contusion, 3-D bullet localization, gas embolism, and blood aspiration to the lung. Unlike traditional autopsy, Virtopsy does not destroy human tissue. It can be used when religious beliefs prohibit, or families object to, the cutting open of the body. The developers of Virtopsy do not envision the procedure as a replacement for traditional autopsy but as a tool to be used in cases where dissection of the body is not feasible or where forensic evidence is particularly hard to visualize.

I do need to take issue to the implication in the article that the standard autopsy "destroys tissue." If anything, the procedure preserves tissue. Despite this quibble, the virtual autopsy (virtopsy) also seems to be taking hold at U.S. institutions such as Johns Hopkins (see: A GROWING NUMBER OF AUTOPSIES ARE DONE USING CT).

Frankly, I can't envision a turf war erupting between pathology and radiology over an expensive, time-consuming, and uncompensated procedure that many pathologists would like to avoid and that seems to to be falling into disfavor (see: The declining autopsy rate and clinicians' attitudes; Declining clinical autopsy rates versus increasing medicolegal autopsy rates in Halifax, Nova Scotia).

Although a virtopsy is better than no autopsy at all, I favor the hybrid approach, the catopsy, because of the opportunity to obtain tissue to confirm imaging impressions with firm histopathologic diagnoses. The autopsy suite is also better equipped to manage deceased patients than the radiology department. This statement, of course, assumes that suitable imaging equipment can be installed in the autopsy suite. Although older CT scanners can probably be obtained at a reasonable cost, substantial costs would also be incurred in retrofitting the autopsy suite for this additional functionality.