View source for Virtopsy

{{Advert|date=March 2014}}

'''Virtopsy''' is a virtual alternative to a traditional autopsy, conducted with scanning and imaging technology. The name is a [[portmanteau]] of "virtual" and "[[autopsy]]" and is a [[trademark]] registered to [[:de:Richard Dirnhofer|Richard Dirnhofer]], the former head of the Institute of Forensic Medicine of the [[University of Bern]], [[Switzerland]].<ref>{{cite web|url=http://www.wirtschaft.ch/trademarks/VIRTOPSY/Universitaet+Bern/Prof+Dr+R+Dirnhofer+Direktor/04728/2001/ |title=VIRTOPSY - wirtschaft.ch - trademarks - Universität Bern Institut für Rechtsmedizin (IRM) Prof. Dr. R. Dirnhofer, Direktor Bern - Trademark no. P-491277 - Application no. 04728/2001 |publisher=wirtschaft.ch |access-date=2013-08-28}}</ref><ref>{{cite web |title=Home |url=http://www.virtopsy.com/ |access-date=4 September 2024 |website=virtopsy.com}}</ref>

Dirnhofer has proposed virtopsy as a partial or complete replacement for traditional autopsy,<ref name="dirnhofer">{{cite book |last1=Dirnhofer |first1=Richard |title=Virtopsy - Obduktion neu in Bildern: gerichtsmedizinische Vorstellung und prozessrechtliche Diskussion einer neuen wissenschaftlichen Autopsiemethode |trans-title=Virtopsy - Autopsy in Pictures: Forensic presentation and procedural discussion of a new scientific autopsy method |date=2010 |publisher=Manz |isbn=978-3-214-10191-6 |language=de }}{{pn|date=December 2024}}</ref> and he has asserted that virtopsy fully satisfies the requirement that medical forensic findings provide “a complete and true picture of the object examined”.{{cite quote|date=December 2024}} Furthermore, virtopsy is said to achieve the objective “that the pathologist’s report should ‘photograph’ with words so that the reader is able to follow his thoughts visually”.{{cite quote|date=December 2024}}

==Concept==

Virtopsy employs imaging methods that are also used in clinical medicine such as [[CT scan|computed tomography (CT) scans]] and [[Magnetic resonance imaging|magnetic resonance imaging (MRI)]].<ref name="p12665000">{{cite journal |last1=Thali |first1=Mj |last2=Yen |first2=K |last3=Schweitzer |first3=W |last4=Vock |first4=P |last5=Boesch |first5=C |last6=Ozdoba |first6=C |last7=Schroth |first7=G |last8=Ith |first8=M |last9=Sonnenschein |first9=M |last10=Doernhoefer |first10=T |last11=Scheurer |first11=E |last12=Plattner |first12=T |last13=Dirnhofer |first13=R |title=Virtopsy, a New Imaging Horizon in Forensic Pathology: Virtual Autopsy by Postmortem Multislice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI)—a Feasibility Study |journal=Journal of Forensic Sciences |date=March 2003 |volume=48 |issue=2 |pages=386–403 |pmid=12665000 |doi=10.1520/JFS2002166 }}</ref> Also, [[3D scanning|3D body surface scanning]] is used to integrate body surface documentation with 3D scene or tool scans. The choice of methods is further supplemented with 3D imaging-guided [[biopsy]] systems<ref name="p19806611">{{cite journal |last1=Ebert |first1=Lars Christian |last2=Ptacek |first2=Wolfgang |last3=Naether |first3=Silvio |last4=Fürst |first4=Martin |last5=Ross |first5=Steffen |last6=Buck |first6=Ursula |last7=Weber |first7=Stefan |last8=Thali |first8=Michael |title=Virtobot—a multi-functional robotic system for 3D surface scanning and automatic post mortem biopsy |journal=The International Journal of Medical Robotics and Computer Assisted Surgery |date=March 2010 |volume=6 |issue=1 |pages=18–27 |doi=10.1002/rcs.285 |pmid=19806611 }}</ref> and post-mortem [[angiography]].<ref name="p17056884">{{cite journal |last1=Grabherr |first1=Silke |last2=Djonov |first2=Valentin |last3=Friess |first3=Armin |last4=Thali |first4=Michael J. |last5=Ranner |first5=Gerhard |last6=Vock |first6=Peter |last7=Dirnhofer |first7=Richard |title=Postmortem Angiography After Vascular Perfusion with Diesel Oil and a Lipophilic Contrast Agent |journal=American Journal of Roentgenology |date=November 2006 |volume=187 |issue=5 |pages=W515–W523 |pmid=17056884 |doi=10.2214/AJR.05.1394 }}</ref>

[[Computed tomography|CT]] is well suited to show foreign objects, bone and air or gas distribution throughout the body, whereas [[MRI]] sequences are strong in detailing organ and soft tissue findings. A comprehensive analysis of both surface and deep tissue findings may require fusion of CT, MRI and 3D surface data.<ref name="p15813556">{{cite journal |last1=Thali |first1=Mj |last2=Braun |first2=M |last3=Buck |first3=U |last4=Aghayev |first4=E |last5=Jackowski |first5=C |last6=Vock |first6=P |last7=Sonnenschein |first7=M |last8=Dirnhofer |first8=R |title=VIRTOPSY—Scientific Documentation, Reconstruction and Animation in Forensic: Individual and Real 3D Data Based Geo-Metric Approach Including Optical Body/Object Surface and Radiological CT/MRI Scanning |journal=Journal of Forensic and Sciences |date=March 2005 |volume=50 |issue=2 |pages=428–442 |pmid=15813556 |doi=10.1520/JFS2004290 }}</ref>

Resulting data can be archived and reproduced without loss,<ref name="p18313007">{{cite journal |last1=Aghayev |first1=Emin |last2=Staub |first2=Lukas |last3=Dirnhofer |first3=Richard |last4=Ambrose |first4=Tony |last5=Jackowski |first5=Christian |last6=Yen |first6=Kathrin |last7=Bolliger |first7=Stephan |last8=Christe |first8=Andreas |last9=Roeder |first9=Christoph |last10=Aebi |first10=Max |last11=Thali |first11=Michael J. |title=Virtopsy – The concept of a centralized database in forensic medicine for analysis and comparison of radiological and autopsy data |journal=Journal of Forensic and Legal Medicine |date=April 2008 |volume=15 |issue=3 |pages=135–140 |pmid=18313007 |doi=10.1016/j.jflm.2007.07.005 }}</ref> analysed elsewhere, or distributed to specialists for technically demanding analysis.

Because traditional autopsies can produce both different and additional findings compared to virtopsies, virtopsy is not a generally accepted method to entirely replace autopsies.<ref name="p18929036">{{cite journal |last1=O'Donnell |first1=C. |last2=Woodford |first2=N. |title=Post-mortem radiology—a new sub-speciality? |journal=Clinical Radiology |date=November 2008 |volume=63 |issue=11 |pages=1189–1194 |doi=10.1016/j.crad.2008.05.008 |pmid=18929036 }}</ref> In fact, the first scientific study detailing the results of comparing postmortem CT scanning with conventional autopsies concluded that single methods were not as useful as the combination of scanning and autopsy were.<ref name="p7932884">{{cite journal |last1=Donchin |first1=Yoel |last2=Rivkind |first2=Avraham I. |last3=Bar-Ziv |first3=Jacob |last4=Hiss |first4=Jehuda |last5=Almog |first5=Joseph |last6=Drescher |first6=Michael |title=Utility of postmortem computed tomography in trauma victims |journal=The Journal of Trauma: Injury, Infection, and Critical Care |date=October 1994 |volume=37 |issue=4 |pages=552–556 |doi=10.1097/00005373-199410000-00006 |pmid=7932884 }}</ref>

==Terms==

The term “Virtobot” is a trademark also registered to Prof. R. Dirnhofer. It describes a multi-functional robotic system.<ref name="p19806611"/>

The "Virtangio" machine is a device that is trademarked to Prof. R. Dirnhofer <ref>{{cite web|url=http://www.wirtschaft.ch/trademarks/VIRTANGIO/Forim+X+AG/Marienstrasse+11/51685/2010/ |title=Virtangio - wirtschaft.ch - trademarks - Forim-X AG c/o Prof. Dr. Richard Dirnhofer Bern - Trademark no. 602006 - Application no. 51685/2010 |publisher=wirtschaft.ch |access-date=2013-08-28}}</ref> and manufactured by Fumedica [http://fumedica.ch/].<ref>{{cite web|url=http://www.postmortem-angio.ch/products/virtangio-machine/ |title=Folders - postmortem-angio |publisher=Postmortem-angio.ch |access-date=2013-08-28}}</ref>

==Operative aspects==

With Prof. Michael Thali as operative head of the group, the virtopsy research team has operated out of the Institute of Forensic Medicine at the [[University of Zurich]], Switzerland since early 2011.<ref>{{cite news|date=28 August 2013 |url=http://www.nzz.ch/aktuell/zuerich/stadt_region/gestochen-scharfe-diagnosen-1.15566713 |title=Gestochen scharfe Diagnosen: Der neue Direktor des Instituts für Rechtsmedizin setzt auf digitale Technik als Ergänzung zum Skalpell - Übersicht Nachrichten |newspaper=Neue Zürcher Zeitung |publisher=[[Neue Zürcher Zeitung|NZZ]] |access-date=2013-08-28}}</ref>

===Examination of death===

The idea to conduct virtual autopsy is not new. In 2003, the British Museum contacted the Institute of Forensic Medicine for their help performing a virtopsy on a 3000-year-old mummy named Nesperennub, as an autopsy could not be done without compromising the body.<ref>{{cite web|url=http://infovalley.net.my/~infovall/bringing-ideas-life-making-virtual-autopsy-reality-edge-malaysia |title=Bringing ideas to life: Making virtual autopsy a reality - The Edge Malaysia |publisher=Infovalley.net.my |date=2010-06-07 |access-date=2013-08-28}}</ref> While manner of death,<ref name="p12665000"/> cause of death,<ref name="p12665000"/> time of death,<ref name="p12418008">{{cite journal |last1=Ith |first1=Michael |last2=Bigler |first2=Peter |last3=Scheurer |first3=Eva |last4=Kreis |first4=Roland |last5=Hofmann |first5=Lucie |last6=Dirnhofer |first6=Richard |last7=Boesch |first7=Chris |title=Observation and identification of metabolites emerging during postmortem decomposition of brain tissue by means of in situ 1 H-magnetic resonance spectroscopy |journal=Magnetic Resonance in Medicine |date=November 2002 |volume=48 |issue=5 |pages=915–920 |doi=10.1002/mrm.10294 |doi-access=free |pmid=12418008 }}</ref><ref name="p15578674">{{cite journal |last1=Scheurer |first1=Eva |last2=Ith |first2=Michael |last3=Dietrich |first3=Daniel |last4=Kreis |first4=Roland |last5=Hüsler |first5=Jürg |last6=Dirnhofer |first6=Richard |last7=Boesch |first7=Chris |title=Statistical evaluation of time-dependent metabolite concentrations: estimation of post-mortem intervals based onin situ1H-MRS of the brain |journal=NMR in Biomedicine |date=May 2005 |volume=18 |issue=3 |pages=163–172 |doi=10.1002/nbm.934 |pmid=15578674 }}</ref> identification of deceased and a range of practical and reconstructive applications are obviously related to medicolegal investigation of death, virtopsy methods were ground breaking in that they have established a new high-tech toolbox into both research and practice morphological investigation aspects of modern forensic pathology.

Since virtopsy is non-invasive, it can be less traumatic for surviving family members and may not violate religious taboos against violating bodily integrity.<ref>{{cite web|url=http://www.gizmag.com/digital-autopsies-infovalley-chandran/28810/ |title=Digital autopsy: Replacing scalpels with scanners |date=27 August 2013 |publisher=Gizmag.com |access-date=2013-08-28}}</ref>

===Examination of the living===

Non-invasive imaging is also conducted in living or surviving subjects, but as that has been the main clinical application of CT and MR imaging to begin with, their use in medicolegal investigation of the living is not as ground breaking as using them for investigation of death. Nevertheless, a number of applications that may be regarded as specific for medicolegal imaging applications in the living have found attraction for virtopsy-derived methods:

* ''Matching weapon or injury-causing agent and injury.'' The application of 3D surface documentation of injuries for the benefit of medicolegal reconstruction must be accredited to Brueschweiler et al. (2003).<ref name="p12711193">{{cite journal |author=W. Brueschweiler and M. Braun and R. Dirnhofer and M.J. Thali|title=Analysis of patterned injuries and injury-causing instruments with forensic 3D/CAD supported photogrammetry (FPHG): an instruction manual for the documentation process|journal=Forensic Science International |volume=132 |issue=2 |pages=130–138 |year=2003 |pmid=12711193 |doi=10.1016/s0379-0738(03)00006-9}}</ref>
* ''Strangulation and estimation of risk of death.'' The first paper documenting systematic application of MRI to survivors of strangulation for the benefit of forensic medicine was published by Yen et al. in 2005.<ref name="p16142698">{{cite journal |author=Yen, Kathrin Thali, Michael J and Aghayev, Emin and Jackowski, Christian and Schweitzer, Wolf and Boesch, Chris and Vock, Peter and Dirnhofer, Richard and Sonnenschein, Martin|title=Strangulation signs: Initial correlation of MRI, MSCT, and forensic neck findings|journal=Journal of Magnetic Resonance Imaging|volume=22 |issue=4 |pages=501–10 |year=2012 |pmid=16142698 |doi=10.1002/jmri.20396|doi-access=free }}</ref>
* ''[[Mule (smuggling)|Body packing]].'' According to a paper of the virtopsy group, CT scanning may be more suitable to body packer identification than conventional or plain abdominal X-rays.<ref name="p22178312">{{cite journal |vauthors=Flach PM, Ross SG, Ampanozi G, Ebert L, Germerott T, Hatch GM, Thali MJ, Patak MA |title="Drug mules" as a radiological challenge: sensitivity and specificity in identifying internal cocaine in body packers, body pushers and body stuffers by computed tomography, plain radiography and Lodox|journal=Eur J Radiol|volume= 81|issue=4 |pages=501–510 |year=2005 |pmid=22178312 |doi=10.1016/j.ejrad.2011.11.025}}</ref>

== Technology ==

The technology currently used for conducting a “virtual autopsy” comprises

* Robot-guided surface scanning for three-dimensional documentation of the surface of the body, to scale and in color, supplementing a visual inspection.<ref name="p19806611"/>
* Multislice spiral CT and MRI for visualising the body in 3D. This supplements the internal postmortem examination of the body in an autopsy.<ref name="p12665000"/>
* Post mortem angiography, which visualises the cardiovascular system of the deceased with the aid of a [[peristaltic pump]] and [[Contrast agent|contrast medium]].<ref name="p17056884"/>
* Image- and robot-guided sampling for supplementary forensic analyses, such as [[histology]], [[bacteriology]], [[virology]], [[toxicology]] and [[Diatom|diatomology]].<ref name="p19806611"/> 

== Virtopsy objectives ==

The virtopsy idea was generated to yield results along a comprehensive number of performance indicators:

* The practical objective of both research and application of virtopsy methods are to improve the objectivity of findings made in forensic autopsies.
* The academic objective of virtopsy research is to publish original and validation type research.
* Last but not the least, financial gains are also a relevant aspect of new technology particularly in the private industry sector whereas saving cost is an aspect for public institutes or offices.

== Advantages ==
This method offers the following advantages:

* Preservation of the body in a virtual form.
* Observer-independent documentation of the evidence – "delegation of seeing to the machine".
* Complete, non-destructive gathering of findings from head to toe
* Data acquisition in parts of the body that otherwise would not be examined out of respect for the deceased (e.g. the face).
* Data acquisition in regions that are difficult to dissect and access (e.g. atlanto-occipital joints), and in cases of advanced decomposition.
* Visualization of the cardiovascular system.
* Replacement of manual dexterity by the "virtual knife" of the automatic sectional imaging technique.
* Standardized data acquisition procedure.
* High-precision, contamination-free sampling (poisons, infections, tissue, etc.) accurate to the millimeter. 
* True-to-scale 3D documentation for precise forensic reconstructions.
* Clean, bloodless visualization of the documentation.
* Improvement in the quality of forensic reports – simultaneous examination by different experts via tele-forensics.
* Simplification of the assessment of evidence by improved comprehensibility of the visual 3D findings.
* Acceptance by relatives and religious communities over conventional autopsies.
* The complete saved data-set can be re-examined at any time if a second expert opinion is required, even after burial or cremation of the body.
* Rapid and complete data acquisition as part of analyses following disasters (terrorist attacks, plane crashes, etc.).

== Disadvantages ==
* High equipment costs
* The limitations for radiology apply:
** Metal foreign objects
** One cannot determine the color of internal organs and color changes
** One cannot determine all the pathological conditions (e.g. inflammation)
** One cannot determine the infection status of tissue
** It is difficult to differentiate antemortem from postmortem wounds and postmortem artifacts
** Small tissue injuries may be overlooked
* The limitations for surface scanning apply:
** Recording concave features, out of view
** Turning the body over for total body recording can alter the body shape due to gravity (e.g. stomach) which may disturb the merging of recorded surfaces
** Recording reflective or transparent surfaces (e.g. the eye) 
* Merging data from multiple techniques will always result in some loss of precision
* A reliance on imagery alone may lead to omissions (e.g. bruising under the scalp not visible with surface scanning)
* Validity
** No proper validation of the method has been made using closely prepared prospective studies
** No error rate available
** No juridical validity (yet)
** As applicable to all simulated evidence presented in the court room, there are concerns of suggestiveness
* Objectivity
** It has not been investigated whether experts are consistent in their judgment
** Context effects (e.g.  post-hoc target shifting in cases in which injury patterns are compared to possible injury-causing objects)

== Best practice ==
The National Research Council in the USA, as part of its proposals for reforms in the forensic sciences, has proposed virtopsy as “Best Practice” for the gathering of forensic evidence.<ref>{{Cite book |last=Committee on Identifying the Needs of the Forensic Sciences Community, National Research Council |title=Strengthening Forensic Science in the United States: A Path Forward |publisher=National Academies Press |year=2009 |isbn=978-0-309-13135-3}}{{pn|date=December 2024}}</ref>

In addition, the International Society of [[Forensic Radiology]] and Imaging was founded in 2012 with the aim of enabling a continuous exchange of research results among its members and developing quality standards for the techniques employed.{{fact|date=December 2024}}

A Technical Working Group Forensic Imaging Methods was founded in 2005 by Michael Thali and Richard Dirnhofer. It aims to promote an increasingly internationally standardised approach.{{fact|date=December 2024}}

Furthermore, a Technical Working Group Postmortem Angiography Methods was founded in 2012 to promote best practice. Under the direction of the [[University Hospital of Lausanne]] and comprising nine European institutes of forensic medicine, it is developing reliable, standardized methods and guidelines for conducting and assessing postmortem angiographic examinations.{{fact|date=December 2024}}

==Virtopsy project leading house==
* [http://www.irm.uzh.ch/index.html Universität Zürich Institut für Rechtsmedizin]
* The [http://www.virtopsy.com/ virtopsy website] at the Institute of Forensic Medicine [http://www.irm.uzh.ch/] at the [[University of Zurich]]

==Institutes contributing to the Virtopsy project==
* [http://www.irm-bs.ch/ir/home.cfm Institut für Rechtsmedizin der Universität Basel]
* [http://remed.charite.de/ Charité Berlin, Institut für Rechtsmedizin]
* [http://www.irm.unibe.ch/content/index_ger.html University of Bern, Institut für Rechtsmedizin]
* [http://www.curml.ch/ Centre universitaire romand de médecine légale, Lausanne - Genève] (CURML)

==Institutes, districts or countries conducting post-mortem scanning==
* India- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences- New Delhi<ref>{{cite journal |last1=Raj K |first1=Dr Karthi Vignesh |last2=Yadav |first2=Dr Abhishek |last3=Manivel |first3=S. |last4=Khan |first4=Dr Anam |last5=Gupta |first5=Dr Sudhir K |title=Corpus Alienum captured in Post Mortem Computed Tomography, death due to an accidental ingestion of 'Momos (Dumpling)' |journal=Forensic Imaging |date=June 2022 |volume=29 |pages=200503 |doi=10.1016/j.fri.2022.200503 }}</ref><ref>{{cite web |author=Deepali Jena |date=Oct 17, 2022 |title=Virtual Autopsy {{!}} Giving dignity to the Dead |url=https://www.indiatoday.in/health/story/what-is-virtual-autopsy-post-mortem-raju-srivastav-heart-attack-2284921-2022-10-17 |access-date=2023-04-02 |website=India Today}}</ref>
* Japan - Autopsy Imaging<ref>{{cite journal |last1=Oyake |first1=Yuji |last2=Aoki |first2=Takeshi |last3=Shiotani |first3=Seiji |last4=Kohno |first4=Mototsugu |last5=Ohashi |first5=Noriyoshi |last6=Akutsu |first6=Hiroyoshi |last7=Yamazaki |first7=Kentaro |title=Postmortem computed tomography for detecting causes of sudden death in infants and children: retrospective review of cases |journal=Radiation Medicine |date=22 September 2006 |volume=24 |issue=7 |pages=493–502 |doi=10.1007/s11604-006-0061-y |pmid=17058143 }}</ref> 
* Australia - Melbourne - VIFM [http://www.vifm.org]<ref name="p18929036"/>
* Europe - Denmark - Odense - Institute of Forensic Medicine, University of Southern Denmark <ref>{{cite web|url=http://www.sdu.dk/en/Om_SDU/Institutter_centre/Ri_retsmedicinsk_institut |title=Institute of Forensic Medicine |publisher=Sdu.dk |date=2012-09-24 |access-date=2013-08-28}}</ref>
* United States - State of Maryland Medical Examiner <ref>{{cite web|url=https://www.nlm.nih.gov/exhibition/visibleproofs/galleries/media/examiners/index.html |title=Visible Proofs: Forensic Views of the Body: Galleries: Media: Medical examiners at work |publisher=Nlm.nih.gov |date=2010-12-14 |access-date=2013-08-28}}</ref>

== Films ==
* [https://www.youtube.com/watch?v=3nd9W5rjepo The Virtopsy Process]
* [https://www.youtube.com/watch?v=bws6vWM1v6g The Virtopsy Table]
* [http://www.vimeo.com/6866296 Virtual Autopsy Table]

== Books and journals ==
* Brogdons's Forensic Radiology, 2nd Edition. Eds: Michael J. Thali, Mark D. Viner, Byron Gil Brogdon. CRC Press; 2011.
* The Virtopsy Approach: 3D Optical and Radiological Scanning and Reconstruction in Forensic Medicine. Eds: Michael J. Thali, Richard Dirnhofer, Peter Vock. CRC Press; 2009.
* [http://www.medizin-und-technik.de/home/-/article/26441625/28782641?returnToFullPageURL=back/ Entwicklung des Systems, Interview mit Thali]
* Virtopsy – Obduktion neu in Bildern; Dirnhofer/Schick/Ranner, Schriftenreihe Recht der Medizin, 2010 Manz
* Revolution in der Gerichtsmedizin erschienen in „Öffentliche Sicherheit 9-10/09
* Die Virtopsie wird die Autopsie ablösen Erschienen in Kriminalpolizei Oktober/November 2009

== Virtopsies in popular culture ==

* In the ''[[CSI: Miami]]'' episode "[[Deep Freeze (CSI: Miami episode)|Deep Freeze]]", Dr. Woods performs a virtopsy on a recently murdered athlete to prevent damaging him so that he could be [[cryonics|cryogenically frozen]].
* In the ''[[CSI: NY]]'' episode "Veritas", Sid does a virtual autopsy on Derek, showing Stella that the bullet that killed him entered through his cheek.

==References==
<references />

== External links ==
* [http://www.nap.edu/catalog.php?record_id=12589 Strengthening Forensic science in the USA]
* [http://www.nationalacademies.org/nrc/ National Research Council]
* {{cite news |last1=Sachs |first1=Jessica Snyder |title=Why Give a Dead Man a Body Scan? |url=https://www.popsci.com/scitech/article/2004-10/why-give-dead-man-body-scan/ |work=Popular Science |date=16 October 2004 }}
* {{cite news |last1=Bigge |first1=Ryan |title=Virtopsy |url=https://www.nytimes.com/2004/12/12/magazine/virtopsy.html |work=The New York Times |date=12 December 2004 }}

{{Medical imaging}}
{{Respiratory system procedures}}
{{Vascular procedures}}

[[Category:X-ray computed tomography]]