Forensic Sci Med Pathol (2013) 9:430–431 DOI 10.1007/s12024-013-9441-7
COMMENTARY
Virtual autopsy Carl Winskog
Accepted: 22 March 2013 / Published online: 6 April 2013 Ó Springer Science+Business Media New York 2013
As outlined by Pollanen and Woodford [1] the field of forensics is changing and forensic pathology has to adapt to new innovations to keep up with modern knowledge and technology. Advanced technology is readily available and the cost associated with the use of sophisticated techniques is continuously decreasing. Post mortem computer assisted tomography (CT) scanning was introduced into routine forensic workflow in the early part of this millennium and is, in some institutions, considered to be part of a standard post mortem examination, not only for suspicious and unusual cases, but also as a screening tool to determine the need for a traditional autopsy [2, 3]. Most of the forensic community has embraced this new technology and numerous forensic centers all over the world have also invested in CT scanners. Some centers use existing CT scanners in nearby hospitals for selected cases. The term ‘‘selected case’’ highlights a problem. Which cases should be CT scanned? On what basis do we select cases? What are the actual benefits from CT scanning? Are the costs justified? Is there enough scientific proof to support the benefits that we attribute to CT scanning? The major portion of publications addressing post mortem CT scanning has been case presentations; these are an important part of the development of a field, and serve as a basis for new ideas and further research. Published papers emphasizing the importance of CT scanning in the field of disaster victim identification (DVI) has focused on assistance in the identification and differentiation of human
C. Winskog (&) Discipline of Pathology, The University of Adelaide, 3rd Floor Medical School North Building, Frome Rd, Adelaide, SA 5005, Australia e-mail:
[email protected]
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from non-human remains and in the detection of foreign material [4, 5]. Pollanen and Woodford [1] also mention that autopsy results in cases of natural, accidental, and suicidal deaths have little, if any, impact on the outcome of the case. The complete autopsy is a time and resource-consuming examination and therefore natural, accidental, and suicidal deaths should be scientifically evaluated to allow the pathologist to efficiently examine these cases without compromising quality and accuracy. The modern pathologist should rely on techniques that originate from evidencebased medicine and even older, more well-established, routines are under systematic review, as they have to be, in order to move forensic pathology forward [6–9]. Published material thus far has established that the CT scan provides a magnificent imaging tool, and the forensic community is in agreement that this excellent technique is here to stay. It is, however, now time to move forward and to scientifically evaluate the use of CT scanning in the forensic setting in order to comfortably place this powerful tool in the hands of the modern forensic pathologist so that we can make conscientious, clear, and judicious use of the current best evidence in our everyday practice.
References 1. Pollanen MS, Woodford N. Virtual autopsy: time for a clinical trial. Forensic Sci Med Pathol. 2013. doi: 10.1007/s12024-013-9408-8. 2. Ljung P, Winskog C, Persson A, Lundstro¨m C, Ynnerman A. Full body virtual autopsies using a state-of-the-art volume rendering pipeline. IEEE Trans Vis Comput Graph. 2006;12(5):869–76. 3. Bedford PJ, Routine CT. Scan combined with preliminary examination as a new method in determining the need for autopsy. Forensic Sci Med Pathol. 2012;8(4):390–4. 4. O’Donnell C, Iino M, Mansharan K, Leditscke J, Woodford N. Contribution of postmortem multidetector CT scanning to
Forensic Sci Med Pathol (2013) 9:430–431 identification of the deceased in a mass disaster: experience gained from the 2009 Victorian bushfires. Forensic Sci Int. 2011;205(1–3): 15–28. 5. Sidler M, Jackowski C, Dirnhofer R, Vock P, Thali M. Use of multislice computed tomography in disaster victim identification-advantages and limitations. Forensic Sci Int. 2007;169(2–3):118–28. 6. Tse R, Langlois N, Winskog C, Byard RW. An assessment of the usefulness of routine histological examination in hanging deaths. J Forensic Sci. 2012;57(4):976–8.
431 7. Langlois NE. The use of histology in 638 coronial post-mortem examinations of adults: an audit. Med Sci Law. 2006;46(4):310–20. 8. Byard RW, Winskog C. Histology in forensic practice: required or redundant? Forensic Sci Med Pathol. 2012;8(1):56–7. 9. Langlois NE, Gilbert JD, Heath KJ, Winskog C, Kostakis C. An audit of the toxicology findings in 555 medico-legal autopsies finds manner of death changed in 5 cases. Forensic Sci Med Pathol. 2013;9(1):44–7.
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