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DIGITAL AUTOPSY

Digital Autopsy (Synonyms: post mortem imaging, post mortem radiography, minimally invasive autopsy, scalpel less autopsy, imaging based autopsy, tele-postmortem examination) is a procedure that employs digital tools and solutions for conducting external and internal examinations of the deceased, without physical manipulations of the dead bodies. It is a new-age approach to visualize, examine and analyze the dead bodies of humans, digitally. Digital autopsy is a solution built for the forensic medicine specialization, which is a medical practice. 1.	CONCEPT Body of a deceased is autopsied to acquire information on the cause of death, inclusive of but not limited to manner of death and evaluation of any diseases or injuries that may be present. The primary aim of Digital Autopsy is to answer the same questions raised in a conventional autopsy without actually involving physical manipulation of the body. The new concept of Digital Autopsy or imaging-based autopsy came into existence to overcome problems faced during conventional autopsies; without losing the objectivity of a post-mortem examination. The aim of this procedure is to collect digital data of the interiors of the dead body in the form of DICOM files as acquired by modern imaging techniques like the CT scan, MRI scan, USG scan, digital radiography, etc. Once the digital data is acquired, the data is rendered into real life 3D volume, multi-planar reconstructions (MPR) and other types of images which can be examined by a pathologist, a radiologist or any other appropriately trained professionals. The examiners will gather various findings of interest which can be digitally stored in the form of high resolution images or recorded. These findings act as appendages to the final digital report of the doctor, thus bypassing the traditional way of pen and paper style of writing post mortem case reports. The digital data is encrypted and stored in a very secure server. Using the saved data, a pathologist or a radiologist can perform a digital examination of the digitized data at a remote site and generate a report to be sent to investigative agencies. However, there are scenarios where certain pathologies are not detected by imaging alone e.g. poisoning, myocardial infarction, in such cases the digital autopsy provides a scope to strengthen the forensic science investigation through a minimally invasive autopsy in the form of targeted endoscopy, targeted and guided biopsy, guided collection of specimens for histo-pathology, toxicology, genetics, etc. for forensic science analysis.

2.	HISTORY One of the first documented Digital autopsy study was conducted at the department of Neuroradiology, University Hospital Mainz, Germany in the year 1980. [1] Since then the arena of 2D CT scan images has gradually evolved to present day technologies of Multi-planar reconstructions (MPR) and real to life high definition three dimensional rendering. In the year 1998 various aspects of human and animal anatomy and pathology were successfully studied by Digital 3D examination on the ancient mummified specimens at the Academic Medical Centre, Amsterdam. [2] Similar studies have also since then been done at the British Museum. The digital 3D analysis of data obtained from CT scanning the mummies has helped in visualization of the faces of some of the mummies, including that of a chantress from the Temple of Karnak. This technology has also given vast information about the embalming and burial processes. [3] In the year 2009 CT scanning and digital analysis of DICOM data was successfully used by the VIFM, Australia during the phase 2 of the DVI process for the Victorian bushfires. All dead bodies and scattered remains were CT scanned in their body bags using specific protocols and analyzed. Digital examination helped not only in separating the presence of non-human remains, but also was useful at the time of autopsy to capture and analyze the identifying features in cases of severe disfiguration. [4] Currently digital autopsy is being successfully used in many countries like Switzerland, The United States of America, The United Kingdom, Malaysia, and Japan.

3.	OBJECTIVES OF DIGITAL AUTOPSY •	To make a positive identification of the body •	To determine the cause of death •	To determine mode and manner of death •	To demonstrate all abnormalities, mal formations and diseases •	To demonstrate injuries •	To obtain samples for analysis (microbiological and histological examination and any other investigation)

4.	TERMINOLOGY Autopsy — also known as post-mortem examination, necropsy (particularly as to non-human bodies), autopsia cadaverum, or obduction — is a highly specialized surgical procedure that consists of a thorough examination of a corpse, to determine the cause and manner of death; and to evaluate any diseases or injuries that may be present. It is usually performed by a specialized medical doctor called a pathologist.

Computed Tomography is a technology that uses computer-processed x-rays to produce tomographic images (virtual 'slices') of specific areas of the scanned object, allowing the user to see what is inside it without cutting it open. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional radiographic images taken around a single axis of rotation. [5] Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues within the body. 3D Body - Three-dimensional reconstruction of the whole body/regional scan from imaging modalities (commonly multi-sliced computed tomography). 5.	TECHNOLOGY Imaging Hardware: The diagnostic imaging modalities: x-ray angiography, computed radiography, computed tomography and magnetic resonance imaging are currently being used to analyze dead bodies. The following modalities may be used as the ancillary investigations for the analysis of dead bodies: •	Fiber-optic and rigid-scope endoscopy •	Light microscopy for anatomic pathology •	General anatomic photography [6] Imaging output of modalities: The output from imaging modalities is called DICOM data. DICOM is a standard (i.e., a specification for interchange of information between computer systems). It is a comprehensive specification of information content, structure, encoding, and communications protocols for electronic interchange of diagnostic and therapeutic images and image-related information. The DICOM protocol is compatible with TCP/IP. This enables DICOM application entities to communicate over the Internet. [6] Conducting Digital Autopsy: The DICOM data is converted into 3D “bodies” by using hi-end software solutions. This is then visualized on a high resolution screen, where the pathologist has access to a variety of tools that can be used to dissect 3D bodies, digitally. Experts perform a non-invasive autopsy using a digital scalpel and explore the 3D digital body by removing the layers of skin, tissue, bones and organs. The procedures involved can be saved as snapshots or movie records with or without annotations. Digital Autopsy enables pathologists to explore the entire body, in an ‘intact’ condition. Dimensions and colors produced by image processing tools make it possible for pathologists to visualize a body organ and isolate it from almost all its surrounding organs. On a second screen, pathologist can create a complete digital report including all digital findings (as still images and movies from areas of interest) for official and legal reference. This information will finally produce a multimedia digital autopsy report. Figure1: A Forensic Pathologist performing examination of a digitized dead body.

Figure 3: Reconstructed images in all 3 dimensions (MPR) for examination and reporting.

Figure4: A rendered 3D volume of lungs (normal) ready for examination and reporting.

REFERENCES [1] Flodmark O, Becker LE, Harwood-Nash DC, Fitzhardinge PM, Fitz CR, Chuang SH. Correlation between computed tomography and autopsy in premature and full-term neonates that have suffered perinatal asphyxia. Radiology. 1980 Oct; 137(1 Pt 1):93-103. [2] Sieswerda-Hoogendoorn T, van Rijn RR. Current techniques in postmortem imaging with specific attention to paediatric applications. J Pediatr Radiol. 2010 Feb; 40(2):141-52; quiz 259. doi: 10.1007/s00247-009-1486-0. Epub 2009 Dec 16. [3] http://www.independent.co.uk/news/science/archaeology/mummy-dearest-british-museum-uses-ct-scans-to-show-mummies-faces-after-thousands-of-years-9248965.html. Last accessed on 29/12/14 [4] O'Donnell C, Iino M, Mansharan K, Leditscke J, Woodford N. Contribution of postmortem multidetector CT scanning to identification of the deceased in a mass disaster:Experience gained from the 2009 Victorian bushfires. Forensic Sci Int. 2011 Feb 25;205(1-3):15-28. doi: 10.1016/j.forsciint.2010.05.026. Epub 2010 Aug 5.

[5] Herman G T. Fundamentals of computerized tomography: Image reconstruction from projection, 2nd edition, Springer, 2009. [6] Bidgood WD Jr, Horii SC, Prior FW, Van Syckle DE. Understanding and using DICOM, the data interchange standard for biomedical imaging. J Am Med Inform Assoc. 1997 May-Jun; 4(3):199-212.

EXTERNAL LINKS http://www.infovalley.net.my/node/77 http://www.mydigitalautopsy.com/ http://www.virtopsy.com/ http://www.nlm.nih.gov/visibleproofs/galleries/technologies/virtopsy.html http://www.spiegel.de/fotostrecke/photo-gallery-a-virtual-look-at-the-cause-of-death-fotostrecke-91607.html

UK introduces digital autopsies http://www.cnet.com.au/uk-introduces-digital-autopsies-339346085.htm

Digital Post-Mortem Centre To Open In UK http://news.sky.com/story/1174191/digital-post-mortem-centre-to-open-in-uk

Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the pediatric virtual autopsy trial http://www.biomedcentral.com/1471-2431/14/15

Utility of Whole-body Computed Tomography Imaging in Post Mortem Detection of Elder Abuse and Neglect: Comparison with and Potential Substitution for Standard Autopsy : Final Report https://www.ncjrs.gov/pdffiles1/nij/grants/237613.pdf

The conventional autopsy in modern medicine by Journal of the Royal Society of Medicine (J R Soc Med., 2008 Apr 1, 101(4): 177–181.) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2312379/

Minimally Invasive Autopsy: An Alternative to Conventional Autopsy? pubs.rsna.org/doi/abs/10.1148/radiol.2503080421?queryID.