About a year ago, popular comedian Raju Srivastava succumbed to cardiac arrest post his workout session. Not many know that the post-mortem examination in his case was done digitally through a method called Virtual autopsy. 

Virtual autopsy, also known as virtual post-mortem examination or Virtual Autopsy imaging, is a modern, non-invasive method of examining a body to determine the cause of death or investigate injuries. This advanced technique uses imaging technologies to provide a detailed analysis of the body without the need for traditional invasive autopsy procedures.

Also, since Virtual Autopsies are minimally invasive, they enable the prompt release of the body for the last rites. It not only preserves the dignity of the deceased, but provides relief to their families, who may have otherwise received a stitched-up body after the post-mortem examination. Unlike traditional autopsies, which require incisions and tissue sampling, virtual autopsies are non-invasive and do not require physical alteration of the body. This can be particularly important in cases where cultural or religious beliefs prohibit traditional autopsies.

While it is generally non-invasive, it can be considered minimally invasive in certain situations. It allows the identification of regions of interest in the body to determine the cause of death. Instead of cutting open the body, it focuses on specific areas such as the thoracic region, making only small incisions when required to investigate the death. 

The Tech Stack

In an interview with AIM, Ash Govind, founder & CEO of Virtual Autopsy Solutions, explained that the two software requirements in their field of work are visualisation and forensic information system. Visualisation involves manipulating 3D images of the body, while the forensic information system logs the entire case from the scene of crime or death to the post-mortem examination, including additional examinations like toxicology, microbiology, or DNA testing.

The global medico-legal system aims to determine the probable cause of death in cases of unnatural, sudden, and unexpected deaths. Traditionally, this was done through physical autopsies using a scalpel, but now it can be accomplished through multimedia files that include videos, screenshots, and other digital data in a report. The process involves using a CT scanner to obtain DICOM data, which is rendered through software to create a 3D reconstruction of the body. Pathologists and radiologists examine the 3D reconstruction to determine the probable cause of death and this information is then integrated into a multimedia report on the cause of death.

This software works effectively for the purpose of virtual autopsies to an extent where Govind claimed that they conduct approximately 13,000 cases annually in the UK, making the country a world leader in post-mortem imaging and virtual autopsies.

India Adoption

In 2019, Union health minister Harsh Vardhan expressed interest in AIIMS and ICMR’s initiative to establish a virtual autopsy lab. He emphasised the government’s commitment to developing multiple centres across the country. To support the implementation of virtual autopsies, the Indian Council of Medical Research (ICMR) provided Rs 5 crore to AIIMS, and the process of acquiring a CT machine for the procedure is in progress.

Initially, the virtual autopsy facility will be exclusive to AIIMS, but there are plans to extend it to other medical institutions nationwide, with AIIMS providing training. AIIMS currently conducts approximately 3,000 autopsies per year, as per a statement made in the Lok Sabha.

Virtual Autopsy India is in conversations with AIIMS Delhi and other medical institutions and academia across the country. Other institutions like AIIMS Bibinagar, AIIMS Nagpur, Government Medical College Kashmir, PGIMS Rohtak and a few more are also in the process of setting up a virtual autopsy centre. It’s not just limited to India. Globally, virtual autopsy India is in discussion with the Dubai police and the Kazakhstan government as well.

Recently, in June 2023 The Government Medical College (GMC) Anantnag hosted a groundbreaking two-day conference on ‘virtual autopsy’, a first-of-its-kind in Jammu & Kashmir. Organised by the Department of Forensic Medicine, the conference aimed to explore the non-invasive method. Dr Azia Manzoor, the head of the department, provided an overview of virtual autopsy, highlighting how it digitally reconstructs detailed images of the body’s internal structures.

Dr Hemant Naik, CMO of Virtual Autopsy India, explained the benefits of virtual autopsy, emphasizing its precision and non-invasiveness. The conference was well-attended, with over 200 delegates from Jammu & Kashmir and other parts of the country, particularly north India. 

By involving forensic experts, trained autopsy technicians, and police officers, the process’s effectiveness and accuracy can be further enhanced.

Challenges Facing Adoption of Virtual Autopsy

In a conversation with AIM, Dr Naik discussed the challenges facing the adoption of virtual autopsies in India. Firstly, acquiring funds is a major obstacle due to the significant cost involved in setting up the required infrastructure, such as a CT scanner and other technology, including software and hardware. The total cost for each project can amount to more than Rs 10 crore, making it essential to secure government funding, which can be challenging.

Secondly, since virtual autopsy is a new technology, medical professionals need proper training to use it effectively. While training initiatives can overcome this challenge, it still requires dedicated effort.

The third challenge lies in the ambiguity within the Indian medico-legal system regarding the acceptance of virtual autopsy as evidence in court. Although the Indian Evidence Act of 1965 allows digital evidence to be submitted, it does not specifically address medical imaging evidence, creating a grey area in the legal acceptance of virtual autopsy results. Overcoming these obstacles will be crucial in fully adopting and utilising virtual autopsies in the Indian medical field.

The Benefits 

The advantages of virtual autopsies are numerous. Along with it being non-invasive, virtopsy will also save time compared to conventional autopsies due to quicker imaging processes. Moreover, virtual autopsies keep the body intact, ensuring that evidence remains intact for potential future investigations. The use of advanced imaging technologies enables detailed visualisations and interactive analysis in three dimensions, aiding in the identification of injuries or abnormalities contributing to the cause of death.

Additionally, virtual autopsies have educational and research benefits. The digital storage of reports allows for future reviews, which is not feasible in cases where cremation is performed. They serve as valuable tools for training forensic pathologists and medical students, and they facilitate research through the storage and analysis of large datasets.

Autopsies play a crucial role in police investigations, especially in cases of unnatural deaths. Traditional autopsies can take anywhere from 30 minutes to three days, depending on the complexity of the case and availability of experts. However, virtual autopsy offers a faster alternative, with the procedure being completed within minutes. Dr Abhishek Yadav, an associate professor of forensic medicine at AIIMS, highlighted the time and manpower-saving benefits of virtual autopsies.

History of Virtual Autopsy

Dr Michael Thali, a professor at the University of Zurich and co-founder of The Virtopsy Project, introduced virtual autopsies in 1999, creating permanent 3D models of bodies that can be easily accessed and shared for second opinions. This technique has become common practice in Swiss forensic investigations and is gaining popularity worldwide. Although cost is a consideration, the benefits of preserving 3D information without altering the anatomy outweigh the expense. 

The Virtobot system, a robotic tool working with CT scanners, generates high-resolution 3D images and documents injuries. The visualisation capabilities of virtual autopsies have proven valuable in court cases, aiding in understanding injuries. 

While not widely used in the US yet, the military and some forensics institutes have adopted virtual autopsies. India positioned itself to be the first country in the Southeast Asian region to introduce virtual autopsies. Several developed countries, including Switzerland, the UK, Germany, Canada, Australia, Japan, Hong Kong, Norway, Sweden, South Africa, Israel, and Middle-East countries, have already adopted this innovative procedure.

Limitations 

However, virtual autopsies have limitations. They may not be suitable for cases requiring histological or toxicological analyses, as these procedures typically require tissue samples. Furthermore, the accurate interpretation of imaging findings relies heavily on the skills and experience of the pathologist or radiologist performing the analysis.

To counter this, Naik discussed basic training, where participants are introduced to the technology, learn how to read the upper motor, and understand common findings. The training is focused on live demonstrations of scanning, reporting scans, performing biopsies, and conducting post-mortem examinations.

When asked about the accuracy rate, Naik confidently stated that it is up to 98%. However, in January, a study in Germany compared pre-death diagnoses with results from traditional and virtual autopsies. Among 47 patients, both types of autopsies were used, and among 115 patients, only virtual autopsies were performed due to family’s refusal of standard autopsies. Virtual autopsies confirmed 88% of pre-death diagnoses, while traditional autopsies had a confirmation rate of 93%.

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