The post-mortem made modern
Even the most modern technology can have roots in the distant past; that’s certainly true for digital autopsy. The path to this advanced process began when x-rays were first used to examine the human body back in 1895. Today, it offers a hi-tech alternative to post-mortem and numerous potential benefits to bereaved families, funeral directors, pathologists and others.
Ken Morgan of iGene, a company that is pioneering the use of digital autopsy in the UK with dedicated facilities, said: “A CT scanner, which is one of the pieces of equipment used in digital autopsy, employs x-rays; they were first developed in the late 19th century. The first CT scan was produced in 1983 and the first clinical CT scan of a deceased person took place in 1998.
“Modern digital autopsy dates from 2008 when researchers began carrying out comprehensive studies of adult post-mortem CT scanning.”
As Ken explained, much of the exploratory work in the UK was undertaken in hospitals using NHS scanners. It had to be done out of hours when equipment was not being used for day-to-day medical work. That brought limitations, not least finding available forensic trained radiographers, and funeral directors who were able to transport the deceased at the required times.
The first independent, ‘9 to 5’ service for scanning deceased people was launched in 2013 when iGene opened its facility in Sheffield. The company has since extended its network with bases in Bradford and Sandwell.
Ken outlined the process: “We scan the whole body in much greater detail than is carried out in hospitals. Since x-rays have no adverse effect on someone who has passed away, we can use the maximum dose.” When the scan has been completed radiologists, who have had specialist training, view the scanned images to evaluate the cause of death.
The radiologist’s report is sent to the coroner’s pathologist who would have carried out a traditional post-mortem. They undertake an external examination, study the report and issue the necessary findings to the coroner. If they are not happy with the radiologist’s report and it is deemed necessary, the pathologist can perform a full or limited invasive post-mortem.
Refusing tradition
It appears that there are a number of reasons behind the potential demand for digital autopsy. These include a decline in the acceptability of traditional autopsies and post-mortems among the general public and faith groups, who may feel uneasy about the idea of a deceased body going through that process. “There is a concern about the body being disfigured,” said Ken, “and the concept of organs being removed can fill people with horror.”
He also highlighted families’ concern that a post-mortem might delay funeral arrangements and, from the professionals’ perspective, the need to take a range of precautions when dealing with people who have died from diseases that can be easily passed on.
Digital autopsy is able to counter many of these concerns, and bring other benefits.
From a funeral director’s point of view they have an intact and untouched body. This makes the task of the embalmer much more straightforward and quick, and makes the presentation of the deceased to the bereaved family much simpler and more dignified.
There is improved efficiency for the coroner, coroner’s officers and bereaved families, leading to saving of time, effort and expenditure.
It is possible to discover evidence that can be overlooked in a traditional open autopsy.
If a digital autopsy is undertaken and it throws up evidence that necessitates a full post-mortem, the CT scan allows a pathologist to plan aspects of the procedure in advance.
Importantly, a digital autopsy does not damage or destroy key forensic evidence and is extremely accurate in identifying the location of metallic and other objects within the body. In digital autopsy all areas of the patient are scanned, whereas open autopsies do not always look at every part of the body.
The process is ideal for complex cases where examination and interpretation are compromised
by the destruction of the body, and, on the wider scale, it is excellent in the case of mass fatalities where authorities are keen to identify the pattern of injuries, gather forensic evidence, or identify disaster victims.
Decisions
Although demand for digital autopsy may be rising, the decision on whether one goes ahead does not lie solely with the deceased’s family. As Ken said: “The bereaved family pays for a digital autopsy – the current cost is around £600. However, because the deceased body belongs to the coroner it is his or her decision if it should proceed.”
The Ministry of Justice has said that families can opt for digital autopsy, but at no extra expense to the coronial service. Families need to pay any costs, whereas they get a traditional post-mortem for free.
On the plus side, though most local authorities are not yet prepared to pick up the cost, there are signs that situation may be changing.
Ken explained: “Sandwell Council agreed that if any residents would prefer a digital autopsy the local authority will pay. That may encourage other councils to follow.”
Despite its widespread application, digital autopsy cannot be used in every case. For example, if the deceased had been suffering from a sepsis, such as blood poisoning, that will not show up. Accordingly, before undertaking any procedure the iGene team will ask for previous medical history, which will provide an indication of cause of death.
At the moment, the process uses CT and MRI scanners, with the software developed by iGene for CT scanners, allowing the production of rich and detailed 3D images. However, even though it is a relatively recent procedure, digital autopsy is already developing.
Ken said: “People are starting to explore the possibility of using ultrasound scanning. The added benefit is that ultrasound scanners are small and mobile – they can be taken to the deceased and so there is no need for the body to be transported to a scanning facility.”
It seems that before it’s even established, digital autopsy is moving ahead. A fact that would surely be approved of by those who were pioneering the use of x-rays more than 120 years ago.
To find out more information visit: www.digitalautopsy.co.uk