Virtual Autopsies Provide New Insights into Death

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A 'Revolution'

It was only the move to the University of Zurich and a bequest from a wealthy ophthalmologist that led to the project's breakthrough. But it was poorly received in the professional world at first. "Initially we were decried as the enfant terrible of forensics," says Thali. Older champions of the autopsy room would often tersely refer to the idea of virtual autopsy as "crap," Thali recalls.

But a younger generation of forensic scientists, who have since taken over at most institutions, are much more open to the new technology. Michael Tsokos, the chief forensic scientist at Berlin's Charité Hospital, recently ordered a pared-down version of the Virtobot.

"We use a version that a poor city-state like Berlin can afford," says Tsokos.

He characterizes the new possibilities of post mortem imaging a "revolution for forensic medicine," on a par with the discovery of the genetic fingerprint and hair analysis.

"If (former German politician) Uwe Barschel or (singer) Kurt Cobain had been pushed into CT scan machines, their deaths wouldn't raise so many questions today," says Tsokos.

In addition to Charité, three out of a total of 35 forensic medicine institutes at German universities can now conduct virtual autopsies. But even in Berlin, scans are made of only a fraction of dead bodies due to a lack of technicians trained to use the equipment. Tsokos and his colleagues likewise felt clueless at first. The manufacturer hadn't provided anything resembling a manual on how to store, archive and interpret the data that had been obtained.

The complexity of the new procedure means that the once prominent role of the forensic scientist as the maestro of the autopsy table could fade. In Thali's laboratory in Zurich, he wouldn't even be able to operate his suite of machines without radiologists and engineers as equal partners at his side.

Dwindling Number of Autopsies

Furthermore, virtual autopsies could also lead to changes in ordinary autopsies. Nowadays most family doctors decide whether or not a person died of natural causes. But this practice has fallen into disrepute in Germany. Forensic scientist Tsokos suspects that about half of all homicides are currently being overlooked. He attributes this to doctors who simply have not mastered this part of their profession, or who do not treat it with sufficient seriousness.

Employees at the Institute of Forensic Medicine of the Hannover Medical School (MHH) in northern Germany agree with Tsokos's critical assessment. In an essay recently published in the German criminology journal Archiv für Kriminologie, the MHH experts write "that the post-mortem in more than 10 percent of cases is performed incompletely or not in accordance with legal requirements." They conclude: "The inspection of corpses currently does not satisfy the intended quality standards, especially not with regard to legal certainty."

In contrast to forensic medicine institutes, autopsies are hardly performed at all in hospitals anymore. Whereas a forensic autopsy is ordered by the public prosecutor's office in suspected murder cases, a pathologist can only perform a clinical autopsy with the permission of the family of the deceased.

There has been a drastic decline in this clinical form of autopsy in Germany in the last few decades. Only about 3 percent of all corpses of the recently deceased are opened up to inspect the internal organs. By comparison, 10 times as many cases end up in a pathology department in Austria.

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