Nonsurgical Autopsy Technique May Transform Postmortems

A new nonsurgical postmortem technique pioneered by British forensic pathologists and radiologists has the potential to revolutionize the way autopsies are conducted worldwide.

The technology was developed by a team from the University of Leicester (UK) in collaboration with the University Hospitals of Leicester NHS [National Health Service] Trust in the East Midlands Forensic Pathology Unit at the University of Leicester. This study presents the development of the methodology and protocol for this technique from independent research commissioned by the UK National Institute for Health Research (NIHR; London, UK). The study, according to the investigators, has taken another step towards a minimally invasive autopsy for natural and unnatural deaths, for either single cases or mass fatalities. It could also potentially dispel reservations from certain faith groups that object to autopsies.

Prof. Guy Rutty, chief forensic pathologist to the East Midlands Forensic Pathology Unit, which is part of the department of cancer studies and molecular medicine, University of Leicester, reported that the pilot study had shown the potential of the technique to change the future of post-mortem procedures. He said, "Autopsies are not popular with the general public and are viewed with great distaste. There are a number of faith groups who voice objections to the autopsy. The development of a minimally invasive autopsy technique would reduce the overall number of invasive autopsies performed in the UK but would still provide a service to the Coroner and determine the cause of a person's death. Currently, without the use of angiography, cardiac-related death cannot be reliably diagnosed using a postmortem CT [computed tomography] scan so we needed to develop a system that could do this.”

The study's findings were published March 1, 2011, in the International Journal of Legal Medicine. "In collaboration with the radiology team, led by Prof. Bruno Morgan, we have successfully developed a quick and simple technique of minimally invasive targeted coronary angiography where we inject contrast into the body of a deceased person through a small incision in the neck and then perform a full body CT scan. Using this method, we are able to determine the cause of death in up to 80% of cases [in the series analyzed to date]. The technique is used to highlight and examine the vessels of the heart in people who have died. The technique is inexpensive, easy to use, and applicable to natural and unnatural death, both single and mass fatalities.”

Prof. Rutty explained the technique was innovative because it uses catheterization, contrast, and imaging modalities that have not been used previously. "Developing a new catheterization system and using two different types of contrast to highlight the coronary vessels [air and standard coronary radio-opaque contrast media] sets us apart from other research groups,” he said.

The research article presents the findings from an initial pilot of 24 cases. The University team will now complete a further 200 cases in 2011 to additionally assess the technique and assemble a bigger evidence base.
Prof. Rutty added, "We were the first unit in the world to our knowledge to propose targeted angiography as the way forward, and are now the first to describe the development, methodology and protocols involved for cadaver cardiac CT angiography. Other groups have done whole body angiography, which is time-consuming and expensive, and is unlikely to be implemented in the UK for everyday autopsies. We are incredibly excited about the potential of this new research. This technique could see the beginning of a permanent change in autopsy practice in the UK, with fewer autopsies being performed. This technique could be used in other centers across the world.”

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