Virtopsy

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As Virtopsy ® a forensic medical procedure is called that a great part of conventional post-mortem examinations ( autopsies to replace, autopsies) through a minimally invasive procedure. This should take place against the background of the exponential technological development of medical imaging that began in 1970 .

Designation "Virtopsy"

The research project called “Virtopsy” was initiated at the end of the last century under the direction of Richard Dirnhofer (CV) at the Institute for Forensic Medicine at the University of Bern. The neologism "Virtopsy" - a fusion of the words virtual and autopsy - stands for an improved presentation and documentation of forensic medical findings. The term “virtual” is not used in the sense of a contrast to real, but in its original word meaning of the Latin root “virtus” (virtue) and thus describes the properties: fit, capable, better. Virtual replaces the Greek stem autopsy car - itself. This should be an expression of the fact that the virtoptische® method leads to a further development for more objectivity of forensic medical reports.

Virtopsy is a brand name registered to the emeritus director of the Institute for Forensic Medicine at the University of Bern (Switzerland), Richard Dirnhofer .

With Michael Thali as operational director, the Virtopsy® research group has been affiliated with the Institute for Forensic Medicine at the University of Zurich since the beginning of 2011 .

The Ludwig Boltzmann Institute for Clinical Forensic Imaging (LBI-CFI) in Graz focuses on clinical imaging of victims of violence .

While Virtopsy is a protected brand name, the terms PMI ( Postmortem Imaging ), postmortem imaging and in Japan AI ( Autopsy Imaging ) are used to summarize the use of imaging methods mainly in the case of the deceased.

origin

The first scientific study describing post-mortem CT imaging in the deceased comes from Israel and was published in 1994. The conclusion at that time was that it is the combination of imaging methods with conventional autopsy (and not the use of only individual modalities) that improves the documentation of findings most comprehensively.

Procedure

Forensic medicine is a medical field in which doctors examine possible, suspected or certain victims of violence who ultimately die . Clinical forensic medicine deals with possible, suspected or certain surviving victims of violence; on the other hand, the areas of traffic medicine and age estimation deal with questions that are also dealt with by general practitioners , paediatricians or other medical professionals. Since these investigations are usually carried out on behalf of an investigating authority, there are legal, u. a. criminal procedural regulations for the procedure.

One of the most important work steps in forensic medicine is the documentation of the forensic findings. The documentation is based on the diagnosis and expert opinion of the forensic doctor, which can be important for the case law.

Virtopsy uses imaging methods for documentation, as they have been used in clinical medicine and industry for some time. Computed tomography and magnetic resonance imaging are suitable for capturing parts of or the entire body volume. In vehicle construction and surveying technology, 3D surface scanning is used to create precisely dimensioned surface documentation; In forensic medicine, injury findings are integrated with measurement data from the location of the incident or accident. In addition, 3D image-supported biopsy procedures and post-mortem angiography with the representation of the cardiovascular system are used. Merged into a data set , the 3D recordings make the decisive, qualitative difference to the classic forensic medical diagnosis documentation.

Digital data collection and storage , on the other hand, allow findings to be documented without the risk of subjective misinterpretation. While wounds in living bodies heal and injuries in the deceased are subject to natural decay, the documentation of findings from imaging procedures permanently records all the details of a body. The data can be archived and reproduced independently of time. They can be shown in reconstructions of the crime scene and course of events and are available for research and teaching for study and exercise purposes. Obtaining second opinions is made possible as well as cooperation in international research teams and in the global fight against crime.

The instruments currently used for performing a "virtual autopsy" consist of:

  • Surface scanning by camera robots for three-dimensional, true-to-scale and colored documentation of the body surface; corresponds in the classic autopsy procedure to the “external inspection of the corpse”;
  • Multi-slice spiral CT and MRT for the representation of the body in layers in all spatial levels, optionally also in 3D; corresponds to the "internal corpse inspection" of the autopsy;
  • Virtangio machine, with which the corpse's heart and blood vessel system is displayed together with a contrast medium;
  • Contamination-free sampling with image-controlled robots for a wide variety of additional forensic analyzes , such as B. Histology , Bacteriology , Virology , Toxicology and Diatom Studies ; replaces the usual preservation of specimens on the corpse.

Against the background of various robotized processes for data acquisition, Dirnhofer introduced the term “Virtobot”. With that, the motto created by Jens Bauer, “Virtobot makes Virtopsy happen”, was born.

Research goal

The aim of the “Virtopsy” research project is to fundamentally improve forensic medical reports in forensic autopsies with regard to their objectivity. Through the combined use of the various imaging methods, a high-precision pictorial 3D data set of the deceased is generated. This "facsimile" - d. H. The original scale replica of the corpse as evidence can then be examined in all of its details on the computer screen by different people ( multiple eyes principle , teleforensics).

advantages

The following advantages are associated with this process:

  • Preservation of the real evidence object corpse in its virtual existence.
  • Person-independent documentation of the evidence object - "delegating seeing" to the machine.
  • Complete, non-destructive recording of the findings from head to toe
  • Data acquisition in body regions that are otherwise spared for reasons of piety (e.g. face).
  • Data acquisition in preparatory areas that are difficult to access (e.g. head joints) and in the case of advanced cadaveric changes.
  • Representation of the entire blood vessel system.
  • Replacement of manual dexterity with the “virtual knife” of the machine-based cutting method.
  • Standardized data acquisition process.
  • Highly precise, contamination-free sampling with millimeter accuracy (toxins, infections, tissue, etc.)
  • True-to-scale 3D documentation for precise forensic reconstructions
  • Clean, bloodless presentation of the documentation
  • Quality improvement of the reports - teleforensic "multiple eyes principle"
  • Facilitation of the evaluation of evidence through better traceability of the 3D visual findings.
  • Acceptance by relatives and religious communities with negative attitudes towards opening bodies
  • The entire stored data set can be inspected as a source of knowledge for a new expert assessment - even after the body has been buried.
  • Rapid and complete data acquisition in the context of analyzes in the event of mass disasters ( terrorist attacks , plane crashes , etc.)

With “Virtopsy”, a forensic medical report in the sense of an old requirement, namely “a complete and faithful view of the viewed object” (E. von Hofmann) is fully sufficient. With “Virtopsy”, the old concern “to take photos with words when creating the protocol so that one can visually understand the thoughts of the obducent” (Schwarzacher) has been fulfilled.

Best practices

This is also the reason that the National Research Council of its proposals for reform of the forensic sciences, Virtopsy as "in the US as part of best practices " for the forensic medical evidence has suggested. In 2012 an international scientific society for the field of forensic radiology and imaging (ISFRI) was founded in order to continuously exchange the research results and to standardize the corresponding procedures.

Furthermore, a Technical Working Group Postmortem Angiography Methods (TWGPAM) was founded in 2012 under the aspect of best practices. Under the leadership of the Center hospitalier universitaire vaudois (CHUV) at the University Hospital Lausanne , (Silke Grabherr), this Scientific Group (nine European institutes for forensic medicine) develops reliable, standardized methods and guidelines for the implementation and assessment of imaging, post-mortem, angiographic examinations.

Institutes conducting research under the Virtopsy project

Web links

Movies

Book and magazine articles

  • Brogdons's Forensic Radiology, 2nd Edition Michael J. Thali, Mark D. Viner, Byron Gil Brogdon, 2011 CRC Press
  • The Virtopsy Approach: 3D Optical and Radiological Scanning and Reconstruction in Forensic Medicine Michael J. Thali, Richard Dirnhofer, Peter Vock, 2009 CRC Press
  • Development of the system, interview with Thali
  • Virtopsy - autopsy new in pictures; Dirnhofer / Schick / Ranner, Law of Medicine Series, 2010 Manz
  • Revolution in forensic medicine published in "Public Safety 9-10 / 09"
  • The virtopsy will replace the autopsy. Published in CRIME POLICE October / November 2009

Individual evidence

  1. ↑ Virtopsy
  2. ^ Richard Dirnhofer, Peter J. Schick, Gerhard Ranner: Virtopsy - autopsy new in pictures . Vienna, Austria: Manzsche Verlag- und Universitaetsbuchhandlung, 2010, ISBN 978-3-214-10191-6 .
  3. ↑ Ampanozi G, Ruder TD, Thali MJ: Autopsy, necropsy, and necrotomy: if used, why not correctly? . In: Am J Forensic Med Pathol . 33 (2), 2012. PMID 21224734 .
  4. ↑ Wirtschaft (CH) brand names
  5. ^ LBI-CFI
  6. ↑ Donchin Y, Rivkind AI, Bar-Ziv J, Hiss J, Almog J, Drescher M .: Utility of postmortem computed tomography in trauma victims. . In: The Journal of Trauma . 37, No. 4, 1994, pp. 552-555. PMID 7932884 .
  7. ↑ Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, Schroth G, Ith M, Sonnenschein M, Doernhoefer T, Scheurer E, Plattner T, Dirnhofer R: Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) - a feasibility study. . In: J Forensic Sci . 48, No. 2, 2003, pp. 386-403. PMID 12665000 .
  8. ↑ Ebert LC, Ptacek W, Naether S, Fürst M, Ross S, Buck U, Weber S, Thali M .: Virtobot - a multi-functional robotic system for 3D surface scanning and automatic post mortem biopsy. . In: Int J Med Robot . 6, No. 1, 2010, pp. 18-27. PMID 19806611 .
  9. ↑ Grabherr S, Djonov V, Friess A, Thali MJ, Ranner G, Vock P, Dirnhofer R .: Postmortem angiography after vascular perfusion with diesel oil and a lipophilic contrast agent. . In: AJR Am J Roentgenol. . 187, No. 5, 2006, pp. W515-23. PMID 17056884 .
  10. ↑ Thali MJ, Braun M, Buck U, Aghayev E, Jackowski C, Vock P, Sonnenschein M, Dirnhofer R .: VIRTOPSY - scientific documentation, reconstruction and animation in forensic: individual and real 3D data based geo-metric approach including optical body / object surface and radiological CT / MRI scanning. . In: J Forensic Sci. . 50, No. 2, 2005, pp. 428-442. PMID 15813556 .
  11. ↑ Aghayev E, Staub L, Dirnhofer R, Ambrose T, Jackowski C, Yen K, Bolliger S, Christe A, Roeder C, Aebi M, Thali MJ .: Virtopsy - the concept of a centralized database in forensic medicine for analysis and comparison of radiological and autopsy data. . In: J Forensic Med Leg. . 15, No. 3, 2010, pp. 135-140. PMID 18929036 .
  12. ^ O'Donnell C, Woodford N .: Post-mortem radiology - a new sub-specialty? . In: Clin Radiol . 63, No. 11, 2008, pp. 1189-1194. PMID 18313007 .
  13. ^ International Society of Forensic Radiology
  14. ↑ Div. Post-mortem angio