Autopsy Imaging (Ai)

Past, Present, and Future of Autopsy Imaging

The Nature of Autopsy Imaging (Ai)

Cadavers can be analyzed using diagnostic imaging, which comprises one aspect of medical assessment after death. Imaging of cadavers has also been referred to as postmortem imaging (PMI). Ezawa et al. [155] noted that computed tomographic (CT) imaging before autopsy was valuable, and they referred to the procedure in Japan as autopsy imaging (Ai). Images obtained after death are variously described as “virtopsy” in Switzerland [156] and “virtual autopsy” in France [157, 158] and in Germany [159]. Although the descriptions and concept of Ai somewhat differ, all involve analysis of a cadaver by CT and/or MRI to acquire postmortem medical information.

The History of Ai

Early forensic imaging was applied to identify foreign objects in cadavers such as bullets. A murder victim killed by a bullet was assessed using forensic radiography in Lancashire, England in April, 1896 [160,161]. One report describing a dissection view in 1910 is considered an example of a chest radiographic examination of a cadaver. Although cadavers thereafter were sporadically visualized by radiography and photographed, the information generated in this manner was of little value, and forensic radiology did not develop further.

The appearance and dissemination of computed tomography (CT) during the 1970s generated vast amounts of useful medical information. Imaging of cadavers also began to attract interest, particularly from the viewpoint of crime-related forensics and accidental death. Reports began to describe systematic postmortem imaging during the late 1980s, when Shiotani et al. applied systematic postmortem CT to patients in cardiopulmonary arrest on arrival (CPAOA) [162-164].

A questionnaire sent to hospitals associated with Japanese university medical schools by the Japan Radiological Society between November and December 2010 revealed that 51% of hospitals already employed Ai. Hospitals had begun sporadic CT assessment of patients with CPAOA, and by 2006, about 90% of hospitals in Japan had used CT-based Ai on an emergency basis [165]. Why Ai was implemented in this manner in Japan might be explained by the fact that a medical examiner system had not yet been fully established and the diffusion rate of CT in Japan is the highest in the world.

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