An app to die for

There was a time when all that really mattered in medical imaging was technology that dealt with, well, medicine. That's changed. Though clinical molecular imaging using advanced biomarkers is still a ways away, we've opened the door a crack to use miniature PET scanners in animal research with these agents. Now one of life's inevitabilities is wedging the door open a bit more.

Earlier this month, in Sydney, the Royal Australian College of Radiologists hosted a two-day conference on advances in postmortem radiology. Radiologists, pathologists, medical examiners, forensic scientists, and legal experts convened to take a gander at 3D technologies that could make the autopsy a grisly thing of the past.

This seems like an awfully good idea. Gone would be the sawing of bone, the cutting of tissue, the plopping of organs into stainless steel pans - not to mention the financial costs associated with these procedures. Autopsies are anything but attractive prospects for families to consider, and religious and cultural resistance are issues as well. Take away the x-ray dose constraints that limit resolution on living subjects, and you're talking about some potentially spectacular clarity.

The 3D models that come from CT and, sometimes, MR can be even better than the real thing, putting details under a digital microscope to uncover conditions difficult or impossible to detect by traditional means. Unlike actual bone and tissue, the digital models can be easily shared among forensic pathologists, while serving as permanent records that can be retrieved and examined in the future, if needed. They can also be used in the courtroom, providing exact documentation of deadly outcomes, a welcome relief for juries from the gruesome autopsy photographs that are often entered into evidence.

For all its advantages, however, virtual autopsy hardly registers on the industry's radar. Silicon Graphics was the only provider of postprocessing equipment to give a presentation at the conference. This is not surprising. Only about 1000 bodies have been scanned for postmortem examinations worldwide. Switzerland's Institute of Forensic Medicine has been doing these digital autopsies for more than five years, and yet the institute has only about 100 postmortems in its database.

In the U.S., one of the early adopters of this approach is the Department of Defense, which has used virtual autopsy to examine the effects of improvised explosive devices, high-temperature injuries, aircraft and vehicle mishaps, drownings, and high-velocity gunshot wounds. The DOD has also used the information to research and conduct training in combat casualty care, improve head and body armor, and perform ballistic fragment analysis.

In a world punctuated by war, hurricanes, and earthquakes, virtual autopsy offers a way to help establish the identity and cause of death for victims who can number in the hundreds or thousands. Low-cost CT scanners and software tailored for virtual autopsy could be marketed to coroner's offices across the U.S. There are contract opportunities with the DOD, the Office of Homeland Security, even the Federal Emergency Management Agency.

Virtual autopsy is literally an application to die for.