الفهرس 
Introduction and Aim of the Work ..Only 14 pages are availabe for public view
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Abstract
Summary
The application of imaging techniques for non-invasive
documentation and analysis of relevant forensic findings in
living and dead persons has lagged behind the enormous
technical development of imaging methods.
The trans-disciplinary research project Virtopsy is
dedicated to implementing modern imaging techniques into
forensic medicine and pathology in order to augment current
examination techniques or even to offer alternative methods.
This study aims to define virtopsy and describe its
technique and illustrate various applications of virtopsy in
forensic medicine. It focuses on comparison of autopsy
findings and virtopsy findings in different forensic applications
and highlights the advantages and disadvantages of virtopsy as
a new imaging technique in forensic radiology.
Autopsy:
Autopsy is the scientific examination of bodies after
death, where whole surface of the body as well as all the body
cavities are explored to record the findings.
There are two types of autopsy: 1-hospital autopsy
which is performed to learn the extent of a disease or for
research purposes and needs consent of relatives of the
deceased to be carried out. 2- Forensic autopsy which is
conducted in a government facility and consent is not sought
from the next of kin.
Forensic autopsy procedure includes: 1) Death scene
investigations which is done by the police and the medical
examiner. 2) Identification of the body: Direct identification of
the body by the family members is not always reliable. The
highest order of identification is scientific including DNA and
Summary
159
fingerprints analysis and dental identification. 3) Physical
examination of the body (internal and external body
examination). 4) Ancillary procedures: This step is followed
by reconstitution of the body such that it can be viewed by
relatives of the deceased. 5) Autopsy report should contain the
name of the deceased and an accession number, birth date, and
gender. Autopsy reports have objective sections dealing with
the external examination the internal examination and ancillary
procedures. The subjective section of autopsy report consists
of the diagnoses, the cause-of-death according to the
pathologist opinion.
The autopsy rates have declined since the latter half of
the 20th century and refused by relatives of the deceased and
some religions.
Radiology in forensic medicine
In 1895, Wilhelm Röntgen discovered “x-rays”. Few
years later x –ray found entry into the courtrooms as evidence
of projectiles in living and dead persons. Today, X-ray images
are admissible in courts of law and are accepted as scientific
evidence.
In modern forensic practice a range of radiological
techniques are available. These include plain X ray,
fluoroscopy, ultrasound, angiography, and axial radiography
(Computed Tomography (CT) and magnetic resonance
imaging (MRI)).
The stage at which radiology is implemented during
autopsy will vary according to every case circumstances.
Generally, radiographs are taken after the external examination
and before the dissection, except in cases of bombings and
charred bodies, where it should be performed before external
examination.
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160
The applications of forensic radiology include:
identification, trauma cases and detection of packing and
smuggling.
Identification: The direct comparison of antemortem and
postmortem X-rays is widely applied for personal
identification. Radiographs of skull, chest, abdomen and pelvis
areas are the most frequently used for identification purpose.
Dental identification is the most useful and powerful tool in
identification especially in mass disaster victims. Forensic
radiology has a major role in determination of biological file of
the individuals and identification of individual remains.
Trauma cases: Forensic imaging has another major
application which is documentation of injury. Bone injuries, as
fractures and hematomas can easily be detected by radiology.
The presence of a pneumothorax is demonstrated on chest Xray
in similar manner of its clinical evaluation
In gunshot wounds, radiography is invaluable in the
forensic investigation. It is used to locate the bullet, identify
the type of ammunition and weapon used, document the path
of the bullet, and to assist in the retrieval of the bullet.
In battered child syndrome, radiology especially CT is
advocated for detection of skull fractures while MRI is
effective to document and localize intracranial injury. Other
specific skeletal fractures as spiral-oblique fractures of long
bones, corner and bucket-handle fracture and multiple
posterior rib fractures are easily detected radioligically.
Detection of packing and smuggling: plain abdominal xray
is a relatively good screening tool in evaluating suspected
body packers.
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161
Virtopsy
The Virtopsy, or ”virtual autopsy” was developed by
Richard Dirnhofer and his colleagues at the University of
Berne’s Institute of Forensic Medicine, Switzerland. Virtopsy
basically consists of (a) internal body documentation using
CT, MR imaging, and micro-radiology; and (b) 3D body
surface documentation using photogrammetry and 3D optical
scanning. Additional applications that have also been
implemented into the Virtopsy project are post-mortem biopsy,
post-mortem angiography, Micro-MR, Micro-CT and MRspectroscopy.
Finally, the resulting data sets can be postprocessed
and fused by volume-rendering tools at a
workstation to perform a 3D reconstruction.
All virtopsy studies aim to validate this new approach
by systematically comparing the radiologic and surface
scanning findings with those obtained at traditional autopsy
Virtopsy is a valuable technique in many forensic
applications, as in identification especially in mass disaster
situations, poly-trauma cases, blunt and sharp trauma
assessments, firearms injuries and drowning cases. Also, it is
helpful in revealing some causes of death and some potmortem
changes.
MSCT offers excellent spatial resolution for the
visualisation of the fracture system, foreign bodies such as
bullets, and gas (e.g.; air embolism, subcutaneous emphysema,
and decomposition effects).While, MRI shows soft-tissue
pathology excellently.
Emerging technologies such as micro-CT and MR
microscopy provide images with high resolution. They will
have a comparable impact on histopathology leading to virtual
histology.
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162
By using body surface scanning and post-processing 3D
visualization, virtopsy allows 3D reconstruction of traffic
accident and crime scene and allows comparison between
patterned injuries and assumed injury causing tool.
Virtopsy is superior to autopsy, as it is non-destructive,
allowing second examination of the corpse and can be done in
reasonable time compared to autopsy. It also provides large
information sets which can be stored for years, re-examined by
experts for second opinion, and transferred worldwide
(teleconsultation). Forensic imaging, even if minimally
invasive, is more acceptable by deceased relatives and some
religions.
Virtual autopsy has a number of disadvantages.
Postmortem MSCT and MRI imaging provide no colour
documentation of the body, no information about histology
and chemistry, nor visualization of the circulation and possible
bleeding. These limitations can be solved to certain extent by
using MSCT-guided biopsies or MR spectroscopy and
postmortem angiography.
A major virtopsy limitation is its limited ability to detect
all causes of death especially natural causes as hyper-acute
myocardial infarction (commonest cause of sudden death).
Postmortem changes may cause confusion with antemortem
findings especially if the radiologist has minimal forensic
knowledge. Also, the area of estimation postmortem interval is
still lagging in virtopsy application and needs more studies.
Current studies provide inconsistent evidence on
virtopsy reliability to be an alternative for autopsy. To examine
both the complementary (add-on) and replacement function of
virtopsy in postmortem examination of deceased, welldesigned
and larger prospective studies are needed.