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Medicine Science Technology

The Virtues of the Virtual Autopsy 48

Posted by Soulskill
from the cheerful-tech-of-the-day dept.
Hugh Pickens writes "Maryn McKenna writes in Scientific American that the standard autopsy is becoming increasingly rare for cost reasons, religious objections, and because autopsies reveal medical mistakes, making doctors and hospitals uncomfortable. Researchers in several countries have been exploring the possibility that medical imaging might substitute a 'virtual autopsy' for the more traditional variety. 'So few autopsies are being done now that many medical students get out of school never having seen one,' says Gregory Davis. 'And yet in medicine, autopsy is the most powerful quality-control technique that we have and the reason we know as much as we do about many diseases and injuries.' The process, dubbed 'virtopsy,' combines MRI and CT scanning with computer-aided 3-D reconstruction to prove causes of death for difficult cases, which included drownings, flaming car crashes, and severe injuries to the skull and face. Since 2004 the U.S. military has performed x-rays and CT scans on the bodies of every service member killed where the armed forces have exclusive jurisdiction — that is, not just on battlefields abroad but on U.S. bases as well. 'It allows us to identify any foreign bodies present, such as projectiles,' says Edward Mazuchowski. 'X-rays give you the edge detail of radio-opaque or metallic objects, so you can sort out what the object might be, and CT, because it is three-dimensional, shows you where the object is in the body.' A study conducted among intensive care unit patients in Germany compared diagnoses made before death with the results of both traditional and virtual autopsy in 47 patients and with only virtual autopsy in another 115 whose families refused standard autopsy. Virtual autopsies confirmed 88 percent of diagnoses made before death, not far behind the 93 percent rate for traditional postmortem exams. 'The findings so far are mixed,' says Elizabeth Burton of Johns Hopkins University. Virtual autopsy, she says, 'is better for examining trauma, for wartime injuries, for structural defects. But when you start getting into tumors, infections and chronic conditions, it's not as good, and I doubt it will ever be better.'"
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The Virtues of the Virtual Autopsy

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  • Wait (Score:5, Insightful)

    by Mephistophocles (930357) on Tuesday October 23, 2012 @04:55PM (#41745781) Homepage

    ...cost reasons, religious objections, and because autopsies reveal medical mistakes, making doctors and hospitals uncomfortable.

    Say what? Does anyone else see that last reason list as completely asinine with regards to not doing an autopsy? Ok, maybe the religious one is a silly objection, but there's no need to go against the religious beliefs of the deceased/close family members, at least as long as foul play isn't a concern. But, because it might reveal the f*ck-ups of the quack that took your tonsils out? Yeah, I'm not getting the point of that one...

    • Re:Wait (Score:5, Insightful)

      by iiii (541004) on Tuesday October 23, 2012 @05:01PM (#41745827) Homepage
      Yes. That's what jumped out at me too. Revealing medical mistakes is a reason to do *more* autopsies. And any doctors or hospitals who are "uncomfortable" with that need to get out of the business. If you are not interested in having some QC to improve your processes, I don't want you involved in my medical care.
    • ...cost reasons, religious objections, and because autopsies reveal medical mistakes, making doctors and hospitals uncomfortable.

      Say what? Does anyone else see that last reason list as completely asinine with regards to not doing an autopsy? Ok, maybe the religious one is a silly objection, but there's no need to go against the religious beliefs of the deceased/close family members, at least as long as foul play isn't a concern. But, because it might reveal the f*ck-ups of the quack that took your tonsils out? Yeah, I'm not getting the point of that one...

      Well, welcome to the 21st century, Encino Man! Funniest thing - while you were encased in frozen carbonite, society took, er, a bit of a left turn, see, so now we collectively pretend that it's far more important to protect the reputation of rich quacks, than to enact social justice.


      Whaddayamean, 'that's batshit crazy?' Just what era do you hail from, bub?

    • by alexander_686 (957440) on Tuesday October 23, 2012 @05:06PM (#41745869)

      No – it makes complete rational sense. You want other hospitals to do autopsies – you want other people to bear the expense, the time, the embarrassment of mistakes gone wrong (and the potential lawsuits) to do the basic research that will help you.

      It is a classic (and I mean classic) of things not getting done because the positive externalities are not captured.

    • by Anonymous Coward

      ...cost reasons, religious objections, and because autopsies reveal medical mistakes, making doctors and hospitals uncomfortable.

      Say what? Does anyone else see that last reason list as completely asinine with regards to not doing an autopsy? Ok, maybe the religious one is a silly objection, but there's no need to go against the religious beliefs of the deceased/close family members, at least as long as foul play isn't a concern. But, because it might reveal the f*ck-ups of the quack that took your tonsils out? Yeah, I'm not getting the point of that one...

      remember, corporations aren't just people, they can get their feelings hurt, and they might get sued which would make them sad.

      Now if you'll just check the 520 page electronic contract you signed in 2 point type before agreeing to surgery, you'll see that your first born child is now our indentured servant ...

    • Re:Wait (Score:5, Interesting)

      by daem0n1x (748565) on Tuesday October 23, 2012 @05:21PM (#41745985)

      You're right. Not doing an autopsy because it might reveal the fuckups of some doctor is not only stupid, it's evil.

      What also makes me uncomfortable is seeing something as retarded as "religious objections" as a growing reason for not doing an autopsy. In the Middle Ages, scientists had to buy bodies illegally to make their studies, risking to be burned at the stake for that "horrible crime". Haven't people learned anything yet? What the fuck does their god of choice care if someone cuts open a dead body? He refuses to welcome the deceased guy in Heaven, or Valhalla or whatever?

      After I die, take me to medical college and study me for as long as you like. It may make someone's life better, or even save lives. Then burn me to ashes so I don't go occupying precious real estate. What the fuck do I care? I'll be dead.

      • by Anonymous Coward

        The ritual gives closure to the living. I am sure you would care about the living, even if you are dead.

        • by daem0n1x (748565)
          What prevents my family to get together and perform the ritual? The only difference between a cremation and a funeral is that the box goes into an oven and not a grave.
      • Re:Wait (Score:5, Informative)

        by ShmuelP (5675) on Tuesday October 23, 2012 @08:16PM (#41747179)

        What also makes me uncomfortable is seeing something as retarded as "religious objections" as a growing reason for not doing an autopsy. In the Middle Ages, scientists had to buy bodies illegally to make their studies, risking to be burned at the stake for that "horrible crime". Haven't people learned anything yet? What the fuck does their god of choice care if someone cuts open a dead body? He refuses to welcome the deceased guy in Heaven, or Valhalla or whatever?

        Western civilization has a notion called "religious freedom". We've discovered that things are much more peaceful if we ensure that everyone can practice as they see fit, regardless of how wrong we their religious beliefs (or lack thereof) may be. (Exceptions to the above when said practices involve harm to others.) So if my religion doesn't allow for routine autopsies, for whatever reason that you clearly don't understand, how about leaving it alone? You may feel free to instruct your heirs to handle your remains as you see fit, and the rest of us might appreciate the same courtesy in return.

        • by daem0n1x (748565)

          So if my religion doesn't allow for routine autopsies, for whatever reason that you clearly don't understand, how about leaving it alone? You may feel free to instruct your heirs to handle your remains as you see fit, and the rest of us might appreciate the same courtesy in return.

          I have to leave it alone, unfortunately. That doesn't make it less retarded.

        • by Anonymous Coward

          That's all well and good, buddy, but then there's the little issue of you and other autopsy-deniers "free-loading" medical advancements from other members of society that _do_ allow autopsy.

          Should hospitals and medical companies be allowed to deny treatments derived from medical research, to people that object to that research (you)?

          • by tibit (1762298)

            I wouldn't consider it the most humane thing to do, but hey, if it'd teach some dumb fucks a lesson and make them less hypocritical: why not.

    • The reason you don't get it is because you are not the quack in question, nor are you his insurer, nor his employer...

      • -Doctors are against autopsies because it could show that they erred. Everyone makes mistakes.
      • -Insurance companies have to pay when a doctor's mistake is shown to be the cause of or a contributing factor in someones death.
      • -Hospitals share responsibility for procedures performed by their staff.
      • by tibit (1762298)

        Sure everyone makes mistakes. But the deal is that there are lessons to be learned from such mistakes. Autopsies are the only way to let you learn that lesson.

    • by RKBA (622932)
      ... or it might reveal the f*chk-ups of the quack that took your life.
    • by Anonymous Coward

      This story is misleading, there are more and more private practices that are doing autopsies, relying on the county corner has always been a problem is some cases, and the reasons for private pratices are due to medical fuck ups, and families wanting to know for sure if there was a foul up from surgery, or if the doctors missed a diagnosis, that would have kept that person alive. There is a story from frontline on PBS over this, I believe that corners were giving false autopsy results on patients who deaths

    • Well, to a certain extent there is this idea that doctors should bat 1,000.

      Brian Goldman has an excellent TED talk about this [ted.com]

      You should check it out - it's very informative and it tries to put this problem into context as well as explain why the culture behind it is broken.

  • don't have time to read all that - can anyone summarize?

  • From TFA: "...and because autopsies reveal medical mistakes, making doctors and hospitals uncomfortable..."

    Isn't the point of autopsy to find the reason for death?  Even if it is a mistake of some hack in a white coat?   Really?

    • From TFA:

      Which one? there's, like, 4 of them...

  • I wonder how much x-rays can be improved if you don't care at all about the dose.

    • Re: (Score:2, Informative)

      by Anonymous Coward

      Potentially by a significant margin. In practice, most of the equipment is tuned to specific requirements of resolution, etc. Some flexibility is possible, for example, the use of mammography film/sensors for x-raying limbs for forensic purposes (usually child abuse cases). Mammography films/sensors have very low sensitivity but exceptional resolution and very high contrast; however, the full benefit cannot be obtained as a micro focus mammography x-ray source has insufficient energy to penetrate bone,

  • Wouldn't giving a dead soldier a CT scan be a very dangerous thing to do, considering that the soldier's body could be filled with undetected pieces of metal?

  • For the foreseeable future it will take a real doctor's mark one eyeballs to recognize a tumor, the prick of a needle, several kinds of trauma, or the wrong kind of fluid in various places. Bad, bad idea unless your only purpose is to hide the truth.
  • .. own the bodies of deceased personnel (in as far as OKing the autopsy) if the member dies on a base or a battlefield. Wonder if that's in the Terms and Conditions when you sign up...
  • the standard autopsy is becoming increasingly rare for cost reasons, religious objections,

    Is there any major religion other than "Cult of the Dead" that America is slowly devolving into in which autopsies are forbidden?

    • by Macgrrl (762836)

      LMGTFY [medscape.com] Judaism and Islamic religions have strictures about keeping the body intact, which some sects take to mean autopsies are forbidden.

      • by Alomex (148003)

        Sorry, but you your LMGTFY is a fail:

        "some sects" != "major religion"

        • by dmr001 (103373)
          In my experience (as a physician) most objections to an autopsy are from family members who don't like the idea of their loved ones being opened up and disassembled.

          But there are major religions which objections to autopsy as well, including Islam [archivesofpathology.org] and Judaism [jewishvirtuallibrary.org], though as usual it seems to depend on the local imam/rabbi.

          I'm sure they are out there, but I've never actually known a case of a physician objecting to an autopsy for fear of uncovering their errors. The egotistical among us I suspect feel they w

    • by Guppy (12314)

      Perhaps there are occasional devout individuals who have given thought to the theological implications of an autopsy, or who follow some particular clerical leader who have issued an explicit edict. But I'm guess more often, "religious objection" is used by the general public as a more acceptable way to say "It makes me feel afraid" or "It makes me feel icky". It's not pleasant to think of your loved one having their rib cage cracked open and organs poked at, or their brain sliced up and soaked in formali

  • by Anonymous Coward

    "because autopsies reveal medical mistakes, making doctors and hospitals uncomfortable."

    And? if we don't own up to mistakes, we never learn. Not to mention medical Malpractice. Seriously. This had NO RIGHT to be in the article, except to inflame people and make it a media-bait.

  • If I was an intern, I think I would be more emotionally impacted by cutting into what used to be a living person, rather than staring at some innards on a monitor. The loss of this may hinder the education of medical students.
  • Famous last words, as well as being the second evidence of protectionism of the 'profession' of medicine. The first was the reason NOT to autopsy as making medical staff uncomfortable as it might reveal mistakes. The second downplaying of the technology's potential is typical. Machines are already on-par with humans for diagnostic accuracy virtually anywhere they've been used. The machine's problem is that when a mistake is made, it can't baffle the patient with BS to talk their way out of a lawsuit nor

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