The Virtues of the Virtual Autopsy

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.'"

Wait

[Mephistophocles]

...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

[iiii]

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.

Positive Externalities

[alexander_686]

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.