×

Welcome to the Slashdot Beta site -- learn more here. Use the link in the footer or click here to return to the Classic version of Slashdot.

Thank you!

Before you choose to head back to the Classic look of the site, we'd appreciate it if you share your thoughts on the Beta; your feedback is what drives our ongoing development.

Beta is different and we value you taking the time to try it out. Please take a look at the changes we've made in Beta and  learn more about it. Thanks for reading, and for making the site better!

The Virtues of the Virtual Autopsy

Soulskill posted about a year and a half ago | from the cheerful-tech-of-the-day dept.

Medicine 48

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.'"

cancel ×
This is a preview of your comment

No Comment Title Entered

Anonymous Coward 1 minute ago

No Comment Entered

48 comments

Did anyone else read this as (0)

Anonymous Coward | about a year and a half ago | (#41745659)

The Virtues of the Virtual Apostacy

Wait (4, Insightful)

Mephistophocles (930357) | about a year and a half ago | (#41745781)

...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 (4, Insightful)

iiii (541004) | about a year and a half ago | (#41745827)

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.

Re:Wait (2)

CanHasDIY (1672858) | about a year and a half ago | (#41745861)

...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?

Positive Externalities (3, Insightful)

alexander_686 (957440) | about a year and a half ago | (#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.

But Corporations are People (1)

Anonymous Coward | about a year and a half ago | (#41745919)

...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 (4, Interesting)

daem0n1x (748565) | about a year and a half ago | (#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.

Re:Wait (1)

Anonymous Coward | about a year and a half ago | (#41746751)

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

Re:Wait (1)

daem0n1x (748565) | about a year and a half ago | (#41750313)

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 (4, Informative)

ShmuelP (5675) | about a year and a half ago | (#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.

Re:Wait (0)

Anonymous Coward | about a year and a half ago | (#41749145)

The "remains" are just that, I find it utterly ridiculous to not utilize everything we have to better human kind. F*ck you're dead body, if it can advance science do what you must, this religious acceptance needs to end in the face of science.

Re:Wait (1)

daem0n1x (748565) | about a year and a half ago | (#41749795)

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.

Re:Wait (1)

Anonymous Coward | about a year and a half ago | (#41750565)

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)?

Re:Wait (1)

tibit (1762298) | about a year and a half ago | (#41752457)

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.

Re:Wait (2)

Local ID10T (790134) | about a year and a half ago | (#41746365)

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.

Re:Wait (1)

tibit (1762298) | about a year and a half ago | (#41752469)

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.

Re:Wait, Other Autopsy experts (1)

Anonymous Coward | about a year and a half ago | (#41748705)

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 were because of medical malpractice.

And yes these private practices go through the required training to perform a correct and accurate atuospy, about the same as the idiot who has extensive education but still manages to screw up, and not just a few times, several times a year.

longest...summary...EVAR (1)

xxxJonBoyxxx (565205) | about a year and a half ago | (#41745821)

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

Re:longest...summary...EVAR (3, Funny)

ShanghaiBill (739463) | about a year and a half ago | (#41746005)

can anyone summarize?

Sure. If you substitute a CAT scan for a real autopsy it works just as well, except when it doesn't.

what? (1)

bmimatt (1021295) | about a year and a half ago | (#41745837)

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?

Re:what? (0)

Anonymous Coward | about a year and a half ago | (#41746101)

I have to confess that as an MD, that's the first time I've ever heard that reason given for not doing autopsies. The normal reasons are religious or personal objections by the relatives, cost (autopsies are very expensive taking many hours of a pathologists time as well as extensive time of technical and assistant staff).

In many jurisdictions, if the cause of death is unknown, or medical malpractice or some other forms of crime is suspected, then it is mandatory that the physician confirming death must inform the coroner who will then arrange a medico-legal autopsy.

Re:what? (2)

Guppy (12314) | about a year and a half ago | (#41747479)

autopsies are very expensive taking many hours of a pathologists time as well as extensive time of technical and assistant staff.

Quite right, it's not really clear who's on the hook to pay. In theory, the cost of autopsies are supposedly covered in the contracts hospitals have with government and private insurance, but often as a hazy "it's included" concept, often with no budget earmarks for the departments that would actually do the work, and no change in funds for increased (or decreased) use of autopsies.

As a physician, another reason (0)

Anonymous Coward | about a year and a half ago | (#41762253)

I am an MD as well. I have absolutely never heard of this. Most physicians I know are constantly lamenting the fact that autopsies are rare. We want to know just as much as the patient's family. Think of reading a mystery novel missing the last chapter!

It is mostly cost that is the reason for not doing autopsies any more.

The other factor that I have not yet seen mentioned yet: physicians feel uncomfortable asking for this immediately after death. The family is grieving, many people are offended (religiously) by requests for autopsy, and in many cases organ donation was just discussed - and in our minds that is a much more important decision that needs to be made. Finally, many people want to hold a viewing, and they don't understand that this is absolutely doable after autopsy. Pathologists take great care to preserve the external appearance of the body.

safe dose (1)

queazocotal (915608) | about a year and a half ago | (#41745853)

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

Re:safe dose (2, Informative)

Anonymous Coward | about a year and a half ago | (#41746275)

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, so a conventional x-ray source with poorer focus must be used.

CT has greater scope for improving the images quality, because CT image noise limited by photon shot noise in order to keep doses down. With modern scanners, they typically scan at maximum resolution always, but can then resample the images to lower resolution if desired for viewing (usually to reduce noise, or in my hospital's case because their SAN contract means archiving the full resolution data is cost-prohibitive). The technologist instead of controlling scanner parameters directly, merely specifies the desired quantity of noise at a standard resolution.

From a medical perspective, this doesn't actually give much benefit in terms of diagnostic performance. From a practical perspective there are other issues as technologists are often barely trained. I once asked a CT technologist to scan a dry skull for use as an anatomical teaching tool, and asked them to crank up everything on the scanner to maximum; they couldn't do it even when I told them exactly what settings to change. As another example, I was looking at the functionality available on the scanner, which used a "tab page" control for the scan parameters and when I finished, I left the 2nd page visited rather than the first; I got my ass chewed out for that because the technologist couldn't work out what had happened to the scan settings, necessitating delaying an emergency scan and prompting an emergency support call to the scanner manufacturer.

CT scan for soliders? (1)

Stoutlimb (143245) | about a year and a half ago | (#41745981)

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?

Re:CT scan for soliders? (0)

Anonymous Coward | about a year and a half ago | (#41746195)

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?

Yes, indeed: the additional scattered radiation reflecting from the metal shards will give terminal cancer to any tech who is busy humping the scanner during these scans.

The smarter techs, will as normal, be in another room behind radiation shielding...

Re:CT scan for soliders? (0)

Anonymous Coward | about a year and a half ago | (#41746517)

MRI = Magnetic Resonant Imaging
CAT = Computer Aided Tomography

MRI is the superconducting coil method. CAT involves taking hundreds of X-ray slices in different planes and reconstructing the volume by mathematical means.

There's also PET = Positron Emission Tomography.

MRI is safe if the metal fragments are not magnetic. That's down to which elements are used.

I do wonder if MRI could be used to give someone a heavy metal detox as all those atoms would be pulled through the body. Wouldn't there be some build up on the walls?

bad idea (1)

Iamthecheese (1264298) | about a year and a half ago | (#41746213)

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.

Interesting point - the military (1)

Kittenman (971447) | about a year and a half ago | (#41746229)

.. 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 dead as demi-gods (1)

Alomex (148003) | about a year and a half ago | (#41746349)

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?

Re:The dead as demi-gods (1)

Macgrrl (762836) | about a year and a half ago | (#41746673)

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

Re:The dead as demi-gods (1)

Alomex (148003) | about a year and a half ago | (#41746853)

Sorry, but you your LMGTFY is a fail:

"some sects" != "major religion"

Re:The dead as demi-gods (2)

dmr001 (103373) | about a year and a half ago | (#41747821)

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 would likely be exonerated, and many (perhaps most others in these parts anyway, among my colleagues in the US Pacific Northwest) honestly would want to learn from their mistakes. Nevertheless, it's hard to figure out who funds them, and many families tend to feel it's a final act of violence. Still, it's hard for me to wrap my head around getting a more accurate, cost-effective answer from a CT scan than a old-fashioned postmortem.

Re:The dead as demi-gods (1)

Alomex (148003) | about a year and a half ago | (#41748011)

Actually the main branches of Judaism and Islam do not oppose autopsies.

Re:The dead as demi-gods (1)

Guppy (12314) | about a year and a half ago | (#41747635)

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 formalin.

WTF (1)

Anonymous Coward | about a year and a half ago | (#41746423)

"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.

Well I'm not a Doctor but... (1)

Eddy_D (557002) | about a year and a half ago | (#41746455)

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.

Wrong (0)

Anonymous Coward | about a year and a half ago | (#41748791)

I assist with autopsies and have performed over 500 this year alone. We do more and more cases a year, not less. And we almost never hear of religious objection. Maybe once a year. Maybe. This article is so wrong I'm disgusted even seeing it on here.

"...I doubt it will ever be better.'" (1)

fygment (444210) | about a year and a half ago | (#41750461)

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 do they have a profession ready to leap to their defense.

Paragraph? (0)

Anonymous Coward | about a year and a half ago | (#41750867)

Pickens apparently knows not what a paragraph is. Jamming everything into one paragraph is the mark of an amateur writer.

Check for New Comments
Slashdot Account

Need an Account?

Forgot your password?

Don't worry, we never post anything without your permission.

Submission Text Formatting Tips

We support a small subset of HTML, namely these tags:

  • b
  • i
  • p
  • br
  • a
  • ol
  • ul
  • li
  • dl
  • dt
  • dd
  • em
  • strong
  • tt
  • blockquote
  • div
  • quote
  • ecode

"ecode" can be used for code snippets, for example:

<ecode>    while(1) { do_something(); } </ecode>
Sign up for Slashdot Newsletters
Create a Slashdot Account

Loading...