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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 28-32

Prospective and practical significance of virtual autopsy laboratory


1 Department of Clinical Medicine, Jilin University, Changchun, China
2 Department of Forensic Medicine, College of Basic Medical Sciences, Jilin University, Changchun, China
3 Evidence Identification Center, Jilin Province Public Security Bureau, Changchun, China
4 Department of Radiology, First Hospital of Jilin University, Changchun, China
5 Institute for Artificial Intelligence and Clinical Innovation, Neusoft Medical Systems Co., Ltd., Shenyang, China
6 Changchun Public Security Bureau, Forensic Center, Changchun, China

Date of Submission10-Dec-2020
Date of Decision15-Dec-2020
Date of Acceptance31-Dec-2020
Date of Web Publication24-Mar-2021

Correspondence Address:
Lijun Wang
Forensic Center, Changchun Public Security Bureau, Changchun 130021
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfsm.jfsm_72_20

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  Abstract 


The virtual anatomy laboratory was jointly established by the Jilin Province Department of Public Security, Public Security Bureau of Changchun, Jilin University and Neusoft Medical Systems Co., Ltd. on December 30, 2019. Details of the laboratory construction, virtual autopsy process, case analysis, research and development, establishment of standards, application in teaching, and other aspects of the center are summarized in this paper. In addition, we expound the prospective and practical significance of the virtual anatomy laboratory. Based on computed tomography and magnetic resonance detection methods, the prospective applications of virtual anatomy in forensic identification are explored through the analyses of two real-life cases. Using information from traditional anatomy as the gold standard, this study expanded on and explored the application technology and scenarios of virtual anatomy in imaging, clinical diagnosis, and equipment manufacturing, among other fields. The four cooperating units have their strengths and will yield valuable scientific research results and social benefits.

Keywords: Computed tomography, forensic, magnetic resonance imaging, virtual autopsy


How to cite this article:
Wang Y, Chen Z, Liu G, Zhu W, Wang W, Zhou D, Chen W, Gao Y, Yang J, Huang F, Zhang H, Yu G, Wang L. Prospective and practical significance of virtual autopsy laboratory. J Forensic Sci Med 2021;7:28-32

How to cite this URL:
Wang Y, Chen Z, Liu G, Zhu W, Wang W, Zhou D, Chen W, Gao Y, Yang J, Huang F, Zhang H, Yu G, Wang L. Prospective and practical significance of virtual autopsy laboratory. J Forensic Sci Med [serial online] 2021 [cited 2021 Jun 14];7:28-32. Available from: https://www.jfsmonline.com/text.asp?2021/7/1/28/311865



After the German scientist Roentgen discovered X-rays in as early as 1895, forensic scholars in Montreal, Canada, started using X-ray technology to locate the bullets in the shooting victims' legs. In recent years, due to the rapid development of medical imaging technology, especially the advancement in medical imaging technologies such as the multislice spiral computed tomography (CT) and magnetic resonance (MR), “virtual autopsy” technology has been used to reconstruct images of human organs and tissues, which has provided a fundamental basis for inferring important clues, such as the cause and time of death in forensic identification.[1],[2],[3],[4],[5] Virtual autopsy technology can play a huge role in forensic science. Based on the progress in science and technology as well as the demands in practice, the Changchun Public Security Bureau established the virtual autopsy joint experiment center in 2019 and purchased one multislice spiral CT (MDCT) and one 1.5T MR. In cooperation with Jilin University and Neusoft Medical Systems Co., Ltd., the Changchun Public Security Bureau achieved university-police and university-enterprise cooperation and became the first virtual autopsy joint experiment center using multimodality fusion technology (CT/MR) in China.


  Laboratory Construction Top


Environment and facilities

With an area of over 500 square meters, the laboratory is located at the College of Basic Medical Sciences, Jilin University. It has one conventional autopsy room, two virtual autopsy scan rooms (one CT room and one MR room), one operation room, and one information interpretation room. The instruments and equipment available include one Prime 128-slice spiral CT system of Neusoft Medical System, one NeuMR 1.5T, an AVW medical image post-processing workstation (Version 2.0), one Bayer MEDRAD high-pressure injector (model: Stellant D-CE), and one mobile ultraviolet sterilization robot.

Technical support

Senior radiologists with more than 10 years of clinical experience of First Hospital of Jilin University are responsible for image analysis and diagnosis. The lab staff of with many years of clinical diagnosis experience are good at diagnosis of various common clinical diseases and have conducted in-depth research on common injuries and death. The imaging center of First Hospital of Jilin University has a modern medical imaging system with a variety of advanced equipment and sufficient personnel. The center has a large number of advanced equipment reaching the highest international level. The PACS (a medical images storage and transmission system) can realize the network transmission of data and remote consultation.

Research direction

Based on the virtual autopsy technology of CT and MR images, the whole body will be scanned to obtain the imaging data of the cadavers, and explore the development of new technologies in forensic identification technology, medical imaging devices.


  Service Practice Top


Scope of application

Currently, the virtual anatomy laboratory is applicable for forensic identification of corpses in criminal, civil, and traffic accidents; where the autopsy is not applicable due to religious beliefs or ethnic customs, etc.; where families are unwilling to perform the autopsy; where the corpses have been contaminated by infectious disease, toxic substances, radionuclides, or other biological hazards; mummies with a cultural relic value; and circumstances in which the autopsy is unnecessary or inappropriate.

The research projects of lab mainly focus on traffic accidents, mechanical asphyxia, mechanical injuries, and medical disputes. The application spreads across the four Northeastern provinces. An autopsy can be conducted using virtual technology without destroying the integrity of the body. For example, in death cases due to the novel coronavirus disease (COVID-19), autopsies were not performed in the early stages of the pandemic because of the high infectivity of the virus; however, the virtual autopsy could be conducted in time to provide reference for treatment.

Examination procedures

  1. After receiving the corpse, professional technicians conducting clinical work in the Radiology Department at First Hospital of Jilin University operate the instruments and equipment, which are preheated and calibrated. For frozen corpses, the virtual autopsy should be carried out after defrosting to avoid the frozen organs and tissues affecting the imaging examination results
  2. During the examination, the corpse is kept in a body bag that does not produce artifacts (one end of the thick transparent plastic body bag is closed) to limit the extravasation of blood and body fluids, which can contaminate the examination equipment. The corpse is placed on the examination bed in the supine position: Effort should be made to ensure that the corpse is placed in an anatomical position. Metal objects (such as hairpins, keys, buttons containing metal substances, and mobile phones, among others) on the corpse must be removed before MR examination to prevent artifacts or interference with the normal operation of the instrument
  3. According to the relevant information of the case and the requirements of the chief forensic physician, the site for targeted examination should be determined, imaging technology should be selected and technical parameters should be set
  4. After scanning, the corpse is transported to the corpse refrigerator for preservation, and the laboratory is sterilized
  5. Remote consultation and data analysis are conducted on the image data using the LAN of the First Hospital of Jilin University, an image report is issued, and the Changchun Public Security Bureau then issues an identification document based on various examination information.


Examination records

According to a power of attorney for identification and the letter confirming identification, the corpse sample is uniquely numbered. The following information should be entered: The details of the deceased (name, sex, date of birth, ID number), and the case information (time, place, nature of the case, suspicious cause of death); the date, time, and location of the virtual autopsy examination; the names and technical titles of the imaging professionals and forensic experts; examination record of the corpse surface, imaging examination method, examination sites, reconstruction technique, imaging sequence, and other vital technical parameters; imaging examination results, including positive and negative findings, measured values, and three-dimensional (3D) reconstruction results; and the locations, shapes, sizes, and quantities of injuries and lesions. Important information should be printed and archived together with the identification document.

Identification opinions

After the virtual autopsy examination, the imaging professionals and technicians should objectively describe the positive and negative imaging findings. The virtual autopsy report is jointly issued by the imaging professional and technicians of Jilin University and the judicial appraiser. Based on the virtual autopsy results, the appraiser decides whether to carry out an autopsy and microscopic pathological examination, according to the situation of the case. Before the virtual autopsy, we should pay attention to the suspected positive examination sites in combination with the corpse surface examination and past medical history. In the absence of positive sites, the examination can be simplified according to the actual situation. The autopsy can be compared against the virtual autopsy results in real time, which can guide the key sites that need attention during the autopsy.

Data interpretation and archiving

Virtual autopsy technology allows the acquisition of high-quality images, image transmission, and remote consultation. As court evidence, the images are clear, intuitive, vivid, and easy to understand. Imaging data should be converted into DICOM format and archived in tapes, CDs/DVDs, or a PACS system, and a virtual autopsy image database can be established.

Cases

Currently, our center has conducted 10 virtual autopsies, and this article introduces two of these cases as follows.

Case 1

The deceased was a 41-year-old male. On March 15, 2020, while unloading cargo from a truck in a cement plant, the door suddenly broke open, and Pan fell off the truck and was buried underneath the cargo. On March 30, 2020, the virtual autopsy experiment center examined the corpse using the virtual autopsy technology, including MDCT whole-body scan (from the head to legs) and MR scan, and conducted an image postprocessing analysis on the AVW medical image postprocessing workstation version 2.0 and supporting software. The CT scan took three minutes and three seconds. According to the information obtained from the CT image of the corpse [Figure 1]a, no brain contusion or intracranial hemorrhage was found, but scattered gas density shadows were found in the skull and spinal canal, which were considered to be due to the gas produced by postmortem decay. As shown in [Figure 1]b, the right chest was slightly smaller, the mediastinum and trachea were roughly centered, high-density shadows could be seen in the bronchial lumina of each lobe segment, a gas density shadow could be seen in the bilateral chest cavity, liquid density shadows could be seen in the posterior part, part of which was slightly higher and patchy, and ground-glass density enhancement shadows were scattered in both lungs, showing changes of hydropneumothorax and lung contusion. Following 3D reconstruction of the skeletal system, as shown in [Figure 1]c, it could be confirmed that the sternum, right ribs 2–8, and the left anterior ribs 1–5 were fractured, and soft tissues from the lower sternum down to the right chest wall were extensively damaged; however, the epidermis was still continuous, as shown in [Figure 1]d.
Figure 1: (a) Computed tomography image of the brain. (b) Computed tomography image of the lung. (c) Ribs fracture position and fracture cross-section. (d) Extensive soft tissue defect. (e) Magnetic resonance image of the brain. (f) Magnetic resonance image of the chest

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On the MR image [Figure 1]e of the corpse, gas shadows were observed in the cranial cavity, but no brain contusion was found. The bronchi in the middle segment of the right lung were cut-off from their starting points, distal lung tissues were small in volume, and a large number of liquid pockets could be seen in the right thoracic cavity [Figure 1]f. The imaging diagnosis was multiple rib fractures, sternal fractures, and lung contusions. The analysis showed that this was consistent with death from multiple chest injuries, lung contusion, and hydropneumothorax after falling.

An autopsy was carried out after the imaging examination, and the autopsy findings were consistent with the imaging examination results. No skull fracture or brain injury was found. The bilateral pneumothorax test during the autopsy was positive. The autopsy confirmed sternal and multiple rib fractures [Figure 2]a, and a large amount of bloody fluid was found in the chest cavity [Figure 2]b. Autopsy results confirmed that the deceased died of hemopneumothorax due to chest injury after the high fall. Combining virtual autopsy with gross autopsy, we found that postmortem CT and MRI can diagnose mechanical injuries quickly and correctly, which is of great significance for determining the cause of death in cases of mechanical injury.
Figure 2: (a) Multiple fractures of the sternum and ribs. (b) Plenty of blood in the pleural cavity

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Case 2

The deceased was a 39-year-old male. He was found dead in his rented housing unit on March 31, 2020, with no signs of struggle observed at the scene. On March 31, 2020, the virtual autopsy experiment center analyzed the corpse using the virtual autopsy technology, including MDCT whole-body scan (from head to legs) and MR scan, and performed image post-processing analysis using AVW medical image postprocessing workstation and supporting software. The CT scan took 2 min and 14 s.

CT showed that the brain tissue was roughly symmetrical, and there was no injury in the brain parenchyma [Figure 3]a. No injury or lesion was found in the 3D reconstruction of the chest, abdominal cavity, or bones [Figure 3]b.
Figure 3: (a) Computed tomography image of the brain. (b) Three-dimensional reconstruction. (c) Computed tomography image of the brain and skull

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Considering the information provided by the MR image of the corpse, it could be observed that the brain tissue had a good morphology and that there was no sign of hemorrhage in the skull or brain [Figure 3]c. Based on the CT and MR images of the deceased, no fatal injuries were detected. In addition, from the available imaging materials, it could be ruled out that the deceased suffered fatal mechanical injuries before his death.

An autopsy was carried out after the imaging examination, which showed consistent results with the imaging examination. No fatal mechanical injury was found; however, subsequent histopathological examination showed that the deceased had Grade IV stenosis of the coronary artery [Figure 4]a. In addition, cardiomyocyte degeneration and necrosis were observed, revealing pathological changes of acute myocardial infarction [Figure 4]b. Autopsy and histopathological examination confirmed that the deceased died of cardiac dysfunction caused by acute myocardial infarction on the basis of the Grade IV coronary artery stenosis.
Figure 4: (a) Grade IV stenosis of the coronary artery. (b) Grade IV stenosis of the coronary artery and fibrous scar

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Our study found that it is still difficult to diagnose the cause of death in acute myocardial infarction through CT and MRI examinations on the corpse. Intravascular injection of contrast media combined with CT examination is expected to improve the diagnosis of the cause of death in such cases, which will be one of the development directions of our center's research in the future. However, it is undeniable that CT and MRI are of great significance for diagnosing or excluding mechanical injuries.


  Application Value of Virtual Autopsy Technology Top


Application value in forensic examinations

Since CT was first used for postmortem examination in 1990, scholars have investigated its value and advantages in whole-body autopsy.[6] Virtual autopsy can be applied in the field of forensic pathology, such as in inferencing the cause of death, time of death, and the object causing injury. It has been applied in the following aspects of forensic anthropology: gender, height, age, race, facial imaging reconstruction, etc.

CT is a high-speed examination technique, which can complete the whole-body scanning in 1 min. This technical advantage demonstrates its application value in large-scale disasters. Through big data, modeling, and deep computing, the role of CT will be expanded to more situations.

Virtual autopsy CT examination was initially mainly applied to deceased persons with bullet trauma, especially in brain trauma. Later, scholars have continuously explored its value and advantages in whole-body autopsy examinations. Virtual autopsy, using imaging equipment such as CT and MRI, can obtain medical image data that cannot be obtained using traditional anatomy studies, thus solving a large number of problems in autopsy and providing a high social application value.

Research and development value of the imaging technology

Currently, multislice spiral CT and 3D reconstruction technology have significant advantages in detecting bone injuries, soft tissue injuries, and gas and blood changes in the body. However, it is crucial to reduce the radiation dose by CT scanning.[7] Since the subject of virtual autopsies are corpses, there are no artifacts and concerns to minimize injury caused by excessive radiation dose. Continuous scanning with different low doses can be repeated in the examination. Through integrating AI imaging technology and comparing the quality of multiple groups of images, the optimal dose units for different tissue parts can be explored.

Traditional MR imaging has the disadvantages of long scanning time, low accuracy, and unsatisfactory resolution. As virtual autopsy subjects are corpses, satisfactory sampling data can be obtained by scanning for a longer time. By utilizing artificial intelligence algorithms, MR scanning time and image processing speed can be greatly improved; additionally, a large number of clear tissue structure images can be obtained, which provides better image verification while exploring the state-of-the-art scientific research such as quantitative imaging.

Formulation of standards

The establishment of standards for virtual autopsy will be the next goal of our peers. At present, there are no international standards. In China, the SF/ZJD0101003-2015 Operating Procedures for Virtual autopsy in Forensic Medicine issued by the Ministry of Justice is being implemented. Expertise can be summed up as soon as possible through extensive work and cooperation with peers, which can provide the basis for formulating relevant standards.

Teaching application

Currently, the application of 3D virtual autopsy technology has shown an important role in medical education. The panoramic scanning of CT scanning equipment is used to relay corpse structure in the form of images so that anatomical images with similar proportions to living people can be presented on the virtual autopsy table. Through 3D virtual imaging technology, colored 3D images conforming to real human physiological structures can be constructed, and students can perform and learn dissection on the constructed digital corpses.[8] In addition, digital images based on real cases of virtual forensic autopsy can cover many types of cases, such as traffic accident injuries, criminal case injuries, and even medical disputes. Through imaging workstations, 3D pseudo-color images of internal organs and 3D images of the body surface can be formed. Supplemented by real case descriptions, related scenes, medical records, and other materials, 3D images can provide vivid and real-life learning material for medical students.

Acknowledgment

This article was originally released in the Chinese Journal of Forensic Medicine in Chinese. The publication has been approved by the editorial office of Chinese Journal of Forensic Medicine.

Ethic clearance

This study has been approved by the institutional ethic review board and the patient consent has been exempted.

Financial support and sponsorship

The project was funded by the National Natural Science Foundation of China (U1708261).

Conflicts of interest

There are no conflicts of interest.



 
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Michaud K, Genet P, Sabatasso S, Grabherr S. Postmortem imaging as a complementary tool for the investigation of cardiac death. Forensic Sci Res, 2020;4:211-22.  Back to cited text no. 4
    
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Sapienza D, Bottari A, Gualniera P, Asmundo A, Perri F, Gaeta M. Post mortem CT of intrahepatic gas distribution in twenty-seven victims of a flood: Patterns and timing. Leg Med (Tokyo) 2017;29:18-21.  Back to cited text no. 5
    
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Al-Waheeb S, Al-Kandary N, Aljerian K. Forensic autopsy practice in the Middle East: Comparisons with the west. J Forensic Leg Med 2015;32:4-9.  Back to cited text no. 6
    
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Wang YN, Jin ZY, Kong LY, Zhang ZH, Mu WB, Wang Y, et al. Study on optimal contrast noise ratio of dual-energy CT coronary and myocardial imaging. Chin J Med Imaging 2010;18:449-53.  Back to cited text no. 7
    
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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