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Death and DX: Pathologists swap scalpels for software

Digital autopsies to become the default in Kent.

Last year coroners in the UK ordered some 80,000 post-mortems. These were carried out by pathologists who remove and examine internal organs; lift the top of the skull and assess the body as part of a coroner’s investigation into the cause of death. (Few people who have attended an inquest will forget the sound of a pathologist gently intoning the weight of a heart, removed from the body of some recently lost soul.)

All deaths in England and Wales must be registered, but the coroner only has a statutory duty to investigate certain deaths – a duty that investigate only arises when the coroner has reason to believe that the death is violent, unnatural, the cause of death is unknown or occurring in custody or other state detention.

That process has evolved over the years but had some continuity since Antistius examined Julius Caesar’s body after his assassination in 44 BC to determine which of the 23 stab wounds he suffered proved fatal; or indeed since a magistrate in Bologna ordered Bartolomeo da Varignana to conduct the first recorded legal autopsy.

The digital autopsy

Yet few lines of work are immune to digital transformation and so it is with pathology – which is making a digitally-driven departure from the physical incisions and organ removal that marked it for centuries.

In southeast England, for example, the UK’s largest local authority, Kent County Council (KCC) and the Kent Senior Coroners have agreed to use Digital Autopsy as “the principal means of establishing the cause of death for all cases referred to the coroner that would otherwise be dealt with using traditional invasive post-mortem procedures” they said this week – as they began a public procurement process for the technology they need.

“The successful supplier will be required to provide digital autopsies for an average demand of 3,300 post-mortems per annum” they said in a tender posted on December 20, 2021; a number that may of course vary depending on the number of investigations ordered by Kent’s four coroners every year. (They had to investigate a “distressing” number of deaths in 2021 – which on at least one occasion reached 300 in a  week.)

Compute, rendering software improvements

The technology is not new. Wüllenweber et al. first reported the use of computed tomography (CT) scans for a forensic inquest in 1977, but has been evolving fast with improved compute and imaging capabilities. 2D visualisations for example replaced by 3D. These, in turn, typically previously used so-called “surface-shaded displays (SSD)”; a technique that visualises elements of the image within a defined Hounsfield (greyscale) range, with simplistic lighting. Yet as one April 2021 paper in the International Journal of Legal Medicine volume notes, “SSD have been mostly replaced by volume-rendering techniques (VRT) in most medical image viewers due to the increasing processing power [and]… sophisticated rendering algorithms available.”

The KCC decision comes eight years after the UK’s first digital autopsy centre opened in Sheffield, with the technology having evolved considerably since. In counties without such facilities families who have requested a digital autopsy, including for religious reasons, have typically had to fund the investigation themselves.

Digital Autopsy, the tender notes meanwhile, uses Computerised Tomography (CT) techniques to develop “three dimensional images for a virtual exploration of the human body”. (KCC has received planning permission for a dedicated facility on its former transport workshop site in Beddow Way in Aylesford.)

Post-mortem CTs, academics say, permit “assessment of most forensically relevant conditions such as bone fractures, hemorrhage, parenchymal lacerations, free intracorporal gas accumulation, and the presence of foreign bodies” with various forensic disciplines, including forensic medicine, forensic anthropology, and forensic crime scene reconstruction, having routinely worked with post-mortem image data for some time.

Yet like so many sectors, from banking to retail, defence to healthcare, digital transformation is upending established ways of doing business. And as its advocates say in the digital autopsies space, the technology can hugely reduce the distress that can be caused to loved ones when someone that they have lost is made subject to an intrusive post mortem examination. Few would argue with that as a positive change.

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