Virtopsy: Is It Feasible?

by Andrea Campbell

(photo left:Jensen Larson/Discovery Health: TV Guide site)

If only the world of television was closer to reality or even on the horizon of probability, examinations for evidence and especially the cause of death would be so much easier. Take for example, the autopsy. This is a grueling, back-breaking process calling for much determination, the correct tools, and years of knowledge. Breaking skin with cutting tools, using saws to split through cartilage and bone is a difficult, highly specialized and tedious task. If it could only be done in a high-tech manner such as what we see on television shows such as Bones and CSI—with detailed scans and video images of what lay inside—so, can it?

Virtopsy Up for Opinion

According to an article for Newswise from Johns Hopkins Hospital, high-tech “Virtopsies” are not total reality and the more traditional physical examination of autopsy is ‘still the gold standard for determining cause of death’ experts claim. “The latest virtual imaging technologies–including full-body computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, X-ray and angiography are helpful, they say, but cannot yet replace a direct physical inspection of the body’s main organs.”

Pathologist Elizabeth Burton, M.D., deputy director of the autopsy service at Johns Hopkins, reiterates that traditional autopsies to determine how and why someone died are less frequently performed, but the original methodology is still the basic process used. According to an article written in the January online Annals of Internal Medicine by Burton, along with Johns Hopkins clinical fellow, Mahmud Mossa-Basha, M.D., they offer their own opinion as to why the numbers of conventional autopsies have steadily declined over the past decade and why, despite this drop, the virtopsy is unlikely to properly replace it anytime soon.

Autopsy Drawbacks

A recent German study using the conventional method of both autopsy and imaging, versus just virtopsy, showed that the diagnoses using both techniques together netted more accuracy then just the virtual version alone which failed to find almost double the new diagnoses as the conventional version.

Problematic Concerns of Both

"Medical problems most commonly missed or not seen by autopsy included air pockets in collapsed lungs (which could have impeded breathing) and bone fractures, and the most common diagnoses missed by imaging were heart attack, pulmonary emboli and cancer,” says Burton. She believes that imaging results can also create question because most tissue examples need to be physically examined for analysis. Costs may also be prohibitive as imaging equipment costs hundreds of thousands of dollars and full-body CT scans for example can run about $1,500 each, which, when added to device purchasing and maintenance fees, make vitropsy an awfully expensive option.

One of the positive reasons for imaging usage on the other hand, are that the body can remain closed; and Virtopsy detects internal bleeding, and hidden fractures hard to find in a traditional autopsy. And it is also best at something like following bullet trajectories in gunshot victims, where the track is easiest to follow from the unique image perspective.

“Steady progress in imaging technology is refining conventional autopsy, making it better and more accurate,” says Mossa-Basha, a clinical fellow in neuroradiology at Johns Hopkins. “Physicians really need to be selective and proactive—even before a critically injured patient in hospital dies—in deciding whether an autopsy is likely to be needed and, if so, whether to approach the family in advance. Only in this way do we ensure that we are using the latest scanning devices appropriately during autopsy and when it is most effective in producing the most accurate-as-possible death certificates.”

For additional information, visit the National Institutes site at: http://www.nlm.nih.gov/visibleproofs/galleries/technologies/virtopsy.html

Source:

http://www.hopkinsmedicine.org/doctors/results/directory/profile/6976979/Elizabethburton?setsize=10&dbase=main spec_disease=Anatomic%20and%20Clinical%20Pathology

For some interesting real life cases on autopsy and the subsequent evidence, visit:

http://www.nlm.nih.gov/visibleproofs/galleries/cases/index.htm

Photos: Lifelog.it, Brooklyn Museum

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Thank You, Dr. Kevorkian

by Diane Dimond 

Hardly a day goes by that I don’t remember holding my stricken mother’s hand as she laid on a special hospital bed we had set up in her living room. It was there she took her last breath. Almost every day I think about how my father died in the bedroom of the home he loved so much. Both my parents passed away exactly how they lived – on their own terms. 

They wanted no heroic measures to prolong their lives and they adamantly told me – their only child – that they did not want to die in a cold, impersonal hospital room. They made me promise to abide by their wishes. And just in case, they signed a living will putting it all in writing. I thank Dr. Jack Kevorkian for that. He started the national dialogue about death that opened up the topic for discussion in my household.

When Kevorkian started down the path that ultimately earned him the nickname “Dr. Death” it was the early 80′s. He wrote a series of articles on the ethics of euthanasia for a German journal called Medicine and Law. In 1987, he hung out a shingle in Michigan as a physician available for consultation on “death counseling.” His first publicly revealed assisted suicide occurred in 1990 when he helped an Alzheimer’s patient take her life. She, like many other of his patients, was not terminal. But, she was suffering and for Kevorkian that was enough. 

“What difference does it make I’d someone is terminal,” he once said during an interview with CNN. “We are all terminal.” Truer words were never spoken. 

Jack Kevorkian, the son of Armenian immigrants, believed every person held the ultimate decision making power over their own life and death should be a dignified event. Yet, his legacy will likely be focused only on his stand on physician assisted suicide. Once asked what it felt like to take someone’s life Kevorkian said, “I didn’t do it to end a life. I did it to end the suffering the patient’s going through. The patient’s obviously suffering — what’s a doctor supposed to do, turn his back?"

Kevorkian wasn’t perfect in his judgment, as he assisted more than 130 people to end their lives, but I’m not one that believes he had self aggrandizement in mind. Like my parents, Kevorkian believed a mentally competent patient should always be in charge of his or her fate. The justice system may have branded him a criminal but it is clear he singlehandedly made generations of both young and older Americans think about their final moment.

When Kevorkian began to publicly preach about “the right to die” in Michigan in the early 90′s my parents in Albuquerque, New Mexico became disciples. Both Mom and Dad were the type who didn’t use twenty words if ten would do. They sat me down and bluntly told me they believed they – alone – should be in charge of their own lives right up until the moment of their deaths. They showed me their living will and made me promise.

My parents never faltered in their resolve – not even after Dr. Kevorkian had his medical license pulled by the state of Michigan or after he was sentenced to 10 to 25 years in prison on second degree murder charges in 1999. Kevorkian’s book Prescription: Medicide, The Goodness of Planned Death was in my father’s library. Included within was Kevorkian’s idea that executed prisoners should be put to death in a certain way so as to preserve their organs for donation to others. You see, he wasn’t all about death. 

By the time Kevorkian was released from prison on parole in June 2007 on his promise that he would never assist in another suicide both my parents were gone. But their life and death lesson remains indelibly etched in my soul. Because I watched them depart this earth marching to the drummer of their own choosing, I find I don’t fear death like I used to. I’m now able to look at it as a next adventure.

It’s ironic to think that at the end of his life Dr. Kevorkian did not choose the course toward death that he’d preached to so many. He died in a hospital in Royal Oak, Michigan after a month long battle with kidney problems and pneumonia. He was 83. He never married and had no children. His life became all about the death of others.

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Ways to Die: Hanging

by Andrea Campbell

I am pretty sure it's not often that you sit around and imagine what it's like to die by hanging, gunshot wounds, drowning, and all the other means to expire. But mystery writers and novelists have to consider these things for their own fictional world. So, who do you turn to for information? 

Well, a lot of Mystery Writers of America members look to Doug Lyle, MD for answers. You remember D.P. Lyle when we featured his book, Stress Fracture on Women In Crime Ink not too long ago? Today, we welcome him back as a guest editor to answer a question he received on his own blog, The Writer's Forensics Blog, and this particular query is about hanging. Here's Doug's answer to this question:

Question: What Happens When Someone Is Hanged?

Q.: I’ve got a couple of questions about hanging. I have a 140-pound man of slight build who has been hanged. His neck is not broken and thus he is strangling. His hands are bound. How long might he survive before death? Would he lose consciousness well before or shortly before death? If he is taken down before death, we would certainly see abrasion of the neck. What else would we see? If unconscious, would he revive quickly? Could his injuries be life-threatening? (I’m thinking of throat swelling here) I am looking at pre-modern society here. No ER or modern medicine. 

Doug Lyle: In hangings, death results from asphyxia, which is the reduction of oxygen to the brain. Asphyxia in hangings results from the compression of the airways and the carotid arteries (the arteries on either side of the neck that carry blood to the brain) by a noose or other ligature that is pulled tight by the body weight. Thus, the victim must be completely or partially suspended.

Though the airway can be compressed and breathing can be interrupted, the real cause of loss of consciousness and death in most hangings is compression of the carotid arteries, which blocks blood flow to the brain. 

Except for judicial (legally directed) hangings, fractures of the cervical vertebrae (spinal bones of the neck) are uncommon. The reason is that these fractures require that the body drop a sufficient distance to break them. How far is this? The answer depends upon several factors. Individuals who are obese, have small neck musculature, or who have arthritis of the cervical spine may suffer neck fractures quite easily. Just the opposite is true for muscular, thick-necked persons. In judicial hangings, these factors are considered in gauging the distance of the drop. Too little drop and the condemned person is strangled to death, too far and he could be decapitated.

The neck markings seen after hanging depends mainly on the nature of the noose used. Soft nooses such as sheets may leave little or no markings. Bruises and abrasions are not common with softer devices. In fact, if the victim uses a soft noose and if the body is discovered fairly quickly and cut down, the ME may not be able to find any marks at all. A rope or cord may leave a very deep, distinct furrow in the victim’s neck. The longer the body hangs, the deeper the furrow. Abrasions and contusions are more common with these types of nooses. Occasionally the furrow and any associated bruising may reveal the braid pattern of a rope or the link configuration of a chain.

In hangings, the furrow and the bruising will follow a typical course. The pattern is that of an inverted V. The furrow tends to be diagonal across the neck with its high end where the knot is located. The knot is usually to one side. This means that if the knot is to the victim’s left side, the furrow will be lower on the neck and much deeper on the right side and will angle upward toward the left ear. Near the knot, the furrow may shallow and disappear. This pattern is due to the body hanging by the “bottom” of the nose.

Okay, enough about hangings, let’s get to your situation. Since the asphyxia is due to compression of the arteries and not the prevention of breathing, loss of consciousness occurs very quickly, usually in a minute or less and maybe as short as 20 seconds. The brain needs a continuous supply of blood and when this is interrupted, consciousness is lost quickly. Death may take from one to five or six minutes.

If your victim is found within two to three minutes, he would be unconscious but could wake up fairly quickly—in a couple of minutes. Or not. Some people die in a minute while others can take many minutes. Go with a couple of minutes but not longer and you’ll be okay. He would probably have the typical V-shaped bruises on his neck and a furrow that would resolve over a half hour or so.

He could return completely to normal or be left with brain damage or even remain in a coma for hours, days, weeks, months, years, or forever. It all depends upon how long the brain was deprived of blood and luck. This varies from person to person.

D.P. Lyle, MD

Website: http://www.dplylemd.com

Blog: http://writersforensicsblog.wordpress.com

Coming June 2011: HOT LIGHTS, COLD STEEL, a Dub Walker Thriller

Image Credits:

http://commons.wikimedia.org/wiki/File:Hanging.gif

Author's clipart.com account

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