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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Forensics Reveal Truth

by Diane Dimond

Imagine the hushed, sterile atmosphere of an autopsy room. A body arrives and a team of forensic experts quietly gets to work to try to determine cause of death. Scientific evidence is gathered to determine whether a crime was committed to cause the death, whether it occurred from natural, unavoidable causes or if it was death by suicide.

In many cases, such as that of retired NFL quarterback Steve McNair, the cause of death is pretty obvious. McNair, was found sprawled on his condo’s couch, shot twice in the head and twice in the chest. Nearby was the dead body of his 20 year old mistress, a gun underneath her. It was quickly ruled a murder/suicide.

But other deaths are not so clear cut. Take the case of 50-year-old infomercial scream-seller Billy Mays. After he was found dead in his bed by his wife, we heard that he’d violently bumped his head in an airplane just hours earlier. It was thought the hit on the head had something to do with his sudden death. But forensic science proved it wasn’t so. Once the medical professionals opened Mays’ chest they immediately discovered a diseased heart was to blame, an affliction Mays apparently was unaware he had.

And then there are the full blown forensic death investigations like the one surrounding entertainer Michael Jackson, suspected of dying at home from an overdose of a hospital strength anesthesia called Diprivan and, perhaps, a cocktail of other drugs. Cases like Jackson’s demand a full toxicology and histology workup. In layman’s terms: a full examination of blood, tissue, hair and organ samples to determine if someone should be charged with a crime.

All this scientific sleuthing takes time to accomplish and in the meantime families of the dead anxiously await the final verdict.

Autopsy blood workups are routine. The sample is usually taken from deep inside the body’s heart chamber and tests determine what compounds are present in the bloodstream. Some drugs like cocaine break down in the body quickly and are hard to detect. But most drugs stop metabolizing when the person dies and so the traces found in the bloodstream are indicative of what was present at the time of death. The forensic investigators also examine urine, bile and tissue samples from the liver, heart, spleen and kidneys. The information gathered fits together like pieces in a cause-of-death puzzle.

Hair is especially revealing, holding on to what the body has ingested like rings on a tree. Since scalp hair usually grows about half an inch a month the longer the body’s hair the more information can be found. A six inch hair will reveal a full year’s worth of clues. Traces of each drug used will be stored in the hair shaft and the coroner’s office will be able to list every one, be they prescription or illegal drugs, and when they were used. In the case of a bald person shorter hair from armpits or the groin area can be used, they’ll just yield less historical information.

But there is nothing as telling as what the scientists can deduce from studying the brain. Unlike other organs from which samples can be taken immediately, the brain requires special handling. The entire brain mass must be submerged and hardened in formaldehyde for about three weeks before samples can be taken. Once gathered a neuron-forensic pathologist usually needs four to six weeks to unravel all the telltale evidence about what happened to the body during life.

If the decedent was beaten as a child contusions on the brain will be seen as dead tissue, called necrosis spots. If in life the person suffered a drug overdose (or multiple drug overdoses) the scientist will be able to see evidence of that and can determine when the overdose(s) occurred. If the decedent suffered strokes there will be visible scar tissue.

When a family receives a negative cause of death determination from the coroner they are often in denial. They don’t want to believe their family member could have committed suicide or died of a self-inflicted drug overdose.

Media leaks about the state of Jackson’s body at death have been excruciating. The almost six foot tall performer was reported to have weighed just 112 pounds. The skin on his arms, neck and legs were said to have been pockmarked with both old and new needle punctures. All indications are he died from a fatal overdose of several different drugs.

If that is the final judgment on what killed Michael Jackson something tells me the Jackson family will never accept it. It will be more comforting to believe some outside force killed their loved one. It’s much harder to accept the fact that someone you cherished slowly and deliberately shortened his own life.

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A Criminal Autopsy of Michael Jackson

by Kathryn Casey

Today, huge crowds will gather in L.A. to memorialize Michael Jackson. More than a million-and-a-half people tried to get tickets. I do understand. Right out of the gate, I want to say how much I enjoy his music. He was an amazing artist and an exciting performer, and I sometimes find myself humming his songs while I write. "Billy Jean" is my favorite.

That said, I'm uncomfortable with this outpouring of adulation and the massive media coverage it's scheduled to receive. There's little beyond a presidential inauguration that merits live coverage on six networks. But that's what we're doing today for Jackson's service. Why? Come on, folks. Why are we doing this? Especially when we consider the circumstances of his life and his death.

I am sincerely very sorry for Michael Jackson's children, for his family. For them, this is a true tragedy. But why are we making Jackson a hero in death, when he wasn't in life? The truth is that Jackson was a very troubled man. Need proof? Look at the way he paid doctors to disfigure his own face.

Second: He was an addict. For many years, Jackson was known to be addicted to prescription meds. His family tried to stage an intervention. In his final months, friends worried about his drug use. It was so bad that just weeks before his death, Jackson begged a nurse to inject him with Propofol, a powerful anesthetic used exclusively in operating rooms. Despite the drug's dangers, it appears that he found someone to hand it over to him, since the drug was found in his home. Autopsy results aren't in yet, but will anyone be surprised to find out that Jackson's death is the result of some misuse of narcotics?

This at a time when prescription drug abuse is a growing trend among teenagers. In January 2008, around the time actor Heath Ledger died of a combination of prescription drugs, a study was released that showed today's teens abuse prescription meds more than any other type of drug, with the exception of pot. Yet here we are, again as we did with Ledger, portraying the death of a celebrity who died of such drug abuse as a national tragedy.

What message does this send to our children?

Then there's the way past child molestation charges against Jackson are being white-washed in the media. Now I haven't seen everything, so if your experience is different than mine, perhaps you're watching other channels, reading other articles? What I've noted is an ongoing tribute to Jackson the performer and a write-off of the questions surrounding his behavior with children. Whenever it's brought up, I've heard a brief mention of his 2005 trial on charges of child sexual abuse and an immediate dismissal of the case's validity.

"He was acquitted," Matt Lauer quickly said when Vanity Fair's Maureen Orth mentioned the trial on the Today Show.

Orth agreed but then went on to peg the reason for the not guilty verdict not on Jackson's innocence but his talented legal team, especially defense attorney Thomas Mesereau, who all but put the mother of Jackson's 13-year-old accuser on trial instead of Jackson. In the end, many press reports theorized that jurors voted not guilty more out of contempt for the boy's mother than support of the King of Pop. (That's Jackson showing up at court in his pajamas on the right.)

But the 2005 allegations weren't the only ones. Remember the 1993 case, dropped after Jackson settled with another young boy and his family for a reported $22 million? I do.

My point is that there are certainly a lot of questions about Michael Jackson. This man is not a role model, not someone to be idolized. Yet that's what we're doing. Through this over-the-top coverage, we're buying into the myth of Michael Jackson the tragic superstar, and we're setting him up to be remembered for decades to come, especially by our children, as a fallen hero. Is that really what we want to do?

Personally, I'm left regretting that there isn't some kind of test that could be run on autopsy to confirm or disprove allegations that the man Jackson looked at in the mirror each morning was a pedophile.

In the week following his death, Jackson was autopsied twice. First up was an L.A. County coroner. Then, due to questions about the circumstances surrounding Jackson's demise, a private autopsy commissioned by the Jackson family. Once the medical examiners made the "Y" cut through Jackson's chest, sternum to belly button, they inspected his internal organs, his heart, lungs, his kidneys and his liver. They used a saw to slice through his skull and examined his brain. Theoretically, they should have been able to diagnose all the superstar's illnesses.

Pedophilia, however, doesn't show up on autopsy. Experts could run every known test on Jackson's brain and not uncover evidence either proving or disproving the claims made against him over the past sixteen years. The result is that without some concrete evidence emerging, Michael Jackson has taken his secrets to the grave.

So I'm left wondering about the wisdom of turning Jackson's death into a national tragedy, and I'm uncomfortable about celebrating the life of a man who abused drugs and may have victimized young children. What about the rest of you?

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