About 13.4% of deaths in Australia get referred to the coroner’s office, of which around half will go on to a coronial investigation and autopsy. An autopsy remains standard practice for determining cause of death when there are no obvious signs of disease or injury.
However, consenting to an autopsy remains a difficult and traumatic experience for family and friends of the deceased – particularly when there are religious or social taboos surrounding death. An autopsy also raises serious ethical issues about the dignity of the diseased and the limits of death investigation.
One alternative to a full autopsy is to determine possible causes of death through radiological techniques such as ‘post-mortem computed tomography’ (post-mortem CT) where the full body is scanned in three dimensions allowing radiologists and pathologists to evaluate internal tissues through sections to detect internal bleeding, injury or disease without dissection.
Whilst currently used as a ‘companion’ to the standard autopsy, CT scans have proven very useful in detecting injuries due to trauma (particularly gunshot wounds), ocular abnormalities and a variety causes of death including drowning, cardiac events and aneurysm.
The usefulness of CT scans and other 3D imaging techniques such as magnetic resonance imaging (MRI) raises the question as to whether the standard autopsy is still neccesary.
This question is currently a key question in the clinical autopsy setting. For example, a study entitled ‘The Value of Autopsies in the Era of High-Tech Medicine‘ published in the Journal of Clinical Pathology in 2013, asked the question: is the standard autopsy still valuable in a time of CT scans and microscopic examinations? Unfortunately for family and friends of deceased individuals, the answer appears to be yes.
Researchers found that although imaging techniques and lab-based forensic medicine were useful tools in determining cause of death, there remains a discrepancy of about 37.8% between what can be determined through ‘high tech’ means and what can be determined through dissection..
This is in line with other studies which have found that although there has been a steady decrease in the use of standard autopsies in many countries, CT scans are still not as effective in determining cause of death.
Nevertheless, many papers have suggested that CT scans may prove an effective replacement in ‘high risk’ autopsies (such as when a patient has HIV), in relatively simple cases such as motor vehicle accidents and where there is difficulty in obtaining consent from family, such as in the case of infant and children autopsies, although there are some reasons to be cautious in regard to the latter.
Overall, CT scans are an effective aid in determining cause of death in lieu of autopsy. However, the age of the invasive standard autopsy is certainly far from over.