Divining Death's Cause
Pathologists are embracing new no-touch "virtual autopsies," with 3-D images that reveal valuable clues
In a decade or two, hands-on autopsies will be gone-replaced by the virtual version, says CFIV Director Michael Thali. At least in Europe, it is beginning to be integrated into the teaching curriculum. Sweden's CMIV has a 15-meter, high-resolution screen for that purpose. "We have stopped using ordinary autopsy as a training tool," says Persson, because the clear, precise images on the huge screen are far more instructive.
Autopsy comeback? The technology's boosters think it also might substitute, if not perfectly, for hospital autopsies, which have all but disappeared. One reason for the dive in autopsy rates from about 50 percent in the 1960s to an average of 5 percent now is that since 1970, hospitals no longer have to perform a minimum rate of autopsies to remain accredited. Another is physicians' widespread belief that autopsies tell them nothing about diagnosing and treating patients that sophisticated monitoring, imaging, and lab tests don't provide. And at a cost of several thousand dollars per autopsy, few hospitals are eager to do lots of them.
Accreditation and expense aside, autopsies have repeatedly demonstrated that doctors are often wrong about the reason a patient died. One pathology journal reported in 2002 that half the autopsy reports reviewed at one teaching hospital reflected at least one misdiagnosis, and the majority of the errors were so bad that at least some of the patients might have lived had they been diagnosed correctly. "If autopsy findings were used broadly across multiple doctors and specialties, one could learn from others' problems," says George Lundberg, former editor of the Journal of the American Medical Association and now editor-in-chief of the professional site eMedicine.com. A pathologist who frequently and vigorously laments the demise of the autopsy, Lundberg thinks virtual autopsies could be useful. "A good pathologist," he says, "has always used other modalities besides cutting and feeling."
Even if lessons learned from autopsies do not always prevent deaths, "families need to know," says Kim Collins, director of medical and forensic autopsy at the Medical University of South Carolina in Charleston. "There are a lot of diseases you die with, but not necessarily from-heart disease and cancer are two. The autopsy findings could foretell a family's medical future." Yet doctors often don't ask families for permission to perform an autopsy, and most families don't know they can request one.
The benefits can extend beyond a few doctors and families, says Collins. Now 42 years old, she was diagnosed with high-grade breast cancer in 2003, and had a bilateral mastectomy followed by chemotherapy and radiation. "So far I am doing great," she says. "But if I die of breast cancer, I would like for my doctors to be able to study the cancer cells." The findings could be used by researchers, and adding virtual autopsy, says Collins, "would be super."
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