PMCTA – Minimal Invasive Autopsies for Natural Sudden Death

When people die there is a need to have a medical cause of death. If a medical cause of death cannot be given often an investigation by the HM Coroner will start and they will want to obtain a medical cause of death and the most common way they will do that will be to request a post-mortem investigation which will normally be what we call autopsy. However because we already have strong diagnostic tools available to us such as CT and MRI there has long been an interest in using these diagnostic tools at the start of the investigation to see if a medical cause of death can be obtained without the need to go towards the invasive autopsy. Currently in England and Wales about a 100,000 autopsies are performed a year and we were feeling if we could replace a percentage of that that would have a large impact onto services but also in the attitudes towards autopsy in many people in the community. Most people will think of an autopsy as being an invasive procedure where a body is examined in a mortuary with its head chest and abdomen opened as a surgical procedure. All of the organs removed examined and then replaced. The system that is run here has an external examination as would be required, both at the front and the back of the body, but having done the external examination the internal examination is replaced by a CT scan followed by a CT scan with contrast. The contrast being delivered specifically to the arteries that supply blood to the heart, the coronary arteries and this is done by the insertion of a small tube or catheter through an incision about an inch long at the bottom of the left-hand-side of the neck. So you’ve gone from a major incision and removal of virtually the entire body parts down to a one inch incision with an insertion of a tube and some contrast medium. So it’s a much more conceptually acceptable procedure for natural disease not for suspicious death, homicides or trauma. The future is not the invasive autopsy as the sole investigation for death, every single person would go on a journey through their death investigation, which would start with a thorough check of the scene and the clinical history, to ensure that there is nothing there that is in anyway suspicious, followed by a thorough external examination, a laboratory test, principally for toxicology, scanning with angiography to cover the heart and then a large proportion of people will stop at that point and those that don’t stop at that point will go forward to a limited or a whole body autopsy. So the future will I think be CT in all cases, sometimes to improve the investigation and sometimes to replace autopsy depending on what the actual question at the start of the investigation is. So you will always have an autopsy practitioner, you will always have autopsies but you won’t have them to the volume and cross sectional imaging, post-mortem scanning will become the main stay of all natural sudden death.