Virtuelle Autopsie (Virtopsy) in der Forensik: Vom Skalpell zum Scanner

Zusammenfassung: "Virtopsy" nutzt moderne Imaging-Technologie, um die klassische Dokumentation der Autopsie zu optimieren. Vorteile der Virtopsy sind die untersucherunabhängige, objektive 3D-Dokumentation von Körperbefunden und der nichtinvasive Ansatz. Virtopsy ist eine Option bei Autopsieablehnung durch die Familie oder aus religiösen Gründen. Virtopsy eignet sich bei Massenkatastrophen für eine schnelle Identifizierung von Opfern. Für Staatsanwälte und Gerichte können medizinische Befunde dreidimensional ohne blutige Bilder gezeigt werde

Material differentiation in forensic radiology with single-source dual-energy computed tomography

The goal of this study was to investigate the use of dual-energy computed tomography (CT) in differentiating frequently encountered foreign material on CT images using a standard single-source CT scanner. We scanned 20 different, forensically relevant materials at two X-Ray energy levels (80 and 130kVp) on CT. CT values were measured in each object at both energy levels. Intraclass correlation coefficient (ICC) was used to determine intra-reader reliability. Analysis of variance (ANOVA) was performed to assess significance levels between X-Ray attenuation at 80 and 130kVp. T test was used to investigate significance levels between mean HU values of individual object pairings at single energy levels of 80 and 130kVp, respectively. ANOVA revealed that the difference in attenuation between beam energies of 80kVp compared to 130kVp was statistically significant (p<0.005) for all materials except brass and lead. ICC was excellent at 80kVp (0.999, p<0.001) and at 130kVp (0.998, p<0.001). T test showed that using single energy levels of 80 and 130kVp respectively 181/190 objects pairs could be differentiated from one another based on HU measurements. Using the combined information from both energy levels, 189/190 object pairs could be differentiated. Scanning with different energy levels is a simple way to apply dual-energy technique on a regular single-energy CT and improves the ability to differentiate foreign bodies with CT, based on their attenuation value

Unusual foreign bodies visualized by postmortem computed tomography in a deceased with borderline personality disorder

The objective of this case report is the visualization and assessment of ingested or inserted foreign bodies by postmortem computed tomography and autopsy. The presence of foreign objects in the gastrointestinal tract involves, among many other medical subdisciplines, the fields of forensic medicine and psychiatry. We present a case of an 18-year-old female Caucasian with borderline personality disorder who was found unconscious in a closed psychiatric ward with suspected ingested foreign bodies. Cardiopulmonary resuscitation was unsuccessful. Postmortem computed tomography revealed several sharp foreign bodies in the intestine varying in radiodensity and shape but not perforating any anatomic structures. The autopsy showed well-preserved tablets in the intestine, a few inserted glass fragments and one metal fragment. Ultimately, fatal intoxication involving a mixture of opioids, benzodiazepines, neuroleptics and antidepressants resulted. This case illustrates the potential contribution of postmortem computed tomography in diagnosing, localizing and defining ingested and inserted foreign bodies in deceased as well as living individuals. Thus, diagnostic imaging might increase safety not only for the affected individuals but also for medical staff

Discretionary medical reporting of potentially unfit drivers: a questionnaire-based survey in Southeast Switzerland

In Switzerland, every physician has the right to report a patient that is potentially unfit to drive to the licensing authority without violating medical confidentiality. Verified information regarding physicians' attitudes concerning this discretionary reporting and the frequency of such reports are not available. In order to answer these questions, 635 resident physicians were sent a questionnaire. The response rate was 52%. On average, the responding physicians—for all specialties—reported 0.31 patients (SD 0.64, 95% CI 0.24-0.38) in the year before the survey and 1.00 patient (SD 1.74, 95% CI 0.81-1.20) in the past 5years. Seventy-nine percent of the responding physicians indicated knowing the current legal requirements for driving in Switzerland. In applied logistic regression analysis, only two factors correlate significantly with reporting: male sex (odds ratio 5.4) and the specialty "general medicine” (odds ratio 3.4). Ninety-seven percent of the physicians were against abolishing medical discretionary reporting and 29% were in favor of introducing mandatory reporting. The great majority of the questioned physicians supported the discretionary reporting of drivers that are potentially unfit to drive as currently practiced in Switzerland. The importance and the necessity of a regular traffic medicine-related continuing education for medical professionals are shown by the low number of reports per physicia

Physicians' knowledge and continuing medical education regarding fitness to drive: a questionnaire-based survey in Southeast Switzerland

Valid information for physicians in Switzerland concerning knowledge and continuing education in traffic medicine is not available. Also, their attitude to the legally prescribed periodic driving fitness examinations is unclear. In order to gain more information about these topics, 635 resident physicians in Southeast Switzerland were sent a questionnaire (response rate 52%). In a self-estimation, 79% of the queried physicians claimed to know the minimal medical requirements for drivers which are important in their specialty. Statistically significant differences existed between the specialties, whereby general practitioners most frequently claimed to know the minimal medical requirements (90%). It appears that the minimal medical requirements for drivers are well known to the queried physicians. Fifty-two percent of the physicians favored an expansion of continuing education in traffic medicine. Such an expansion was desired to a lesser extent by physicians without knowledge of the minimal requirements (p < 0.001). A clear majority of the medical professionals adjudged the legally prescribed periodic driving fitness examinations as being an expedient means to identify unfit drivers. A national standardized form for reporting potentially unfit drivers to the licensing authorities was supported by 68% of the responding physicians. Such a form could simplify and standardize the reports to the licensing authoritie

Virtopsy®-Untersuchungsmethoden in der Strafverfolgung: Umfrage in den Schweizer Kantonen Aargau und Bern

Zusammenfassung: Hintergrund: Das Institut für Rechtsmedizin (IRM) Bern lancierte vor über 10Jahren das Virtopsy®-Projekt. Bei der Virtopsy® werden aus der Medizin, Radiologie und Vermessungstechnik bekannte Verfahren wie dreidimensionaler (3D)Oberflächen-Scan, Computertomographie (CT), Magnetresonanztomographie (MRT), postmortale Biopsie und postmortale Angiographie benutzt, um außergewöhnliche Todesfälle (agT), aber auch Verletzungen an Lebenden zu dokumentieren. Seit 2006 greifen die Strafverfolgungsbehörden der Kantone Bern und Aargau routinemäßig auf diese bildgebenden Verfahren zurück. Methode: Das IRM Bern hat in diesem Zusammenhang eine elektronische Umfrage bei den Untersuchungsrichtern (UR) durchgeführt. Ergebnisse: Die Umfrage ergab z.T. große kantonale Unterschiede. Insbesondere sind die bildgebenden Verfahren bzw. ist die Virtopsy® bei den UR des Kantons Aargau weniger (lange) bekannt als bei den Berner UR. Die UR gewinnen jedoch den bildgebenden Verfahren einen Mehrwert gegenüber den klassischen Methoden ab. Die Zukunft der Virtopsy®, auch in juristischer Sicht (neue schweizerische Strafprozessordnung), wird durch die UR optimistisch bewertet. Schlussfolgerung: Einer Zukunft dieser bildgebenden Verfahren in der Strafverfolgung steht bis auf den momentan noch geringen Bekanntheitsgrad seitens der Strafverfolgungsbehörden grundsätzlich nichts entgege

Computed tomographic appearance of urachal adenocarcinomas: review of 25 cases

Twenty-five cases of surgically proven urachal carcinomas were retrospectively reviewed. The radiological archives at the Armed Forces Institute of Pathology were searched for cases of surgically proven urachal carcinomas that had a computed tomographic (CT) scan as a part of their radiologic evaluation. CT images from all cases were evaluated to determine tumor morphology, presence and localization of calcification, extent of bladder invasion and metastases. Tumor size at presentation averaged 6cm. Twenty-one of 25 (84%) were mixed cystic solid lesions and 4/25 (16%) were completely solid. Calcifications were present in 18/25 (72%), with 11 peripherally located, 3 central only and 4 both. Bladder wall invasion was present in 23/25 (92%), but was seen as an intraluminal mass in only 13/25 (52%). The bulk of the mass was extravesicular in 22/25 (88%). Metastases were present in 12/25 (48%). Our series supports observations from other smaller series that a midline, calcified, supravesicular mass is highly suspicious, if not pathognomonic, for urachal carcinom

Using the iPhone's LiDAR technology to capture 3D forensic data at crime and crash scenes

Background: Three-dimensional (3D) documentation of crime and crash scenes is common practice during forensic and medicolegal investigations. Such documentation at a scene is usually carried out by specially trained personnel using various 3D imaging devices and methods, such as terrestrial laser scanners. Unfortunately, this causes the implementation of 3D documentation at the scenes to be expensive and not readily accessible. In 2020, Apple introduced a light detection and ranging (LiDAR) sensor into their high-end mobile devices. In 2022, Recon-3D, an iOS application (app), was launched. This app turns an iPhone or iPad into a 3D scanner and is specifically targeted at crime and crash scene applications. Objectives: The aim of this study was to test the Recon-3D app based on exemplary scenarios to see whether this technology is generally applicable to document crime or crash scenes. Materials and Methods: An iPhone 13 Pro in combination with the Recon-3D app was used to document two indoor scenarios, a mock-up crime scene and a garage, as well as an outdoor scenario of a parked car. Each scenario was documented multiple times. Results: On average, data acquisition for one scene took less than 2 min. Known distances within the scenes were measured with a mean absolute error of 0.22 cm and a standard deviation of 0.18 cm. Conclusion: The imaging workflow was simple and quick, enabling any person to perform 3D documentation at a crime or crash scene. Overall, Recon-3D appeared to be a useful application for forensic investigators

Comparison of very affordable immersion pump and heart-lung-machine for post mortem CT angiography in forensic pathology – A case-control study

Full body post mortem CT angiography (PMCTA) in forensic medicine started on a larger scale with relatively expensive roller-pumps for what in essence seems to be a task consisting of pumping mostly homogenous contrast fluids. At considerably lower cost, centrifugal pumps are a technically powerful alternative. We compare a very affordable immersion pump (IP) with a heart lung machine (HLM) for an iodine based vascular contrast agent in a age-sex matched case-control study of 10 each. The IP outperformed the HLM, in part with statistical significance, depending on the aspect or metric that was compared. Concluding, the IP may be preferred as a useful and affordable alternative over a more expensive roller-pump

Postmortem radiological imaging of natural causes of death in adults – a review

Radiological findings of natural causes of death in adults in postmortem imaging are of enormous value for medicolegal investigation. Postmortem computed tomography (PMCT) in particular is increasingly used as a triage tool after external inspection and before a full autopsy. Forensic pathologists and radiologists commonly deal with a wide variety of deaths from natural causes. The most common encountered natural causes of death refer to the cardiovascular, central nervous, respiratory, gastrointestinal and metabolic system. This review provides an overview of the literature on postmortem imaging of the major natural causes of death in adults, categorized by organ systems