Digital autopsies should be the first-line approach in postmortem investigations of probable natural death, and should be offered free of charge to families, researchers have said.
About 90,000 autopsies requested by coroners are carried out in England and Wales every year, with the majority of deaths found to be a result of natural causes.
A switch to body-scanning techniques could prove valuable, say researchers, since a traditional autopsy can be upsetting for the bereaved and a number of religions, including Islam and Judaism, teach that a body should be buried quickly and not violated after death.
“The main benefit is about avoiding the autopsy,” said Bruno Morgan, co-author of the research from the University of Leicester. “The autopsy is not just a simple operation, it is opening [the body] up fully, taking all the organs out and slicing them all into pieces.”
CT scans have long been used to aid postmortem investigations, while more recently studies have explored targeted coronary angiography – another CT scanner-based technique that involves inserting a catheter into an artery and is used to reveal whether blockages are present in the coronary arteries, and to investigate the heart itself.
The latter is a major step forward, since one limitation of digital autopsies has been the difficulty of standard CT scans in establishing causes of death such as coronary heart disease.
The latest study offers a large-scale comparison of the accuracy of the combined CT techniques to traditional autopsy.
“This paper is the first one that has come out and says this is as accurate as autopsy is in this setting. It works and therefore it is a valid alternative,” said Morgan.
Writing in the Lancet, researchers led by a team at the University of Leicester describe how they studied 241 cases of adults who had died suddenly and unexpectedly of natural causes or had died a non-suspicious unnatural death.
Each was assessed by a postmortem CT scan, with targeted coronary angiography successfully carried out in 85% of the cases. Standard autopsies were then carried out for each case, with the pathologists not told about the findings from the body scans.
After excluding 31 cases, including 24 cases for which the cause of death was clearly traumatic, such as a gunshot wound, the team found that the body-scan approach gave a cause of death, based on “the balance of probabilities”, in 92% of cases.
In 11% of this group, results from either the scans or the autopsy were at odds with findings from a combination of the two. Further analysis revealed that these discrepancies were evenly split between errors in the body-scan approach and errors in the traditional autopsy.
The team say the gold standard for postmortem is the use of both traditional autopsy and body scans, but say the findings support a move to using digital autopsy as the first-line technique in cases of probable natural death. Should more evidence be required, they add, a traditional autopsy can subsequently be carried out.
The public are already allowed to request – usually at a cost of about £500, typically paid by the family – that digital autopsies are used for postmortem investigations where appropriate.
But Morgan says that option should be made available free of charge – a service currently only offered by a small number of councils.
“If you don’t want an invasive autopsy on yourself or on your family, you should be raising the debate and saying why can’t the council pay for this?” he said. “It strikes me that it is wrong that we should make people pay for something that is a statutory obligation,” he added.
Dr Mike Osborn, a fellow of the Royal College of Pathologists, said that postmortem investigations are vital in understanding why people die, as well as improving understanding of disease. But he acknowledged that autopsies can be distressing and clash with religious beliefs.
The development of digital autopsies, including those based on CT scans, he added, was exciting and important. While Osborn noted that some conditions still require a diagnosis from a traditional autopsy, he welcomed further research in the field to reduce the number of traditional autopsies required. “The accuracy of cross-sectional imaging postmortem has improved over the last 20 years and is likely to continue to do so,” he said. “The College fully supports further research in this area while reinforcing the need for thorough and robust governance in this emerging field.”