How Yorkshire is pioneering the scalpel-free post mortem

Digital technology has revolutionised many areas of life, but could it soon see pathologists finally do away with the surgeon's knife? Sarah Freeman reports.

One of iGene's radiographer's looking at a 3D digital autopsy scan.
One of iGene's radiographer's looking at a 3D digital autopsy scan.

Paul Hunter recently got a call from detectives. They were dealing with a particularly tricky case and they needed the radiographer’s help.

“A man had died as a result of a stabbing,” explains Paul. “The tip of the knife had broken off and despite having undergone a traditional post mortem the pathologist had been unable to find it. That’s when they called us.”

Us is the iGene Digital Autopsy facility just a short hop from Bradford’s mortuary which could, given the chance, revolutionise the traditional post mortem which has remained largely unchanged for the best part of the 300 years.

The scanner at iGene's digital autopsy facility in Bradford.

The technology, developed in Malaysia, arrived in the UK three years ago. The first site opened in Sheffield and with Bradford following soon after, Yorkshire has become the hub for the procedure which relies on 3D scans rather than scalpels.

“There it is,” says Paul, pulling up the image of the knife victim. At the bottom of the spine there is a bright yellow spot where the the tip of the blade had become embedded. “It was buried in such an awkward part of the body that it would have been almost impossible to find using traditional methods. But within a few minutes we were able to pinpoint its precise location and the police had another vital piece of forensic evidence.

“These scans are also really useful when it comes to analysing ballistic patterns. Again they show up as bright yellow spots and you instantly have a really clear picture of where a bullet left and entered the body.

“The end result may be the same as a traditional post mortem, but it has so many more potential uses and because of the 3D element it can also help in reconstructions. Not all that long ago we were called in by the British Transport Police after a man was hit by a train. They had carried out extensive inquiries to try to identify the victim, but had drawn a blank. By using our initial scans, a team of experts from the forensic anthropology department at Dundee University were able to create a quite detailed reconstruction of what the victim might have looked like and that image is now being used as part of an appeal to help trace his relatives.”

The scanner at iGene's digital autopsy facility in Bradford.

Taking 3,000 images of a body during each 30 minute scan it’s impressive stuff. However, while its application to forensic science is clear the main impact of iGene’s digital autopsy may yet be on ordinary families who would rather their loved ones didn’t have to go through what they see as the indignity of a traditional post-mortem which results in organs being removed for examination.

If the system works as it should, it’s also potentially much quicker than a traditional post mortem. From the body arriving at the facility, the team aim to complete a scan within 45 minutes and have the results that same day or within 48 hours.

“Every year in the UK there are 200,000 deaths which are unexplained or require further examination,” says Peter Coulson-Smith, iGene’s business development executive. “Of those we estimate that we could identify a cause of death in 70 per cent of cases.

“This technology does have its limitations in that it can’t detect some lung-related deaths or conditions like sepsis, but it is a quick and easy way to pinpoint everything from brain haemorrhages to ruptured aneurysms.

“We know from our experience over the last three years that families can find it incredibly distressing to think of their loved one having to undergo a post mortem, but until now there has been no alternative. The digital autopsy is finally a practical alternative and one which we know can bring a small degree of comfort in the darkest of times.”

With all the analysis done via a computer screen, there is also far reduced risk of infection which is useful in cases where the deceased has say HIV. And with the scans stored for posterity it means not only that the cause of death can be revisited and reinvestigated long after the body has been laid to rest, but the results can be quickly examined by experts in a particular field even if they are based thousands of miles away.

It has been welcomed by Jewish and Muslim people, whose faiths stress non-violation of the body and quick burial. All of which begs the question why digital autopsies aren’t routinely available across the UK. The one stumbling block, perhaps unsurprisingly is financial.

While the bill for traditional post mortems are picked up by individual local authorities, in all but one part of the country families wanting to opt for a digital autopsy have to pay £500 plus VAT. For some that cost is prohibitive and while iGene, which eventually hopes to have a £50m network of centres, is in discussion with a number of councils only one has so far agreed to fund the procedure.

Last year, Sandwell in the West Midlands followed Bradford and Sheffield by installing a £1.2m scan facility, but the council also went one further by agreeing to foot the bill for every digital autopsy carried out on individuals who lived within its boundaries.

The move wasn’t universally well-received, with the local paper questioning how the ‘cash strapped council’ had found the money to pay not only for the scanner, but the ongoing cost of the service.

However, during its first year of operation, 123 digital autopsies were carried out in the Sandwell area, and deputy council leader Syeda Khatun, insists the authority’s decision has been vindicated.

He said: “The decision to offer a digital autopsy is based on the discretion of the coroner. We have always recognised the importance all its residents place, at what is a very difficult time in their lives, on frontline services and introducing a digital autopsy service was simply another way to help those who need it most at an unfortunate time in their lives.”

iGene hopes other local authorities will follow Sandwell’s lead and says that the change in the way post mortems have been carried out has been a long time coming.

“In any profession there will always be those who prefer the old way of doing things, but forward thinking pathologists are on board,” says Coulson-Smith. “So much has changed when it comes to medicine - just think how keyhole surgery has revolutionised what were once major operations - but the post mortem has not changed since the 1700s.”

However, change may be on the horizon. A few months ago crime writer Michael Wood released his first novel in the new DCI Matilda Darke series. Outside Looking In featured one character based on one of iGene’s lead radiographers and the team hope it will help further raise the profile of digital autopsies.

“It’s based on fact not fiction and we know that what we do could make a real difference to so many families,” says Coulson-Smith. “Now we just need to let people know we are here.”

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