Imaging the dead

Derived from the Greek for “self” and “eye” the word autopsy means to see for yourself. In the context of a body, and whether the viewing is for forensic or other purposes, seeing for yourself has meant cutting and slicing to examine the internal organs. But relatives dislike such intrusion, and some religions, especially Islam and Judaism, discourage it. So why do we still do it when recent decades have witnessed the advent and development of scanning technologies that can give us the same information non-invasively?

The short answer is that they can’t. More precisely, they can’t tell us everything we need to know in every case. But can they tell us enough, and sufficiently often, to justify their routine use? The preliminary results of a couple of pilot studies commissioned by the Department of Health have begun to provide tentative answers.

Some half a million deaths are registered annually in England and Wales. In 2009, 46% were referred to coroners, and 46% of these bodies had a postmortem examination. This figure is much higher than in most countries. Indeed, in the view of some commentators, it is too high. Speaking at a recent Royal Society of Medicine conference on the use of postmortem imaging, the medical secretary of the Coroners’ Society of England and Wales, Roy Palmer, wondered if we could safely reduce our invasive autopsy rate nearer to those found in comparable countries—in the United States, for example, the figure is more like 8%—and whether imaging techniques might help to achieve this goal.

One compelling argument for a general reconsideration of the present autopsy arrangements is their less than impressive accuracy. A 2006 report by the National Confidential Enquiry into Patient Outcome and …