The importance of autopsy is well known, but the decreasing trend in the frequency of autopsies has become an extremely serious issue.
To overcome this issue, one solution has been suggested, namely, the introduction of the concept of Autopsy imaging (Ai) into the procedure.
Ai is a newly developed procedure that will enhance the classic autopsy, giving it the capacity to achieve more reliable results. On performing Ai-autopsy, this term meaning that autopsy is associated with Ai, we are convinced that the introduction of Ai-autopsy will be a great help for the qualitative repletion of the field of medicine.

Our society will require “Twin Medical check and Audit system for Diseased (TMCAD)” . For achiving accurate Medical audit for diseased, we will need to perform the autopsy and Ai.
Widely, Ai is defined as an imaging diagnosis performed in relation to autopsy. Ai has two characteritics and dimensions. Narrow difinition of Ai is almost equal to postmortem imaging (PMI). And probably almost equal to Virtopsy R. The general difinition of Ai is proximate to Ai-autopsy.
The information of Ai is passed along to the pathologist before autopsy. Thereafter, the diagnosis obtained by macroscopic findings is returned to the imaging diagnosis section, and Ai is checked again more strictly in accordance with the rapid pathological report.

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Ai is a new concept of diagnostic imaging with outstanding characteristics. It is a unique imaging that can be entirely underpinned by the pathological findings. Diagnosis of the imaging will be precisely determined because Ai corresponds point-for-point with the pathological findings. Moreover, there is no time lag between the macroscopic findings and Ai. In other words, for evaluating the correspondence with macroscopic findings, the most recent ordinary MRI data provides approximate correspondence, while Ai is temporally and spatially exact.

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In Ai-autopsy, the corpus will be subjected to dissection twice. X-ray, electrical, magnetic, or ultrasound sword dissect the corpus, and subsequently ordinary surgical dissection will be performed in light of the information obtained by the imaging dissection.

Then, the removed organs are dissected with imaging sword again before the examination of the organs by the real blade.

For the pathologist, Ai supplies guidebook-like images of the corpse. This can be expected to result in sophisticated methodologies for the purpose of downsizing and obtaining a more concentrated focus.

The adaptation of the imaging-pathological sequence for autopsy improves the procedure, because the performance of the classic autopsy suffers from certain disadvantages. 1) Broad, systematic examinations of the whole body are impossible, for example, entire examination of the bone or skin system. 2) The protean-shaped lesion invading neighboring tissues cannot be precisely delineated. 3) The presence of coelomic fluid prevents detection of the exact condition. 4) Pathologists will never obtain information concerning the regions where autopsy techniques cannot reach or the regions for which the family’s permission was not obtained.

These problems result from the necessary invasiveness of the autopsy, but they will be easily overcome if Ai is used in combination.

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Ai is a component of the autopsy. When the concept of Ai has become widely spread and understood, when the medical professions agree with its introduction into the medical administration system, it is tender that PMI will be used as autopsy substitute. Because of the cost benefit, this is sure to become a strong current. However, from a long-term view of the benefits for medical care and medical science, it will be an adverse tide.
Medical professions should be deeply impressed　below description; separately performed Ai should be considered an emergency evacuation approach for autopsy-refusal cases, and should be recognized as an imperfect procedure of the Ai-autopsy.

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At the Research Center Hospital for Charged Particle Therapy (RCCPT) of the National Institute of Radiological Sciences (NIRS), Ai has been in use since January 2000. The Ai procedure is composed of MRI, CT, and other imaging diagnostic tools, for example, three-dimensional echo.
Tracing the history of Ai, we found that attempts of postmortem CT (PMCT) have been performed at Tsukuba Medical Center Hospital (TMCH) since 1985, and over 700 PMCT examinations have been performed . After the meeting of TMCH and RCCPT, members of the two facilities reached an agreement regarding the concepts of Ai and PMCT being unified as Ai. To be more accurate, Ai includes the PMCT concept. Following this agreement, The Japan Society of Autopsy imaging (JSAi) was founded on July, 2003. By March 2005, the member of JSAI had reached over 200, consisting of established pathologists, forensic pathologists, radiologists, medical technologists and clinicians.
The several activities of JSAi members are shown below;

  1. Shiotani et al. Tsukuba Medical Center Hospital.
    Community-based postmortem CT (PMCT). (1985)
  2. Takatsu et al. Forensic medicine, Jikei university.
    Trial of 3D imaging analysis for corpus. (1995)
  3. Kawaguchi et al. Kawaguchi Hospital (Kumamoto).
    Community-based PMCT.(1999)
  4. Otani et al. Tsukuba Medical Center Hospital.
    The infantile PMCT. (2002)
  5. Iwase et al. Forensic medicine, Chiba university.
    Mobile CT car trial for PMCT. (2003)
  6. Uchigasaki et al. Forensic medicine, Nihon university.
    The ultrasound trial for postmortem. (2003)
  7. Kobatake et al. Tokyo University of Agriculture & Technology.
    Application of computer-aided Diagnosis (CAD) for Ai.
    Establishment of Ai-CAD system. (2004)
  8. Ikeda et al. Forensic medicine, Kyusyu university.
    The pitfall of PMCT Diagnosis.(2005)

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Autopsy is recognized as a valuable medical procedure. However, the methodology of autopsy has not undergone any major transformation in the recent past.
In the middle of the 19th century, Virchow introduced microscopic examination to classic pathology, thereby helping to establish modern pathology, a discipline that has since exerted great influence over the medical world. For new advances in pathology, it seems that the time has come to learn and adapt the most advanced technologies from a variety of fields. We are of the strong conviction that Ai will be encompassed into the autopsy system in the very near future. The first step of this attempt has already taken place in Japan.
The integration of the concepts of autopsy and diagnostic imaging may lead to the dawn of a new medical entity, under the possible title of “Necro-diagnostics”.

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Virtopsy

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Autopsy imaging (Ai) in Japan;

  • National Institute of Radiological Sciences,4-9-1 Anagawa, Inageku, Chiba 263-8555,Japan
  • Tel: +81-43-251-2111, Fax: +81-43-206-3344,
  • email: ai-ai@fml.nirs.go.jp