Virtopsy concept around the world: Institute-based survey of worldwide forensic postmortem imaging

Introduction: Forensic routine postmortem imaging in excess of photography and conventional X-ray has been pushed since a few years, in some instances under the name "Virtopsy". It constitutes a pivotal innovation in forensic medicine as it allows for the non-invasive exploration of the deceased through diverse imaging techniques. This study offers an analysis of a survey with focus on the worldwide adoption and application of postmortem imaging. Our goal is to uncover and understand regional variances in its deployment application. Methods: A survey comprising 18 questions, both closed-ended and open-ended, was designed collaboratively and distributed globally via email and social network. The survey addressed topics such as autopsy rates, imaging modalities, indications for postmortem imaging, personnel involved, evaluation methods, and communication of findings. The survey was initially sent to institutes with published postmortem imaging research, and later, it was distributed through international forensic radiology and radiographer associations. Statistical analysis was conducted to interpret the results. Results: Responses were obtained from 29 countries, representing 6 continents, with a total of 100 participating institutions. European institutions were predominant (69%), followed by Australia (9), North America (8), Asia (7), Africa (6) and South America (1). The majority of institutions reported 100-500 autopsies annually (31). Among the institutes that reported that they perform post mortem imaging (PMI), most listed postmortem computed tomography (PMCT) as modality (89%). The request to perform PMI was issued by institutes of forensic medicine (51%), researchers (42%), police (43%) or public prosecutor's office (54%). 48% of the respondents stated that an autopsy must always be performed, even if the cause and manner of death can be ascertained by postmortem imaging. radiographers were primarily responsible for technically performing PMCT (65%) whereas physicians were listed in 28%, autopsy technicians in 18%. The majority of the institutions (32%) identified clinical radiologists as the primary individuals responsible for reading, evaluating radiological images, and writing reports. Many respondents (64%) reported that their image readers had attended specialized postmortem imaging courses. Communication of findings typically involved written reports (28%) or a combination of written reports and illustrated images (31%). Membership of survey respondents was indicated in 38% for the International Society of Forensic Radiology and Imaging (ISFRI) and 5% for the International Association of Forensic Radiographers (IAFR). The question was how many of the responders are members of a PMI focused radiological society or work group. 52% (44 out of 85) respondents indicated they were not a member of a postmortem imaging society. The memberships listed are ISFRI (38%), IAFR (5%) and AGFB (Arbeitsgruppe Forensische Bildgebung, 4%). Conclusion: This study provides a global perspective on the utilization of postmortem imaging in forensic medicine, revealing regional variations in practices and technology adoption. It offers insights into the personnel, techniques, and procedures involved in this field in different countries.