KOCHI: “Doctor, is it possible to avoid performing a postmortem on my child?” It was a heart-wrenching question that a forensic surgeon in Kerala encountered recently when an eight-year-old boy, who had drowned in a swimming pool during a family outing, was brought for postmortem examination. For grieving families, the anguish is often compounded by the thought of a surgical blade cutting into the body of a loved one, the distress of seeing it stitched up after examination, or religious beliefs surrounding death and dignity.
To address such concerns, forensic experts in Kerala have proposed a modern method —‘virtual autopsy’ (VA) or ‘virtopsy’. A detailed project report for establishing a VA centre in the public sector is pending with the state government.
According to Dr A K Unmesh, head of forensic medicine department at Kottayam Medical College Hospital (MCH) and police surgeon, who prepared the report, the technique makes it possible to determine the cause of death without cutting open the body. While VA may not be applicable in all cases, it could significantly reduce the need for conventional open-body autopsies, he said.
The report states that every human being deserves dignity in life and after death. Traditional autopsies, involving large incisions and extensive dissection, are often distressing for grieving families and add to their emotional trauma. VA has emerged as a valuable alternative, supporting both forensic experts and families by reducing the need for invasive procedures.
Virtual autopsy cannot fully replace conventional postmortems: Doctor
Although medico-legal autopsy is mandatory in suspicious or unnatural deaths worldwide, conventional techniques require opening body cavities through long incisions and altering the appearance of the deceased. This, the report notes, causes immense mental distress to relatives, with studies indicating a societal preference for non-invasive alternatives.
Dr Unmesh pointed out that if implemented, the facility would become not only Kerala’s first virtual autopsy centre, but the first of its kind in government medical colleges in South India. “Virtual autopsy aligns with legal standards while promoting dignity, scientific accuracy and emotional comfort for families,” he told TNIE.
Under law, postmortem examination is mandatory in cases of unnatural death in the country. Only in rare instances do investigating officers release a body without postmortem, based on circumstantial evidence and findings from the preliminary investigation.
The report highlights that conventional autopsies are invasive and often controversial. VA has already been introduced in select centres across India, including Delhi, Rishikesh, Shillong and Bengaluru. The proposal aims to strengthen collaboration between forensic medicine, radiology, the judiciary and law-enforcement agencies. It also recommends launching a pilot project at Kottayam MCH, citing its status as a tertiary-level government hospital and referral centre with an established department of forensic medicine.
While a section of doctors has expressed concerns over the accuracy of VA, Dr Unmesh clarified that it cannot completely replace conventional postmortem examinations in all cases.
“Statistics indicate that in nearly 60% of cases in Kerala, the cause of death and other findings can be determined solely through virtual autopsy, without the need for invasive examination,” he said.
He added that a substantial number of road accident deaths, certain categories of natural deaths reported under unusual circumstances, and accidental deaths with eyewitness accounts fall within the category where conventional dissection-based postmortem procedures may be avoided.
No cuts and stitches
Challenges to current system
Religious & cultural objections to invasive autopsies
Backlog of cases due to shortage of forensic manpower
Difficulty in presenting autopsy findings effectively in court
Limited long-term preservation of forensic evidence, as traditional autopsy findings degrade over time
Why virtual autopsy in Kerala?
Improves medico-legal services
Enhances judicial transparency
Reduces distress among families
Provides permanent digital evidence for appeals and case reviews
Core equipment proposed
16/32-slice CT scanner for whole-body scans, particularly bone injuries and internal trauma
1.5T/3T MRI scanner for detailed soft tissue, brain and cardiac evaluation
3D image reconstruction workstations for forensic visualisation and virtual dissection
Forensic radiology software with medico-legal modules such as Amira, Mimics and OsiriX MD
Picture archiving and communication system (PACS) with secure cloud backup