15283-B-Blokker

15 General introduction 1 Post-mortem radiology Imaging techniques have a long history in forensic pathology. Shortly after the discovery of x-rays by Roentgen, at the end of the nineteenth century, this technique was applied to locate bullets, detect fractures and identify bodies. 49 More recently, in the late seventies of the twentieth century computed tomography (CT) was used for similar purposes. 50 From the nineties on, the value of imaging techniques, including CT and magnetic resonance imaging (MRI), were increasingly recognised and applied. Among the pioneers in the forensic field was the Virtopsy group in Bern. Their method includedsurface imagingmethods todocument injuries, CT-scans todetect bone injuries and gross pathologies and MRI-scans to identify soft tissue injuries. The Virtopsy was always followed by a conventional forensic autopsy. 51 In the Netherlands, modern cross-sectional imaging techniques, CT and MRI were increasingly used for forensic pathology from the end of the twentieth century, to complement the conventional forensic autopsy, among others to investigate child abuse. 52 In the clinical setting, the radiological techniques were primarily used for perinatal autopsies. 53 X-rays commonly complement conventional autopsy on foetuses (babygram) or neonates, mainly for the detection of skeletal anomalies. CT-scanning also allows the examination of the body in 3D reconstructions. MRI, on the other hand, can be performed to identify pathologies of the internal organs and central nervous system. In addition, if invasive autopsy is not permitted, needle biopsies and aspiration of for example blood allow histological, microbiological and metabolic examination. 54,55 Alongside these perinatal autopsies, alternative autopsy methods for naturally deceased adults, either non-invasive or minimally invasive, have been developed and compared to the CA. Many of the alternative methods use radiological imaging techniques, and the minimally invasive autopsy techniques often include tissue biopsies and/ or contrast-enhanced images (e.g. angiography). In this thesis, we present what we learned from previous studies about alternative methods for the CA in non-forensic cases, 56 and how we aimed to improve our own version 57 of the Minimally Invasive Autopsy (MIA).