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175 General discussion 9 FUTURE PERSPECTIVES A MIA including MRI and CT scans, and CT-guided tissue biopsies seems a valid alternative for CA, however, more experience is needed to establish for which pathologies or clinical questions MIA is less appropriate or even not suitable. If MIA is to be implemented on a larger scale in hospitals, we should strive for the highest possible diagnostic quality at a reasonable price. Like in forensic practice, clinical radiologists and pathologists should be adequately trained for correct interpretation of post-mortem imaging 255 and biopsy findings 116 with the goal to create an integrated diagnostic specialty for post-mortems that is embedded in the routine workflow. Then, aiming for higher overall autopsy rates, both the intramural and the extramural physicians should be encouraged to request consent for autopsy. During medical training we should stress the importance of post-mortem examination and discuss all forms of post-mortem examination, including MIA, even though many medical schools do no longer require autopsy attendance and favour case-based studies over anatomic pathology. 272,273 Young physicians should be taught how to request an autopsy and discuss the various autopsy methods with the next-of-kin. 205 Medical students and residents should be made familiar with MIA and CA as a means to train themselves in understanding how pathologic processes develop, interact and lead to death. Residents in pathology and radiology should learn how to integrate the post-mortem radiological images and biopsy findings. The database assembled in this study constitutes a valuable teaching set for practicing the MIA. Costs of the Minimally Invasive Autopsy In most countries, an in-hospital CA is a free service. However, in some countries or medical institutes, the costs of post-mortem examinations, although they are not that high compared to many clinical interventions, are a reason for the decreasing autopsy rates, 43,274 especially if there are no minimum requirements for the number of post- mortems. 42 Therefore, it is important to keep the price of a MIA as low as possible. In the UK, the price for an alternative method of post-mortem examination is estimated at around £1000, whereas the autopsy costs little under £100, not taking into account a substantial subsidy from hospital funds. 254 In Switzerland each forensic autopsy is preceded by at least CT, and the reimbursement per post-mortem examination including CT, CTA, MRI, and forensic expert opinion is $820 to $1,150. 116 According to the studies we reviewed, a MIA including both biopsies and CTA costs $1,649 to $1,945, whereas an autopsy costs $2,170 to $2,378. 56 Thus, MIA may be either more expensive or less expensive than CA depending on the context and country. Either way, the costs for MIA are too high for low-income and middle-income countries with even