15283-B-Blokker

27 Autopsy rates in the Netherlands: 35 years of decline 2 clinicians 12 who underestimate the relevance of clinical autopsy. This was confirmed in a recent study, which showed that the main reason for clinicians not to request an autopsy was the assumption that the cause of death was known. 45 To revive the interest of clinicians in the autopsy with its various significant applications is medicine, we may as well use these improved imaging techniques to our advantage. If, in the future, next-of-kin refuse conventional autopsy, clinicians could offer them alternatives, whereby state of the art imaging is the basis of a minimally invasive autopsy technique. Recently, the feasibility of both non-invasive and minimally invasive approaches, using CT and/ or MRI as alternatives for the autopsy, is being investigated. 57,80 With minimally invasive autopsy techniques tissue biopsies can be obtained for histologic examination and molecular analyses. 26 Importantly, these alternatives may be more acceptable to populations that have fundamental problems with the conventional autopsy. Epidemiology might also benefit from introduction of imaging-based post-mortem investigation, because it makes a snapshot and a permanent record of the deceased that can be revisited as new questions arise. CONCLUSIONS Clinical autopsy rates have been declining rapidly, probablymost of all because clinicians are convinced that the autopsy will not showanything other thanwhat is already known through pre-mortem diagnostics. This is a major concern, because autopsies to this day disclose findings that might have changed the treatment of the patient, in addition to being an important tool for quality control, education and research in medicine. Efforts should be made to revive the interest in the clinical autopsy, in particular by introducing approaches whereby state of the art imaging is integrated with a minimally invasive autopsy technique.