15283-B-Blokker

82 Chapter 5 Exclusion criteria were (suspected) unnatural cause of death; body size exceeding height of 16 inches in supine position (limitation for PMMR); known or suspected transmittable disease, such as HIV, tuberculosis, hepatitis-B and hepatitis-C; open abdominal wounds that could not be completely closed or taped to prevent leakage of body fluids. Examination of the brain, either biopsies and/ or autopsy, was not compulsory. Excluded cases are shown in Appendix A. Preparation for Autopsy Procedures ForeachcasetheclinicallyassumedCOD,specificclinicalquestions,andacomprehensive medical history of the deceased, including pre-mortem imaging, were collected. This file was made available to the MIA and CA team. Minimally Invasive Autopsy PMMR and PMCT scans were made according to standardized protocols (Appendix B). A MIA radiologist (ACW, MdV, AEO, MJPR) performed the initial read of the PMMR and PMCT scans, according to protocol, compared these to the available pre-mortem imaging, and marked suspected pathological lesions for biopsy. The MIA researcher (BMB, IMW, JWO) obtained CT-guided biopsies (12 Gauge) from heart, lungs, liver, kidneys, spleen, and radiologically suspected pathology as indicated. Assisted by a neurosurgeon (RD, JSSvH, RKB) stereotactic biopsies were taken from the brain (Appendix C). The MIA pathologist (JWO) and researcher (BMB) examined the microscopic slides of the biopsies; when in doubt they consulted pathologists with specific expertise, not involved in the matching CA, to reach a conclusion. A general radiologist (NSR) independently performed a second read of the PMCT and PMMR scans. A cardiovascular radiologist (AP) performed a second read of the PMMR scans of the heart. Both were blinded to the initial radiological read. In case of disagreement between the initial and second read, consensus was reached in joint sessions. Radiological and histological findings were combined in the MIA report featuring clinical history, post - mortem diagnoses, a presumed COD and answers to specific clinical questions. Conventional Autopsy The day after MIA, a resident in pathology, supervised by the attending pathologist, performed CA according to the departmental protocol. The CA report included clinical history, post - mortem diagnoses, a presumed COD, and answers to specific clinical questions, and was authorized by the attending pathologist.