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From mines to hospitals to mortuaries – yet another use for SA’s Lodox scanner

Dr Janette Verster discusses the use of the Lodox scanner in autopsies

22nd May 2015

By: Irma Venter

Creamer Media Senior Deputy Editor

  

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Within a decade conventional invasive autopsies may be a rarity, says head of the Department of Forensic Medicine at the University of Pretoria (UP), Professor Gert Saayman.

Instead, pathologists will use imaging technologies to conduct virtual post-mortems.

Such an advance will be welcome in busy morgues in resource-poor countries like South Africa.

The technology behind the advance of the local virtual post-mortem is the South African developed Lodox – or low-dosage digital X-ray – scanner, which has migrated from the diamond-mining industry to hospitals, and now also morgues.

Diamond mines use the full-body scanner to screen staff in order to prevent diamond theft.

The Gauteng Department of Health’s purchase of a Lodox StatScan for the Pretoria medico-legal mortuary has enabled forensic pathologists at UP’s Department of Forensic Medicine to join the global quest to make virtual autopsies a common reality. (Forensic pathologists at the mortuary hold dual appointments between the Gauteng Department of Health and UP.)

A focussed research programme has already been established to achieve this goal.

Senior lecturer Dr Janette Verster earlier this year travelled to Switzerland to attend an advanced course in post-mortem imaging, also called a virtual autopsy, or ‘Virtopsy’.

Virtopsy is a registered trademark of the Virtopsy Group at the universities of Bern and Zurich, in Switzerland, explains Verster, with the idea born in the 1990s.

“The use of more modern radiological apparatus and imaging modalities in the forensic investigation of deceased bodies, rather than the simple use of conventional X‐ray imaging, developed substantially over the last decade, perhaps because of the greater availability of computerised tomography (CT) scans, potential reduction in unit costs and greater legal scrutiny of autopsy results,” says Verster.

“The idea was mooted that in time, modern non‐invasive imaging techniques may yield results that are comparable to the conventional autopsy.”

The aim of UP’s research is mainly to document the added value of Lodox digital images in a death investigation, adds Verster.

VIRTUAL ADVANTAGES
A Lodox scan produces a composite image of the entire human body, which can be digitally manipulated to represent or enhance any physical region of the body.

“The Lodox scanner allows us to identify and locate bullets and sharp or other foreign objects in the body and to detect the presence of contagious diseases like tuberculosis, which may pose a health risk for pathologists and assistants,” explains Verster.

“It also provides tremendous help in positively identifying individuals by revealing old skeletal fractures or the presence of prostheses and medical devices like pacemakers.”

She adds that cases that are traditionally difficult to examine, such as charred or decomposed bodies, can now be scanned to reveal the presence of bullets, fractures, or other possible evidence of foul play.

Previously, radiographic imaging of deceased bodies admitted to the Pretoria medico‐legal mortuary was primarily done by means of fluoroscopic imaging – a very time and radiation-intensive exercise with poor image quality. On occasion and where relevant, bodies were individually transported to the Steve Biko Academic Hospital for CT‐scanning. (Fluoroscopy is an enhanced X-ray that produces an image on a television-like monitor).

This process also required the involvement of qualified radiographers to complete the process, which impacted substantially on operating costs, says Verster.

In contrast to this, the Lodox apparatus is relatively easy to use, requiring minimal operator training to yield good images.

Lodox is also safe to use, as it emits low radiation and can be placed directly in the autopsy suite, without exposing staff to dangerous radiation and without the need to wear additional protective gear, says Verster.

As opposed to other time-consuming processes, the Lodox scanner allows for each body admitted to the Pretoria mortuary to be scanned head-to-toe in 13 seconds by forensic officers, generating a digital record within a further 10 seconds – this in a facility that examines almost 2 000 bodies every year.

Other advantages include the fact that the Lodox StatScan allows for the collection of objective data that could be archived permanently and digitally.

Flouroscopy rendered no permanent radiological images that could be stored for visual aid in court proceedings, or even research at a later stage, notes Verster. However, using the actual‐size Lodox images as a visual aid, results in better understanding in court cases.

“Digital Lodox radiological images are an accurate, objective and permanent record of the body and, thus, will be accepted as evidence in court.

“This adds detail to the autopsy investigation at minimal additional cost per case,” says Verster.

LIMITATIONS
There are limitations to any virtual autopsy, says Verster. For example, the colour and consistency of human tissues, organs and fluid collections cannot be reliably and directly observed by radiological or other imaging techniques alone.

The aim is currently not to replace the traditional autopsy, but to add value to findings.

In some instances, however, based on the Lodox/radiological findings, a decision may be taken by the attending pathologist not to proceed with a full autopsy.

This may be done, for example, to protect personnel from exposure to contaminous biohazards such as Mycobacterium tuberculosis bacilli.

In time, the practice of a radiological/scanning investigation may see an even greater number of cases not being subjected to full conventional autopsy procedures, says Verster.

This will be especially advantageous in cases where families object to an autopsy, or where conventional autopsy is not tolerated by the religious beliefs of the deceased.

12 NEW LODOX STATSCANS
The Gauteng Department of Health is in the process of acquiring 12 Lodox StatScans.

These include installation of three Lodox StatScans at Forensic Pathology Service centres (medico‐legal mortuaries), including the one at the Pretoria medico‐legal mortuary, which was introduced in July last year.

The other nine Lodox scanners will be installed in various hospitals and clinics across Gauteng.

There are only fifteen Lodox scanners in use at mortuaries worldwide, excluding the four in South Africa.

Edited by Creamer Media Reporter

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