Sliced and diced, digitally autopsy as a service
Jeremy Wagstaffe in Singapore
Malaysian entrepreneur Matt Chandran wants to revive the moribund post-mortem by replacing the scalpel with a scanner and the autopsy slab with a touchscreen computer.
He believes his so-called digital autopsy could largely displace the centuries-old traditional knife-bound one, speeding up investigations, reducing the stress on grieving families and placating religious sensibilities.
He is confident there’s money in what he calls his Autopsy as a Service, and hopes to launch the first of at least 18 digital autopsy facilities in Britain in October, working closely with local authorities.
Around 70 million people die each year, says Chandran, and around a tenth of those deaths are medico-legal cases that require an autopsy. “That’s a huge number, so we’re of the view that this is a major line of services that is shaping up around the world,” he said in an interview.
The poor common perception of autopsies has undermined their commercial appeal. “Unfortunately, because the process of the post-mortem is seen as gruesome, one tends to ignore that,” says Chandran.
Humans have been cutting each other open for at least 3,000 years to learn more about death, but the autopsy has never been widely embraced outside TV crime dramas. Surgeons in 18th century Britain, for example, robbed graves for corpses to dissect, some even commissioning murders when supplies dried up.
By the 1950s, the autopsy was at its zenith, with pathologists performing post-mortems on more than 60 per cent of those who died in the United States and Europe - helping uncover more than 80 major, and perhaps thousands of minor, medical conditions.
But the number of autopsies has fallen steadily: Today, fewer than 20 per cent of deaths in Britain are followed by autopsy, and most of these are ordered by coroners in cases where the cause of death is unclear or disputed.
The fall has been blamed on a growing distaste for a procedure regarded by some as crude and outdated - a feeling fanned by the public discovery in Britain in 1999 that medical institutions had been retaining organs and tissue after post-mortems for decades.
Chandran, 45, wants to change all this by simply connecting his company iGene’s 3D imaging software to any standard medical CT or MRI scanner. An expert can then inspect the virtual cadaver in 3D, removing layers of cloth, skin and bone with a mouse or by gestures on a tabletop touchscreen.
The advantages, Chandran says, are considerable.
The digital evidence remains intact and can be reviewed; experts can more easily spot and identify fracture, foreign objects such as bullets, and the tips of knife wounds; and grieving families can swiftly learn how their loved ones died and without having to cut open the body.
iGene isn’t the first to run a scanner over a corpse. Radiology has been used on skulls for 30 years, and Israel first introduced the concept of a virtual autopsy in 1994. The US military started conducting CT scans of all soldiers killed in Iraq and Afghanistan in 2004 in addition to traditional autopsies.
The results have been encouraging. Researchers from University College London concluded that in foetuses and individuals aged 16 and younger, a minimally invasive autopsy incorporating an MRI scan identified the same cause of death as 90 per cent of traditional autopsies.
But iGene is, Chandran says, the first to package the process and offer it commercially as a suite of services that stretches from the moment of death to the delivery of a post-mortem report.
His company provides a software suite that uses existing medical scanners from the likes of Siemens, General Electric, Toshiba and Philips. These form the heart of iGene’s digital autopsy facilities which the company plans to build close to UK mortuaries. The first will open in October in the northern English city of Sheffield.
A spokesperson for Sheffield City Council confirmed it was working with iGene on such a centre, but declined to give details.
Chandran says his company will spend around US$77 million to build and run the facilities and will make its money from those cases where a coroner demands a post-mortem. About 200,000 deaths require autopsies each year in Britain, he said.
Next of kin will be given the option of a classical autopsy, paid for by the state, or a digital autopsy, costing about 500 pounds (HK$6,072) and paid for by the family.
Not everyone believes the digital autopsy is ready for prime time. Some question whether it can spot some diseases. And even a pioneer like Guy Rutty, chief forensic pathologist at the University of Leicester and the first to use CT images as evidence in a criminal trial, says that while demand may be growing there are limits to what a digital autopsy can do - particularly determining where and in some cases when a patient died.
“There are centres providing such services, but others have been more cautious and are still at a research stage,” he said in an email interview.
Chandran and his team are undeterred. They say the digital autopsy facility combines with other non-invasive diagnostic tools such as angiography and toxicology.
Pramod Bagali, chief operations officer of iGene’s parent company InfoValley, says the system is “a complementary method, not a complete replacement” to traditional autopsies, but could handle 70 per cent of routine cases. The others could be done digitally to start with and then a decision could be made about whether to open up the body. “It’s not replacing one flawed system with another,” he says.
Crucially, iGene offers a business model that overcomes concerns that scanning corpses is expensive, says Chandran. He estimates his UK operation will be profitable within three years. But that, he says, is just the start. By then, he says, he hopes to have built at least 10 more facilities in his native Malaysia, with interest also from the Middle East, Latin America and elsewhere in Asia.
“The potential for this is global,” said Mark Rozario, chief executive of Agensi Inovasi Malaysia, a government body which this year bought a 20 per cent stake in iGene for US$21.5 million.
Chandran and his supporters see this as the beginning of his innovation, not the end of it. The digital autopsy facilities are nodes in a broader ecosystem Chandran likens to Apple’s iTunes.
Michael Thali, a Swiss academic who has been promoting a “virtual autopsy” for more than a decade, said he tried and failed to get the scanner makers interested in developing such services. Now an adviser to iGene, Thali says this leaves open the field to other companies to deliver improvements in the chain of examination.
“The future will be for smaller companies who are bringing a service for this niche,” he says. “The most important thing is that you have a real chain based on IT.”
This is some way off - and may never happen.
Milos Todorovic, lead analyst at Lux Research and a specialist in medical innovation, says that while iGene’s approach is intriguing, it faces hurdles - not least the fact that the company is starting from scratch in an expensive business. “A lot of things would have to fall into place for them to be able to succeed with something like this,” he said.
That isn’t stopping Chandran from dreaming big - including the idea of scanning the living as part of any regular medical checkup.
“Just like a birth certificate starts with the birth of a baby, the end of a person’s life will end with a report in which the 3D body of a person is captured,” he said. “In that way we can archive every person born on this planet.”