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 percent 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 percent 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regarded by some as crude and outdated - a feeling fanned by the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.
DIGITAL MAKEOVER
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 U.S. 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 fetuses and individuals aged 16
and younger, a minimally invasive autopsy incorporating an MRI scan
identified the same cause of death as 90 percent of traditional
autopsies.
COMMERCIALISE
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 $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
($780) and paid for by the family.
SKEPTICS
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 centers 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
percent 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, CEO of
Agensi Inovasi Malaysia, a government body which this year bought a
20 percent stake in iGene for $21.5 million.
SUPPORTERS
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 Inc'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."
