Virtual autopsy in legal medicine: literature review and example of application on the mummified remains

  • Ivana Kružić University Department of Forensic Sciences, University of Split
  • Ivan Jerković University Department of Forensic Sciences, University of Split
  • Frane Mihanović University Department of Health Studies, University of Split
  • Ana Marušić Department of Research in Bioimedicine and Health, University of Split School of Medicine
  • Šimun Anđelinović University of Split, Rector’s Office
  • Željana Bašić University Department of Forensic Sciences, University of Split
Keywords: Virtual examination, autopsy, MSCT, paleopathology, mummy, sacral remains


The virtual autopsy and post-mortem imaging methods are relatively novel methods used in medicine to determine cause and manner of death. They can also be exceptionally useful in the process of identification. Although they have numerous advantages, they are still not implemented in practice to a sufficient extent because the methodology has not yet been validated, and studies that deal with legal and practical implications of those methods are relatively scarce. In this article we describe basic principles and advantages of the methodology, explore related legal and practical issues, and present a case of virtual autopsy in practice on the mummified remains of St. Ivan Olini from Church of St. Blaise in Vodnjan (Croatia).

Virtualna obdukcija in postmortalna metoda slikanja sta relativno novi metodi v medicini za ugotovljanje vzroka in načina smrti. Izjemno koristni sta lahko tudi v procesu identifikacije. Kljub številnim prednostim pa se v praksi še vedno ne izvajata v zadovoljivem obsegu, ker metodologija še ni potrjena, študije, ki se ukvarjajo s pravnimi in praktičnimi posledicami teh metod, pa so redke. V tem članku so opisana temeljna načela in prednosti metodologije, preučevana so pravna in praktična vprašanja ter predstavljen primer virtualne obdukcije v praksi na mumificiranih ostankih sv. Ivana Olinija iz cerkve sv. Blaža v Vodnjanu (Hrvaška).


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Albrecht, T. L., Scutter, S. & Henneberg, M (2007) Radiographic method to assess the prevalence of sacral spina bifida occulta, Clinical Anatomy, 20 (2), pp. 170-174, doi: 10.1002/ca.20367.

Appleby, J., Rutty, G. N., Hainsworth, S. V., Woosnam-Savage, R. C., Morgan, B., Brough, A., Earp, R. W., Robinson, C., King, T. E. & Morris, M (2015) Perimortem trauma in King Richard III: a skeletal analysis, The Lancet, 385(9964), pp. 253-259, doi: 10.1016/S0140-6736(14)60804-7.

Arthurs, O. J., Hutchinson, J. C. & Sebire, N. J. (2017) Current issues in postmortem imaging of perinatal and forensic childhood deaths, Forensic Science, Medicine and Pathology, 13(1), pp. 58-66., doi: 10.1007/s12024-016-9821-x.

Baier, W., Warnett, J. M., Payne, M. & Williams, M. A. (2017) Introducing 3d printed models as demonstrative evidence at criminal trials, Journal of Forensic Sciences, 63(4), doi: 10.1111/1556-4029.13700.

Blokker, B. M., Wagensveld, I. M., Weustink, A. C., Oosterhuis, J. W, & Hunink, M. M. (2016) Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review, European radiology, 26(4), pp. 1159-1179, doi: 10.1007/s00330-015-3908-8.

Blum, A., Kolopp, M., Teixeira, P. G., Stroud. T., Noirtin, P., Coudane, H., & Martrille, L. (2018) Synergistic Role of Newer Techniques for Forensic and Postmortem CT Examinations, American Journal of Roentgenology, 211, pp. 3-10, doi: 10.2214/AJR.17.19046.

Bolliger, S. A. & Thali, M. J. (2015) Imaging and virtual autopsy: looking back and forward, Philosophical Transactions of the Royal Society B: Biological Sciences, 370(1674), pp. 20140253, doi: 10.1098/rstb.2014.0253.

Brailsford, J. (1953) The Radiology of Bones and Joints (London: Churchill).

Bushong, S. C. (2013) Radiologic Science for Technologists-E-Book: Physics, Biology, and Protection (Elsevier Health Sciences).

Cobo, F. B. (2010) Inca religion and customs (Texas: University of Texas Press).

Cosmacini, P. & Piacentini, P. (2008) Notes on the history of the radiological study of Egyptian mummies: from X-rays to new imaging techniques, La radiologia medica, 113 (5), pp. 615-626, doi: 10.1007/s11547-008-0280-7.

Davey, J., Stewart, M. E. B. & Drummer, O. H. (2013) The value of CT imaging of Horus in determining the method of mummification and the sex of the mummy, Journal of medical imaging and radiation oncology, 57(6), pp. 657-662, doi: 10.1111/1754-9485.12070.

Dedouit, F., Géraut, A., Baranov, V., Ludes, B., Rougé, D., Telmon, N. & Crubézy, E. (2010) Virtual and macroscopical studies of mummies—Differences or complementarity? Report of a natural frozen Siberian mummy, Forensic science international, 200, pp. e7-e13, doi: 10.1016/j.forsciint.2010.03.028.

Dedouit, F., Guglielmi, G., Perilli, G., Nasuto, M., Telmon, N., Fineschi, V. & Pomara, C. (2014a) Virtual anthropological study of the skeletal remains of San Fortunato (Italy, third century AD) with multislice computed tomography, Journal of Forensic Radiology and Imaging, 2(1), pp. 9-16, doi: 10.1016/j.jofri.2013.11.006.

Dedouit, F., Savall, F., Mokrane, F., Rousseau, H., Crubézy, E., Rouge, D. & Telmon, N. (2014b) Virtual anthropology and forensic identification using multidetector CT, The British journal of radiology, 87(1036), 20130468, doi: 10.1259/bjr.20130468.

Del Ton, G. (1929) Cenni storici sui 'Corpi Santi' di Dignano (Poreč).

DiMaio, V. J. & Francis, J. R. (2001) Heterotopic ossification in unidentified skeletal remains, The American journal of forensic medicine and pathology, 22(2), pp. 160-164.

Ebert, L., Flach, P., Schweitzer, W., Leipner, A., Kottner, S., Gascho, D., Thali, M. & Breitbeck, R. (2016) Forensic 3D surface documentation at the Institute of Forensic Medicine in Zurich–Workflow and communication pipeline, Journal of Forensic Radiology and Imaging, 5, pp. 1-7.

Eeckhout, P. & Owens, L. S. (2008) Human sacrifice at Pachacamac, Latin American Antiquity, 19(4), pp. 375-398, doi: 10.1017/S104566350000434X.

Eubanks, J. D. & Cheruvu, V. K. (2009) Prevalence of sacral spina bifida occulta and its relationship to age, sex, race, and the sacral table angle: an anatomic, osteologic study of three thousand one hundred specimens, Spine, 34(15), pp. 1539-1543, doi: 10.1097/BRS.0b013e3181a98560.

Fernando, L. (2008) Place of autopsy in quality assurance of curative service, Galle Medical Journal, 13, pp. 51-54, doi: 10.4038/gmj.v13i1.897.

Fishman, M. (2003) Disturbances in neural tube closure and spine and cerebrospinal fluid dynamics (New York: McGraw-Hill Medical Publishing Division).

Fulcheri, E. (1996) Mummies of Saints: a particular category of Italian mummies, In: Spindler, K. (eds.) [et al.] Human Mummies: A Global Survey of their Status and the Techniques of conservation (Vienna: Springer), pp. 219-230.

Gascho, D., Philipp, H., Flach, P. M., Thali, M. J. & Kottner, S. (2018) Standardized medical image registration for radiological identification of decedents based on paranasal sinuses, Journal of Forensic and Legal Medicine, 54, pp. 96-101, doi: 10.1016/j.jflm.2017.12.003.

Garetier, M., Deloire, L., Dédouit, F., Dumousset, E., Saccardy, C., & Salem, D. B ( 2017) Postmortem computed tomography findings in suicide victims, Diagnostic and interventional imaging, 98(2), pp. 101-112, doi: 10.1016/j.diii.2016.06.023.

Hayakawa, M., Yamamoto, S., Motani, H., Yajima, D., Sato, Y, & Iwase, H. (2006) Does imaging technology overcome problems of conventional postmortem examination?, International journal of legal medicine, 120(1), pp. 24-26, doi: 10.1007/s00414-005-0038-x.

Hawass, Z., Gad, Y. Z., Ismail, S., Khairat, R., Fathalla, D., Hasan, N., Ahmed, A., Elleithy, H., Ball, M. & Gaballah, F. (2010) Ancestry and pathology in King Tutankhamun's family, JAMA, 303(7), pp. 638-647, doi: 10.1001/jama.2010.121.

Iscan, M. Y. & Steyn, M. (2013) The human skeleton in forensic medicine (Charles C Thomas Publisher).

Jakobsen, L. S., Lundemose, S., Banner, J., Lynnerup, N., & Jacobsen, C. (2016) Forensic postmortem computed tomography: volumetric measurement of the heart and liver, Forensic science, medicine, and pathology, 12(4), pp. 510-516, doi: 10.1007/s12024-016-9810-0.

Jackowski, C., Bolliger, S. & Thali, M. J. (2008) Common and unexpected findings in mummies from ancient Egypt and South America as revealed by CT, Radiographics, 28(5), pp. 1477-1492, doi: 10.1148/rg.285075112.

Jelenić, M. (2000) Čudo u Vodnjanu (Vodnjan: Program Mi).

Johnson, R. J., Feehally, J. & Floege, J. (2014) Comprehensive Clinical Nephrology E-Book (Elsevier Health Sciences).

Junghanns, H. & Schmorl, G. (1971) The human spine in health and disease (Oxford: Oxford University Press).

Krentz, B. V., Alamo, L., Grimm, J., Dédouit, F., Bruguier, C., Chevallier, C., Egger, C., Da Silva, L. F., & Grabherr, S. (2016) Performance of post-mortem CT compared to autopsy in children, International journal of legal medicine, 130(4), pp. 1089-1099, doi: 10.1007/s00414-016-1370-z.

Kristóf, L. A., Kovács, M., Baksa, G., Bereczki, Z., Szatmári, F., Patonay, L., Pálfi, G. & Pohárnok, L. (2015) Condition assessment of two early Christian martyrs’, St. Christine's and St. Augustine's relics with paleoradiological methods in Hungary, Journal of Cultural Heritage, 16(2), pp. 249-253, doi: 10.1016/j.culher.2014.04.001.

Ling, T. (2010) How Do You Get Clinicians Involved in Quality Improvement?: An Evaluation of the Health Foundation's Engaging with Quality Initiative: A Programme of Work to Support Clinicians to Drive Forward Quality (The Health Foundation).

Liu, C., & He, H. (2018) Developments and Applications of Calcium Phosphate Bone Cements (Singapore: Springer).

Lovett, A. A. & Gatrell, A. C. (1988) The geography of spina bifida in England and Wales, Transactions of the Institute of British Geographers, 13(3), pp. 288-302, doi: 10.2307/622992.

Lynnerup, N. (2010) Medical imaging of mummies and bog bodies–a mini-review, Gerontology, 56(5), pp. 441-448, doi: 10.1159/000266031.

Makino, Y., Yokota, H., Nakatani, E., Yajima, D., Inokuchi, G., Motomura, A., Chiba, F., Torimitsu, S., Uno, T., & Iwase, H. (2017) Differences between postmortem CT and autopsy in death investigation of cervical spine injuries, Forensic Science International, 281, pp. 44-51, doi: 10.1016/j.forsciint.2017.10.029.

Markel, H. (2010) King Tutankhamun, Modern Medical Science, and the Expanding Boundaries of Historical Inquiry, JAMA, 303(7), pp. 667-668, doi: 10.1001/jama.2010.153.

MRC Vitamin Study Research Group (1991) Prevention of neural tube defects: results of the Medical Research Council Vitamin Study, The Lancet, 338(8760), pp. 131-137.

Mihanović, F., Jerković, I., Kružić, I., Anđelinović, Š., Janković, S. & Bašić, Ž. (2017) From biography to osteobiography: an example of anthropological historical identification of the remains of St. Paul, The Anatomical Record, 300(9), pp. 1535-1546, doi: 10.1002/ar.23602.

Mohammed, M. & Kharoshah, M. A. (2014) Autopsy in Islam and current practice in Arab Muslim countries, Journal of forensic and legal medicine, 23, pp. 80-83, doi: 10.1016/j.jflm.2014.02.005.

Nissan, E. (2012) Virtopsy: The Virtual Autopsy, Computer Applications for Handling Legal Evidence, Police Investigation and Case Argumentation (Springer).

Öhrström, L. M., von Waldburg, H., Speier, P., Bock, M., Suri, R. E. & Rühli, F. J. (2013) Scenes from the past: MR imaging versus CT of ancient Peruvian and Egyptian mummified tissues, Radiographics, 33(1), pp. 291-296., doi: 10.1148/rg.331125711.

Ortner, D. J. (2003) Identification of pathological conditions in human skeletal remains (Academic Press).

Panzer, S., Borumandi, F., Wanek, J., Papageorgopoulou, C., Shved, N., Colacicco, G. & Rühli, F. J. (2013a) “Modeling ancient Egyptian embalming”: radiological assessment of experimentally mummified human tissue by CT and MRI, Skeletal radiology, 42(11), pp. 1527-1535, doi: 10.1007/s00256-013-1696-2.

Panzer, S., Gill-Frerking, H., Rosendahl, W., Zink, A. R. & Piombino-Mascali, D. (2013b) Multidetector CT investigation of the mummy of Rosalia Lombardo (1918–1920). Annals of Anatomy-Anatomischer Anzeiger, 195(5), pp. 401-408, doi: 10.1016/j.aanat.2013.03.009.

Payne-James, J., McGovern, C., Jones, R., Karch, S. & Manlove, J. (2014) Simpson's Forensic Medicine: Irish Version (CRC Press).

Petaros, A., Škrobonja, A. & Bosnar, A. (2012) Mummified saints of the Northern Croatian Littoral, Acta Medico-Historica Adriatica, 10(1), pp. 131-140.

Pettersson, H. & Allison, D. J. (1998) The encyclopaedia of medical imaging (Nicer Institute).

Ross, S. G., Bolliger, S. A., Ampanozi, G., Oesterhelweg, L., Thali, M. J. & Flach, P. M. (2014) Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death, Radiographics, 34(3), pp. 830-846, doi: 10.1148/rg.343115169.

Saleem, S. N. & Hawass, Z. (2014) Multidetector computed tomographic study of amulets, jewelry, and other foreign objects in royal Egyptian mummies dated from the 18th to 20th dynasties, Journal of computer assisted tomography, 38(2), pp. 153-158, doi: 10.1097/RCT.0b013e3182ab2221.

Sav, A. (2008) Pathological anatomy of spina bifida, In: The Spina Bifida (Springer, Milano), pp. 43-57.

Schweitzer, W., Thali, M., Breitbeck, R. & Ampanoz, G. (2014) Virtopsy®, available at: (September 13, 2018).

Simalcsik, A., Miu, G., Groza, V.-M. & Simalcsik, R.-D. (2011) Regarding occult spinal dysraphism (spina bifida occulta), focusing especially on a medieval population from Iași, Analele șt. Univ.“Al. I. Cuza” Iași, s. I, Biologie animală, pp. 131-140.

Swaroop, V. T. & Dias, L. (2009) Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities, Journal of children's orthopaedics, 3(6), pp. 441-449, doi: 10.1007/s11832-009-0214-5.

Thali, M., Dirnhofer, R. & Vock, P. (2009) The virtopsy approach: 3D optical and radiological scanning and reconstruction in forensic medicine (CRC Press).

Thali, M. J., Viner, M. D. & Brogdon, B. G. (2010) Brogdon's forensic radiology (CRC Press).

Tuchtan, L., Gorincour, G., Kolopp, M., Massiani, P., Léonetti, G., Piercecchi-Marti. M., & Bartoli, C. (2017). Combined use of postmortem 3D computed tomography reconstructions and 3D-design software for postmortem ballistic analysis, Diagnostic and Interventional Imaging, 98(11), pp. 809-812, doi: 10.1016/j.diii.2017.06.016.

van Kan, R., Haest, I., Lahaye, M., & Hofman, P. (2017) The diagnostic value of forensic imaging in fatal gunshot incidents: A review of literature, Journal of Forensic Radiology and Imaging, 10, pp. 9-14, doi: 10.1016/j.jofri.2017.07.003.

Zimmermann, D. (2011) Virtopsy & forensic imaging: legal parameters and impact. AsiaPacific Coroners Society Conference 2011 Noosa, Queensland, available at: (September 13, 2018).

How to Cite
Kružić I., Jerković I., Mihanović F., Marušić A., Anđelinović Šimun, & Bašić Željana. (2018). Virtual autopsy in legal medicine: literature review and example of application on the mummified remains. Medicine, Law & Society, 11(2), 67-90.