Artigo de revisão
Evaluation of the effectiveness of computed tomography in autopsies
Como citar: Nogueira VIG, Alves PST. Evaluation of the effectiveness of computed tomography in autopsies. Persp Med Legal Pericia Med. Vol. 11, 2026; 260646.
https://dx.doi.org/10.47005/260646
Recebido em 02/06/2026
Aceito em 23/06/2026
The authors report no conflict of interest.
Evaluation of the effectiveness of computed tomography in autopsies
Resumo
INTRODUÇÃO: A autópsia é o padrão-ouro para determinação da causa da morte, porém seu caráter invasivo pode gerar objeções religiosas e culturais. Nesse contexto, a tomografia computadorizada post-mortem (TCPM), inserida no conceito de virtopsia, destaca-se como método não invasivo capaz de fornecer avaliação detalhada do corpo e documentação permanente dos achados. OBJETIVO: Analisar a eficácia da TCPM na investigação médico-legal em casos de restrição à autópsia por motivos religiosos, avaliando sua acurácia diagnóstica, vantagens, limitações e relevância ética e jurídica. MÉTODO: Revisão bibliográfica descritiva de 20 artigos científicos sobre investigação post-mortem por imagem. A busca foi realizada nas bases PubMed, SciELO e Google Acadêmico, contemplando publicações entre 2015 e 2025, além de estudos clássicos relevantes ao tema. RESULTADOS: A TCPM demonstrou elevada eficácia na identificação de fraturas, lesões traumáticas, trajetórias de projéteis, hemorragias e presença de gases. Entre as vantagens destacam-se a preservação da integridade corporal, maior aceitação familiar e religiosa e menor risco ocupacional. Como limitações, apresenta menor sensibilidade para alterações microscópicas, doenças metabólicas e algumas causas naturais de morte. CONCLUSÃO: A TCPM representa importante avanço na medicina legal, especialmente diante de objeções religiosas à autópsia. Embora não substitua integralmente o exame convencional, mostra-se valiosa como método complementar, conciliando precisão diagnóstica, exigências legais e respeito aos valores culturais e religiosos.
Palavras Chave: Autópsia; Tomografia Computadorizada por Raios X; Antropologia Forense; Religião e Medicina
Abstract
INTRODUCTION: Autopsy is the gold standard for determining the cause of death; however, its invasive nature may generate religious and cultural objections. In this context, post-mortem computed tomography (PMCT), within the concept of virtopsy, stands out as a non-invasive method capable of providing detailed body assessment and permanent documentation of findings. OBJECTIVE: To analyze the effectiveness of PMCT in forensic investigations when conventional autopsy is restricted for religious reasons, evaluating its diagnostic accuracy, advantages, limitations, and ethical and legal relevance. METHOD: A descriptive literature review was conducted based on 20 scientific articles addressing post-mortem imaging investigations. The search was performed in PubMed, SciELO, and Google Scholar, including publications from 2015 to 2025, as well as relevant classical studies on the subject. RESULTS: PMCT demonstrated high effectiveness in identifying fractures, traumatic injuries, projectile trajectories, hemorrhages, and the presence of gases. Its main advantages include preservation of bodily integrity, greater family and religious acceptance, and reduced occupational risk. Limitations include lower sensitivity for detecting microscopic alterations, metabolic diseases, and certain natural causes of death. CONCLUSION: PMCT represents an important advance in forensic medicine, particularly in cases involving religious objections to autopsy. Although it does not fully replace conventional examination, it is a valuable complementary method, balancing diagnostic accuracy, legal requirements, and respect for cultural and religious values.
Keywords (MeSH): Autopsy; X-Ray Computed Tomography; Forensic Anthropology; Religion and Medicine.
1. INTRODUCTION
Autopsy is an essential tool in forensic medicine and has historically been recognized as the gold standard for determining the cause of death. In addition to its importance in elucidating deaths of legal, scientific, and epidemiological interest, the procedure contributes to the generation of statistical data, the advancement of medical knowledge, and the identification of hereditary diseases and conditions relevant to public health (1,3).
The term autopsy derives from the Greek words auto (“self”) and opsis (“to see”), literally meaning “to see for oneself.” It is a post-mortem examination in which a physician conducts a detailed assessment of the body and may perform complementary laboratory analyses when necessary (1). The practice has existed since antiquity and has become established throughout history as one of the cornerstones of forensic medicine and pathology (1,2).
Despite its scientific and legal relevance, autopsy is an invasive procedure, as it requires opening and dissecting the body. This characteristic may generate resistance in certain religious and cultural contexts, particularly among groups that place significant value on preserving bodily integrity after death. In Islam and Judaism, for example, invasive manipulation of the deceased is often discouraged and is generally permitted only under exceptional circumstances, such as legal requirements or situations involving collective benefit (2,7–9). Although Christianity generally demonstrates greater doctrinal flexibility, family and cultural objections may still arise (6,7).
In this context, post-mortem computed tomography (PMCT), within the broader concept of virtopsy, has emerged as a non-invasive method for medico-legal investigation. Developed from the 1990s onward, this technique employs imaging examinations to digitally reconstruct bodily structures, allowing detailed assessment of injuries, fractures, hemorrhages, gas collections, and projectile trajectories without the need for body dissection (1,3,4,10–12).
Computed tomography is based on the emission of X-rays from multiple angles around the body, followed by computerized image processing to generate axial slices and high-resolution three-dimensional reconstructions (5). This technology enables permanent documentation, digital storage, and subsequent review of findings, features that enhance its diagnostic and legal value in forensic practice (3,10,15).
Therefore, PMCT represents a relevant technological alternative in situations where traditional autopsy faces religious, cultural, or ethical restrictions. Although it does not completely replace conventional autopsy, its use may reduce the invasiveness of the procedure and promote greater family and social acceptance without significantly compromising the quality of the medico-legal investigation (1,3,4,15,18).
The present study aims to analyze the effectiveness of post-mortem computed tomography as a medico-legal investigative method in cases where traditional autopsy is restricted for religious reasons, evaluating its diagnostic accuracy, advantages, and limitations in comparison with conventional examination, as well as its ethical, cultural, and legal relevance in the contemporary context.
2. METHODS
This study consists of a descriptive literature review conducted based on scientific articles published between 2015 and 2025. Searches were performed in the PubMed, SciELO, and Google Scholar databases. Exceptionally, the studies by Amaro Júnior and Yamashita and by Zerbini et al. were included despite being published outside the established time frame, as they provided relevant and pertinent contributions to the subject under investigation.
The descriptors used in the search strategy were autopsy, X-ray computed tomography, forensic anthropology, and religion and medicine.
All religions discussed in this study were approached with due respect and without value judgment.
3. RESULTS
A total of 20 scientific articles addressing virtopsy, traditional autopsy, imaging techniques applied to post-mortem investigations, and the influence of religious beliefs on autopsy practice were analyzed. The studies identified significant technological advances, methodological limitations, and ethical, cultural, and scientific implications associated with methods used for cause-of-death investigation.
Studies examining traditional autopsy from religious and cultural perspectives demonstrated that, although autopsy is widely recognized as essential for the scientific and legal investigation of death, it faces resistance in several religious contexts (2,6–9,16,17). In Islam and Judaism, traditional autopsy is generally discouraged due to the importance attributed to preserving bodily integrity after death and is usually accepted only in situations involving legal requirements or collective benefit, such as the preservation of life (2,7–9). Christianity was found to exhibit greater flexibility, although cultural and family objections may still occur in certain contexts (6,7). These restrictions may limit cause-of-death investigations in multicultural societies, potentially affecting the collection of epidemiological and forensic data (6,9,17). In this context, virtopsy has been proposed as a more ethically acceptable alternative that reconciles legal, scientific, and religious considerations (13,16).
Overall, the studies analyzed indicated that virtopsy contributes to the humanization of forensic practice by respecting religious and cultural beliefs while maintaining the quality of medico-legal investigations (13,16). Furthermore, it facilitates communication with family members, increases transparency in the forensic process, and may improve social acceptance of post-mortem examinations (3,6,16). Greater acceptance among relatives and religious communities was also reported, particularly in contexts where opening the body is considered culturally sensitive (13,16).
As advances in imaging technology have substantially enhanced the diagnostic capabilities of forensic investigations by enabling detailed virtual reconstructions and greater accuracy in the interpretation of findings (10,15), virtopsy has increasingly been regarded as an important development in forensic medicine, particularly through the use of computed tomography (CT) as a post-mortem assessment method (1,3,4,10–12,15,18).
The method proved effective in identifying fractures, traumatic injuries, foreign bodies, projectile trajectories, internal hemorrhages, and the presence of gases, while also enabling permanent three-dimensional documentation of findings (1,11,15). Compared with traditional autopsy, virtopsy offers several advantages beyond its non-invasive nature, including preservation of bodily integrity, reduced occupational exposure for professionals involved in the examination, and the possibility of re-evaluating findings through stored digital images (3,12,18).
However, the reviewed articles also highlighted important limitations, including reduced capacity to detect microscopic alterations, early inflammatory processes, metabolic diseases, and certain natural causes of death, particularly those of cardiovascular origin (10,11,15). Additional challenges to widespread implementation include the high cost of equipment, the need for appropriate infrastructure, and specialized professional training (4,10,15). Studies addressing the technical principles of CT emphasized the importance of these tools in modern forensic investigations (4,5,10,15).
A comparison between traditional autopsy and virtopsy demonstrates relevant differences regarding invasiveness, religious acceptance, diagnostic capability, and forensic applicability, as summarized in Table 1.
Table 1. Comparison between traditional autopsy and post-mortem computed tomography (PMCT)-based virtopsy.
| Aspect | Traditional Autopsy | Virtopsy (PMCT) |
| Nature of the procedure | Invasive examination requiring body opening and dissection | Non-invasive examination |
| Bodily integrity | May be compromised | Preserved |
| Religious and cultural acceptance | Often more limited | Generally higher |
| Assessment of fractures and traumatic injuries | Excellent | Excellent |
| Projectile trajectory analysis | Good | Excellent, with three-dimensional reconstruction capabilities |
| Detection of hemorrhages and gas collections | Possible | Possible with high accuracy |
| Microscopic alterations | Can be identified through histopathological examination | Not directly detectable |
| Metabolic diseases | Investigation possible | Limited diagnostic capability |
| Toxicological analyses | Can be performed | Require complementary sample collection |
| Permanent documentation | Based on photographs and written reports | Based on digitally stored and reviewable images |
| Reassessment by other experts | More limited | Facilitated |
| Occupational risk | Greater biological exposure | Reduced biological exposure |
| Time required for body release | Generally longer | Generally shorter |
| Initial cost | Lower | Higher |
| Infrastructure requirements | Moderate | High |
| Specialist requirements | Forensic pathologist | Forensic pathologist and radiologist |
| Evidentiary value | High | High |
| Ability to completely replace the other method | Not applicable | Does not fully replace traditional autopsy |
4. DISCUSSION
Autopsy has always occupied a central role in forensic medicine, constituting one of its fundamental pillars, historically responsible for the advancement of medical knowledge and the elucidation of deaths from unknown causes. Thus, it remains the gold standard of post-mortem investigation in many medico-legal systems. However, precisely because of its invasive nature, the method encounters strong resistance in religious contexts, which prioritize bodily integrity (6,9). Recent studies show that such conflicts are not homogeneous, varying according to the sociocultural context and, above all, according to the religious doctrines involved (7,9), which directly influence the acceptance of the practice by family members and communities.
Several authors highlight that, especially in Muslim and Jewish communities, the integrity of the body after death is considered a fundamental principle, which makes invasive autopsy a frequently unacceptable procedure (8,9). Sharma and Sharma (6) expand on this discussion by emphasizing that family refusal to perform an autopsy should not be interpreted merely as scientific ignorance, but as a legitimate manifestation of ethical and cultural values, requiring sensitivity on the part of health professionals and the legal system.
In Islamic understanding, the human body is considered sacred both in life and after death and should be preserved from mutilation or unnecessary interventions. Avşar et al. (8), in a study with Muslim religious leaders, show that autopsy is often perceived as a violation of the dignity of the deceased and an affront to the teachings of the Quran and Sharia (Islamic law). Among the main Islamic principles that influence this stance are the obligation of rapid burial, usually within 24 hours, and the prohibition of bodily disfigurement. Atanda et al. (9) emphasize that, even in cases of violent or suspicious death, authorization for autopsy is often a source of conflict between legal authorities and family members, especially when there is no adequate clarification about the legal obligation of the procedure.
In Judaism, the relationship with autopsy is also marked by strong restrictions. According to Halakha (Jewish law), the human body must be treated with extreme respect after death, and any form of mutilation or unjustified delay of burial is prohibited. Autopsy is generally rejected, as it violates the principles of kavod hamet (honoring the dead) and nivul hamet (prohibition of disfigurement of the body) (7). Furthermore, Judaism advocates immediate burial, preferably on the same day as death, which directly conflicts with these procedures. However, as in Islam, there are exceptions provided for when autopsy can save other lives, such as in cases of hereditary diseases or risks to public health. However, Atanda et al. (9) and Kwaghe et al. (7) note that, even in these situations, there is a preference for less invasive methods and for interventions limited to the strictly necessary areas.
Christianity, as the majority religion in many parts of the world, has historically had a more flexible relationship with the practice of autopsy. In general, Christian doctrines do not explicitly prohibit the violation of the body after death, especially when the procedure is performed for scientific, medical, or legal purposes. Kwaghe et al. (7) point out that, since the Middle Ages, there have been periods of initial resistance, mainly due to interpretations related to the resurrection of the body, but such objections have been gradually overcome with the advancement of scientific thought. Currently, most Christian denominations—including Catholicism, Protestantism, and Anglicanism—accept autopsy as a morally justifiable act when it aims at the common good, justice, or the protection of life. The Catholic Church, for example, recognizes the value of autopsy for medical and legal purposes, provided that the body is treated with respect and dignity. However, despite doctrinal permissiveness, family refusals based on personal beliefs, local interpretations, or emotional factors associated with grief may still occur (6). Thus, although Christianity presents less institutional resistance to autopsy, cultural and individual factors can negatively influence its acceptance, especially in more conservative communities or those with less access to scientific information.
In this context, post-mortem investigation using imaging methods has evolved significantly in recent decades, establishing itself as an essential field of contemporary forensic medicine.
According to Badam et al. (1) and Joseph et al. (18), virtual autopsy or virtoppsy has been gaining prominence due to its technical potential, probative value and greater cultural and religious acceptance. This approach is based on the integrated use of radiological examinations and presents itself not only as a complement, but as an alternative to autopsy, especially in ethical, religious and sociocultural contexts. Duffner and Hodge (3) also highlight the growing relevance of virtoppsy in the legal field, while Sharma and Sharma (6) and Atanda et al. (9) emphasize its ethical and sociocultural impact.
Post-mortem computed tomography (PMCT) is widely recognized as the main method of modern virtoppsy. It is a non-invasive imaging method capable of producing detailed three-dimensional reconstructions of the human body, allowing the visualization of its structures, as well as fractures, hemorrhages, gas collections, foreign bodies and projectile trajectories. Its use allows detailed analysis of internal structures without the need for body dissection, significantly reducing the invasiveness of the procedure (10,18). Badam et al. (1) also describe PMCT as an autopsy technique capable of generating detailed and reproducible three-dimensional documentation.
From a technical point of view, the method is based on volumetric image acquisition in thin axial slices, enabling multiplanar and three-dimensional reconstructions. The use of thin slices, generally between 1 and 2 mm, associated with specific algorithms for bone and soft tissues, allows high spatial resolution and excellent anatomical detail (4). These reconstructions allow precise visualization of complex fractures, bone displacements and anatomical discontinuities in different body structures.
Sá, Santos and Martins (20) describe in detail the operational protocols of PMCT. It was performed with continuous acquisition from the vertex of the skull to the pubic symphysis, with the cadaver properly conditioned to avoid contamination of the equipment. The authors emphasize the importance of using multiple reconstruction algorithms — bone and soft tissue — allowing comprehensive analysis of different tissues. This methodological rigor contributes to the standardization of examinations and the reproducibility of expert findings.
PMCT also stands out for the permanent and revisable documentation of findings. Tomographic images can be stored, shared, and re-evaluated by different experts, which strengthens the legal value of the examination. The technique enables digital reconstructions that assist in the presentation of results in court, making the communication of findings clearer for judges and jurors (3,12).
In the context of violent deaths, the method is particularly relevant in the analysis of injury trajectories. As described by Zerbini et al. (11), it allows for the precise reconstruction of the trajectory of sharp instruments and projectiles, the identification of multiple injury planes, and the correlation of findings with the dynamics of the event. Since there is no need for incision, there is no risk of the trajectory corresponding to the object used as a weapon being destroyed, which would make it impossible to analyze the object in question and determine the cause of death. Dedouit et al. (15) reinforce that the technological evolution of forensic imaging has broadened the diagnostic scope of virtopsy, making it increasingly relevant in contemporary medico-legal practice. Sá, Santos and Martins (20) add that PMCT is superior to traditional radiography in assessing the depth, direction and extent of injuries, especially in complex anatomical regions such as the skull, thorax and abdomen.
Another fundamental technical aspect is the ability to identify and differentiate gases. The instrument allows distinguishing gas resulting from pathological processes, such as pneumothorax or gas embolism, from that related to cadaveric decomposition, which represents a relevant diagnostic differential in investigations of cause of death (4,15). This characteristic makes it particularly valuable in cases of sudden deaths, drownings and suspected thoracic trauma.
Compared to traditional autopsy, PMCT has advantages, but there are some limitations. Although it is highly effective in detecting traumatic injuries, it has limitations in identifying microscopic diseases, initial inflammatory processes and specific intoxications (11). In this sense, Dedouit et al. (15) argue that the integration between TCPM and autopsy currently represents the most complete model of medico-legal investigation. It is noted that there is a high cost of equipment, the need for specialized professionals and the absence of legal standardization in many countries (12,15). Furthermore, the inability to perform detailed histopathological analyses limits its exclusive use in certain situations, reinforcing the need for integration between traditional and technological methods.
In the Islamic context, PMCT is widely perceived as an ethically acceptable solution by religious leaders, especially when used as an initial examination (16). In cases where tomographic findings are sufficient to determine the cause of death, autopsy may be dispensed with or limited to minimally invasive procedures, preserving bodily integrity and accelerating the release of the body for burial. In Judaism, because it does not involve physical violation of the body, TCPM respects the concepts of kavod hamet (honor to the dead) and nivul hamet (prohibition of disfigurement), in addition to enabling rapid release for burial. Sharma and Sharma (6) point out that the acceptance of virtopsy in Jewish communities tends to be greater when accompanied by dialogue between forensic professionals and religious authorities. Although Christian doctrine does not formally prohibit opening the body after death, even in Christian settings, computed tomography may be preferred by family members who wish to minimize manipulation of the body, demonstrating that cultural and emotional factors also influence the choice of method, regardless of religion (6).
From a religious perspective, this integrated model is particularly relevant, as it allows for a reduction in the degree of invasiveness whenever possible. The combination of this method and minimally invasive techniques, such as image-guided biopsies, represents a significant advance in building a forensic medicine that is more sensitive to religious beliefs and cultural values (12,15).
Nevertheless, CT scans do not completely replace the traditional autopsy. Adopting this approach can favor family acceptance, reduce legal conflicts, and promote greater cooperation between authorities, health professionals, and religious communities. The best approach is the integration of methods, using CT scans as an initial examination and reserving conventional autopsy for cases in which imaging findings are inconclusive.
5. CONCLUSION
Autopsy remains an essential tool in forensic medicine, making a decisive contribution to the determination of the cause of death, the clarification of events of judicial interest, and the advancement of scientific knowledge. However, its invasive nature generates significant conflicts when confronted with religious, cultural, and ethical values, particularly in contexts where the integrity of the human body after death is regarded as a fundamental principle. In this regard, post-mortem computed tomography (PMCT) emerges as a relevant technological alternative capable of reducing the invasiveness of post-mortem examinations and, consequently, the religious concerns associated with death investigations. PMCT has demonstrated effectiveness in the evaluation of traumatic deaths, providing substantial diagnostic value while offering greater compliance with religious principles that prioritize the preservation of bodily integrity.
Nevertheless, virtopsy does not fully replace conventional autopsy, particularly in cases requiring detailed histopathological examination or comprehensive toxicological investigation. Therefore, the integration of conventional and technological methods represents the most appropriate approach, enabling a balance between diagnostic accuracy, legal requirements, and cultural sensitivity. The evolution of forensic medicine should thus move toward a hybrid model of post-mortem investigation. The incorporation of PMCT constitutes a significant step in this process, contributing to a more respectful, effective, and socially responsive forensic practice. Such an approach strengthens the dialogue among science, law, and religion, promotes greater social acceptance of post-mortem examinations, and enhances the quality of medico-legal investigations.
The authors declare that there are no conflicts of interest related to this study.
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