Open Access Open Badges Study protocol

Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial

Christoph M Rüegger12*, Christine Bartsch3, Rosa Maria Martinez3, Steffen Ross3, Stephan A Bolliger3, Brigitte Koller1, Leonhard Held4, Elisabeth Bruder5, Peter Karl Bode6, Rosmarie Caduff6, Bernhard Frey2, Leonhard Schäffer7 and Hans Ulrich Bucher1

Author Affiliations

1 Department of Neonatology, University Hospital Zurich, Zurich, Switzerland

2 University Children’s Hospital, Zurich, Switzerland

3 Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland

4 Division of Biostatistics, University of Zurich, Zurich, Switzerland

5 Institute for Pathology, University Hospital Basel, Basel, Switzerland

6 Department of Pathology, University Hospital Zurich, Zurich, Switzerland

7 Division of Obstetrics, University Hospital Zurich, Zurich, Switzerland

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BMC Pediatrics 2014, 14:15  doi:10.1186/1471-2431-14-15

Published: 20 January 2014



In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population.


Foetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard.


There is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures.

Trial Registration NCT01888380

Autopsy; Post-mortem imaging; Minimally invasive virtual autopsy; Guided biopsy; Virtopsy®; Foetus; Stillbirth; Newborn; Infant