Imaging protocols for the autopsy service in a time of pandemic emergency minimizing the contagion of SARS-CoV-2 expert government agents




Forensic anthropology; Radiology; Autopsy; SARS-CoV-2.


Objective: To contribute to the construction of parameters of biosafety in order to protect government agents in the exercise of their investigative functions in the context of a pandemic, as well as to resolve clinical, pathological and possibly legal issues. Methodology: The development of an exploratory review study with a qualitative approach was defined. The methodological design was carried out on the platforms: PubMed and SciELO through the descriptors: Human identification, Radiology, Virtópsia and Autopsy. The exclusion criteria include articles with duplicate information or that do not have information related to the objectives of the study. For inclusion, materials published in Portuguese, English or Spanish were used and at the end 76 articles were obtained. Results and discussion: Conventional autopsy is the most common method for post-mortem investigation in humans. However, with the evolution of imaging methods and the current pandemic threatening the health of government agents, Virtópsia has shown itself to be the most promising way to remedy the dichotomy of occupational risk and legal benefit. Final considerations: In this article, the main advances in Forensic Radiology in the last 11 years were described, with regard to the use of ante and post mortem radiographs in the identification process. Among the various radiological techniques treated, the following stand out: radiographic techniques produced by radiology professionals with different assessments in the radiological area. The images produced are security methods with invasive manipulation and use of all PPE, suitable for the pandemic moment.


Asri, M. N. M., Nestrgan, N. F., Nor, N. A. M., &Verma, R. (2021). On the discrimination of inkjet, laser and photocopier printed documents using Raman spectroscopy and chemometrics: Application in forensic science. MicrochemicalJournal, 165, 106136.

Balthazar, M. A. P., Andrade, M., Ferreira de Souza, D., Machado Cavagna, V., & Cavalcanti Valente, G. S. (2017). Occupational risk management in hospital services: a reflective analysis. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 11(9).

Bettoni, J., Balédent, O., Petruzzo, P., Duisit, J., Kanitakis, J., Devauchelle, B., ...&Dakpé, S. (2020). Role of flow magnetic resonance imaging in the monitoring of facial allotransplantations: preliminary results on graft vasculopathy. International journal of oral and maxillofacial surgery, 49(2), 169-175.

Biswas, U. K., Hossain, M. A., Moinuddin, K. M., & Khan, N. T. (2021). Virtopsy: New Dimension in the Field of Forensic Medicine communities. Journal of Z H Sikder Women’s Medical college, 3(1).

Boland, D. M., Reidy, L. J., Seither, J. M., Radtke, J. M., & Lew, E. O. (2020). Forty‐three fatalities involving the synthetic cannabinoid, 5‐fluoro‐ADB: Forensic pathology and toxicology implications. Journal of forensic sciences, 65(1), 170-182.

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), 20140253.

Bradley, B. T., Maioli, H., Johnston, R., Chaudhry, I., Fink, S. L., Xu, H., ...& Marshall, D. A. (2020). Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series. The Lancet, 396(10247), 320-332.

Carvalho, L. R., & Silva, M. F. (2020). COVID-19 e biossegurança, uma nova perspectiva para a prática odontológica COVID-19 andbiosafety, a new perspective for dental practice. Revista da Faculdade de Odontologia da UFBA, 50(3).

Chen, Y. (2017). State of the art in post-mortem forensic imaging in China. Forensic sciences research, 2(2), 75-84.

Cho, H., Zin, T. T., Shinkawa, N., & Nishii, R. (2018). Post-Mortem Human Identification Using Chest X-Ray and CT Scan Images. International Journal of Biomedical Soft Computing and Human Sciences: the official journal of the Biomedical Fuzzy Systems Association, 23(2), 51-57.

Christe, A., Flach, P., Ross, S., Spendlove, D., Bolliger, S., Vock, P., & Thali, M. J. (2010). Clinical radiology and postmortem imaging (Virtopsy) are not the same: specific and unspecific postmortem signs. Legal medicine, 12(5), 215-222.

Chughtai, A. A., Chen, X., & Macintyre, C. R. (2018). Risk of self-contamination during doffing of personal protective equipment. American journal of infection control, 46(12), 1329-1334.

Cnudde, V., &Boone, MN (2013). Tomografia computadorizada de raios-X de alta resolução em geociências: uma revisão da tecnologia e aplicações atuais. Earth-Science Reviews, 123 , 1-17.

Cordeiro, C., Ordóñez-Mayán, L., Lendoiro, E., Febrero-Bande, M., Vieira, D. N., &Muñoz-Barús, J. I. (2019). A reliable method for estimating the postmortem interval from the biochemistry of the vitreous humor, temperature and body weight. Forensicscienceinternational, 295, 157-168.

Cordner, S., &Tidball-Binz, M. (2017). Humanitarian forensic action—Its origins and future. Forensicscienceinternational, 279, 65-71.

Curado, M., Rodrigues, J. V., & Pereira, A. D. (2020). Enmarzo de 2020: luchar contra laenfermedad, superar ladesesperación, pensar enlasalud. Cadernos Ibero-Americanos De Direito Sanitário, 9(1), 10-23.

Da Silva Aquino, I., Porto, J. C. S., da Silva, J. L., Morais, K. F. C., Coelho, F. A., de Sousa Lopes, T., ... &Mobin, M. (2016). Evaluation of disinfectants for elimination of fungal contamination of patient beds in a reference hospital in Piauí, Brazil. Environmental monitoring and assessment, 188(11), 1-4.

Da Silva, A. S. T., Pinto, R. L. G., & Martins, A. A. (2020). Implementation of the post-death body management protocol in the context of the new Coronavirus / Implementation of the body management protocol in the context of the new Coronavirus. Journal of Nursing and Health, 10 (4).

De Boer, H. H., Maat, G. J., Kadarmo, D. A., Widodo, P. T., Kloosterman, A. D., &Kal, A. J. (2018). DNA identification of human remains in Disaster Victim Identification (DVI): An efficient sampling method for muscle, bone, bone marrow and teeth. Forensicscienceinternational, 289, 253-259.

De Lima, L. C., & Júnior, A. D. S. D. (2020). O retorno ao dilema de antígona: a dignidade do corpo morto no contexto pandêmico da COVID-19. Revista Pensamento Jurídico, 14(2).

Dos Santos Rolo, T., Ershov, A., Van De Kamp, T., &Baumbach, T. (2014). In vivo X-ray cine-tomography for tracking morphological dynamics. Proceedings of the National Academy of Sciences, 111(11), 3921-3926.

Finegan, O., Fonseca, S., Guyomarc’h, P., Mendez, M. D. M., Gonzalez, J. R., Tidball-Binz, M., & on the Management, I. A. G. (2020). International Committee of the Red Cross (ICRC): General guidance for the management of the dead related to COVID-19. Forensic Science International: Synergy, 2, 129-137.

Fineschi, V., Aprile, A., Aquila, I., Arcangeli, M., Asmundo, A., Bacci, …&Sapino, A. (2020). Management of the corpse with suspect, probable or confirmed COVID-19 respiratory infection - Italian interim recommendations for personnel potentially exposed to material from corpses, including body fluids, in morgue structures and during autopsy practice. Pathologica, 112(2), 64–77.

Flach, P. M., Gascho, D., Schweitzer, W., Ruder, T. D., Berger, N., Ross, S. G., ...&Ampanozi, G. (2014). Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols. Forensic science, medicine, and pathology, 10(4), 583-606.

Fonstad, M. A., Dietrich, J. T., Courville, B. C., Jensen, J. L., &Carbonneau, P. E. (2013). Topographic structure from motion: a new development in photogrammetric measurement. Earth surface processes and Landforms, 38(4), 421-430.

Garrido, R. G., & de Almeida, M. P. (2020). Impasses entre dignidade e saúde no manejo de cadáveres da COVID-19: identificar ou reconhecer?.Comunicação em Ciências da Saúde, 31(Suppl 1), 84-93.

Ghosh, S. K. (2015). Humancadavericdissection: a historical account from ancient Greece to the modern era. Anatomy & cell biology, 48(3), 153.

Grabherr, S., Grimm, J., Dominguez, A., Vanhaebost, J., &Mangin, P. (2014). Advances in post-mortem CT-angiography. The British journal of radiology, 87(1036), 20130488.

Germerott, T., et al. (2012). Postmortem ventilation: A new method for improved detection of pulmonary pathologies in forensic imaging. Legal Medicine, 14(1)223-228.

Guillet, J. P., Recur, B., Frederique, L., Bousquet, B., Canioni, L., Manek-Hönninger, I., ...&Mounaix, P. (2014). Review of terahertz tomography techniques. Journal of Infrared, Millimeter, and Terahertz Waves, 35(4), 382-411.

Gupta, S., Gupta, V., Vij, H., Vij, R., &Tyagi, N. (2015). Forensic facial reconstruction: The final frontier. Journal of clinical and diagnostic research: JCDR, 9(9), ZE26.

Hartmann, F. V. G et al., (2020). Manual COVID-19 - prevenção e tratamento. Hospital da escola de medicina da universidade de Zhejiang. Brasília: Fepecs, 2020. Disponível em:

Htun, Y. M., Win, T. T., Aung, A., Latt, T. Z., Phyo, Y. N., Tun, T. M.,&Htun, K. A. (2021). Initial Presenting Symptoms, Comorbidities and Severity of COVID-19 Patients Attending Hmawbi and Indine Treatment Centers During the Second Wave of Epidemic in Myanmar: a Cross-sectional Study.Research square,(1)365594.

Hui, D. S., Zumla, A., & Tang, J. W. (2021). Lethal zoonotic coronavirus infections of humans–comparative phylogenetics, epidemiology, transmission, and clinical features of coronavirus disease 2019, The Middle East respiratory syndrome and severe acute respiratory syndrome. Current Opinion in Pulmonary Medicine, 27(3), 146-154.

Ibrahim, M. A., Abdel-Karim, R. I., Ibrahim, M. S., & Dar, U. F. (2020). Comparative study of the reliability of frontal and maxillary sinuses in sex identification using multidetector computed tomography among Egyptians. Forensic Imaging, 22, 200390.

Islam, M. N., Khan, J., Ikematsu, K., Bagali, P. G., & Raman, V. K. (2018). Digital Autopsy: Popular Tools for an Unpopular Procedure. Arab Journal of Forensic Sciences & Forensic Medicine, 1(7), 792-799.

Jabal, K. A., Ben-Amram, H., Beiruti, K., Batheesh, Y., Sussan, C., Zarka, S., & Edelstein, M. (2021). Impact of age, ethnicity, sex and prior infection status on immunogenicity following a single dose of the BNT162b2 mRNA COVID-19 vaccine: real-world evidence from healthcare workers, Israel, December 2020 to January 2021. Eurosurveillance, 26(6), 2100096.

Jo, Y. H., & Hong, S. (2019). Three-dimensional digital documentation of cultural heritage site based on the convergence of terrestrial laser scanning and unmanned aerial vehicle photogrammetry. ISPRS International Journal of Geo-Information, 8(2), 53.

Joshi, R. R., &Dwivedi, R. (2015). Presentation and Management of Soft-Tissue Foreign Bodies in a Teaching Hospital of Western Nepal. JournalofLumbini Medical College, 3(2), 50-54.

Júnior, A. B. (2020). Biopolítica, asfixia e pandemias no brasil: sobre a aids e a COVID-19. RevistaLinguasagem, 35(1), 98-118.

Kalmbach, K. (2013). Radiation and borders: Chernobyl as a national and transnational site of memory. Global Environment, 6(11), 130-159.

Karus, A., Praakle, K., Saar, T., Must, K., Randoja, H., &Viltrop, A. (2018). Biosafety and biosecurity manual,(15)1-9.

Khoo, L. S., Hasmi, A. H., Ibrahim, M. A., & Mahmood, M. S. (2020). Management of the dead during COVID-19 outbreak in Malaysia. Forensic Science, Medicine and Pathology, 16, 463-470.

Kremer, S., Lersy, F., Anheim, M., Merdji, H., Schenck, M., Oesterlé, H., ...& Cotton, F. (2020). Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study. Neurology, 95(13), e1868-e1882.

Krishan, K., Chatterjee, P. M., Kanchan, T., Kaur, S., Baryah, N., & Singh, R. K. (2016). A review of sex estimation techniques during examination of skeletal remains in forensic anthropology casework. Forensic science international, 261, 165.e1–165.e1658.

Lacy, J. M., Brooks, E. G., Akers, J., Armstrong, D., Decker, L., Gonzalez, A., ...& Utley, S. (2020). COVID-19: postmortem diagnostic and biosafety considerations. The American journal of forensic medicine and pathology, 41(3), 143.

Li, R., Yin, K., Zhang, K., Wang, Y. Y., Wu, Q. P., Tang, S. B., & Cheng, J. D. (2020). Application Prospects of Virtual Autopsy in Forensic Pathological Investigations on COVID-19. Fayixuezazhi, 36(2), 149–156.

Lima, F. L. O. ., Gomes, L. N. L. ., Santos, C. S. C. dos ., & Oliveira, G. A. L. de . (2020). Diagnosis of COVID-19: importance of laboratory tests and imaging exams. Research, Society and Development, 9(9), e259997162.

Livingston, E., Desai, A., &Berkwits, M. (2020). Sourcing personal protective equipment during the COVID-19 pandemic. Jama, 323(19), 1912-1914.

Loveday, H. P., Wilson, J. A., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., ...& Wilcox, M. (2014). epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.

Manigandan, T., Sumathy, C., Elumalai, M., Sathasivasubramanian, S., & Kannan, A. (2015). Forensic radiology in dentistry. Journal of pharmacy &bioallied sciences, 7(Suppl 1), S260.

Marques, L. J. P., Silva, Z. P. D., Alencar, G. P., & Almeida, M. F. D. (2021). Contribuições da investigação dos óbitos fetais para melhoria da definição da causa básica do óbito no Município de São Paulo, Brasil. Cadernos de Saúde Pública, 37, e00079120.

Matushita, J.P., &Khoury, H.J. (2011). Some Aspects of Diagnostic Radiology in Brazil. InternationalAtomic Energy Agency (IAEA): IAEA, 41(10) 43017582.

Morais, H. H. A. D., Silva, A. P. D., Paiva, A. C. S., Medeiros, F. D. C. D. D., & Araújo, F. A. D. C. (2011). Corpo estranho orgânico em face: relato de caso. Revista de Cirurgia e Traumatologia Buco-maxilo-facial, 11(1), 47-53.

Nesbit, P. R., Durkin, P. R., Hugenholtz, C. H., Hubbard, S. M., &Kucharczyk, M. (2018). 3-D stratigraphic mapping using a digital outcrop model derived from UAV images and structure-from-motion photogrammetry. Geosphere, 14(6), 2469-2486.

Nissan, E. (2012). Virtopsy: The Virtual Autopsy. In Computer Applications for Handling Legal Evidence, Police Investigation and Case Argumentation. Springer, Dordrecht. (pp. 991-1015).

Panchbhai, A. S. (2015). Wilhelm Conrad Röntgen and the discovery of X-rays: Revisited after centennial. Journal of Indian academy of oral medicine and radiology, 27(1), 90.

Panda, A., Kumar, A., Gamanagatti, S., & Mishra, B. (2015). Virtopsy computed tomography in trauma: normal postmortem changes and pathologic spectrum of findings. Current problems in diagnostic radiology, 44(5), 391-406.

Pandit, R. R., & Boland, M. V. (2015). Impact of digital imaging and communications in medicine workflow on the integration of patient demographics and ophthalmic test data. Ophthalmology, 122(2), 227-232.

Rabay Guerra, G. U. S. T. A. V. O., Marcos, H., & Ítalo Hardman, A. N. T. Ô. N. I. O. (2020). De Wuhan ao Planalto Central: Federalismo, Patriotismo Constitucional e o Supremo Frente a COVID-19. Revista Jurídica (0103-3506), 4(61).

Ross, S. G., Bolliger, S. A., et. al.(2014). Postmortem CT Angiography: Capabilities and Limitations in Traumatic and Natural Causes of Death. RadioGraphics. 34(1)830-846.

Ruder, T. D., Kraehenbuehl, M., Gotsmy, W. F., Mathier, S., Ebert, L. C., Thali, M. J., &Hatch, G. M. (2012). Radiologic identification of disaster victims: a simple and reliable method using CT of the paranasal sinuses. European journal of radiology, 81(2), e132-e138.

Sakr, Y., Giovini, M., Leone, M., Pizzilli, G., Kortgen, A., Bauer, M., ...&Antonucci, E. (2021). The clinical spectrum of pulmonary thromboembolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: A European case series. Journal of critical care, 61, 39-44.

Savadjiev, P., Chong, J., Dohan, A., Vakalopoulou, M., Reinhold, C., Paragios, N., &Gallix, B. (2019). Demystification of AI-driven medical image interpretation: past, present and future. European radiology, 29(3), 1616-1624.

Sehba, F. A., Pluta, R. M., & Zhang, J. H. (2011). Metamorphosis of subarachnoid hemorrhage research: from delayed vasospasm to early brain injury. Molecular neurobiology, 43(1), 27-40.

Siebke, I., Campana, L., Ramstein, M., Furtwängler, A., Hafner, A., &Lösch, S. (2018). The application of different 3D-scan-systems and photogrammetry at an excavation—A Neolithic dolmen from Switzerland. Digital Applications in Archaeology and Cultural Heritage, 10, e00078.

Sims-Waterhouse, D., Piano, S., & Leach, R. (2017). Verification of micro-scale photogrammetry for smooth three-dimensional object measurement. Measurement Science and Technology, 28(5), 055010.

Tchanque-Fossuo, C. N., Monson, L. A., Farberg, A. S., Donneys, A., Zehtabzadeh, A. J., Razdolsky, E. R., & Buchman, S. R. (2011). Dose-response effect of human equivalent radiation in the murine mandible. Part I. A histomorphometric assessment. Plastic and reconstructive surgery, 128(1), 114.

Thayyil, S., Sebire, N. J., Chitty, L. S., Wade, A., Chong, W. K., Olsen, O., ...& Taylor, A. M. (2013). Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. The Lancet, 382(9888), 223-233.

Valentin, M. V., Dias, C. C., Barbosa, H. L. M., & Braga, D. O. (2020). Aspectos radiológicos em paciente com covid-19: um relato de caso. Revista Interdisciplinar de Saúde e Educação, 1(2), 249-259.

Vaverka, O., Koutny, D., &Palousek, D. (2019). Topologically optimized axle carrier for Formula Student produced by selective laser melting. Rapid Prototyping Journal, 25(9), 1545-1551.

Viner, M. D., & Robson, J. (2017). Post-Mortem Forensic Dental Radiography-a review of current techniques and future developments. Journal of Forensic Radiology and Imaging, 8, 22-37.

Widder, J. (2014). The origins of radiotherapy: Discovery of biological effects of X-rays by Freund in 1897, Kienböck’s crucial experiments in 1900, and still it is the dose. Radiotherapy and Oncology, 112(1), 150-152.

Willer, K., Fingerle, A. A., Gromann, L. B., De Marco, F., Herzen, J., Achterhold, K., ... & Noël, P. B. (2018). X-ray dark-field imaging of the human lung—A feasibility study on a deceased body. PLoS One, 13(9), e0204565.

Wood, R. E., &Kogon, S. L. (2010). Dental radiology considerations in DVI incidents: A review. Forensic science international, 201(1-3), 27-32.

Zerbini, T., &Saldiva, P. H. N. (2014). The Historical Evolution of the Tools Available for Initial Chronothanagnosis. Brazilian Journal of Forensic Sciences, Medical Law and Bioethics, 3(2), 165-185.




How to Cite

SANTOS, A. S. F. dos .; DIAS, R. S.; SILVA , W. da L. Imaging protocols for the autopsy service in a time of pandemic emergency minimizing the contagion of SARS-CoV-2 expert government agents. Research, Society and Development, [S. l.], v. 10, n. 6, p. e28810615860, 2021. DOI: 10.33448/rsd-v10i6.15860. Disponível em: Acesso em: 26 mar. 2023.



Review Article