Diagnostic Thermography

What is Thermography?
• In medicine, is the measurement of body heat emitted by the skin
• Is a non – invasive, diagnostic imaging procedure involving the detection of
and recording of cutaneous thermal patterns using instruments which can
provide visual and quantitative documentation of these temperature
measurements. Because thermography detects pathophysiologic changes in
cutaneous temperature, it may be used as an integral part of the physical
examination or, alternatively, as an adjunct to that examination.
• Thermal patterns are displayed on the skin and detected by the infrared
sensor of the camera. Interpreted as temperature data it is transmitted into
the computer where all images are stored as picture, where red means hot
and blue means cold.
• The interpretation of these temperatures and thermal patterns can be
important in the development of diagnostic impression.
• It may contribute to a diagnosis and patient management by aiding in the
determination of the site and degree of lesion, the type of functional disorder,
and the prognosis for treatment outcomes, as well as assisting in the
determination of the most effective course treatment through continual case
evaluation.
 Why Thermography?
• Thermography can detect the increased metabolic heat associated
with increased vascularity of most suspicious growth, and can sense
the thermal signal – often years in advance of the mass detected on
x – ray.
• Thermography is appropriate an germane to any healthcare practice
whenever the treating professional feels a physiological imaging is
needed for diagnosis or case management. It provides information
about acute as well as chronic conditions and can be useful in
distinguishing aggravated from residual tissue injury.
• Because the temperature of human skin changes in response to
disorders in the underlying tissue, conditions such as poor
circulation, swelling, and cancer are visible with cameras sensitive to
infrared heat.
• Variations in skin temperature depend on the number of blood
vessels and their nearness to the body surface under observation,
among other factors.
 Physiological Basis
Blood flow allows core temperature to come to the surface or not, and
will change the temperature of the skin territorially. Each area of the
body has a particular cutaneous – cordal connection by the sympathetic
nervous system. The alteration of the thermal content of a territory
occurs based upon alterations of this nervous control. Only the dermal
blood flow changes explain the heart seen on the surface of the body.
The heat of a muscle, joint, or a bone is not conducted to the dermal
tissues and cannot influence the dermal temperature recorded by
thermography. Conduction of heat from the deeper portions of the body
to the surface does not occur or create changes in the surface
temperature. However, there are neurochemical processes in the dermis
which can block the normal sympathetic control of blood flow in the skin,
such as histamines, prostaglandins, and myovascular receptor inhibitors
of mast cells. These, however, can be easily differentiated from neural
control by clinical correlation.
• Areas of the surface of the body are recorded as
symmetrical. The frontal areas, the thumbs, the great
toes, the knees, the buttocks, the posterior shoulders
should be contra laterally symmetrical and isothermic. If
there is a difference, it is described as a delta T and
means simply the difference in temperature. In order to
interpret thermographic patterns, one must know the
normal pattern. The normal pattern of the skin surface
is symmetrical, and it is thought that the 95 percentile
range in the normal subject deviates less than 0.3 °C.
Uematsu and others have established the normal
patterns of the human surface temperature.
• The hands are usually colder than the shoulders. The
buttock and the feet are the coldest in the lower body,
followed by the anterior knees. The thenar side of a given
hand is usually warmer than the hypothenar, and the
fingers are cooler than the palm.
• It has been shown that the surface temperature of the
human body is symmetrical. It is a reflection of blood flow
in the dermal microcirculation, and the control of this
microcirculation is autonomic and specifically,
sympathetic. The major basis of clinical thermography is
the correlation of temperature recordings with various
conditions from disease and injury as it relates to
autonomic function.
 Emissivity
• Emissivity is a term representing a
material's ability to emit thermal radiation.
Each material has a different emissivity
and it can be quite a task to determine the
appropriate emissivity for a subject. A
material's emissivity can range from 0.00
(completely not-emitting) to 1.00
(completely emitting); the emissivity often
varies with temperature.
• A black body is a theoretical object which will radiate infrared
radiation at its contact temperature. If a thermocouple on a
black body radiator reads 50 °C, the radiation the black body
will give up will also be 50 °C. Therefore a true black body will
have an emissivity of 1.
• Since there is no such thing as a perfect black body, the
infrared radiation of normal objects will appear to be less than
the contact temperature. The rate of emission of infrared
radiation will thus be a fraction of the true contact temperature.
This fraction is called emissivity.
• Some objects have different emissivities in long wave as
compared to mid wave emissions. Emissivities may also
change as a function of temperature in some materials.
• To make a temperature measurement of
an object, the thermographer will refer to
the emissivity table to choose the
emissivity value of the object, which is
then entered into the camera. The
camera's algorithm will correct the
temperature by using the emissivity to
calculate a temperature that more closely
matches the actual contact temperature of
the object.
• If possible the thermographer would try to test the emissivity
of the object in question. This would be more accurate than
attempting to determine the emissivity of the object via a
table. The usual method of testing the emissivity is to place
a material of known, high emissivity, in contact with the
surface of the object. The material of known emissivity can
be as complex as industrial emissivity spray which is
produced specifically for this purpose or it can be as simple
as standard black insulation tape, emissivity 0.97. A
temperature reading can then be taken of the object with the
emissivity level on the imager set to the value of the test
material. This will give an accurate value of the temperature
of the object.
• The temperature can then be read on a part of
the object not covered with the test material. If
the temperature reading is different, the
emissivity level on the imager can be adjusted
until the object reads the same temperature.
This will give the thermographer a much more
accurate emissivity reading. There are times,
however, when an emissivity test is not possible
due to dangerous or inaccessible conditions. In
these situations the thermographer must rely on
tables.
• he usual method of testing the emissivity is to place a material of known,
high emissivity, in contact with the surface of the object. The material of
known emissivity can be as complex as industrial emissivity spray which
is produced specifically for this purpose or it can be as simple as
standard black insulation tape, emissivity 0.97. A temperature reading
can then be taken of the object with the emissivity level on the imager
set to the value of the test material. This will give an accurate value of
the temperature of the object. The temperature can then be read on a
part of the object not covered with the test material. If the temperature
reading is different, the emissivity level on the imager can be adjusted
until the object reads the same temperature. This will give the
thermographer a much more accurate emissivity reading. There are
times, however, when an emissivity test is not possible due to dangerous
or inaccessible conditions. In these situations the thermographer must
rely on tables.
 How is Thermography used?
Two of the most exciting, yet overlooked, diagnostic procedures of this
century are Digital Infrared Thermal Imaging (DITI) and Contact Regulation
Thermography (CRT), otherwise simply termed thermography. Dr. Ali Meschi
is a board- certified naturopathic physician at the forefront of this technique.
"Thermography is a non-invasive, objective [and] nonradiative tool that uses
[body heat] to diagnose the causes of a host of health conditions," he
explains. Because it uses no radiation, it is completely safe. Utilizing high
speed computers and very accurate thermal imaging cameras, body heat is
processed, recorded and translated by a computer. The image map it
produces can then be analyzed on screen, printed or sent via e-mail.
• During the thermography procedure 112 electrodes are placed
on the patient's body to acquire temperature readings. Two
different readings are
taken. First, the patient sits in a fairly cool, but not uncomfortable,
room for 10 minutes. Then, the first temperature readings of the
face/head, teeth and neck are taken by gently touching the body
part's surface with the probe. The patient is then asked to
remove her clothes from the waist up to create "cold stress" at
about 68 degrees Farenheit and complete the first reading of the
112 data points. Then, the patient stands in her underwear
another 10 minutes. After this period, the second reading of the
data points is taken and the test is concluded.
• Doctors use the image map acquired from these readings to
determine if abnormal hot or cold areas are present. These
hot and cold areas can relate to a number of conditions for
which the FDA, Bureau of Medical Devices, has approved
the thermography procedure. These include screening for
breast cancer, extra-cranial vessel disease
(head and neck vessels), neuro-musculo-skeletal disorders
and vascular disease of the lower extremities. In the past
decade, a number of advancements have brought thermal
imaging to the diagnosis forefront.
• "Thermography measures the heat from one's
body. Metastatic cancers create heat, which can
be imaged by digital infrared imaging. This is
due to the metabolic activity of the tumor tissue
as compared with the temperature of tissue
adjacent to the tumor and in the opposite breast.
By comparing the breast in question with the
normal
breast, which acts as the patient's own control,
abnormal heat signatures associated with the
metabolism of the tumor can be easily detected."
• Cancer tumors produce a chemical which
promotes the development of blood vessels
supplying the area where the tumor resides.
Also, normal blood vessels under the control of
the sympathetic nervous system are essentially
paralyzed, causing an increase in blood vessel
size. The blood increase in the region simply
means more heat.
• Since "thermal imaging has demonstrated in
numerous studies to be capable of measuring
these heat signatures years before conventional
technologies can see a mass, the procedure
uses no radiation, compression of breast tissue
and is totally safe, thermography or DITI/CRT
provides a safe early warning detection system,
“Meschi adds. A monthly self exam, annual
physical exam, yearly thermal imaging and
mammography, when indicated, increase the
effectiveness of early detection to greater than
95 percent.
 Advantages of thermography

• It shows a visual picture so temperatures over a large

area can be compared
• It is capable of catching moving targets in real time
• It is able to find deteriorating, i.e., higher temperature
components prior to their failure
• It can be used to measure or observe in areas
inaccessible or hazardous for other methods
• It is a non-destructive test method
• It can be used to find defects in shafts, pipes, and other
metal or plastic parts
• It can be used to see better in dark areas
 Limitations and disadvantages of
thermography
• Due to the low volume of thermal cameras, quality cameras
often have a high price range (often US$6,000 or more)
• Images can be difficult to interpret accurately when based
upon certain objects, specifically objects with erratic
temperatures, although this problem is reduced in active
thermal imaging.
• Accurate temperature measurements are hindered by
differing emissivities and reflections from other surfaces.
• Most cameras have ±2% accuracy or worse and are not as
accurate as contact methods.
• Only able to directly detect surface temperatures