Green Technology for Health Imaging
Studies of Interest in Thermology
Over 6,000 published papers in the medical literature on medical thermal imaging
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J Therm Biol. 2016 Oct;61:133-139.
Comparison of abdominal skin temperature between fertile and infertile women by infrared thermography: A diagnostic approach.
Jo J1, Kim H2.1-Department of Korean Gynecology, Conmaul Hospital, Seoul 06634, Republic of Korea.2-Department of Biofunctional Medicine & Diagnostics, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea.
This retrospective study aimed to
evaluate the differences in abdominal
temperature (AT) between fertile (n=206; age)
and infertile (n=250) women between the ages of
30 and 39 years. We evaluated the differences in
two distinctive skin temperatures by thermography:
ΔT1 (CV8 index) - difference in
temperature between the mid-abdomen (CV8 acupuncture
area) and ventral upper arm (VUA) and ΔT2
(CV4 index) - difference in temperature between
the lower abdomen (CV4 acupuncture
area) and VUA. The results indicated that
the ΔT1 and ΔT2 of
infertile women were significantly lower (by
1.05°C and 0.79°C, respectively; p<0.001,
both) compared to those of fertile women.
Additionally, the area under the curve of ΔT1
(0.78) was greater compared to that of ΔT2
(0.736), and its threshold was set at 0.675°C,
by which, the sensitivity and specificity of ΔT1
for determination of fertility were found to be
80.8% and 68.4%, respectively. In conclusion,
infertility is associated with lower AT. The
decrease in AT in infertile women might be due
to poor blood perfusion to the core muscles and
tissues of the body. These findings provide
a basis for further research for evaluation of
clinical feasibility of thermography
for analysis of infertility in women. Further
evaluation of the influence of AT on fertility
outcomes is required to determine the causal
relationship between AT and infertility.
Lasers Med Sci. 2016 Nov;31(8):1645-1649.
Laser acupuncture causes thermal changes in small intestine meridian pathway.
de Souza RC1, Pansini M2, Arruda G3, Valente C4, Brioschi ML5.1-Department of Acupuncture, Soepar-Ceap-PR, Rua Lamenha Lins, 1719, Centro, Curitiba, PR, Brazil.2-Department of Health Sciences, Faculty Herrero, Curitiba, PR; Soepar-Ceap, Curitiba, PR, Brazil.3-Department of Biological Science, UFFS, Realeza, PR, Brazil.4-Department of Natural Sciences, FURB, Blumenau, SC, Brazil.5-Department of Clinical, Thermology and Thermography, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil.
The acupuncture meridians represent the flow of corporal energy which contains the acupuncture points. Laser acupuncture is a form of acupuncture stimulation by the use of laser. Thermographic images represent the propagation of heat in micro-environmental systems. The objective of this study was to investigate the use of thermographic images to document the changes on the small intestine meridian (S.I.M.) when submitted to laser acupuncture. Another important issue regards to the analysis of the flow direction if it is upward when stimulated by acupuncture points. For the execution of this work, a laser acupuncture pen was used in points of the meridian in the S.I.M. Two healthy male volunteers were selected (18 and 60 years old, respectively), and doses of 576,92 J/cm2 with low-power infrared laser equipment with a wavelength of 780 nm in the SI.3 and SI.19 points were applied. An infrared thermal camera was used to measure the temperature of the S.I.M. during the 6 min laser acupuncture pen stimulus. When the laser acupuncture of both volunteers was conducted in the SI.3 point, it presented hyper-radiation of the hemi face in the same side, far from the application site. When this was applied in the SI.19 point, hyper-radiation in the same point and temperature lowering at the end of the meridian were observed. The laser energy caused thermal changes along the path of the S.I.M., distal, and proximal at the same time, proving the existence of the S.I.M.
Anesthesiology. 2009 Sep;111(3):632-9.
Contact-free infrared thermography for assessing effects during acupuncture: a randomized, single-blinded, placebo-controlled crossover clinical trial.
Agarwal-Kozlowski K, Lange AC, Beck H.
Center for Palliative Care and Pain Management, Doerenberg Medical Center, Bad Iburg, Germany.
Although evidence of its effects is tentative, acupuncture has long been used in the treatment of multiple maladies. So far, it has not been possible to discriminate the effects of the venue from specific results of needling itself, thus physicians merely depend on patients' statements. The authors investigated the efficacy of infrared thermography in distinguishing response to true acupuncture as compared to nonacupoint cutaneous and muscular needling (sham or minimal acupuncture), as well as without manipulation. METHODS: Thermographic imaging was performed in 50 healthy volunteers randomly assigned to four groups: Acupuncture of Hegu (LI 4), needling of a cutaneous and a muscular point where no acupuncture point has been described yet, and without manipulation. In a crossover protocol, each proband completed all four arms of the protocol in a random order. Infrared thermograms were gathered at defined points in each group. RESULTS: A significant increase in surface temperature occurred within 2 min after needling the acupuncture point Hegu (from 30.1 +/- 2.7 degrees C [SD] to 31.2 +/- 3.0 degrees C and to 31.9 +/- 2.5 degrees C after 10 min, P < 0.001), whereas needling of the cutaneous and muscular point, as well as without any manipulation resulted in a decrease of temperature in the monitored area. CONCLUSION: Contact-free infrared thermographic imaging is a reliable and easy-to-handle tool to distinguish between needling at Hegu and needling of a nonacupoint ("sham" acupuncture).
Am J Chin Med. 2007;35(2):231-40
Appearance of human meridian-like structure and acupoints and its time correlation by infrared thermal imaging.
Yang HQ, Xie SS, Hu XL, Chen L, Li H. Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Institute of Laser and OptoElectronics Technology, Fujian Normal University, Fuzhou 350007, China.
"The meridians and acupoints of human bodies at natural condition are investigated among 30 healthy volunteers by infrared thermal imaging technique. The results give clear evidence of the existence of infrared radiant tracks along human meridian courses. The time dependent evolution of the infrared radiant track is observed for the first time. The time rhythm of acupoints is also studied. Our findings not only support the view that infrared radiant tracks along human meridian courses is a normal vital and physiological phenomenon appearing in human beings, but also offer a potential method for noninvasive diagnostic by studying the physiological function and pathological change of meridians or acupoints by means of thermography."
Am J Chin Med. 2001;29(2):187-99.
The analgesic efficacy of bee venom acupuncture for knee osteoarthritis: a comparative study with needle acupuncture.
Kwon YB, Kim JH, Yoon JH, Lee JD, Han HJ, Mar WC, Beitz AJ, Lee JH
Department of Veterinary Physiology, College of Veterinary Medicine and School of Agricultural Biotechnology, Seoul National University, Suwon, Korea.
The aim of this investigation was to determine whether bee venom (BV) administered directly into an acupoint was a clinically effective and safe method for relieving the pain of patients with knee osteoarthritis (OA) as compared to traditional needle acupuncture. We evaluated the efficacy of BV acupuncture using both pain relief scores and computerized infrared thermography (IRT) following 4 weeks of BV acupuncture treatment. We observed that a significantly higher proportion of subjects receiving BV acupuncture reported substantial pain relief as compared with those receiving traditional needle acupuncture therapy. Furthermore, the IRT score was significantly improved and paralleled the level of pain relief.
Journal of Traditional Chinese Medicine, 1991 Jun, 11(2):139-45
Peripheral facial paralysis aided by infrared thermography.
We have carried out clinical observations on 34 patients with peripheral facial paralysis treated by acupuncture therapy prescribed according to selection of treatment regimen on the basis of facial thermogram and temperature. A comparison was made with a control group of 97 patients who received conventional acupuncture therapy only. It was found that: (1) The cure rate in the group of selecting acupoints by thermogram (hereinafter referred to as the thermography--aided treatment group) was 67.65%, with a marked improvement rate of 26.40%; while the cure rate of the conventional acupuncture treatment group (hereinafter called the conventional treatment group) was 46.39%, the marked improvement rate being 29.90%, indicating a significant difference in therapeutic efficacy between the two groups (P less than 0.02). (2) The average duration of acupuncture therapy for the thermography aided treatment group was 6.02 weeks, whereas that for the conventional treatment group, 24 weeks. There was also a significant difference between the two groups (p less than 0.01). (3) During the entire therapeutic course, 25.2 sessions of treatment were given on the average in the thermography--aided treatment group, and 78.8 sessions in the conventional treatment group, showing a very significant difference (P less than 0.001). The present thermography--aided method exhibits advantages over the conventional one in enhancing the cure rate and shortening the duration of treatment, which is worthy to be popularized in clinical practice. It is also of certain significance in standardization and scientification of acupuncture therapy. Zhang D; Wei Z; Wen B; Gao H; Peng Y; Wang F.
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J Immunol Methods. 2018 Aug;459:29-34.
Stratification of peanut allergic murine model into anaphylaxis severity risk groups using thermography.
Peppers BP1, Jhaveri D2, Van Heeckeren R3, Fletcher D3, Sutton M3, Hostoffer RW2, Bonfield T3.1-Adult and Pediatric Allergy and Immunology Fellowship Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Lake Erie Consortium of Osteopathic Medical Training, Erie, PA, United States.2-Adult and Pediatric Allergy and Immunology Fellowship Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Allergy/Immunology Associates, Inc, Mayfield Heights, OH, United States.3-Department of Immunology, Case Western Reserve University, Mayfield Heights, OH, United States.
Murine models are readily used to
investigate mechanisms potentially involved in
anaphylaxis. Determining successful
sensitization with current methods remain
potentially lethal, invasive, expensive and/or
cumbersome. Here we describe the use of thermography
to read intradermal testing to detect peanut
allergic sensitization in the murine model and
as a first time sensitive tool for anaphylaxis
stratification. The relative wheal size in
the thermal image can be used to stratify
anaphylaxis severity risk groups prior to a
challenge. This screening method is
nonlethal, inexpensive, minimally invasive and
can be carried out expeditiously.
Facial thermography is a sensitive and specific method for assessing food challenge outcome.
Clark AT, Mangat JS, Tay SS, King Y, Monk CJ, White PA, Ewan PW.
Department of Allergy, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, Cambridge, UK.
BACKGROUND: Oral challenge is widely used for diagnosing food allergy but variable interpretation of subjective symptoms may cause error. Facial thermography was evaluated as a novel, objective and sensitive indicator of challenge outcome. METHODS: A total of 24 children with a history of egg allergy underwent oral challenge, which were scored positive when objective symptoms occurred or negative after all doses were consumed without reaction. Facial temperatures were recorded at baseline and 10-min intervals. The difference between mean and baseline temperature (DeltaT), maximum DeltaT during challenge (DeltaT(max)) and area under curve of DeltaT against time (DeltaTAUC) were calculated for predefined nasal, oral and forehead areas, and related to objective challenge outcome. RESULTS: There were 13 positive and 11 negative challenges. Median nasal DeltaTAUC and DeltaT(max) were greater in positive compared with negative challenges (231- and 5-fold, respectively; P < 0.05). In positive challenges, nasal temperatures showed an early transient rise at 20 min, preceding objective symptoms at median 67 min. There was a sustained temperature increase from 60 min, which was reduced by antihistamines. A cut-off for nasal DeltaT(max) of 0.8 degrees C occurring within 20 min of the start of the challenge predicted outcome with 91% sensitivity (positive predictive value [PPV] 100%) and 100% specificity (negative predictive value [NPV] 93%). Subjective symptoms occurred in four of 13 positive and three of 11 negative challenges. CONCLUSIONS: Facial thermography consistently detects a significant early rise in nasal temperature during positive compared with negative food challenges, which is evident before objective symptoms occur. Thermography may therefore provide a sensitive method to determine outcome of food challenges and investigate the pathophysiology of food allergic reactions.
Proc Inst Mech Eng H. 2017 Dec;231(12):1178-1187
Computer-based automated analysis of X-ray and thermal imaging of knee region in evaluation of rheumatoid arthritis.
Snekhalatha U1, Rajalakshmi T1, Gopikrishnan M1, Gupta N2.1- Department of Biomedical Engineering, Faculty of Engineering and Technology, SRM University, Chennai, India.2-Center for Environmental Nuclear Research, SRM University, Chennai, India.
The aim and objectives of the study are as follows: (1) to perform automated segmentation of knee X-ray images using fast greedy snake algorithm and feature extraction using gray level co-occurrence matrix method, (2) to implement automated segmentation of knee thermal image using RGB segmentation method and (3) to compare the features extracted from the segmented knee region of X-ray and thermal images in rheumatoid arthritis patients using a biochemical method as standard. In all, 30 rheumatoid arthritis patients and 30 age- and sex-matched healthy volunteers were included in the study. X-ray and thermography images of knee regions were acquired, and biochemical tests were carried out subsequently. The X-ray images were segmented using fast greedy snake algorithm, and feature extractions were performed using gray level co-occurrence matrix method. The thermal image was segmented using RGB-based segmentation method and statistical features were extracted. Statistical features extracted after segmentation from X-ray and thermal imaging of knee region were correlated with the standard biochemical parameters. The erythrocyte sedimentation rate shows statistically significant correlations (p < 0.01) with the X-ray parameters such as joint space width and % combined cortical thickness. The skin surface temperature measured from knee region of thermal imaging was highly correlated with erythrocyte sedimentation rate. Among all the extracted features namely mean, variance, energy, homogeneity and difference entropy depict statistically significant percentage differences between the rheumatoid arthritis and healthy subjects. From this study, it was observed that thermal infrared imaging technique serves as a potential tool in the evaluation of rheumatoid arthritis at an earlier stage compared to radiography. Hence, it was predicted that thermal imaging method has a competency in the diagnosis of rheumatoid arthritis by automated segmentation methods.
Rheumatology (Oxford). 2004 Jul;43(7):915-9. Epub 2004 May 04.
Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods.
Varju G, Pieper CF, Renner JB, Kraus VB. Box 3416, Duke University Medical Center, Durham, NC 27710, USA.
OBJECTIVE: Anatomical stages of digital osteoarthritis (OA) have been characterized radiographically as progressing through sequential phases from normal to osteophyte formation, progressive loss of joint space, joint erosion and joint remodelling. Our study was designed to evaluate a physiological parameter, joint surface temperature, measured with computerized digital infrared thermal imaging, and its association with sequential stages of radiographic OA (rOA). METHODS: Thermograms, radiographs and digital photographs were taken of both hands of 91 subjects with nodal hand OA. Temperature measurements were made on digits 2-5 at distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints and metacarpophalangeal (MCP) joints (2184 joints in total). We fitted a repeated measures ANCOVA model to analyse the effects of rOA on temperature, with handedness, joint group, digit and NSAID use as covariates. RESULTS: The reliability of the thermoscanning procedure was high (generalizability coefficient 0.899 for two scans performed 3 h apart). The mean joint temperature decreased with increasing rOA severity, defined by the Kellgren-Lawrence (KL) scale. The mean temperature of KL0 joints was significantly different from that of each of the other KL grades (P </= 0.002). After adjustment for the other covariates, there was a strong association of rOA with joint surface temperature (P<0.001). The earliest discernible radiographic disease (KL1) was associated with a higher surface temperature than KL0 joints (P = 0.01) and a higher surface temperature than any other KL grade. Joint erosions were not associated with a change in joint temperature. CONCLUSION: Joint surface temperature varied with the severity of rOA. Joints were warmer than normal at the onset of OA. As the severity of rOA worsened, joint surface temperature declined. These data support the supposition that digital OA progresses in phases initiated by an inflammatory process. The cooler surface temperatures in later stages of the disease may in part explain the paucity of symptoms reported by patients with hand OA.
Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity.
Brenner M, Braun C, Oster M, Gulko PS
North Shore-LIJ Research Institute, United States.
OBJECTIVES: To determine the potential usefulness of a novel thermal imaging technology to evaluate and monitor inflammatory arthritis activity in small joints using rat models, and to determine whether thermal changes can be used to detect pre-clinical stages of synovitis. METHODS: Three different rat strains were studied in a monoarticular model of inflammatory arthritis of the ankle induced with an intra-articular (IA) injection of complete Freund's adjuvant (CFA), and compared with the contra-lateral ankle injected with normal saline. Arthritis activity and severity scores, ankle diameters, pain related posture scores, and thermal images were obtained at ten different time-points between 0h (before induction) and day 7. The pristane-induced arthritis (PIA) model was used to study pre-clinical synovitis. Thermal images were obtained at each time-point using the TSA ImagIR System and digitally analyzed. RESULTS: Rats developed similar ankle arthritis detected 6h after the IA injection of CFA, which persisted for seven days. All ankle clinical parameters, including arthritis activity and severity scores, significantly correlated with ankle thermal imaging changes in the monoarthritis model (P<0.003). No thermal imaging changes were detected in pre-clinical stages of PIA. However, PIA onset coincided with increased ankle thermal signature. CONCLUSION:Thermal measurements significantly correlated with arthritis activity and severity parameters. This technology was highly sensitive and could directly measure two cardinal signs of inflammation (warmth and edema - based on ankle diameter) in an area (ankle) that is less than half the size of a human interphalangeal joint, suggesting a potential use to monitor drug responses of rheumatoid arthritis in drug trials or clinical practice.
Brain Behav. 2018 Jul 11:e01040
Utility of thermographic measurements of laterality of body surface temperature to prevent misdiagnosis of acute Wallenberg's syndrome.
Takahashi M1, Shinya A1, Ito N1, Ebina J1, Abe K1, Inaba A1, Orimo S1.Department of Neurology, Kanto Central Hospital, Tokyo, Japan..
Acute Wallenberg's syndrome (WS) is sometimes misdiagnosed as a nonstroke disease including auditory vertigo, and careful neurological examination is required for a precise diagnosis. Lateral difference of body surface temperature (BST) had been reported as a symptom of WS, although further details of this symptom are currently lacking. Our aim was to investigate the laterality of BST of patients with acute WS using thermography and the usefulness of thermography to detect acute WS.
Nine consecutive patients with new-onset acute WS and nine patients with acute pontine infarction, intended for a comparison, were enrolled. Using thermography, the BST of patients was measured and initially evaluated visually. Detailed BSTs were measured using dedicated software. We examined the relationship between BST and other clinical factors, including first diagnosis, clinical symptoms, and MRI findings.
Four patients with WS (44.44%) were misdiagnosed with nonstroke disease and did not receive a thermography assessment at their first visit; in contrast, all acute pontine infarction patients were diagnosed with brain infarction. Eight patients with WS (89%) showed a laterality of BST at multiple sites, and three of eight patients showed a whole-body laterality of BST; in contrast, only two pontine infarction patients showed laterality of BST at one or two sites. These lateral BST differences were easily observed visually using thermography within two minutes. The BST laterality gradually decreased over time in almost all patients with WS. The infarction size in the WS patients with whole-body laterality of BST was craniocaudally larger than in the other patients, and the size was smallest in the patient showing no BST laterality.
In contrast to acute pontine infarction patients, almost all patients with acute WS showed lateral BST differences, which was easily detected with thermography. Thermography may thus be a useful tool to prevent misdiagnosis of acute WS.
Cephalalgia. 2018 Jan 1:333102418788341
Frontal infrared thermography in healthy individuals and chronic migraine patients: Reliability of the method.
Antonaci F1, Rossi E2,3, Voiticovschi-Iosob C4, Dalla Volta G5, Marceglia S6.1 Headache Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.2 Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.3 Newronika srl, Milan, Italy.4 State Medical and Pharmaceutical University "Nicolae Testemitanu", Chisinau, Moldova.5-Unità Operativa Neurologia, Istituto Clinico Città di Brescia, Brescia, Italy.6-Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste, Trieste, Italy.
Background: The use of frontal infrared thermography in the diagnosis of primary headaches provided scattering results due to measurement fluctuations and different types of headaches or research protocols. Objective This study aims to assess the reliability of frontal infrared thermography in healthy individuals and provide a preliminary evaluation in chronic migraine patients using a commercial infrared thermal camera. Methods Thermographic images were acquired in 20 controls and 15 patients at three consecutive time-points in two daily sessions. The Side Difference and Asymmetry Index parameters were defined. The reproducibility of the measurements, the correlation of Asymmetry Index and Side Difference with clinical evaluations and patient perceptions, and the ability of the parameters to discriminate between patients and controls were investigated. Results We reported a good reproducibility of the measurements (Inter-class Correlation Coefficient > 0.75 and Coefficient of Variation < 13.4%), independent from external factors. The Side Difference was significantly different between patients and controls ( p < 0.001). The Asymmetry Index showed good correlation with the side of unilateral pain ( p = 0.0056). Conclusions Frontal infrared thermography can be used to quantify the difference between the right and the left side of frontal vascular changes in chronic migraine patients, provided that standardized conditions are satisfied.
Med Biol. 2016 Feb 25
Numerous clinical conditions, including complex regional pain syndrome, are characterized by autonomic dysfunctions (e.g. altered thermoregulation, sometimes confined to a single limb), and disrupted cortical representation of the body and the surrounding space. The presence, in patients with complex regional pain syndrome, of a disruption in spatial perception, bodily ownership and thermoregulation led us to hypothesize that impaired spatial perception might result in a spatial-dependent modulation of thermoregulation and bodily ownership over the affected limb. In five experiments involving a total of 23 patients with complex regional pain syndrome of one arm and 10 healthy control subjects, we measured skin temperature of the hand with infrared thermal imaging, before and after experimental periods of either 9 or 10 min each, during which the hand was held on one or the other side of the body midline. Tactile processing was assessed by temporal order judgements of pairs of vibrotactile stimuli, delivered one to each hand. Pain and sense of ownership over the hand were assessed by self-report scales. Across experiments, when kept on its usual side of the body midline, the affected hand was 0.5 ± 0.3°C cooler than the healthy hand (P < 0.02 for all, a common finding in cold-type complex regional pain syndrome), and tactile stimuli delivered to the healthy hand were prioritized over those delivered to the affected hand. Simply crossing both hands over the midline resulted in (i) warming of the affected hand (the affected hand became 0.4 ± 0.3°C warmer than when it was in the uncrossed position; P = 0.01); (ii) cooling of the healthy hand (by 0.3 ± 0.3°C; P = 0.02); and (iii) reversal of the prioritization of tactile processing. When only the affected hand was crossed over the midline, it became warmer (by 0.5 ± 0.3°C; P = 0.01). When only the healthy hand was crossed over the midline, it became cooler (by 0.3 ± 0.3°C; P = 0.01). The temperature change of either hand was positively related to its distance from the body midline (pooled data: r = 0.76, P < 0.001). Crossing the affected hand over the body midline had small but significant effects on both spontaneous pain (which was reduced) and the sense of ownership over the hand (which was increased) (P < 0.04 for both). We conclude that impaired spatial perception modulated temperature of the limbs, tactile processing, spontaneous pain and the sense of ownership over the hands. These results show that complex regional pain syndrome involves more complex neurological dysfunction than has previously been considered.
Intraoperative infrared imaging of brain tumors.
Gorbach AM, Heiss JD, Kopylev L, Oldfield EH.
National Institute of Neurological Disorders and Stroke, Bioengineering and Physical Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-5766, USA.
Although clinical imaging defines the anatomical relationship between a brain tumor and the surrounding brain and neurological deficits indicate the neurophysiological consequences of the tumor, the effect of a brain tumor on vascular physiology is less clear. ... Brain tumors induce changes in cerebral blood flow (CBF) in the cortex, which can be made visible by performing infrared imaging during cranial surgery. A reduction in CBF beyond the tumor margin improves after removal of the lesion.
J Neurosurg 2002 Dec;97(6):1460-71
Vision of the future: initial experience with intraoperative real-time
high-resolution dynamic infrared imaging. Technical note.
Ecker RD, Goerss SJ, Meyer FB, Cohen-Gadol AA, Britton JW, Levine JA. Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota, USA.
High-resolution dynamic infrared (DIR) imaging provides intraoperative real-time physiological, anatomical, and pathological information; however, DIR imaging has rarely been used in neurosurgical patients. The authors report on their initial experience with intraoperative DIR imaging in 30 such patients. A novel, long-wave (8-10 micron), narrow-band, focal-plane-array infrared photodetector was incorporated into a camera system with a temperature resolution of 0.006 degrees C, providing 65,000 pixels/frame at a data acquisition rate of 200 frames/second. Intraoperative imaging of patients was performed before and after surgery. Infrared data were subsequently analyzed by examining absolute differences in cortical temperatures, changes in temperature over time, and infrared intensities at varying physiological frequencies. Dynamic infrared imaging was applied in a variety of neurosurgical cases. After resection of an arteriovenous malformation, there was postoperative hyperperfusion of the surrounding brain parenchyma, which was consistent with a loss of autoregulation. Bypass patency and increased perfusion of adjacent brain were documented during two of three extracranial-intracranial bypasses. In seven of nine patients with epilepsy the results of DIR imaging corresponded to seizure foci that had been electrocorticographically mapped preoperatively. Dynamic infrared imaging demonstrated the functional cortex in four of nine patients undergoing awake resection and cortical stimulation. Finally, DIR imaging exhibited the distinct thermal footprints of 14 of 16 brain tumors. Dynamic infrared imaging may prove to be a powerful adjunctive intraoperative diagnostic tool in the neurosurgical imaging armamentarium. Real-time assessment of cerebral vessel patency and cerebral perfusion are the most direct applications of this technology. Uses of this imaging modality in the localization of epileptic foci, identification of functional cortex during awake craniotomy, and determination of tumor border and intraoperative brain shift are avenues of inquiry that require further investigation.
Infrared imaging of human brain sections. A new biomedical application of the thermocamera.
Human brains, removed at routine autopsy, were subjected to neuropathological investigation. The usual gross morphological investigation of the brains was extended to include the detection of their infrared emissions. Fundamental structures, such as the grey and white matter, were separated on the infrared images. Furthermore, pathological processes, such as ischaemic damage, haemorrhage, and sclerotic plaques, hardly seen on the normal photographs, gave a strong signal on the infrared pictures. These pilot experiments demonstrated that infrared detection is a reproducible method in this type of biomedical application, and potentially a very useful tool in macroscopic pathology. Gati I, Papp L, Polgar T, Department of Neurology, University of Pecs Medical School, Hungary.
Rev Neurol 1999 Mar 16-31;28(6):535-43
[Neurophysiological study of thin myelinated and unmyelinated fibers]. [Article in Spanish] Espinosa ML, Santiago S, Guzman JJ, Prieto J, Ferrer T; Laboratorio de SNA, Hospital General La Paz, Madrid, Espana.
INTRODUCTION: Standard neurophysiological techniques evaluate thick myelinated fibers. Yet, peripheral nerves are equally composed of thin myelinated and unmyelinated fibers. The latter are responsible for autonomic function as well as temperature and pain perception. DEVELOPMENT: Microneurographic studies are restricted to investigation laboratories. Since the techniques are complex and invasive, their performance is still poor for clinical purposes and some of the components to be analyzed, such as cardiovagal, cannot be directly recorded. The clinical need to evaluate the functions regulated by the autonomic nervous system (ANS) had led to devising a series of tests which, in most cases, rely on reflex responses evoked by already known standardize stimuli. The battery chosen has to be non invasive, reproducible, specific, providing relevant data to the investigated function, with a readily available technology, which has to be managed being aware of the physiological and pathological factors that might bear an influence on the results. The recent development of heart rate blood pressure power spectral analysis, provides a new interesting insight for quantification of ANS abnormalities. The study of thermography and thermometry of body surface brings forward evidence on the activity of other thin and unmyelinated fibers components of the peripheral nerve spectrum. CONCLUSION: The adequate management of the above mentioned tests gives rise to a more extensive and appropriate knowledge of the whole peripheral nerve fiber spectrum.
J Biomed Opt. 2018 May;23(5):1-6.
Thermal imaging as a tool for evaluating tumor treatment efficacy.
Hoffer OA1,2, Ben-David MA3,4, Katz E2, Zoltnik Kirshenabum D2, Alezra D4, Zimmer Y5, Kelson I6, Gannot I1,7.1-Tel Aviv University, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv, Israe. l2-Afeka College of Engineering, School of Electrical Engineering, Tel-Aviv, Israel.3-Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel 4-Sheba Medical Center, Radiation Oncology Department, Ramat-Gan, Israel.5-Afeka College of Engineering, School of Medical Engineering, Tel-Aviv, Israel.6-Tel Aviv University, School of Physics and Astronomy, Raymond and Beverly Sackler Faculty of Exact S, Israel.7-John Hopkins University, Whiting School of Engineering, Department of Electrical and Computer Engine, United States.
Breast cancer is the most frequently diagnosed cancer among women in the Western world. Thermography is a nonionizing, noninvasive, portable, and low-cost method that can be used in an outpatient clinic. It was tried as a tool to detect breast cancer tumors, however, it had too many false readings. Thermography has been extensively studied as a breast cancer detection tool but was not used as a treatment monitoring tool. The purpose of this study was to investigate the possibility of using thermal imaging as a feedback system to optimize radiation therapy. Patients were imaged with a thermal camera prior and throughout the radiotherapy sessions. At the end of the session, the images were analyzed for temporal vasculature changes through vessels segmentation image processing tools. Tumors that were not responsive to treatment were observed before the radiation therapy sessions were concluded. Assessing the efficacy of radiotherapy during treatment makes it possible to change the treatment regimen, dose, and radiation field during treatment as well as to individualize treatment schedules to optimize treatment effectiveness.
Int J Surg 2014 Nov 7;12(12):1439-1443.
Evaluation of digital infra-red thermal imaging as an adjunctive screening method for breast carcinoma: A pilot study.
Rassiwala M1, Mathur P2, Mathur R3, Farid K3, Shukla S3, Gupta PK4, Jain B4.
Coll Antropol. 2013 Jun;37(2):583-8.
Thermography--a feasible method for screening breast cancer?
Kolarić D, Herceg Z, Nola IA, Ramljak V, Kulis T, Holjevac JK, Deutsch JA, Antonini S.
Potential use of thermography for more effective detection of breast carcinoma was evaluated on 26 patients scheduled for breast carcinoma surgery. Ultrasonographic scan, mammography and thermography were performed at the University Hospital for Tumors. Thermographic imaging was performed using a new generation of digital thermal cameras with high sensitivity and resolution (ThermoTracer TH7102WL, NEC). Five images for each patient were recorded: front, right semi-oblique, right oblique, left- semi oblique and left oblique. While mammography detected 31 changes in 26 patients, thermography was more sensitive and detected 6 more changes in the same patients. All 37 changes were subjected to the cytological analysis and it was found that 16 of samples were malignant, 8 were suspected malignant and 11 were benign with atypia or proliferation while only 2 samples had benign findings. The pathohistological method (PHD) recorded 75.75% malignant changes within the total number of samples. Statistical analysis of the data has shown a probability of a correct mammographic finding in 85% of the cases (sensitivity of 85%, specificity of 84%) and a probability of a correct thermographic finding in 92% of the cases (sensitivity of 100%, specificity of 79%). As breast cancer remains the most prevalent cancer in women and thermography exhibited superior sensitivity, we believe that thermography should immediately find its place in the screening programs for early detection of breast carcinoma, in order to reduce the sufferings from this devastating disease.
J Biomed Opt.2013;18(11):111410. doi: 10.1117/1.JBO.18.11.111410.
Thermographic investigation of tumor size, and its correlation to tumor relative temperature, in mice with transplantable solid breast carcinoma.
Tepper M, Shoval A, Hoffer O, Confino H, Schmidt M, Kelson I, Keisari Y, Gannot I.
Treating cancer is one of the major challenges of modern medicine. Since mice models are an important tool in cancer treatment research, it is required to assess murine tumor development. Existing methods for investigating tumor development are either high cost and limited by their availability or suffer from low accuracy and reproducibility. In order to overcome these drawbacks, thermography may be used. DA3 breast cancer carcinoma tumors in 12 Balb/c mice were thermally imaged and monitored for a period of several weeks. Eight mice were treated with diffusing alpha emitters radiation therapy (DaRT) wires, while four were treated with inert wires. For large tumors, the area was estimated by analyzing thermal images and was found to be in correlation with manual caliper measurements. In addition, the correlation between tumor area and relative temperatures was calculated and compared to previous works. Temperature differences were larger for tumors treated with DaRT wires than tumors with inert wires. These correlations can be used to assist in tumor size estimation and reveal information regarding its metabolic state. Overall, thermography was shown to be a promising tool for assessing tumor development with the additional advantages of being nonradiative and potentially providing indication of intratumoral biological processes.
Am J Surg. 2008 Oct;196(4):523-6.
Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer.
Arora N, Martins D, Ruggerio D, Tousimis E, Swistel AJ, Osborne MP, Simmons RM
Department of Surgery, New York Presbyterian Hospital-Cornell, New York, NY
BACKGROUND: Digital infrared thermal imaging (DITI) has resurfaced in this era of modernized computer technology. Its role in the detection of breast cancer is evaluated. METHODS: In this prospective clinical trial, 92 patients for whom a breast biopsy was recommended based on prior mammogram or ultrasound underwent DITI. Three scores were generated: an overall risk score in the screening mode, a clinical score based on patient information, and a third assessment by artificial neural network. RESULTS: Sixty of 94 biopsies were malignant and 34 were benign. DITI identified 58 of 60 malignancies, with 97% sensitivity, 44% specificity, and 82% negative predictive value depending on the mode used. Compared to an overall risk score of 0, a score of 3 or greater was significantly more likely to be associated with malignancy (30% vs 90%, P < .03). CONCLUSION: DITI is a valuable adjunct to mammography and ultrasound, especially in women with dense breast parenchyma.
Surg Technol Int. 2005;14:51-6.
Advances in breast imaging.
Agnese DM. The Ohio State University, Columbus, Ohio.
Although mammography remains the most widely used tool for the early detection of breast cancers and evaluation of palpable abnormalities, a number of other imaging tools are being developed and used. Ultrasonography (US) is an excellent adjunct to conventional mammography. In addition to identifying solid and cystic abnormalities, US can often distinguish benign and malignant solid nodules. Magnetic resonance imaging (MRI) also is useful in assessing the extent of disease within the breast, particularly in women with dense breasts. MRI may be a more sensitive screening tool in women at elevated breast cancer risk. Newer techniques based on the metabolic activity of breast tumors also have been developed. One such technique is scintimammography, which uses radiolabeled tracers to detect breast malignancies. Positron emission tomography (PET), which relies on the high metabolic rate of tumors, also has been described as a method to evaluate breast disease. Other techniques, such as optical tomography and thermography, rely on angiogenesis and generated heat to identify cancers. These and other tools may help to improve both the sensitivity and specificity of cancer detection. Ideally, this improved detection results in improved outcomes in those who have breast cancer and avoidance of unnecessary procedures in those who do not.
J Biomech Eng. 2004 Apr;126(2):204-11.
Effect of forced convection on the skin thermal expression of breast cancer.
Hu L, Gupta A, Gore JP, Xu LX.; School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA.
A bioheat-transfer-based numerical model was utilized to study the energy balance in healthy and malignant breasts subjected to forced convection in a wind tunnel. Steady-state temperature distributions on the skin surface of the breasts were obtained by numerically solving the conjugate heat transfer problem. Parametric studies on the influences of the airflow on the skin thermal expression of tumors were performed. It was found that the presence of tumor may not be clearly shown due to the irregularities of the skin temperature distribution induced by the airflow field. Nevertheless, image subtraction techniques could be employed to eliminate the effects of the flow field and thermal noise and significantly improve the thermal signature of the tumor on the skin surface. Inclusion of the possible skin vascular response to cold stress caused by the airflow further enhances the signal, especially for deeply embedded tumors that otherwise may not be detectable.
Int J Fertil Womens Med 2001 Sep-Oct;46(5):238-47
Circadian rhythm chaos: a new breast cancer marker.
Keith LG, Oleszczuk JJ, Laguens M.; Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA.
The most disappointing aspect of breast cancer treatment as a public health issue has been the failure of screening to improve mortality figures. Since treatment of late-stage cancer has indeed advanced, mortality can only be decreased by improving the rate of early diagnosis. From the mid-1950s to the mid-1970s, it was expected that thermography would hold the key to breast cancer detection, as surface temperature increases overlying malignant tumors had been demonstrated by thermographic imaging. Unfortunately, detection of the 1-3 degrees C thermal differences failed to bear out its promise in early identification of cancer. In the intervening two-and-a-half decades, three new factors have emerged: it is now apparent that breast cancer has a lengthy genesis; a long-established tumor-even one of a certain minimum size-induces increased arterial/capillary vascularity in its vicinity; and thermal variations that characterize tissue metabolism are circadian ("about 24 hours") in periodicity. This paper reviews the evidence for a connection between disturbances of circadian rhythms and breast cancer. Furthermore, a scheme is proposed in which circadian rhythm "chaos" is taken as a signal of high risk for breast cancer even in the absence of mammographic evidence of neoplasm or a palpable tumor. Recent studies along this line suggest that an abnormal thermal sign, in the light of our present knowledge of breast cancer, is ten times as important an indication as is family history data.
Breast Cancer 2000 Apr 25;7(2):142-148
Skin Reactions after Breast-conserving Therapy and Prediction of Late Complications Using Physiological Functions.
Sekine H, Kobayashi M, Honda C, Aoki M, Nakagawa M, Kanehira C; Department of Radiology, Division of Radiotherapy, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
BACKGROUND: The temperature of the skin remains elevated long after breast-conserving treatment with irradiation, perhaps because evaporative cooling is impaired. We investigated physiological changes of the irradiated skin and reevaluated the radiosensitivity of sweat glands on a functional basis to determine whether severe complications can be predicted. METHODS: Breast and axillary skin temperatures were measured with thermography and sweat production in response to local thermal stimuli was measured on the basis of changes in electrical skin resistance with a bridge circuit in 45 women before, during, and after breast irradiation for breast cancer. RESULTS: Breast and axillary temperatures were significantly increased after irradiation. In response to cutaneous thermal stimuli, the electric skin resistance of nonirradiated areas decreased significantly because of sweating, but that of irradiated areas was unchanged. CONCLUSION: Impairment of sweating may play an important role in skin damage after irradiation. Although glandular tissue is not usually radiosensitive, the results of our functional assessment suggest that sweat glands are more radiosensitive than expected.
The Breast Journal, Volume 4, Number 4, 1998, 245-251
Infrared Imaging of the Breast: Initial Reappraisal Using High-Resolution Digital Technology in 100 Successive Cases of Stage I and II Breast Cancer.
Department of Oncology, St. Mary's Hospital, Montreal, Quebec; Department of Radiotherapy, London Cancer Center, London, Ontario; and Ville Marie Breast and Oncology Center, Montreal, Quebec, Canada.
Our initial experience would suggest that, when done concomitantly with clinical exam and mammography, high-resolution digital infrared imaging can provide additional safe, practical, and objective information. Our initial reappraisal would also suggest that infrared imaging, based more on process than structural changes and requiring neither contact, compression, radiation nor venous access, can provide pertinent and practical complementary information to both clinical exam and mammography, our current primary basic detection modalities.
BURNS Return to Health Categories Receive Updates
J Am Coll Surg. 2018 Apr;226(4):687-693.
Early Assessment of Burn Depth with Far Infrared Time-Lapse Thermography.
Simmons JD1, Kahn SA2, Vickers AL3, Crockett ES4, Whitehead JD3, Krecker AK3, Lee YL2, Miller AN2, Patterson SB2, Richards WO2, Wagner WW Jr5.1-Department of Surgery, University of South Alabama School of Medicine, Mobile, AL; Department of Molecular and Cellular Pharmacology, University of South Alabama School of Medicine, Mobile, AL; Center for Lung Biology, University of South Alabama School of Medicine, Mobile, AL.2-Department of Surgery, University of South Alabama School of Medicine, Mobile, AL.3-University of South Alabama School of Medicine, Mobile, AL.4-Department of Molecular and Cellular Pharmacology, University of South Alabama School of Medicine, Mobile, AL.5-Department of Molecular and Cellular Pharmacology, University of South Alabama School of Medicine, Mobile, AL; Center for Lung Biology, University of South Alabama School of Medicine, Mobile, AL.
BACKGROUND: Diagnosing the extremes of superficial burns and full-thickness burns is straightforward. It is in the middle ground of partial-thickness burns where the diagnostic difficulties emerge; it can take up to 3 to 5 days for signs of healing to appear. We hypothesize that cooling partial-thickness burns and tracking the rate of rewarming will immediately reflect the condition of the burn: shallow partial-thickness burns that retain cell health and blood flow will rewarm rapidly, and deeper burns with damaged microvessels will rewarm slowly.
STUDY DESIGN: We enrolled 16 patients with isolated, partial-thickness burns on their extremities who were diagnosed as indeterminate by our burn surgeon. Within 24 hours after presentation, room-temperature saline was poured over the burn as a cooling challenge. An infrared camera that was sensitive to body temperature produced false-color images showing pixel-by-pixel temperatures. A time-lapse recording from the infrared camera images taken as the burn rewarmed produced a time-temperature curve that reflected the kinetics of rewarming. The outcomes variable was whether or not the patient received a skin graft, which was determined 72 hours after presentation.
RESULTS: The method correctly predicted whether or not the patient required a skin graft.
report a new
the first day
of the burn
and make the
graft or not
Res. 2015 Dec.
Infrared Thermal Imaging Has the Potential to Reduce Unnecessary Surgery and Delays to Necessary Surgery in Burn Patients.
Singer AJ, Relan P, et al.
Department of Emergency Medicine, Department of Surgery, Department of Dermatology, and Department of Biomedical Engineering, Stony Brook University, New York.
Clinical distinction between superficial and deep burns is problematic. The authors determined whether an infrared thermal imaging (IRTI) camera could predict burn depth. Burn depth was assessed by an experienced surgeon, and the burns were imaged with a portable, lightweight IRTI camera that measures heat emission from the skin using long infrared wavelengths (7.5-13 μm). Burns were considered "deep" if they were surgically excised and confirmed to be of full thickness on microscopic evaluation or if they did not heal spontaneously within 21 days of injury. All other burns were considered "nondeep." There were 39 burns that had both days 1 and 2 IRTI measurements and available outcome. Of these, 16 were "deep" burns and 23 were "nondeep." The mean temperatures of "nondeep" burns between days 1 and 2 increased from 30.6 ± 2.7 to 32.1 ± 3.0°C (difference of 1.5 ± 2.3°C). The mean temperatures of "deep" burns decreased from 32.3 ± 2.0 to 30.8 ± 1.3°C (difference of -1.5 ± 2.0°C) between days 1 and 2. Any decrease in temperatures between days 1 and 2 was predictive of a deep wound, and any increase between days 1 and 2 was predictive of a nondeep burn. Using the ultimate burn depth as the criterion standard, the overall accuracy of IRTI was considerably higher than that of clinical assessment; 87.2% (95% CI: 71.8-95.2) vs 54.1% (95% CI: 37.1-70.2). Any decrease in temperatures between days 1 and 2 was predictive of a deep wound. Our results suggest that thermography using IRTI is more accurate than clinical examination in predicting burn depth and could potentially reduce unnecessary surgery as well as reduce delays to surgery when necessary.
J. Burn Care Res. 2015 August 17
Active Dynamic Thermography is a Sensitive Method for Distinguishing Burn Wound Conversion.
Prindeze NJ, Hoffman HA et al.
The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
The Burn Center, Department of Surgery, MedStar Washington Hospital Center, DC
J Biomed Opt. 2013 Jun;18(6):061204.
Noninvasive determination of burn depth in children by digital infrared thermal imaging.
Medina-Preciado JD, Kolosovas-Machuca ES, Velez-Gomez E, Miranda-Altamirano A, González FJ.
Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
imaging is used to assess noninvasively
of burn wounds
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size of the
Burns. 2013 Feb;39(1):76-81. doi: 10.1016/j.burns.2012.03.014.
A pilot evaluation study of high resolution digital thermal imaging in the assessment of burn depth.
Hardwicke J, Thomson R, Bamford A, Moiemen N. West Midlands Regional Burns Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
Thermal imaging is a tool that can be used to
depth. We have
use of this
of burns and aim to establish if high
burns affecting upper and lower limbs
Digital and thermal images were
between 42 h
and 5 days
burns were significantly cooler
as were deep
thickness burns (p<0.05).
thickness burns were not
burns were 2.3°C cooler than non-burnt
thickness burns were 1.2°C
superficial burns were only 0.1°C
cooler. Thermal imaging can correctly determine
The thermal camera produces images of high
is quick and
easy to use.
Cooling extensive burns: Sprayed coolants can improve initial cooling management A thermography-based study
Schnell HM, Zaspel JG.
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
This pilot study was designed to verify whether the spraying of coolant improves initial cooling in extensive burns. The cooling effects of 1l of sprayed water and 5l of poured water (at 22 degrees C) were tested; 53 healthy participants were cooled for 15min over 18% of their total body surface, twice. Thermographic imaging measured the loss of skin temperature and assessed the homogeneity of cooling. With sprayed coolant the mean decrease of skin temperature was significantly higher (p<0.003) throughout the entire cooling period and more homogeneous for the first 9min (p<0.003), compared with poured coolant. Infrared tympanic thermometry estimated core body temperature; neither poured nor sprayed water caused hypothermia. Even with a fifth of the volume of poured water, sprayed water cooled more efficiently. Thus, we conclude that spraying of coolant improves initial management.
IEEE Trans Biomed Eng. 2007 Feb;54(2):303-12.
Thermal parametric imaging in the evaluation of skin burn depth.
Rumiński J, Kaczmarek M, Renkielska A, Nowakowski A.
Department of Biomedical Engineering, Gdansk University of Technology, Narutowicza 11/12, Poland.
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Timing of the thermographic assessment of burns. The thermographic assessment of burns using infrared imaging has previously been shown to be a useful aid in the estimation of burn depth. In this study, thermographic images of burns, obtained from 65 patients over a 4-year period, were reviewed. ... The results of this study suggest that thermography of burns, to assess depth, should be performed within 3 days following the injury.
Annals of Plastic Surgery, 1995
Burns, 1991 Apr;17(2):117-22.
IV Pluronic F-127 in early burn wound treatment in rats.The non-ionic surfactant Pluronic F-127 shows a positive therapeutic effect on wound closure rates and healing. Between 90 min. and 48 hours postinjury, thermography showed the alterations in the F-127 treated injuries.
DENTAL Return to Health Categories Receive Updates
Dent Mater J. 2003 Dec;22(4):436-43.
Application of thermography in dentistry--visualization of temperature distribution on oral tissues.
Komoriyama M, Nomoto R, Tanaka R, Hosoya N, Gomi K, Iino F, Yashima A, Takayama Y, Tsuruta M, Tokiwa H, Kawasaki K, Arai T, Hosoi T, Hirashita A, Hirano S.; Department of Dental Engineering, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
The purpose of this study was to devise and propose appropriate conditions for the photographing of thermal images in the oral cavity and to evaluate which thermography techniques can be applied to dentistry by evaluating the differences in temperature among oral tissues. Thermal images of oral cavities of 20 volunteers in normal oral condition were taken according to the guidelines of the Japanese Society of Thermography, with five added items for oral observation. The use of a mirror made it possible to take thermal images of the posterior portion or palate. Teeth, free gingiva, attached gingiva and alveolar mucosa were identified on thermal images. There were differences in temperature between teeth, free gingiva, attached gingiva and alveolar mucosa. These were nearly in agreement with the anatomical view. Thermography need no longer be restricted to the anterior portion using a mirror, and can now be applied to the dental region.
Eur J Orthod 1999 Apr;21(2):111-8
Thermal image analysis of electrothermal debonding of ceramic brackets: an in vitro study.
Cummings M, Biagioni P, Lamey PJ, Burden DJ; Division of Orthodontics, School of Clinical Dentistry, Queen's University of Belfast, UK. This study used modern thermal imaging techniques to investigate the temperature rise induced at the pulpal well during thermal debonding of ceramic brackets. Ceramic brackets were debonded from vertically sectioned premolar teeth using an electrothermal debonding unit. Ten teeth were debonded at the end of a single 3-second heating cycle. For a further group of 10 teeth, the bracket and heating element were left in contact with the tooth during the 3-second heating cycle and the 6-second cooling cycle. The average pulpal wall temperature increase for the teeth debonded at the end of the 3-second heating cycle was 16.8 degrees C. When the heating element and bracket remained in contact with the tooth during the 6-second cooling cycle an average temperature increase of 45.6 degrees C was recorded.
DERMATOLOGY & Plastic Surgery Return to Health Categories Receive Updates
J Biomed Opt. 2014 Apr;19(4):046019
Assessment technique for acne treatments based on statistical parameters of skin thermal images.
Padilla-Medina JA, León-Ordoñez F, Prado-Olivarez J, Vela-Aguirre N, Ramírez-Agundis A, Díaz-Carmona J.
Acne vulgaris as an inflammatory disease, with an excessive production of subdermal fat, modifies the dynamics of the bloodstream, and consequently temperature, on the affected skin zone. A high percentage of this heat interchange is manifested as electromagnetic radiation with far-infrared wavelengths, which can be captured through a thermal imaging camera. A technique based on thermal image analysis for efficiency assessment in acne vulgaris is described. The procedure is based on computing statistical parameters of thermal images captured from the affected skin zone being attended by an acne treatment. The proposed technique was used to determine the skin thermal behavior according to acne severity levels in different acne treatment stages. Infrared images of acne skin zones on eight patients, diagnosed with acne vulgaris and attended by one specific acne treatment, were weekly registered during 11 weeks. The infrared images were captured until no more improvement in affected zones was detected. The obtained results suggest a direct relationship between the used statistical parameters, particularly first- and second-order statistics, and the acne vulgaris severity level on the affected zones.
J Vis Exp. 2011 May 5;(51).
Quantitative visualization and detection of skin cancer using dynamic thermal imaging.
Herman C, Pirtini Cetingul M. Department of Mechanical Engineering, The Johns Hopkins University.
In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death (1). To date, the only effective treatment for melanoma remains surgical excision, therefore, the key to extended survival is early detection (2,3). Considering the large numbers of patients diagnosed every year and the limitations in accessing specialized care quickly, the development of objective in vivo diagnostic instruments to aid the diagnosis is essential. New techniques to detect skin cancer, especially non-invasive diagnostic tools, are being explored in numerous laboratories. Along with the surgical methods, techniques such as digital photography, dermoscopy, multispectral imaging systems (MelaFind), laser-based systems (confocal scanning laser microscopy, laser doppler perfusion imaging, optical coherence tomography), ultrasound, magnetic resonance imaging, are being tested. Each technique offers unique advantages and disadvantages, many of which pose a compromise between effectiveness and accuracy versus ease of use and cost considerations. Details about these techniques and comparisons are available in the literature (4). Infrared (IR) imaging was shown to be a useful method to diagnose the signs of certain diseases by measuring the local skin temperature. There is a large body of evidence showing that disease or deviation from normal functioning are accompanied by changes of the temperature of the body, which again affect the temperature of the skin (5,6). Accurate data about the temperature of the human body and skin can provide a wealth of information on the processes responsible for heat generation and thermoregulation, in particular the deviation from normal conditions, often caused by disease. However, IR imaging has not been widely recognized in medicine due to the premature use of the technology (7,8) several decades ago, when temperature measurement accuracy and the spatial resolution were inadequate and sophisticated image processing tools were unavailable. This situation changed dramatically in the late 1990s-2000s. Advances in IR instrumentation, implementation of digital image processing algorithms and dynamic IR imaging, which enables scientists to analyze not only the spatial, but also the temporal thermal behavior of the skin (9), allowed breakthroughs in the field. In our research, we explore the feasibility of IR imaging, combined with theoretical and experimental studies, as a cost effective, non-invasive, in vivo optical measurement technique for tumor detection, with emphasis on the screening and early detection of melanoma (10-13). In this study, we show data obtained in a patient study in which patients that possess a pigmented lesion with a clinical indication for biopsy are selected for imaging. We compared the difference in thermal responses between healthy and malignant tissue and compared our data with biopsy results. We concluded that the increased metabolic activity of the melanoma lesion can be detected by dynamic infrared imaging.
Ann Plast Surg. 2011 Apr;66(4):324-5.
Images in plastic surgery: digital thermographic photography ("thermal imaging") for preoperative perforator mapping.
Chubb D, Rozen WM, Whitaker IS, Ashton MW.
The Taylor Laboratory, Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Parkville, Victoria 3050, Australia.
Preoperative imaging to identify the location of individual perforators has been shown to improve operative outcomes, and while computed tomographic angiography (CTA) and magnetic resonance angiography are currently the most widely used modalities, these have substantial limitations. Such limitations include the need for intravenous access, the need for iodinated contrast media, radiation exposure with CTA, and long scanning times with magnetic resonance angiography. Complications from the use of contrast media are also noteworthy, and can include anaphylactoid reactions and renal toxicity. In a move to avoid these problems, we have recently introduced a technique that is readily available and easy to implement for preoperative imaging, and may show an accuracy that matches the more advanced imaging modalities. Thermal imaging is a readily performed technique, and can be undertaken by the reconstructive surgeon themselves at the initial consultation, enabling prompt operative planning, and avoiding the need for delays in imaging, confusion in the interpretation of a radiologist report, and the need for an intermediary radiologist altogether. In our experience thus far, the technique matches the accuracy for location of CTA, and a larger clinical trial of the technique is underway.
DIABETES Return to Health Categories Receive Updates
Diabetes Technol Ther. 2014 Apr 1.
Assessment of Signs of Foot Infection in Diabetes Patients Using Photographic Foot Imaging and Infrared Thermography
Hazenberg CE, van Netten JJ, van Baal Sg, Bus SA.
Abstract Background: Patients
with diabetic foot disease require frequent
screening to prevent complications and may be
helped through telemedical home monitoring.
Within this context, the goal was to determine
the validity and reliability of assessing
diabetic foot infection using photographic foot
imaging and infrared thermography.
Subjects and Methods: For 38 patients with
diabetes who presented with a foot infection or
were admitted to the hospital with a
foot-related complication, photographs of the
plantar foot surface using a photographic
imaging device and temperature data from six
plantar regions using an infrared thermometer
were obtained. A temperature difference between
feet of >2.2°C defined a "hotspot." Two
independent observers assessed each foot for
presence of foot infection, both live (using the
classification) and from photographs 2 and 4
weeks later (for presence of erythema and
ulcers). Agreement in diagnosis between live
assessment and (the combination of )
photographic assessment and temperature
recordings was calculated. Results: Diagnosis of
infection from photographs was specific
(>85%) but not very sensitive (<60%).
Diagnosis based on hotspots present was
sensitive (>90%) but not very specific
(<25%). Diagnosis based on the combination of
photographic and temperature assessments was
both sensitive (>60%) and specific (>79%).
Intra-observer agreement between photographic
assessments was good (Cohen's κ=0.77 and 0.52
for both observers). Conclusions: Diagnosis of
foot infection in patients with diabetes seems
valid and reliable using photographic imaging in
combination with infrared thermography.
This supports the intended use of these
modalities for the home monitoring of high-risk
patients with diabetes to facilitate early
diagnosis of signs of foot infection.
J. Diabetes Sci Technol. 2013 Sept 1;7(5):1122-9
Infrared thermal imaging for automated detection of diabetic foot complications.
van Netten JJ, van Baal JG, Liu C, van der Heijden F, Bus SA.
Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands
Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease. METHODS: The plantar foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had diffuse complications (e.g., Charcot foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole foot and for specified regions of interest (ROIs). RESULTS: No differences in mean temperature >1.5 °C between the ipsilateral and the contralateral foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral foot were similar, but temperature at the ROI was >2 °C higher compared with the corresponding region in the contralateral foot and to the mean of the whole ipsilateral foot. In patients with diffuse complications, mean temperature differences of >3 °C between ipsilateral and contralateral foot were found. CONCLUSIONS: With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or diffuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings.
of this study was to evaluate the possible
use of infrared thermography as a
supplementary method to the ankle-brachial
index used in assessing the treatment effect
of percutaneous transluminal angioplasty.
The study included 21 patients, mean age was
60.22 years. Healthy control group included
20 persons, mean age was 55.60 years.
Patients with symptomatic peripheral
arterial disease (Fontaine stages I-III)
were admitted for endovascular treatment by
percutaneous transluminal angioplasty.
Thermal images and ankle-brachial index
values were obtained before and after
treatment by percutaneous transluminal
angioplasty. Median temperature change in
the treated limb was 0.4℃, for non-treated
limb was -0.5℃. The median value of ankle-brachial
index in the treated limb increased by 0.17
from 0.81 after the procedure. The median
value of ankle-brachial index in the
non-treated limb decreased by 0.03 from the
value of 1.01. Significant difference
between treated limb and non-treated limb in
change of ankle-brachial index was found
with p value = .0035. The surface
temperature obtained by the infrared
thermography correlates with ankle-brachial
index. We present data showing that the
increase of ankle-brachial index is
associated with increase of skin temperature
in the case of limbs treated by percutaneous
transluminal angioplasty. Our
results also suggest potential of the use
of infrared thermography for monitoring
foot temperature as a means of early
detection of onset of foot ischemic
ed Phys. 012 Dec; 39(12):7224-31
Infrared thermal imaging as a novel evaluation method for deep vein thrombosis in lower limbs.
Deng F, TangQ, Zheng Y. Zeng G. Zhong N , State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China.
Purpose: Early detection of deep vein thrombosis
(DVT) is critical to prevent clinical pulmonary
thromboembolism. However, most conventional methods
for diagnosing DVT are functionally limited and
complicated. The aim of this study was to evaluate the
value of infrared-thermal-imaging
(IRTI), a novel imaging detection or screening
technique, in diagnosis of DVT in animal
models.Methods: DVT model of femoral veins was
established in nine New Zealand rabbits. The right
hind femoral vein was embolized and the contralateral
one served as a nonembolized control. Measurements of
IRTI, compression ultrasonography (CPUS), and
angiography under ultrasonic observation (AGUO) were
performed at three time points: T1 (baseline, 10 min
prior to surgery), T2 (2 h after thrombin injection),
and T3 (48 h postoperatively). Qualitative pseudocolor
analysis and quantitative temperature analysis were
performed based on mean area temperature (Tav) and
mean curvilinear temperature (Tca) of the region of
interest as shown in IRTI. Temperature differences
(TD) in Tav (TD(Tav)) and Tca (TD(Tca)) between the
DVT and control sides were computed. Comparative
statistical analysis was carried out by paired t-test
and repeated measure, while multiple comparisons were
performed by using Greenhouse-Geisser and Bonferroni
approach. Values of P < 0.05 and P < 0.01 were
considered statistically significant and highly
significant.Results: Modeling of DVT was successful in
all rabbits, as confirmed by CPUS and AGUO and
immediately detected by IRTI. IRTI qualitative
analysis of pseudocolor revealed that the bilateral
temperatures were apparently asymmetrical and that
there were abnormally high temperature zones on the
DVT side where thrombosis formed. The results of
paired t-test of Tav and Tca between DVT side and
control sides did not reveal statistical difference at
T1 (Tav: P = 0.817; Tca: P = 0.983) yet showed
statistical differences at both T2 (Tav: P = 0.023;
Tca: P = 0.021) and T3 (Tav: P = 0.016; Tca: P =
0.028). Results of repeated measure and multiple
comparisons of TD(Tav) and TD(Tca) were highly
different and significant differences across the T2
(TD(Tav): P = 0.009; TD(Tav): P = 0.03) and T3
(TD(Tav): P = 0.015; TD(Tav): P = 0.021).Conclusions:
IRTI temperature quantitative analysis may help
further detection of DVT. Additionally, IRTI could
serve as a novel detection and screening tool for DVT
due to its convenience, rapid response, and high
Expert Rev Med
Devices. 2010 Sep;7(5):711-8.
Pain 1995 Mar;60(3):295-302
Parameters of thick and thin nerve-fiber functions as predictors of pain in carpal tunnel syndrome.
Neundorfer B, Handwerker HO; Neurologische Klinik, Lang E, Claus D, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Germany. Pain intensity in carpal tunnel syndrome (CTS) was correlated with neuro- and psychophysiological parameters related to the function of different nerve fiber classes within the median nerve in 23 patients. Control data were obtained from 16 normal subjects. Mean intensity of all pain attacks which occurred 14 days before surgical treatment was assessed on visual analogue scales (average CTS pain). Functions of thick myelinated nerve fibers were determined by motor and sensory nerve conduction studies. Functions of thin myelinated and unmyelinated nerve fibers were evaluated by measuring thresholds of warmth, cold and heat pain on the index and little finger. Pain intensity and neurogenic vasodilatation following noxious mechano-stimulation on the interdigital web between index and middle finger provided additional information on the functioning of nociceptive nerve fibers. Sympathetic reflexes induced by these painful stimuli were assessed by means of infrared thermography and photoplethysmography. Mean intensity of pain attacks (40 +/- 19% VAS) correlated significantly with latency (r = 0.58, P < 0.01) and amplitude (r = -0.50, P < 0.01) of the compound action potential from abductor pollicis brevis muscle following distal median nerve stimulation. Thresholds of warmth, cold and heat pain on index finger were significantly increased during CTS when compared to the control subjects. The magnitude of neurogenic vasodilatation and sympathetic vasoconstrictor reflexes were not significantly different. Average CTS pain correlated inversely to the threshold of heat pain on index (r = -0.46, P < 0.05), but also on the little finger (r = -0.41, P < 0.05), which is not innervated by the median nerve.
Reliability and normal values for measuring the skin temperature of the hand with an infrared tympanic thermometer: a pilot study. Oerlemans HM, Graff MJ, Dijkstra-Hekkink JB, de Boo T, Goris RJ, Oostendorp RA; Allied Health Services, University Hospital Nijmegen, The Netherlands. Recording asymmetry in skin temperature between symmetric body areas is useful in monitoring diseases that alter skin temperature. This pilot study checked the reported high reliability of recording skin temperature of the hands with an infrared tympanic thermometer, provided insight into the relationship between dorsal and palmar temperature differences, and assessed the agreement between these data and normative data obtained from thermograms. Using an infrared tympanic thermometer, two independent assessors measured the temperature of 13 asymptomatic, right-handed subjects (mean age, 30 years; range, 21 to 44 years). Both test-retest and interobserver reliabilities were high. Skin temperature of the hand differed with the site where it was measured; differences between sites changed over time. The mean absolute differences in skin temperature between dorsal and palmar aspects of the hands were 0.30 degrees C and 0.25 degrees C, respectively. These data match normative values reported in the literature for infrared thermograms.
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Curr Eye Res. 2013 Nov 11.
Evaluation of Ocular Surface Temperature in Patients with Pterygium
Gonnermann J, Maier AK, Klein JP, Bertelmann E, Pleyer U, Klamann MK.
Abstract Purpose: To investigate ocular surface temperature in eyes with pterygium and dry eye disease. Methods: Eighteen eyes of 18 patients with pterygium (group 1), 18 eyes of 18 patients diagnosed with dry eye disease (group 2), and 22 eyes of 22 healthy subjects with no signs of dry eye (group 3), were included in this prospective study. Schirmer's test I and II, and tear film break up time (BUT) were evaluated. Infrared thermal imaging (Tomey TG 1000, Tomey Corp, Nagoya, Japan) was used to study the temperature of the ocular surface. All measurements were performed by one examiner only. Results: No significant difference in temperature course over ten seconds of eye opening was present between groups 1 and 2 (p = 0.551). However, a significant difference was present between groups 1 and 3 (p = 0.001) and between groups 2 and 3 (p = 0.003). Comparing group 1 and group 2, statistically significant differences in Schirmer's test I (p < 0.001) and II (p < 0.001) and BUT (p = 0.04) were present. There were also significant differences in Schirmer`s test I (p < 0.001) and II (p < 0.001) and BUT (p < 0.001) between group 2 and group 3. No significant difference in Schirmer's test I (p = 0.785) and II (p = 0.871) was present between group 1 and group 3. However, a statistically significant difference in BUT was noted (p < 0.001). Conclusion: During sustained eye opening, a significant decrease in corneal surface temperature occurred in eyes with pterygium and dry eye disease. Thermography, in addition to other investigations, might be used to objectively identify dry eye symptoms in patients with pterygium. In addition to cosmetic appearance, increasing astigmatism, and expanding growth towards the center of the cornea, this new supplementary data may help to determine the proper time for intervention.
Am J of Ophthalmol. 2006 Feb;141(2):322-326.
Thermal imaging study comparing phacoemulsification with the Sovereign with WhiteStar system to the Legacy with AdvanTec and NeoSoniX system.
Rose AD, Kanade V. Eye Care Group, Yale University School of Medicine, Yale University School of Nursing, New Haven, Connecticut 06510-2716, USA.
PURPOSE: To assess intraoperative thermal levels at the wound site during divide-and-conquer phacoemulsification with the Sovereign with WhiteStar (SWS) system or the Legacy with AdvanTec and NeoSoniX (LAD) system. DESIGN: Prospective, randomized, parallel-group, comparative study. METHODS: Twenty-six subjects from a private clinical practice underwent divide-and-conquer phacoemulsification with either the SWS system or the LAD system. CB/CF settings (60%/33% duty cycles) were utilized with SWS and 12 pulses per second with the LAD system. Key criteria assessed were peak wound-site temperature, mean temperature change at the wound site, effective phaco time, average phaco power, procedure time, amount of BSS used, and surgical complications. RESULTS: Mean temperature change at the wound site was greater for the LAD than the SWS group. There was a statistically significant difference (P=.0002) in mean peak wound temperatures, with the LAD group having higher mean peak temperatures (42.47+/-5.33 degrees C) than the SWS group (36.59+/-1.33 degrees C). Highest wound-site temperature was 51 degrees C for the LAD group and 39.3 degrees C for the SWS group. A statistically significant difference (P=.0031) in mean peak temperature was found between the LAD and SWS systems for subjects with a cataract density of 4: higher mean peak temperatures were observed for LAD patients with a cataract density of 4. CONCLUSIONS: Our findings show that phacoemulsification using the SWS system results in lower peak temperatures and less temperature change at the phaco wound site compared with the LAD system.
Physiol. Meas. 2006 Apr;27(4):371-84. Epub 2006 Mar 8.
Thermography used for analysis and comparison of different cataract surgery procedures based on phacoemulsification.
Corvi A, Innocenti B, Mencucci R. Dipartimento di Meccanica e Tecnologie Industriali-Universita degli Studi di Firenze, via di S. Marta 3, 50139 Firenze, Italy.
Thermography has been employed to analyze and compare three cataract surgery procedures performed in vivo with phacoemulsification, namely, the Sovereign phacoemulsification system with a traditional technique, the Sovereign WhiteStar phacoemulsification system with a traditional technique and the Sovereign WhiteStar phacoemulsification system with a bimanual technique. During the entire surgical procedure, the temperature of the ocular surface was monitored. The temperature values in the area where the phaco probe was inserted in the eye were measured, and the quantities of heat transmitted to the eye in the different procedures were assessed through suitable indices. In this study the highest temperature measured for each procedure during the surgical operation was 44.9 degrees C for the Sovereign phacoemulsification system with a traditional technique, 41 degrees C for the Sovereign WhiteStar phacoemulsification system with a traditional technique and 39.5 degrees C for the Sovereign WhiteStar phacoemulsification system with a bimanual technique, which is also the surgical procedure having the lowest thermal impact on the eye, i.e., the one in which the temperature peaks are lowest in amplitude and the least amount of heat is transmitted to the eye. Thermography, used in this study as a temperature monitoring instrument, has allowed analysis to be effected through a useful and advantageous methodology, totally non-invasive as regards both surgeon and patient, and has been applied in vivo without requiring any change in the surgical procedure.
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J Med Phys. 2014 Apr;39(2):98-105
Potential of thermal imaging as a tool for prediction of cardiovascular disease.
Thiruvengadam J, Anburajan M, Menaka M, Venkatraman B.
Vascular dysfunction is associated with onset of cardiovascular disease (CVD). Its effect is reflected as temperature change on the skin. The aim of this work was to test the potential of thermal imaging as cost effective screening tool for prediction of CVD. Thermal imaging of various parts of the subject (N = 80, male/female =44/36, aged 25-75 years) was done using noncontact infrared (IR) camera. In each subject, total cholesterol (TC; mg/dl) and high-density lipoprotein (HDL, mg/dl) were measured according to standard biochemical analysis. Based on National Cholesterol Education Program ATP III criteria, subject with known CVD (N = 16) and age- and sex- matched normal subjects (N = 21) were included in the study. The average surface temperature of various parts from head to toe was calculated and statistical analysis was performed between the groups. In the total population (N = 37), correlation study shows TC (mg/dl) was correlated with measured surface temperature of the following regions: Temporal left (r = -0.316) and right (r = -0.417), neck left (r = 0.347) and right (r = -0.410), and hand left (r = 0.387). HDL (mg/dl) was found to be correlated with measured surface temperature of the following regions: Temporal left (r = 0.445) and right (r = 0.458), hand left (r = -0.470), and foot anterior left (r = -0.332) and right (r = -0.336). Temperature asymmetry was more significant in upper extremity in CVD group. Using the surface temperature, regression models were calculated for noninvasive estimation of TC and HDL. The predictive ability of measured surface temperature for TC and HDL was 60%. The model for noninvasive estimation gave sensitivity and specificity value of 79 and 83% for TC and 78 and 81% for HDL, respectively. Thus, the surface temperature can be one of the screening tools for prediction of CVD. The limitation of the present study is also discussed under future work.
Herz. 2003 Sep;28(6):505-12.
Schmermund A, Rodermann J, Erbel R. Department of Cardiology, University Clinic Essen, Germany. Axel.
Arteriosclerosis is an inflammatory disease. Inflammatory processes play a role in the initiation of plaque development and the early stages of the disease as well as in complex plaques and complications such as intraarterial thrombosis. A method to detect inflammation in coronary arteries has the potential to characterize both local and systemic activation of arteriosclerotic plaque disease. It could help to define in more detail what constitutes a vulnerable plaque or vulnerable vessel and thus improve the prediction of acute coronary syndromes. Intracoronary thermography records a cardinal sign of inflammation. Heat is probably produced by (activated) macrophages. Experimental work has suggested that thermal heterogeneity is present in arteriosclerotic plaques and that increased temperature is found at the site of inflammatory cellular-macrophage-infiltration. Preliminary experience in patients undergoing coronary angiography has demonstrated that it is safe and feasible to perform intracoronary thermography using various systems. A graded relationship between thermal heterogeneity and clinical symptoms has been reported, with the greatest temperature elevation in acute myocardial infarction. Increases in thermal heterogeneity appeared to be associated with a comparably unfavorable long-term prognosis. Intracoronary thermography has the potential to provide insights into location and extent of inflammation as well as the prognostic consequences. Currently, this novel method and the underlying concepts are extensively evaluated.
Med Eng Phys 1998
Cardiovasc Intervent Radiol 1998
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J Obstet Gynecol Neonatal Nurs. 2013 Sep-Oct;42(5):562-74.
A pilot study to examine maturation of body temperature control in preterm infants.
Knobel RB, Levy J, Katz L, Guenther B, Holditch-Davis D.
OBJECTIVE: To test instrumentation and develop analytic models to use in a larger study to examine developmental trajectories of body temperature and peripheral perfusion from birth in extremely low-birth-weight (EBLW) infants. DESIGN: A case study design. SETTING: The study took place in a Level 4 neonatal intensive care unit (NICU) in North Carolina. PARTICIPANTS: Four ELBW infants, fewer than 29 weeks gestational age at birth. METHODS: Physiologic data were measured every minute for the first 5 days of life: peripheral perfusion using perfusion index by Masimo and body temperature using thermistors. Body temperature was also measured using infrared thermal imaging. Stimulation and care events were recorded over the first 5 days using video which was coded with Noldus Observer software. Novel analytical models using the state space approach to time-series analysis were developed to explore maturation of neural control over central and peripheral body temperature. RESULTS/CONCLUSION: Results from this pilot study confirmed the feasibility of using multiple instruments to measure temperature and perfusion in ELBW infants. This approach added rich data to our case study design and set a clinical context with which to interpret longitudinal physiological data.
Gynakol Geburtshilfliche Rundsch 2003;43(1):31-5
Infrared thermography in newborns: the first hour after birth.
Christidis I, Zotter H, Rosegger H, Engele H, Kurz R, Kerbl R. Department of Pediatrics, University of Graz, Austria.
"OBJECTIVE: It was the aim of this study to investigate the surface temperature in newborns within the first hour after delivery. Furthermore, the influence of different environmental conditions with regard to surface temperature was documented. METHODS: Body surface temperature was recorded under several environmental conditions by use of infrared thermography. 42 newborns, all delivered at term and with weight appropriate for date, were investigated under controlled conditions. RESULTS: The surface temperature immediately after birth shows a uniform picture of the whole body; however, it is significantly lower than the core temperature. Soon after birth, peripheral sites become cooler whereas a constant temperature is maintained at the trunk. Bathing in warm water again leads to a more even temperature profile. Radiant heaters and skin-to-skin contact with the mother are both effective methods to prevent heat loss in neonates. CONCLUSIONS: Infrared thermography is a simple and reliable tool for the measurement of skin temperature profiles in neonates. Without the need of direct skin contact, it may be helpful for optimizing environmental conditions at delivery suites and neonatal intensive-care units." Ref. S. Karger AG, Basel
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Eur J Pediatr. 2014 Sep 23.
Infrared thermography is useful for ruling out fractures in paediatric emergencies.
Sanchis-Sanchez E, Salvador-Palmer R, et al.
Department of Physical Therapy, Universitat de València, Valencia, Spain
Musculoskeletal injuries are a leading cause of paediatric injuries and emergency department visits in Western countries. Diagnosis usually involves radiography, but this exposes children without fractures to unnecessary ionising radiation. We explored whether infrared thermography could provide a viable alternative in trauma cases. We compared radiography and thermal images of 133 children who had been diagnosed with a trauma injury in the emergency unit of a Spanish hospital. As well as the thermal variables in the literature, we introduced a new quantifier variable, the size of the lesion. Decision tree models were built to assess the technique's accuracy in diagnosing whether a bone had been fractured or not. Infrared thermography had a sensitivity of 0.91, a specificity of 0.88 and a negative predictive value of 0.95. The new lesion size variable introduced appeared to be of main importance to the discriminatory power of the method. Conclusion: The high negative predictive value of infrared thermography suggests that it is a promising method for ruling out fractures.
Eur J Pediatr. 2007 Aug 30;
Infrared thermography: Experience from a decade of pediatric imaging.
Saxena AK, Willital GH.
Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, Graz, A-8036, Austria
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UROLOGY Return to Health Categories Receive Updates
J Urol. 2004 Oct; 172(4 Pt 1):1239-40
Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities.
Gat Y, Bachar GN, Zukerman Z, Belenky A, Gorenish M. Andrology Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
PURPOSE: We evaluated the sensitivity of 3 noninvasive methods for detecting left and right varicoceles. MATERIALS AND METHODS: Three noninvasive methods for the detection of varicocele in the left and right internal spermatic veins were evaluated in 214 infertile men, namely, physical examination, scrotal contact thermography and ultrasound Doppler. Venography was used as the reference diagnosis. RESULTS: Varicocele was detected in 195 patients (91.1%), on the left side in 37 (19%), on the right side in 3 (1.5%) and bilaterally in 155 (79.5%). Scrotal contact thermography using varicoscreen proved to be the most accurate method. Sensitivity, specificity, accuracy and positive predictive value were 98.9%, 66.6%, 98.5% and 100%, respectively, for left varicocele, and 95.6%, 91.6%, 94.9% and 98%, respectively, for right varicocele. Doppler sonography was associated with the highest number of false-positive results. Accuracy in evaluating retrograde flow was lowest for both sides for physical examination and highest for the combination of Doppler sonography and contact thermography, with a sensitivity, specificity, accuracy and positive predictive value of 100%, 33.3%, 99.0% and 98.9%, respectively, for the left side, and 97.4%, 58.3%, 90.3% and 91.1%, respectively, for the right side. In 165 (85%) of the 195 patients who underwent internal spermatic vein embolization sperm parameters were improved. CONCLUSIONS: The present study yielded 2 major findings. Thermography is more sensitive and accurate for the detection of varicocele than Doppler ultrasound and physical examination, and it can be used for screening as a single modality in infertile men. Doppler ultrasound and thermography are complementary and their combined use yields the highest sensitivity and accuracy.
Gat Y, Zukerman Z, Chakraborty J, Gornish M
Andrology Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Israel.
BACKGROUND: Varicocele is a bilateral vascular disease, involving a network of collaterals and small, retroperitoneal bypasses. ... It was considered a predominantly unilateral (left-sided) disease. Its pathophysiology has not been clearly delineated and the treatments offered do not seem to be effective. ... Based on our findings (i) varicocele is a bilateral disease; (ii) the disease is expressed earlier in the left side and is more intense because the blood column is longer in the left side than the right; (iii) partial treatment to the left side only and ignoring bypasses is not adequate to correct the problem; ... (vi) thermography alone or combined with ultrasonography with special attention to the bilaterality of the disease are the best non-invasive tools for its detection.
Curr Opin Urol 2002 Mar;12(2):149-53
Watanabe Y. Department of Radiology, Kurashiki Central Hospital, Kurashiki, Japan. Color Doppler ultrasound has been the mainstay for the evaluation of the scrotum in a variety of clinical settings. However, ultrasonography results are not always accurate or conclusive. Despite the high cost and limited availability, magnetic resonance imaging with the dynamic contrast-enhanced subtraction technique provides accurate information on morphology as well as blood flow. Infrared scrotal thermography increases accuracy in the diagnosis of varicocele. This article attempts to summarize recent advances in scrotal imaging with regard to testicular and extratesticular disorders.
Reliability and repeatability of thermographic examination and the normal thermographic image of the thoracolumbar region in the horse.
Tunley BV, Henson FM; Queen's Veterinary School Hospital, Department of Clinical Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, Cambridgeshire CB3 0ES, UK.
REASONS FOR PERFORMING STUDY: Thermographic imaging is an increasingly used diagnostic tool. When performing thermography, guidelines suggest that horses should be left for 10-20 mins to 'acclimatise' to the thermographic imaging environment, with no experimental data to substantiate this recommendation. In addition, little objective work has been published on the repeatability and reliability of the data obtained. Thermography has been widely used to identify areas of abnormal body surface temperature in horses with back pathology; however, no normal data is available on the thermographic 'map' of the thoracolumbar region with which to compare horses with suspected pathology. OBJECTIVES: To i) investigate whether equilibration of the thermographic subject was required and, if so, how long it should take, ii) investigate what factors affect time to equilibration, iii) investigate the repeatability and reliability of the technique and iv) generate a topographic thermographic 'map' of the thoracolumbar region. METHODS: A total of 52 horses were used. The following investigations were undertaken: thermal imaging validation, i.e. detection of movement around the baseline of an object of constant temperature; factors affecting equilibration; pattern reproducibility during equilibration and over time (n = 25); and imaging of the thoracolumbar region (n = 27). RESULTS: A 1 degrees C change was detected in an object of stable temperature using this detection system, i.e the 'noise' in the system. The average time taken to equilibrate, ie. reach a plateau temperature, was 39 mins (40.2 in the gluteal region, 36.2 in lateral thoracic region and 40.4 in metacarpophalangeal region). Only 19% of horses reached plateau within 10-20 mins. Of the factors analysed hair length and difference between the external environment and the internal environment where the measurements were being taken both significantly affected time to plateau (P<0.05). However, during equilibration, the thermographic patterns obtained did not change, nor when assessed over a 7 day period. A 'normal' map of the surface temperature of the thoracolumbar region has been produced, demonstrating that the midline is the hottest, with a fall off of 3 degrees C either side of the midline. CONCLUSIONS: This study demonstrates that horses may not need time to equilibrate prior to taking thermographic images and that thermographic patterns are reproducible over periods up to 7 days. A topographical thermographic 'map' of the thoracolumbar region has been obtained. POTENTIAL RELEVANCE: Clinicians can obtain relevant thermographic images without the need for prior equilibration and can compare cases with thoracolumbar pathology to a normal topographic thermographic map.
J Dairy Sci. 2010 Aug;93(8):3525-32. doi: 10.3168/jds.2009-2807.
Sensitivity and specificity of infrared thermography in detection of subclinical mastitis in dairy cows.
Polat B, Colak A, Cengiz M, Yanmaz LE, Oral H, Bastan A, Kaya S, Hayirli A. Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Atatürk University, Erzurum 25240, Turkey.
objectives of this experiment were to determine
interrelationships among mastitis indicators and
evaluate the subclinical mastitis detection ability of
infrared thermography (IRT)
in comparison with the California Mastitis Test (CMT).
Somatic cell count (SCC), CMT, and udder skin surface
temperature (USST) data were compiled from 62 Brown
Swiss dairy cows (days in milk=117+/-51, milk
yield=14.7+/-5.2 kg; mean +/- SD). The CORR, REG, and
NLIN procedures of Statistical Analysis System (SAS
Institute Inc., Cary, NC) were employed to attain
interrelationships among mastitis indicators. The
diagnostic merit of IRT as an indirect measure of
subclinical mastitis was compared with CMT using the
receiver operating characteristics curves. The udder
skin surface temperature was positively correlated
with the CMT score (r=0.86) and SCC (r=0.73). There
was an exponential increase in SCC (SCC, x10(3)
cells/mL=22.35 x e(1.31 x CMT score); R(2)=0.98) and a
linear increase in USST (USST, degrees C=33.45+1.08 x
CMT score; R(2)=0.75) as the CMT score increased. As
SCC increased, USST increased logarithmically [USST,
degrees C=28.72+0.49 x ln(SCC, x10(3) cells/mL);
R(2)=0.72]. The USST for healthy quarters (SCC
<or=400,000 cells/mL; n=94) was different from that
for subclinical mastitic quarters (SCC >400,000
cells/mL; n=135) (mean +/- SE; 33.45+/-0.09 vs.
35.80+/-0.08 degrees C). The sensitivity, specificity,
positive likelihood ratio, negative likelihood ratio,
positive predictive value, and negative predictive
value were 95.6, 93.6, 14.97, 0.05, 95.0, and 93.6,
respectively, for IRT and 88.9, 98.9, 83.56, 0.11,
99.2, and 86.1, respectively, for CMT. The area under
the receiver operating characteristics curve for IRT
and CMT was not different. In conclusion, as a
noninvasive and quick tool, IRT can be employed for
screening subclinical mastitis via measuring USST,
with a high predictive diagnostic ability similar to
CMT when microbiological culturing is unavailable.
However, the reliability of IRT among cows with
different characteristics and those living under
various environmental conditions remains to be
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Infrared thermography for examination of skin temperature in the dorsal hand of office workers.
Gold JE, Cherniack M, Buchholz B. Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, MA 01854, Lowell, USA
Reduced blood flow may contribute to the pathophysiology of upper extremity musculoskeletal disorders (UEMSD), such as tendinitis and carpal tunnel syndrome. The study objective was to characterize potential differences in cutaneous temperature, among three groups of office workers assessed by dynamic thermography following a 9-min typing challenge: those with UEMSD, with ( n=6) or without ( n=10) cold hands exacerbated by keyboard use, and control subjects ( n=12). Temperature images of the metacarpal region of the dorsal hand were obtained 1 min before typing, and during three 2-min sample periods [0-2 min (early), 3-5 min (middle), and 8-10 min (late)] after typing. Mean temperature increased from baseline levels immediately after typing by a similar magnitude, 0.7 (0.3) degrees C in controls and 0.6 (0.2) degrees C in UEMSD cases without cold hands, but only by 0.1 (0.3) degrees C in those with cold hands. Using paired t-tests for within group comparisons of mean dorsal temperature between successive imaging periods, three patterns of temperature change were apparent during 10 min following typing. Controls further increased mean temperature by 0.1 degrees C ( t-test, P=0.001) at 3-5 min post-typing before a late temperature decline of -0.3 degrees C ( t-test, P=0.04), while cases without cold hands showed no change from initial post-typing mean temperature rise during middle or late periods. In contrast, subjects with keyboard-induced cold hands had no change from initial post-typing temperature until a decrease at the late period of -0.3 degrees C ( t-test, P=0.06). Infrared thermography appears to distinguish between the three groups of subjects, with keyboard-induced cold hand symptoms presumably due, at least partially, to reduced blood flow.
Vascular surgical society of great britain and ireland: analysis of cold provocation thermography in the objective diagnosis of the hand-arm vibration syndrome.
Coughlin P, Chetter IC, Kent PJ, Kester RC; St James's University Hospital, Leeds, UK.
BACKGROUND: The hand-arm vibration syndrome (HAVS) is the commonest prescribed disease in the UK. Presently the diagnosis is subjective and the need for an objective investigation to support the diagnosis has been highlighted. This study analyses the potential of cold provocation thermography (CPT) to fulfil this role. METHODS: CPT was performed in ten controls (five men, five women; median age 35 (range 24-78) years) and 21 patients with HAVS (20 men, one woman; median age 45 (range 29-81) years). With an infrared camera, a precooling (PC) image was taken and then, following hand cooling in water at a temperature of 5 degrees C for 1 min, further rewarming images were taken every minute for 10 min. RESULTS: Patient finger tip temperatures were significantly cooler than control temperatures at all time points (P < 0.01, Student's t test). The following Table shows the sensitivity, specificity and PPV of CPT. CONCLUSION: CPT provides strong objective evidence to support the clinical diagnosis of HAVS.
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functional analysis of deception detection of a mock
crime using infrared thermal imaging
and the Concealed Information Test.
The purpose of this study was to utilize
thermal imaging and the Concealed Information
Test to detect deception in participants who
committed a mock crime. A functional analysis
using a functional ANOVA and a functional
discriminant analysis was conducted to
decrease the variation in the physiological
data collected through the thermal imaging
camera. Participants chose between a non-crime
mission (Innocent Condition: IC), or a mock
crime (Guilty Condition: GC) of stealing a
wallet in a computer lab. Temperature in the
periorbital region of the face was measured
while questioning participants regarding mock
crime details. Results revealed that the GC
showed significantly higher temperatures when
responding to crime relevant items compared to
irrelevant items, while the IC did not. The
functional ANOVA supported the initial results
that facial temperatures of the GC elevated
when responding to crime relevant items,
demonstrating an interaction between group
(guilty/innocent) and relevance
(relevant/irrelevant). The functional
discriminant analysis revealed that answering
crime relevant items can be used to
discriminate guilty from innocent
participants. These results suggest that
measuring facial temperatures in the
periorbital region while conducting the
Concealed Information Test is able to
differentiate the GC from the IC.
J Surg Res. 2012 Dec;178(2):539-44
Real-time infrared thermography for ureter detection during hysterectomy.
Angioli R, Terranova C, Plotti F, Montera R, Damiani P, Scaletta G, Portuesi A, Bonanni A, Tombolini L, Novelli L.Department of Obstetrics and Gynaecology, Campus Bio Medico, University of Rome, Rome, Italy
BACKGROUND: Recognition of different anatomic structures might be difficult in the presence of diseases such as neoplasm or endometriosis that can subvert the anatomy. This can be a challenge for young surgeons approaching gynecologic surgery. The aim of the present study was to evaluate the effectiveness of infrared thermocamera to identify the anatomic structures in gynecologic surgery. MATERIALS AND METHODS: From February 2010 to May 2011, consecutive patients who required abdominal hysterectomy were considered for eligibility. During a procedure for benign disease, we evaluated the temperature difference between the ureter and infundibulopelvic vessel (experiment A). In patients with gynecologic cancer, the thermal gradient was determined between the iliac vessels and the ureter (experiment B). RESULTS: The data from 21 patients were recorded, 12 for experiment A and 9 for experiment B. We found a statistically significant difference between the ureter and vessels in both experiments (31.675°C ± 0.673°C for the ureter and 33.332°C ± 0.828°C for the infundibulopelvic vessel, P < 0.0001; 31.706°C ± 0.751°C for the ureter, 33.787°C ± 0.63°C for the iliac vein, and 33.784°C ± 0.639°C for the iliac artery, P < 0.0001). CONCLUSIONS: Infrared imaging allowed us to identify the anatomic structures in laparotomy, providing preliminary data for its application in laparoscopy.
Infrared thermography as an access pathway for individuals with severe motor impairments.
Memarian N, Venetsanopoulos AN, Chau T.
Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
Fujita K, Noguchi M, Yuzuriha S, Yanagisawa D, Matsuo K.
and Objective. The Nuss procedure is widely
used in the treatment of pectus excavatum
worldwide. Postoperative pectus bar
infection is one of the most serious
complications associated with this
procedure. Therefore, early detection of
signs of implant infection is very
important. However, this is difficult, and
effective methods have yet to be
established. Methods. We use a handheld
infrared thermal imaging camera to screen
patients for postoperative infection
following the Nuss procedure. Here, we
report a 28-year-old man with recurrent
postoperative (Ravitch procedure) pectus
excavatum. Results. Infrared thermography
camera clearly indicated slight cellulitis
in the right chest. Conclusion. Our
technique may assist in preventing
postoperative bar infection and removal
caused by severe bar infection. Furthermore,
this camera is potentially suitable for many
situations in infection monitoring following
subcutaneous implant surgery.
Int J Occup Saf
Dis Colon Rectum 2000
We have developed a high-definition thermal-imaging technique that can detect attempted deceit by recording the thermal patterns from people's faces. This technique has an accuracy comparable to that of polygraph examination by experts and has potential for application in remote and rapid security screening, without the need for skilled staff or physical contact.
Anesth. Analg. 2006 Feb;102(2):598-604.
Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks.
Galvin EM, Niehof S, Medina HJ, Zijlstra FJ, van Bommel J, Klein J, Verbrugge SJ. Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
We designed this study to evaluate the usefulness of thermographic temperature measurement with an infrared camera, compared with patient response to cold and pinprick, as a means of assessing the success or failure of axillary blockades. Axillary blocks were performed on 25 patients undergoing surgery on the hand or forearm using a nerve stimulator technique with mepivacaine 1.5%. Pinprick and cold sensation were assessed on the operative site at 5-min intervals for 30 min. A thermographic image of the operative limb was recorded at similar time intervals. Thermographic images of the unblocked limb were taken before block placement and at 30 min. Temperature values at the operative site and unblocked limb were calculated from the thermographic images. Results revealed that thermography had higher combined values for sensitivity, specificity, and positive and negative predictive values than both cold and pinprick at all time intervals, with statistically significant differences at 15 min (thermography versus cold, P = 0.006; thermography versus pinprick, P = 0.026) and 30 min (thermography versus cold, P = 0.038; thermography versus pinprick, P = 0.040). For thermography as a method of block assessment, an optimal time of 15 min after mepivacaine local anesthetic injection gives the highest combined values for predicting a successful block (P = 0.004). We conclude that thermography provides an early and objective assessment of the success and failure of axillary regional blockades.
Nature. 2002 Jan 3;415(6867):35.
Med Biol Eng Comput 2000
Presymptomatic visualization of plant-virus interactions by thermography. Chaerle L, Van Caeneghem W, Messens E, Lambers H, Van Montagu M, Van Der Straeten D; Laboratorium voor Genetica, Departement Plantengenetica, Vlaams Interuniversitair Instituut voor Biotechnologie, Universiteit Gent, K.L. Ledeganckstraat 35, B-9000 Gent, Belgium. Salicylic acid (SA), produced by plants as a signal in defense against induces metabolic heating mediated by alternative respiration in flowers of thermogenic plants, and, when exogenously applied, increases leaf temperature in nonthermogenic plants. We have postulated that the latter phenomenon would be detectable when SA is synthesized locally in plant leaves. Here, resistance to tobacco mosaic virus (TMV) was monitored thermographically before any disease symptoms became visible on tobacco leaves. Spots of elevated temperature that were confined to the place of infection increased in intensity from 8 h before the onset of visible cell death, and remained detectable as a halo around the ongoing necrosis. Salicylic acid accumulates during the prenecrotic phase in TMV-infected tobacco and is known to induce stomatal closure in certain species. We show that the time course of SA accumulation correlates with the evolution of both localized thermal effect and stomatal closure. Since the contribution of leaf respiration is marginal, we concluded that the thermal effect results predominantly from localized, SA-induced stomatal closure. The presymptomatic temperature increase could be of general significance in incompatible plant-pathogen interactions.
Laryngorhinootologie 1998 Dec;77(12):677-81
[Thermographic study of temperature gradient during ear surgery intervention].[Article in German] Pau HW, Fichelmann J, Wild W; HNO-Universitatsklinik und Poliklinik Rostock. BACKGROUND: During middle ear surgery manipulations like burring, cooling with water, suction or even screwing cause changes of temperature which should be known to the surgeon. METHOD: An infrared thermovision device was introduced for registration. RESULTS: Thermography is an easy way for continuously recording thermic effects during surgery. If sufficient cooling is guaranteed, no temperatures high enough to cause tissue damage or functional defects could be observed. CONCLUSIONS: Adequate cooling provided, thermal injuries during ear surgery can be neglected. Thermography is an easy method for answering such questions, not only in ear surgery but also in other medical fields.
Ginekol Pol 1998 Dec;69(12):1268-72
[Infrared thermographic imaging of normal vulva and
uterine cervix: a preliminary report].
[Article in Polish] Sikorski R, Smaga A, Paszkowski T, Walczak R; Kliniki Ginekologii II Katedry Poloznictwa i Chorob Kobiecych Wydzialu Lekarskiego AM w Lublinie. OBJECTIVES: To evaluate in the standardized conditions the thermal emission by normal uterine cervix and vulva. MATERIALS AND METHODS: Infrared telethermography (ITT) was used to examine vulva and uterine cervix in 32 women aged 24-54 years without colposcopic and cytologic abnormalities. RESULTS: The measured temperatures differed between different topographic points of vulva and uterine vaginal portio. The inter-individual variability of temperatures determined at the same vulvar structures was relatively low. CONCLUSION: The obtained results constitute a basis for further studies on thermovisual definition of therapeutic targets in cases of vulvar and cervical lesions.
Following the severe acute respiratory syndrome (SARS) outbreak, remote-sensing infrared thermography (IRT) has been advocated as a possible means of screening for fever in travelers at airports and border crossings, but its applicability has not been established. We therefore set out to evaluate (1) the feasibility of IRT imaging to identify subjects with fever, and (2) the optimal instrumental configuration and validity for such testing. CONCLUSIONS: IRT readings from the side of the face, especially from the ear at 0.5 m, yielded the most reliable, precise and consistent estimates of conventionally determined body temperatures. Our results have important implications for walk-through IRT scanning/screening systems at airports and border crossings, particularly as the point prevalence of fever in such subjects would be very low.
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