Thermology Teletherm infrared imaging
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Research Studies of Interest in Thermology

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Acupuncture research
                                  with infrared thermal imaging Use of thermal imaging for
                                  allergy research Arthritis studies with thermal
                                  imaging Brain research using thermal
                                  imaging technology Breast health research with
                                    infrared thermal imaging
Infrared thermal imaging for
                                    assessing burn depth
Dental research with infrared
                                    imaging Diabetes research with thermal
                                    imaging Extremities, legs, hands,
                                      feet infrared studies Eye research with infrared
                                      thermal imaging
Heart and cardiovascular
                                      research with thermal imaging Neonatal research with
                                      infrared thermal imaging Pediatric studies with infrared
                                    thermal imaging Sleep studies & research
                                      with infrared thermal imaging Smoking research with thermal
Spinal Studies with infrared
                                      thermal imaging Urological studies with
                                      infrared thermal imaging Veterinary and equine thermal
                                    imaging research studies Work related research
                                      evaluation with thermal imaging Other research studies
                                      conducted with infrared thermal


Historical profile study using earlier model Teletherm infrared camera.

the non-invasive advantage of thermal imaging.

cover of magazine with
                                          expectant mother
Biomed Instrum Technol. 1996 Nov-Dec;30(6):526-30.

Application of telethermography in the evaluation of preterm premature rupture of the fetal membranes.

Sheinberg M, Hayashi R, Bromley J, Dormer L.; Department of Obstetrics and Gynecology, University of Michigan Hospitals, Ann Arbor, USA

The development of chorioamnionitis is a serious complication associated with preterm premature rupture of the fetal membranes (PPROM). There is no reliable early indicator of this infection. The objective of this study was to determine the sensitivity of telethermography (TTG) in the detection of subclinical chorioamnionitis in women with PPROM. Fourteen pregnant women with PPROM between 23 and 34 weeks' gestation were the subjects of the study. Serial frontal-abdominal TTG scans were obtained up to the time of delivery using the MARK-1026 telethermography imager. Following delivery, placental cultures and pathology results were obtained and infant sepsis evaluation was performed. Images were analyzed for temperature differences between umbilical, inguinal, four-quadrant average, and abdominal-wall hot spots. Data were compared with norms obtained from 12 pregnant women with intact membranes who served as gestational age-matched controls. Of five patients with pathology-proven chorioamnionitis and TTG scans within three days of delivery, four demonstrated significant increases in temperature differences between umbilical and abdominal-wall hot spots versus inguinal and four-quadrant averages (z-scores > or = 2.0). All three patients with negative pathology and cultures as well as scans within three days of delivery showed no increase in temperature differences of the above variables. No patient had any overt clinical sign of chorioamnionitis. This limited but consistent evidence demonstrates that telethermography is a sensitive, noninvasive diagnostic method for detecting subclinical chorioamnionitis in pregnant women with preterm rupture of the fetal membranes.



 Over 6,000
 published papers
 in the medical literature

 on medical thermal imaging


    Specialty groups 
    using this technology:
    Biomedical Engineering,
    Sports Medicine,
    Pain Management,
    Plastic Surgery,
    Internal Medicine,
    Rehabilitation Medicine,
    Neuro Surgery,
    Cardiothoracic Surgery,
    Alternative & Integrated

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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 Cosmet Dermatol. 2022 Mar;21(3):895-904.
Evaluation of skin using infrared thermal imaging for dermatology and aesthetic applications
Mariane Massufero Vergilio  1 , Guilherme Gomes  2   3 , Laura Moretti Aiello  4 , Monique Fontana  4 , Alexandre Aldred  3 , João Alberto de Souza Ribeiro  5 , Tatiana Villas Boas Gabbi  6 , Gislaine Ricci Leonardi  1   4  Affiliations 1Graduate Program in Internal Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.2 Department of Physics and Interdisciplinary Science, University of São Paulo (IFSC-USP), São Carlos, SP, Brazil.3 Predikta Soluções em Pesquisa, São Paulo, SP, Brazil.4 School of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil. 5 Termodiagnose Institute, Itu, SP, Brazil.6 Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina (HC - FMUSP), University of São Paulo, São Paulo, SP, Brazil.

Introduction: The use of thermography in the medical field has been experiencing a renaissance due to advances in the infrared thermographic imaging technology, which improves thermographic equipment and promises cost saving and increased safety. Dermatology is one of the most promising fields of application among the medical areas with potential for the use of thermography.

Objective: To review the findings on this subject and to describe the use of such technique for dermatology and aesthetic applications.

Methods: A bibliographic survey was carried out, selecting relevant publications and guidelines, focused on monitoring medical diagnostic applications and benefits of thermography for dermatology, inflammatory skin diseases, and aesthetic applications.

Results: Inflammatory skin diseases lead to changes of the IRT image. A quantification of treatment effects and monitoring changes on skin can be possible by repeated measurements over time.

Conclusion: Infrared imaging is a noninvasive, powerful tool in the diagnosis and clinical management of skin conditions and monitoring of aesthetic procedures.

Sci Rep. 2022 Feb 16;12(1):2648.
Thermography based skin allergic reaction recognition by convolutional neural networks
Łukasz Neumann  1 , Robert Nowak  2 , Jacek Stępień  3 , Ewelina Chmielewska  2 , Patryk Pankiewicz  2 , Radosław Solan  3 , Karina Jahnz-Różyk  4 Affiliations 1 Institute of Computer Science, Warsaw University of Technology, ul. Nowowiejska 15/19, 00-665, Warsaw, Poland.  2  Institute of Computer Science, Warsaw University of Technology, ul. Nowowiejska 15/19, 00-665, Warsaw, Poland. 3  Milton Essex S.A., ul. J. P. Woronicza 31/348, 02-640, Warsaw, Poland. 4 Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw, Poland.

In this work we present an automated approach to allergy recognition based on neural networks. Allergic reaction classification is an important task in modern medicine. Currently it is done by humans, which has obvious drawbacks, such as subjectivity in the process. We propose an automated method to classify prick allergic reactions using correlated visible-spectrum and thermal images of a patient's forearm. We test our model on a real-life dataset of 100 patients (1584 separate allergen injections). Our solution yields good results-0.98 ROC AUC; 0.97 AP; 93.6% accuracy. Additionally, we present a method to segment separate allergen injection areas from the image of the patient's forearm (multiple injections per forearm). The proposed approach can possibly reduce the time of an examination, while taking into consideration more information than possible by human staff.

Allergy. 2007 Jul;62(7):744-9
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.

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J Therm Biol. 2022 Feb;104:103172.
Clinical applicability of infrared thermography in rheumatic diseases: A systematic review
Joaquim H L Branco  1 , Ruy L L Branco  1 , Thais C Siqueira  1 , Loiane C de Souza  1 , Keyla M S Dalago  1 , Alexandro Andrade  2  Affiliations 1 Laboratory of Sport and Exercise Psychology (Lape) of the Santa Catarina State University (UDESC), Florianópolis, Brazil; Postgraduate Program in Human Movement Science (PPGCMH/UDESC), Brazil.2  Laboratory of Sport and Exercise Psychology (Lape) of the Santa Catarina State University (UDESC), Florianópolis, Brazil; Postgraduate Program in Human Movement Science (PPGCMH/UDESC), Brazil; Santa Catarina State University (UDESC) - Florianópolis (SC), Brazil.

Rheumatic Diseases (RD) are a class of disorders of the musculoskeletal system, including different conditions, and are considered a major cause of disability among the population. RD do not have an objective and quick diagnosis and are sometimes challenging. In this way, Infrared Thermography (IT) could represent a fast and effective tool to detect essential information for diagnosing RD. Thus, the aim of this systematic review was to summarize and describe the clinical applicability of IT in RD. This innovative systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) (CRD42020214601). The risk of bias assessment was performed using the Cochrane tool. The PubMed, EMBASE, Science Direct, Web of Science, CINAHL, and SciELO databases were searched from their inception to June 2021. In total, 476 studies were identified and 12 studies met the inclusion criteria. The main RD analyzed were Raynaud's Phenomenon (RP), Scleroderma, Osteoarthritis (OA), Rheumatoid arthritis (RA), and localized juvenile scleroderma. The assessment protocols were similar in terms of acclimatization time, distance between the camera and the individual, temperature, and ambient humidity.
Evidence demonstrates that infrared thermography is an effective tool to assess the health status of individuals with rheumatic diseases, producing clinical information relevant to diagnosis and treatment.

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.

Ann Rheum Dis. 2005 Sep 8;
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.

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Ultrasound Med Biol. 2016 Feb 25
Brain Surface Heating After Exposure to Ultrasound: An Analysis Using Thermography.
Schneider ME, Lombardo P
Dept. of Medical Imaging and Radiation Sciences, School of Biomedical Science, Monash University, Victoria, Australia

Ultrasound is the imaging modality of choice to monitor brain pathologies in neonates after complicated deliveries. Animal studies have indicated that ultrasound may cause heating of brain tissues. To date, no study has explored brain surface heating by ultrasound during clinically relevant exposure. Hence, we investigated heating effects of B-mode and pulsed Doppler (PD) mode on ex vivo lamb brains using thermography. Five brains were scanned for 5 min in B-mode or for 3 min, 1 min, 30 s or 15 s in PD mode. Brain surface temperature was measured pre- and post-exposure using thermography. The highest mean temperature increase was recorded by B-mode (3.82 ± 0.43°C). All five PD exposure protocols were associated with surface temperature increases of 2.1-2.7°C. These outcomes highlight for the first time that B-mode ultrasound can contribute to brain surface heating during a routine cranial scan. Scan duration should be minimised whenever possible.

Brain, 2012 Dec;135(pt12):3676-86
Spatially defined modulation of skin temperature and hand ownership of both hands in patients with unilateral complex regional pain syndrome.
Moseley Gl, Gallace A, Iannetti GD.  Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, Australia.

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.

Neurosurgery. 2007 Apr;60(4 Suppl 2):362-5; 
Intraoperative application of thermography in extracranial-intracranial bypass surgery.
Okada Y, Kawamata T, Kawashima A, Hori T  Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. 

OBJECTIVE: The extracranial-intracranial bypass may have the potential to improve hemodynamic cerebral ischemia caused by occlusive diseases of the main cerebral arteries. Intraoperative confirmation of effective distribution of blood flow via the donor arteries to the involved region will assure a successful bypass surgery. METHODS: Infrared thermography was used to measure the temperature of the cortical surface at the operative field. Regional cerebral blood flow (rCBF) was measured with a laser Doppler flow meter. Changes in the cortical surface temperature before and after temporary occlusion of the bypass were compared with changes in rCBF values in the corresponding sites. RESULTS: Thermographic examination demonstrated a heterogeneous increase of cortical surface temperature caused by the blood flow via the extracranial-intracranial bypass and was closely related to rCBF changes. CONCLUSION:  Thermography is useful not only to demonstrate the distribution of blood flow through the extracranial-intracranial bypass but also to quantitatively evaluate the rCBF changes in the operative field.

J Neurosurg. 2004 Dec;101(6):960-9.
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.

APMIS, 1997 Oct; 105(10):801-805
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.

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Microsurgery. 2022 Jun 6.
Deep inferior epigastric perforator flap preoperative planning: A comparative analysis between dynamic infrared thermography, computerized tomography angiography, and hand-held Doppler
Regina Sonda  1 , Laura Pandis  1 , Franco Bassetto  1 , Paolo Marchica  1 , Francesco Messana  1 , Cesare Tiengo  1 , Anto Luigi Andres  2 , Tito Brambullo  1 , Vincenzo Vindigni  1.  Affiliations:1 Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua, Italy. 2 Radiology Unit, Department of Neuroscience, Padua University Hospital, Padua, Italy.

Introduction: Hand-held Doppler (HHD) sonography and computerized tomography angiography (CTA) are the common assessment tools for deep inferior epigastric perforator (DIEP) flap preoperative planning. CTA is considered the gold standard method for preoperative perforator mapping but necessitates contrast medium and X-ray exposure. Dynamic infrared thermography (DIRT) does not have these drawbacks and allows the detection of hot and cold spots on a given body area. Our study aimed to compare DIRT, HHD, and CTA in perforator mapping for breast reconstruction using DIEP flap.

Patients and methods: From March to September 2020, 12 consecutive patients scheduled for DIEP flap breast reconstruction were preoperatively investigated with HHD, CTA, and DIRT. The patients' mean age was 53 and the mean BMI was 29.23 kg/m2 . All the reconstructions were due to breast cancer. The results of preoperative perforator mapping on the lower abdomen were compared among the three techniques. All the evidence was compared to the intraoperative findings, during flap harvesting, to establish if the techniques were able to correctly locate the perforator.

Results: We detected 178 perforators intraoperatively, 178 with CTA, 178 with DIRT, and 125 with HHD. The latter revealed a lower number of perforator vessels for each patient (10.42 ± 3.58), compared with CTA (14.83 ± 3.04) and DIRT (14.83 ± 4.76). DIRT resulted superior to HHD (p < .05), while no statistically significant difference (p > .05) was found between DIRT and CTA. We calculated a mean sensitivity of 93.87% for CTA, 69.02% for HHD, and 92.06% for DIRT.

Conclusion: DIRT is a useful tool in the preoperative planning of DIEP flaps, as it provides information about the location of perforators and the hemodynamic properties of angiosomes. It is easy to use, and it does not involve ionizing radiation. DIRT could represent an innovative and promising implementation of CTA and HHD techniques for preoperative perforator mapping in DIEP breast reconstruction.

Int J Environ Res Public Health. 2022 Jun 4;19(11):6891.
Long-Term Skin Temperature Changes after Breast Cancer Radiotherapy
Agnieszka Baic  1 , Dominika Plaza  2 , Barbara Lange  3 , Łukasz Michalecki  4 , Agata Stanek  5 , Anna Kowalczyk  6 , Krzysztof Ślosarek  2 , Armand Cholewka  1. Affiliations: 1 Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty Street 1A, 41-500 Chorzów, Poland. 2  Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland. 3 IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland. 4 Department of Radiation Oncology, University Clinical Center, Medical University of Silesia, Ceglana Street 35, 40-514 Katowice, Poland.5 Clinical Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Poniatowskiego Steet 15, 40-055 Katowice, Poland. 6 Department of Physiotherapy, School of Health Sciences, Medical University of Silesia, Medyków Street 12, 40-752 Katowice, Poland.

The aim of the study was to use thermal imaging to evaluate long-term chest temperature changes in patients who had previously been treated with radiotherapy. The examination with a thermal imaging camera involved 144 women-48 of them were patients after RT, 48 were females before breast cancer radiotherapy and the last group of participants were 48 healthy women. All patients (before and after radiotherapy) were divided into women after mastectomy and those after conservative surgery. In addition, the first group of women, those who had received radiotherapy, were divided into three other groups: up to 1 year after RT, over 1 year and up to 5 years after RT and over 5 years after RT. Due to this, it was possible to compare the results and analyse the differences between the temperature in the healthy and treated breasts. The comparison of obtained temperature results showed that the area treated by ionizing radiation is characterized by a higher temperature even a few years after the finished treatment. It is worth mentioning that despite the fact that the difference was visible on the thermograms, the patients had no observable skin lesion or change in color at the treatment site. For the results of the study provided for the group of healthy patients, there were no significant differences observed between the average temperatures in the breasts. The use of thermal imaging in the evaluation of skin temperature changes after radiotherapy showed that the average temperature in the treated breast area can change even a long time after treatment.

Multimed Tools Appl. 2022;81(7):9331-9349

Screening of breast cancer from thermogram images by edge detection aided deep transfer learning model
Subhrajit Dey  1 , Rajarshi Roychoudhury  2 , Samir Malakar  3 , Ram Sarkar  2. Affiliations 1 Department of Electrical Engineering, Jadavpur University, Kolkata, India. 2 Department of Computer Science and Engineering, Jadavpur University, Kolkata, India.3
    Department of Computer Science, Asutosh College, Kolkata, India.

Breast cancer, the most common invasive cancer, causes deaths of thousands of women in the world every year. Early detection of the same is a remedy to lessen the death rate. Hence, screening of breast cancer in its early stage is utmost required. However, in the developing nations not many can afford the screening and detection procedures owing to its cost. Hence, an effective and less expensive way of detecting breast cancer is performed using thermography which, unlike other methods, can be used on women of various ages. To this end, we propose a computer aided breast cancer detection system that accepts thermal breast images to detect the same. Here, we use the pre-trained DenseNet121 model as a feature extractor to build a classifier for the said purpose. Before extracting features, we work on the original thermal breast images to get outputs using two edge detectors - Prewitt and Roberts. These two edge-maps along with the original image make the input to the DenseNet121 model as a 3-channel image. The thermal breast image dataset namely, Database for Mastology Research (DMR-IR) is used to evaluate performance of our model. We achieve the highest classification accuracy of 98.80% on the said database, which outperforms many state-of-the-art methods, thereby confirming the superiority of the proposed model. Source code of this work is available here:

Comput Biol Med. 2022 Feb;141:105027.
Breast cancer detection from thermal images using a Grunwald-Letnikov-aided Dragonfly algorithm-based deep feature selection method
Somnath Chatterjee  1 , Shreya Biswas  2 , Arindam Majee  3 , Shibaprasad Sen  4 , Diego Oliva  5 , Ram Sarkar  6. Affiliations1
    Future Institute of Engineering and Management, Kolkata, West Bengal, India. 2 Jadavpur University, Kolkata, West Bengal, India, Jadavpur University, Kolkata, West Bengal, India. 4 University of Engineering and Management, Kolkata, West Bengal, India.  5  Depto. de Ciencias Computacionales, Universidad de Guadalajara, CUCEI, Guadalajara, Mexico  6  Jadavpur University, Kolkata, West Bengal, India.  

Breast cancer is one of the deadliest diseases in women and its incidence is growing at an alarming rate. However, early detection of this disease can be life-saving. The rapid development of deep learning techniques has generated a great deal of interest in the medical imaging field. Researchers around the world are working on developing breast cancer detection methods using medical imaging. In the present work, we have proposed a two-stage model for breast cancer detection using thermographic images. Firstly, features are extracted from images using a deep learning model, called VGG16. To select the optimal subset of features, we use a meta-heuristic algorithm called the Dragonfly Algorithm (DA) in the second step. To improve the performance of the DA, a memory-based version of DA is proposed using the Grunwald-Letnikov (GL) method. The proposed two-stage framework has been evaluated on a publicly available standard dataset called DMR-IR. The proposed model efficiently filters out non-essential features and had 100% diagnostic accuracy on the standard dataset, with 82% fewer features compared to the VGG16 model.

J Healthc Eng. 2022 Feb 28;2022:4295221.
Detection of Breast Cancer from Five-View Thermal Images Using Convolutional Neural Networks
Mathew Jose Mammoottil  1 , Lloyd J Kulangara  1 , Anna Susan Cherian  1 , Prabu Mohandas  1 , Khairunnisa Hasikin  2   3 , Mufti Mahmud  4.Affiliations:  1 Intelligent Computing Lab, Department of Computer Science and Engineering, National Institute of Technology, Calicut, PO Box: 673601, Kerala, India. 2 Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Lembah Pantai 50603, Kuala Lumpur, Malaysia 3 Center of Image and Signal Processing (CISIP), Faculty of Engineering, Universiti Malaya, Lembah Pantai 50603, Kuala Lumpur, Malaysia. 4 Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK.

Breast cancer is one of the most common forms of cancer. Its aggressive nature coupled with high mortality rates makes this cancer life-threatening; hence early detection gives the patient a greater chance of survival. Currently, the preferred diagnosis method is mammography. However, mammography is expensive and exposes the patient to radiation. A cost-effective and less invasive method known as thermography is gaining popularity. Bearing this in mind, the work aims to initially create machine learning models based on convolutional neural networks using multiple thermal views of the breast to detect breast cancer using the Visual DMR dataset. The performances of these models are then verified with the clinical data. Findings indicate that the addition of clinical data decisions to the model helped increase its performance. After building and testing two models with different architectures, the model used the same architecture for all three views performed best. It performed with an accuracy of 85.4%, which increased to 93.8% after the clinical data decision was added. After the addition of clinical data decisions, the model was able to classify more patients correctly with a specificity of 96.7% and sensitivity of 88.9% when considering sick patients as the positive class. Currently, thermography is among the lesser-known diagnosis methods with only one public dataset. We hope our work will divert more attention to this area.

PLoS One. 2022 Jan 14;17(1):e0262349.
Deep learning model for fully automated breast cancer detection system from thermograms
Esraa A Mohamed  1 , Essam A Rashed  1   2 , Tarek Gaber  3   4 , Omar Karam  5  Affiliations 1  Department of Mathematics, Faculty of Science, Suez Canal University, Ismailia, Egypt. 2 Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan. 3 School of Science, Engineering and Environment University of Salford, Manchester, United Kingdom. 4 Faculty of Computers and Informatics, Suez Canal University, Ismailia, Egypt. 5 Faculty of Informatics and Computer Science, British University in Egypt (BUE), Cairo, Egypt.

Breast cancer is one of the most common diseases among women worldwide. It is considered one of the leading causes of death among women. Therefore, early detection is necessary to save lives. Thermography imaging is an effective diagnostic technique which is used for breast cancer detection with the help of infrared technology. In this paper, we propose a fully automatic breast cancer detection system. First, U-Net network is used to automatically extract and isolate the breast area from the rest of the body which behaves as noise during the breast cancer detection model. Second, we propose a two-class deep learning model, which is trained from scratch for the classification of normal and abnormal breast tissues from thermal images. Also, it is used to extract more characteristics from the dataset that is helpful in training the network and improve the efficiency of the classification process. The proposed system is evaluated using real data (A benchmark, database (DMR-IR)) and achieved accuracy = 99.33%, sensitivity = 100% and specificity = 98.67%. The proposed system is expected to be a helpful tool for physicians in clinical use.

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.
  • 1Department of Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India. 
  • 2Department of Obstetrics & Gynaecology, M.G.M. Medical College and M.Y. Hospital, Indore, India.
  • 3Department of Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India.
  • 4LASER & Biomedical Applications, RRCAT, Indore, India.

Background: Early screening plays a pivotal role in management of breast cancer. Given the socio-economic situation in India, there is a strong felt need for a screening tool which reaches the masses rather than waiting for the masses to reach tertiary centers to be screened. Digital infra-red thermal imaging (DITI) or breast thermography as a screening test offers this possibility and needs to be carefully assessed in Indian scenario.Methods: The study involved 1008 female patients of age 20-60 years that had not been diagnosed of cancer of breast earlier. All the subjects in this population were screened for both the breasts using DITI. Based on the measured temperature gradients (ΔT) in thermograms, the subjects were classified in one of the three groups, normal (ΔT ≤ 2.5), abnormal (ΔT > 2.5, <3) and potentially having breast cancer (ΔT ≥ 3). All those having (ΔT > 2.5) underwent triple assessment that consisted of clinical examination, radiological and histopathological examination. Those with normal thermograms were subjected to only clinical examination. Results: Forty nine female breasts had thermograms with temperature gradients exceeding 2.5 and were subjected to triple assessment. Forty one of these which had ΔT ≥ 3 were proven to be having cancer of breast and were offered suitable treatment. Eight thermograms had temperature gradients exceeding 2.5 but less than 3. Most of these were lactating mothers or had fibrocystic breast diseases. As a screening modality, DITI showed sensitivity of 97.6%, specificity of 99.17%, positive predictive value 83.67% and negative predictive value 99.89%. Conclusion: Based on the results of this study involving 1008 subjects for screening of breast cancer, thermography turns out to be a very useful tool for screening. Because it is non-contact, pain-free, radiation free and comparatively portable it can be used in as a proactive technique for detection of breast carcinoma.

Coll Antropol. 2013 Jun;37(2):583-8.

--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.

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Burn Care Res. 2015 Dec. 29
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.
he Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
The Burn Center, Department of Surgery, MedStar Washington Hospital Center, DC

Burn conversion is a contributor to morbidity that currently has no quantitative measurement system. Active dynamic thermography (ADT) has recently been characterized for the early assessment of burn wounds and resolves the three-dimensional structure of materials by heat transfer analysis. As conversion is a product of physiological changes in three-dimensional structure, with subsequent modification of heat transfer properties, the authors hypothesize that ADT can specifically identify the process of burn conversion and serve as an important tool for burn care. A heated comb was used to create four contact burns separated by three interspaces on bilateral flanks of 18 rats, resulting in 144 burns and 108 interspaces. Wounds were imaged by ADT and laser Doppler imaging (LDI) pre- and post-injury through hour 36, with a subset undergoing biopsy collection. Direct analysis of thermographic and perfusion data revealed an increasing difference between burns and interspaces by ADT with increasing injury severity (P < .05), while LDI characterized the opposite. Comparison of stasis zones to burns reveals the ability of ADT to distinguish these two regions in both intermediate and deep burns at every assessment (P < .05). In addition, when wounds are grouped as converting or not converting, ADT identifies by hour 12, wounds that will convert (P < .05). LDI identifies by hour 4 wounds that will not (P < .05). This study has demonstrated that ADT can directly identify burn wound conversion, while LDI can identify nonconverting wounds. Further advancement of ADT technology has the potential to guide real-time interventional techniques.

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

Digital infrared thermal imaging is used to assess noninvasively the severity of burn wounds in 13 pediatric patients. A delta-T (ΔT) parameter obtained by subtracting the temperature of a healthy contralateral region from the temperature of the burn wound is compared with the burn depth measured histopathologically. Thermal imaging results show that superficial dermal burns (IIa) show increased temperature compared with their contralateral healthy region, while deep dermal burns (IIb) show a lower temperature than their contralateral healthy region. This difference in temperature is statistically significant (p<0.0001) and provides a way of distinguishing deep dermal from superficial dermal burns. These results show that digital infrared thermal imaging could be used as a noninvasive procedure to assess burn wounds. An additional advantage of using thermal imaging, which can image a large skin surface area, is that it can be used to identify regions with different burn depths and estimate the size of the grafts needed for deep dermal burns.

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 determine burn depth. We have revisited the use of this technology in the assessment of burns and aim to establish if high resolution, real-time technology can be practically used in conjunction with clinical examination to determine burn depth. 11 patients with burns affecting upper and lower limbs and the anterior and posterior trunk were included in this study. Digital and thermal images were recorded at between 42 h and 5 days post burn. When compared to skin temperature, full thickness burns were significantly cooler (p<0.001), as were deep partial thickness burns (p<0.05). Superficial partial thickness burns were not significantly different in temperature than non-burnt skin (p>0.05). Typically, full thickness burns were 2.3°C cooler than non-burnt skin; deep partial thickness burns were 1.2°C cooler than non-burnt skin; whilst superficial burns were only 0.1°C cooler. Thermal imaging can correctly determine difference in burn depth. The thermal camera produces images of high resolution and is quick and easy to use.

Burns. 2007 Oct 4;
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.
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.

The aim of this paper is to determine the extent to which infrared (IR) thermal imaging may be used for skin burn depth evaluation. The analysis can be made on the basis of the development of a thermal model of the burned skin. Different methods such as the traditional clinical visual approach and the IR imaging modalities of static IR thermal imaging, active IR thermal imaging and active-dynamic IR thermal imaging (ADT) are analyzed from the point of view of skin burn depth diagnostics. In ADT, a new approach is proposed on the basis of parametric image synthesis. Calculation software is implemented for single-node and distributed systems. The properties of all the methods are verified in experiments using phantoms and subsequently in vivo with animals with a reference histopathological examination. The results indicate that it is possible to distinguish objectively and quantitatively burns which will heal spontaneously within three weeks of infliction and which should be treated conservatively from those which need surgery because they will not heal within this period.

Burns, 1996 Feb;22(1):26-28
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 May;34(5):507-11.
Recovery enhanced thermography (preapplication of ice followed by image of response) to localize cutaneous perforators. Conclusion: clinically, preoperative recovery-enhanced thermography is useful for the design of perforator-based flaps.

Burns, 1991 Apr;17(2):117-22.
Thermographic assessment of burns using a nonpermeable membrane as wound covering. Thermographic assessment of damage to skin blood vessels caused by thermal injury correlates with healing time of burn wounds. NOTE: clever technique of using PVC film (Saran Wrap or Glad Wrap) shown to abolish the artifacts of evaporative water loss from the wound without interfering with surface imaging.

Burns, 1993 Jun;19(3):187-91.
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.

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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.

Dentomaxillofac Radiol 1998 Mar;27(2):68-74 
Thermology and facial telethermography: Part II. Current and future clinical applications in dentistry.
Gratt BM, Anbar M Section of Oral Radiology, UCLA School of Dentistry 90095-1668, USA.
Selected clinical applications using thermal imaging as an aid in dentistry are reviewed. Facial skin temperature can easily be measured in a clinical setting, without direct skin contact, by monitoring the emitted infrared radiation. This is the basis of static area telethermography (SAT) and dynamic area telethermography (DAT). SAT has recently been shown to be of help to the dentist in (1) the diagnosis of chronic orofacial pain, (2) as a unique tool in assessment of TMJ disorders, (3) as an aid in assessment of inferior alveolar nerve deficit, and (4) as a promising research tool. DAT, recently made possible by advances in computing technology combined with advanced infrared sensor technology, extracts quantitative information about hemodynamic processes from hundreds to thousands of digital thermal images of the affected facial areas, measured and collected within less than 3 min. DAT has promise of offering a better insight into aberrations of the neuronal control of facial skin perfusion and aiding our understanding of the correlation between orofacial pain and facial thermal abnormalities. This promising new insight may help in the management of orofacial pain. 

DERMATOLOGY & Plastic Surgery
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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.

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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 Perfusion-Extent-Depth-Infection-Sensation 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.

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Vascular 2016 Mar 17
Infrared thermography as option for evaluating the treatment effect of percutaneous transluminal angioplasty by patients with peripheral arterial disease.
Staffa E, Bernard V et al.
Department of Surgery, Center for Vascular Disease, St. Anne’s Univ. Hospital, Masaryk University, Czech Republic

Aim 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 disorders.

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 sensitivity.

Expert Rev Med Devices. 2010 Sep;7(5):711-8.
An overview of temperature monitoring devices for early detection of diabetic foot disorders.
Roback K.
Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden.

Diabetic foot complications are associated with substantial costs and loss of quality of life. This article gives an overview of available and emerging devices for the monitoring of foot temperature as a means of early detection of foot disorders in diabetes. The aim is to describe the technologies and to summarize experiences from experimental use. Studies show that regular monitoring of foot temperature may limit the incidence of disabling conditions such as foot ulcers and lower-limb amputations. Infrared thermometry and liquid crystal thermography were identified as the leading technologies in use today. Both technologies are feasible for temperature monitoring of the feet and could be used as a complement to current practices for foot examinations in diabetes.

Deep Vein Thrombosis:
Proceedings - 19th International Conference - IEEE/EMBS Oct. 30-Nov. 2, 1997 Chicago, IL 
Is DVT Excluded by Normal Thermal Imaging? - An Outcome Study of 700 Cases.
Harding, J. Richard; Barnes, Kathryn M.; Department of Clinical Radiology, St Woolos Hospital, Glan Hafren NHS Trust, Newport, Gwent, U.K.
In view of the many advantages compared with venography or Doppler ultrasound, and the ability to avoid the necessity for over one third of these investigations, thermal imaging should be considered the initial investigation of choice in clinically suspected DVT, proceeding to venography or Doppler ultrasound only when thermal imaging is positive. There are risks and disadvantages to the most commonly utilised conventional tests for DVT, over one third of which examinations can be avoided by performing thermal imaging as the initial investigation, which excludes DVT when normal. This outcome study followed up patients with clinically suspected DVT who were not further investigated or treated following normal thermal imaging, and showed that no patients developed PE (pulmonary embolism) following normal thermography with no further investigation for DVT and withholding of anticoagulant therapy.

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.

J Hand Ther 1999 Oct-Dec;12(4):284-90
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. 
Intracoronary thermography. 
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.

South Med J. 2003 Nov;96(11):1142-7. 

Imaging of the vulnerable plaque: new modalities.
Bhatia V, Bhatia R, Dhindsa S, Dhindsa M.; Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY, USA. 
Atherosclerosis is currently considered to be an inflammatory and thus a systemic disease  affecting multiple arterial beds. Recent advances in intravascular imaging have shown multiple sites of atherosclerotic changes in coronary arterial wall. Traditionally, angiography has been used to detect and characterize atherosclerotic plaque in coronary arteries, but recently it has been found that plaques that are not significantly stenotic on angiography cause acute myocardial infarction. As a result, newer imaging and diagnostic modalities are required to predict which of the atherosclerotic plaque are prone to rupture and hence distinguish "stable" and "vulnerable" plaques. Intravascular ultrasound can identify multiple plaques that are not seen on coronary angiography. Thermography has shown much promise and is based on the concept that the inflammatory plaques are associated with increased temperature and can also identify "vulnerable patients." Of all these newer modalities, magnetic resonance imaging has shown the most promise in identification and characterization of vulnerable plaques. In this article, we review the newer coronary artery imaging modalities and discuss the limitations of traditional coronary angiography.

Med Eng Phys 1998 Sep;20(6):443-51 
Thermographic imaging in the beating heart: a method for
coronary flow estimation based on a heat transfer model.

Gordon N, Rispler S, Sideman S, Shofty R, Beyar R; Heart System Research Center, Department of Biomedical Engineering, Technion-IIT, Haifa, Israel. Intraoperative thermographic imaging in open-chest conditions can provide the surgeon with important qualitative information regarding coronary flow by utilizing heat transfer analysis following injection of cold saline into the aortic root. The heat transfer model is based on the assumption that the epicardial temperature changes are mainly due to convection of heat by the blood flow, which may, therefore, be estimated by measuring the temperature variations. Hearts of eight dogs were exposed and imaged by a thermographic camera. Flow in the left arterial descending (LAD) coronary branch was measured by a transit-time flowmeter. 20 ml of cold saline were injected into the aortic root (just after the aortic valve) and the epicardial temperature images were recorded at end-diastole, for 20-30 s. Different flow rates were achieved by 1 min occlusion of the LAD, which affected a reactive hyperemic response. The dynamics of the temperature in the arterial coronary tree was obtained by averaging the temperature over an edge-detected arterial segment for each frame. The heat transfer equation was curve-fitted, and the flow-dependent heat transfer index was correlated with the experimentally determined coronary flow (r = 0.69, p < 0.001). In summary: a method for quantitative estimation of coronary blood flow by thermography and heat transfer analysis was developed and tested in animal experiments. This method can provide important information regarding coronary blood flow during open-chest surgical procedures.

Cardiovasc Intervent Radiol 1998 Nov-Dec;21(6):481-6
Can rotational atherectomy cause thermal tissue damage? A study of the potential heating and thermal tissue effects of a rotational atherectomy device.
Gehani AA, Rees MR; Cardiac Research Unit, Killingbeck Hospital, Leeds, United Kingdom.
  PURPOSE: Thermal tissue damage (TTD) is customarily associated with some lasers. The thermal potential of rotational atherectomy (RA) devices is unknown. We investigated the temperature profile and potential TTD as well as the value of fluid flushing of an RA device. METHODS: We used a high-resolution infrared imaging system that can detect changes as small as 0.1 degree C to measure the temperature changes at the tip of a fast RA device with and without fluid flushing. To assess TTD, segments of porcine aorta were subjected to the rotating tip under controlled conditions, stained by a special histochemical stain (picrisirius red) and examined under normal and polarized light microscopy. RESULTS: There was significant heating of the rotating cam. The mean "peak" temperature rise was 52.8 +/- 16.9 degrees C. This was related to rotational speed; thus the "peak" temperature rise was 88.3 +/- 12.6 degrees C at 80,000 rpm and 17.3 +/- 3.8 degrees C at 20,000 rpm (p < 0.001, t-test). Fluid flushing at 18 ml/min reduced, but did not abolish, heating of the device (11.8 +/- 2.9 degrees C). A crater was observed in all segments exposed to the rotating tip. The following features were most notable: (i) A zone of "thermal" tissue damage extended radially from the crater reaching adventitia in some sections, especially at high speeds. This zone showed markedly reduced or absent birefringence. (ii) Fluid flushing of the catheter reduced the above changes but increased the incidence and extent of dissections in the media, especially when combined with high atherectomy speeds. (iii) These changes were observed in five of six specimens exposed to RA without flushing, but in only one of six with flushing (p < 0.05). (iv) None of the above changes was seen in control segments. CONCLUSION: RA is capable of generating significant heat and potential TTD. Fluid flushing reduced heating and TTD. These findings warrant further studies in vivo, and may influence the design of atherectomy devices.

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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

J Perinat Neonatal Nurs 2000 Mar;13(4):50-66

Neoteric physiologic and immunologic methods for assessing early-onset neonatal sepsis
Horns KM; College of Nursing, NBICU, University of Utah, Salt Lake City, USA.
Septicemia is a growing problem among low birth weight infants. Early identification and treatment of sepsis in these infants would help to reduce the high mortality and morbidity seen with this disorder. Newer techniques may make earlier diagnosis a reality. In the following review article, early-onset sepsis in the premature infant is described, specifically focusing on the neonatal inflammatory response, neutropenia, and its somewhat inconsistent and delayed role as a marker for sepsis risk factors. Physiological signs, laboratory indicators, skin temperature, peripheral perfusion, and the interaction of macro-environmental factors are also discussed. Newer (neoteric) immunologic and cytokine markers of sepsis are reviewed. Finally, thermography, a noninvasive bioinstrument measuring vasoactive peripheral perfusion, which has  potential for early recognition of neonatal septicemia, is described.

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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

The aim of this study was to evaluate the feasibility of clinical application of infrared thermography (IRT) in the pediatric population and to identify pathological states that can be diagnosed as well as followed up using this non-invasive technique. In real time computer-assisted IRT, 483 examinations were performed over a period of 10 years from 1990-2000 on 285 patients in the pediatric age group (range 1 week-16 years) presenting with a wide range of pathologies. The temperature was measured in centigrade ( degrees C), and color images obtained were computer analyzed and stored on floppy discs. IRT was found to be an excellent noninvasive tool in the follow-up of hemangiomas, vascular malformations and digit amputations related to reimplantation, burns as well as skin and vascular growth after biomaterial implants in newborns with gastroschisis and giant omphaloceles. In the emergency room, it was a valuable tool for rapid diagnosis of extremity thrombosis, varicoceles, inflammation, abscesses, gangrene and wound infections. In conclusion, IRT can be performed in the pediatric age group, is non-invasive, without any biological side effects, requires no sedation or anesthesia and can be repeated as desired for follow-ups, with objective results that can demonstrated as colored images. Periodic thermographic studies to follow progression of lesions seem to be a useful and reproducible method.

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Physiol Meas. 2003 Aug;24(3):717-25.

Comparison of digital infrared thermal imaging (DITI) with contact thermometry: pilot data from a sleep research laboratory.
van den Heuvel CJ, Ferguson SA, Dawson D, Gilbert SS.; The Centre for Sleep Research, University of South Australia, Level 5 Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
Body temperature regulation is associated with changes in sleep propensity; therefore, sleep research often necessitates concomitant assessment of core and skin surface temperatures. Attachment to thermistors may limit the range of movement and comfort, introducing a potential confound that may prolong sleep initiation or increase wakefulness after sleep onset. It has been suggested that contact thermometry may artificially increase temperatures due to insulation. We report here on a method of remote sensing skin temperatures using a digital infrared thermal imaging (DITI) system, which can reduce these potential confounds. Using data from four healthy young adult volunteers (age = 26.8 +/- 2.2 years; mean +/- SEM), we compared measures of skin temperature using a DITI system with contact thermometry methods already in use in our sleep laboratory. A total of 416 skin temperature measurements (T(sk)) were collected from various sites, resulting in an overall correlation coefficient of R = 0.99 (p < 0.0001) between both methods. Regression analyses for individuals resulted in correlation coefficients between 0.80 and 0.97. These pilot results suggest that DITI can assess skin surface temperatures as accurately as contact thermometry, provided the interest is in relative and not absolute temperature changes. This and some other important limitations are discussed in more detail hereafter.

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Diabetes Res Clin Pract 1998 Oct;42(1):29-34 
Peripheral vascular reactions to smoking--profound vasoconstriction by atherosclerosis. Fushimi H, Kubo M, Inoue T, Yamada Y, Matsuyama Y, Kameyama M; Department of Medicine, Sumitomo Hospital, Osaka, Japan. Analyses of direct effects of smoking on peripheral arteries were done using thermography, blood fluorometry and echography on 97 habitual smoker-diabetics without triopathy. There were found to be four types of thermographic changes following smoking, which varied according to the degree of atherosclerosis of the artery. The smoking-stimulated thermographic pattern in the control group of healthy volunteers was a small wavy pattern, fluctuating along the base line every few minutes within a temperature range of 1.0-1.5 degrees C (N type). In diabetics, four types of thermographic patterns were produced: normal (N) type as control, increasing (I) type (increasing in skin temperature), decreasing (D) type (decreasing in temperature), and F type (no changes in temperature). The most significant finding was the decreasing pattern which closely connected to clinical and echographic aspects of macroangiopathic changes. The increasing type was characterized by a paradoxical increase in temperature after smoking in order diabetics with good blood glucose control and who were less atherosclerotic. Blood flow was correlated to the skin temperature at the base state and changes after smoking. Moreover, blood flow changes measured by fluorometry suggest that vasoconstriction or vasodilatation following smoking took place. These results suggest that this smoking test might be a good tool for diagnosing for the degree of atherosclerosis and for its following up. 

Clin Physiol 1991 Mar;11(2):135-41 

Thermography and laser-Doppler flowmetry for monitoring changes in finger skin blood flow upon cigarette smoking. Bornmyr S, Svensson H.; Department of Clinical Physiology, Allmanna Sjukhuset, Malmo, Sweden. Haemodynamic changes after smoking two 1.1 mg nicotine cigarettes were monitored in 24 smokers on two different occasions. Smoking caused an increase in heart rate and arterial blood pressure, whereas finger temperature as measured by thermography and finger skin blood flow as measured by laser-Doppler flowmetry (LDF) decreased. Lowest values were seen within 15 min by LDF, and after 30 min by thermography. Changes in the two methods correlated closely, however, when maximum responses during a 45-min period after smoking were compared. The wider distribution of LDF values would seem to be due to the small measuring volume which is susceptible to differences in vascular anatomy and reactivity. In both methods, responses showed a high degree of reproducibility.

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Yonsei Med J 1999 Oct;40(5):401-12

Thermatomal changes in cervical disc herniations.
Zhang HY, Kim YS, Cho YE; Department of Neurosurgery, Yongdong Severance Hospital, Yonsei  College of Medicine, Seoul, Korea.

Subjective symptoms of a cool or warm sensation in the arm could be shown objectively by using of thermography with the detection of thermal change in the case of radiculopathy, including cervical disc herniation (CDH). However, the precise location of each thermal change at CDH has not been established in humans. This study used digital infrared thermographic imaging (DITI) for 50 controls and 115 CDH patients, analyzed the data statistically with t-test, and defined the areas of thermatomal change in CDH C3/4, C4/5, C5/6, C6/7 and C7/T1. The temperature of the upper trunk and upper extremities of the control group ranged from 29.8 degrees C to 32.8 degrees C. The minimal abnormal thermal difference in the right and left upper extremities ranged from 0.1 degree C  to 0.3 degree C in 99% confidence interval. If delta T was more than 0.1 degree C, the anterior middle shoulder sector was considered abnormal (p < 0.01). If delta T was more than 0.3 degree C, the medial upper aspect of the forearm and  dorsal aspect of the arm, some areas of the palm and anterior part of the fourth  finger, and their opposite side sectors and all dorsal aspects of fingers were considered abnormal (p < 0.01). Other areas except those mentioned above were considered abnormal if delta T was more than 0.2 degree C (p < 0.01). In p < 0.05, thermal change in CDH C3/4 included the posterior upper back and shoulder and the anterior shoulder. Thermal change in CDH C4/5 included the middle and lateral aspect of the triceps muscle, proximal radial region, the  posterior medial aspect of the forearm and distal lateral forearm. Thermal  change in CDH C5/6 included the anterior aspects of the thenar, thumb and second finger  and the anterior aspects of the radial region and posterior aspects of the pararadial  region. Thermal change in CDH C6/7 included the posterior aspect of the ulnar and palmar region and the anterior aspects of the ulnar region and some fingers.  Thermal change in CDH C7/T1 included the scapula and posterior medial aspect of the arm and the anterior medial aspect of the arm. The areas of thermal change in each CDH included wider sensory dermatome and sympathetic dermatome There was a statistically significant change of temperature in the areas of thermal change in all CDH patients. In conclusion, the areas of thermal change in CDH can  be helpful in diagnosing the level of disc protrusion and in detecting the  symptomatic level in multiple CDH patients.

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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.

Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system.
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
Scrotal imaging.
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.

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Equine Vet J. 2004 May;36(4):306-12.
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.

The 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 determined.

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Eur J Appl Physiol. 2004 Oct;93(1-2):245-51.
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.

Br J Surg 1999 May;86(5):694-5
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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A functional analysis of deception detection of a mock crime using infrared thermal imaging and the Concealed Information Test.
Park KK, Suk HW, Hwang H, Lee JH.
Clinical Neuro-pSychology Lab., Department of Psychology, Chung-Ang University Seoul, South Korea.

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

  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.

J Neuroeng Rehabil. 2009 Apr 16;6:11.
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.

People with severe motor impairments often require an alternative access pathway, such as a binary switch, to communicate and to interact with their environment. A wide range of access pathways have been developed from simple mechanical switches to sophisticated physiological ones. In this manuscript we report the inaugural investigation of infrared thermography as a non-invasive and non-contact access pathway by which individuals with disabilities can interact and perhaps eventually communicate.  METHODS:  Our method exploits the local temperature changes associated with mouth opening/closing to enable a highly sensitive and specific binary switch. Ten participants (two with severe disabilities) provided examples of mouth opening and closing. Thermographic videos of each participant were recorded with an infrared thermal camera and processed using a computerized algorithm. The algorithm detected a mouth open-close pattern using a combination of adaptive thermal intensity filtering, motion tracking and morphological analysis.  RESULTS:  High detection sensitivity and low error rate were achieved for the majority of the participants (mean sensitivity of all participants: 88.5% +/- 11.3; mean specificity of all participants: 99.4% +/- 0.7). The algorithm performance was robust against participant motion and changes in the background scene.  CONCLUSION: 
Our findings suggest that further research on the infrared thermographic access pathway is warranted. Flexible camera location, convenience of use and robustness to ambient lighting levels, changes in background scene and extraneous body movements make this a potential new access modality that can be used night or day in unconstrained environments.

Rhinology. 2009 Mar;47(1):89-92.

Dynamic infrared thermography of the nasal vestibules: a new method.
Kastl KG, Wiesmiller KM, Lindemann J.
Department of Otorhinolaryngology, University of Ulm, Ulm, Germany. 
The surface temperature distribution within the nasal vestibule and the nasal cavity strongly depends on the exact intranasal detection site and point of time during the respiratory cycle. Therefore, conventional temperature measurements e.g. with thermocouples only provide selective measurements. The use of infrared thermography cameras could present a new contactless method with a high spatiotemporal resolution. The aim of the present study was to evaluate the use of infrared thermography camera systems for measurements of the nasal surface temperature during respiration.  METHODS:  The surface temperature profiles within the nasal vestibules of healthy volunteers were recorded with infrared thermography cameras during several breathing cycles. Two different types of infrared thermography standard systems were used.  RESULTS:  The recordings allowed a display of temperature alterations within the nasal vestibules in a high spatiotemporal resolution synchronous to the breathing cycle. During inspiration, the vestibular surface cooled down presenting a non-homogenous distribution (range, 24.7 to 30.2 degrees C). During expiration, the vestibular surface was warmed again with a non-homogenous distribution (range, 33.1 to 36.2 degrees C). The results of both camera systems were comparable.  CONCLUSION:  Infrared thermography cameras allow the exact mapping of nasal surface temperature within the nasal vestibules with a high spatiotemporal resolution without surface contact.

Int J Cancer. 2007 May 8; 
Thermographic assessment of tumor growth in mouse xenografts. 
Song C, Appleyard V, Murray K, Frank T, Sibbett W, Cuschieri A, Thompson A. Department of Surgery and Molecular Oncology, University of Dundee, Scotland. "...Here we tested the hypothesis that thermal imaging might represent a useful adjunctive technique in monitoring the growth dynamics of human tumor xenografts....In one case, a smaller secondary tumor, otherwise undetectable, was clearly evident by thermal imaging. The tumors were cooler than the surrounding tissue with a maximum temperature reduction of 1.5 degrees C for MDA-MB-231 tumor and 3 degrees C for MCF7 tumors observed on day 14....It was demonstrated that thermographic imaging could detect temperature changes as small as 0.1 degrees C on the skin surface at an early stage of tumor development. The findings of the study indicate that thermographic imaging might have considerable potential in monitoring human tumor xenografts and their response to anticancer drugs."

Case Rep Surg. 2013;2013:946156.
Usefulness of infrared thermal imaging camera for screening of postoperative surgical site infection after the nuss procedure.

Fujita K, Noguchi M, Yuzuriha S, Yanagisawa D, Matsuo K.

Introduction 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 Ergon. 2009;15(4):363-71.
Active thermography in qualitative evaluation of protective materials.
Gralewicz G, Wiecek B.
Department of Personal Protective Equipment, Central Institute for Labour Protection - National Research Institute, Łódź, Poland.

This is a study of the possibilities of a qualitative evaluation of protective materials with active thermography. It presents a simulation of a periodic excitation of a multilayer composite material. Tests were conducted with lock-in thermography on Kevlar composite consisting of 16 layers of Kevlar fabric reinforced with formaldehyde resin with implanted delamination defects. Lock-in thermography is a versatile tool for nondestructive evaluation. It is a fast, remote and nondestructive procedure. Hence, it was used to detect delaminations in the composite structure of materials used in the production of components designed for personal protection. This method directly contributes to an improvement in safety.

Dis Colon Rectum 2000 Sep;43(9):1319-21
Thermal imaging in the detection of bowel ischemia.
Brooks JP, Perry WB, Putnam AT, Karulf RE Department of Colorectal Surgery, Wilford Hall Medical Center, San  Antonio, Texas, USA.
PURPOSE: The aim of this study was to introduce thermal imaging in the intraoperative detection of bowel ischemia by comparing thermal imaging with conventional techniques in detecting acutely ischemic bowel, using histologic evidence for intestinal necrosis as the standard. METHODS: A prospective study was performed using a porcine model. Laparotomy was performed on four pigs under general anesthesia. A 25-cm segment of mid jejunum was tagged with proximal and distal sutures, and its mesentery was ligated and divided. Thermal imaging, visual inspection, Doppler ultrasound, and fluorescence with Wood's lamp after fluorescein were used to estimate the extent of bowel ischemia five minutes after ligation of the mesentery. Measurements were taken in reference to both the proximal and distal tags to obtain two data points per animal for each method. After two hours of warm ischemia, the jejunum was harvested and sectioned longitudinally. Comparisons were made between the estimated region of necrosis for each method and microscopic evidence of necrosis. RESULTS: Visual inspection was the only method unable to detect a difference between vascularized and devascularized bowel for each of the eight data points. Fluorescein dye missed 3 cm of ischemic bowel. Doppler ultrasound and thermal imaging were 100 percent sensitive for necrotic bowel, with thermal imaging overestimating necrosis to a greater extent than Doppler ultrasound. The positive predictive value of fluorescein dye, Doppler ultrasound, and thermal imaging for determining nonviable bowel was 91.8, 80.8, and 69.5 percent, respectively. CONCLUSIONS: Thermal imaging has the potential to be a useful adjunct in the intraoperative determination of bowel ischemia. Further studies are indicated to study this technique.

Ann Biomed Eng. 2006 Jul;34(7):1182-9. Epub 2006 Jun 20. 
Facial skin surface temperature changes during a "concealed information" test. 
Department of Defense Polygraph Institute, 7540 Pickens Ave., Fort Jackson, SC, 29207, USA.

When individuals who commit a crime are questioned, they often show involuntary physiological responses to remembered details of that crime. This phenomenon is the basis for the concealed information test, in which rarely occurring crime-related details are embedded in a series of more frequently occurring crime-irrelevant items while respiratory, cardiovascular, and electrodermal responses are recorded. Two experiments were completed to investigate the feasibility of using facial skin surface temperature (SST) measures recorded using high definition thermographic images as the physiological measure during a concealed information test. ... During both experiments, there were significant facial SST differences between deceptive and nondeceptive participants early in the analysis interval. In the second experiment, hemifacial (i.e., "half-face" divided along the longitudinal axis) effects were combined with the bilateral responses to correctly classify 91.7% of participants. These results suggest that thermal image analysis can be effective in discriminating deceptive and nondeceptive individuals during a concealed information test.

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.

Seeing through the face of deception.
Pavlidis I, et. al. Honeywell Laboratories, 3660 Technology Drive, Minneapolis, MN  55418

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.

Med Biol Eng Comput 2000 Jan;38(1):31-4
Analysis of thermal properties of wheelchair cushions with thermography.
Ferrarin M, Ludwig N; Centro di Bioingegneria, Fondazione Don Carlo Gnocchi, IRCCS-Politecnico di Milano, Italy.
Thermal properties of wheelchair cushions have been traditionally studied with thermistor probes, which provide temperature values of limited areas (spot analysis). In this paper, we describe a novel procedure based on thermography for assessing the distribution of temperature over the entire surface of wheelchair cushions. The thermal transient during contact with the body (heating phase) and after use (cooling phase) is considered. The procedure was tested in four different seat cushions (with a gel pad, air-filled cells, gel-filled bubbles and foam-filled bubbles) used by a normal subject. Observed results were compatible with the predicted outcomes based on an analysis of the materials and structures. Specifically: (i) air-filled cushions exhibited the fastest thermal transients, gel cushions the slowest transients, while cushions with a mixed structure exhibited intermediate behaviour; (ii) cushions made from flat surfaces of foam exhibited the highest peak temperatures (30.8 degrees C) as compared to those with air-filled cells (30.35 degrees C) or bubble-shaped surfaces (29.7 degrees C); (iii) the average temperature under the thighs was significantly higher than that under the ischiatic area in all cushions (29.6 degrees C compared with 28.7 degrees C, p < 0.05). It is shown that the present method can be used to differentiate between different cushions. Although the 'macro-analysis' inherent in thermography appears to be suited for improving cushion design, this approach should be further investigated to determine its reliability.

Nat Biotechnol 1999 Aug;17(8):813-6
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.

J Travel Med. 2004 Sep-Oct;11(5):273-9.
Screening for fever by remote-sensing infrared thermographic camera. 
Chan LS et al.; Department of Earth Sciences, The University of Hong Kong, Hong Kong.   

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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