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Thermal Imaging in the Investigation of Deep Venous Thrombosis. Harding R. St Woolos Hospital, Newport, U.K. EMBC95 paper 8.1.1.3.
Preliminary assessment of clinically suspected deep venous thrombosis (DVT) of the lower limb by thermography avoids the need for over one third of venograms or duplex Doppler ultrasound scans. Clinical diagnosis of DVT is notoriously unreliable – hence the need for an accurate means of clinical investigation. Untreated DVT is dangerous as it can progress to pulmonary embolism (PE) which is frequently fatal or life-threatening. Treatment of DVT by anticoagulation poses risks of its own however, and should not be undertaken without a confirmed diagnosis. Thermal imaging is quick, simple, non- invasive, risk-free, cost-effective and highly sensitive in the initial investigation of suspected DVT; a negative thermogram excludes DVT and avoids the necessity for further investigation. Thermal imaging is, however, non-specific; a positive thermogram has a number of possible causes and is an indication for further assessment by venography or Doppler ultrasound to confirm or exclude DVT. Thermography should be considered the initial investigation of choice in clinically suspected DVT, proceeding to venography or Doppler ultrasound only when thermography is positive.

The Thrombo-embolic Risk in Surgery. Hoffmann R. Department of Surgery, University Hospital, Zurich, Switzerland. Hepato-Gastroentrol (1991) 38, 272-278.
Postoperative deep-vein thrombosis can lead to fatal pulmonary embolism on one side, and the development of a disabling postthrombotic syndrome, which can occur after some time. General thrombo-embolic prophylaxis can reduce the risk of postoperative thrombo-embolic complications. Predisposing factors include age, obesity, immobilization and recumbency. Cardiovascular diseases, malignant neoplasms, venous disorders, diseases associated with increased viscosity of blood, past deep-vein thrombosis and pulmonary embolisms, some infectious diseases with raised fibrinogen levels, and inherited or acquired clotting factor deficiency syndromes (antithrombin Ill, protein C. protein S) have an elevated risk of thrombosis. The surgery itself, when taking more than 20 minutes and performed under general anesthesia, is a major risk factor, as proven initiation of thrombosis is often on the operation table. Patients receiving regional or local anesthesia have a clearly reduced risk of thrombosis. After general surgery without thrombosis prophylaxis, a deep-vein thrombosis can be demonstrated by the fibrinogen uptake test in about 30 % of all patients over the age of 40. After abdominal surgery an incidence of thrombosis of 14-33 %, and after hip surgery an incidence of nearly 50 %, have been established by means of the fibrinogen uptake test. However only 10 % of these thromboses are expressed clinically. We therefore recommend Liquid Crystal Contact Thermography, which has a sensitivity of 94 % and a specificity of over 80 %, as a non-invasive, easily performed screening method in the diagnosis of deep-vein thrombosis.

JOINT COUNCIL OF STATE NEUROSURGICAL SOCIETIES of the AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS and the CONGRESS OF NEUROLOGICAL SURGEONS Neurological clinical procedure review; Thermography Lyle Leibrook, M.D.

AVAILABLE PROOF OF EFFICACY: Evidence of prospective studies. Prospective studies have shown the excellent sensitivity and good correlation of thermography with other imaging methods. A high correlation of 84% has been demonstrated in studies comparing thermography and CT scanning of patients with low back pain and sciatica. Surgical treatment has also shown similar high rates of sensitivity. A large study of 805 patients with upper and low back pain confirm good correlation between thermographic evaluation and myelography, CAT scanning and EMG. The two objective tests for documentation of sensory radiculopathy, thermography and somatosensory cortical evoked potential’s, show equal sensitivity in the diagnosis of clinical lumbosacral radiculopathy.

SAFETY: The procedure is totally non-invasive and does not involve ionising radiation. It is without patient risk.

CONCLUSION OF REVlEW: Thermography is a safe and effective means for evaluation of vasomotor instability due to irritation or injury of spinal roots, nerves or sympathetic fibres. It is to be considered an adjunctive test and not solely diagnostic except in cases of reflex sympathetic dystrophy. While one cannot extend the technique of thermography to indicate the central phenomena of perception of pain, it is useful in detecting associated vasomotor instability and complex pain states associated with arthritis, soft tissue injuries, low back disease or reflex sympathetic dystrophy and does provide objective data to identify dysfunction in roots that are irritated in the lumbar spine, peripheral nerves that are irritated, and damage to the sympathetic nervous system.

Is Thermography A Valid Diagnostic Tool for Breast Cancer? By Patricia Prijatel Dec 20, 09 05:55PM

Thermography, which uses infrared imaging to detect changes in breast cancer tissue, can be effective in screening for breast cancer, according to research published in 2008 in the American Journal of Surgery. One huge benefit of this technique is that it is less painless than mammograms and does not emit radiation. In a randomized clinical trial, researchers used digital infrared imaging thermal imagining (DITI) on 92 patients for whom a breast biopsy was recommended. Thermography was 97 percent accurate. The researchers wrote:

DITI is painless, noninvasive,does not emit harmful radiation, has no patient risk, provides immediate results, and is relatively inexpensive.Compared to magnetic resonance imaging (MRI)—an adjunctive diagnostic tool for breast malignancy gaining more popularity—DITI is considerably more affordable to both patient and provider. MRI may cost $2,000 to the patient for each examination and $2 million to own the equipment, while DITI costs less than $200 for each exam and approximately $25,000 to own the equipment.

Researchers do not recommend thermography as a replacement for mammography, but suggest that some patients might benefit from this technique:

Patients who could potentially stand to benefit from this technology are those whose diagnosis of breast cancer can be difficult, including younger women, men, patients with dense breasts, or patients with surgically altered breasts (implants, breast reduction; provided nipples are intact for orientation and asymmetry analysis). Future studies using DITI for these individual groups can help to asses this potential

BREAST SCREENING –The development of Thermal Imaging (Thermography)

by Bill Bradford, Meditherm, June 2009

No external test of the breasts is 100% accurate nor can an external test detect breast cancer per se. Indications of breast disease require further tests and the determination of the disease is established in the laboratory.

Mammography, MRI, Thermal Imaging, Ultra-sound, Self Examination, Light test et al, all make a contribution to the campaign to reduce the risks of this dreadful disease. Clinical trials have established the efficacy of many screening protocols and it is wise to use every safe weapon in the medical armoury.

Why is there a Mammography programme for women over 50? 50 was considered the correct age to begin testing for the ‘possibility’ of the occurrence of breast disease in post menopausal women when breast density is decreasing.

The world moves on

Since the time Mammography was established as the basic test, other existing systems and subsequent systems have been tested, approved and some have been accepted generally into the medical profession.

Infrared Rays were discovered in 1800 by William Herschel and further developed by his son William Herschel (Jnr) in 1830. Infrared technology languished in the shadows for many years until it was further developed in the 20th Century for security and military applications with Infrared cameras and weapons sighting systems. The entry of Infrared Imaging and detection into the medical fraternity in the second half of the 20th century was met with suspicion by the establishment. Lack of knowledge and experience with medical thermal imaging led to unsubstantiated claims. The systems were complex, slow, and erratic and the users had limited medical knowledge. Subsequently Thermal Imaging once again took a backward step.

Enter the age of faster computers, digitisation and improved thermal cameras that combined to permit the development of faster and more efficient systems. This is an ongoing development. In the last two decades the world has embraced Infrared Thermal Camera technology into many spheres of modern life. Weather forecasting, security & search applications, military uses, industrial uses and in the past 6 years very effectively in entry and exit port controls for febrile travellers (Avian and Swine Flu). The systems were still basically for industrial applications and their use in medical and clinical applications limited. However in the late 80’s one company (Meditherm) set out to develop Digital Infrared Thermal Imaging (DITI) systems specifically for the medical profession, for both human and animal applications. In 1982 the FDA registered DITI as an acceptable device for medical use. The NHS requires all equipment used to be in accordance with 2007/47/EC (formerly 93/42/EEC). Meditherm complies with these requirements and all other EEC & USA regulations as well as local regulations in many other countries.

DITI is used extensively worldwide in animal (mainly equine) applications and in human medicine for many medical conditions. DITI is a study of physiology and not of anatomy or structure. DITI will detect inflammatory, vascular, visceral and various pain conditions as an abnormally warm pattern. Neurological dysfunction, compromised immune systems and accident trauma will be indicated as a cooler pattern. All these facilities assist the medical practitioner to more swiftly assess the condition and apply the correct treatment. Furthermore DITI as a non-invasive, pain free, zero radiation and safe modality is ideal for pre & post treatment/surgical use.

The political issues

But when it comes to Breast Screening in the NHS there is a wall of resentment and objection to the use of DITI as an additional tool in the campaign against breast disease. What are the Radiologists and Radiographers afraid of? It is not the intent of DITI to replace other anatomical tests, when and if required. It is admitted by the NHS that Mammography is not a 100% effective breast screening modality and, as I said at the start, there is no system at present that can make this claim. Figures from the NHS and the medical world for the efficacy of Mammography in the 50+ age group of women vary between 45% and 84%. Tests using Mammography + MRI or Mammography + Ultra Sound can improve the detection rate to as high as 90+%. Tests using Thermography + Mammography also produce a 90+% result.

Now move to the 30 – 50 age group of women where there is an increasing rate of breast disease and very recently even in younger females. It is admitted by the NHS and other institutions that in this group Mammography is less effective due the density of breast tissue. In this age group DITI is consistently 84% effective in the detection of active breast disease. Here the problems start, because if the patient is then tested by Mammography, there can be a negative result because Mammography is less effective for the aforementioned reason. The patient is then told that Thermography is useless and that Thermographers are simply trying to frighten patients. Why would a Thermographer do that? They are not in the business of providing treatment for the condition as the patient is normally referred to their own healthcare provider for ongoing attention. Worryingly, 4 – 5 years later most of these untreated patients present with a positive test in the same area of the breast that DITI had previously indicated.

There have been many clinical trials using DITI for breast screening as an adjunctive test. DITI has been noted as detecting active breast disease as much as 8 – 10 years before anatomical tests. This permits earlier, less invasive and less aggressive treatment, something the UK health authorities are constantly arguing in favour of!

Furthermore DITI can be used as often as is required post treatment without exposure to excessive radiation. If the disease has reached the level when it is visible by anatomical systems it has been developing for some time and the next step is to introduce invasive treatment, biopsies, surgery, Chemotherapy, radiotherapy and pharmaceuticals. Enter the pharmaceutical companies and their products. No need for other actions like more DITI.

Special Benefits of Thermal Imaging (Thermography)

Whilst considering this matter let’s not forget a few special benefits of DITI. Mammography, along with other anatomical tests, has a valuable place in the fight against breast cancer. For the Mammography test women have their breasts clamped between two plates. The radiation – about which there is a frenetic debate still being waged – passes through the breast tissue lying between the two plates. However, any abnormal activity related to breast disease that is outside the borders of the breast/s between the plates will be missed. And this is a huge issue. For example:

1. Abnormal Lymph, Thyroid, Carotid, Brachial and other conditions in the whole of the chest area including the breasts will be missed. Brachial conditions often indicate the onset of neovascular activity that relate to the development of blood vessels to feed tumours. This is a valuable early pointer to breast disease and thus can be dealt with much sooner. DITI can pick all this up.
2. Some breast conditions are not ‘visible’ to the Mammography test e.g. Inflammatory Breast disease which grows in sheets across the skin surface. Early detection of this physiological condition is essential as it is a serious and fast developing cancer.

Then there are other issues:
1. Small breasted women have a real problem with Mammograms
2. Whilst less than 1% of breast cancers are found in male patients, mammography has problems in screening men
3. Women with breast implants need very special care with mammography
4. Post-mastectomy screening in more difficult with mammography
DITI is a very suitable tool for these types of screening

DITI is also effective in all age groups and to repeat DITI is
1. Safe and radiation free.
2. Non-invasive
3. Painless
4. With no side effects

The ‘nay-sayers’ allege that DITI Thermographers are just in it for the money and require patients to attend every 90 days. This is misinformation put out to discredit the practice. All women have a unique thermal breast pattern (a fingerprint if you like) which is only altered by pathology. When a patient presents for a breast study she will receive the usual medical protocol of consultation and specific clinical practice before the screening takes place. This set of images will be assessed and reported on by a Medical Doctor Thermologist. At this stage it will not be known if this is the normal or abnormal thermal pattern for the patient. It is known that the usual cell doubling rate is 80 days therefore the patient will present 90 days later for a repeat study. These two sets of images are compared and provided there are no changes in the thermal pattern this will establish a reliable baseline for future comparison. Thereafter the patient only attends for an annual study. If there were any relevant or suspicious changes the next step would be recommended – the Doctor is in charge. Equally if a very obvious or suspicious pattern was noted on the initial first visit this too would be referred for further attention without waiting for the 90-day follow up study. On rare occasions some patients are recalled for a 180 day interim test if after the 90-day test the results are inconclusive. Healthy women can then continue with a DITI programme having an annual test until and if any change takes place that calls for further investigation.

Thermography on the NHS?

The politics of breast screening are immense.

The good news is that the NHS has just announced that it will approve the use of Acupuncture and Osteopathy treatments, providing perhaps a glimmer of hope for other practices. On a recent TV programme ‘Operation Live’ the surgeon said, “We are always open to new technologies and the patient (Reflux – Hiatus Hernia) would never have benefitted from a prolonged pharmaceutical regime”. This is a rare comment in our experience.

There is a much more usual routine: For example, despite the death from breast cancer of a notable media correspondent, her own employer/newspaper would not print information about DITI that, if

applied to her earlier, could probably have saved her life. The comment was that, “It (DITI) was too safe & benign”. What can we conclude from this statement? Perhaps only, “if you have any gory clinical reports that would be better. Because if it bleeds, it reads”! Not interested to help others, just to sell newspapers. Or am I being too cynical?
We have had an increasing number of patients referred to us by NHS consultants for pain assessments so what is the problem with the Breast Screening service of the NHS? All that is needed is that the establishment recognises that DITI has a role in the detection of breast disease for all ages of women. Meditherm is not reliant on the provision of DITI systems to the NHS for its continuing success as the world leader in medical infrared thermal imaging systems. Women are entitled to know that there are choices that they can make about breast screening, albeit they will have to pay for it themselves. However, the average fee for an annual breast study is less than the cost of a cup of coffee a week throughout the year.

Early detection of an abnormal breast condition can justify changes in lifestyle and diet amongst others that could reverse the development of the disease. This is exactly what the NHS claims to want when it encourages earlier detection and claims that ‘screening saves lives’. Regular monitoring of the condition will thereafter indicate what further action might be required.

There are currently 10 operational Meditherm equipped clinics in the UK with more coming on line and there are a few other clinics offering a Thermography service. Meditherm has been established in the UK for over 10 years. Check out the website www.meditherm.com where there is a great deal of information. Also click here to read the article “Mammograms and Screen – What every woman should know”

More informed Choices

Now is the time for women to take control of their own lives. Check out all the options and make an educated decision.

But beware. Any DITI practice that alleges that it can detect cancer by Thermography is to be avoided and reported.

If you take a Thermography report to your doctor who dismisses it, probably because he/she knows little or nothing about Thermal Imaging, ask him to place a copy of the report on your medical records and then advise that you will take further advice. The reporting doctor on the DITI report is always prepared to speak directly with your own healthcare provider. The lack of knowledge by your own doctor does not make the test invalid. They need to be alerted to the facts, but the establishment makes it very difficult for them so they will have to be courageous.

In the political climate today, all the ‘establishment’ organisations are in disarray. Who can take their word as the truth? The icon Magazine has not been afraid to speak out against narrow minded and restrictive attitudes in the medical profession. Now is the time for everyone to review many medical myths, to start asking questions and to demand straight answers. Nowhere is this more true than with the subject of Breast Cancer Screening.

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.

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.

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.

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.

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.