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Research Papers on Thermography

The Journal Oncology, Oncology News International September 1997, Volume 6 Number 9

PDF – Infrared Imaging as a Useful Adjunct to Mammography

Montreal, Canada – Researchers from the Ville Marie Breast Center examined infrared imaging in 100 women with non invasive stage I and II breast cancer. In this study, the 84% sensitivity rate of mammography alone was increased to 95% when infrared imaging was added.

PDF – Infrared Imaging in Medicine by HairongQi, Nicholas A. Diakides

This article discussed recent research achievements in medical thermography with a focus on early breast cancer detection. The objective is to show that due to the advances in infrared technology, image processing techniques, and the pathophysiological-based understanding of thermograms, IR imaging is mature to be used as a first line supplement to both health monitoring and clinical diagnosis.

Medical Devices and Systems
Chapter 25 The Biomedical Engineering Handbook Third Edition, Edited by Joseph D. Bronzino

PDF – Infrared Imaging of the Breast – An Overview

The use of infrared imaging in health care is not a recent phenomenon. Its utilization in breast cancer screening, however, is seeing renewed interest. This attention is fueled by research that clearly demonstrates the value of this procedure and the tremendous impact it has on the mortality of breast cancer.

Infrared imaging of the breast has undergone extensive research since the late 1950’s. Over 800 papers can be found in the indexed medical literature. In this database, well over 300,000 women have been included as study participants. The number of participants in many studies are very large and range from 10,000 to 85,000 women. Some of these studies have followed patients up to 12 years in order to establish the technology’s ability as a risk marker.

With strict standardized interpretation protocols having been established for over 15 years, infrared imaging of the breast has obtained an average sensitivity and specificity of 90%. As a future risk indicator for breast cancer, a persistent abnormal thermogram caries a 22 times higher risk and is 10 times more significant than a first order family history of the disease. Studies clearly show that an abnormal infrared image is the single most important risk marker for the existence of or future development of breast cancer.

Conclusion: Currently available high-resolution digital infrared imaging technology benefits greatly from enhanced image production, computerized image processing and analysis, and standardized image interpretation protocols….. Considering the contribution that infrared imaging has demonstrated thus far in the field of early breast cancer detection, all possibilities should be considered for promoting further technical, biological, and clinical research along with the incorporation of the technology into common clinical use.

Engineering in Medicine and Biology Vol 21 Number 6 November/December 2002

PDF – Infrared: From Tanks to Tumors

This article summarizes proceeding of the “Tanks to Tumors” workshop that was held in Arlington, Virginia, 4-5 December 2001. The workshop was co-sponsored by the Office of the Director, Defense Research and Engineering, Space and Sensor Technology Directorate; the Deputy Assistant Secretary of the Army for Environment, Safety and Occupational Health; the Defense Advanced Research Projects Agency; and the Army Research Office. The purpose was to explore means for exploiting the technological opportunities in the integration of image processing, Web-based database management and development, and infrared sensor technology for the early detection of breast cancer. Summary: The panel recommendations will serve to guide the transition of military technology developments in ART, the VDL, and IR sensors to the civilian medical community. The result will be a new tool in the war against breast cancer – a major benefit to the military and civilian population.

Department of the Navy Science & Technology 4 Sept 2002

PDF – Detecting Breast Cancer with a New Algorithm and a Multi-spectral Infra-Red imaging System

“This multispectral, sub-pixel super-resolution is potentially more accurate by an order of magniturde,” states Dr. Sze, “it offers a passive, inexpensive, non-intrusive, convenient means of screening pre-cancer patients without radiation hazard, and may potentially detect in situ carcinomas long before a mammogram might detect them”

Thermal breast scanning has been employed for a number of years, especially in Europe and Asia, but its use has been limited to a single infra-red band, using a single camera. The application of the “unsupervised” classification algorithm may offer an unbiased, more snsitive, accurate, and generally more effective way to track the development of breast cancer, without demanding the variables of a long wait in a cold room, increasing the variability inaccuracy in thermal detection and causing patient discomfort.

The success of the initial double-blind experiment substantiates the promising application for the use of multispectral imaging in improving the early detection process for breast cancer and possibly other dermal carcinomas.

American Journal of Roentgenology: 180, January 2003

PDF –  Efficacy of Computerized Infrared Imaging Analysis to Evaluate mammographically Suspicious Lesions

Objective: The purpose of this clinical trial was to determine the efficacy of a dynamic computerized infrared imaging system for distinguishing between benign and malignant lesions in patients undergoing biopsy on the basis of mammographic findings. Conclusion: Infrared imaging offers a safe noninvasive procedure that would be valuable as an adjunct to mammogrphy in determining whether a lesion is benign or malignant.

The Breast Journal , Volume 4, Number 4, July/August 1998, 245-252 The Official Journal of the American Society of Breast Disease, The American Society of Breast Surgeons and The Senologic International Society
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.

PDF –  Infrared Imaging of the Breast: Initial Reappraisal Using High-Resolution Digital Technology in 100 Successive Cases of State I and II Breast Cancer.

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.

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.

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.

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.

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 remodeling. 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

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.

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 utilized 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.

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.

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

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. [email protected]
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.

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.

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.

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.

Burns, plastic surgery:
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.

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