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An experimental investigation into the use of implanted thermocouples and differential thermometry as monitors for microvascular anastomoses.

It has been suggested that direct monitoring of arterial temperature using implanted thermocouples, may have value as a clinical postoperative monitor for vascularized free tissue transfers, including those with no visible surfaces. This study evaluated the technique in experimental animals, using simple, inexpensive equipment. Mean arterial differential temperature changes, with ipsilateral (n = 20) and contralateral (n = 21) references, of 0.6 degrees C and 0.5 degrees C respectively, reliably indicated occlusion of the superficial femoral artery in situ. In epigastric island flaps, arterial occlusion (n = 24) produced mean arterial temperature changes of 0.5 degrees C, but changes after venous occlusion were not significantly greater than unoccluded base line fluctuation. Venous differential temperature did not change significantly after either arterial or venous occlusion. In six epigastric free flaps, success or failure could not be distinguished, as the wide variation in measurements in the four successful flaps overlapped the recordings in the two which failed. It was shown that the nearer to the body core, the less the temperature difference between arterial wall and periarterial tissue. Occlusion of deeply sited arteries produced little or no change in arterial temperature. In view of these findings and because of the invasive nature of the technique, the authors did not pursue it clinically.

Anastomosis, Surgical↗

Cerebral, tympanic and colonic thermometry in the piglet.

The temperature of the brain is crucial for the outcome of hypoxic/ischaemic brain damage. In clinical medicine and in animal experiments involving survival after hypoxia/ischaemia, non-invasive measurement of cerebral temperature is needed. We have therefore compared tympanic and colonic temperature with cerebral temperature in the newborn piglet during hypothermia. Ten piglets aged 12-60 h were cooled to 35 degrees C (mild hypothermia) for 150 min and rewarmed. Thereafter, four of the piglets were again cooled to approximately 29 degrees C for less than one hour (moderate hypothermia). During stable mild hypothermia and normothermia the cerebro-tympanic temperature difference in individual piglets was less than +/- 0.4 degrees C (95% confidence intervals < or = 0.18 degrees C) and the cerebro-colonic temperature difference was -0.7 to 0.4 (95% confidence interval < or = 0.28 degrees C). The differences were larger during moderate than during mild hypothermia and largest during rapid changes in body temperature. Then the tympanic temperature correlated with the cerebral temperature significantly better than did the colonic temperature (95% confidence interval -0.3 to 0.3 versus -0.6 to 1.4 for the ten minutes with the least good correlation).

Animals↗

Effects of hyperthermia on the rat bladder: a pre-clinical study on thermometry and functional damage after treatment.

The rat bladder was heated using a microwave applicator which was equipped with a system of circulating deionized water. The applicator was operated at 434 MHz and was placed at the ventral side with the rats in supine position. Temperatures in the bladder and adjacent were monitored using thermocouples with single or multiple sensors. One thermocouple located most centrally in the bladder served as reference. The rats were treated at intravesical reference temperature of 41, 42, 43, 44 and 45 degrees C for 1 h. The heating time to reach the reference temperature was approximately 5 min. Temperatures inside the bladder varied within 0.5 degrees C from the reference value, while the temperatures in the urethra were approximately 1.0 degrees C lower. At the left and the right side of the outer bladder wall, temperatures were approximately 0.5 degrees C lower than the reference value, while the temperature on the dorsal and ventral sides of the bladder wall were 1.0-1.5 degrees C lower. In the rectum, located in the treatment field, the temperature reached 39.1, 40.5, 42.4 and 42.5 degrees C after 1 h of hyperthermia at intravesical reference temperatures of 41, 42, 43, 44 and 45 degrees C, respectively. Body core temperature measured in the esophagus behind the pericardium never exceeded 40.0 degrees C. The capacity of the bladder was assessed after 1 h at 43, 44 and 45 degrees C at various intervals after heat treatment. In the sham treated control group and in the animals treated at 43 degrees C, no reduction in bladder capacity was observed. The treatment group where the bladder was kept at 44 degrees C for 1 h showed a clear reduction in bladder capacity at days 1 and 3 after hyperthermia. In the 45 degrees C treatment group, four out of seven rats died, this within a few days after treatment. The three surviving rats were tested for bladder capacity and all had a reduced capacity at days 3 and 7 post-treatment. Four weeks after 44 degrees C hyperthermia, all rats had recovered. After hyperthermia, depending on the heat-dose, an increase in blood urea nitrogen (BUN) was observed. After treatment at 42, 43 and 44 degrees C, peak values were observed after approximately 1 day (16 or 24 h) followed by recovery; after 42 degrees C, BUN levels were almost back to normal after 1 week; after 43 degrees C, the level was still twice as high as control levels; and after 44 degrees C, recovery of BUN levels to normal seemed slow, 1 week after treatment it was still five times as high as control. From these results, it is concluded that temperatures in the bladder below 44 degrees C are well tolerated. After 1 h at 44 degrees C, a transient decrease in bladder capacity was observed, as well as a high level of azotemia. After 1 h at 45 degrees C, a high mortality rate was observed. These observations agree with early clinical observations and may be used as guidelines for further clinical work.

Animals↗

Image accuracy improvements in microwave tomographic thermometry: phantom experience.

Evaluation of a laboratory-scale microwave imaging system for non-invasive temperature monitoring has previously been reported with good results in terms of both spatial and temperature resolution. However, a new formulation of the reconstruction algorithm in terms of the log-magnitude and phase of the electric fields has dramatically improved the ability of the system to track the temperature-dependent electrical conductivity distribution. This algorithmic enhancement was originally implemented as a way of improving overall imaging capability in cases of large, high contrast permittivity scatterers, but has also proved to be sensitive to subtle conductivity changes as required in thermal imaging. Additional refinements in the regularization procedure have strengthened the reliability and robustness of image convergence. Imaging experiments were performed for a single heated target consisting of a 5.1 cm diameter PVC tube located within 15 and 25 cm diameter monopole antenna arrays, respectively. The performance of both log-magnitude/phase and complex-valued reconstructions when subjected to four different regularization schemes has been compared based on this experimental data. The results demonstrate a significant accuracy improvement (to 0.2 degrees C as compared with 1.6 degrees C for the previously published approach) in tracking thermal changes in phantoms where electrical properties vary linearly with temperature over a range relevant to hyperthermia cancer therapy.

Algorithms↗

Microwave thermotherapy of prostatic enlargement--analysis of radiometric thermometry using a hybrid bio-heat equation.

The radiometric temperature measurement included in a commercial device for transurethral microwave thermotherapy (TUMT) of the prostate was investigated utilizing both phantom experiments and computer simulations. Two finite element (FE) models were developed. One is in part based on the experimental results, and serves as a complement to the experiments, while the other describes a perfused tissue situation for which the hybrid bio-heat equation was used to model the thermal effects of blood perfusion. The aim of the study was to investigate how the radiometric thermometer is affected by the temperature close to the antenna, and to analyze the relation between blood perfusion, temperature distribution and radiometric temperature measurement. It was found that the radiometric temperature was affected to a greater extent by the temperature very close to the antenna, in contrast to what has been expected in previous studies. The blood perfusion was found to mainly affect the temperature distribution outside the maximum temperature (located 2-3 mm outside the cooled catheter). Thus, the relation between the radiometric temperature and the temperature in the treated area is relatively weak.

Artifacts↗

MRI thermometry in phantoms by use of the proton resonance frequency shift method: application to interstitial laser thermotherapy.

In this work the temperature dependence of the proton resonance frequency was assessed in agarose gel with a high melting temperature (95 degrees C) and in porcine liver in vitro at temperatures relevant to thermotherapy (25-80 degrees C). Furthermore, an optically tissue-like agarose gel phantom was developed and evaluated for use in MRI. The phantom was used to visualize temperature distributions from a diffusing laser fibre by means of the proton resonance frequency shift method. An approximately linear relationship (0.0085 ppm degrees C(-1)) between proton resonance frequency shift and temperature change was found for agarose gel, whereas deviations from a linear relationship were observed for porcine liver. The optically tissue-like agarose gel allowed reliable MRI temperature monitoring, and the MR relaxation times (T1 and T2) and the optical properties were found to be independently alterable. Temperature distributions around a diffusing laser fibre, during irradiation and subsequent cooling, were assessed with high spatial resolution (voxel size = 4.3 mm3) and with random uncertainties ranging from 0.3 degrees C to 1.4 degrees C (1 SD) with a 40 s scan time.

Animals↗

Thermocouple thermometry in microwave fields.

The causes of some of the artefacts and hazards resulting from the use of thermocouples in a 434 MHz microwave field have been investigated. The factors influencing their magnitudes are discussed.

Humans↗

Non-invasive microwave radiometry thermometry.

Near-field microwave radiometry and radiometric imaging are non-invasive techniques that are able to provide temperature information at a depth of up to several centimetres in subcutaneous tissues. They are based on the measurement of microwave electromagnetic thermal noise. This paper describes the basic principles, measurement methods and limitations of the techniques and the results of clinical studies, and it reviews recent progress.

Hot Temperature↗

The patient: a novel source of error in clinical temperature measurement using infrared aural thermometry.

INTRODUCTION: The vital signs are an important component of patient assessment. With respect to body temperature; there has been a move away from mercury-in-glass thermometers toward the relatively inexpensive, safer to use infrared tympanic, auricular, or ear thermometer. Although already in widespread use, the reliability of these devices has increasingly been called into question. Few studies, however, have considered that the problem might reside outside the device itself. OBJECTIVE: To investigate the correlation between left ear temperature and right ear temperature using an infrared tympanic thermometer (ITT). DESIGN: A prospective, single-blind trail with randomized assignment of the first ear to be assessed. SETTING/LOCATION: Welsh Institute of Chiropractic (WIOC), University of Glamorgan. SUBJECTS: One hundred and thirty two (132) asymptomatic subjects who were opportunistically sampled on entry into the WIOC. None of the subjects had any neurologic deficit, or any known underlying pathologic problems. All were students at the University of Glamorgan (age range, 18-48 years). A smaller sample of the same cohort was used on a separate occasion to compare ITTs from 2 different manufacturers using the same protocol. INTERVENTION: Measurement of ear (ear canal/tympanic) temperature bilaterally using an ITT. OUTCOME MEASURES: Bilateral asymmetry in ear canal temperature. Analysis consisted of nonparametric statistical tests, using Spearman's correlation for comparison and the Wilcoxon matched pairs test for differences. RESULTS: In 132 subjects who completed the main study, although a degree of correlation was found, the relationship did not extrapolate through zero. At temperatures more than 0.4 degrees C above or below 36.7 degrees C, there was a significant difference in temperature in the left compared with the right ear. Additionally, the left ear tended to register a lower temperature than the right ear at temperatures below 36.7 degrees C, whereas the left ear tended to read a higher temperature than the right ear above 36.7 degrees C. CONCLUSIONS: The authors suggest that clinicians consider measuring both ears, and take the greater of the readings to be a more accurate reflection of the patient's core temperature. The difference may perhaps even be related to the person's health. This change in methodology should increase the reliability of the measurement and go some way toward restoring confidence in the use of ITT devices.

Adult↗

Interstitial thermometry in men undergoing electrovaporization of the prostate.

BACKGROUND AND OBJECTIVES: Transurethral electrovaporization of the prostate (TVP) has been utilized increasingly in the therapeutic management of benign prostatic hyperplasia (BPH). The temperature profile within both prostatic and periprostatic tissue has been presented as a parameter of safety in various preliminary studies. This prospective study measured interstitial temperature during TVP in both the prostate and the surrounding tissue of 18 men. METHODS: These 18 men undergoing TVP had three interstitial thermocouple probes placed under ultrasound guidance. Probes were positioned in the rectal wall and at the 5 and 7 o'clock position of the prostate capsule. A fourth probe was placed within 1 mm of the area of vaporization to determine "lesion" temperature. Temperature was measured at baseline and at 15-minute intervals as TVP was performed utilizing the VaporTrode at 240 to 280 W with a Valley Lab Force 40 generator. RESULTS: The maximum temperature variability was 1.9 degrees C. The temperature within 0.5 mm of the area of vaporization was >100 degrees C. These results were independent of the temperature of the irrigating solution. CONCLUSIONS: These results provide compelling evidence that high vaporization temperatures do not affect surrounding prostatic tissue. In theory, the risk of injury to either the rectum or the neurovascular bundle during TVP should be extremely low.

Aged↗

Detection of fever with infrared thermometry: a feasibility study.

Fever is a remarkably sensitive indicator of infectious disease. The thermometer in clinical use today is basically that developed over a century ago, measuring heat conducted from skin or mucous membranes to an adjacent probe. In dealing with immunosuppressed granulocytopenic patients, the need was realized for an instrument by which temperature might be determined without a probe contact. Infrared pyrometers have been used in industry to record the temperature of mechanical objects at a distance. We tested the feasibility of using such an instrument to detect fever in humans. In a controlled and blinded fashion, infrared measurements from the eyes, axillae, and areas below the ear lobes (E spot) of 140 febrile and afebrile patients were compared with rectal temperatures recorded by a standard thermometer. The eye and E spot provided the most accurate readings. Infrared measurements of the right eye identified 57 (95%) of 60 febrile and 72 (90%) of 80 afebrile patients correctly. Overall, 92% of all patients were correctly categorized by use of the infrared thermometer at this site. We conclude that this approach is feasible and, with further technical developments, may be applicable for routine clinical use.

Child↗