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Clinical thermometry: possible causes and potential solutions to electronic, digital thermometer inaccuracies.

Previous research has indicated that the improvements in safety, speed, and ease of use of the newer electronic, digital oral and tympanic clinical thermometers have been offset by a loss in accuracy and reliability when compared with the traditional glass/mercury oral clinical thermometers. The purpose of this study was to determine possible causes of the relative lack of accuracy and reliability in these thermometers and suggest logical potential solutions. Evidence has been reviewed, which suggests that problems with the tympanic thermometers are the result of the range of normal anatomical variability. The combination of an otoscope with the tympanic thermometers is suggested and discussed as a potential solution. Evidence has been reviewed, which suggests that problems with the newer oral thermometers are the results of the size of the temperature sensors and the speed with which they respond. The small sensor size results in variability in placement relative to the primary heat source. The speed of sensor response results in too great a sensitivity to local, acute vasomotor activity (clinical temperature noise). Potential solutions, including an increase in sensor size and a reduction in response speed are discussed.

Body Temperature↗

Adjuvant pelvic hyperthermia in advanced cervical carcinoma. I. Feasibility, thermometry and device comparison.

From 1981 to 1989, a total of 26 women with locally or regionally advanced carcinoma of the uterine cervix were treated with radiotherapy (RT) and pelvic regional hyperthermia (HT), in the Divisions of Radiation Oncology at the University of Utah Medical Center (UU) and the Kenneth Norris Jr Cancer Hospital of the University of Southern California (USC). HT was produced by the BSD-1000 HT system and the annular phased array (AA) applicator usually driven at 60-65 MHz, or the BSD-2000 HT system and the Sigma-60 (S60) applicator usually driven at 70-85 MHz. During the HT sessions acute toxicity was common, particularly because of pain within or outside the applicator, which was power-limiting in 43% of the patients overall. Pain was more easily manipulated, but more commonly power-limiting with the S60. Systemic stress was power-limiting in 22% of patients treated with the AA, but in no patients with the S60. Detailed thermal mapping and temperature analysis were performed on 26 patients. The mean overall average intratumour temperature achieved was 41 +/- 1.1 degrees C for 30 min; 5% and 35% of the monitored intratumour loci exceeded 43 degrees C and 42 degrees C, respectively. Temperatures recorded in the cervical os and proximal vagina appeared lower relative to the monitored normal structures in the region. Subacute treatment related toxicities occurred in five patients and included protracted pain (three) and superficial second degree burns (one), all of which resolved with supportive non-surgical therapy.

Adenocarcinoma↗

Encapsulated liquid crystals as probes for remote thermometry.

A temperature probe based on the magnetic resonance properties of an encapsulated liquid crystal has been investigated. Large changes in magnetic resonance signals occur as the liquid crystal undergoes a phase transition from an anisotropic (nematic) state to the isotropic liquid. The low latent heat of such phase transitions allows for rapid phase changes during a hyperthermia treatment. Transition temperatures can be tailored by adding suitable compounds such as analogues of the liquid crystal or various solvents. Encapsulation is required to maintain the integrity of the liquid crystal, particularly for applications in vivo. Results of preliminary studies designed to demonstrate the technical feasibility of the concept are presented.

Benzylidene Compounds↗

Automated mechanical thermometry probe mapping systems for hyperthermia.

In order to better assess temperature distribution patterns in patients, tissue equivalent phantoms, and experimental animals, mechanical devices and automated control systems for positioning temperature probes in implanted catheters and catheters laid on the skin surface have been developed. They employ stepper motor actuated roller and idler wheel drives to move the probes. Two devices incorporate positive positioners in addition to the drive rollers in order to obtain higher positioning accuracy where significant probe to catheter friction is present. Automated systems have been constructed which can simultaneously position, record and display data from up to 10 temperature sensors in a colour-coded position versus temperature format to produce a real time two-dimensional colour-coded pseudo isotherm display. These thermal mapping devices have been used for characterizing the power deposition patterns of several large area microwave applicators (on the surface and at depth within tissue equivalent phantoms), for intraorgan temperature mapping in experimental animals, and for surface and subcutaneous temperature mapping during clinical treatments.

Animals↗

In-vivo NMR thermometry with liposomes containing 59Co complexes.

The ability to make localized temperature measurements in tissue during hyperthermia treatment of cancer is an essential factor in optimizing its efficacy. To this end we have developed and evaluated the complex tris(ethylenediamine) cobalt(III) trichloride as a temperature sensor by determining the temperature dependence of it 59Co nuclear magnetic resonance chemical shift. Encapsulating this complex within liposomes targets the agent to the reticuloendothelial system. Temperature changes of the order of 0.1 degrees C have been measured in vivo on rats, and the half-life of the complex within the body determined by plasma emission spectroscopy.

Animals↗

A method for bone-cement interface thermometry. An in vitro comparison between low temperature curing cement Palavit, and Surgical Simplex P.

Previous temperature measurements at the bone-cement intreface have all shown large variations. To evaluate more precisely the temperature profiles during cement curing, a new experimental model was developed. Eight thermocouple electrodes at the bone-cement interface for each test specimen were used for continuous temperature recordings. Temperature profiles of Palavit was compared with those of Surgical Simplex P in an in vitro model using isolated pig femurs. Defects of 12 x 17 mm in the femoral metaphysis were filled with cement. In six tests with each type of cement, Palavit peaked at a temperature of 50 +/- 0.5 degrees C, whereas Surgical Simplex P peaked at 60 +/- 0.7 degrees C. Core temperatures reached peak values of 70 +/- 0.8 degrees C and 95 +/- 2.2 degrees C for Palavit and Surgical Simplex P, respectively.

Animals↗

Hyperthermia during occipito-cervical fusion with acrylic cement. Epidural thermometry in 23 cases.

In 22 patients, 23 posterior occipito-cervical fusions using acrylic cement were studied; 18 had seropositive rheumatoid arthritis and 4 traumatic atlanto-axial instability. The mean age was 60 (39-75) years. During the curing of the cement, epidural temperature measurements were performed over the cerebellum and between the foramen magnum and C1. Temperatures up to 69 degrees C were recorded. Cooling with profuse surface irrigation using normal saline solution or precooled 8 degrees C fluid did not influence the maximal temperatures recorded under the cement. Even though no gross neurological damage was noted, the epidural temperatures in occipito-cervical fusion with acrylic cement can be of sufficient degree to be hazardous; surface irrigation does not seem to be an effective way to reduce this risk.

Adult↗