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The author provides data concerned with the examination of 71 patients suffering from glomerulonephritis with the aid of dynamic radiation thermometry, with the procedure of thermometry and assessment of the results. It is concluded that dynamic thermometry may be used for diagnostic purposes as well as for treatment efficacy control.
Heat stroke is a medical emergency. Quick diagnosis, and sorting of victims for severity is very important for positive prognosis. Tympanic membrane thermometry was introduced as a good index for core body temperature. Therefore, we have used a sheep model for heat stroke, to study the reliability of measuring body temperature at the tympanic membrane, as a diagnostic index in heat stroke management. This was compared to measuring body temperature at the skin and the rectum. We have observed no major superiority of tympanic over rectal thermometry in regard to its ability to sort out heat stroke cases according to severity. On the other hand, skin thermometry was found not to be a reliable index in this regard.
BACKGROUND: Computerized digital thermometry has been used for instrumental diagnosis of Raynaud's disease, that is characterized by diminution of the cutaneous temperature of the fingers and the late delayed recovery. Thermometry permits to measure basal temperature of the ten fingers, during cooling to 10 degrees C ("cold test") and the response, measuring temperature minute by minute up to 25 degrees. METHODS: In order to assess vasospastic ischemic disease a total of 66 subjects have been examined: 19 were asymptomatic for acrolocalised pathologies (control subjects) and 47 were symptomatic. RESULTS: No close correlation was observed between clinic and instrumental data. In fact 31.5% of the asymptomatic subjects had a "non-normal" reaction to the test; on the other hand, in the group of female over-50-years-old with symptoms suggesting Raynaud's disease, 38.5% of cases revealed "normal" instrumental patterns. Therefore no discriminating parameters were identified which might have allowed the instrumental identification of subjects suffering from Raynaud's disease compared to healthy individuals. CONCLUSIONS: In conclusion, computerised digital thermometry is a technique with a good level of sensitivity, while the specificity is scarce.
One of the main problems of the use of liver cryosurgery is to be sure that a defined hepatic volume has been completely destroyed. We undertook an experimental pig study to determine histopathological evolution of cryolesions, to evaluate the value of intraoperative sonography, thermometry, and impedancemetry to monitor necrosis and to evaluate clinical and biological repercussions of hepatic cryosurgery. Forty-eight cryolesions were obtained by freezing each liver lobe of 12 experimental pigs during a 5-min contact with a flat cryoprobe cooled with liquid nitrogen. Cryolesions and the surrounding liver were monitored during cryosurgery by six thermocouple electrodes, five impedance electrodes, and intraoperative sonography. Animals were sacrificed immediately, 6 hr and between day 1 and day 32 after the procedure. Cryolesions were excised, and a full size pathological study was carried out. No morbidity or mortality was observed. At the end of the freezing time, cryolesions were hemispheric in shape, and their radius measured by sonography was 17.7 +/- 1.2 mm (mean +/- SD). Microscopic study showed sequential tissue alterations with edema, ischemic necrosis, tissue slough, and granulation. Cryolesions were sharply delineated from the normal liver tissue. The radius of necrosis at days 2 and 3 was 17 +/- 0.3 mm (mean +/- SD). It showed good correlation with the cryolesion size measured by intraoperative sonography. The temperature threshold to obtain complete normal liver necrosis was -15 degrees C. We found impedancemetry too difficult to use and not precise enough to monitor cryonecrosis. We conclude that intraoperative sonography and thermometry are useful means to monitor the extent of cryonecrosis during liver cryosurgery.
The proton-resonance frequency (PRF) shift method of MR thermometry provides an easy and practical means of quantitatively monitoring in vivo temperatures for MR image-guided thermal-coagulation therapy. However, reported discrepancies in the numerical value of the PRF-thermal coefficient persist, when measured in a variety of experimental conditions and in different tissue types, both ex vivo and in vivo. In this report, a potential source of variation in the PRF-shift method of thermometry is identified that manifests as a constant incremental phase shift per unit change in temperature that is independent of the echo-time setting, when constructing temperature-sensitive phase images from a gradient-echo pulse sequence. It is proposed that this confounding phase-shift offset arises from thermally induced changes in the electrical conductivity of the material. To this end, it is demonstrated that the MR-derived temperature changes could be in error by as much as 28%, as measured from a simple calibration experiment on freshly excised cow liver. A simple method of overcoming this phase-shift offset is described.
Using the on-chip refractive index (RI) detector based on backscatter interferometry, sensitive, small volume, noninvasive thermometry can be performed. The current optical configuration for the on-chip interferometric backscatter detector (OCIBD) is quite simple and consists of an unfocused laser, an unaltered chip with a hemispherical channel and a photodetector. Alignment is straightforward with the only requirement being that the beam fully fills the channel. The interaction of an unfocused laser beam with the uncoated etched channel with a curvature within the silica plate (chip) produces fringes whose positional changes scale with respect to the refractive index (RI), n, of the fluid in the channel. Due to the inherently high value of dn/dT for most fluids and the high sensitivity of OCIBD to RI changes, the measurement of small temperature variations in sub-nanoliter volumes is possible. Performing OCIBD with a 75 microm diameter laser beam on a silica chip that contains an etched channel with a 40 microm radius facilitates noninvasive thermometry on a N-(2-hydroxyethyl)piperazine-(2-ethanesulfonic acid) (HEPES) solution in a 188 x 10(-12) L probe volume with a temperature resolution of 9.9 x 10(-4) degrees C, at the 99% confidence level.
Many magnetic resonance test-object properties are temperature-dependent, with typical temperature coefficients of approximately 2-3% K(-1). Therefore, to achieve consistent quality assurance measurements to within 1%, test object temperatures should ideally be known to within 0.3 K. Proton magnetic resonance spectroscopy has previously been used to estimate accurately absolute tissue temperature in vivo, based on the linear temperature dependence of the chemical shift difference between water and temperature-stable reference metabolites such as N-acetylaspartate. In this study, this method of 'internal thermometry' in quality assurance test-objects was investigated, and in particular the value of sodium 3-(trimethylsilyl)propane-1-sulfonate (DSS) as a chemical shift reference was demonstrated. The relationship between the DSS-water chemical shift difference (sigma, expressed in ppm) and temperature tau (in K) was shown to be tau = 764.55 (+/-5.05) - 97.72 (+/-1.05) sigma (286 <or= tau <or= 309 K). Internal thermometry in MRI test-objects is feasible and straightforward, using readily available (1)H-MRS pulse sequences and standard spectroscopy evaluation packages, with a minimum detectable temperature difference of 100 (+/-20) mK.
The lanthanide complex, thulium 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (TmDOTA-), has been investigated as an agent for MR thermometry in vivo. The chemical shifts of the TmDOTA- protons were highly sensitive to temperature at a clinically relevant field strength, yet insensitive to pH and the presence of Ca2+. Given the excellent stability of lanthanide-DOTA complexes and high thermal sensitivity, TmDOTA- is expected to be a good candidate for MR thermometry in vivo.
This chapter has discussed some recent technical developments and trends in clinical hyperthermia. Several techniques for the treatment of tumours within 3-4 cm of the body surfaces were described. Each technique has its minor advantages and disadvantages; all techniques employing a single applicator produce temperature distributions with considerable gradients. The introduction of microwave and ultrasound techniques using multiple applicators in which there is some control of the pattern of the energy deposition within the treatment area should improve superficial treatments in this respect. A number of electromagnetic devices for regional hyperthermia are being developed and evaluated. The theoretical predictions of their performances are beginning to suggest restrictions to their use; the limited clinical experience is in general agreement with these predictions. Scanned and focussed ultrasound beams may offer the unique possibility of non-invasive, deep, yet localised hyperthermia in some locations. Such systems are at an early stage of their development; if they prove successful, their controlled and safe use will require detailed information of the temperature distributions produced. Invasive methods for inducing hyperthermia can produce relatively good temperature distributions. The development of 'constant temperature seeds' is promising. Both RF and microwave interstitial systems offering individual control of power to several channels should lead to improved temperature distributions. In general, non-invasive thermometry in clinical hyperthermia remains a distant goal, although developments in microwave radiometry may lead to systems with suitable spatial, temporal and temperature resolutions for use in superficial treatments. Invasive thermometry techniques can provide temperature measurements from several points or from along tracks within the treatment volume. The development of computer models to infer temperature distributions from the limited information available will be a major step in quantifying hyperthermal treatments.
Two methods of estimating body heat storage were compared under differing conditions of clothing, training, and acclimation to heat. Six male subjects underwent 8 weeks of physical training [60-80% of maximal aerobic power (VO2max) for 30-45 min.day-1, 3-4 days.week-1 at < 25 degrees C dry bulb (db)] followed by 6 consecutive days of heat acclimation (45-55% VO2max for 60 min.day-1 at 40 degrees C db, 30% relative humidity)]. Nine other male subjects underwent corresponding periods of control observation followed by heat acclimation. Before and after each treatment, subjects walked continuously on a treadmill (1.34 m.s-1, 2% grade) in a climatic chamber (40 degrees C db, 30% relative humidity) for an average of 118 min (range 92-120 min) when wearing normal light combat clothing and for an average of 50 min (range 32-68 min) when wearing protective clothing resistant to nuclear, biological, and chemical agents. The heat storage was determined calorimetrically (by the balance of heat gains and losses) and thermometrically [by the conventional equations, using one or two set(s) of relative weightings for the rectal temperature (Tre) to mean skin temperature (Tsk) of 4:1 and 4:1, 2:1 and 4:1, or 2:1 and 9:1 in thermoneutral and hot environments, respectively]. Tsk was calculated from 12-site measurements, weighted according to the regional distribution of body surface area and the first eigenvectors of principal component analysis. There were only minor differences (< 5%) between the heat storage values calculated by given weighting factors for Tre and Tsk, whether the individual coefficients were derived from estimates of regional surface area or principal component methodologies. When wearing normal clothing, no significant differences were found between the two estimates of heat storage (calorimetry vs thermometry with an invariant relative weighting of 4:1) in any experimental condition, with one specific exception: when wearing protective clothing, thermometry underestimated the heat storage by 24-31%. This under-estimation was attenuated by using two sets of relative weightings of 2:1 and 4:1 or 2:1 and 9:1. The results suggest that when subjects wearing protective clothing are transferred from thermoneutral to hot environments, the accuracy of thermometric estimates of heat storage can be improved by using two sets of weighting factors for Tre and Tsk.
BACKGROUND: In the long-term, non-invasive thermometry is vital for the continued clinical and technological development of regional hyperthermia. In magnetic resonance tomography. T1 relaxation time, diffusion and proton resonance frequency are used to measure temperature distributions. When used clinically in the pelvic region, all of these methods are plagued with errors and artefacts on account of the tissue relationships, tissue changes under hyperthermia, physiological and stochastic movements, inhomogeneities, drift phenomena and instabilities. MATERIAL AND METHOD: We tested the relationship between the temperature and the chemical shift of a methyl group of a lanthanide complex with central atom praseodymium (Pr-MOE-DO3A. Schering AG). To do this we used cylindrical phantoms containing a 5-mmol-solution of this temperature-sensitive substance. High resolution spectra and relaxation times were determined in a Bruker AMX at 11.5 T. A calibration curve was then recorded by a Siemens Magnetom SP63 at 1.5 T. Local temperature distributions were determined using the chemical shift imaging method, with a matrix size of 16 x 8 and a narrow-band excitation pulse. The temperature distribution was created using a Nd:YAG laser applicator. RESULTS: At a distance of -25.7 ppm from the water line, we found a singlet line with a temperature-dependent chemical shift of 0.13 ppm/C. In the phantom experiment we found that the chemical shift had a linear relationship with a gradient independent of the surroundings, and a temperature resolution of +/-0.6 degree C. With a concentration of 1 mmol/l, a matrix size of 8 x 8 and a measurement period of 5 s per acquisition, phantom measurements using the CSI method produced a signal to noise ratio of 3.5 per acquisition, i.e a measurement period of 10 to 20 s per spectrum. CONCLUSIONS: Our in vitro data show that spectroscopic temperature measurement using a temperature-sensitive praseodymium complex with a therapeutically practical concentration of 1 mmol/l already appears to be suitable for clinical use Compared with the methods tested so far (T1, diffusion, proton resonance), this method has the special advantage of not being very susceptible to artefacts. The competing methods of non-invasive thermometry using magnetic resonance tomography/spectroscopy will be investigated next.
A study was designed to measure noninvasively the deep temperature of the temporomandibular joint (TMJ) region and corresponding regions of the masticatory muscles at rest. With a transcutaneous probe, the deep thermometry of the right and left anterior (Ta) and the posterior portion (Tp) of the temporal muscles, the mid-portion of the superficial belly of the masseter muscles (Mm), and the TMJ regions were measured. In 20 normal male subjects, the deep temperature of the Ta region (mean 36.342 degrees C), the Tp region (mean 36.345 degrees C), and the TMJ region (mean 36.06 degrees C) was higher than that of the Mm region (mean 35.897 degrees C) at rest. In addition, no differences in the deep temperature were observed between the right and left Ta, Tp, Mm, and TMJ regions at rest. All of the normal subjects showed differences between the right and left TMJ region of less than 0.3 degrees C. In 10 patients with craniomandibular disorders, however, eight patients showed differences of more than 0.3 degrees C between the asymptomatic and asymptomatic TMJ region. Because of high sensitivity and specificity, the deep thermometry measurements can provide useful non-invasive information.
To determine the utility of infrared emission detection (IRED) tympanic thermometry in diagnosing acute suppurative otitis media (ASOM), a prospective, nonblinded sampling of ear temperatures was performed. Children between the ages of 6 months and 6 years presenting to an urban emergency department were included in the study. Tympanic temperatures were determined in all subjects. Clinical data, tympanic audiometry, and telephone follow-up were used to define ASOM. Temperature differences were determined for children with unilateral ASOM and those without ear infection. Data from 48 patients were analyzed. The mean temperature difference in the control group, 0.23 degrees +/- 0.15 degrees C (95% confidence interval [CI], 0.17 degree to 0.29 degree C) differed from those with ASOM: 0.39 degree +/- 0.29 degree C (95% CI, 0.25 degree to 0.53 degree C, P = .047). Logistic regression was used to describe the predictive relationship between temperature difference and probability of ASOM. We conclude that IRED tympanic thermometry may be useful in diagnosing ASOM when used with other clinical data.
Hemispheric activation during cognitive tasks using functional magnetic resonance imaging (fMRI) can be difficult to interpret, uncomfortable, and is not widely available. This study investigated whether tympanic membrane thermometry could be used as a broad measure of hemispheric activation. Infrared probes measured ear temperature continuously while subjects performed left or right hemisphere tasks. Temperature decreased in the left ear as activation increased in the left hemisphere during a verbal task, and in the right ear during a visuo-spatial task. When compared to a baseline, ear temperature measurements appeared to reflect relative changes in activation of the left and right hemispheres. Tympanic membrane thermometry therefore may be used as a broad marker of hemispheric activation. Its ability to demonstrate relative involvement of the two hemispheres during cognitive processes makes it especially useful in studies of hemispheric interaction. Its low cost, rapid set-up, and non-invasive nature also make it particularly attractive.
STUDY OBJECTIVE: Recently published clinical guidelines for the management of febrile children are based on studies that used rectal temperature data to stratify the risk of bacteremia and septic complications. Appropriate management decisions rely on accurate detection and categorization of fever. Accordingly, this study compared the newer infrared tympanic thermometry (ITT) to rectal thermometry in this regard. DESIGN: Prospective observational study. SETTING: Urban teaching hospital ED with annual census of 60,000. PARTICIPANTS: Consecutive children 6 months to 6 years old who had rectal temperatures measured. INTERVENTIONS: Triage nurses recorded rectal temperatures and bilateral ITT temperatures. Temperatures were correlated by Pearson correlation coefficients and compared using paired t tests with significance set at P < .01. Children were categorized by degree of fever using rectal temperature (afebrile, less than 100.4 degrees F; low fever, 100.4 to 102.9 degrees F; and high fever, more than 102.9 degrees F), and the accuracy of ITT in detecting fever and high fever was determined. RESULTS: Three hundred seventy patients were enrolled in the study. The mean age was 18.4 +/- 11.3 months; boys comprised 56% of patients. The mean temperatures were rectal, 101.0 +/- 2.0 degrees F; right tympanic membrane, 100.4 +/- 1.9 degrees F; and left tympanic membrane, 100.3 +/- 1.9 degrees F. The tympanic membrane temperatures were significantly lower than rectal readings (P << .001 for both right and left versus rectal). Rectal temperatures showed good correlation with both right and left tympanic membrane temperatures (r = .83 and .85, respectively). ITT was 76% sensitive and 92% specific in detecting fever of 100.4 degrees F or more (positive predictive value, 0.92; negative predictive value, 0.76). In the detection of high fever, ITT was only 57% sensitive but 98% specific (positive predictive value, 0.90; negative predictive value, 0.90). Rectal and TM temperatures differed by at least 0.5 degree F in 70% of the patients, 1.0 degree F in 41%, 2.0 degrees F in 12%, and 3.0 degrees F in 3%. CONCLUSION: Despite the statistical correlation between ITT and rectal temperatures, the modalities may yield significantly different temperatures. The poor sensitivity of ITT in detecting fever and high fever may result in clinically important miscategorizations of individual patients. Current clinical management that is based on the presence and height of fever may be adversely affected if ITT is used.
OBJECTIVE: To assess the reliability of body temperature estimated by infrared tympanic thermometry. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: 71 patients in a neurosurgical intensive care unit. 393 triplets of measurements were performed: right ear, left ear and right ear again. RESULTS: Limits of agreements are [-1, +1 degree C] between both ears, and [-0.6, +0.7 degree C] for two consecutive measurements in the right ear. The Bland and Altman diagram show that most of the points responsible for the lack of accuracy are between 36 and 37 degrees C. CONCLUSION: These values give an estimation of the technique's accuracy. In our point of view, such a reproducibility is adequate for daily clinical practice. The accuracy of infrared tympanic thermometry with the First Temp Genius seems reasonable for the clinical practice when the temperature is over 37 degrees C.
In 25 sheep and 5 goats, which were anesthetized, intubated and mechanically ventilated a sudden decrease in the inspired gas humidity was used to cool the lungs. The dynamics of the temperature of expired gas and its relationship to ventilation rate and cardiac output measured by thermodilution were investigated. In six animals minute ventilation was changed at a stable cardiac output and in 14 animals cardiac output was changed by infusion of saline or by bleeding at a constant ventilation. The difference between the blood temperature and the expired gas temperature at a steady state is proportional to minute ventilation and is inversely proportional to the cardiac output. The inverse time constant of the decay of temperature of the expired gas is proportional to the cardiac output and does not depend on ventilation. The lungs function as a natural humidifier of the respiratory gases with an inner heat source from the pulmonary circulation and an outer heat sink to the expired gas. A simple lumped heat capacity model of non-steady state heat exchange in the lungs was developed, which may be used as a basis for the non-invasive method for determining cardiac output. The coefficient of the lung thermal conductivity (KT/(rho WCpW) = 0.156 +/- 0.056) was determined and applied to measure cardiac output in a separate group, designed as a prospective study. When calculations of cardiac output were done based on the lung mass, estimated from the body weight (12 g/kg), bias and precision compared with thermodilution were -0.27 l/min and 0.38 l/min, respectively in 15 animals. Measurements of blood flow by the air thermometry correlated very well with thermodilution cardiac output (r = 0.92). Thermometry of the expired gas is a promising approach to measure the cardiac output non-invasively.
A novel magnetic resonance imaging (MRI) thermometry technique is demonstrated in vitro based upon the use of a PARACEST (PARAmagnetic Chemical Exchange Saturation Transfer) agent. This new method takes advantage of the high concentration of bulk water (the readout signal for imaging) and the hyperfine frequency shift properties of PARACEST agents. For two prototypes, Dy(1)3+ and Eu(2)-, the chemical shifts (delta, in ppm) of the Ln3+-bound water molecules are linearly dependent on temperature (T, in degrees C) over the range of 20-50 degrees C (delta = 6.9 x T - 944.7 and delta = -0.4 x T + 64.6, respectively). This offers the exciting possibility of improving the temperature dependencies approximately 690- and approximately 40-fold over the most widely used water PRF thermometry (Proton Resonance Frequency: -0.01 ppm/ degrees C).