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Simple design changes to wires to substantially reduce MRI-induced heating at 1.5 T: implications for implanted leads.

Reductions in MRI-induced heating at 1.5 T resulting from a simple design change to coiled wires were investigated. MRI-induced heating was assessed for two different coiled wire forms (length, 26 cm): (1) multi-filar coiled wire form and (2) multi-filar coiled wire form having a different coiled pitch, providing an air gap spacing between adjacent five-filar coil loops. Each wire had an electrode and was insulated to create a lead, similar to that which would be used for a medical implant. The wire forms were placed in a gelled-saline-filled head/torso phantom and imaged at 1.5 T [whole-body average specific absorption rate (SAR), 1.79 W/kg]. Fluoroptic thermometry probes were used to measure temperatures at the distal ends of the wires. The experiments demonstrated a substantial reduction in MRI-induced heating for the modified wire compared to the unmodified wire (i.e., 10.5 degrees C difference observed in one experiment and 26 degrees C difference in another). These findings have important implications for MRI-induced heating of leads used for medical implants.

Electric Wiring↗

MR-guided interventions of the breast.

Techniques and instrumentation are now widely available that enable interventional MR-guided preoperative needle localization and lesion marking. Minimally invasive MR-guided core biopsy techniques have been demonstrated but remain limited for small lesions and will be facilitated by the development of biopsy instruments that can be directly visualized using MR imaging. MR-guided tumor ablation is beginning to be evaluated in a few centers. It holds promise as new treatment modality in the continuing trend toward greater breast conservation in the local therapy of breast cancer. Further studies are needed to document the ability of MR-guided ablation to control the margins of a tumor as effectively as surgery. Patients with an extensive in situ intra-ductal component may pose a significant hurdle because the extent of ductal carcinoma in situ maybe underestimated on breast MR images. Ultimately, the success of MR-guided thermal ablation depends on the ability of MR imaging to map the extent of heating during the procedure so that the procedure can be performed to achieve complete control of the tumor margins. It is unfortunate that the conventional method for MR thermometry--the proton resonance frequency shift method--does not work in fat or in voxels with a mix of fat and glandular tissue and, hence, has limited applicability in the breast. Other methods, including measurement of T1 and T2, are being investigated as alternatives.

Biopsy, Needle↗

Peripheral arteriographic studies in leprosy.

There is a considerable controversy regarding the frequency and significance of vascular lesions in leprosy. Twenty-six cases of leprosy below the age of 40 years, without any local or systemic arterial disease and normal looking hands were subjected to brachial arteriography. One patient had posterior tibial arteriography also. The diagnosis of leprosy was confirmed by histology or bacteriological staining techniques. Biopsy material was studied from the involved areas and similar material was obtained from nine matched control subjects at autopsy. Skin thermometry and reflex vasodilatation was studied in eight cases. Arteriographic abnormalities such as occlusion, narrowing, tortuosity, dilatation, irregularity and incomplete filling were seen in more than two vessels in the hand in 50%, and in the digits in 75% of the cases. The ulnar artery was more frequently involved than the radial. Superficial and deep palmar arches were equally affected. Marked increase in arcuate vessels was noticed in nearly three-quarters of the patients, and in some, arcuate vessles were serving as collaterals. Histologically all sizes of vessles, including the capillaries, showed changes in nearly half the cases. Reflex vasodilation was lost in three cases of dimorphous leprosy and impaired or absent in three out of five cases of lepromatous leprosy. There was no predilection for any form of leprosy to show arterial changes more than the other. This study clearly demonstrates that the arterial involvement in leprosy is very frequent and must be playing an important role in causing mutilation and deformities of hands and feet.

Adult↗

Kinetics of antifreeze protein-induced ice growth inhibition.

Antifreeze proteins (AFPs) depress the freezing temperature of a solution in a non-colligative manner, by arresting the growth of ice crystals. The kinetics of this effect, studied here for the first time using a new technique called temperature gradient thermometry, are consistent with an adsorption-mediated inhibitory mechanism. The results obtained by this approach provide a new experimental basis for understanding AFP interaction with ice.

Antifreeze Proteins↗

High intensity focused ultrasound for the treatment of benign prostatic hyperplasia: early United States clinical experience.

High intensity focused ultrasound via a transrectal approach was used to treat 15 patients with symptomatic benign prostatic hyperplasia. The first 10 of these 15 patients underwent continuous temperature monitoring of the periprostatic region throughout the treatment. Patients undergoing transperineal thermocouple placement for the purpose of thermometry were treated while under general or spinal anesthesia, whereas 4 of the 5 remaining patients were successfully treated using intravenous sedation alone. Of the 10 patients 9 did not demonstrate a significant temperature elevation. One patient with a small prostatic anteroposterior diameter had a transient elevation of 17C. No patient experienced a complication related to periprostatic heating. Followup was available at 90 days in all patients. At 90 days the symptom scores decreased from a pretreatment value (American Urological Association questions 1 to 7) of 31.2 (range 22 to 38) to 15.8 (range 8 to 31). Peak flow rate increased by a mean of 4.7 ml per second from 9.3 ml per second before treatment to 14.0 ml per second at 90 days. The most frequent complication was that of transient urinary retention in 11 of 15 patients (73.3%) and hematospermia in 7 (46.7%). No adverse reactions persisted at 90 days. This study represents an initial attempt using high intensity focused ultrasound to treat symptomatic benign prostatic hyperplasia. Overall, the safety and effectiveness of high intensity focused ultrasound demonstrated in this pilot study are encouraging.

Aged↗

Electrosurgical vaporization of the prostate in the canine model.

OBJECTIVES: To investigate the histopathologic changes and heating patterns caused by electrosurgical vaporization of the prostate in the living canine model. METHODS: Prostate electrosurgical vaporization was undertaken in the canine model. Temperatures within and near the prostate and of the irrigation fluid were measured during a single pass and during the creation of a vaporized cavity. The prostate and adjacent tissues were examined by gross and microscopic pathology. RESULTS: Coagulation occurred deep to the vaporization zone for 1.38 to 1.44 mm for a single pass of the rolling cylinder and up to 2.52 mm for multiple passes. Thermometry revealed temperature increases of only 4 degrees C 5 mm away from the vaporization site. The largest temperature increases were found in the irrigation fluid as it passed through the prostatic fossa. Microscopic pathology revealed no damage to adjacent tissues. CONCLUSIONS: Electrosurgical vaporization creates minimal deep heating and coagulation beyond the vaporized cavity. The majority of the heat is removed by the irrigation fluid.

Animals↗

Outbreak of Salmonella eimsbuettel in newborn infants spread by rectal thermometers.

Over a six-week period there were 25 episodes of Salmonella eimsbuettel infection in newborn infants, mothers, and staff in a modern maternity hospital with 3600 annual deliveries. The probable source was a mother and her child, and the organism was spread by rectal thermometers in the labour suite and one of the wings (wards). When the thermometers were withdrawn from use and correctly disinfected the outbreak in babies ceased. Environmental cross-infection of staff was halted by closure, cleaning, and disinfection of the clinical area mainly affected. Some babies had diarrhoea but quickly recovered, and none came to harm. The infected staff had no symptoms and returned to duty after three negative cultures. Measurement of temperature is still an important observation in the care of newborn infants, but for everyday care it is recommended that rectal thermometry be discontinued and replaced by axillary measurement.

Cross Infection↗

MRI detection of the thermal effects of focused ultrasound on the brain.

This study tested the hypothesis that MRI thermometry can be correlated with the different degrees of tissue damage observed after focused ultrasound (US) exposure of brain. The brains of 6 rabbits were sonicated to calibrate the MRI proton resonant shift with temperature. In addition, 13 rabbits were sonicated at acoustic powers ranging from 3.5 to 17.5 W. The experiments were performed in a 1.5-T MRI scanner with the temperature-sensitive phase imaging used during the sonications of 4-5 different locations in each rabbit. MR images were obtained 2 h and 2 days after the sonications, depending on when the animals were sacrificed. Whole brain histologic evaluation was performed by sectioning the brain and performing a microscopic investigation. The MRI-derived temperature elevation was found to correlate well with the degree of tissue damage. In addition to the common histology findings, apoptotic cells were observed in the lesions. The T1-weighted contrast enhanced and T2-weighted scans both detected the brain damage. The applied acoustic power did not correlate well with the degree of damage. As a conclusion, the results showed that the measurement of temperature elevations by MRI during sonications can improve the accuracy and safety of clinical US brain surgery.

Animals↗

Apoptosis in ultrasound-produced threshold lesions in the rabbit brain.

Focused ultrasound (US) surgery has been used to induce high temperature elevations in tissue to coagulate the proteins and kill the tissue. The introduction of noninvasive online temperature monitoring has made it possible to induce well-controlled thermal exposures. In this study, we used magnetic resonance imaging (MRI) thermometry to monitor thermal exposures near the threshold of tissue damage, and then investigated if apoptosis was induced. Rabbit brains were sonicated with an eight-sector phased array to create a large region of uniform temperature elevation at the end of a 30-s sonication. Histological examination demonstrated that apoptosis was induced in some cells. At 4 h after the sonications, the apoptotic cells constituted 9 +/- 7% of identifiable cells. By 48 h after the sonications, the number of apoptotic cells had increased up to 17 +/- 9%. The impact of this finding for therapy needs to be explored further.

Animals↗

Skin temperature side differences--a diagnostic tool for CRPS?

Complex regional pain syndrome type I (CRPS I) is a chronic painful disease of one extremity that may develop as a disproportionate consequence of a trauma affecting the limbs without overt nerve injury. It is clinically characterized by sensory, motor and autonomic symptoms including vascular abnormalities. Previously, we have reported that pathophysiological alterations of the ongoing sympathetic activity play a crucial role in vasomotor disturbances (Brain 124 (2001) 587). As a companion article, the aim of this study was to evaluate the diagnostic value of skin temperature side differences in consideration of the spontaneous sympathetic vasoconstrictor activity. Twenty-five patients with CRPS I were studied. Fifteen patients with painful limbs of other origin and 20 healthy individuals served as controls. Controlled thermoregulation was performed to change cutaneous sympathetic vasoconstrictor activity by the use of a thermal suit: skin sympathetic vasoconstrictor neurones were activated by whole-body cooling and nerve activity was abolished by whole-body warming. Skin temperature at the affected and unaffected limbs (infra-red thermometry) was measured under resting conditions and continuously monitored during controlled modulation of sympathetic activity. The results showed only minor skin temperature asymmetries between both limbs under resting conditions in most CRPS patients. However, during controlled thermoregulation temperature differences between both sides increased dynamically and were most prominent at a high to medium level of vasoconstrictor activity. In both control groups, there were only minor side differences in temperature both in rest and during thermoregulatory changes of sympathetic activity. When comparing the diagnostic value of skin temperature asymmetries in CRPS I, sensitivity was only 32% under resting conditions, but increased up to 76% during controlled alteration of sympathetic activity. Specificity was 100% at rest and 93% at controlled thermoregulation. We concluded that the degree of unilateral vascular disturbances in CRPS I depends critically on spontaneous sympathetic activity. Taking this into consideration, skin temperature differences in the distal limbs are capable of reliably distinguishing CRPS I from other extremity pain syndromes with high sensitivity and specificity.

Adult↗

Preoperative radiochemotherapy in locally advanced or recurrent rectal cancer: regional radiofrequency hyperthermia correlates with clinical parameters.

PURPOSE: Preoperative radiochemotherapy (RCT) is a widely used means of treatment for patients suffering from primary, locally advanced, or recurrent rectal cancer. We evaluated the efficacy of treatment due to additional application of regional hyperthermia (HRCT) to this conventional therapy regime in a Phase II study, employing the annular phased-array system BSD-2000 (SIGMA-60 applicator). The clinical results of the trial were encouraging. We investigated the relationship between a variety of thermal and clinical parameters in order to assess the adequacy of thermometry, the effectiveness of hyperthermia therapy, and its potential contribution to clinical endpoints. METHODS AND MATERIALS: A preoperative combination of radiotherapy (1.8 Gy for 5 days a week, total dose 45 Gy applied over 5 weeks) and chemotherapy (low-dose 5-fluorouracil [5-FU] plus leucovorin in the first and fourth week) was administered to 37 patients with primary rectal cancer (PRC) and 18 patients with recurrent rectal cancer (RRC). Regional hyperthermia (RHT) was applied once a week prior to the daily irradiation fraction of 1.8 Gy. Temperatures were registered along rectal catheters using Bowman thermistors. Measurement points related to the tumor were specified after estimating the section of the catheter in near contact with the tumor. Three patients with local recurrence after abdominoperineal resection, had their catheters positioned transgluteally under CT guidance, where the section of the catheter related to the tumor was estimated from the CT scans. Index temperatures (especially T(max), T(90)) averaged over time, cumulative minutes (cum min) (here for T(90) > reference temperature 40.5 degrees C), and equivalent minutes (equ min) (with respect to 43 degrees C) were derived from repetitive temperature-position scans (5- to 10-min intervals) utilizing software specially developed for this purpose on a PC platform. Using the statistical software package SPSS a careful analysis was performed, not only of the variance of thermal parameters with respect to clinical criteria such as toxicity, response, and survival but also its dependency on tumor characteristics. RESULTS: The rate of resectability (89%) and response (59%) were high for the PRC group, and a clear positive correlation existed between index temperatures (T(90)) and thermal doses (cum min T(90) >/= 40.5 degrees C). Even though the overall 5-year survival was encouraging (60%) and significantly associated with response, there was no statistically significant relationship between temperature parameters and long-term survival for this limited number of patients. However, nonresectable tumors with higher thermal parameters (especially cum min T(90) >/= 40.5 degrees C) had a tendency for better overall survival. We found even higher temperatures in patients with recurrences (T(90) = 40.7 degrees C versus T(90) = 40.2 degrees C). However, these conditions for easier heating did not involve a favorable clinical outcome, since surgical resectability (22%) and response rate (28%) for the RRC group were low. We did not notice any other dependency of thermal parameters to a specific tumor or patient characteristics. Finally, neither acute toxicity (hot spots) induced by hyperthermia or RCT nor perioperative morbidity were correlated with temperature-derived parameters. Only a higher probability for the occurrence of hot spots was found during treatment with elevated power levels. CONCLUSION: In this study with two subgroups, i.e., patients with PRC (n = 37) and RRC (n = 18), there exists a positive interrelationship between thermal parameters (such as T(90), cum min T(90) >/= 40,5 degrees C) and clinical parameters concerning effectiveness. Additional hyperthermia treatment does not seem to enhance toxicity or subacute morbidity. Procedures to measure temperatures and to derive thermal parameters, as well as the hyperthermia technique itself appear adequate enough to classify heat treatments in

Age Factors↗

A phase I and II clinical trial of a newly developed ultrasound hyperthermia system with an improved planar transducer.

PURPOSE: The clinical usefulness of a newly developed ultrasound hyperthermia system was evaluated. METHODS AND MATERIALS: The hyperthermia system uses a modified planer transducer operated at frequencies of 0.5, 1.0, and 1.5 MHz. The transducer has a nonvibrating part at the center to reduce the central hot spot. Frequency sweeping technique is also used to eliminate the annular hot spot around the center. Thirty-eight tumors in 29 patients were examined in this study. In 35 tumors, hyperthermia was given in conjunction with irradiation and/or chemotherapy, and in the remaining 3 tumors, hyperthermia alone was given. In all, a total of 153 hyperthermia sessions were performed. RESULTS: The number of hyperthermia sessions per tumor ranged from 1 to 7 (mean, 4.0 +/- 1.3). The number of intratumor thermometry points per session ranged from 1 to 8 (mean, 4.3 +/- 1.5). The average intratumor temperature for tumors with a maximum depth of <3 cm, 3-6 cm, and >6 cm was 42.1 +/- 1.2, 41.7 +/- 1.4, and 39.9 +/- 2.0 degrees C, respectively. The percentage of monitored intratumor points with temperature exceeding 42 degrees C was 56 +/- 31%, 43 +/- 34%, and 21 +/- 24%, respectively. Of the 30 evaluable tumors treated with combined irradiation, 12 showed complete response, 14 partial response, and 4 no change. Observed complications included pain at the treatment site in 13 of the 153 treatment sessions and vesicle formation in 3 of the 38 treatment sites. No serious complication was seen. CONCLUSIONS: These results indicate that the newly developed ultrasound hyperthermia system is clinically useful for the treatment of localized superficial and subsurface tumors with a maximum tumor depth of no more than 6 cm.

Adult↗

An ultrasound system for simultaneous ultrasound hyperthermia and photon beam irradiation.

PURPOSE: An existing ultrasound system has been adapted for simultaneous use with external photon beam irradiation. The system is being used to investigate the potential for increased biological benefit of simultaneously combined hyperthermia and external beam irradiation with currently achievable temperature distributions. METHODS AND MATERIALS: An existing clinical ultrasound system has been modified for simultaneous operation with a 60Co teletherapy machine. The generator, thermometry system, computer, and applicators are located inside the treatment room, while the monitor and system control are located at the control console. Two approaches have been used clinically to combine the two modalities. In the first approach, an en-face setup is used in which the ultrasound beam and the photon beam travel through the same window of entry to the tumor. This is acheived by a reflecting system designed to deflect the ultrasound to the tumor while positioning the ultrasound transducer outside the radiation beam. The reflecting system consists of water and water-equivalent materials except for a 1 mm sheet of polished brass that is used as the reflector. The relative pressure fields were measured in water at the same distance from the ultrasound source using a scanning hydrophone with and without the reflector at the two operating frequencies of the device (1.0 and 3.4 MHz) for two applicators. Radiation dosimetry measurements were performed to determine the relationship between 60Co irradiation through the reflector and absorbed dose. In the second approach the ultrasound and the radiation beam travel into the tumor from different windows of entry such that the radiation beam passes through no portion of the water bolus prior to entering the patient. We have termed this approach the orthogonal approach. For both approaches, the radiation fraction is given in the middle of an uninterrupted 60-min hyperthermia treatment. RESULTS: The system modifications did not impair the ability to effectively deliver ultrasound hyperthermia or 60Co teletherapy. With the en-face approach the ultrasonic patterns generated with and without the reflector demonstrated that the ultrasound system maintained both a uniform and controllable heating pattern. The 60Co beam had no effect on the performance of the thermocouple thermometers. The radiation beam is attenuated nearly uniformly by the reflector system. To date, 10 patients have been treated with the en-face approach and 12 have been treated with the orthogonal approach (90 treatments). CONCLUSIONS: The clinical implementation of ultrasound hyperthermia simultaneous with 60Co irradiation is technically and clinically feasible without any complications or hazards to the patient. The implementation of a reflecting device allows en-face delivery of both the ultrasound and 60Co irradiation. Temperatures obtained during simultaneous treatments are comparable to those historically obtained during sequential treatments with the same commercial ultrasound device.

Calorimetry↗

The treatment of high-grade soft tissue sarcomas with preoperative thermoradiotherapy.

PURPOSE: To explore the use of a novel program of preoperative radiation and hyperthermia in the management of high-grade soft tissue sarcomas (STS). METHODS AND MATERIALS: Eligible patients were adults over 18 with Grade 2 or 3 STS, surgically resectable without a local excision prior to referral to Duke University Medical Center and without distant metastases. Patients were staged generally with CT and/or MR imaging. The diagnosis was established with fine needle aspiration or incisional biopsy. Patients were then treated with 5000 to 5040 cGy, 180-200 cGy per fraction. Chemotherapy was usually not employed. Generally two hyperthermia treatments per week were given with a planned thermal dose of 10-100 CEM 43 degrees T90. Invasive thermometry and thermal mapping were done in all patients. Surgical resection was planned 4-6 weeks after the completion of radiation and hyperthermia. RESULTS: Ninety-seven patients were treated on study between 1984 and 1996. Follow-up ranged from 12 to 155 months (median 32). All tumors were high-grade in nature, 44 greater than 10 cm in size (maximum tumor diameter), 43 5-10 cm in size, 10 less than 5 cm. Seventy-eight of the 97 tumors were located in an extremity. Of the 97 patients, 48 remain alive and continually free of disease following initial therapy. Of the remaining 49 patients, 44 have relapsed (34 dead, 10 living with disease), 3 have died secondary to complications of therapy, and 2 have died of unrelated causes. Ten-year actuarial overall survival, cause-specific survival, and relapse-free survival are 50, 47, and 47% respectively. The predominant pattern of failure has been distant metastases with only 2 patients developing local failure alone. Ten-year actuarial local control for extremity tumors is 94%, 63% for the 19 patients with tumors at sites other than the extremity. Of the 78 patients with extremity lesions, 63 have had limb preservation and remain locally controlled. Overall 38 patients experienced 57 major complications. There were 3 deaths, one due to adriamycin cardiomyopathy and two secondary to wound infections. Four patients required amputation secondary to postoperative wound healing problems. Complications directly attributable to hyperthermia occurred in 15 patients with 11 instances of second- or third-degree burns and two instances of subcutaneous fat necrosis. The hyperthermia complications were generally not severe and either healed readily or were excised at the time of surgical resection of the primary tumor. CONCLUSIONS: For these aggressive high-grade soft tissue sarcomas, this treatment program of preoperative thermoradiotherapy provided excellent local regional control for extremity lesions (95%) and satisfactory local regional control (63%) of nonextremity sarcomas, but did not appear to influence the rate of distant metastases or survival. Complications were frequent but apart from the direct thermal burns, not too different from those reported for preoperative radiotherapy alone. More effective adjuvant systemic therapy is necessary to impact favorably on survival.

Adult↗

A difference of 5 degrees C between ear and rectal temperatures in a febrile patient.

A 4-year-old boy with a history of seizures triggered by fever presented at an emergency department (ED) with tachycardia, skin vasoconstriction, and a rectal temperature of 42.2 degrees C. However, his ear temperature (as repeatedly measured in two ears, by two experienced nurses, and with two infrared thermometers) was between 36.4 degrees C and 37.6 degrees C. Antipyretic therapy resulted in skin vasodilation, a rapid decrease of rectal temperature, restoration of heart rate, and disappearance of the difference between the two temperatures. Seizures did not occur. This case shows that infrared ear thermometry cannot be recommended in EDs as the procedure of choice for detecting fever in small children, especially when they are vasoconstricted.

Body Temperature↗

Temperature changes associated with radiofrequency energy-induced heating of bovine capsular tissue: evaluation of bipolar RF electrodes.

SUMMARY: This in vitro study determined the temperature changes associated with radiofrequency (RF) energy-induced heating of bovine capsular tissue using bipolar RF electrodes. Tissue samples were placed in a saline bath (37 degrees C) and RF energy was applied using 2 different types of bipolar electrodes (VAPR T End Effect and Vapor T Side Effect; Mitek, Westwood, MA). Each electrode was activated for 3 seconds at 10 W, 16 W, and 20 W, for 6 separate data acquisitions. Fluoroptic thermometry designed to be unperturbed by RF fields was used to record temperatures on the tissue surface and at depths of 2 mm, 4 mm, and 5 mm, at 1-second intervals before (5 seconds), during (3 seconds), and after (7 seconds) the application of RF energy. The highest mean temperatures were recorded at the tissue surfaces for the different power settings for each RF electrode type, as follows: End Effect: 48.9 degrees C (10 W), 57.0 degrees C (16 W), and 67.3 degrees C (20 W). Side Effect: 51.5 degrees C (10 W), 62.1 degrees C (16 W), and 71.2 degrees C (20 W). All recorded surface temperatures were within the range known to be acceptable for tissue shrinkage. Gradient effects (i.e., higher-to-lower) were observed for the tissue temperatures measured at the different depth positions. None of the temperatures recorded at the different depths were excessive, suggesting that sensitive anatomic structures should not be damaged by RF energy-induced heating under the conditions described above.

Animals↗

Quantitative evaluation of postsurgical inflammation by infrared radiation thermometer and laser flare-cell meter.

Using an infrared radiation thermometer and a laser flare-cell meter, we evaluated intraocular inflammation in 40 patients who had cataract surgery by measuring central corneal temperature, number of cells, and amount of flare in the anterior chamber. Patients were divided into two groups based on duration of surgery: Group A, more than 40 minutes; Group B, less than 40 minutes. In Group A (n = 32), corneal temperature (degrees Celsius) increased by 1.10 +/- 0.57, 0.75 +/- 0.69, 0.41 +/- 0.56, and 0.24 +/- 0.45 on days 1, 2, 14, and 30, respectively. Group B (n = 8) had no significant rise in corneal temperature, but cell count (mean +/- 1 SD) increased to 39.3 +/- 13.6, 36.4 +/- 18.1, 15.5 +/- 16.5, and 4.4 +/- 3.1 on days 1, 2, 7, and 14, respectively. Flare increased to 88.9 +/- 88.9, 45.8 +/- 30.1, 38.3 +/- 25.4, and 18.5 +/- 9.4 on days 2, 7, 14, and 30, respectively. These observations show that the longer the cataract surgery, the greater the inflammation. Although inflammation was evaluated quantitatively by both infrared radiation thermometer and laser flare-cell meter, the latter appears to be more sensitive. Thermometry will only detect the results of very traumatic surgery, with a corresponding breakdown of the blood-aqueous barrier.

Anterior Chamber↗

Temperature taking in the ICU: which route is best?

Temperature measurement in an intensive care environment requires accurate estimation of core temperature via reliable equipment. Intermittent rectal probes were routinely used to measure core temperature in all extubated patients admitted to the Intensive Care Unit (ICU) which was the setting for this project. The nursing and medical staff identified various problems associated with this practice and a quality improvement project was implemented to compare temperatures recorded using three different routes: rectal, infrared tympanic and nasopharyngeal. Forty-nine patients were included in the study. Nasopharyngeal temperature measurements were recorded for all intubated patients and rectal temperature measurements were recorded for all extubated patients. During data collection, infrared tympanic temperature measurements were recorded at the same time as all other temperature measurements. The main comparison was between the rectal route and the infrared tympanic route because of the problems with the rectal probes that had been identified by staff. The results indicated statistically significant correlations between temperatures measured at the different sites. These results confirmed previous literature and the ICU involved in this study replaced rectal temperature measurement via intermittent probe insertion with infrared tympanic thermometry for the measurement of core temperature in extubated patients.

Body Temperature↗