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Thermography was performed before ascending phlebography in a series of 232 patients with suggested deep venous thrombosis. Thirty per cent of the patients were thermo-negative. The predictive value of a negative thermography was 88 per cent. Thermography is useful as a screening method, but it has low specificity and thus a relatively high incidence of false positives must be accepted.
In 22 patients with deep venous insufficiency thermography performed at rest and immediately after exercise was compared with conventional ascending phlebography. Thermography was found to have a high sensitivity in detecting incompetent perforating veins, while the specificity was low. The non-invasive thermography is an attractive technique for preoperative detection of perforating veins.
To evaluate observer variation in mammary thermography, a teaching file test of 159 thermographies was worked out by 4 senology centers. The evaluation of accuracy and the K index of variability demonstrated a significant variability among centers. The reliability of thermography in senology seems to be too poor for it to be able to direct any therapeutic decision, either diagnostic or prognostic.
There are currently 3 established techniques employed routinely to determine the risk of foot ulceration in the patient with diabetes mellitus. These are the assessment of circulation, neuropathy, and foot pressure. These assessments are widely used clinically as well as in the research domain with an aim to prevent the onset of foot ulceration. Routine neuropathic evaluation includes the assessment of sensory loss in the plantar skin of the foot using both the Semmes Weinstein monofilament and the biothesiometer. Thermological measurements of the foot to assess responses to thermal stimuli and cutaneous thermal discrimination threshold are relatively uncommon. Indeed, there remains uncertainty regarding the importance of thermal changes in the development of foot ulcers. Applications of thermography and thermometry in lower extremity wounds, vascular complications, and neuropathic complications have progressed as a result of improved imaging software and transducer technology. However, the uncertainty associated with the specific thermal modality, the costs, and processing times render its adaptation to the clinic. Therefore, wider adoption of thermological measurements has been limited. This article reviews thermal measurement techniques specific to diabetic foot such as electrical contact thermometry, cutaneous thermal discrimination thresholds, infrared thermography, and liquid crystal thermography.
Eight Danish Holstein cows were milked with a 1-mm thick specially designed soft liner on their right rear teat and a standard liner mounted under extra high tension on their left rear teat. Four of the animals were overmilked for 5 min. Rear teats were subjected to ultrasound examination on the first day and to infrared thermography on the second day. Teats were submersed in ethanol 20 min post-milking on the second day. Ultrasonography measurements showed that teat canal length increased by 30-41% during milking. Twenty minutes after milking, teats milked with modified standard liners still had elongated teat canals while teats milked with the soft liner were normalized. Overmilking tended to increase teat wall thickness. Approximately 80% of variability in teat canal length, from before teat preparation to after milking, could be explained by changes during teat preparation. Thermography indicated a general drop in teat temperature during teat preparation. Teat temperature increased during milking and continued to increase until the ethanol challenge induced a significant drop. Temperatures approached pre-challenge rather than pre-milking temperatures within 10 minutes after challenge. Teat temperatures were dependent on type of liner. Mid-teat temperatures post-challenge relative to pre-teat preparation were dependent on overmilking. Thermography and ultrasound were considered useful methods to indirectly and non invasively evaluate teat tissue integrity.
We studied 20 normal subjects, 22 patients with carpal tunnel syndrome, and 15 with ulnar neuropathy at the elbow to compare the diagnostic accuracy of infrared thermography with that of conventional electrodiagnostic studies. We found abnormal thermograms in 55% of patients with carpal tunnel syndrome and 47% with ulnar neuropathy, using 2.5 SD from the normal mean as criteria for abnormality. The abnormalities consisted of either an increase in interside temperature difference in the fingers and hands or an alteration of the normal thenar-hypothenar temperature gradient in the fingers. The sensitivity of thermography was considerably lower than that of conventional electrodiagnostic methods. Moreover, the thermographic abnormalities were nonspecific, and could be misleading as they did not reliably identify the side of lesion or distinguish between median or ulnar nerve involvement. Thus, thermography is not helpful in the diagnosis of these two common entrapment neuropathies.
We studied 27 normal subjects and 30 patients with low back pain to evaluate the diagnostic accuracy of thermography in the diagnosis of lumbosacral radiculopathy. Thermographic abnormality was defined as the presence of either interside temperature difference exceeding 3 standard deviations from the normal mean, or an abnormal heat pattern overlying the lumbosacral spine. In patients with clinically unequivocal radiculopathy, thermography and electrophysiologic study were similar in diagnostic sensitivity, and the 2 methods agreed on the presence or absence of abnormality in 71% of cases. However, the thermographic findings had limited localizing value. Relative limb warming was often seen in patients with acute denervation on EMG, and limb cooling in those with more chronic lesions, but the side of the root lesion could not be identified confidently by thermography alone. Moreover, thermographic abnormalities appeared not to follow a dermatomal distribution and failed to identify the clinical or electrophysiologic level of radiculopathy in most cases. Thus, the thermographic findings are nonspecific, of little diagnostic value, and of uncertain prognostic relevance.
At the University of Virginia Hospital, patients undergoing preoperative irradiation for carcinoma in the head and neck region are usually scheduled for surgery four to six weeks after completion of therapy. Since preoperative irradiation produces no significant difference in the operative difficulty or postoperative morbidity, it is assumed that the vascularity of the area has returned to the pre-treatemtn level. Thermography is being used to quantitatively gauge the amount of vascularity and thus, help predict the optimum time for surgery. Thermography is obtained at two-week intervals after a pre-treatment baseline and is carried out for eight weeks after completion of therapy. During therapy the vascularity as determined by thermography is noted to increase to a maximum at approximately three to four weeks or 3 to 4,000 rads. Following completion of treatment, the vascularity subsides gradually and returns to the pre-treatment level at four to six weeks after completion of therapy.
The dental literature does not yet indicate the full range of facial thermographic findings in health and disease. Thermography is not useful in assessing some common dental problems, such as periapical granuloma. Promising reports, however, support its use in the diagnosis of neuralgias and atypical odontalgia, TMJ, nerve damage and repair after oral surgery, and in evaluating local dental anesthesia. Unfortunately, few if any of these studies were properly designed or conducted, limiting current attempts to define the value of thermography in dentistry. Until this situation resolves, ET of the face, for use in dentistry, can only be considered an investigational procedure. More research will clarify the precise contribution of thermography to dental problems.
The aim of this study was to determine whether infrared thermography before and after challenge of the lower leg in cold water may be a useful tool to detect abnormalities in skin blood flow in adolescent asymptomatic patients with type 1 diabetes mellitus (DM1) and to assess the optimal setting of skin temperature measurements. Twenty-five adolescents (10 female, 15 male, mean age 21.2 +/- 6.2 years, body mass index [BMI] 23.0 +/- 2.1 kg/m2) with a duration of DMI of 13.8 +/- 5.4 years and mean HbA1c levels 8.5 +/- 1.3% were compared to age- and sex-matched controls (BMI 22.9 +/- 2.2 kg/m2). Seven defined sites of the lower leg were assessed by infrared thermography before and for 10 min after exposure of the leg to 14 degrees C cold water. As skin temperature before exposure to cold water differs from individual to individual and basal temperature was significantly warmer in patients at the tip of the first (p < 0.05) and fifth (p < 0.05) toe, the rewarming index was calculated in order to compare data. Rewarming indexes of skin temperature during the whole measurement procedure (0-10 min) were significantly lower at the tip of the first (p < 0.05) and fifth (p < 0.01) toes and from minute 2-10 also at the inner ankle (p < 0.05) in patients compared to healthy controls. Rewarming indexes of the other four sites were not significantly different between patients and controls. Infrared thermography of the lower leg after cold water exposure is an easily applicable method and a useful tool to detect abnormalities of skin blood flow in adolescents with DM1 especially at the tips of the first and fifth toes and the inner ankle.
The leading cause of male infertility is the presence of varicocele. Recently, selective spermatic vein embolization during spermatic venography has afforded a simple, nonoperative treatment. In this study, liquid crystal contact thermography was employed before spermatic venography and after embolization or surgery. Pretreatment thermographic results were in agreement with venography in 15 of 17 cases as 13 were considered positive and two negative by both methods. Thermography further served to document objectively the immediate physiologic effectiveness of either therapy in controlling spermatic vein reflux into the pampiniform plexus. It therefore provides a noninvasive means of evaluating treatment success or recurrence at an early stage. Preliminary thermographic evidence indicates that embolization is a highly effective treatment of reflux. Thermography can also function as a useful, noninvasive screening technique to aid in selecting patients for spermatic venography and embolization therapy.
The re-introduction of acupuncture into the United States rekindled the interest in the management of chronic pain. Thermography has been shown to be a simple, non-invasive, reliable, and objective method to study pain. Our investigation included 81 patients with a variety of chronic pain conditions, one pain-free patients with left hemiparesis, and two normal subjects as controls. When pain was alleviated by acupuncture, thermography consistently demonstrated an increase of the infra-red radiation (IRR) of the affected parts of the body. Even though a patient might not report any reduction of pain, an elevation of the IRR of the affected site by acupuncture might imply the patient's denial of such an occurrence subconsciously or consciously. Acupuncture applied to pain-free patients tended to cause either no remarkable change of the infra-red pattern, or sometimes a slight decrease of the IRR if they experienced discomfort from needling. If normal thermographic patterns were observed in a patient with subjective pain, it practically excludes an actual existence of the complaint. The cooling effect of needling discomfort could be due to vasovagal over-activities. In conclusion, our investigation seemed to confirm that thermography indeed offered a simple, non-invasive, objective technique to study chronic pain and to provide an accurate measure of the effectiveness of acupuncture.
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.
OBJECTIVE: To evaluate the currently perceived status of thermography in the diagnosis of musculoskeletal disorders. DATA SOURCES: Medical and legal journals published from 1956 onwards; report of the United States Office of Health Technology Assessment and personal communication with the author of that report. STUDY SELECTION: Confined to application of thermography to musculoskeletal and neurological medicine. DATA EXTRACTION AND SYNTHESIS: Weighted towards prospective and controlled studies. CONCLUSION: Little evidence exists of any application of thermography in which it is unequivocally superior to conventional diagnostic imaging methods.
The preliminary study is concerned with 25 cases that have been examined using thermography in planes to check the conditions of temperature of the testes in normal and pathological states. Normal testicular thermography is characterised by a symmetrical and constant thermographic picture, the temperature staying between 32.5 and 34.5 degrees. In the pathological states of oligoasthenospermia plate thermography shows up a particular thermic picture associated with a varicocoele whether this is clinical or subclinical. The picture is one of hyperthermia and lack of symmetry in the case of a unilateral lesion. In these cases tyeing off the spermatic vein shows a rapid return to a normal thermographic picture. These positive results have led to a more extensive and deep study which is at present in progress.
Infrared thermography contributes to the care of insensitive limbs. The inflammatory response of near damaged or damaged tissue presents areas of increased heat on the surface which can be detected and followed. Thermography was found to be a valuable aid to the established management methods used for insensitivity problems including management of healing and freshly healed ulcerations, management of neuropathic bone and joint problems and fitting of prosthetic devices and custom shoes. The most important contribution thermography offered was the detection of irritated tissue prior to frank breakdown often in time to prevent permanent injury if quick and effective management followed.
Statistical analysis of approximately 800 cases of breast cancer followed up for at least 3-5 years with careful correlation between mammography, thermography and clinical data has confirmed the accuracy and indispensable use of thermography for prognosis and follow-up. Pre-therapeutic prognosis. Strong correlations exist between the thermographic class and survival for T1, T2 and T3 cancers, confirming the contribution of thermography in therapeutic decision. Thus, a T1 cancer should be treated differently depending on the thermographic findings. Post-irradiation follow-up. Correlations exist between the development of thermic anomalies and the effect of irradiation on the cancer, showing the possibility of confirming sterilization or early detection of a recurrence. This is valid only if the thermic effects of radiation on the skin and gland are recognized and discounted.
The problem of the correlation between angiography (surgical) and thermography using liquid crystals on a plate (non-surgical, easy, low cost, quick and repeatable) is examined on the basis of a small series. Presuming clinical history is adequate and examinations have eliminated typically surgical cases, the results of thermography appear to coincide with angiographic pictures; long-term follow up can, however, only be carried out by means of nonsurgical means such as thermography and photoplethysmography. These pinpoint the improvement and consolidation of therapy, or any worsening which demands diagnostic and therapeutic surgical or parasurgical measures.