Quantitative visualization and detection of skin cancer using dynamic thermal imaging.

Quantitative visualization and detection of skin cancer using dynamic thermal imaging.
Herman C1, Cetingul MP.

Abstract
In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death. To date, the only effective treatment for melanoma remains surgical excision, therefore, the key to extended survival is early detection. Considering the large numbers of patients diagnosed every year and the limitations in accessing specialized care quickly, the development of objective in vivo diagnostic instruments to aid the diagnosis is essential. New techniques to detect skin cancer, especially non-invasive diagnostic tools, are being explored in numerous laboratories. Along with the surgical methods, techniques such as digital photography, dermoscopy, multi-spectral imaging systems (MelaFind), laser-based systems (confocal scanning laser microscopy, laser Doppler perfusion imaging, optical coherence tomography), ultrasound, magnetic resonance imaging, are being tested. Each technique offers unique advantages and disadvantages, many of which pose a compromise between effectiveness and accuracy versus ease of use and cost considerations. Details about these techniques and comparisons are available in the literature. Infrared (IR) imaging was shown to be a useful method to diagnose the signs of certain diseases by measuring the local skin temperature. There is a large body of evidence showing that disease or deviation from normal functioning are accompanied by changes of the temperature of the body, which again affect the temperature of the skin. Accurate data about the temperature of the human body and skin can provide a wealth of information on the processes responsible for heat generation and thermoregulation, in particular the deviation from normal conditions, often caused by disease. However, IR imaging has not been widely recognized in medicine due to the premature use of the technology several decades ago, when temperature measurement accuracy and the spatial resolution were inadequate and sophisticated image processing tools were unavailable. This situation changed dramatically in the late 1990s-2000s. Advances in IR instrumentation, implementation of digital image processing algorithms and dynamic IR imaging, which enables scientists to analyze not only the spatial, but also the temporal thermal behavior of the skin, allowed breakthroughs in the field. In our research, we explore the feasibility of IR imaging, combined with theoretical and experimental studies, as a cost effective, non-invasive, in vivo optical measurement technique for tumor detection, with emphasis on the screening and early detection of melanoma. In this study, we show data obtained in a patient study in which patients that possess a pigmented lesion with a clinical indication for biopsy are selected for imaging. We compared the difference in thermal responses between healthy and malignant tissue and compared our data with biopsy results. We concluded that the increased metabolic activity of the melanoma lesion can be detected by dynamic infrared imaging.

Interexaminer reliability of infrared thermography for the diagnosis of complex regional pain syndrome.

Inter-examiner reliability of infrared thermography for the diagnosis of complex regional pain syndrome. 

Eunjoo Choi

Pyung-Bok Lee

Francis Sahngun Nahm

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 

ABSTRACT BACKGROUND/PURPOSE: Infrared thermography (IRT) is a useful tool for assessing skin temperature abnormalities in patients with complex regional pain syndrome (CRPS). Although determining regions of interest (ROIs) is an essential process for interpreting thermographic images, there are no validated and standardized guidelines to determine ROIs. Therefore, ROIs may be determined differently by each observer even for the same IRT images, which can result in an important issue for IRT reliability. The purpose of this study was to investigate the inter-examiner reliability of IRT in patients with CRPS.

METHODS: Infrared thermographic images of 28 patients diagnosed with CRPS were reviewed by three independent examiners. The shapes, sizes, and the detailed locations of the ROIs were determined by the investigator's own opinion based on patient history and symptoms. After maximal skin temperature of the ROI was obtained for each patient, the degree of agreement among the three examiners limbs was assessed.

RESULTS: The intraclass correlation coefficient among the three independent raters was 0.865 (95% confidence interval, 0.748-0.933), indicating a high degree of reliability (P < 0.001).

CONCLUSIONS: The reliability of IRT for assessing skin temperature abnormalities in CRPS was high when the ROIs were determined based on patient history and symptoms.

Peripheral vascular reactions to smoking--profound vasoconstriction by atherosclerosis.

Peripheral vascular reactions to smoking--profound vasoconstriction by atherosclerosis. 

Fushimi H, Kubo M, Inoue T, Yamada Y, Matsuyama Y, Kameyama M; Department
of Medicine, Sumitomo Hospital, Osaka, Japan.

Analyses of direct effects of smoking on peripheral arteries were done using thermography, blood fluorometry and echography on 97 habitual smoker diabetics without triopathy. There were found to be four types of thermographic changes following smoking, which varied according to the degree of atherosclerosis of the artery. The smoking-stimulated thermographic pattern in the control group of healthy volunteers was a small wavy pattern, fluctuating along the base line every few minutes within a temperature range of 1.0-1.5 degrees C (N type). In diabetics, four types of thermographic patterns were produced: normal (N) type as control, increasing (I) type (increasing in skin temperature), decreasing (D) type (decreasing in temperature), and F type (no changes in temperature). The most significant finding was the decreasing pattern which closely connected to clinical and echographic aspects of macroangiopathic changes. The increasing type was characterized by a paradoxical increase in temperature after smoking in order diabetics with good blood glucose control and who were less atherosclerotic. Blood flow was correlated to the skin temperature at the base state and changes after smoking. Moreover, blood flow changes measured by fluorometry suggest that vasoconstriction or vasodilatation following smoking took place. These results suggest that
this smoking test might be a good tool for diagnosing for the degree of atherosclerosis and for its
following up.

Circadian rhythm chaos: a new breast cancer marker.

Circadian rhythm chaos: a new breast cancer marker.
Keith LG, Oleszczuk JJ, Laguens M.; Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA.

The most disappointing aspect of breast cancer treatment as a public health issue has been the failure of screening to improve mortality figures. Since treatment of late stage cancer has indeed advanced, mortality can only be decreased by improving the rate of early diagnosis. From the mid-1950s to the mid-1970s, it was expected that thermography would hold the key to breast cancer detection, as surface temperature increases overlying malignant tumors had been demonstrated by thermographic
imaging. Unfortunately, detection of the 1-3 degrees C thermal differences failed to bear out its promise in early identification of cancer. In the intervening two-and-a-half decades, three new factors have emerged: it is now apparent that breast cancer has a lengthy genesis; a long-established tumor-even one of a certain minimum size-induces increased arterial/capillary vascularity in its vicinity; and thermal variations that characterize tissue metabolism are circadian ("about 24 hours") in periodicity. This paper reviews the evidence for a connection between disturbances of circadian rhythms and breast cancer. Furthermore, a scheme is proposed in which circadian rhythm "chaos" is taken as a signal of high risk for breast cancer even in the absence of mammographic evidence of neoplasm or a palpable tumor. Recent studies along this line suggest that an abnormal thermal sign, in the light of our present knowledge of breast cancer, is ten times as important an indication as is family history data.

Appearance of human meridian-like structure and acupoints and its time correlation by infrared thermal imaging.

Appearance of human meridian-like structure and acupoints and its time correlation by infrared thermal imaging. 
Yang HQ, Xie SS, Hu XL, Chen L, Li H. Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Institute of Laser and OptoElectronics Technology, Fujian Normal University, Fuzhou 350007, China.

"The meridians and acupoints of human bodies at natural condition are investigated among 30 healthy volunteers by infrared thermal imaging technique. The results give clear evidence of the existence of infrared radiant tracks along human meridian courses. The time dependent evolution of the infrared radiant track is observed for the first time. The time rhythm of acupoints is also studied. Our findings not only support the view that infrared radiant tracks along human meridian courses is a normal vital and physiological phenomenon appearing in human beings, but also offer a potential method for noninvasive diagnostic by studying the physiological function and pathological change of meridians or acupoints by means of thermography."

Application of thermography for non-invasive diagnosis of thyroid gland disease.

Application of thermography for non-invasive diagnosis of thyroid gland disease.
Helmy A1, Holdmann M, Rizkalla M.

Abstract
In this paper, a computer-based prototype device was designed based on an economical noninvasive system that could detect and display the relative skin temperature variations present in human patients suffering from thyroid disorders. Such a system could be used to augment the normal procedures followed by the physician in diagnosing the thyroid to detect areas of hyperactivity within the gland. Because a hyperactive nodule is a center of increased blood flow and chemical activity, it might be also a center of heat production that is detectable by thermal sensing. This paper also presents a finite-element analysis (FEA) of a hot thyroid nodule that is used for investigating the temperature distribution in conjunction with the prototype. The instrumentation model built was based on actual dimensional human model for thyroid nodules obtained from various patients. A software program was written in Visual Basic to detect the temperature distribution around the hot spot. The software also incorporates means to minimize the thermal noise associated with the body temperature. The FEA utilizes the same boundary values used in the practical settings. This includes initial values of temperatures for the hot spot and its surroundings. The results of the finite-element simulation assisted in the selection of the solid state sensors that were used in the instrumentation of the thermographic system. The selected sensors were calibrated for their functionality and dynamic performance according to the specifications. The new noninvasive diagnostic technique was applied to patients having Graves' diseases at the Indiana University (IU) Hospital, and compared with the existing scheme that utilizes I Scan. The results of the new diagnostic method were in good agreement with the current existing method.

Isotope perfusion and infrared thermography of arterialised, venous flow-through and pedicled venous flaps.

Isotope perfusion and infrared thermography of arterialised, venous flow-through and pedicled venous flaps. 
Wolff KD, Telzrow T, Rudolph KH, Franke J, Wartenberg E. Source Department of Maxillofacial Plastic Surgery, Steglitz Medical Center, Free University of Berlin, Germany.

Abstract
In an experimental study on the epigastric venous system of rats, we examined three types of venous flaps with regard to their perfusion and long-term results: arterialised venous flaps, flow-through venous flaps and venous island flaps. We documented afferent and efferent blood flow with radiolabelled substances and blood distribution with infrared thermography. By measuring the surviving flap surfaces after 4 months, the relative success rate for each flap type was determined. The results show that in the chosen model the entire surface of the arterialised venous flap had a survival rate of 92.7%, the flow-through venous flap 62.4%, and the venous island flap about 31%. The venous island flaps had the worst distribution of intravenously injected 125J-Fibrinogen, and it was significantly worse in all types of venous flaps than in standard epigastric flaps; moreover, the clearance of intracutaneously injected 99mTc was the lowest in venous island flaps. The infrared thermographic study showed that the blood in the arterialised venous flaps dispersed faster and over a larger area than in flow-through venous and island flaps. Given these results, we conclude that arterialised venous flaps are the safest form of venous flaps, whereas venous island flaps carry a high risk of partial or total necrosis.

Infrared thermography: Experience from a decade of pediatric imaging.

Infrared thermography: Experience from a decade of pediatric imaging.
Saxena AK, Willital GH. Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, Graz, A-8036, Austria

The aim of this study was to evaluate the feasibility of clinical application of infrared thermography (IRT) in the pediatric population and to identify pathological states that can be diagnosed as well as followed up using this non-invasive technique. In real time computer-assisted IRT, 483 examinations were performed over a period of 10 years from 1990-2000 on 285 patients in the pediatric age group (range 1 week-16 years) presenting with a wide range of pathologies. The temperature was measured in centigrade (degrees C), and color images obtained were computer analyzed and stored on floppy discs. IRT was found to be an excellent noninvasive tool in the follow-up of hemangiomas, vascular
malformations and digit amputations related to re implantation, burns as well as skin and vascular
growth after bio-material implants in newborns with gastroschisis and giant omphaloceles. In the
emergency room, it was a valuable tool for rapid diagnosis of extremity thrombosis, varicoceles,
inflammation, abscesses, gangrene and wound infections. In conclusion, IRT can be performed in
the pediatric age group, is non-invasive, without any biological side effects, requires no sedation or
anesthesia and can be repeated as desired for follow-ups, with objective results that can demonstrated as colored images. Periodic thermographic studies to follow progression of lesions seem to be a
useful and reproducible method.

Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity.

Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity.
Brenner M, Braun C, Oster M, Gulko PS. North Shore-LIJ Research Institute, United States.

OBJECTIVES: To determine the potential usefulness of a novel thermal imaging technology to evaluate and monitor inflammatory arthritis activity in small joints using rat models, and to determine whether thermal changes can be used to detect pre-clinical stages of synovitis.

METHODS: Three different rat strains were studied in a mono-articular model of inflammatory arthritis of the ankle induced with an intraarticular (IA) injection of complete Freund's adjuvant (CFA), and compared with the contra-lateral ankle injected with normal saline. Arthritis activity and severity scores, ankle diameters, pain related posture scores, and thermal images were obtained at ten different time-points between 0h (before induction) and day 7. The pristane-induced arthritis (PIA) model was used to study pre-clinical synovitis. 

RESULTS: Rats developed similar ankle arthritis detected 6h after the IA injection of CFA, which persisted for seven days. All ankle clinical parameters, including arthritis activity and severity scores, significantly correlated with ankle thermal imaging changes in the mono-arthritis model (P<0.003). No thermal imaging changes were detected in pre-clinical stages of PIA. However, PIA onset coincided with increased ankle thermal signature.

CONCLUSION:Thermal measurements significantly correlated with arthritis activity and severity parameters. This technology was highly sensitive and could directly measure two cardinal signs of inflammation (warmth and edema - based on ankle diameter) in an area (ankle) that is less than half the size of a human interphalangeal joint, suggesting a potential use to monitor drug responses of rheumatoid arthritis in drug trials or clinical practice.

Timing of the thermographic assessment of burns.

Timing of the thermographic assessment of burns. 

The thermographic assessment of burns using infrared imaging has previously been shown to be a useful aid in the estimation of burn depth. In this study, thermographic images of burns, obtained from 65 patients over a 4-year period, were reviewed. ... The results of this study suggest that thermography of burns, to assess depth, should be performed within 3 days following the injury.