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.
Friday, June 17, 2016
Thursday, June 16, 2016
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.
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.
Wednesday, June 15, 2016
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.
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.
Tuesday, June 14, 2016
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.
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.
Monday, June 13, 2016
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."
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."
Friday, June 10, 2016
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.
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.
Thursday, June 9, 2016
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.
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.
Wednesday, June 8, 2016
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.
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.
Tuesday, June 7, 2016
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.
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.
Monday, June 6, 2016
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.
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.
Friday, June 3, 2016
Contemporary applications of infrared imaging in medical diagnostics.
Contemporary applications of infrared imaging in medical diagnostics.
Mikulska D. Katedra i Klinika Chorób Skórnych i Wenerycznych Pomorskiej Akademii Medycznej al. Powstanców Wlkp. 72, 70-111 Szczecin.
INTRODUCTION: Thermal imaging is a non-contact, non-invasive diagnostic method for study human body temperature. Therefore infrared thermal imaging finds increasing application in clinical medicine.
PURPOSE: The aim of this paper was to present and discuss the history and applications of thermal imaging in medicine.
MATERIAL AND METHODS: The literature dealing with the history and applications of thermal imaging in medicine has been reviewed.
RESULTS: Medical thermography was born in 1957 when a surgeon, Dr. R. Lawson discovered that his breast cancer patients had higher skin temperature over the cancer area. Since the 1970's thermography has been used in many areas of medicine. Early problems such as low detector sensitivity, but most significantly, poor training of thermography technicians was the source of error in thermography and retarded the acceptance of this technique until 1990. Since that time, thermographic equipment has evolved significantly. Modern thermal imaging systems comprise
technically advanced thermal cameras coupled to computers with sophisticated software solutions. The recorded images are now of good quality and may be further processed to obtain reliable information. Thermography can be applied as a diagnostic tool in oncology, allergic diseases, angiology, plastic surgery, rheumatology, and elsewhere. Contemporary thermal imaging must be performed according to certain principles aimed at reliability and reproducibility of results.
CONCLUSIONS: 1. Thermography is a safe, accurate and, most importantly, a noninvasive diagnostic method in clinical medicine. 2. Ignoring any of the principles worked out by the European Association of Thermology leaves thermography open to error and thus reduces acceptance of this technique in medical diagnostics.
Mikulska D. Katedra i Klinika Chorób Skórnych i Wenerycznych Pomorskiej Akademii Medycznej al. Powstanców Wlkp. 72, 70-111 Szczecin.
INTRODUCTION: Thermal imaging is a non-contact, non-invasive diagnostic method for study human body temperature. Therefore infrared thermal imaging finds increasing application in clinical medicine.
PURPOSE: The aim of this paper was to present and discuss the history and applications of thermal imaging in medicine.
MATERIAL AND METHODS: The literature dealing with the history and applications of thermal imaging in medicine has been reviewed.
RESULTS: Medical thermography was born in 1957 when a surgeon, Dr. R. Lawson discovered that his breast cancer patients had higher skin temperature over the cancer area. Since the 1970's thermography has been used in many areas of medicine. Early problems such as low detector sensitivity, but most significantly, poor training of thermography technicians was the source of error in thermography and retarded the acceptance of this technique until 1990. Since that time, thermographic equipment has evolved significantly. Modern thermal imaging systems comprise
technically advanced thermal cameras coupled to computers with sophisticated software solutions. The recorded images are now of good quality and may be further processed to obtain reliable information. Thermography can be applied as a diagnostic tool in oncology, allergic diseases, angiology, plastic surgery, rheumatology, and elsewhere. Contemporary thermal imaging must be performed according to certain principles aimed at reliability and reproducibility of results.
CONCLUSIONS: 1. Thermography is a safe, accurate and, most importantly, a noninvasive diagnostic method in clinical medicine. 2. Ignoring any of the principles worked out by the European Association of Thermology leaves thermography open to error and thus reduces acceptance of this technique in medical diagnostics.
Thursday, June 2, 2016
Thermographic assessment of temporomandibular disorders symptomology during orthodontic treatment.
Thermographic assessment of temporomandibular disorders symptomology during orthodontic treatment.
McBeth SB, Gratt BM.
Source
University of California, School of Dentistry, Los Angeles, USA.
Abstract
The relationship between orthodontic treatment and temporomandibular disorder (TMD) symptoms has been the focus of many subjective studies. Objective studies are now needed. Electronic thermography (ET) has shown promise as an objective tool for assessing temporomandibular disorders. Clinical TMD examinations and ET were performed on 21 control subjects, 18 subjects undergoing orthodontic treatment, and 20 subjects with TMD pain. Standardized blinded clinical examinations that used algometry were conducted. Data were analyzed to determine the usefulness of ET as an objective measure of TMD symptoms. The ET alone identified the subjects with painful clicking TMD with a sensitivity of 87%. Subjects with no painful clicking (controls) were identified with a specificity of 86%. The ET findings also had a strong correlation with pain to muscle palpation. This study indicates that ET shows promise as an objective tool for selecting normal subjects from subjects with TMD symptoms. The ET could prove to be valuable in accessing the relationship between orthodontic treatment and TMD symptoms in future longitudinal studies.
McBeth SB, Gratt BM.
Source
University of California, School of Dentistry, Los Angeles, USA.
Abstract
The relationship between orthodontic treatment and temporomandibular disorder (TMD) symptoms has been the focus of many subjective studies. Objective studies are now needed. Electronic thermography (ET) has shown promise as an objective tool for assessing temporomandibular disorders. Clinical TMD examinations and ET were performed on 21 control subjects, 18 subjects undergoing orthodontic treatment, and 20 subjects with TMD pain. Standardized blinded clinical examinations that used algometry were conducted. Data were analyzed to determine the usefulness of ET as an objective measure of TMD symptoms. The ET alone identified the subjects with painful clicking TMD with a sensitivity of 87%. Subjects with no painful clicking (controls) were identified with a specificity of 86%. The ET findings also had a strong correlation with pain to muscle palpation. This study indicates that ET shows promise as an objective tool for selecting normal subjects from subjects with TMD symptoms. The ET could prove to be valuable in accessing the relationship between orthodontic treatment and TMD symptoms in future longitudinal studies.
Wednesday, June 1, 2016
Dynamic infrared imaging of cutaneous melanoma and normal skin in patients treated with BNCT.
Dynamic infrared imaging of cutaneous melanoma and normal skin in patients treated with BNCT.
Santa Cruz GA, Bertotti J, MarÃn J, González SJ, Gossio S, Alvarez D, Roth BM, Menéndez P, Pereira MD, Albero M, Cubau L, Orellano P, Liberman SJ.
Source
Dpto. de Instrumentación y Control, Comisión Nacional de EnergÃa Atómica, Av. del Libertador 8250 (1429), Buenos Aires, Argentina. santacr@cnea.gov.ar
Abstract
We recently initiated a program aimed to investigate the suitability of dynamic infrared imaging for following-up nodular melanoma patients treated with BNCT. The reason that makes infrared imaging attractive is the fact that it constitutes a functional and non-invasive imaging method, providing information on the normal and abnormal physiologic response of the nervous and vascular systems, as well as the local metabolic rate and inflammatory processes that ultimately appear as differences in the skin temperature. An infrared camera, with a focal plane array of 320 x 240 uncooled ferroelectric detectors is employed, which provides a video stream of the infrared emission in the 7-14 micron wavelength band. A double black-body is used as reference for absolute temperature calibration. After following a protocol for patient preparation and acclimatization, a basal study is performed. Subsequently, the anatomic region of interest is subjected to a provocation test (a cold stimulus), which induces an autonomic vasoconstriction reflex in normal structures, thus enhancing the thermal contrast due to the differences in the vasculature of the different skin regions. Radiation erythema reactions and melanoma nodules possess typically a faster temperature recovery than healthy, non-irradiated skin. However, some other non-pathological structures are also detectable by infrared imaging, (e.g. scars, vessels, arteriovenous anastomoses and injuries), thus requiring a multi-study comparison in order to discriminate the tumor signal. Besides the superficial nodules, which are readily noticeable by infrared imaging, we have detected thermal signals that are coincident with the location of non-palpable nodules, which are observable by CT and ultrasound. Diffuse regions of fast temperature recovery after a cold stimulus were observed between the third and sixth weeks post-BNCT, concurrent with the clinical manifestation of radiation erythema. The location of the erythematous visible and infrared regions is consistent with the 3D dosimetry calculations.
Santa Cruz GA, Bertotti J, MarÃn J, González SJ, Gossio S, Alvarez D, Roth BM, Menéndez P, Pereira MD, Albero M, Cubau L, Orellano P, Liberman SJ.
Source
Dpto. de Instrumentación y Control, Comisión Nacional de EnergÃa Atómica, Av. del Libertador 8250 (1429), Buenos Aires, Argentina. santacr@cnea.gov.ar
Abstract
We recently initiated a program aimed to investigate the suitability of dynamic infrared imaging for following-up nodular melanoma patients treated with BNCT. The reason that makes infrared imaging attractive is the fact that it constitutes a functional and non-invasive imaging method, providing information on the normal and abnormal physiologic response of the nervous and vascular systems, as well as the local metabolic rate and inflammatory processes that ultimately appear as differences in the skin temperature. An infrared camera, with a focal plane array of 320 x 240 uncooled ferroelectric detectors is employed, which provides a video stream of the infrared emission in the 7-14 micron wavelength band. A double black-body is used as reference for absolute temperature calibration. After following a protocol for patient preparation and acclimatization, a basal study is performed. Subsequently, the anatomic region of interest is subjected to a provocation test (a cold stimulus), which induces an autonomic vasoconstriction reflex in normal structures, thus enhancing the thermal contrast due to the differences in the vasculature of the different skin regions. Radiation erythema reactions and melanoma nodules possess typically a faster temperature recovery than healthy, non-irradiated skin. However, some other non-pathological structures are also detectable by infrared imaging, (e.g. scars, vessels, arteriovenous anastomoses and injuries), thus requiring a multi-study comparison in order to discriminate the tumor signal. Besides the superficial nodules, which are readily noticeable by infrared imaging, we have detected thermal signals that are coincident with the location of non-palpable nodules, which are observable by CT and ultrasound. Diffuse regions of fast temperature recovery after a cold stimulus were observed between the third and sixth weeks post-BNCT, concurrent with the clinical manifestation of radiation erythema. The location of the erythematous visible and infrared regions is consistent with the 3D dosimetry calculations.
Tuesday, May 31, 2016
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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.
Skin Research and Technology (Impact Factor: 1.41). 01/2013; DOI: 10.1111/srt.12032
Source: PubMed
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.
Eunjoo Choi Pyung-Bok Lee Francis Sahngun Nahm Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Skin Research and Technology (Impact Factor: 1.41). 01/2013; DOI: 10.1111/srt.12032
Source: PubMed
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.
Friday, May 20, 2016
Can rotational atherectomy cause thermal tissue damage? A study of the potential heating and thermal tissue effects of a rotational atherectomy device.
Can rotational atherectomy cause thermal tissue damage? A study of the potential heating and thermal tissue effects of a rotational atherectomy device.
Gehani AA, Rees MR; Cardiac Research Unit, Killingbeck Hospital, Leeds, United Kingdom.
PURPOSE: Thermal tissue damage (TTD) is customarily associated with some lasers. The thermal potential of rotational atherectomy (RA) devices is unknown. We investigated the temperature profile and potential TTD as well as the value of fluid flushing of an RA device.
METHODS: We used a high-resolution infrared imaging system that can detect changes as small as 0.1 degree C to measure the temperature changes at the tip of a fast RA device with and without fluid flushing. To assess TTD, segments of porcine aorta were subjected to the rotating tip under controlled conditions, stained by a special histochemical stain (picrisirius red) and examined under normal and polarized light microscopy.
RESULTS: There was significant heating of the rotating cam. The mean "peak" temperature rise was 52.8 +/- 16.9 degrees C. This was related to rotational speed; thus the "peak" temperature rise was 88.3 +/- 12.6 degrees C at 80,000 rpm and 17.3 +/- 3.8 degrees C at 20,000 rpm (p < 0.001, t-test). Fluid flushing at 18 ml/min reduced, but did not abolish, heating of the device (11.8 +/- 2.9 degrees C). A crater was observed in all segments exposed to the rotating tip. The following features were most notable: (i) A zone of "thermal" tissue damage extended radially from the crater reaching adventitia in some sections, especially at high speeds. This zone showed markedly reduced or absent birefringence. (ii) Fluid flushing of the catheter reduced the above changes but increased the incidence and extent of dissections in the media, especially when combined with high atherectomy speeds. (iii) These changes were observed in five of six specimens exposed to RA without flushing, but in only one of six with flushing (p < 0.05). (iv) None of the above changes was seen in control segments.
CONCLUSION: RA is capable of generating significant heat and potential TTD. Fluid flushing reduced heating and TTD. These findings warrant further studies in vivo, and may influence the design of atherectomy devices.
Gehani AA, Rees MR; Cardiac Research Unit, Killingbeck Hospital, Leeds, United Kingdom.
PURPOSE: Thermal tissue damage (TTD) is customarily associated with some lasers. The thermal potential of rotational atherectomy (RA) devices is unknown. We investigated the temperature profile and potential TTD as well as the value of fluid flushing of an RA device.
METHODS: We used a high-resolution infrared imaging system that can detect changes as small as 0.1 degree C to measure the temperature changes at the tip of a fast RA device with and without fluid flushing. To assess TTD, segments of porcine aorta were subjected to the rotating tip under controlled conditions, stained by a special histochemical stain (picrisirius red) and examined under normal and polarized light microscopy.
RESULTS: There was significant heating of the rotating cam. The mean "peak" temperature rise was 52.8 +/- 16.9 degrees C. This was related to rotational speed; thus the "peak" temperature rise was 88.3 +/- 12.6 degrees C at 80,000 rpm and 17.3 +/- 3.8 degrees C at 20,000 rpm (p < 0.001, t-test). Fluid flushing at 18 ml/min reduced, but did not abolish, heating of the device (11.8 +/- 2.9 degrees C). A crater was observed in all segments exposed to the rotating tip. The following features were most notable: (i) A zone of "thermal" tissue damage extended radially from the crater reaching adventitia in some sections, especially at high speeds. This zone showed markedly reduced or absent birefringence. (ii) Fluid flushing of the catheter reduced the above changes but increased the incidence and extent of dissections in the media, especially when combined with high atherectomy speeds. (iii) These changes were observed in five of six specimens exposed to RA without flushing, but in only one of six with flushing (p < 0.05). (iv) None of the above changes was seen in control segments.
CONCLUSION: RA is capable of generating significant heat and potential TTD. Fluid flushing reduced heating and TTD. These findings warrant further studies in vivo, and may influence the design of atherectomy devices.
Thursday, May 19, 2016
Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer.
Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer.
Arora N, Martins D, Ruggerio D, Tousimis E, Swistel AJ, Osborne MP, Simmons RM.
Department of Surgery, New York Presbyterian Hospital-Cornell, New York, NY, USA.
BACKGROUND: Digital infrared thermal imaging (DITI) has resurfaced in this era of modernized computer technology. Its role in the detection of breast cancer is evaluated.
METHODS: In this prospective clinical trial, 92 patients for whom a breast biopsy was recommended based on prior mammogram or ultrasound underwent DITI. Three scores were generated: an overall risk score in the screening mode, a clinical score based on patient information, and a third assessment by artificial neural network.
RESULTS: Sixty
of 94 biopsies were malignant and 34 were benign. DITI identified 58 of 60 malignancies, with 97% sensitivity, 44% specificity, and 82% negative predictive value depending on the mode used. Compared to an overall risk score of 0, a score of 3 or greater was significantly more likely to be associated with malignancy (30% vs 90%, P <.03).
CONCLUSION: DITI is a valuable adjunct to mammography and ultrasound, especially in women with dense breast parenchyma.
Arora N, Martins D, Ruggerio D, Tousimis E, Swistel AJ, Osborne MP, Simmons RM.
Department of Surgery, New York Presbyterian Hospital-Cornell, New York, NY, USA.
BACKGROUND: Digital infrared thermal imaging (DITI) has resurfaced in this era of modernized computer technology. Its role in the detection of breast cancer is evaluated.
METHODS: In this prospective clinical trial, 92 patients for whom a breast biopsy was recommended based on prior mammogram or ultrasound underwent DITI. Three scores were generated: an overall risk score in the screening mode, a clinical score based on patient information, and a third assessment by artificial neural network.
RESULTS: Sixty
of 94 biopsies were malignant and 34 were benign. DITI identified 58 of 60 malignancies, with 97% sensitivity, 44% specificity, and 82% negative predictive value depending on the mode used. Compared to an overall risk score of 0, a score of 3 or greater was significantly more likely to be associated with malignancy (30% vs 90%, P <.03).
CONCLUSION: DITI is a valuable adjunct to mammography and ultrasound, especially in women with dense breast parenchyma.
Wednesday, May 18, 2016
The analgesic efficacy of bee venom acupuncture for knee osteoarthritis: a comparative study with needle acupuncture.
The analgesic efficacy of bee venom acupuncture for knee osteoarthritis: a comparative study with needle acupuncture.
Kwon YB, Kim JH, Yoon JH, Lee JD, Han HJ, Mar WC, Beitz AJ, Lee JH. Department of Veterinary Physiology, College of Veterinary Medicine and School of Agricultural Biotechnology, Seoul National University, Suwon, Korea.
The aim of this investigation was to determine whether bee venom (BV) administered directly into an acupoint was a clinically effective and safe method for relieving the pain of patients with knee osteoarthritis (OA) as compared to traditional needle acupuncture. We evaluated the efficacy of BV acupuncture using both pain relief scores and computerized infrared thermography (IRT) following 4 weeks of BV acupuncture treatment. We observed that a significantly higher proportion of subjects receiving BV acupuncture reported substantial pain relief as compared with those receiving traditional needle acupuncture therapy. Furthermore, the IRT score was significantly improved and paralleled the level of pain relief.
Kwon YB, Kim JH, Yoon JH, Lee JD, Han HJ, Mar WC, Beitz AJ, Lee JH. Department of Veterinary Physiology, College of Veterinary Medicine and School of Agricultural Biotechnology, Seoul National University, Suwon, Korea.
The aim of this investigation was to determine whether bee venom (BV) administered directly into an acupoint was a clinically effective and safe method for relieving the pain of patients with knee osteoarthritis (OA) as compared to traditional needle acupuncture. We evaluated the efficacy of BV acupuncture using both pain relief scores and computerized infrared thermography (IRT) following 4 weeks of BV acupuncture treatment. We observed that a significantly higher proportion of subjects receiving BV acupuncture reported substantial pain relief as compared with those receiving traditional needle acupuncture therapy. Furthermore, the IRT score was significantly improved and paralleled the level of pain relief.
Friday, May 13, 2016
Thyroid diagnosis by thermogram sequence analysis.
Thyroid diagnosis by thermogram sequence analysis.
Chan FH, So AT, Kung AW, Lam FK, Yip HC. Source Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong.
Abstract
A computerized thermal imaging system for thyroid diagnosis was developed by the authors and it was discovered that the rate of changes of temperature, rather than the absolute values, associated with a sequence of thermograms could help the medical doctors to identify clinical disorders. In order to further enhance the diagnostic capabilities and speed, a new method for medical thermogram analysis has been developed that compresses a sequence of thermograms into one thermogram while retaining the important information such as the geometrical patterns of the objects and the rate of temperature changes of each pixel within the images. As motion artifacts are unavoidable when a patient undergoes minutes of thermogram recording, direct comparison between images is deemed impossible. A high speed image matching algorithm has been developed to provide an absolute geometrical foundation for pixel-to-pixel comparison. The rate of change of temperature of a particular pixel along the sequence is represented by one single parameter after a process of temperature integration which can then be converted into a corresponding gray level for display. The resultant compressed thermogram can give a clear distinction between problem areas and normal ones. Although our emphasis is on thyroid diagnosis, it is anticipated that this new technique can be applicable to other areas of a human body.
Chan FH, So AT, Kung AW, Lam FK, Yip HC. Source Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong.
Abstract
A computerized thermal imaging system for thyroid diagnosis was developed by the authors and it was discovered that the rate of changes of temperature, rather than the absolute values, associated with a sequence of thermograms could help the medical doctors to identify clinical disorders. In order to further enhance the diagnostic capabilities and speed, a new method for medical thermogram analysis has been developed that compresses a sequence of thermograms into one thermogram while retaining the important information such as the geometrical patterns of the objects and the rate of temperature changes of each pixel within the images. As motion artifacts are unavoidable when a patient undergoes minutes of thermogram recording, direct comparison between images is deemed impossible. A high speed image matching algorithm has been developed to provide an absolute geometrical foundation for pixel-to-pixel comparison. The rate of change of temperature of a particular pixel along the sequence is represented by one single parameter after a process of temperature integration which can then be converted into a corresponding gray level for display. The resultant compressed thermogram can give a clear distinction between problem areas and normal ones. Although our emphasis is on thyroid diagnosis, it is anticipated that this new technique can be applicable to other areas of a human body.
Thursday, May 12, 2016
Use of recovery-enhanced thermography to localize cutaneous perforators.
Use of recovery-enhanced thermography to localize cutaneous perforators.
Itoh Y, Arai K. Source Division of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Japan.
Abstract
Recovery-enhanced thermography implies the scanning, after cooling, of the skin surface with ice water for several seconds. Using this method, cutaneous perforators were clearly identified in constant distributions on the trunks of 12 healthy volunteers. Clinically, preoperative recovery-enhanced thermography is useful for the design of perforator-based flaps. We describe this method in detail and demonstrate its reliability with successful clinical cases.
Itoh Y, Arai K. Source Division of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Japan.
Abstract
Recovery-enhanced thermography implies the scanning, after cooling, of the skin surface with ice water for several seconds. Using this method, cutaneous perforators were clearly identified in constant distributions on the trunks of 12 healthy volunteers. Clinically, preoperative recovery-enhanced thermography is useful for the design of perforator-based flaps. We describe this method in detail and demonstrate its reliability with successful clinical cases.
Wednesday, May 11, 2016
Infrared thermography in newborns: the first hour after birth.
Infrared thermography in newborns: the first hour after birth.
Christidis I, Zotter H, Rosegger H, Engele H, Kurz R, Kerbl R. Department of Pediatrics, University of Graz, Austria.
"OBJECTIVE: It was the aim of this study to investigate the surface temperature in newborns within the first hour after delivery. Furthermore, the influence of different environmental conditions with regard to surface temperature was documented.
METHODS: Body surface temperature was recorded under several environmental conditions by use of infrared thermography. 42 newborns, all delivered at term and with weight appropriate for date, were investigated under controlled conditions.
RESULTS: The surface temperature immediately after birth shows a uniform picture of the whole body; however, it is significantly lower than the core temperature. Soon after birth, peripheral sites become cooler whereas a constant temperature is maintained at the trunk. Bathing in warm water again leads to a more even temperature profile. Radiant heaters and skin-to-skin contact with the mother are both effective methods to prevent heat loss in neonates.
CONCLUSIONS: Infrared thermography is a simple and reliable tool for the measurement of skin temperature profiles in neonates. Without the need of direct skin contact, it may be helpful for optimizing environmental conditions at delivery suites and neonatal intensive care units."
Ref. S. Karger AG, Basel
Christidis I, Zotter H, Rosegger H, Engele H, Kurz R, Kerbl R. Department of Pediatrics, University of Graz, Austria.
"OBJECTIVE: It was the aim of this study to investigate the surface temperature in newborns within the first hour after delivery. Furthermore, the influence of different environmental conditions with regard to surface temperature was documented.
METHODS: Body surface temperature was recorded under several environmental conditions by use of infrared thermography. 42 newborns, all delivered at term and with weight appropriate for date, were investigated under controlled conditions.
RESULTS: The surface temperature immediately after birth shows a uniform picture of the whole body; however, it is significantly lower than the core temperature. Soon after birth, peripheral sites become cooler whereas a constant temperature is maintained at the trunk. Bathing in warm water again leads to a more even temperature profile. Radiant heaters and skin-to-skin contact with the mother are both effective methods to prevent heat loss in neonates.
CONCLUSIONS: Infrared thermography is a simple and reliable tool for the measurement of skin temperature profiles in neonates. Without the need of direct skin contact, it may be helpful for optimizing environmental conditions at delivery suites and neonatal intensive care units."
Ref. S. Karger AG, Basel
Tuesday, May 10, 2016
Thermographic investigation of osseous stress pathology.
Thermographic investigation of osseous stress pathology.
Arthur DT, Khan MM, Barclay LC. Source Faculty of Science and Engineering, Curtin University of Technology Perth, WA 6102, AUS. masood.khan@curtin.edu.au
Abstract
The debilitating pathology of stress fracture accounts for 10% of all athletic injuries[2], with prevalence as high as 20% in modern military basic training cohorts [3]. Increasing concerns surrounding adverse effects of radiology [5], combined with the 12.5% contribution of diagnostic imaging to Australian Medicare benefits paid in 2009-10 [6], have prompted the search for alternative/adjunct electronic decision support systems[7]. Within conducive physio-anatomic milieu, thermal infrared imaging (TIRI) may feasibly be used to remotely detect and topographically map diagnostically useful signs of supra-threshold thermodynamic pathophysiology. This paper details a three month clinical pilot study into TIRI-based detection of osseous stress pathology in the lower legs of Australian Army basic trainees. A data set of over 500 TIRI's was amassed. The apparent 'normal' thermal profile of the anterior aspect of the asymptomatic lower leg is topographically defined and validated against current thermophysiological theory [8] via cadaveric dissection.
Arthur DT, Khan MM, Barclay LC. Source Faculty of Science and Engineering, Curtin University of Technology Perth, WA 6102, AUS. masood.khan@curtin.edu.au
Abstract
The debilitating pathology of stress fracture accounts for 10% of all athletic injuries[2], with prevalence as high as 20% in modern military basic training cohorts [3]. Increasing concerns surrounding adverse effects of radiology [5], combined with the 12.5% contribution of diagnostic imaging to Australian Medicare benefits paid in 2009-10 [6], have prompted the search for alternative/adjunct electronic decision support systems[7]. Within conducive physio-anatomic milieu, thermal infrared imaging (TIRI) may feasibly be used to remotely detect and topographically map diagnostically useful signs of supra-threshold thermodynamic pathophysiology. This paper details a three month clinical pilot study into TIRI-based detection of osseous stress pathology in the lower legs of Australian Army basic trainees. A data set of over 500 TIRI's was amassed. The apparent 'normal' thermal profile of the anterior aspect of the asymptomatic lower leg is topographically defined and validated against current thermophysiological theory [8] via cadaveric dissection.
Monday, May 9, 2016
Peripheral facial paralysis aided by infrared thermography.
Peripheral facial paralysis aided by infrared thermography.
We have carried out clinical observations on 34 patients with peripheral facial paralysis treated by
acupuncture therapy prescribed according to selection of treatment regimen on the basis of facial
thermogram and temperature. A comparison was made with a control group of 97 patients who received conventional acupuncture therapy only. It was found that: (1) The cure rate in the group of selecting acupoints by thermogram (hereinafter referred to as the thermography--aided treatment group) was 67.65%, with a marked improvement rate of 26.40%; while the cure rate of the conventional acupuncture treatment group (hereinafter called the conventional treatment group) was 46.39%, the marked improvement rate being 29.90%, indicating a significant difference in therapeutic efficacy between the two groups (P less than 0.02). (2) The average duration of acupuncture therapy for the thermography aided treatment group was 6.02 weeks, whereas that for the conventional treatment group, 24 weeks. There was also a significant difference between the two groups (p less than 0.01). (3) During the entire therapeutic course, 25.2 sessions of treatment were given on the average in the thermography--aided treatment group, and 78.8 sessions in the conventional treatment group, showing a very significant difference (P less than 0.001). The present thermography--aided method exhibits advantages over the conventional one in enhancing the cure rate and shortening the duration of treatment, which is worthy to be popularized in clinical practice. It is also of certain significance in standardization and scientification of acupuncture therapy.
Zhang D; Wei Z; Wen B; Gao H; Peng Y; Wang F.
We have carried out clinical observations on 34 patients with peripheral facial paralysis treated by
acupuncture therapy prescribed according to selection of treatment regimen on the basis of facial
thermogram and temperature. A comparison was made with a control group of 97 patients who received conventional acupuncture therapy only. It was found that: (1) The cure rate in the group of selecting acupoints by thermogram (hereinafter referred to as the thermography--aided treatment group) was 67.65%, with a marked improvement rate of 26.40%; while the cure rate of the conventional acupuncture treatment group (hereinafter called the conventional treatment group) was 46.39%, the marked improvement rate being 29.90%, indicating a significant difference in therapeutic efficacy between the two groups (P less than 0.02). (2) The average duration of acupuncture therapy for the thermography aided treatment group was 6.02 weeks, whereas that for the conventional treatment group, 24 weeks. There was also a significant difference between the two groups (p less than 0.01). (3) During the entire therapeutic course, 25.2 sessions of treatment were given on the average in the thermography--aided treatment group, and 78.8 sessions in the conventional treatment group, showing a very significant difference (P less than 0.001). The present thermography--aided method exhibits advantages over the conventional one in enhancing the cure rate and shortening the duration of treatment, which is worthy to be popularized in clinical practice. It is also of certain significance in standardization and scientification of acupuncture therapy.
Zhang D; Wei Z; Wen B; Gao H; Peng Y; Wang F.
Friday, May 6, 2016
Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation.
Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation.
Hakgüder A, Birtane M, Gürcan S, Kokino S, Turan FN. Source Department of Physical Medicine and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.
Abstract
BACKGROUND AND OBJECTIVES: The efficacy of low level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. Our aim was to clarify the effect of LLLT in MPS by using algometry and thermography.
STUDY DESIGN/MATERIALS AND METHODS: Sixty-two patients with MPS having an active trigger point in the neck or upper back region were randomly divided into two equal groups according to therapy applied (group 1: LLLT + stretching exercises, group 2: stretching exercises alone). The outcome measures were pain measured with visual analogue scale (VAS), algometry on the trigger point, algometric difference, thermographic difference, and thermal asymmetry. Comparison was made within and between the groups pre- and post-therapeutically and 3 weeks after therapy.
RESULTS: Mean pain values decreased more significantly in group 1 from baseline to 3 weeks follow up (7.54-3.06) while these values were 7.03-5.19 in group 2 (P < 0.05). Group comparisons revealed significant favorable differences in group 1 patients in terms of all other parameters at the first and the second evaluation post therapeutically (P < 0.05).
CONCLUSIONS: LLLT seemed to be beneficial for pain in MPS by using algometry and thermography.
Hakgüder A, Birtane M, Gürcan S, Kokino S, Turan FN. Source Department of Physical Medicine and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.
Abstract
BACKGROUND AND OBJECTIVES: The efficacy of low level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. Our aim was to clarify the effect of LLLT in MPS by using algometry and thermography.
STUDY DESIGN/MATERIALS AND METHODS: Sixty-two patients with MPS having an active trigger point in the neck or upper back region were randomly divided into two equal groups according to therapy applied (group 1: LLLT + stretching exercises, group 2: stretching exercises alone). The outcome measures were pain measured with visual analogue scale (VAS), algometry on the trigger point, algometric difference, thermographic difference, and thermal asymmetry. Comparison was made within and between the groups pre- and post-therapeutically and 3 weeks after therapy.
RESULTS: Mean pain values decreased more significantly in group 1 from baseline to 3 weeks follow up (7.54-3.06) while these values were 7.03-5.19 in group 2 (P < 0.05). Group comparisons revealed significant favorable differences in group 1 patients in terms of all other parameters at the first and the second evaluation post therapeutically (P < 0.05).
CONCLUSIONS: LLLT seemed to be beneficial for pain in MPS by using algometry and thermography.
Thursday, May 5, 2016
Analysis of thermal properties of wheelchair cushions with thermography.
Analysis of thermal properties of wheelchair cushions with thermography.
Ferrarin M, Ludwig N; Centro di Bioingegneria, Fondazione Don Carlo Gnocchi, IRCCS-Politecnico diMilano, Italy. ferramau@mail.cbi.polimi.it
Thermal properties of wheelchair cushions have been traditionally studied with thermistor probes, which provide temperature values of limited areas (spot analysis). In this paper, we describe a novel procedure based on thermography for assessing the distribution of temperature over the entire surface of wheelchair cushions. The thermal transient during contact with the body (heating phase) and after use (cooling phase) is considered. The procedure was tested in four different seat cushions (with a gel pad, air-filled cells, gel-filled bubbles and foam-filled bubbles) used by a normal subject. Observed results were compatible with the predicted outcomes based on an analysis of the materials and structures. Specifically: (i) air-filled cushions exhibited the fastest thermal transients, gel cushions the slowest transients, while cushions with a mixed structure exhibited intermediate behavior; (ii) cushions made from flat surfaces of foam exhibited the highest peak temperatures (30.8 degrees C) as compared to those with air-filled cells (30.35 degrees C) or bubble shaped surfaces (29.7 degrees C); (iii) the average temperature under the thighs was significantly higher than that under the ischiatic area in all cushions (29.6 degrees C compared with 28.7 degrees C, p <0.05). It is shown that the present method can be used to differentiate between different cushions. Although the 'macro-analysis' inherent in thermography appears to be suited for improving cushion design, this approach should be further investigated to determine its reliability.
Ferrarin M, Ludwig N; Centro di Bioingegneria, Fondazione Don Carlo Gnocchi, IRCCS-Politecnico diMilano, Italy. ferramau@mail.cbi.polimi.it
Thermal properties of wheelchair cushions have been traditionally studied with thermistor probes, which provide temperature values of limited areas (spot analysis). In this paper, we describe a novel procedure based on thermography for assessing the distribution of temperature over the entire surface of wheelchair cushions. The thermal transient during contact with the body (heating phase) and after use (cooling phase) is considered. The procedure was tested in four different seat cushions (with a gel pad, air-filled cells, gel-filled bubbles and foam-filled bubbles) used by a normal subject. Observed results were compatible with the predicted outcomes based on an analysis of the materials and structures. Specifically: (i) air-filled cushions exhibited the fastest thermal transients, gel cushions the slowest transients, while cushions with a mixed structure exhibited intermediate behavior; (ii) cushions made from flat surfaces of foam exhibited the highest peak temperatures (30.8 degrees C) as compared to those with air-filled cells (30.35 degrees C) or bubble shaped surfaces (29.7 degrees C); (iii) the average temperature under the thighs was significantly higher than that under the ischiatic area in all cushions (29.6 degrees C compared with 28.7 degrees C, p <0.05). It is shown that the present method can be used to differentiate between different cushions. Although the 'macro-analysis' inherent in thermography appears to be suited for improving cushion design, this approach should be further investigated to determine its reliability.
Wednesday, May 4, 2016
Screening for fever by remote-sensing infrared thermographic camera.
Screening for fever by remote-sensing infrared thermographic camera.
Chan LS et al.; Department of Earth Sciences, The University of Hong Kong, Hong Kong.
Following the severe acute respiratory syndrome (SARS) outbreak, remote-sensing infrared
thermography (IRT) has been advocated as a possible means of screening for fever in travelers
at airports and border crossings, but its applicability has not been established. We therefore set
out to evaluate (1) the feasibility of IRT imaging to identify subjects with fever, and (2) the optimal
instrumental configuration and validity for such testing. CONCLUSIONS: IRT readings from the
side of the face, especially from the ear at 0.5 m, yielded the most reliable, precise and consistent
estimates of conventionally determined body temperatures. Our results have important
implications for walk-through IRT scanning/screening systems at airports and border crossings,
particularly as the point prevalence of fever in such subjects would be very low.
Chan LS et al.; Department of Earth Sciences, The University of Hong Kong, Hong Kong.
Following the severe acute respiratory syndrome (SARS) outbreak, remote-sensing infrared
thermography (IRT) has been advocated as a possible means of screening for fever in travelers
at airports and border crossings, but its applicability has not been established. We therefore set
out to evaluate (1) the feasibility of IRT imaging to identify subjects with fever, and (2) the optimal
instrumental configuration and validity for such testing. CONCLUSIONS: IRT readings from the
side of the face, especially from the ear at 0.5 m, yielded the most reliable, precise and consistent
estimates of conventionally determined body temperatures. Our results have important
implications for walk-through IRT scanning/screening systems at airports and border crossings,
particularly as the point prevalence of fever in such subjects would be very low.
Monday, May 2, 2016
Facial Thermography
Facial Thermography
Allergy. 2007 Jul;62(7):744-9
Facial thermography is a sensitive and specific method for assessing food challenge outcome.
Clark AT, Mangat JS, Tay SS, King Y, Monk CJ, White PA, Ewan PW.
Department of Allergy, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, Cambridge, UK.
BACKGROUND: Oral challenge is widely used for diagnosing food allergy but variable interpretation of subjective symptoms may cause error. Facial thermography was evaluated as a novel, objective and sensitive indicator of challenge outcome.
METHODS: A total of 24 children with a history of egg allergy underwent oral challenge, which were scored positive when objective symptoms occurred or negative after all doses were consumed without reaction. Facial temperatures were recorded at baseline and 10-min intervals. The difference between mean and baseline temperature (DeltaT), maximum DeltaT during challenge (DeltaT(max)) and area under curve of DeltaT against time (DeltaTAUC) were calculated for predefined nasal, oral and forehead areas, and related to objective challenge outcome.
RESULTS: There were 13 positive and 11 negative challenges. Median nasal DeltaTAUC and DeltaT(max) were greater in positive compared with negative challenges (231- and 5-fold, respectively; P < 0.05). In positive challenges, nasal temperatures showed an early transient rise at 20 min, preceding objective symptoms at median 67 min. There was a sustained temperature increase from 60 min, which was reduced by antihistamines. A cut-off for nasal DeltaT(max) of 0.8 degrees C occurring within 20 min of the start of the challenge predicted outcome with 91% sensitivity (positive predictive value [PPV] 100%) and 100% specificity (negative predictive value [NPV] 93%). Subjective symptoms occurred in four of 13 positive and
three of 11 negative challenges.
CONCLUSIONS: Facial thermography consistently detects a significant early rise in nasal temperature during positive compared with negative food challenges, which is evident before objective symptoms occur. Thermography may therefore provide a sensitive method to determine outcome of food challenges and investigate the pathophysiology of food allergic reactions.
Allergy. 2007 Jul;62(7):744-9
Facial thermography is a sensitive and specific method for assessing food challenge outcome.
Clark AT, Mangat JS, Tay SS, King Y, Monk CJ, White PA, Ewan PW.
Department of Allergy, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, Cambridge, UK.
BACKGROUND: Oral challenge is widely used for diagnosing food allergy but variable interpretation of subjective symptoms may cause error. Facial thermography was evaluated as a novel, objective and sensitive indicator of challenge outcome.
METHODS: A total of 24 children with a history of egg allergy underwent oral challenge, which were scored positive when objective symptoms occurred or negative after all doses were consumed without reaction. Facial temperatures were recorded at baseline and 10-min intervals. The difference between mean and baseline temperature (DeltaT), maximum DeltaT during challenge (DeltaT(max)) and area under curve of DeltaT against time (DeltaTAUC) were calculated for predefined nasal, oral and forehead areas, and related to objective challenge outcome.
RESULTS: There were 13 positive and 11 negative challenges. Median nasal DeltaTAUC and DeltaT(max) were greater in positive compared with negative challenges (231- and 5-fold, respectively; P < 0.05). In positive challenges, nasal temperatures showed an early transient rise at 20 min, preceding objective symptoms at median 67 min. There was a sustained temperature increase from 60 min, which was reduced by antihistamines. A cut-off for nasal DeltaT(max) of 0.8 degrees C occurring within 20 min of the start of the challenge predicted outcome with 91% sensitivity (positive predictive value [PPV] 100%) and 100% specificity (negative predictive value [NPV] 93%). Subjective symptoms occurred in four of 13 positive and
three of 11 negative challenges.
CONCLUSIONS: Facial thermography consistently detects a significant early rise in nasal temperature during positive compared with negative food challenges, which is evident before objective symptoms occur. Thermography may therefore provide a sensitive method to determine outcome of food challenges and investigate the pathophysiology of food allergic reactions.
Friday, April 29, 2016
Foot evaluation by infrared imaging.
Foot evaluation by infrared imaging.
DiBenedetto M, Yoshida M, Sharp M, Jones B.
Source
University of Virginia, Department of Physical Medicine and Rehabilitation, 545 Ray C. Hunt Drive, Suite 240, Charlottesville, VA 22903-2981, USA.
Abstract
For better assessment of foot injury severity during basic military training, we evaluated a simple
noninvasive technique: thermography. With this infrared imaging method, we determined normal foot
parameters (from 30 soldiers before training), thermographic findings in different foot stress fractures (from 30 soldiers so diagnosed), and normal responses to abnormal stresses in 30 trainees who underwent the same training as the previous group but did not have musculoskeletal complaints. We found that normal foot thermograms show onion peel-like progressive cooling on the plantar surface, with a medially located warm center at the instep. Thermograms of injured feet show areas of increased heat, but excessive weight bearing pressures on feet, new shoes, or boots also cause increased infrared emission even without discomfort. Differentiation remains difficult; however, thermography can detect injury early. It does not reveal exact diagnoses, but its greatest benefit is easy follow-up to monitor severity and healing.
DiBenedetto M, Yoshida M, Sharp M, Jones B.
Source
University of Virginia, Department of Physical Medicine and Rehabilitation, 545 Ray C. Hunt Drive, Suite 240, Charlottesville, VA 22903-2981, USA.
Abstract
For better assessment of foot injury severity during basic military training, we evaluated a simple
noninvasive technique: thermography. With this infrared imaging method, we determined normal foot
parameters (from 30 soldiers before training), thermographic findings in different foot stress fractures (from 30 soldiers so diagnosed), and normal responses to abnormal stresses in 30 trainees who underwent the same training as the previous group but did not have musculoskeletal complaints. We found that normal foot thermograms show onion peel-like progressive cooling on the plantar surface, with a medially located warm center at the instep. Thermograms of injured feet show areas of increased heat, but excessive weight bearing pressures on feet, new shoes, or boots also cause increased infrared emission even without discomfort. Differentiation remains difficult; however, thermography can detect injury early. It does not reveal exact diagnoses, but its greatest benefit is easy follow-up to monitor severity and healing.
Thursday, April 28, 2016
Infrared thermography. Its role in dental research with particular reference to craniomandibular disorders.
Infrared thermography. Its role in dental research with particular reference to craniomandibular disorders.
Biagioni PA, Longmore RB, McGimpsey JG, Lamey PJ.
Source
School of Clinical Dentistry, Queen's University of Belfast, UK.
Abstract
The use of infrared thermography in dentistry has been minimal, principally due to technological inadequacies of previous thermal imaging systems. However, with the ever-developing advancement in technology, current systems are capable of producing real-time, highly sensitive digitized thermal images. This development has led to an increased use of infrared imaging within both medical and dental research. The present paper describes these techniques and their previous applications within dentistry, and, through the use of a pilot study, highlights possible future applications in the assessment of craniomandibular disorders.
Biagioni PA, Longmore RB, McGimpsey JG, Lamey PJ.
Source
School of Clinical Dentistry, Queen's University of Belfast, UK.
Abstract
The use of infrared thermography in dentistry has been minimal, principally due to technological inadequacies of previous thermal imaging systems. However, with the ever-developing advancement in technology, current systems are capable of producing real-time, highly sensitive digitized thermal images. This development has led to an increased use of infrared imaging within both medical and dental research. The present paper describes these techniques and their previous applications within dentistry, and, through the use of a pilot study, highlights possible future applications in the assessment of craniomandibular disorders.
Wednesday, April 27, 2016
Evaluation of provocation test monitoring palmoplantar temperature with the use of thermography for diagnosis of focal tonsillar infection in palmoplantar pustulosis.
Evaluation of
provocation test monitoring palmoplantar temperature with the use of thermography for diagnosis of focal
tonsillar infection in palmoplantar pustulosis.
Source
Department of Dermatology, Nara Medical University, 840 Shijo-cho Kashihara, 634-8522,
Nara, Japan. asadah@naramed-u.ac.jp
Abstract
BACKGROUND:
Since focal tonsillar
infections are often associated with palmoplantar pustulosis (PPP), provocation
tests have been performed for preoperative evaluation of tonsillectomy.
However, these tests have not been fully established.
OBJECTIVES:
To introduce a more sensitive operative indication for
tonsillectomy to the patients with PPP, we have monitored the temperature after
provocation tests at palmoplantar sites, as measured by thermography, and we hypothesized that this methodology may
lead to a more sensitive marker for tonsillectomy.
METHODS:
Twenty-two PPP patients with/without clinical tonsillitis were
included in this study. After mechanical tonsillar massage, using infrared thermography, we have monitored the surface temperature at
palmoplantar sites of 22 patients with PPP, five chronic tonsillitis patients
without PPP, and four healthy controls, to compare the findings with the skin
lesional outcome after tonsillectomy.
RESULTS:
There was a significant relationship between the effects of
tonsillectomy and the results of provocation tests assessed by thermography. The sensitivity, specificity, and efficiency
of the provocation tests with thermography of detecting a favorable outcome of tonsillectomy were 75.0, 83.3,
and 77.3%, respectively, while those of the provocation tests as estimated with
the conventional criteria were 37.5, 83.3, and 50.0%, respectively.
CONCLUSION:
Our results suggest that
a new indicator using non-invasive thermography for the provocation tests is useful in
predicting the effects of tonsillectomy for PPP.
Wednesday, April 20, 2016
About Complex Region Pain Syndrome
About Complex Region Pain Syndrome
“The more names the medical profession has for a condition, the less they understand it”
--Charlie April M.D. ISIS Meeting October 2006
Previously called Reflex Sympathetic Dystrophy (RSD), CRPS (called crips) is a subset of neuropathic pain that generalizes from an injury site to affect an entire extremity. It will occasionally ‘spread’ without additional injury to other parts of the body. Statistically it is a rare condition. There are considered to be about 15,000 new cases diagnosed in the United States each year, one new case for every 100,000-300,000 people. Unfortunately, CRPS is like being struck by lightning or bitten by a shark, it doesn’t matter how rare it is if it happens to you.
The condition has never been well understood by clinicians. However, a model is slowly emerging and treatment options are available for the condition.
First, it is important to understand Neuropathic Pain. While all CRPS is neuropathic, not all neuropathic pain is CRPS. Neuropathic pain occurs when nerves are injured, deteriorate, or are compressed. Some common examples are carpal tunnel syndrome, radiculopathy, or diabetic neuropathy. Common features of nerve pain are a reduction in normal ability to feel replaced with burning and shooting pain in the distribution of the affected nerve. These conditions are treated with a variety of medical tools ranging from epidural steroid injections, to physical therapy, to acupuncture and chiropractic, to pharmacologic agents, to decompressive surgeries. The hallmark of neuropathic pain is its clinical pattern of distribution along the zone of the damaged nerve or nerves.
It is also important to be aware of the difference between the inflammation of infection, tissue injury, and arthritis. Each of these conditions is similar but slightly different. The body has a way of using similar mechanisms to solve different problems. Inflammation to combat infection results in the activation of white cells, other components of the immune system and the vascular system. Inflammation to treat injury is a mechanism to clean up a damaged component of the body. In autoimmune inflammation such as rheumatoid arthritis the body actually attacks itself as if it were a foreign object. One of the components of CRPS is an inflammation that is activated by the nervous system that seems to incorporate both normal and pathologic elements of the inflammatory process.
In some fashion the sympathetic nervous system becomes involved (the old name Reflex Sympathetic Dystrophy). The primary role of the sympathetic nervous system is the regulation of blood flow into the extremities and tissues to control heat regulation, excretion of metabolites, and nutrition. In normal tissues it has no role in pain. This seems to change in CRPS with confusing series of changes in the tissues, warm and red, blue and sweaty, and rapid changes back and forth.
Compared to neuropathic pain and injury, which is very common, Complex Regional Pain is very highly unusual. For CRPS to develop linkage to the central nervous system including the brain and the spinal cord relay centers occurs. Peripheral links to the immune system and the endocrine system can occur. Changes in the involved limb take on characteristics seen when the nerve is
severely injured. Burning pain rapidly moves beyond the area of the original injury. Unpredictable changes in limb color, temperature, and sweating occur. ‘Trophic changes’, meaning unexpected swelling, atrophy, and nail bed changes occur.
Diagnosis can be relatively simple when the limb changes are obvious and far more difficult when the changes are more subtle. One of the more common mistakes is for a practioner to classify neuropathic injury as CRPS. Unfortunately there is no gold standard test for the condition. Commonly use studies in Colorado are the three phase bone scan, quantitative Sudomotor reflex testing (QSART), and infrared thermography. Sympathetic blocks are still commonly used for treatment but are not very helpful for the diagnosis. Each of the tests documents a different element of how the nervous system changes. However, the changes seen in each case can occur in other conditions. The International Association for the Study of Pain (the people who named it CRPS) has a set of clinical criteria that form the basis of clinical diagnosis and research protocols.
These include the following:
1. The presence of an initiating noxious event, or a cause of immobilization.
2. Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event.
3. Evidence at some time of edema, changes in skin blood flow, or abnormal Sudomotor activity in the region of the pain.
4. This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.
5. Criteria 2-4 must be satisfied.
Treatment of the condition has evolved rapidly of the last few years. In reality the treatment is not much different that that used for neuropathic pain. A pyramid of medications including the tricylic antidressants, older and newer anticonvulsants such as carbamazipine and pregabalin, as well as several medications directed toward the NMDA (n-methyl D aspartate) receptor are used. Pain control includes cervical or lumbar blocks, antiinflamatories, opioids, physical therapy, electrical stimulation, topical lidocaine (EMLA or Lidoderm), custom made local anesthetic creams, and even spinal cord stimulation or implantable pumps.
With recent advances in medications many cases of CRPS can be helped. STAR makes every attempt to return patients to work and to living the most normal life possible. Just as in the case of other chronic conditions such as stroke, spinal cord injury, or heart disease much of the treatment is about solving and treating the conditions that can be treated, managing the others and helping a patient come to terms with the condition.
1. CRPS: Current Diagnosis and Therapy / Eds Peter R. Wilson, Michael-Hicks, R. Normal Harden. ISBN 0-931092-55-8, IASP Press, 2005
2. Mechanisms and Mediators of Neuropathic Pain, Malberg & Chaplin, eds., Berkhauser Verlag, Sweden 2002. ISBN 3-7643-6237-5
3. Emerging Strategies for the Treatment of Neuropathic Pain, Campbell, et al eds, IASP Press Seattle 2006 ISBN 0-931092-61-2
4. Hyperalgesia: Molecular Mechanisms and Clinical Implications Brune & Handwerker, eds IASP Press Seattle 2004 ISBN 0-931092-50-7
“The more names the medical profession has for a condition, the less they understand it”
--Charlie April M.D. ISIS Meeting October 2006
Previously called Reflex Sympathetic Dystrophy (RSD), CRPS (called crips) is a subset of neuropathic pain that generalizes from an injury site to affect an entire extremity. It will occasionally ‘spread’ without additional injury to other parts of the body. Statistically it is a rare condition. There are considered to be about 15,000 new cases diagnosed in the United States each year, one new case for every 100,000-300,000 people. Unfortunately, CRPS is like being struck by lightning or bitten by a shark, it doesn’t matter how rare it is if it happens to you.
The condition has never been well understood by clinicians. However, a model is slowly emerging and treatment options are available for the condition.
First, it is important to understand Neuropathic Pain. While all CRPS is neuropathic, not all neuropathic pain is CRPS. Neuropathic pain occurs when nerves are injured, deteriorate, or are compressed. Some common examples are carpal tunnel syndrome, radiculopathy, or diabetic neuropathy. Common features of nerve pain are a reduction in normal ability to feel replaced with burning and shooting pain in the distribution of the affected nerve. These conditions are treated with a variety of medical tools ranging from epidural steroid injections, to physical therapy, to acupuncture and chiropractic, to pharmacologic agents, to decompressive surgeries. The hallmark of neuropathic pain is its clinical pattern of distribution along the zone of the damaged nerve or nerves.
It is also important to be aware of the difference between the inflammation of infection, tissue injury, and arthritis. Each of these conditions is similar but slightly different. The body has a way of using similar mechanisms to solve different problems. Inflammation to combat infection results in the activation of white cells, other components of the immune system and the vascular system. Inflammation to treat injury is a mechanism to clean up a damaged component of the body. In autoimmune inflammation such as rheumatoid arthritis the body actually attacks itself as if it were a foreign object. One of the components of CRPS is an inflammation that is activated by the nervous system that seems to incorporate both normal and pathologic elements of the inflammatory process.
In some fashion the sympathetic nervous system becomes involved (the old name Reflex Sympathetic Dystrophy). The primary role of the sympathetic nervous system is the regulation of blood flow into the extremities and tissues to control heat regulation, excretion of metabolites, and nutrition. In normal tissues it has no role in pain. This seems to change in CRPS with confusing series of changes in the tissues, warm and red, blue and sweaty, and rapid changes back and forth.
Compared to neuropathic pain and injury, which is very common, Complex Regional Pain is very highly unusual. For CRPS to develop linkage to the central nervous system including the brain and the spinal cord relay centers occurs. Peripheral links to the immune system and the endocrine system can occur. Changes in the involved limb take on characteristics seen when the nerve is
severely injured. Burning pain rapidly moves beyond the area of the original injury. Unpredictable changes in limb color, temperature, and sweating occur. ‘Trophic changes’, meaning unexpected swelling, atrophy, and nail bed changes occur.
Diagnosis can be relatively simple when the limb changes are obvious and far more difficult when the changes are more subtle. One of the more common mistakes is for a practioner to classify neuropathic injury as CRPS. Unfortunately there is no gold standard test for the condition. Commonly use studies in Colorado are the three phase bone scan, quantitative Sudomotor reflex testing (QSART), and infrared thermography. Sympathetic blocks are still commonly used for treatment but are not very helpful for the diagnosis. Each of the tests documents a different element of how the nervous system changes. However, the changes seen in each case can occur in other conditions. The International Association for the Study of Pain (the people who named it CRPS) has a set of clinical criteria that form the basis of clinical diagnosis and research protocols.
These include the following:
1. The presence of an initiating noxious event, or a cause of immobilization.
2. Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event.
3. Evidence at some time of edema, changes in skin blood flow, or abnormal Sudomotor activity in the region of the pain.
4. This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.
5. Criteria 2-4 must be satisfied.
Treatment of the condition has evolved rapidly of the last few years. In reality the treatment is not much different that that used for neuropathic pain. A pyramid of medications including the tricylic antidressants, older and newer anticonvulsants such as carbamazipine and pregabalin, as well as several medications directed toward the NMDA (n-methyl D aspartate) receptor are used. Pain control includes cervical or lumbar blocks, antiinflamatories, opioids, physical therapy, electrical stimulation, topical lidocaine (EMLA or Lidoderm), custom made local anesthetic creams, and even spinal cord stimulation or implantable pumps.
With recent advances in medications many cases of CRPS can be helped. STAR makes every attempt to return patients to work and to living the most normal life possible. Just as in the case of other chronic conditions such as stroke, spinal cord injury, or heart disease much of the treatment is about solving and treating the conditions that can be treated, managing the others and helping a patient come to terms with the condition.
1. CRPS: Current Diagnosis and Therapy / Eds Peter R. Wilson, Michael-Hicks, R. Normal Harden. ISBN 0-931092-55-8, IASP Press, 2005
2. Mechanisms and Mediators of Neuropathic Pain, Malberg & Chaplin, eds., Berkhauser Verlag, Sweden 2002. ISBN 3-7643-6237-5
3. Emerging Strategies for the Treatment of Neuropathic Pain, Campbell, et al eds, IASP Press Seattle 2006 ISBN 0-931092-61-2
4. Hyperalgesia: Molecular Mechanisms and Clinical Implications Brune & Handwerker, eds IASP Press Seattle 2004 ISBN 0-931092-50-7
Thermography and laser-Doppler flowmetry for monitoring changes in finger skin
blood flow upon cigarette smoking.
Bornmyr S, Svensson H.; Department of Clinical Physiology, Allmanna Sjukhuset, Malmo, Sweden.
Haemodynamic changes after smoking two 1.1 mg nicotine cigarettes were monitored in 24 smokers on two different occasions. Smoking caused an increase in heart rate and arterial blood pressure, whereas finger temperature as measured by thermography and finger skin blood flow as measured by laser-Doppler flowmetry (LDF) decreased. Lowest values were seen within 15 min by LDF, and after 30 min by thermography. Changes in the two methods correlated closely, however, when maximum responses during a 45-min period after smoking were compared. The wider distribution of LDF values would seem to be due to the small measuring volume which is susceptible to differences in vascular anatomy and reactivity. In both methods, responses showed a high degree of reproducibility.
blood flow upon cigarette smoking.
Bornmyr S, Svensson H.; Department of Clinical Physiology, Allmanna Sjukhuset, Malmo, Sweden.
Haemodynamic changes after smoking two 1.1 mg nicotine cigarettes were monitored in 24 smokers on two different occasions. Smoking caused an increase in heart rate and arterial blood pressure, whereas finger temperature as measured by thermography and finger skin blood flow as measured by laser-Doppler flowmetry (LDF) decreased. Lowest values were seen within 15 min by LDF, and after 30 min by thermography. Changes in the two methods correlated closely, however, when maximum responses during a 45-min period after smoking were compared. The wider distribution of LDF values would seem to be due to the small measuring volume which is susceptible to differences in vascular anatomy and reactivity. In both methods, responses showed a high degree of reproducibility.
Tuesday, April 19, 2016
Advances in breast imaging.
Advances in breast imaging.
Agnese DM. The Ohio State University, Columbus, Ohio.
Although mammography remains the most widely used tool for the early detection of breast cancers and evaluation of palpable abnormalities, a number of other imaging tools are being developed and used. Ultrasonography (US) is an excellent adjunct to conventional mammography. In addition to identifying solid and cystic abnormalities, US can often distinguish benign and malignant solid nodules. Magnetic resonance imaging (MRI) also is useful in assessing the extent of disease within the breast, particularly in women with dense breasts. MRI may be a more sensitive screening tool in women at elevated breast cancer risk. Newer techniques based on the metabolic activity of breast tumors also have been developed. One such technique is scintimammography, which uses radiolabeled tracers to detect breast malignancies. Positron emission tomography (PET), which relies on the high metabolic rate of tumors, also has been described as a method to evaluate breast disease. Other techniques, such as optical tomography and thermography, rely on angiogenesis and generated heat to identify cancers. These and other tools may help to improve both the sensitivity and specificity of cancer detection. Ideally, this improved detection results in improved outcomes in those who have breast cancer and avoidance of unnecessary procedures in those who do not.
J Biomech Eng. 2004 Apr;126(2):204-11.
Agnese DM. The Ohio State University, Columbus, Ohio.
Although mammography remains the most widely used tool for the early detection of breast cancers and evaluation of palpable abnormalities, a number of other imaging tools are being developed and used. Ultrasonography (US) is an excellent adjunct to conventional mammography. In addition to identifying solid and cystic abnormalities, US can often distinguish benign and malignant solid nodules. Magnetic resonance imaging (MRI) also is useful in assessing the extent of disease within the breast, particularly in women with dense breasts. MRI may be a more sensitive screening tool in women at elevated breast cancer risk. Newer techniques based on the metabolic activity of breast tumors also have been developed. One such technique is scintimammography, which uses radiolabeled tracers to detect breast malignancies. Positron emission tomography (PET), which relies on the high metabolic rate of tumors, also has been described as a method to evaluate breast disease. Other techniques, such as optical tomography and thermography, rely on angiogenesis and generated heat to identify cancers. These and other tools may help to improve both the sensitivity and specificity of cancer detection. Ideally, this improved detection results in improved outcomes in those who have breast cancer and avoidance of unnecessary procedures in those who do not.
J Biomech Eng. 2004 Apr;126(2):204-11.
Somatic sympathetic vasomotor changes documented by medical thermographic imaging during acupuncture analgesia.
Somatic sympathetic vasomotor changes documented by medical thermographic imaging during acupuncture analgesia.
Thomas D1, Collins S, Strauss S.
Abstract
Acupuncture is widely used for pain relief in many musculoskeletal disorders, and evidence suggests that modulation of the sympathetic nervous system responses which play an integral part in somatic pain, is an important mechanism of acupuncture action. This prospective study of 20 patients with neck and arm pain measured finger temperature, controlled by somatic sympathetic vasomotor activity before and after needle acupuncture. Responses were correlated with visual analogue scale (VAS) of pain severity. An association was found between pain relief and reduced sympathetic vasomotor activity. In 10 patients with significant reduction in visual analogue scale (VAS) pain (p less than .05), the mean change in temperature (delta t degrees C) was 0.55 (SD +/- 0.86) with significant difference in pre to post treatment temperatures (p less than .01). In 10 patients without significant pain relief on VAS scoring (p greater than .05), the mean t degrees C was 0.20 (SD +0.72) without significant difference in pre to post treatment temperatures (p greater than .05). The relevance of somatic sympathetic influences on musculoskeletal pain and modulation of sympathetic activity by acupuncture will be discussed.
Thomas D1, Collins S, Strauss S.
Abstract
Acupuncture is widely used for pain relief in many musculoskeletal disorders, and evidence suggests that modulation of the sympathetic nervous system responses which play an integral part in somatic pain, is an important mechanism of acupuncture action. This prospective study of 20 patients with neck and arm pain measured finger temperature, controlled by somatic sympathetic vasomotor activity before and after needle acupuncture. Responses were correlated with visual analogue scale (VAS) of pain severity. An association was found between pain relief and reduced sympathetic vasomotor activity. In 10 patients with significant reduction in visual analogue scale (VAS) pain (p less than .05), the mean change in temperature (delta t degrees C) was 0.55 (SD +/- 0.86) with significant difference in pre to post treatment temperatures (p less than .01). In 10 patients without significant pain relief on VAS scoring (p greater than .05), the mean t degrees C was 0.20 (SD +0.72) without significant difference in pre to post treatment temperatures (p greater than .05). The relevance of somatic sympathetic influences on musculoskeletal pain and modulation of sympathetic activity by acupuncture will be discussed.
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