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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.