INTRODUCTION TO HUMAN MEDICAL THERMOGRAPHY

The human body generates heat � a byproduct of metabolism � and must dissipate it
to regulate internal body temperature. The majority of metabolic heat is dispersed
into the environment by the skin surface. When viewed through a thermal imager, the
human body stands out strongly against cooler backgrounds. Variations, patterns,
and differences in skin temperature can be readily visualized. The result is a
thermogram, a graphic rendering of the pattern of infrared emissions either in
color or shades of gray showing the temperature distribution over the body�s
surface. Actual surface temperatures may be measured on the image, providing a view
of the body�s thermal pattern that is both quantitative (numerical) and qualitative
(visual).
Quantitative thermography involves the analysis of the actual temperature data of
thermograms � the �science of thermography.� Qualitative thermography � the �art of
thermography� � involves properly adjusting the image thermal span to maximize the
information presented to the human visual system. In addition, the art of
thermography includes selecting the proper equilibration time, imaging protocol,
and patient positioning to display the thermal findings. Though certain procedures
such as breast thermography are becoming routine, general thermography examinations
may be quite varied.
With the ability to display thermal changes, asymmetries, inflammation, and
anomalies, infrared imaging provides valid information to augment medical diagnosis
and research. Yet thermography may be the most misunderstood and undervalued of all
medical imaging technologies. Just as radiologists at first rejected ultrasound
imaging fifty years ago, so too they officially dismiss medical thermography today.
This misunderstanding has been largely due to the inferior infrared scanners and
substandard methodology of yore; however, much has changed in infrared imaging over
the past 25 years. No longer can thermography be regarded as an �alternative� or of
questionable medical value. Numerous peer-reviewed studies have demonstrated its
efficacy in a diverse range of conditions; practitioners around the world today are
using thermography to screen, detect, and monitor diseases.
In 1994, military infrared imager integrated circuits were declassified and
released for civilian use. By 2000, temperature-calibrated, microbolometer-based
integrated circuits coupled with microprocessors and full-color digital display
systems allowed practitioners to visualize a thermographic image in exquisite
detail, detecting features and patterns of disease and dysfunction that were
previously hidden from view. The older thermal scanner technology quickly became
obsolete. Today�s infrared imagers can detect minute variations in 10-�m (thermal)
radiation and record actual surface temperatures over large areas of the body in
one image. This book has been written to demonstrate the capabilities of these new
21st-century thermal imagers.
Human Medical Thermography was written with three primary objectives in mind: (1)
to illuminate the physics, anatomy, physiology, pathology, and clinical application
of thermal imaging; (2) to advance the use of thermal imaging by guiding
practitioners in setting up a scientific thermography service to take, format, and
interpret the images; and (3) to promote an evidence-based approach by reviewing
some of the thermography�s benefits for both clinical medicine and laboratory
research.
As a physiological imaging method, the clinical use of thermography requires a
basic understanding of the mechanisms of temperature distribution on the body
surface, as well as how and pattern variations might relate to disease. Small
differences in skin temperature can have important medical implications,
particularly in the detection of circulatory, inflammatory, neurological, and
malignant diseases.
The success of clinical thermography depends on its proper use, requiring a clear
understanding of thermal physics, imager operation, patient preparation, and the
imaging environment. Human Medical Thermography devotes considerable attention to
imager choice, care, calibration, proper imaging technique, image scaling, and
thermogram interpretation. The book highlights simple ways to choose, check, and
operate a modern thermal imager. Using software to best visualize and interpret the
images and generate professional reports is also covered.
In recent years, thermographic breast cancer screening has garnered renewed
interest due to its superior sensitivity when compared to digital mammography. This
superior sensitivity is a direct result of modern imagers and preparation
protocols. In the 1970s, breast thermography was declared to be inferior to
mammography based on a study that used thermal scanners with poor spatial and
thermal resolution. The vastly improved qualitative and quantitative thermal
findings in breast cancer patients using modern imagers suggest that a repeat of
that study is now warranted.
General Thermography, sometimes known as �full-body� thermography, is useful in the
detection and follow-up of numerous disease states. The range of possible topics is
so broad that it requires two chapters to cover. Chapter 10 explores the general
thermal appearance of common conditions and diseases addressed in a head-to-foot
order. Thermal artifacts and scams are also discussed. Chapter 11 covers the use of
thermography by various medical and surgical specialties; orthopedics,
rheumatology, ophthalmology, neurology, vascular, and surgical specialties are
featured in detail.
The terminology of thermography has changed over the years. Given the much improved
resolution of modern thermographic devices, this book will use the term imagers to
denote those systems that employ lenses that focus infrared light onto a
monolithic, two-dimensional array of temperature-sensing elements. Older
electromechanical devices relying on moving mirrors to direct the infrared rays
onto a thermal detector will be referred to as scanners. Even though these older
scanners with their inferior spatial and temperature display resolution are no
longer clinically useful, most thermography research before 2000 was performed with
those devices. The term camera is reserved here for the visual-band cameras that
are often incorporated into a modern thermal imager.
When determining the absolute temperature of a remote surface, even a modern
digital imaging system has a wide offset error band. Without a known temperature
reference in the image, a typical microbolometer imager can be off by �2.0�C
(3.6�F) and still be within the specifications for the device. Unfortunately, many
research papers offer no information on temperature calibration of the imagers or
scanners used for a particular study, and many accept the absolute surface
temperatures reported by a single instrument as accurate. As a consequence, many of
the absolute temperature measurements quoted in this book may vary considerably,
reflecting the uncalibrated data obtained in the respective studies. Quantitative
(numerical) temperature