PEDIATRICS Eur J Pediatr. 2007 Aug 30;
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 reimplantation, burns as well as skin and vascular growth after biomaterial 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.
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.
EYES Am J of Ophthalmol. 2006 Feb;141(2):322-326.
Thermal imaging study comparing phacoemulsification with the Sovereign with WhiteStar system to the Legacy with AdvanTec and NeoSoniX system. Rose AD, Kanade V. Eye Care Group, Yale University School of Medicine, Yale University School of Nursing, New Haven, Connecticut 06510-2716, USA. PURPOSE: To assess intraoperative thermal levels at the wound site during divide-and-conquer phacoemulsification with the Sovereign with WhiteStar (SWS) system or the Legacy with AdvanTec and NeoSoniX (LAD) system. DESIGN: Prospective, randomized, parallel-group, comparative study. METHODS: Twenty-six subjects from a private clinical practice underwent divide-and-conquer phacoemulsification with either the SWS system or the LAD system. CB/CF settings (60%/33% duty cycles) were utilized with SWS and 12 pulses per second with the LAD system. Key criteria assessed were peak wound-site temperature, mean temperature change at the wound site, effective phaco time, average phaco power, procedure time, amount of BSS used, and surgical complications. RESULTS: Mean temperature change at the wound site was greater for the LAD than the SWS group. There was a statistically significant difference (P=.0002) in mean peak wound temperatures, with the LAD group having higher mean peak temperatures (42.47+/-5.33 degrees C) than the SWS group (36.59+/-1.33 degrees C). Highest wound-site temperature was 51 degrees C for the LAD group and 39.3 degrees C for the SWS group. A statistically significant difference (P=.0031) in mean peak temperature was found between the LAD and SWS systems for subjects with a cataract density of 4: higher mean peak temperatures were observed for LAD patients with a cataract density of 4. CONCLUSIONS: Our findings show that phacoemulsification using the SWS system results in lower peak temperatures and less temperature change at the phaco wound site compared with the LAD system. Physiol. Meas. 2006 Apr;27(4):371-84. Epub 2006 Mar 8.
Thermography used for analysis and comparison of different cataract surgery procedures based on phacoemulsification. Corvi A, Innocenti B, Mencucci R. Dipartimento di Meccanica e Tecnologie Industriali-Universita degli Studi di Firenze, via di S. Marta 3, 50139 Firenze, Italy. Thermography has been employed to analyze and compare three cataract surgery procedures performed in vivo with phacoemulsification, namely, the Sovereign phacoemulsification system with a traditional technique, the Sovereign WhiteStar phacoemulsification system with a traditional technique and the Sovereign WhiteStar phacoemulsification system with a bimanual technique. During the entire surgical procedure, the temperature of the ocular surface was monitored. The temperature values in the area where the phaco probe was inserted in the eye were measured, and the quantities of heat transmitted to the eye in the different procedures were assessed through suitable indices. In this study the highest temperature measured for each procedure during the surgical operation was 44.9 degrees C for the Sovereign phacoemulsification system with a traditional technique, 41 degrees C for the Sovereign WhiteStar phacoemulsification system with a traditional technique and 39.5 degrees C for the Sovereign WhiteStar phacoemulsification system with a bimanual technique, which is also the surgical procedure having the lowest thermal impact on the eye, i.e., the one in which the temperature peaks are lowest in amplitude and the least amount of heat is transmitted to the eye. Thermography, used in this study as a temperature monitoring instrument, has allowed analysis to be effected through a useful and advantageous methodology, totally non-invasive as regards both surgeon and patient, and has been applied in vivo without requiring any change in the surgical procedure.
ANESTHESIOLOGY Anesth. Analg. 2006 Feb;102(2):598-604.
Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks. Galvin EM, Niehof S, Medina HJ, Zijlstra FJ, van Bommel J, Klein J, Verbrugge SJ. Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands. We designed this study to evaluate the usefulness of thermographic temperature measurement with an infrared camera, compared with patient response to cold and pinprick, as a means of assessing the success or failure of axillary blockades. Axillary blocks were performed on 25 patients undergoing surgery on the hand or forearm using a nerve stimulator technique with mepivacaine 1.5%. Pinprick and cold sensation were assessed on the operative site at 5-min intervals for 30 min. A thermographic image of the operative limb was recorded at similar time intervals. Thermographic images of the unblocked limb were taken before block placement and at 30 min. Temperature values at the operative site and unblocked limb were calculated from the thermographic images. Results revealed that thermography had higher combined values for sensitivity, specificity, and positive and negative predictive values than both cold and pinprick at all time intervals, with statistically significant differences at 15 min (thermography versus cold, P = 0.006; thermography versus pinprick, P = 0.026) and 30 min (thermography versus cold, P = 0.038; thermography versus pinprick, P = 0.040). For thermography as a method of block assessment, an optimal time of 15 min after mepivacaine local anesthetic injection gives the highest combined values for predicting a successful block (P = 0.004). We conclude that thermography provides an early and objective assessment of the success and failure of axillary regional blockades.
Eur J Appl Physiol. 2004 Oct;93(1-2):245-51.
Infrared thermography for examination of skin temperature in the dorsal hand of office workers. Gold JE, Cherniack M, Buchholz B. Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, MA 01854, Lowell, USA,
[email protected]. Reduced blood flow may contribute to the pathophysiology of upper extremity musculoskeletal disorders (UEMSD), such as tendinitis and carpal tunnel syndrome. The study objective was to characterize potential differences in cutaneous temperature, among three groups of office workers assessed by dynamic thermography following a 9-min typing challenge: those with UEMSD, with ( n=6) or without ( n=10) cold hands exacerbated by keyboard use, and control subjects ( n=12). Temperature images of the metacarpal region of the dorsal hand were obtained 1 min before typing, and during three 2-min sample periods [0-2 min (early), 3-5 min (middle), and 8-10 min (late)] after typing. Mean temperature increased from baseline levels immediately after typing by a similar magnitude, 0.7 (0.3) degrees C in controls and 0.6 (0.2) degrees C in UEMSD cases without cold hands, but only by 0.1 (0.3) degrees C in those with cold hands. Using paired t-tests for within group comparisons of mean dorsal temperature between successive imaging periods, three patterns of temperature change were apparent during 10 min following typing. Controls further increased mean temperature by 0.1 degrees C ( t-test, P=0.001) at 3-5 min posttyping before a late temperature decline of -0.3 degrees C ( t-test, P=0.04), while cases without cold hands showed no change from initial post-typing mean temperature rise during middle or late periods. In contrast, subjects with keyboard-induced cold hands had no change from initial post-typing temperature until a decrease at the late period of -0.3 degrees C ( t-test, P=0.06). Infrared thermography appears to distinguish between the three groups of subjects, with keyboard-induced cold hand symptoms presumably due, at least partially, to reduced blood flow.
Hand-Arm Vibration Syndrome Br J Surg 1999 May;86(5):694-5
Vascular surgical society of great britain and ireland: analysis of cold provocation thermography in the objective diagnosis of the hand-arm vibration syndrome. Coughlin P, Chetter IC, Kent PJ, Kester RC; St James's University Hospital, Leeds, UK. BACKGROUND: The hand-arm vibration syndrome (HAVS) is the commonest prescribed disease in the UK. Presently the diagnosis is subjective and the need for an objective investigation to support the diagnosis has been highlighted. This study analyses the potential of cold provocation thermography (CPT) to fulfil this role. METHODS: CPT was performed in ten controls (five men, five women; median age 35 (range 24-78) years) and 21 patients with HAVS (20 men, one woman; median age 45 (range 2981) years). With an infrared camera, a precooling (PC) image was taken and then, following hand cooling in water at a temperature of 5 degrees C for 1 min, further rewarming images were taken every minute for 10 min. RESULTS: Patient finger tip temperatures were significantly cooler than control temperatures at all time points (P < 0.01, Student's t test). The following Table shows the sensitivity, specificity and PPV of CPT. CONCLUSION: CPT provides strong objective evidence to support the clinical diagnosis of HAVS.
GYNECOLOGY J Urol. 2004 Oct; 172(4 Pt 1):1239-40
Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities. Gat Y, Bachar GN, Zukerman Z, Belenky A, Gorenish M. Andrology Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. PURPOSE: We evaluated the sensitivity of 3 noninvasive methods for detecting left and right varicoceles. MATERIALS AND METHODS: Three noninvasive methods for the detection of varicocele in the left and right internal spermatic veins were evaluated in 214 infertile men, namely, physical examination, scrotal contact thermography and ultrasound Doppler. Venography was used as the reference diagnosis. RESULTS: Varicocele was detected in 195 patients (91.1%), on the left side in 37 (19%), on the right side in 3 (1.5%) and bilaterally in 155 (79.5%). Scrotal contact thermography using varicoscreen proved to be the most accurate method. Sensitivity, specificity, accuracy and positive predictive value were 98.9%, 66.6%, 98.5% and 100%, respectively, for left varicocele, and 95.6%, 91.6%, 94.9% and 98%, respectively, for right varicocele. Doppler sonography was associated with the highest number of falsepositive results. Accuracy in evaluating retrograde flow was lowest for both sides for physical examination and highest for the combination of Doppler sonography and contact thermography, with a sensitivity, specificity, accuracy and positive predictive value of 100%, 33.3%, 99.0% and 98.9%, respectively, for the left side, and 97.4%, 58.3%, 90.3% and 91.1%, respectively, for the right side. In 165 (85%) of the 195 patients who underwent internal spermatic vein embolization sperm parameters were improved. CONCLUSIONS: The present study yielded 2 major findings. Thermography is more sensitive and accurate for the detection of varicocele than Doppler ultrasound and physical examination, and it can be used for screening as a single modality in infertile men. Doppler ultrasound and thermography are complementary and their combined use yields the highest sensitivity and accuracy.
Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system. Gat Y, Zukerman Z, Chakraborty J, Gornish M. Andrology Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Israel. BACKGROUND: Varicocele is a bilateral vascular disease, involving a network of collaterals and small, retroperitoneal bypasses. ... It was considered a predominantly unilateral (left-sided) disease. Its pathophysiology has not been clearly delineated and the treatments offered do not seem to be effective. ... Based on our findings (i) varicocele is a bilateral disease; (ii) the disease is expressed earlier in the left side and is more intense because the blood column is longer in the left side than the right; (iii) partial
treatment to the left side only and ignoring bypasses is not adequate to correct the problem; ... (vi) thermography alone or combined with ultrasonography with special attention to the bilaterality of the disease are the best non-invasive tools for its detection. Curr Opin Urol 2002 Mar;12(2):149-53
Scrotal imaging. Watanabe Y. Department of Radiology, Kurashiki Central Hospital, Kurashiki, Japan. Color Doppler ultrasound has been the mainstay for the evaluation of the scrotum in a variety of clinical settings. However, ultrasonography results are not always accurate or conclusive. Despite the high cost and limited availability, magnetic resonance imaging with the dynamic contrast-enhanced subtraction technique provides accurate information on morphology as well as blood flow. Infrared scrotal thermography increases accuracy in the diagnosis of varicocele. This article attempts to summarize recent advances in scrotal imaging with regard to testicular and extratesticular disorders.
RHEUMATOLOGY (Oxford). 2004 Jul;43(7):915-9. Epub 2004 May 04.
Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods. Varju G, Pieper CF, Renner JB, Kraus VB. Box 3416, Duke University Medical Center, Durham, NC 27710, USA. OBJECTIVE: Anatomical stages of digital osteoarthritis (OA) have been characterized radiographically as progressing through sequential phases from normal to osteophyte formation, progressive loss of joint space, joint erosion and joint remodelling. Our study was designed to evaluate a physiological parameter, joint surface temperature, measured with computerized digital infrared thermal imaging, and its association with sequential stages of radiographic OA (rOA). METHODS: Thermograms, radiographs and digital photographs were taken of both hands of 91 subjects with nodal hand OA. Temperature measurements were made on digits 2-5 at distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints and metacarpophalangeal (MCP) joints (2184 joints in total). We fitted a repeated measures ANCOVA model to analyse the effects of rOA on temperature, with handedness, joint group, digit and NSAID use as covariates. RESULTS: The reliability of the thermoscanning procedure was high (generalizability coefficient 0.899 for two scans performed 3 h apart). The mean joint temperature decreased with increasing rOA severity, defined by the Kellgren-Lawrence (KL) scale. The mean temperature of KL0 joints was significantly different from that of each of the other KL grades (P
