Thermal Imaging in Monitoring of Laser Acupuncture – A Case Report D. Nikolovski1, Z. Steviü2 1
Biomedical Engineering and Technologies, University of Belgrade, Serbia - student 2 Technical faculty in Bor, University of Belgrade, Serbia
Abstract— Many studies show the alterations of electrical conductivity of the skin along the acupuncture points and canals or optical characterists of heat transfer after moxibustion. The aim of this paper was to compare the heat zones on the treated lower extremities with the contralateral one and to objectivize the shape of temperature curve of the pulse laser beam effect. The digital thermovisual camera Wohler IK 21 with SnapView Pro v.2.1. software package was used and the pulse laser in IR range, Ȝ=830nm. Results show that in two zones of interest - in the environment of the treated acupuncture point ST 36 and the same zone on the other non treated leg there are the same curve shapes of temperature changes during and after laser treatment. The obtained results are in accordance with the theory of needle acupuncture and it is proved on laser effects too. Keywords— thermography, thermovision, monitoring, laser, acupuncture.
which heats the acupuncture point). It has been established that the heat transfer path follows the line which matches corresponding acupuncture meridians [6]. Some authors refer that in other conditions: wave lenght and laser power, pulse effect, or applied manual needle stimulation and moxibustion is not possible to visualize energetic paths in the sense of meridians using thermography [7,8]. The lowpower lasers have photochemical effect and one of the main mechanisms of action is by taking place at the mitochondria level [9]. The effect depends on used wavelength, power radiation density and transport to target tissue in determined period of time and characteristic mode. The therapeutic effect of the pulse laser beam is reflected in tissue reparation, anti-inflammatory effect, while continuous flow gives more analgesic effects [10,11]. II. AIM OF PAPER
I. INTRODUCTION Thermography is approved as an early diagnostics method by FDA – The Food and Drug Administration of the USA and also by the Russian Academy of Sciences [1,2]. It is noncontact and harmless method which can test multiple body functions and systems. Recorded thermograms could be observing on the screen in real-time mode. Infrared radiation (IR) is a form of electromagnetic radiation with a wavelength between 0.7-1000ȝm. Thermal radiance is emitted by all objects, including bodies and it is the product of the basal metabolism, the specific organ activity and the local muscle activity. This radiance is measured on the surface of the skin and interpreted into an image called thermogram by a computer. Normal body temperature (36,60C) can be lower on the surface, depending on the fat and muscle obesity which makes resistance. Temperature changes inside the body are also reflected on the surface of the skin and those dynamics allow diagnosis of certain diseases [3]. Physical features of the acupuncture points and meridians have been examined in different ways: many studies show the alterations of electrical conductivity of the skin along the acupuncture points and canals [4,5]. Optical characterists of the acupuncture meridians are thermographicaly traced by moxibustion effects (a method
Aim of this paper was to compare the heat zones on the treated lower extremities with the contralateral one and to objectivize the shape of temperature curve of the pulse laser beam effect. III. METHODS The digital thermovisual camera Wohler IK 21, with resolution of 128x128 pixels and sensitivity of 0.10C has been used for a thermovisual recording. Its principle is based on no culled germanium thermoelectric in line detector. Chosen camera itself has an integrated infrared optics, IR radiation detector, a monitor and data storage card. It forms a thermal image by measuring IR radiation of a certain body part. Recorded thermograms have been processed using SnapView Pro v.2.1. software package, which has enabled processing, thermogram analysis and reports creating. The software performs a correction during the conversion of thermal image into a thermogram, that represents an approximation of the exact body temperature and temperature distribution on the skin surface. The camera has a wide temperature interval (0-350oC). Images are displayed on the LCD color screen, with a 10.2cm
Á. Jobbágy (Ed.): 5th European IFMBE Conference, IFMBE Proceedings 37, pp. 611–613, 2011. www.springerlink.com
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diagonal. Temperature distribution of a recorded surface is represented by variety of colours. The warmest body parts are displayed in white colour, medium temperatures in red and yellow, while blue presents cold surfaces. A chosen female patient has been properly prepared according to the thermovisual recording protocol. The basic conditions were satisfied: the room temperature was maintained in the comfort zone (230C), relative humidity (64%), the patient spent 30min at room temperature before treatment, without taking any food or drugs that may affect bloodstream and blood vessels. The pulse laser in IR range, O=830nm, with 7W power, 14Ps pulse width, 1kHz frequency has been used. The acupuncture point on the stomach acupuncture meridian was stimulated using ST 36 Zusanli, left-sided, total duration of 80s, total energy delivered of 4J/cm2. Thermovisual data recording has been done before the therapy, during the therapy after 40s, after therapy (80s), and every 3minutes in the next 15 minutes after therapy ending. The ST 36 (Zusanli) acupuncture point is placed on the stomach meridian, 3 cun below the knee, lower lateral angle of the patella and 1 cun lateral from the tuberosity tibiae. This is one of the most important points in acupuncture and represents a great regulator of the general bioenergy. It is used in neurology in motor and sensory disorders of the lower limbs, polyneuritis, hypertonia and hypotonia of the lower limbs’ muscles, in gastrointestinal disorders, so as within the rheumatic pains.
Results show (Table 1 and Fig. 3) that there are changes in the maximal temperature in the zone of the treated ST 36 point during and after therapy (A2 zone). The maximal temperature increases during the first 40s of treatment and after that it decreases. On 4th minute it is on its minimum. After that, the maximal temperature increases again and it achieves its maximum on 10th minute, when it decreases again. The same temperature curve shape is notable on the right leg (A1 zone) which was not treated.
Fig. 1 Thermogram before therapy
IV. RESULTS A 40 year old female patient was admitted to rehabilitation of lower back pain with propagation in left leg and poor peripheral circulation. These symptoms have lasted over years ago. She was treated with conventional and alternative medicine. Traditional Chinese diagnostic shows Spleen and Kidney meridian deficiency. The nuclear magnetic resonance examination of the lumbosacral spine shows discus hernia incipiens. The electromyography examination registered radiculopathia L5 – S1. A minimal temperature limit has been software determined suitable to view changes Tmin=270C. By defining this limit, the software itself makes a distribution within the given values, so the blue colored fields represent the minimal temperature fields, while the red show the maximum temperature defined. Everything outside these limits, below minimal temperature defined, the software displays black. Two zones of interest are defined: A1 and A2 in the environment of acupuncture points ST 36 Zusanli on right and left leg respectively (Fig. 1 and 2).
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Fig. 2 Thermogram after therapy
Fig. 3 Diagram of maximal zone temperatures
Thermal Imaging in Monitoring of Laser Acupuncture – A Case Report
Table 1. Maximal zone temperatures A1 zone Right leg Tmax (0C)
A2 zone Left leg Tmax (0C)
0
31.6
31.9
0.67
31.9
32.1
1.33
31.8
32.0
4.33
31.8
31.8
7.33
31.9
32.0
10.33
31.9
32.2
13.33
31.5
31.9
16.33
31.6
31.9
Zone/ Time (min)
V. DISCUSSION AND CONCLUSIONS This temperature correlation could be explained by theory of acupuncture effects on contra body limb and energy flow. This case shows the accordance with the theory of needle acupuncture and it is proved on laser effects too. The energy transfer dynamic mechanism itself along the acupuncture meridians in the human body is still not explained, and in that way represents a directive for further researches.
REFERENCES 1. 2.
UK National Screening Committee. http://www.nsc.nhs.uk/whatscreening/whatscreen_ind.htm. The National Screening Unit, the Cancer Society of New Zealand and The New Zealand Breast Cancer Foundation.Position Statement:
613 The use of thermography as a breast cancer screening or diagnostic tool. January 2005. http://www.akcansoc.org.nz/Uploads/thermopositstat.pdf 3. ɂɜɚɧɢɰɤɢɣ ȽɊ.Ɍɟɩɥɨɜɨɣ ɩɨɪɬɪɟɬ ɛɨɥɶɧɨɝɨ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ. ȼ ɧɚɭɤɟ ɫɟɝɨɞɧɹ. Ɇɨɫɤɜɚ: ɊȺɇ 2004. 4. Hobbs R. The Biophysics of Acupuncture: Emerging Patterns From Selected Studies. Medical Acupuncture. Volume 21, Number 4, 2009, Mary Ann Liebert, Inc.,DOI: 10.1089=acu.2009.0710. 5. Ahn AC, Colbert AP, Anderson BJ, Martinsen G, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical Properties of Acupuncture Points and Meridians: A Systematic Review. Bioelectromagnetics. 2008,29:245-256. 6. Schlebusch KP, Maric-Oehler W, Popp FA. Biophotonics in the infrared spectral range reveal acupuncture meridian structure of the body. J Altern Complement Med. 2005 Feb;11(1):171-3. 7. Litscher G. Infrared thermography fails to visualize stimulationinduced meridian-like structures. BioMedical Engineering OnLine 2005, 4:38 doi:10.1186/1475-925X-4-38. 8. Litscher G, Ammer K. Visualization of equipment dependent measurement errors, but not of meridian-like channels in complementary medicine – a thermographic human cadaver study. Thermology international. 2007;17(1):32-35. 9. Litscher G. High-tech laser acupuncture research. Proceedings of the 13th International Congress of European Medical Laser Association. Helsinki, Finland, 2008; 23-24 August:54-55. 10. Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or activetreatment controlled. The Lancet. 2009;374(9705):1897-1908. 11. Pejcic A, Mirkovic D. Anti-inflammatory effect of low level laser treatment on chronic periodontitis. Medical Laser Application, 2011;26:27-34. Author: Dubravka Nikolovski Institute: Biomedical Engineering and Technologies, University of Belgrade - student Street: Radoja Domanovica 28 City: Belgrade Country: Serbia Email:
[email protected]
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