Thermal imaging in medicine
Introduction: Body temperature monitoring is one of the oldest and still one of the most basic diagnostic methods in medicine. In recent years thermal imaging has been increasingly used in measurements of body temperature for diagnostic purposes. Thermal imaging is non-invasive, non-contact method for measuring surface body temperature. Method is quick, painless and patient is not exposed to ionizing radiation or any other body burden.
Application of thermal imaging in medicine: Pathological conditions can be indicated as hyper- or hypothermic patterns in many cases. Thermal imaging is presented as a diagnostic method, which can detect such thermal anomalies. This article provides an overview of the thermal imaging applications in various fields of medicine. Thermal imaging has proven to be a suitable method for human febrile temperature screening, for the detection of sites of fractures and infections, a reliable diagnostic tool in the detection of breast cancer and determining the type of skin cancer tumour. It is useful in monitoring the course of a therapy after spinal cord injury, in the detection of food allergies and detecting complications at hemodialysis and is also very effective at the course of treatment of breast reconstruction after mastectomy. With thermal imaging is possible to determine the degrees of burns and early detection of osteomyelitis in diabetic foot phenomenon. The most common and the oldest application of thermal imaging in medicine is the field of rheumatology.
Recommendations for use and standards: Essential performance of a thermal imaging camera, measurement method, preparation of a patient and environmental conditions are very important for proper interpretation of measurement results in medical applications of thermal imaging. Standard for screening thermographs was formed for the human febrile temperature screening application.
Conclusion: Based on presented examples it is shown that thermal imaging can be widely used also in the field of medicine. Implementation of every new technology in a daily clinical practice requires large number of measurements with such equipment compared by reference method for the purpose of clinical validation. The knowledge of measurement problematics is crucial. Collaboration between physicians and engineers on multi- and interdisciplinary level is of high importance for thermal imaging to win confidence of physicians and to gain reliability as a clinical diagnostic tool.
Ring EFJ. The historical development of thermal imaging in medicine. Rheumatology 2004; 43 (6): 800-2.
Ring EFJ, McEvoy H, Jung A, Zuber J, Machin G. New standards for devices used for the measurements of human body temperature. J Med Eng Technol 2010; 34 (4): 249-53.
Evropska komisija. Direktiva 2007/51/ES glede omejitev pri trženju nekaterih merilnih naprav, vsebujočih živo srebro, 2007. Strasbourg, Francija.
Evropska komisija. Direktiva 2002/95/ES o omejevanju uporabe nekaterih nevarnih snovi v električni in elektronski opremi, 2003. Bruselj, Belgija.
Ng EY-K. A review of thermography as promising non-invasive detection modality for breast tumour. Int J Therm Sci 2008; 48: 849-59.
Pušnik I. Razvoj in analiza sistema za ovrednotenje metroloških parametrov in zagotavljanje sledljivosti brezkontaktnih termometrov [PhD Thesis]. Ljubljana: Fakulteta za elektrotehniko; 2004.
Miklavec A. Sistem za umerjanje termovizijskih kamer [PhD Thesis] Ljubljana: Fakulteta za elektrotehniko; 2011.
Hildebrandt C, Raschner C, Ammer K An Overview of Recent Application of Medical Infrared Thermography in Sports Medicine in Austria. Sensors 2010; 10: 4700-4715.
Ring EFJ, Jones BF. The Historical Development of Thermometry and Thermal Imaging in Medicine. In: Bronzino JD. Medical Devices and Systems. 3rd ed. Boca Raton: CRC press, Taylor&Francis Group; 2006. 5 p.
Ring EF, Ammer K. Infrared thermal imaging in medicine. Phys Meas 2012; 33: R33–R46
Ring EFJ, Jung A, Zuber J, Rutowski P, Kalicki B, Bajwa U. Detecting Fever in Polish Children by Infrared Thermography. 9th International Conference on Quantitative InfraRed Thermography; 2008 Jul 2-5; Krakow, Poland: 125-8.
Mercer JB, Ring EFJ. Fever screening and infrared thermal imaging: concerns and guidelines. Thermology International 2009; 19 (3): 67-9.
International Electrotechnical Comission (IEC). IEC 80601-2-59:2008 Medicinska električna oprema - 2-59. del: Posebne zahteve za osnovno varnost in bistvene lastnosti presejalnih termografov za spremljanje človekove temperature pri mrzlici, 2008. Ženeva, Švica.
Cheung BMY, Chan LS, Lauder I, Kumana CR. Detection of Human Body Temperature with Infrared Thermographic Imaging: Accuracy and Feasibility in Detection of Fever in Human Subjects. Research Fund for the Control of Infectious Diseases, Final Report 2008.
Ring EF, Ammer K. Thermal Imaging in Diseases of the Skeletal and Neuromuscular Systems. In: Diakides M, Bronzino JD, Peterson DR. Medical Infrared Imaging: Principles and Practices. 1st ed. Boca Raton: CRC press, Taylor&Francis Group; 2012. 11 p.
Qi H, Kuruganti PT, Snyder WE. Detecting Breast Cancer from Thermal Infrared Images by Asymmetry Analysis, In: Diakides M, Bronzino JD, Peterson DR. Medical Infrared Imaging: Principles and Practices. 1st ed. Boca Raton: CRC press, Taylor&Francis Group; 2012. 13 p.
Buzug TM, Schumann S, Pfaffmann L, Reinhold U, Ruhlmann J. Skin-tumour classification with functional infrared imaging. Proceedings of the 8th IASTED International Conference Signal and Image Processing; 2006 Aug 14-16; Honolulu, Hawaii, USA: 313-22.
Herman C, Cetingul M P. Quantitative visualization and detection of skin cancer using dynamic thermal imaging. J Vis Exp 2011; 51: 2679
Dub P, Drastich A, Novak Z, Riha I. Thermography in Nerve Root Diseases. Thermology International 2002; 12 (2): 76-9.
Clark AT, Mangat JS, Tay SS, King Y, Monk CJ, White PA, Ewan PW. Facial thermography is a sensitive and specific method for assessing food challenge outcome. Allergy 2007; 62: 744-9.
Allen J, Oates CP, Chishti AD, Ahmed IAM, Talbot D, Murray A. Thermography and colour duplex ultrasound assessments of arterio-venous fistula function in renal patients. Physiol Meas 2006; 27: 51-60.
De Weerd L, Weum S, Mercer J B, The value of dynamic infrared thermography (DIRT) in perforator
selection and planning of free DIEP ﬂaps. Ann Plast Surg 2009; 63: 278–83.
Renkielska A, Nowakowski A, Kaczmarek M, Ruminski J. Burn depths evaluation based on active dynamic IR thermal imaging – A preliminary study. Burns 2006; 32: 867-75.
Zalewska A, Gralewicz G, Owczarek G, Wiecek B. Thermography in psoriasis vulgaris evaluation. Proceedings of the IEEE Engineering in Medicine and Biology 27th Annual Conference; 2005 Sep 1-4; Shanghai, China: 627-30.
Harding JR, Wertheim DF, Williams RJ, Melhuish JM, Banerjee D, Harding KG. Infrared imaging in diabetic foot ulceration. Proceedings of the 20th Annual International Conference of the IEEE Engineering in Medicine and Biology Society; 1998 Oct 29 – Nov 1; Hong Kong, China: 20 (2): 916-8.
Ammer K. Cold challenge to provoke a vasospastic reaction in fingers determined by temperature measurements: a systematic review. Thermol Int 2009; 19: 109-18.
Bojkovski J, Đurđević D. Diagnostic of maxillofacial pathology. XX IMEKO World Congress Metrology for Green Growth; 2012 Sep 9−14; Busan, Republic of Korea.
Dąbrowski M, Dulski R, Żmuda S, Zaborowski P, Pogorzelski C. The use of thermovision camera to observe physiological and pathological conditions of oral cavity mucous membrane. Infrared Phys Techn 2002; 43: 265–9.
Varju G, Pieper CF, Renner JB, Kraus VB. Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods. Rheumatology 2004;43:915–9.
Jesenšek Papež B, Palfy M, Turk Z. Infrared Thermography Based on Artificial Intelligence for Carpal Tunnel Syndrome Diagnosis. J Int Med Res 2008; 36: 1363-70.
Thomas D, Siahamis G, Marion M, Boyle C. Computerised infrared thermography and isotopic bone scanning in tennis elbow. Ann Rheum Dis 1992; 51: 103-7.
Helmy A, Holdmann M, Rizkalla M. Application of Thermography for Non-Invasive Diagnosis of Thyroid Gland Disease. IEEE T Bio-Med Eng 2008; 55 (3): 1168-75.
Sefton JM, Yarar C, Berry JW, Pascoe DD. Therapeutic massage of the neck and shoulders produces changes in peripheral blood flow when assessed with dynamic infrared thermography. J Altern Complement Med 2010; 16: 723–32
Selfe J, Hardaker N, Whitaker J, Hayes C. An investigation into the effect on skin surface temperature of three cryotherapy modalities. Thermol Int 2009; 19: 121-6.
International Organization for Standardization. ISO/TR 13154:2009 ISO/TR 80600: Medical electrical equipment – Deployment, implementation and operational guidelines for indentifying febrile humans using a screening thermograph, 2009. Ženeva, Švica.
Urad RS za standardizacijo in meroslovje. Mednarodni slovar osnovnih in splošnih izrazov s področja meroslovja. Ljubljana: Urad RS za standardizacijo in meroslovje; 1999.
Geršak G, Drnovšek J. Avtomatski merilniki krvnega tlaka za domačo rabo – Ali jim lahko zaupamo? Zdrav Vest 2009; 78: 1-7.
International Electrotechnical Comission (IEC). IEC 80601-2-30:2009 Medical electrical equipment -
Part 2-30: Particular requirements for basic safety and essential performance of automated non-invasive sphygmomanometers, 2009. Geneva, Switzerland.
International Organization for Standardization (ISO). ISO 81060-2:2013 Non-invasive sphygmomanometers - Part 2: Clinical investigation of automated measurement type, 2013. Geneva, Switzerland.
International Organization for Standardization (ISO). ISO 80601-2-56:2009 Medical electrical equipment – Part 2-56: Particular requirements for basic safety and essential performance of clinical thermometers for body temperature measurement, 2009. Geneva, Switzerland.
Pušnik I, Miklavec A. Dilemmas in measurement of human body temperature. Instrum Sci Technol 2009;
Pušnik I, Drnovšek J. Infrared ear thermometers - parameters influencing their reading and accuracy. Phys Meas 2005; 26: 1075-84.
Pušnik I, van der Ham E, Drnovšek J. IR ear thermometers: what do they measure and how do they comply with the EU technical regulation?. Phys Meas 2004; 25 (3): 699-708.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.