Role of Thermography in Clinical Practice : Uptodate review of literature

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Role of Thermography in Clinical Practice
Up-to-date review of literature

• Jung Yul Park, M.D., Sang Dae Kim, M.D.,
• Se Hoon Kim, M.D.,Dong Joon Lim, M.D., Tae Hyung
  Cho,M.D.
• Department of Neurosurgery, Korea University,
  Medical Center

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Background

• Currently, great number of articles are published
  and cited on the literature about IT its use in
  medical fields.
• Although IR thermography had been generally
  considered a useful diagnostic tool in many
  clinical fields, its drawbacks are also numerous.
  This fact, along with others, caused it to become
  less interested and declined its use until
  recently.

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Objective

• To review its scientific proofs, causes of
  decline of its use, current limitations and
  disadvantages, up-to-dated developments and
  current status of its use in various clinical
  settings.

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Materials Methods

• Electronically searched articles in literature
  were first acquired through medline under
  headings of thermography or thermogram.
• They were more than 5000 in numbers. Retrievable
  records were 4695.
• All articles were categorized and indexed into
  various fields. Citations that contained
  controversial points on its usefulness versus
  drawbacks were collected in separate fields.

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• Sensitivity, specificity, predictive values, and
  usefulness in various clinical disorders were
  also evaluated.
• Some of drawbacks that can be overcome, along
  with possible technical improvements and
  innovative approaches that are proposed for
  future direction of medical thermography based on
  these findings are discussed.

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Results

Fig. 1. Number of articles listed in medline from
1963 to 2003(expected).
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Fig. 3. Average number of published articles per
year from each decade from sixties.
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Fig. 2. Number of published articles during last
5 years (683) from different regions of the
world.
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Diagnostic aid
97.9
3.6
Monitoring for therapeutic effect disease
progression
Fig.4. Usage of infrared thermography
diagnositc aid vs. monitoring for therapeutic
effect and disease progression.
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33.6
19.4
19.4
11.9
5.3
2.9
2.7
2.1
1.4
0.4
0.1
0.1
0.1
Fig. 5. Number of published articles categorized
according to the organ system. (n2993)
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28.2
27.5
10.6
7.0
3.5
3.0
2.4
2.2
1.5
2.4
1.4
1.5
1.8
1.1
0.7
0.4
Fig. 6. Number of published articles categorized
according to the clinical settings. (n2113)
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Fig. 7. Usage of thrmography in cases with
litigation, compensation, and disability
determination. (26/4695, 0.6)
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• Sensitivity 10.0
• Specificity 7.8
• Useful 23.9
• Not useful 0.5
• Effective 5.5
• Not effective 1.7
• Indicated 4.0
• Unsuitable 0.3

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• Positive vs Negative 10 vs 9.1
• False positive False negative
• 4.8 5.6
• Excellent vs Good vs. Poor study
• 1.7 vs 3.7 vs 1.7

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Causes of decline of IT use
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Other reasons responsible for decline of ITs
use

• Poor sensor quality
• Poor image processing techniques
• Inadequate physiological knowledge
• Indiscreet use improper interpretation with
  
• no standardized protocol
• Too much expectations no regulation

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Current IR Thermography

• Standardized protocol for image acquisition
• Better understanding of clinical physiologic
  mechanisms of various disorders pain
• Refined digital still imaging real-time
  acquisition of images using mobile sensor
  camera
• Powerful image processing 8 -11 bit , 640 X
  480 ?
• - Spatial resolution
• 1 mrad ( 1 x 1 mm at 1 m range )
  or ? ?
• - Thermal resolution gt 0.08C ?

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• Variety of techniques to augment diagnostic
  accuracy image intensification
• - dynamic, functional, image fusion
  technique
• Multiple connections for multiple viewings
• Standardized transfer retrive protocol (DICOM)
• Variety of sensors
• Better scientific proofs with modern equipment
• techniques
• Less expensive smaller size

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Six Major Advantages of IT in Medical Fields

• IT is a window to the autonomic nervous system.
• IT is a unique in that it is test of physiology.
• IT is risk-free and painless.
• IT is cost-effective.
• IT is scientifically valid.
• IT is a useful monitoring device for treatment
  efficacy disease progression.

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Role of IT for Breast Disorders

• ADVANTAGES
• - Free of radiation
• - Highly sensitive tool early vs. late
  detection (7-8yr)
• - Non-invasive and pain-free
• - Reads well regardless of breast tissue
  density
• whereas with mammography, image quality
• diminishes with breast density.
• - With serial exams, benign vs. malignant
  nature can
• be verified 

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The Role of IT in Management of Other
Disorders

• It provides diagnostic and therapeutic
  information regarding autonomic, neuromuscular,
  and neuroinflammatory changes.
• Proper teaching and understanding of
  thermoregulation helps the clinician to obtain
  indispensable information from this test
• The proper identification of hypothermic areas
  guides the clinician in management of pain, more
  accurate diagnoses, and avoidance of further
  traumatizing the already damaged nerves by
  avoiding unnecessary surgical procedures, or
  improper nerve blocks.

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Limitations Disadvantages of IT

• Superficial depth of penetration - 2.5 mm
• (Near infrared - 3 cm)
• Need for examination environment
• Various factors affecting precise measurement,
• imaging acuquisition, and interpretation
• No international standardized protocol and
• equipment

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Factors Influencing Precise Measurements
Interpretation

• Controlled ambient environment
• Good condition of photographic equipment
• Physiologic condition (e.g, age, sex)
• Types of disease
• Labile vasomotor responses dermatologic
• conditions
• Personnel taking thermography
• Expertise in interpretation

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Limitations Disadvantages of IT

• Breast Examination
  
  
• - Unable to show exact mass size
  location for biopsy purpose
• - Verification of benign vs malignant
  may be difficult
• Radiculopathy Peripheral Nerve Disorders
• - Does not provide exact information
  regarding the size
• location of lesion, chronicity, kind of
  lesions, occurrence of
• regenerative events, severity, structural
  features of lesion
• - Other conventional studies usually fail
  to correlates the degree of painful
• conditions that patients experience
• -When IT is negative, pathologic process
  (e.g., nerve root
• compression) will usually not found by
  other studies.

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Peripheral N. Injury

• Althoug EMG provides more definitive conditions
  such as CTS, IT may provide earlier changes of
  nerve entrapment or injury
• It is well documented its usefulness as
  adjunctive procedure for characterizing
  peripheral nerve injury and RSD(CRPS type I)
  more sensitive and provides more vivid changes
  following treatment.
• Its use, however, in detection and
  characterization of polyneuropathy is not yet
  established.

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Headache Impending Stroke

• IT has been extensively studied to validate its
  usefulness in detecting vascular phenomena
  associated with headache and early detection of
  stroke.
• Cluster headache characteristic pattern in
  majority
• IT has been used to study the adequacy of blood
  flow to detect decreased blood flow to the brain.
  Although it may not be the procedure of choice in
  this clinical setting, it provides asymmetricity
  in easy, noninvasive way.
• However, current technique of IT has limitation
  in penetrating the thick skull

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Pain Management 

• The anatomical tests such as MRI, CT, and
  physiological tests such as EMG and NCV tests
  have been the main diagnostic tools applied to
  the management of somatic pain.
• The above tests usually are not informative in
  the diagnosis of neuropathic pain.
• IT provides valuable information for neuropathic
  pain.

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Summary
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In progress Future Innovations

• Real time, on-line, super-dynamic IT
• Ultrafine, Super-resolution IT
• Functional, Regulated IT
• Near Infrared Tech.
• 3-Dimensional IT
• Functional IT
• Mobile IT
• Pain IT
• IT

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Current Projects

• Automated 3-D Reconstruction of Images
• Automated Diagnostic Software Using Pattern
  Recognition
• Subtraction Image Fusion Technique
• Ultra-high Resolution Continouous On-line Real
  Time Imaging
• Microthermal Sensor Probe
• Dual Monitor Display Network Connection
• Funtional Imaging with Various Stress Tests
• Applications of Near-infrared Technique

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Conclusion

• Despite many inherited limitations and
  disadvantages related to IT, authors believe that
  it can be a great tool in medical field when
  strict protocol of its use is applied in selected
  patients not only because it has several
  invaluable potential advantages but also its
  technology has been improving and many ancillary
  appealing features, along with its core
  development, are under intense investigations.

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• However, many good designed, controlled, with
  large population-based, studies with currently
  available techniques will be needed in the future
  to be considered a good, scientifically valid,
  compatible diagnostic tool that can provide
  unique and valuable information compared with
  other diagnostic modalities.

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Great Success
Great Meeting
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Thank You