In 1972, a group of pioneering American scientists and physicians formed the American Thermographic Society as a non-proprietary academy with the expressed purpose to share their research and develop the medical applications of infrared imaging. In 1988, the most accomplished and august among them formed the American Board of Thermology to train, examine and certify the competence of professional thermologists in medical thermology generally and in certain subspecialties. Board Certification from the American Board of Thermology is awarded only after an applicant achieves high standings as a scholar, educator, and practitioner and demonstrates competence before the Board during an oral examination. This is an achievement consistent with the certification process of other medical boards, such as the American College of Cardiology, American College of Obstetrics and Gynecology, American College of Radiology or the American College of Surgeons, and is unmatched in the field of medical thermology. Board Certification by the American Board of Thermology provides a peerage among medical professionals and certainty to regulators and the public of excellence.
The European Association of Thermology was organized to:
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In its earliest stages of development, diagnostic infrared images for breast cancer were evaluated, much like medical X-rays, by an empirical comparison of the shapes of thermal patterns with those of established disease (pattern recognition). Subsequently, important basic scientific discoveries have provided additional and more powerful means of evaluating breast thermograms for the detection of breast cancer.
The most important means by which the human body regulates its core temperature involves a mechanism of the autonomic nervous system that modulates the flow of blood to the skin. Specific metabolic abnormalities of cancer induce great increases in the production of a powerful dilator of blood vessels called nitric oxide. Other metabolites specific to cancer stimulate the development of a specific type of abnormal blood vessels (neo-angiogenic) to feed the growth of a solid cancer beyond a very small stage. These two factors cause excessive flow (hyperemia) of core body-temperature blood channeled to the cancer and produce the “Hot Spots” detected by thermal imaging, even the very smallest cancers; even pre-cancer.The most powerful means of characterizing breast cancer’s excessive flow of core body-temperature blood is to perform an adaptive functional challenge as part of a quantitative thermal imaging procedure. A brief and controlled chill experience will challenge the adaptive mechanism of the autonomic nervous system and permits the distinction of uncontrolled blood flow that can differentiate the “Hot Spots” of breast cancer from normal breast tissue.
The best developed means of an adaptive functional challenge to indicate breast cancer by quantitative thermal imaging is a one-minute immersion of the hands into cool water between two sets of images. This “cold water challenge” has been demonstrated as a powerful component of the quantitative and objective analysis performed by our expert and Board-Certified thermologist at Therma-Scan Reference Laboratory along with pattern recognition, measured temperature differentials and time-based evolution. Anything less is to ignore important scientific discoveries and risk an inadequate evaluation.
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Bibliography
Amalric R., Giraud D., Altschule C. Spitalier J.M. Value and interest of dynamic telethermography in detection of breast cancer. ACTA Thermographica 1976;1(2):89-96.
Anbar, Michael, (1994) Ch 2, p87 in QUANTITATIVE DYNAMIC TELETHERMOMETRY IN MEDICAL DIAGNOSIS AND MANAGEMENT. CRC Press. Boca Raton.
Bansul, V., Toga, H., Raj J.U. Tone dependant nitric oxide production in ovine vessels in vitro Respir Physiol 1993;93:249-260.
Bongard, O., Bounameaux H. Clinical investigation of microcirculation. Dermatology 1993;186:6-11.
Ducharme, M.B., Tikaisis P. Forearm temperature profile during transient phase of thermal stress. Eur J Appl Physiol 1992;64:395-401.
Ducharme, M.B., Tikaisis P. In vivo conductivity of the human forearm tissues. J Apply Physiol 1991;70:2682-2690.
Ducharme, M.B., VanHelder W.P., Radomski M.W. Tissue temperature profile in the human forearm during thermal stress at thermal stability. J Apply Physiol 1991;71:1973-1978.
Fargius, J., Blumberg H. Sympathetic outflow to the hand in patients with Raynaud’s phenomenon. Cardiovasc Res 1985;19:249-253.
Gallen I.W., MacDonald L.A. Effects of two methods of hand heating on body temperature, forearm blood flow, and deep venous oxygen saturation. Am J Physiol 1990;259:E639-643.
Guyton A.C. (1991) Body temperature, temperature regulation, and fever, Ch. 73 in TEXTBOOK OF MEDICAL PHYSIOLOGY, 8th Ed. Saunders.
Hoekstra P.P. The autonomic challenge and breast thermology. Thermology International 2004(14);3,106.
Houdas Y., Ring E.F.J. (1982) Heat loss and conservation, Ch 7, p1988 in HUMAN TEMPERATURE: ITS MEASUREMENT AND REGULATION, Plenum Press, New York.
Johnson C.C. The actions and toxicity of sodium nitroprusside. Arch in Pharmacodyn Ther 1929;35:480-496.
Johnson J.M., Brengelmann G.I., Hales J.R.S., Vanhoutte P.M., Wenger C.B. Regulation of cutaneous circulation. Fed. Proc. 1986;45:2841-2850.
Konerding M.A., Steinberg F. Computerized infrared thermographic and ultrastructural studies of xenotransplanted human tumors on nude mice. Thermography 1988;3:7-14.
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The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS®) is a quality assurance tool designed to standardize mammography reporting, reducing confusion in breast imaging interpretations and facilitate outcome monitoring. BI-RADS® provides a lexicon of standardized terminology, a reporting organization, a coding system and a data collection structure. Results are communicated to the referring physician in a clear fashion with a final assessment that indicates a final course of action. Results are compiled in a standardized manner that permits the maintenance and collection analysis of demographic, mammographic and outcome data. Through a medical audit and outcome monitoring, the system provides important peer review and quality assurance data to improve the quality of patient care.
https://www.acr.org/Quality-Safety/Resources/BIRADS
BI-RADS® is a registered trademark of the The American College of Radiology
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The Health Insurance Portability and Accountability Act (HIPAA) of 1996 provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.
The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.
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In 1975, the results of studies at the prestigious Pasteur University in Marseille, France, established an objective analytic system. This system has been refined by enhanced knowledge of basic science and increased clinical experience but remains the basis for breast thermology (the diagnostic science of infrared imaging) to this day.
Termed the Marseille system, this analytic method provides for a TH-1 through TH-5 scale as a summary based upon specific, objective and quantitative thermal features and differential levels of infrared energy. Thermal features are divided into Signs and Criteria based upon their established characterization of breast disease.
References:
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Thermology is the medical science that derives diagnostic indications from highly detailed and sensitive infrared images of the human body. Thermology is sometimes referred to as digital infrared imaging, diagnostic infrared imaging or tele-thermology and involves the use of highly resolute and sensitive infrared (thermographic) cameras. Thermology is a patho-physiologic discipline that is completely non-contact and involves no form of energy imparted onto or into the body. Thermology has established applications in breast oncology, cardiology/vascular medicine, chiropractic, dentistry, neurology, occupational medicine, orthopedics, pain management and veterinary medicine.
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The first electronic infrared cameras were bulky electro-mechanical-optical devices with revolving prisms and tilting mirrors run by synchronized electric motors that scanned a two dimensional image across a single point detector one point at a time. The first models required twenty minutes to completely scan a single image. These were analog instruments images and the images they produced were non-quantitative. However, they enabled a totally new means of imaging what had previously been invisible; thermal energy and with it a new world of information. Unlike visible light, infrared energy is, usually, evaluated directly from a source rather than by reflection and there are no colors inherent to infrared, just levels and those levels can be quantified in meaningful units, quantum or degrees Celsius. The very large costs involved in developing this technology were been borne by military intelligence and applied to surveillance from orbiting satellites. The first non-military application of this technology was for medicine and the first medical application was to evaluate breast cancer. While infrared imaging has been slow to integrate into common application in Medicine, the many industrial applications have, since the mid 1980’s, spurred the development of solid-state cameras focal plane array detectors; essentially thousands of individual infrared detectors on a chip. These cameras have provided great improvements in reliability. As detector technology has improved, it is possible to place more of these detector elements into the focal plane array for higher spatial resolution and improve the sensitivity of those detector elements for higher thermal resolution. There are a variety of infrared cameras available to meet the many applications that range from industrial preventive maintenance to medical diagnostic imaging and research.
Infrared imaging systems intended for medical application are regulated by the US Food and Drug Administration under Title 21, Parts 800-898 of the Code of Federal Regulations. The ‘510(k)’ provision of this regulation only requires the infrared imaging system be “substantially equivalent to devices legally marketed in interstate commerce prior to the May 28, 1976 enactment of the Medical Devices Amendment to the Federal Food, Drug and Cosmetic Act.” The rate of technological developments of infrared imaging systems in the past thirty-five years has been at least as great as the developments of the personal computer. Consider how much more powerful is the contemporary personal computer than was available in 1976 and you can appreciate the low standards by which infrared imaging systems can be legally sold as a class three medical devices.
The infrared imaging systems that are used in medical applications today fall into two categories: thermal imagers and radiometric infrared cameras.
Thermal imagers typically produce a non-calibrated (non-quantified) analog or digital output signal based upon the level of infrared energy emitted by the body. In order to obtain a temperature measurement of any point within the image, the signal output of the thermal imager must be associated to a known temperature source and requires additional hardware, including calibrated temperature reference sources (blackbody) and an offset adjustment to the imaging software running on a computer. Using the known temperature source, typically placed within the image, the thermal image must be scaled to a calibration equation that interpolates the temperature values along a mathematical curve, fit between the levels of the calibrated temperature reference sources. This interpolation process must be done continuously since thermal imagers have no built-in thermal drift compensation which causes the temperature calibration scale level to “float” over changing conditions in and around the thermal imager. Thermal imagers are speculative tools for any type of quantitative application that will become increasingly unreliable between calibrations due to thermal drift of their detectors but are marketed for medical application as they are significantly less costly.
Radiometric infrared cameras operate in a manner that is significantly different from infrared imagers. Radiometric cameras perform the quantitative thermal measurements of a patient's emitted infrared energy within the firmware of the camera by continuously calculating digital temperature measurements through a large thermal span and not just scaled to two externally calibrated temperature standards. The radiometric infrared cameras also provide for thermal drift compensation that guarantees the temperature measurements are stable and accurate at all points within the camera operating temperature range (i.e. the values do not “float” as with non-calibrated imaging cameras). Therefore, radiometric infrared cameras should be considered instruments as they produce quantified digital temperature measurements internally and output this data to the computer rather than requiring the computer’s software to perform an interpolation of the temperature values.
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Thermology Signs are:
Asymmetric and moderately hyperthermic vascular or focal patterns;
Asymmetric and moderate complexity of a vascular pattern;
Localized heat along a physical distortion of less than a quadrant of a breast (edge sign);
Lack of an adaptive response of a distinct thermal pattern to the autonomic challenge procedure.
Thermology Criteria are:
Asymmetric and significantly hyperthermic vascular or focal patterns;
Asymmetric and significant complexity of a vascular pattern;
Localized heat along a physical distortion of more than a quadrant of a breast (edge sign);
A paradoxical response of a distinct thermal pattern to the autonomic challenge procedure.
References:
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