Wednesday, January 30, 2013


Heat radiation during caloric vestibular test: Thermographic Demonstration in temporal bone experiments.
Pau HWSievert UJust TWild W.
Source
Department of Otorhinolaryngology, Medical School, University of Rostock, Germany.
Abstract
Since Barany's descriptions in 1906, cold and warm irrigations of the external ear canal have been used for unilaterally testing vestibular excitability. The fluid kinetics within the endolymph have been studied thoroughly, whereas relatively few published articles deal with the mechanisms of heat transfer from the external to the internal ear. Even though heat conduction via the bone seemed to be well established in the textbooks, Feldmann and co-workers found heat radiation to be a very important factor. Using a rather uncommon method, we tried to make this heat radiation more apparent: in temporal bone experiments, temperature distribution was followed by thermography. Temporal bone specimens were prepared in such a way that heat distributions became visible after experimental caloric irrigations of the external ear canal. Temperature changes could well be verified by changes in coloration of the 2-dimensional thermograms. Conclusions were drawn from registrations performed in 2 projections, 90 degrees to each other, allowing cautious statements about 3-dimensional distribution. The velocity of heat transfer at the very onset of the reaction can only be explained by radiation, whereas later, other mechanisms, such as conduction via the bone or convection via the middle ear gas, may have some influence. Our results support Feldmann's findings and underline the significance of radiation in the heat transfer mechanism.


Low-intensity laser irradiation improves skin circulation in patients with diabetic microangiopathy.
Schindl ASchindl MSchön HKnobler RHavelec LSchindl L.
Source
Division of Special and Environmental Dermatology, University of Vienna Medical School, Austria. andreas.schindl@akh-wien.ac.at
Abstract
OBJECTIVE:
Diabetic foot problems due to angiopathy and neuropathy account for 50% of all nontraumatic amputations and constitute a significant economic burden to society. Low-intensity laser irradiation has been shown to induce wound healing in conditions of reduced microcirculation. We investigated the influence of low-intensity laser irradiation by means of infrared thermography on skin blood circulation in diabetic patients with diabetic microangiopathy.

RESEARCH DESIGN AND METHODS:
Thirty consecutive patients with diabetic ulcers or gangrenes and elevated levels of glycosylated hemoglobin were randomized by blocks of two to receive either a single low-intensity laser irradiation with an energy density of 30 J/cm2 or a sham irradiation over both forefoot regions in a double-blind placebo-controlled clinical study. Skin blood circulation as indicated by temperature recordings over the forefoot region was detected by infraredthermography.

RESULTS:
After a single transcutaneous low-intensity laser irradiation, a statistically significant rise in skin temperature was noted (P < 0.001 by ANOVA for repeated measurements), whereas in the sham-irradiated control group, a slight but significant drop in temperature (P < 0.001) was found. Subsequently performed contrasts for comparison of measurements before and after irradiation revealed significant temperature increases at 20 min of irradiation time (P < 0.001), at the end of the irradiation (P < 0.001), and 15 min after stopping the irradiation (P < 0.001). In the sham-irradiated feet, the drop in local skin temperature was not significant at 20 min (P = 0.1), but reached significance at the end of the sham-irradiation procedure (P < 0.001) and 15 min after the end of sham irradiation (P < 0.001).
CONCLUSIONS:
The data from this first randomized double-blind placebo-controlled clinical trial demonstrate an increase in skin microcirculation due to athermic laser irradiation in patients with diabetic microangiopathy.

Tuesday, January 29, 2013


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.

Infrared thermographic imaging of normal vulva and
uterine cervix: a preliminary report.
Sikorski R, Smaga A, Paszkowski T, Walczak R; Kliniki Ginekologii II Katedry
Poloznictwa i Chorob Kobiecych Wydzialu Lekarskiego AM w Lublinie.

OBJECTIVES: To evaluate in the standardized conditions the thermal emission by normal uterine cervix and vulva.

MATERIALS AND METHODS: Infrared telethermography (ITT) was used to examine vulva and uterine cervix in 32 women aged 24-54 years without colposcopic and cytologic abnormalities.

RESULTS: The measured temperatures differed between different topographic points of vulva and uterine vaginal portio. The interindividual variability of temperatures determined at the same vulvar structures was relatively low.

CONCLUSION: The obtained results constitute a basis for further studies on thermovisual definition of
therapeutic targets in cases of vulvar and cervical lesions.

Monday, January 28, 2013


Thermatomal changes in cervical disc herniations.
Zhang HY, Kim YS, Cho YE; Department of Neurosurgery, Yongdong Severance Hospital, Yonsei College of Medicine, Seoul, Korea.
hyzhang@unitel.co.kr

Subjective symptoms of a cool or warm sensation in the arm could be shown objectively by using of
thermography with the detection of thermal change in the case of radiculopathy, including cervical disc
herniation (CDH). However, the precise location of each thermal change at CDH has not been
established in humans. This study used digital infrared thermographic imaging (DITI) for 50 controls and
115 CDH patients, analyzed the data statistically with t-test, and defined the areas of thermatomal change
in CDH C3/4, C4/5, C5/6, C6/7 and C7/T1. The temperature of the upper trunk and upper extremities of
the control group ranged from 29.8 degrees C to 32.8 degrees C. The minimal abnormal thermal
difference in the right and left upper extremities ranged from 0.1 degree C to 0.3 degree C in 99%
confidence interval. If delta T was more than 0.1 degree C, the anterior middle shoulder sector was
considered abnormal (p < 0.01). If delta T was more than 0.3 degree C, the medial upper aspect of the
forearm and dorsal aspect of the arm, some areas of the palm and anterior part of the fourth finger, and
their opposite side sectors and all dorsal aspects of fingers were considered abnormal (p < 0.01). Other
areas except those mentioned above were considered abnormal if delta T was more than 0.2 degree C (p
< 0.01). In p < 0.05, thermal change in CDH C3/4 included the posterior upper back and shoulder and the
anterior shoulder. Thermal change in CDH C4/5 included the middle and lateral aspect of the triceps
muscle, proximal radial region, the posterior medial aspect of the forearm and distal lateral forearm.
Thermal change in CDH C5/6 included the anterior aspects of the thenar, thumb and second finger and
the anterior aspects of the radial region and posterior aspects of the pararadial region. Thermal change
in CDH C6/7 included the posterior aspect of the ulnar and palmar region and the anterior aspects of the
ulnar region and some fingers. Thermal change in CDH C7/T1 included the scapula and posterior medial
aspect of the arm and the anterior medial aspect of the arm. The areas of thermal change in each CDH
included wider sensory dermatome and sympathetic dermatome There was a statistically significant
change of temperature in the areas of thermal change in all CDH patients. In conclusion, the areas of
thermal change in CDH can be helpful in diagnosing the level of disc protrusion and in detecting the
symptomatic level in multiple CDH patients.

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.

Friday, January 25, 2013


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.

Appearance of human meridian-like structure and acupoints and its time correlation by infrared thermal imaging.
Yang HQ, Xie SS, Hu XL, Chen L, Li H. Key Laboratory of OptoElectronic Science and
Technology for Medicine of Ministry of Education, Institute of Laser and OptoElectronics Technology,
Fujian Normal University, Fuzhou 350007, China.

"The meridians and acupoints of human bodies at natural condition are investigated among 30 healthy volunteers by infrared thermal imaging technique. The results give clear evidence of the existence of infrared radiant tracks along human meridian courses. The time dependent evolution of the infrared radiant track is observed for the first time. The time rhythm of acupoints is also studied. Our findings not only support the view that infrared radiant tracks along human meridian courses is a normal vital and physiological phenomenon appearing in human beings, but also offer a potential method for noninvasive diagnostic by studying the physiological function and pathological change of meridians or acupoints by means of thermography."

Thursday, January 24, 2013


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 fulfill 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 29-81) 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.

Overview of Medical Infrared Thermal Imaging

Medical Infrared Imaging is a noninvasive, adjunctive diagnostic technique that visualizes and records changes in surface skin temperature. An infrared camera is used to produce the visual image, which graphically maps the body temperature and is referred to as a thermogram. Utilization of surface temperature analysis in a clinical setting is appropriate and germane to the practice of healthcare whenever it is deemed necessary for examination of physiology. Just as it is well known that core temperature yields valuable information on the clinical status of the patient, surface temperature has been shown to produce invaluable
information on the normal and abnormal functioning of the sensory and sympathetic nervous
system, vascular system, musculoskeletal system, and local inflammatory processes.

The most well-known use of medical thermography has been an adjunctive diagnostic screening tool for the
detection of breast cancer. However, the Spectron IR medical imaging camera - with its
exceptional resolution and superior sensitivity – can be used in a variety of other areas to assess a
patient’s internal temperature and locate unusual areas of hot or warm temperatures in the body.

The Spectron IR camera can be used in the following areas:

Cancer Detection- as an adjunct to detect early signs of cancer, with the understanding that
cancerous tissue typically has a higher temperature than noncancerous tissue

Vascular Disease – thermography can be used to obtain a unique view of the blood vessels in
the body.; areas of unusual heat might indicate abnormality, while areas of usually cool
temperatures might indicate lack of circulation.

Rheumatology – the infrared detector measures variations in the temperatures of the body’s
tissues identifying problem areas

Fever Detection – thermography has been used in Asia to screen travelers for fever before
entering or leaving the country, specifically targeting SARS, H1N1 or Asian Bird Flu.

Neuromusculoskeletal Disorders – thermography has been used to detect nerve irritations and
musculoskeletal disorders and help practitioners find the source of a patient’s pain.

Thyroid Disorders – thermography can help to identify a problem with the thyroid based on
heat that is being generated by the gland leading the practitioner to test further.

Inflammatory Conditions – thermography can identify areas that produce abnormal heat
patterns possibly indicating an inflammatory condition exists for such hard to diagnose
conditions such as fibromyalgia. Both hot and cold responses may coexist if the pain associated
with an inflammation focus excites an increase in sympathetic activity. As with any evolving medical technology, there are likely many other areas that this technology could be used. However, use of the Spectron IR medical imaging system is not intended to be the sole diagnostic procedure for these conditions but rather an adjunctive screening tool to identify areas of concern contributing to the pathogenesis and diagnosis made by the practitioner.

Wednesday, January 23, 2013


Thermographic study of temperature gradient during ear surgery intervention.
 Pau HW, Fichelmann J, Wild W; HNO-Universitatsklinik und Poliklinik Rostock.

BACKGROUND: During middle ear surgery manipulations like burring, cooling with
water, suction or even screwing cause changes of temperature which should be known to the surgeon.

METHOD: An infrared thermovision device was introduced for registration.

RESULTS: Thermography is an easy way for continuously recording thermic effects during surgery. If sufficient cooling is guaranteed, no temperatures high enough to cause tissue damage or functional defects could be observed.

CONCLUSIONS: Adequate cooling provided, thermal injuries during ear surgery can be neglected.
Thermography is an easy method for answering such questions, not only in ear surgery but also in other
medical fields.

Tuesday, January 22, 2013







Thermal imaging in the detection of bowel ischemia.

Brooks JP, Perry WB, Putnam AT, Karulf RE Department of Colorectal Surgery, Wilford Hall Medical
Center, San Antonio, Texas, USA.

PURPOSE: The aim of this study was to introduce thermal imaging in the intraoperative detection of
bowel ischemia by comparing thermal imaging with conventional techniques in detecting acutely ischemic
bowel, using histologic evidence for intestinal necrosis as the standard.

METHODS: A prospective study was performed using a porcine model. Laparotomy was performed on four pigs under general anesthesia. A 25-cm segment of mid jejunum was tagged with proximal and distal sutures, and its mesentery was ligated and divided. Thermal imaging, visual inspection, Doppler ultrasound, and fluorescence with Wood's lamp after fluorescein were used to estimate the extent of bowel ischemia five minutes after ligation of the mesentery. Measurements were taken in reference to both the proximal and distal tags to obtain two data points per animal for each method. After two hours of warm ischemia, the jejunum was harvested and sectioned longitudinally. Comparisons were made between the estimated region of
necrosis for each method and microscopic evidence of necrosis.

RESULTS: Visual inspection was the only method unable to detect a difference between vascularized and devascularized bowel for each of the eight data points. Fluorescein dye missed 3 cm of ischemic bowel. Doppler ultrasound and thermal imaging were 100 percent sensitive for necrotic bowel, with thermal imaging overestimating necrosis to a greater extent than Doppler ultrasound. The positive predictive value of fluorescein dye, Doppler ultrasound, and thermal imaging for determining nonviable bowel was 91.8, 80.8, and 69.5 percent, respectively.

CONCLUSIONS: Thermal imaging has the potential to be a useful adjunct in the intraoperative determination of bowel ischemia. Further studies are indicated to study this technique.



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.

Monday, January 21, 2013


Does a doctor have to operate the imaging system or can anyone operate it? 

Any properly trained technician can operate the imaging system, but only a doctor that has been certified as a clinical thermologist should read the images.



Cooling extensive burns: Sprayed coolants can improve initial cooling management A thermography-based study

Schnell HM, Zaspel JG.

Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.

This pilot study was designed to verify whether the spraying of coolant improves initial cooling in
extensive burns. The cooling effects of 1l of sprayed water and 5l of poured water (at 22 degrees C) were
tested; 53 healthy participants were cooled for 15 min over 18% of their total body surface, twice.
Thermographic imaging measured the loss of skin temperature and assessed the homogeneity of
cooling. With sprayed coolant the mean decrease of skin temperature was significantly higher (p<0.003)
throughout the entire cooling period and more homogeneous for the first 9min (p<0.003), compared with
poured coolant. Infrared tympanic thermometry estimated core body temperature; neither poured nor
sprayed water caused hypothermia. Even with a fifth of the volume of poured water, sprayed water cooled
more efficiently. Thus, we conclude that spraying of coolant improves initial management.


Contemporary applications of infrared imaging in medical diagnostics


Contemporary applications of infrared imaging in medical diagnostics

Mikulska D. Katedra i Klinika Chorób Skórnych i Wenerycznych Pomorskiej Akademii Medycznej al.
Powstanców Wlkp. 72, 70-111 Szczecin.

INTRODUCTION: Thermal imaging is a non-contact, non-invasive diagnostic method
for study human body temperature. Therefore infra red thermal imaging finds
increasing application in clinical medicine.

PURPOSE: The aim of this paper was to present and discuss the history and applications of
thermal imaging in medicine.

MATERIAL AND METHODS: The literature dealing with the history and applications
of thermal imaging in medicine has been reviewed.

RESULTS: Medical thermography was born in 1957 when a surgeon, Dr. R. Lawson
discovered that his breast cancer patients had higher skin temperature over the cancer area.
Since the 1970's thermography has been used in many areas of medicine. Early problems
such as low detector sensitivity, but most significantly, poor training of
thermography technicians was the source of error in thermography and retarded
the acceptance of this technique until 1990. Since that time, thermographic
equipment has evolved significantly. Modern thermal imaging systems comprise
technically advanced thermal cameras coupled to computers with sophisticated
software solutions. The recorded images are now of good quality and may be
further processed to obtain reliable information. Thermography can be applied as a
diagnostic tool in oncology, allergic diseases, angiology, plastic surgery,
rheumatology, and elsewhere. Contemporary thermal imaging must be performed
according to certain principles aimed at reliability and reproducibility of results.

CONCLUSIONS:
1. Thermography is a safe, accurate and, most importantly, a noninvasive diagnostic method in clinical medicine.
2. Ignoring any of the principles worked out by the European Association of Thermology leaves thermography open to error and thus reduces acceptance of this technique in medical diagnostics.

Friday, January 18, 2013

Appearance of human meridian-like structure and acupoints and its time correlation by infrared thermal imaging


Am J Chin Med. 2007;35(2):231-40
Appearance of human meridian-like structure and acupoints and its time correlation by infrared thermal imaging.

Yang HQ, Xie SS, Hu XL, Chen L, Li H. Key Laboratory of OptoElectronic Science and
Technology for Medicine of Ministry of Education, Institute of Laser and OptoElectronics Technology,
Fujian Normal University, Fuzhou 350007, China.

"The meridians and acupoints of human bodies at natural condition are investigated among 30 healthy volunteers by infrared thermal imaging technique. The results give clear evidence of the existence of infrared radiant tracks along human meridian courses. The time dependent evolution of the infrared radiant track is observed for the first time. The time rhythm of acupoints is also studied. Our findings not only support the view that infrared radiant tracks along human meridian courses is a normal vital and physiological phenomenon appearing in human beings, but also offer a potential method for noninvasive diagnostic by studying the physiological function and pathological change of meridians or acupoints by means of thermography."


Analysis of thermal properties of wheelchair cushions with thermography


Med Biol Eng Comput 2000 Jan;38(1):31-4
Analysis of thermal properties of wheelchair cushions with thermography.

Ferrarin M, Ludwig N; Centro di Bioingegneria, Fondazione Don Carlo Gnocchi, IRCCS-Politecnico di
Milano, Italy. ferramau@mail.cbi.polimi.it

Thermal properties of wheelchair cushions have been traditionally studied with thermistor probes, which provide temperature values of limited areas (spot analysis). In this paper, we describe a novel procedure based on thermography for assessing the distribution of temperature over the entire surface of wheelchair cushions. The thermal transient during
contact with the body (heating phase) and after use (cooling phase) is considered. The procedure was
tested in four different seat cushions (with a gel pad, air-filled cells, gel-filled bubbles and foam-filled
bubbles) used by a normal subject. Observed results were compatible with the predicted outcomes based
on an analysis of the materials and structures. Specifically: (i) air-filled cushions exhibited the fastest
thermal transients, gel cushions the slowest transients, while cushions with a mixed structure exhibited
intermediate behaviour; (ii) cushions made from flat surfaces of foam exhibited the highest peak
temperatures (30.8 degrees C) as compared to those with air-filled cells (30.35 degrees C) or bubbleshaped
surfaces (29.7 degrees C); (iii) the average temperature under the thighs was significantly higher
than that under the ischiatic area in all cushions (29.6 degrees C compared with 28.7 degrees C, p <
0.05). It is shown that the present method can be used to differentiate between different cushions.
Although the 'macro-analysis' inherent in thermography appears to be suited for improving cushion
design, this approach should be further investigated to determine its reliability.


Wednesday, January 16, 2013

Intraoperative infrared imaging of brain tumors


J Neurosurg. 2004 Dec;101(6):960-9.

Intraoperative infrared imaging of brain tumors.

Gorbach AM, Heiss JD, Kopylev L, Oldfield EH.
National Institute of Neurological Disorders and Stroke, Bioengineering and Physical Science, Warren
Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-5766, USA.

Although clinical imaging defines the anatomical relationship between a brain tumor and the surrounding
brain and neurological deficits indicate the neurophysiological consequences of the tumor, the effect of a
brain tumor on vascular physiology is less clear. ... Brain tumors induce changes in cerebral blood flow (CBF) in the cortex, which can be made visible by performing infrared imaging during cranial surgery. A reduction in CBF beyond the tumor margin improves after removal of the lesion.

Intraoperative application of thermography in extracranial-intracranial bypass surgery


Neurosurgery. 2007 Apr;60(4 Suppl 2):362-5;

Intraoperative application of thermography in extracranial-intracranial bypass surgery.

Okada Y, Kawamata T, Kawashima A, Hori T Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. yokada@nij.twmu.ac.jp

OBJECTIVE: The extracranial-intracranial bypass may have the potential to improve hemodynamic cerebral ischemia caused by occlusive diseases of the main cerebral arteries. Intraoperative confirmation of effective distribution of blood flow via the donor arteries to the involved region will assure a successful bypass surgery.

METHODS: Infrared thermography was used to measure the temperature of the cortical surface at the operative field. Regional cerebral blood flow (rCBF) was measured with a laser Doppler flow meter. Changes in the cortical surface temperature before and after temporary occlusion of the bypass were compared with changes in rCBF values in the corresponding sites.

RESULTS: Thermographic examination demonstrated a heterogeneous increase of cortical surface temperature caused by the blood flow via the extracranial-intracranial bypass and was closely related to rCBF changes.

CONCLUSION: Thermography is useful not only to demonstrate the distribution of blood flow through the extracranial-intracranial bypass but also to quantitatively evaluate the rCBF changes in the operative field.

Tuesday, January 15, 2013


Breast cancer screening cannot be justified, says researcher

Book argues harm outweighs small number of lives saved, and accuses mammography supporters of misconduct

Sarah Boseley, health editor
The Guardian, Monday 23 January 2012

Women in the UK are called for breast screening every three years from the age
of 50.

Breast cancer screening can no longer be justified, because the harm to many
women from needless diagnosis and damaging treatment outweighs the small
number of lives saved, according to a book that accuses many in the scientific
establishment of misconduct in their efforts to bury the evidence of critics and
keep mammography alive.

Peter Gøtzsche, director of the independent Nordic Cochrane Collaboration, has
spent more than 10 years investigating and analysing data from the trials of
breast screening that were run, mostly in Sweden, before countries such as the
UK introduced their national programmes.

Mammography screening: truth, lies and controversy, from Radcliffe Publishing,
spells out the findings of the Nordic Cochrane group for laywomen, rather than
for scientists.

The data, Gøtzsche has maintained for more than a decade, does not support
mass screening as a preventive measure. Screening does not cut breast cancer
deaths by 30%, it saves probably one life for every 2,000 women who go for a
mammogram. But it harms 10 others. Cancerous cells that will go away again or
never progress to disease in the woman's lifetime are excised with surgery and
sometimes (six times in 10) she will lose a breast. Treatment with radiotherapy
and drugs, as well as the surgery itself, all have a heavy mental and physical
cost.

"I believe the time has come to realise that breast cancer screening programmes
can no longer be justified," Gøtzsche said. "I recommend women to do nothing
apart from attending a doctor if they notice anything themselves."

The book is published as a UK review of the evidence for breast cancer
screening, triggered by the Nordic Cochrane group's publications in scientific
journals, gets under way. In October, the cancer tsar Sir Mike Richards promised
an independent investigation of the data. It will be chaired by Sir Michael Marmot
and will include some eminent statisticians, none of whom have been involved in
the breast screening controversy before.

Richards has promised to act on its findings. "Should the independent review
conclude that the balance of harms outweighs the benefits of breast screening, I
will have no hesitation in referring the findings to the UK national screening
committee and then ministers," he wrote at the time.

Women in the UK are called for breast screening every three years from the age
of 50, and the age range is being extended to encompass all from 47 to 73. The
NHS screening programme has consistently disputed the Nordic Cochrane
Collaboration's work.

In July last year, in response to a paper that showed no difference in death rates
between similar pairs of countries that had introduced or not introduced
screening, Professor Julietta Patnick, director of the NHS cancer screening
programmes, said: "We can't comment on screening programmes in other
countries but here in England we do know that the best evidence available shows
that women aged 50-69 who are regularly screened are less likely to die from
breast cancer." She cited an estimate from the International Agency for Research
on Cancer (IARC) of the World Health Organisation which said mortality was
reduced by 35% through screening — a figure Gøtzsche disputes in his book.

Gøtzsche's book tells of personal attacks on him and on other researchers by the
pro-screening lobby, some of whom had financial interests in the continuation of
screening programmes, he alleges.

He compares screening advocates to religious believers and argues that their
hostile attitudes are harmful to scientific progress. A lot of false evidence has
been put forward to claim that the screening effect was large, he writes. Those
who tried to expose the errors came under personal attack, as if they were
blasphemers.

"I cannot help wonder why many people shrug their shoulders when they learn of
scientific misconduct and why many scientists don't care that they deceive their
readers repeatedly and betray the confidence society has bestowed on them,
whether for a political gain, for fame, for money, for getting research funding or
for any other reason. People may keep on being dishonest, may get away with it
and may publish in the same journals time and again, to the hurrahs of like minded
people who are often editors of the same journals," he writes.

Some of the screening trials were biased or badly done, the book says, for
instance by deciding on the cause of death of a woman after researchers knew
whether she had been screened for breast cancer or not. The best trials, it says,
failed to prove that lives were saved by screening.
Gøtzsche's group also found that one in three cancers detected by screening
was misdiagnosed.

Breast cancer deaths have gone down, he says, but better treatment and better aware
women, who go to the doctor as soon as they find a lump, are responsible.
Half of all breast cancers are found between screenings, he says.
Gøtzsche and his group have been highly critical of the leaflet sent to women by
the NHS screening programme, which, they say, inflates the benefits and
discounts the harms. He says he is hopeful that something good will come of the
review.

Klim McPherson, professor of public health epidemiology at Oxford University,
has been a critic of the information given to women by the NHS and is also
hopeful. He gives credit to Gøtzsche for his assiduous work over many years to
get to the truth. "His Cochrane reviews of breast cancer screening are of
extremely high quality and not to be lightly dismissed," he said.

Gøtzsche says his work is focused on helping women understand the risks and
benefits of screening. In the book, he says one of the leaders of the Swedish
trials claimed mammography was the best thing that had happened for women
during the last 3,000 years and added: "There are still people who don't like
mammography. Presumably they don't like women."

Gøtzsche sees it differently. "People who like women, and women themselves,
should no longer accept the pervasive misinformation they have consistently
been exposed to," he writes. "The collective denial and misrepresentation of facts
about over diagnosis and the little benefit there is of screening, if any, coupled
with the disregard of the principles for informed consent and national laws, may
be the biggest ethical scandal ever in health care.

"Hundreds of millions of women have been seduced into attending screening
without knowing it could harm them. This violation of their human rights is the
main reason we have done so much research on mammography screening and
also why I have written this book."

http://www.guardian.co.uk/science/2012/jan/23/breast-cancer-screening-notjustified

Specific thermographic changes during Walker 256 carcinoma development


1: Cancer Detect Prev. 2009;32(5-6):431-6. Epub 2009 Feb 20. Links

Specific thermographic changes during Walker 256 carcinoma development:
differential infrared imaging of tumor, inflammation and haematoma.

Poljak-Blazi M, Kolaric D, Jaganjac M, Zarkovic K, Skala K, Zarkovic N.
Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia.

BACKGROUND: Infrared imaging measures spatial variations in the skin
temperature aiming to determine pathological processes; hence possible use of this
non-invasive analytical method in cancer detection is emerging. 

METHODS: Infrared thermal imaging was used to detect changes in rat skin surface temperature
associated with experimental cancer development (Walker 256 carcinoma),
inflammation (upon s.c. Sephadex injection) and haematoma (provoked by s.c.
blood coagulate injection). Infrared camera with a geometric resolution of 76,800
pixels, spectral range of 8-14 microm and the minimal detectable temperature
resolution of 0.07 degrees C with spatial resolution of 0.48 mm at measuring
distance of 30 cm was used to obtain computerised thermal scans. Genuine
ThermoWEB software developed for remote internet control as open source
software was used. 

RESULTS: The raise of peripheral temperature was observed
after induction of local inflammation or haematoma. Opposite to that, transient
decrease of the skin surface temperature was observed after tumor
transplantation. Progressive growth of tumor was associated with the raise of the
skin surface temperature from the 10th day after tumor inoculation, when the
tumors developed supportive neoangiogenic blood supply, as verified by histology.

CONCLUSION: While the raise of peripheral temperature in advanced tumor was
caused by neoangiogenesis, the reduction in skin surface temperature in an early
period after tumor cell inoculation indicated a decay of transplanted tumor cells
due to the immune response and the lack of blood supply. Thus, infrared thermal
imaging may have considerable value in evaluation of the tumor development and
discrimination of cancer from inflammation and haematoma.

PMID: 19232842 [PubMed - indexed for MEDLINE]