For Clinics

Overview of Digital Infrared Thermal Imaging

Medical DITI is a noninvasive diagnostic technique that allows the examiner to visualise and quantify changes in skin surface temperature. An infrared scanning device is used to convert infrared radiation emitted from the skin surface into electrical impulses that are visualised in colour on a monitor. This visual image graphically maps the body temperature and is referred to as a thermogram. The spectrum of colours indicate an increase or decrease in the amount of infrared radiation being emitted from the body surface. Since there is a high degree of thermal symmetry in the normal body, subtle abnormal temperature asymmetry's can be easily identified.

Medical DITI's major clinical value is in its high sensitivity to pathology in the vascular, muscular, neural and skeletal systems and as such can contribute to the pathogenesis and diagnosis made by the clinician.

Medical DITI has been used extensively in human medicine in the U.S.A., Europe and Asia for the past 20 years. Until now, cumbersome equipment has hampered its diagnostic and economic viability. Current state of the art PC based IR technology designed specifically for clinical application has changed all this.

Clinical uses for DITI include:

  •  To detect early lesions before they are clinically evident
  •  To localise an abnormal area not previously identified, so further diagnostic tests can be performed
  •  To define the extent of a lesion of which a diagnosis has previously been made
  •  To monitor the healing process before the patient is returned to work or training.

Skin blood flow is under the control of the sympathetic nervous system. In normal people there is a symmetrical dermal pattern which is consistent and reproducible for any individual. This is recorded in precise detail with a temperature sensitivity of 0.01°C by DITI.

The neuro-thermography application of DITI measures the somatic component of the sympathetic nervous system by assessing dermal blood flow. The sympathetic nervous system is stimulated at the same anatomical location as its sensory counterpart and produces a 'somato sympathetic response'. The somato sympathetic response appears on DITI as a localised area of altered temperature with specific features for each anatomical lesion.

The mean temperature differential in peripheral nerve injury is 1.5°C. In sympathetic dysfunction's (RSD / SMP / CRPS) temperature differentials ranging from 1° C to 10° C depending on severity are not uncommon. Rheumatological processes generally appear as 'hot areas' with increased temperature patterns. The pathology is generally an inflammatory process, i.e. synovitis of joints and tendon sheaths, epicondylitis, capsular and muscle injuries, etc.

Both hot and cold responses may co exist if the pain associated with an inflammatory focus excites an increase in sympathetic activity. Also, vascular conditions are readily demonstrated by DITI including Raynauds, Vasculitis, Limb Ischemia, DVT, etc.

Medical DITI is filling the gap in clinical diagnosis ...

  • X ray, C.T. Ultrasound and M.R.I. etc., are tests of anatomy.
  • E.M.G. is a test of motor physiology.
  • DITI is unique in its capability to show physiological change and metabolic processes. It has also proven to be a very useful complementary procedure to other diagnostic modalities.

Unlike most diagnostic modalities DITI is non invasive. It is a very sensitive and reliable means of graphically mapping and displaying skin surface temperature. With DITI you can diagnosis, evaluate, monitor and document a large number of injuries and conditions, including soft tissue injuries and sensory/autonomic nerve fibre dysfunction.

Medical DITI can offer considerable financial savings by avoiding the need for more expensive investigations.

Medical DITI can graphically display the very subjective feeling of pain by objectively displaying the changes in skin surface temperature that accompany pain states.

Medical DITI can show a combined effect of the autonomic nervous system and the vascular system, down to capillary dysfunctions. The effects of these changes show as asymmetry's in temperature distribution on the surface of the body.

Medical DITI is a monitor of thermal abnormalities present in a number of diseases and physical injuries. It is used as an aid for diagnosis and prognosis, as well as therapy follow up and rehabilitation monitoring, within clinical fields that include Rheumatology, neurology, physiotherapy, sports medicine, oncology, pediatrics, orthopedics and many others.

Results obtained with medical DITI systems are totally objective and show excellent correlation with other diagnostic tests.

See your patients in a different light! 
 


Short Case Histories

Plantar feet
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  Complex Regional Pain Syndrome right foot, significant increase in sympathetic motor tone right foot 3.7°c colder than left foot. A cold stress test was positive, (no sympathetic change).

CRPS developed in the right foot after a fractured calcaneum 18 months previously. Weight bearing was painful. The diagnosis of CRPS was missed initially since nuclear imaging was not typical of CRPS.

Some cases of CRPS are misdiagnosed as psychological or hysterical pain states. Thermography is able to show characteristic changes if utilised.

A 32 year old housewife and mother presented with acute back pain with right L2 and L3 sensory and motor nerve root involvement.

Thermography confirmed right L2/L3 root irritation and myelography and CT scan showed a large right L2/L3 prolapse with L4/L5 root involvement.

Thermography shows excellent correlation with CT, MRI and Myelography in radiculopathy.

 

Posterior back
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Left lateral leg
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Right lateral leg
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Anterior knees
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Right knee medial
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Right knee lateral
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  Right knee surgery was followed with a painful effusion in the early post operative period.

Thermography confirmed a significant inflammatory reaction. 30cc of blood-stained fluid was aspirated.

Thermography can quantify all grades of joint synovitis and is able to demonstrate minimal changes due to NSAID’s

Post-Traumatic Complex Regional Pain Syndrome. A 34 year old female supermarket worker injured her left wrist 3 years previously. There were typical features of CRPS including severe persistent pain and colour and temperature changes in the left wrist and hand.

There was a good initial response to a right cervical sympathectomy but a year later symptoms returned. Treatment with I.V. Guanethidine gave some relief and reduced the temperature differentials significantly from a deltaT of 6.2°c pre treatment to 0.8°c post treatment.

Thermographic monitoring of sympathetic blockade provides useful objective data to quantify effectiveness of previous blockade and prospective treatments.

 

Palmar hands
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case_9.gif (8103 bytes)   A 28 year old male carpet layer presented with a clinical left carpal tunnel syndrome, The EMG was normal but the left median sensory nerve latency and amplitude suggested minimal dysfunction relative to the right side. Thermography during sympathetic challenge (cold stress test) showed sympathetic nerve dysfunction consistent with an early left carpal tunnel syndrome.

Thermographic sensitivity for detection of early carpal tunnel syndrome is improved by cold stressing both hands. Sympathetic nerve fibres in the symptomatic median nerve are hyperirritable producing a sustained response during cold stress.

DITI Studies  

INFORMATIONAL REPORT OF THE COUNCIL ON SCIENTIFIC AFFAIRS Thermography in Neurological and Musculoskeletal Conditions John H. Moxley, III, M.D., Chairman Abstract

JOINT COUNCIL OF STATE NEUROSURGICAL SOCIETIES of the AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS and the CONGRESS OF NEUROLOGICAL SURGEONS Neurological clinical procedure review; Thermography Lyle Leibrook, M.D. Abstract

Altchek EM; Medical thermography and its use in posttraumatic cephalagia. (Int J Neurosci, 1990 Sep)

Baglin TP; Bone marrow hypervascularity in patients with myelofibrosis identified by infra-red thermography. (Clin Lab Haematol, 1991)

Ben-Eliyahu DJ; Infrared thermographic imaging in the detection of sympathetic dysfunction in patients with patellofemoral pain syndrome [published erratum appears in J Manipulative Physiol Ther 1992 Jul-Aug;15(6):preceding table of contents] (J Manipulative Physiol Ther, 1992 Mar-Apr)

Birdi N; Childhood linear scleroderma: a possible role of thermography for evaluation. (J Rheumatol, 1992 Jun)

Bruehl S; Validation of thermography in the diagnosis of reflex sympathetic dystrophy. (Clin J Pain, 1996 Dec)

Canavan D; Electronic thermography for the assessment of mild and moderate temporomandibular joint dysfunction. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995 Jun)

Chan EK; Visualization of dynamic subcutaneous vasomotor response by computer-assisted thermography. (IEEE Trans Biomed Eng, 1990 Aug)

Chan FH; Generation of three-dimensional medical thermograms. (Biomed Mater Eng, 1996)

Chan FH; Thyroid diagnosis by thermogram sequence analysis. (Biomed Mater Eng, 1995)

Cole RP; Thermographic assessment of hand burns. (Burns, 1990 Feb)

Cooke ED; Reflex sympathetic dystrophy and repetitive strain injury: temperature and microcirculatory changes following mild cold stress. (J R Soc Med, 1993 Dec)

Dalla Volta G; The disappearance of the "cold patch" in recovered migraine patients: thermographic findings (Headache, 1991 May)

Darton K; The use of infra-red thermography in a rheumatology unit (Br J Rheumatol, 1990 Aug)

Devulder J; Epidural spinal cord stimulation does not improve microvascular blood flow in neuropathic pain. (Angiology, 1996 Dec)

Devulder J; Infra-red thermographic evaluation of spinal cord electrostimulation in patients with chronic pain after failed back surgery. (Br J Neurosurg, 1996 Aug)

Diakow PR; Differentiation of active and latent trigger points by thermography. (J Manipulative Physiol Ther, 1992 Sep)

Emery RW; Revascularization using angioplasty and minimally invasive techniques documented by thermal imaging. (Ann Thorac Surg, 1996 Aug)

Feldman F; Thermography of the hand and wrist: practical applications. (Hand Clin, 1991 Feb)

Friedman MS; The use of thermography in sympathetically maintained pain. (Iowa Orthop J, 1994)

Garagiola U; Telethermography and Raynaud's phenomenon. (J Sports Med Phys Fitness, 1991 Mar)

Garagiola U; Use of telethermography in the management of sports injuries. (Sports Med, 1990 Oct)

Geatti O; A comparison of scintigraphy, thermography, ultrasound and phlebography in grading of clinical varicocele. (J Nucl Med, 1991 Nov)

Graff-Radford SB; Thermographic assessment of neuropathic facial pain. (J Orofac Pain, 1995 Spring)

Gratt BM; Electronic thermography in the assessment of internal derangement of the temporomandibular joint. A pilot study. (Oral Surg Oral Med Oral Pathol, 1991 Mar)

Gratt BM; Future applications of electronic thermography. (J Am Dent Assoc, 1991 May)

Gratt BM; Thermographic assessment of craniomandibular disorders: diagnostic interpretation versus temperature measurement analysis. (J Orofac Pain, 1994 Summer)

Gratt BM; Thermographic characterization of osteoarthrosis of the temporomandibular joint. (J Orofac Pain, 1993 Fall)

Gratt BM; Thermographic characterization of the asymptomatic temporomandibular joint. (J Orofacial Pain, 1993 Winter)

Greenstein D; Assessment of chemical lumbar sympathectomy in critical limb ischaemia using thermal imaging. (Int J Clin Monit Comput, 1994 Feb)

Gross EJ; Experimental assessment of phased-array heating of neck tumours. (Int J Hyperthermia, 1990 Mar-Apr)

Harper CM Jr; Utility of thermography in the diagnosis of lumbosacral radiculopathy (Neurology, 1991 Jul)

Hauer JL; Hand skin blood flow in diabetic patients with autonomic neuropathy and microangiopathy. (Diabetes Care, 1991 Oct)

Head JF; Breast thermography is a noninvasive prognostic procedure that predicts tumor growth rate in breast cancer patients. (Ann N Y Acad Sci, 1993 Nov 30)

Herrick A; Abnormal thermoregulatory responses in patients with reflex sympathetic dystrophy syndrome. (J Rheumatol, 1994 Jul)

Heywang-Köbrunner SH; Nonmammographic breast imaging techniques. (Curr Opin Radiol, 1992 Oct)

Hsieh JC; Clinical application of infrared thermography in diagnosis and therapeutic assessment of vascular ischemic pain [published erratum appears in Ma Tsui Hsueh Tsa Chi 1991 Mar;29(1):567] (Ma Tsui Hsueh Tsa Chi, 1990 Dec)

Hunold S; Thermographic studies on patterns of skin temperature after exercise. (Eur J Appl Physiol, 1992)

Itoh Y; Use of recovery-enhanced thermography to localize cutaneous perforators. (Ann Plast Surg, 1995 May)

Iwata G; Thermography in a child with varicocele. (Eur J Pediatr Surg, 1992 Oct)

Janssens LA; Trigger point therapy. (Probl Vet Med, 1992 Mar)

Jeracitano D; Abnormal temperature control suggesting sympathetic dysfunction in the shoulder skin of patients with frozen shoulder. (Br J Rheumatol, 1992 Aug)

Karstetter KW; Use of thermography for initial detection of early reflex sympathetic dystrophy. (J Am Podiatr Med Assoc, 1991 Apr)

Katoh K; Use of prostaglandin E1 (lipo-PGE1) to treat Raynaud's phenomenon associated with connective tissue disease: thermographic and subjective assessment. (J Pharm Pharmacol, 1992 May)

Kruse RA Jr; Thermographic imaging of myofascial trigger points: a follow-up study. (Arch Phys Med Rehabil, 1992 Sep)

Kyle V; Rarity of synovitis in polymyalgia rheumatica (Ann Rheum Dis, 1990 Mar)

Lawson W; Infrared thermography in the detection and management of coronary artery disease. (Am J Cardiol, 1993 Oct 15)

Leclaire R; Diagnostic accuracy of technologies used in low back pain assessment. Thermography, triaxial dynamometry, spinoscopy, and clinical examination. (Spine, 1996 Jun 1)

Liddington MI; Timing of the thermographic assessment of burns. (Burns, 1996 Feb)

MacDonald AG; Microwave thermography as a noninvasive assessment of disease activity in inflammatory arthritis. (Clin Rheumatol, 1994 Dec)

Magerl W; Asymmetry and time-course of cutaneous sympathetic reflex responses following sustained excitation of chemosensitive nociceptors in humans. (J Auton Nerv Syst, 1996 Feb 5)

Mannara G; Ethyl alcohol induced skin temperature changes evaluated by thermography. Preliminary results. (Boll Soc Ital Biol Sper, 1993 Oct)

Matsumura H; Haemodynamic changes in early phase reflex sympathetic dystrophy. (Scand J Plast Reconstr Surg Hand Surg, 1996 Jun)

McBeth SB; Thermographic assessment of temporomandibular disorders symptomology during orthodontic treatment. (Am J Orthod Dentofacial Orthop, 1996 May)

McCulloch J; Thermography as a diagnostic aid in sciatica. (J Spinal Disord, 1993 Oct)

McKinna JA; The early diagnosis of breast cancer--a twenty-year experience at the Royal Marsden Hospital. (Eur J Cancer, 1992)

Menachem A; Levator scapulae syndrome: an anatomic-clinical study. (Bull Hosp Jt Dis, 1993 Spring)

Mirza N; Influence of age on the 'nasal cycle'. (Laryngoscope, 1997 Jan)

O'Reilly D; Measurement of cold challenge responses in primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis. (Ann Rheum Dis, 1992 Nov)

Park ES; Comparison of sympathetic skin response and digital infrared thermographic imaging in peripheral neuropathy. (Yonsei Med J, 1994 Dec)

Pawl RP; Thermography in the diagnosis of low back pain. (Neurosurg Clin N Am, 1991 Oct)

Pierart J; Use of thermography in the differential diagnosis of phylloides tumour. (Br J Surg, 1990 Jul)

Ping Z; Correlation study on infrared thermography and nerve root signs in lumbar intervertebral disk herniation patient: a short report [published erratum appears in J Manipulative Physiol Ther 1993 Oct;16(8):560] (J Manipulative Physiol Ther, 1993 Mar-Apr)

Plaugher G; Skin temperature assessment for neuromusculoskeletal abnormalities of the spinal column. (J Manipulative Physiol Ther, 1992 Jul-Aug)

Ramlau C; Combination of thermographic and ultrasound methods for the diagnosis of female breast cancer. (Eur J Gynaecol Oncol, 1993)

Seifalian AM; Comparison of laser Doppler perfusion imaging, laser Doppler flowmetry, and thermographic imaging for assessment of blood flow in human skin. (Eur J Vasc Surg, 1994 Jan)

Seppey M; Facial thermography during nasal provocation tests with histamine and allergen. (Allergy, 1993 Jul)

Sheinberg M; Application of telethermography in the evaluation of preterm premature rupture of the fetal membranes. (Biomed Instrum Technol, 1996 Nov-Dec)

Shetty V; Thermographic assessment of reversible inferior alveolar nerve deficit. (J Orofac Pain, 1994 Fall)

Sterns EE; Thermography as a predictor of prognosis in cancer of the breast. (Cancer, 1991 Mar 15)

Sterns EE; Thermography. Its relation to pathologic characteristics, vascularity, proliferation rate, and survival of patients with invasive ductal carcinoma of the breast. (Cancer, 1996 Apr 1)

Sterns EE; Vascularity demonstrated by Doppler ultrasound and immunohistochemistry in invasive ductal carcinoma of the breast. (Breast Cancer Res Treat, 1996)

Strong WE; Does the sympathetic block outlast sensory block: a thermographic evaluation. (Pain, 1991 Aug)

Sucher BM; Thoracic outlet syndrome--a myofascial variant: Part 1. Pathology and diagnosis. (J Am Osteopath Assoc, 1990 Aug)

Takahashi Y; Thermal deficit in lumbar radiculopathy. Correlations with pain and neurologic signs and its value for assessing symptomatic severity. (Spine, 1994 Nov 1)

Tchou S; Thermographic observations in unilateral carpal tunnel syndrome: report of 61 cases. (J Hand Surg [Am], 1992 Jul)

Thomas D; Computerised infrared thermography and isotopic bone scanning in tennis elbow. (Ann Rheum Dis, 1992 Jan)

Thomas D; Infrared thermographic imaging, magnetic resonance imaging, CT scan and myelography in low back pain. (Br J Rheumatol, 1990 Aug)

Thomas D; Somatic sympathetic vasomotor changes documented by medical thermographic imaging during acupuncture analgesia. (Clin Rheumatol, 1992 Mar)

Ulmer HU; Thermography in the follow-up of breast cancer patients after breast-conserving treatment by tumorectomy and radiation therapy. (Cancer, 1990 Jun 15)

Vecchio PC; Thermography of frozen shoulder and rotator cuff tendinitis. (Clin Rheumatol, 1992 Sep)

Verdugo RJ; Use and misuse of conventional electrodiagnosis, quantitative sensory testing, thermography, and nerve blocks in the evaluation of painful neuropathic syndromes. (Muscle Nerve, 1993 Oct)

Vujci M; Thermography in the detection and follow up of chondromalacia patellae. (Ann Rheum Dis, 1991 Dec)

Weinstein SA; Facial thermography, basis, protocol, and clinical value. (Cranio, 1991 Jul)

Weinstein SA; Thermophysiologic anthropometry of the face in Homo sapiens. (Cranio, 1990 Jul)

Williams KL; Thermography in screening for breast cancer. (J Epidemiol Community Health, 1990 Jun)

Winsor D; Comparison of various noninvasive techniques for evaluating deep venous thrombosis. (Angiology, 1991 Oct)

Yang WJ; Literature survey on biomedical applications of thermography. (Biomed Mater Eng, 1992 Spring)

Zhang D; Clinical observations on acupuncture treatment of peripheral facial paralysis aided by infra-red thermography--a preliminary report. (J Tradit Chin Med, 1991 Jun)

Zhang D; Research on the acupuncture principles and meridian phenomena by means of infrared thermography. (Chen Tzu Yen Chiu, 1990)

 

INFORMATIONAL REPORT OF THE COUNCIL ON SCIENTIFIC AFFAIRS Thermography in Neurological and Musculoskeletal Conditions John H. Moxley, III, M.D., Chairman

Thermography is a safe adjunctive physiological procedure which may be useful in the diagnosis of selected neurological and musculoskeletal conditions. Thermography is noninvasive and does not involve the use of ionizing radiation. Thermography may facilitate the determination of spinal nerve root and distal peripheral nerve dysfunction. Thermography also contributes to the evaluation of possible autonomic nervous system dysfunction and of spinal disorders.Thermography may be useful in documenting peripheral nerve and soft tissue injuries, such as muscle and ligament sprain, inflammation, muscle spasm, and myositis. Thermography is helpful in the diagnosis of reflex sympathetic dystrophy and can be used to follow the course of patients after spinal surgery. In those applications, thermography does not stand alone as a primary diagnostic tool. It is a test of physiological function that may aid in the interpretation of the significance of information obtained by other tests. return to top

JOINT COUNCIL OF STATE NEUROSURGICAL SOCIETIES of the AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS and the CONGRESS OF NEUROLOGICAL SURGEONS Neurological clinical procedure review; Thermography Lyle Leibrook, M.D.

AVAILABLE PROOF OF EFFICACY: Evidence of prospective studies. Prospective studies have shown the excellent sensitivity and good correlation of thermography with other imaging methods. A high correlation of 84% has been demonstrated in studies comparing thermography and CT scanning of patients with low back pain and sciatica. Surgical treatment has also shown similar high rates of sensitivity. A large study of 805 patients with upper and low back pain confirm good correlation between thermographic evaluation and myelography, CAT scanning and EMG. The two objective tests for documentation of sensory radiculopathy, thermography and somatosensory cortical evoked potential’s, show equal sensitivity in the diagnosis of clinical lumbosacral radiculopathy.

SAFETY: The procedure is totally non-invasive and does not involve ionising radiation. It is without patient risk.

CONCLUSION OF REVlEW: Thermography is a safe and effective means for evaluation of vasomotor instability due to irritation or injury of spinal roots, nerves or sympathetic fibres. It is to be considered an adjunctive test and not solely diagnostic except in cases of reflex sympathetic dystrophy. While one cannot extend the technique of thermography to indicate the central phenomena of perception of pain, it is useful in detecting associated vasomotor instability and complex pain states associated with arthritis, soft tissue injuries, low back disease or reflex sympathetic dystrophy and does provide objective data to identify dysfunction in roots that are irritated in the lumbar spine, peripheral nerves that are irritated, and damage to the sympathetic nervous system. return to top