Breast Thermography.Org

Truth in Marketing and Advertising in the

Thermal Imaging Industry – A Physician and Patient Alert

William Cockburn, DC, FIACT, FABFE

Special thanks to Nina Rea, CTT for her assistance in editing

January 15, 2008

Key Words:   Thermography, Medicine, Sales, Fraud, Misrepresentation

Abstract:  While the medical thermography industry continues to grow, manufacturers and sales representatives continually misrepresent facts about medical thermography systems and thermography protocols in order to make sales to unknowing buyers. This results in division within the field and must end.

Misrepresentation has become a more prevalent occurrence in the medical thermal imaging field, especially among some makers of thermal imaging equipment and their user groups.  These misrepresentations, often made innocently by clinicians and technicians who use certain types of thermal imaging systems, create industry wide confusion and in some cases, contempt between various user groups at a time when cooperation and sharing of data is critical to the continued growth and development of our industry.

This derogatory and divisive activity must stop.  This purpose of this paper is to alert all clinical thermographers, clinical thermography technicians and others interested in the advancement of the industry to be aware of this problem in an attempt to thwart future corruption of the thermal imaging industry.  The fostering of communication and a fairness doctrine within medical thermography is of the utmost importance to the continued advancement of our industry and indeed to the safety and accurate diagnosis of our patients.

As a senior educator in the field of medical thermography, I have the opportunity to teach specialists from nearly all aspects of the medical community. Questions from student thermographers and requests for second opinion consultations coupled with specific inquiries from patients themselves have brought this matter into critical focus.

It is now abundantly clear that the dissemination of misinformation, often in order to sell a thermographic system to an end user, has created confusion, doubt, and ill feelings between thermographers and thermography patients as well.

We will now take a look at the most common misrepresentations currently being made and examine not only the inaccuracy of the statements themselves, but moreover, the impact that this might have on the clinician and the patient. These misrepresentations are not presented in any particular hierarchy of importance as all are weighted issues which confuse and separate us.

Myth #1: “Our camera is specifically built for the human temperature range and is not like military or industrial  

                 cameras that other companies sell.”

Fact:  The U.S. FDA has approved approximately 20 infrared cameras for medical use which are manufactured by    

           a number of corporations.  Some of these cameras have the ability to measure a specific range of

           temperature which includes the human range, but can also exceed that range.   An example would be the

           ability to measure the exhaust from a fighter aircraft.  It is thus implied that one should not consider the

           purchase or use of a camera not built specifically for human range.  Nothing could be further from the

           truth.  This “spin doctoring” technique is a crude and simple “con” tactic designed to prevent potential  

           customers from thoroughly investigating other devices. 

          With the exception of certain specifically designed military infrared cameras, all FDA approved medical             

          systems can be set to measure only the human range.  The reality is that cameras which are claimed to be  

          built specifically for human range are typically very low cost cameras with very low resolution detectors  

          that just happen to “fit” the human temperature span.  Higher resolution cameras are superior to these

          cameras. The mere fact that they have passed FDA clearance is in itself a testament that they are indeed

          suitable for human medical imaging.

Unfortunately, because many doctors and independent technicians have unwittingly bought into such a sales pitch and marketing spin they believe this statement to be true and use these human range only cameras. They have been conditioned by the sales pitch to have contempt for clinicians who may actually be using far superior and more accurate infrared detector.

To summarize, this myth implies that only cameras specifically designed for human range imaging are capable of doing so properly, when in fact there are numerous systems on the market most of which are superior and have been FDA approved specifically for this purpose. Furthermore, belief in this myth can create contempt and disharmony within the thermographic community between different user groups, especially when false claims and uninformed comparisons are made.

Myth #2: Cameras built specifically for the human range negates the need to follow the “harsh” protocols of

                outdated equipment.

Fact:  Firstly, the protocol for medical thermal imaging is not harsh. This is an extreme exaggeration. Secondly,  

          there are a number of very important thermal protocols that are required of both the thermographic lab, and

          the patient. The lab protocols include but are not limited to such controls as:

          a) Having a properly designed thermal laboratory         

          b) Having a draft-free environment

          c) Maintaining a specific room temperature (also known as stable ambient temperature)

          d) Following a specific preset thermographic analysis procedure

               (A full discussion of lab protocols can be found on any responsible medical thermography website,                

                 many of which are listed at the end of this paper.)

These protocols are very easy to meet. However, I have been informed by doctors of their skepticism in purchasing a certain camera because they were led to believe that possible expensive office modifications were needed to meet protocol. The reality is that most conventional office environments today already meet the standard of care for thermal imaging.

In an effort to ease the system sale, this myth implies that because the manufacturer’s camera is superior there is no need to follow proper industry set protocols. Again, this is a false statement. The purpose of laboratory protocol is to create an environment conducive to excellent image capture of a patient who is neither trying to gain heat from or lose heat to the environment. The camera, while sensitive to ambient change, has nothing to do with the “thermal steady state of the patient” (i.e. human physiology).

Myth #3: Cameras built specifically for the human range negates the need for patients to follow pre-

               examination protocol.

Fact:  There are a number of important protocols for the patient to observe prior to their examination.  Some of         

           these protocols are: 

           a) Not smoking four hours prior to the examination

           b) Not consuming hot or cold beverages (especially those containing alcohol or caffeine)

           c) Not being sunburned

           d) Not shaving the area to be examined the morning of the exam, etc 

               (A full discussion of patient protocols can be found on any responsible medical thermography website,               

                 many of which are listed at the end of this paper.)

Depending on the experience of the sales associate, this myth in particular seems to have been modified, in a variety of ways to close the sale. Once again, the spin technique is designed to cause the client to erroneously believe they are purchasing a superior system and can therefore omit proper protocols.

Because of the statement, “our camera is built specifically for the human range”, the assumption is made that the camera is so accurate the protocols are outdated and unnecessary. Many thermographers assume the camera is capable of overcoming the need for established and acceptable protocol. Nothing can be further from the truth. Again, the function of a camera system cannot affect human physiology.  

The patient must be prepared and examined in a thermal “steady-state” so that all possibilities of thermal artifact are removed or limited.  For example, if a patient were sun burned it would be difficult to obtain temperatures of all parts examined in the proper temperature ratio as the sunburned area would be very hot and the surrounding normal tissue would appear excessively cold. 

Another example would be the patient who wears restrictive clothing such as a very tight brassiere, which can create artifact.  If a patient is not acclimated to the room environment for the required amount of time, areas may appear warmer or cooler than actual due to being artificially created by the restrictive clothing. False analysis of the thermal image is then probable.

This spin is designed not only to make the camera product seem superior, but can also very subtly and deceitfully imply that the camera has a higher income generating capability. The inference is that by speeding up the pre-exam requirements it facilitates more patients being seen in the same length of time as those clinicians following acceptable protocol techniques. This unethical implication builds false value into the camera system’s sale price.

Myth #4: Other cameras have the ability to measure extraneous heat.

Fact:  As mentioned above, thermal imaging cameras which have been approved by the U.S. FDA, have the ability

          to be set by the operator for specific ranges of temperature measurement.   For example, the minimum

          and maximum temperature to be measured can be independently set.  Also, the sensitivity of

          temperature measurement between various colors within the image can also be specifically set. On the

          On the more advanced camera systems, the camera operator has the capabilities of setting the temperature    

          range and sensitivity not only specifically for the human range but also for each individual patient if and

           when necessary.

This myth infers that the capability of measuring heat from motors and hot gases such as from jet engines etc. when not used for human physiology can confuse the thermal image data and in turn give false information.

Myth #5:  That older thermographers ruined thermography due to the lack of understanding the physics

                 of the technology and are responsible for the current inability to file for insurance reimbursement due 

                 to the revocation of CPT codes.

Fact:  Thermography exists today because of the continued and concerted efforts of those pioneers who have

           committed themselves to the science and application of a very sound medical device. Although the

           technology has advanced, the science remains unchanged. These advanced clinicians, who have obtained

           legitimate board certifications and Diplomate level credentials, certainly understand the physics and are 

           capable of providing appropriate data to potential purchasers of thermal imaging equipment. Of course,

           since there is no vested interest, this independently sought information would be provided without bias.

            Unfortunately as in many fields, thermography has had fraudulent practitioners who performed the

            procedure improperly in order to further the cause of an automobile accident case or a worker’s

            compensation injury. These unethical practices certainly damaged the credibility of the field; however,  

            they represent a small percentage of the thermographic industry.

Discussion: 

These myths are among the most common and important of the complaints I routinely hear from current thermography users, potential buyers and patients.  No doubt, government inquiries into these claims will follow.

One must realize, that with the exception of the FDA 510K process for approval of medical thermal imaging systems, this industry is virtually unregulated.  Some would argue that less regulation is desirous, but as in these circumstances it would help protect against rogue thermography.

There are currently Doctors and Health Care Practitioners who are interpreting thermograms with very little training. Often this brief training is provided by the very manufacturer who wishes to maintain control of the buyer and conceal the obvious flaws in their paradigm and equipment. The same applies to some physicians involved with interpretation services.

Physicians are unwittingly being pitted against one another and creating distrust and confusion rather than being unified in a technology that has multiple applications and tremendous possibilities, all for the sake of sales and control of the industry. When physicians and technicians do not communicate with one another about truths, dissention arises and growth stops. False paradigms are perpetuated and in the end the patient is the one who suffers.

Finally, there are many training programs in medical thermal imaging.  Some are obviously more comprehensive and thorough than others. To my knowledge, with the exception of one program, all are open to users of many different systems. These training programs emphasize education, not sales, or stirring up dissention within the thermographic field.

I would like to make a call to all members of the thermographic community to make every effort to unify our industry.

For information on thermographic training and certification;

Academy of Medical Infrared Training

International Academy of Clinical Thermology

International Thermographic Society

American Academy of Thermology

American Academy of Medical Infrared Imaging (formerly the Hershel Society)

European Academy of Thermology

Email us at    thermodoc@verizon.net