I have worked for well over two decades to provide not only quality thermographic imaging for all of my patients, but in addition, quality information and protocols for clinicians, researchers and others interested in the field of clinical thermography.
Recently, there has been a very dangerous trend in the marketing of thermographic systems and concepts. This trend nearly destroyed the credibility of thermography in the late 80's.
Now the trend is returning. Those of us who have maintained diligently our practices and have steadily brought thermography forward, are very concerned about mis-statements and false applications of this imaging modality.
To this end, I wish to share with you some of the things I see and hear in my practice daily. It is my sincere desire hat these topics may aid you in determining just who is performing thermography to standards, and who is not. This is an attempt to embellish and expand upon the "rogue thermography" page on this web site.
I am always happy to answer email concerning the subject of quality thermal imaging.
Below you will find a series of basic concepts in thermal imaging that address very specific areas of thermography abuse. I thank you for your interest and I am always available as president of the International Academy of Clinical Thermology to answer questions or field concerns from the medical field and general public as well as from regulatory officers.
About the Technlogy (Equipment)
There are very reliable thermography systems on the market, and then there are those which are promising, but not proven and those that have been abandoned by serious clinical thermographers. Lets take a look at these pieces if thermographic equipment, keeping in mind that I am speaking in relation to the use of thermography in breast cancer screening.
1) Contact Devices: There are two basic classifications of contact thermographic devices which are sold to clinicians and marketed to the public. They are Liquid Crystal Thermography (LCT) and thermocouple type deices:
A) Liquid Crystal Detectors These devices are virtually non existent in today's clinical setting. This does not mean that they are not accurate in the hands of a Board Certified Clinical Thermographer, but the technology is very old and subject to criticism. An LCT system includes a set of latex like plates which are supported in a frame. These plates are placed into a device which holds them firmly in place, allowing the clinician or assistant to push the detector against the breasts. The Latex plates were imbedded with a mic of organic crystals, which when activated by the heat of the body, emitted visible light in varying colors, allowing accurate temperature measurement. A camera is also mounted on the frame holder for photographic purposes. Typically a Polaroid Camera was sold with these systems, although many doctors switched to 35 mm for convenience and cost savings.
As I stated, in the hands of a HIGHLY trained clinical thermographer, this systems produced very good quality thermograms. Systems were sold worldwide, and used by Universities as well as private practice clinicians.
Problems and Concerns of Liquid Crystal Technology.
♦ The doctor plates are very sensitive to ambient room temperature and humidity. If not stored in a very cool and dark place between examinations, the detector plates could activate or "light up" limiting their life span and thus the effectiveness of the procedure, These detector plates cost in the range of $500-$759 each and typically 6 to 12 plates were in a set, so they were very expensive to replace. They also were subject to damage and tearing which ruined them immediately.
♦ Some clinicians are concerned about the contact with the breast. There are two essential concerns which are well founded, but never scientifically evaluated, as LCT was abandoned by most thermographers in the the early 90's. These concerns were: 1) That the actual touching of the breast might produce a sympathetic reflex response in the patient thus altering blood flow to the breast and changing the actual mean temperature. and 2) That actual temperatures could not be measured. A temperature or color scale was provided on the side or bottom of the detector plates, which closely matched the colors of the crystals. but there was some overlap, so actual spot temperatures (quantitative Analysis) was not possible.
♦ Another concern was the fact that as the detectors actually touch the breast, there might be contamination from the previous examination if the prior patient had a nipple infection or other lesion on the surface. Of course, hygienic measures are always taught in thermographic courses utilizing liquid crystal and some manufacturers provided removable thin covers which could be washed. None the less, many of my patients who have had LCT examinations have shared that the technician did not clean the detectors before or after the examination, and when asked, were simply told that the chances of transferring infection were non existent. This attitude is unacceptable.
Overall, my experience with LCT has been a good one, with detectors being very accurate, especially in vascular pattern imaging. My colleague Dr William Hobbins used to teach, if you want to see the forest, use electronic cameras and if you want to see the trees, use LCT! While today's Electronic Cameras are far superior LCT provided a very good and inexpensive screening tool for the average office. (see specs elsewhere on this web site concerning appropriate cameras)
B) Thermocouple Devices These devices have been virtually abandoned by the thermographic community on an international level. The devices are typically a hand held wand with a heat sensitive device called a thermocouple at the end. The device is touched to the skin, and temperature is recorded either by reading a quartz or LCT display similar to modern watches, or by a computer software program specifically designed for that particular product. Many doctors of chiropractic use dual probe thermocouples to measure heat fluctuations at either side of the spine, one practical application of this technology,
Some acupuncturists and other alternative medicine providers are using these devices within there specialties, but research on the reliability and clinical utility of these contact devices remains lacking, and in some cases, spurious. In fact, recently one manufacturer has been marketing that thermography is proven by thousands of research studies, but neglects to inform that the vast majority of these studies were performed with LCT or Electronic Camera based systems, and not thermocouples. Clinicians should be very aware of these claims and devices.
Problems and Concerns of Thermocouple Technology.
Some clinicians are concerned about the contact with the breast. There are concerns which are quite practical and logical, but never scientifically evaluated, as these devices have been abandoned by most certified thermographers in the the early 80's. These concerns were:
♦ That the actual touching of the breast might produce a sympathetic reflex response in the patient thus altering blood flow to the breast and changing the actual mean temperature. and
♦ That the thermocouple itself may maintain a small percentage of heat and when applied to another area of the body, give an artificial or false reading. (carryover temperature) An example of this would be in looking at the delta-t of the nipple. A delta t is simply a difference in temperature right as compared to left. Let us assume that the right nipple is pathologic and is slightly warmer than the left/ The right nipple is measured first, and then touched to the left. The carry over heat pattern may make the left nipple appear warmer than it actually is, and thus the delta, or difference between nipples might appear normal when indeed a serious pathology was present. The cooler and normal nipple would simply appear warmer and closer to the temperature of the affected nipple because of the carry over.
♦ There is a very real concern about contact contamination and spread of disease by using the device unless the strictest of sterile conditions are utilized
These devices are commonly marketed and sold to non physicians who are not licensed to make diagnosis, Thermography is a DIAGNOSTIC PROCEDURE. The general lack of knowledge, skill, training and experience using internationally accepted protocols of thermal imaging is quite obvious in these practices, and diminishes greatly, the value of thermography for all. See Rogue Page)
A significant failing of these devices is the general lack of target sensitivity related to body mass. These devices are very, very small, and typically measure only a few millimeters of skin tissue. Modern electronic thermographic cameras measure and make composite maps of tens of thousands of data points at one moment in time, without contacting the patients body. There is simply no comparison. The important diagnostic information which is missed by these systems is completely unacceptable to modern clinical practice.
Buyer beware: It has been my experience that marketing and sales of some of these devices claim that this is the "new thermography" They claim, as do some of the inept practitioners who use them, that the old thermography cameras have been abandoned. There is SMOKE AND MIRRORS here. Lots of smoke and mirrors, and the unwary can be easily lead astray.
It is important that this be explained and explored thoroughly by any doctor considering using or referring for this examination, or any patient who might acquire an exam of this nature.
These devices are indeed FDA approved for there purpose, which is to measure temperature. If a new company comes on board, gets FDA approval for their device, then this would be considered a "new thermography device" BUT this does not mean that this device is superior than another, replaces another, or is even effective for its particular application. To say that this is new thermography, when the research utilizing electronic cameras goes back to 1957 is simply not acceptable and should be suspect.
Secondly, I have had practitioners who use these devices call me and tell me that they were told their systems were better than electronic cameras, the solaced "old thermography" I inform them that there are two types of electronic cameras which evolved from the 70's and 80's, one is the short wave infrared and the other is long wave infrared, and that it was the low wave infrared that was abandoned, not the long wave which is superior and very diagnostic. Diplomate and Fellows in Thermal Imaging all use the Long Wave IR Cameras. Not one of them is using a thermocouple device, nor would they. It is this slick manipulation of the language for advertising purposes that must be condemned.
Parallel to this thought, I have seen advertising which for one of these products which states that their system is not the system of old thermography that may have been used by chiropractors. This is a tremendous slur on a licensed health care specialty, one in which a number of highly credentialed clinical thermographers exist to this day. Many of these chiropractors have published some of the most important papers related to the thermal imaging field. What a slick and devious tactic, to malign a health care profession simply to advance a product and gain a marketing advantage. This must be considered when fully understanding and appreciating the potentially devastating impact these individuals may have on the thermographic community.
(see "Breast Thermal Imaging, the paradigm shift" article in the library for detailed explanation of the politics of thermal imaging, and how these games have held back a most noble and important diagnostic science.
(c) breastthermography.org - this website is an archived version.