1 Infrared thermography Infrared thermography is a non-invasive method of diagnostics and monitoring of a patient, which is based on remote registration of thermal radiation of the human body. Thermography simultaneously represents anatomical, topographical and functional changes, as the only method capable of giving a visible form of patient’s pain. Changes of local temperature are caused by microcirculation changes associated with inflammatory processes (http://www.icim.ie/articles/medicalthermography.htm, http://mt.chinapapers.com/2/?p=8871). Thermography is a method of functional diagnostics. Normally, distribution and intensity of thermal radiation is determined by the peculiarity of physiological processes in the body (vascular responses, the nature of general and local metabolic processes, and the functional state of relevant organs). Normally, the temperature distribution on a body’s surface is symmetrical and the difference between symmetrical areas normally does not exceed 0.2°-0.4°C. Proximal and distant temperature gradient can be observed: the temperature decreases from the head to the extremities, as well as from the proximal to the distal extremities. A slight hyperthermia in the projection of superficial blood vessels is possible, especially in lean people. Each area of the human body has a characteristic thermographic picture. James B.Mercer (Northern Norwegian Centre for Medical Thermography) has described normal distribution of temperature on a human body (Mercer J.B. Thermal Symmetry – http://www.medimaging.org/). Healthy people usually have stable thermographic patterns (Zaproudina N., Varmavuo V., Airaksinen J. and Närhi M. Reproducibility of infrared thermography measurements in healthy individuals // PHYSIOLOGICAL MEASUREMENT. - №29, 2008. – Р. 515–524). The change of this picture is a clear sign of a pathological process. Various pathological processes are characterized by the presence of thermal asymmetry. They are also characterized by the presence of temperature gradient between the zone of high or low radiation and the surrounding skin or reference point, which is reflected on the thermographic picture. Therefore, a quantitative assessment is based on the comparison of skin temperature in the problem area with the symmetric parts of the body or with surrounding areas. Many pathologic processes (inflammation, tumor, degenerative processes, and circulation disturbances) change the normal distribution of temperature on the surface of the body. These changes are more evident if the pathological center is situated near to the skin surface. In many cases, local changes in temperature appear before other clinical manifestations, which is very important for early diagnosis and timely treatment. Thermography is a highly sensitive method with relatively low specificity. Thermography with the use of standard type thermographs did not gain a wide popularity as a method of diagnostics because of insufficient specificity. At the same time, the method does not have contraindications for repeated use because of its absolute safety. Therefore, thermography is suitable not only for screening and diagnostic purposes, as a part of a comprehensive survey, so, it is an optimal method for monitoring and evaluating the effectiveness of treatment of a wide spectrum of diseases with inflammatory genesis (Ring F., Jung A., Zuber J. New opportunities for infrared thermography in medicine // Acta Bio-Optica et Informatica Medica. – 1/2009, vol.15. – P.28-30.; KANAI SHIGEYUKI, TANIGUCHI NORIMASA, SUSUKI RYUTARO Evaluation of Osteoarthropathy of Knee Monitored with Thermography // Orthopedics & Traumatology. – VOL.48; NO.1; PAGE.348-350(1999); David BenEliyahu Infrared Thermography and the Sports Injury Practice // Dynamic Chiropractic – March 27, 1992, Vol. 10, Issue 07). High sensitivity of examination method is especially important, because the diagnosis is already set, and the patient needs to detect exacerbations on early stages and monitor the results of the treatment. 2 Infrared thermography is used in medicine for over 50 years. The first publication came out in 1956 (Lawson R.N. Implications of surface temperatures in the diagnosis of breast cancers // Can Med Ass J 1956, 75:309-310. 1972 – Registration of the European Association of Thermography in Strassbourg (http://www.europeanthermology.com). Since than, application areas of thermography have significantly widened (Ring EFJ, Jung A., Zuber J. New opportunities for infrared thermography in medicine // Acta Bio-Optica et Informatica Medica. – 1/2009, vol.15. – P.28-30). The first European Congress on Thermography was held in 1974 (Thermography. Proceedings of the first European Congress of Thermography. Amsterdam 1974, Bibliotheca Radiologica No.6, Karger, Basel, 1975). Thermography as an outcome measure had the highest number of papers dedicated, equipment, breast thermography, rheumatology, thermophysiology and microwave detection were the next in rank. The 11th European Association of Thermology European Congress of Medical Thermology took place in Mannheim, Germany from 17th - 20th September 2009. Similar as the scientific literature on thermology, the history of the European Congress of Thermology reflects the peaks and troughs of this discipline. BERZ R., SAUER H. The Medical Use of Infrared-Thermography History and Recent Applications // Thermografie-Kolloquium 2007 – Vortrag 04. – Р.1-12. The medical use of infrared thermography started shortly after 1950 in Germany, where long time before Prof. Czerny in Frankfurt am Main presented the first infrared image of a human subject (1928). In the beginning, single IR detectors have been used. Due to the development of other thermographic devices like contact thermography by electronic thermometers and by LC (liquid crystal) plates they were integrated in medical diagnostic systems. Early infrared imaging cameras derived from military systems suffered for a long time from a poor resolution (thermal as well as spatial) and extremely high prices. Additionally there was a lack of computer hardware and software. Better technology suitable for medical purposes was available since about 1980 and then used worldwide, mostly LN2 cooled MCT (HgCdTe) scanners. Since 2000 uncooled microbolometer FPA systems got more affordable and were, despite some methodological problems leading to medical misinterpretation, frequently used in medicine. In 2007 the first medical infrared imaging systems (MammoVision, ReguVision and FlexiVision by InfraMedic) have received a CE certification allowing to be used as thermal measuring medical devices (Category 1) and matching the European Medical Directive legislation. Other devices without medical CE certification are limited to be used as imagers only without measurement functions and without temperature reading. Qualified medical infrared imaging covers a broad field of applications: female breast, rheumatology and orthopedics, neurology, vascular imaging (arterial and venous), occupational (vibration related vasospastic syndrome), forensic, surgery, and full body screening including thermal stress response examinations (IRI – Infrared Regulation Imaging). Medical infrared imaging can only be applied by physicians who have been educated and trained intensively and have received a medical certificate (either by the German Society for Thermography and Regulation Medicine, the European Association of Thermology, or the University of Glamorgan, Wales). Thermography devices are categorized by the U.S. Food and Drug Administration (FDA) as Class I medical devices under the 510(k) process. Under this process, the manufacturer is not required to supply to the FDA evidence of the effectiveness of the device prior to marketing it. According to FDA labeling, thermal imaging is a noninvasive diagnostic technique that allows a practitioner to quantify and visualize skin surface temperature changes. The device allows the user to map body temperature graphically and display the image on a monitor. Images can be captured and stored on a computer. 3 Thermography may be used as an aid for diagnosis, as well as follow-up therapy in such areas as orthopedics, pain management, neurology and diabetic foot care. In an advisory statement, the American Academy of Orthopedic Surgeons (AAOS, 2005) states that a “review of the literature indicates a lack of specificity, reliability, and reproducibility for this technique in the diagnosis of specific musculoskeletal conditions and neural injuries or disease states” and that “the use of thermography as a clinically useful diagnostic or prognostic test in orthopedic surgery cannot at this time be scientifically justified.” Therefore, monitoring and evaluation of treatment efficiency is the main focus for the use of infrared thermography. Infrared thermography, non-contact, noninvasive technique is widely accepted as a medical diagnostic tool. An IR camera captures heat variations from the skin and maps into thermographs. Thermographs are acquired for the whole body or the region of interest. Thermographs either gray scale or pseudo color are processed for abnormality detection and quantification. However temperature variations are not normally visible to naked eye. Hence it is necessary to develop and analyze the feature extraction algorithms for abnormality detection [Selvarasu N., Alamelu Nachiappan and Nandhitha N.M. Euclidean Distance Based Color Image Segmentation of Abnormality Detection from Pseudo Color Thermographs // International Journal of Computer Theory and Engineering, Vol. 2, No. 4, August, 2010. Р. 1793-8201]. Thermal imaging is now increasingly used for imaging different physiological reactions induced by non-drug treatments such as massage (Bonnett et al 2006, Sefton et al 2010, Holey et al 2011, Wu et al 2009) or manual therapy (Mori et al 2004, Roy et al 2010). Temperature distribution of the skin during and after physical exercise has been reported (Zontak et al 1998, Ferreira et al 2008, Merla et al 2010). The effects of thermotherapy were recorded with means of thermal imaging (Ammer 2004) and water filtered infrared A-irradiation monitored by thermography (Mercer et al 2008, Notter et al 2011). Various modalities for cryotherapy have been evaluated with thermal imaging (Selfe et al 2009, Schnell and Zaspel 2008). Recent studies have also used thermography as an outcome measure in trials investigating low level laser treatment for myofascial pain (Hakg¨uder et al 2003) or knee osteoarthritis (Puzder et al 2010). Hence, IR-thermography method is very convenient and useful for thermo monitoring of diseases’development and treatment’s effectiveness, when the diagnosis is already established (Fig. 1). Fig. 1. The picture is taken from www.drdawn.net/services/thermography/ Infrared thermography is informative and absolutely safe for a user. However, modern infrared cameras can not be used at home without participation of a medical specialist due to complexity and expensiveness of infrared cameras, as well as due to inability of correct automatic analysis of thermograms. Roback K. considers that «...there is also a future for cheaper, uncomplicated devices intended for at homecare. The selfcare alternative will be even more important as public healthcare budgets probably cannot match the increasing costs of the technologic development and higher healthcare need owing to demographic factors» (Roback K. An overview of temperature monitoring devices for early detection of diabetic foot disorders // Expert Rev. Med. Devices 7(5), 711–718 (2010)). 4 Operating principle of IR-thermographs and IR-thermometers In general, IR radiation covers wavelengths that range from 0.75 µm to 1000 µm, among which the human body emissions that are traditionally measured for diagnostic purposes only occupy a narrow band at wavelengths of 8 µm to 12 µm [J. Whale. An introduction to dynamic radiometric thermal diagnostics and dielectric resonance management procedures. Positive Health.], sometimes, diapason from 3 µm to 14 µm is captured (https://www.google.com/search?q=wavelength+in+medical+imagers&oq=wavelength+in+medical +imagers&). This region is also referred to as the long-wave IR (LWIR) or body infrared rays. Infrared thermographs, intended for medical diagnostic purposes and monitoring (medical thermographs) register IR radiation from skin surface. They work in the diapason 3-14 µm, at that, irrespective of the width of infrared radiation diapason, obtained thermograms are roughly equal and they equally successful allow detecting hyperthermic centers, for example, in case of inflammation (Fig. 2). Fig. 2 The picture is taken from the article of Ring E. F. J., Thomas R. A., Howell K. J. SENSORS FOR MEDICAL THERMOGRAPHY AND INFRARED RADIATION MEASUREMENTS // Jones D.P. Biomedical Sensors. - Momentum Press, 2010. – 320 р. Medical Infrared Imaging. Edited by Nicholas A. Diakides, Joseph D. Bronzino. 2008. P.96. – http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&v ed=0CD4QFjAB&url=http%3A%2F%2Fbooks.google.com%2Fbooks%2Fabout%2FMedica l_Infrared_Imaging.html%3Fid%3Dz-EsDmgyF4YC&ei=FkxfU4nIKfS4QT4xIDAAg&usg=AFQjCNHTwNiVoJeVAYpGjvkEO52BkEzBjA&bvm=bv.65397613, d.bGE Infrared thermography provides a thermal map of the skin surface area by measuring the radiant heat that is emitted. Current IR-thermography machines provide accurate skin surface temperatures (<0.05◦C) that are noninvasive, noncontact measurements through the use of stable detectors. These systems produce high speed–high resolution images from which thermal data can be pictorially and quantitatively stored and analyzed. While IR-radiation begins at wavelengths of 0.7 μm, current IR-thermographic imagers are operating at either the mid-range (3–5 μm) or long range (8–14 μm) wavelengths [Jones B.F. and Plassmann P. Digital infrared thermal imaging of human skin. IEEE Eng. Med. 5 Biol. 21, 41–48, 2002.; Otsuka K., Okada S., Hassan M., and Togawa T. Imaging of skin thermal properties with estimation of ambient radiation temperature. IEEE Eng. Med. Biol. 21, 65–71, 2002; Head J.F. and Elliott R.L. Infrared imaging: making progress in fulfilling its medical promise. IEEE Eng. Med. Biol. 21, 80–85, 2002.]. At these wavelengths the skin’s ability to emit the radiant heat is 0.98 on a scale of 1.0 for a perfect radiator, blackbody surface [Flesch, U. Physics of skin-surface temperature. In Thermology Methods. Engel J.M., Flesch U., and Stüttgen G. (eds), translated by Biederman-Thorson M.A. Federal Republic of GermanyWeinheim, pp. 21–37, 1985]. Medical Thermal Imaging Cameras (http://www.infraredcamerasinc.com/ThermalCameras/FDA-Medical-Thermal-Cameras/FDA_Cleared_Medical_Thermal_Imagers.html) FDA has cleared all thermal imaging cameras by ICI with designation S (Scientific) or P (Professional) series as medical thermal imaging cameras. These cameras can be used for a variety of medical diagnostics, monitoring, etc. Below is a list of our medical thermal imaging cameras. The examples of Medical Thermal Imaging Cameras Recommended For Doctors, Physicians, & Veterinarians, having 510(k) Number: ICI ETI 7320 Pro Fix-mounted Sensitivity <27 mK, Resolution: 320 x 240, 7 -14 µm ICI 7320 Scientific Fix-mounted Sensitivity:<38 mK, Resolution: 320 x 240 ICI 7320 Pro Fix-mounted, Sensitivity: <38 mK, Resolution:320 x 240, 7 to 14 microns ICI Prodigy Pro Handheld, Sensitivity: <38 mK, Resolution: 320 x 240 ICI 7640 Pro Sensitivity:<50 mK, Resolution: 640 x 480 Mirage Pro Fix-mounted, Sensitivity:<14 mK, Resolution: 320 x 256, 3-5 µm ICI IR Monitor Pro Fix-mounted, Sensitivity:<80 mK, Resolution: 320 x 240, 7 -14 µm ICI Centurion Pro Fix-mounted, Sensitivity:<65 mK, Resolution:320 x 240 DuraCam 320 Pro Handheld, Sensitivity:<80 mK, Resolution: 320 x 240 ToughCam Pro Handheld, Sensitivity: <60 mK, Resolution:160 x 120 ToughCam Scientific Handheld, Sensitivity:<120 mK, Resolution:160 x 120 The examples of Medical Infrared Thermometers, having 510(k) Number: Derma Temp 1001, Exergen AMPLIFE Digital Infrared Ear Thermometer, Model El 00, Microlife Infrared Thermometer FDIR-Vl, FAMIDOC TECHNOLOGY CO., LTD. Braun Thermoscan® IRT 2000, infrared ear thermometer, Braun GmbH Infrared Thermometer ThermoFlash LX-26, JXB Co, LTD Guangzhou AViTA Radar Thermo IR Thermometer, NT1 Series , NT 152, AViTA Corporation Infrared Thermometer Model: DT-8806H/DT-8806/DT-886, SHENZHEN EVERBEST MACHINERY INDUSTRY CO.,LTD Valeo VT-601 Series ZR Thermometer, Model no.: VT-601D, VT-601E, VT-601F, VALEO Corporation Infrared Thermometer (FT-Fl 1, FT-F21, FT-F31, FT-F41), Fudakang Industrial Co., Ltd. InnoTherm lCT-l00, INNOCHIPS TECHNOLOGY Co., Ltd INFRARED FOREHEAD THERMOMETER, MODEL FS-300&301(K1 01912), HUBDIC CO., LTD Non-contact Infrared Thermometer-JXB 182, Jinxinbao Electronic Co., Ltd Non-contact Infrared Thermometer JPD-FR100, Shenzhen Jumper Medical Equipment Co., Ltd. No Touch + Forehead Thermometer, NTF3OOO, KAZ USA, Inc. 6 Analysis of thermograms obtained with infrared thermographs has showed that increased heat emission in the pathological center is projected on skin surface in the form of thermal anomalies, linear dimensions of which are larger than 1 cm (Beloshenko V.A., Doroshev V. D., Karnachev A. S., Prihodchenko V. V. Equipment complex (thermomammograph) for early diagnostics oncology diseases of mammary gland with contact digital thermography method - http://www.mederbis.com.ua/node/130). In other study, it has shown that the choice of optimal scanning pitch when measuring temperature gradients on the surface with a purpose of obtaining the desired accuracy and resolution as well as reduction of examination time is possible at the determination pitch of 5 cm, if the pathological center is located at a depth of 1 to 5 cm (which corresponds to the average sizes of structures of knee and wrist joints) (S.V. Miheev, Metrologic ensuring temperature measurements in medical technology of diagnostic contact thermography, Moscow, Medical physics 2011 №1.). Analysis of typical thermograms in case of oncologic diseases of bones [Thermo vision method of study in oncology practice. Thermo semiotics of malignant and non-malignant growths. Atlas of thermograms // Leningrad, 1976, 72 p.] has shown that the sizes of thermal anomalies reach 2–3 cm and more. Fig. 3. Denoble A.E., Hall N., Pieper C.F., Kraus V.B. have used the mark (silver sticker) of the size of 2 cm for thermo vision studies. Thermogram shows that the zone of hyperthermia of red-and-orange color at arthritis is significantly larger than the size of the mark (Fig.3). (Denoble A.E., Hall N., Pieper C.F., Kraus V.B. Patellar Skin Surface Temperature by Thermography Reflects Knee Osteoarthritis Severity // Clin Med Insights 7 Arthritis Musculoskelet Disord. 2010; 3: 69–75. – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998980/). Hand joints have small sizes and, accordingly, the centers of hyperthermia have small area: from 1 cm to several square centimeters. In the article of Spalding S.J. et al. (Spalding S.J., Kwoh C.K., Boudreau R., Enama J., Lunich J., Huber D., Denes L., Hirsch R. Three-dimensional and thermal surface imaging produces reliable measures of joint shape and temperature: a potential tool for quantifying arthritis // Arthritis Research & Therapy 2008, 10:R10 – http://arthritis-research.com/content/10/1/R10) the authors have described plotting of volumetric models of hand joints with distinguishing of hyperthermia centers (Fig. 4). These hyperthermia centers are situated exactly in the projection of metacarpophalangeal and interphalangeal joints. Fig. 4. The Smart ThermoGraph Development of new devices for thermo diagnostics and monitoring proceeds in two directions: - Increase of temperature’s measurement accuracy up to thousands of a degree, which naturally leads to a significant increase in the price of thermographs. For medical purposes, such accuracy is not needed, as temperature changes starting from 0.4ºC and more in the projection of the pathological focus are considered to be significant (pathological). - Simplification and cost reduction of the equipment with the required accuracy of measurement, the creation of portable devices that can be used both in hospitals and at home. Prominent representative of the second group of new devices is a Smart ThermoGraph. It is a hardware-software complex, which includes a device (infrared thermometer) that transmits information to a computer and the program that draws thermograms according to the results of measurements of skin temperature. For thermogram plotting, the program uses the same generally accepted Colour and Temperature Scale that is described in the article of Ring EFJ, Ammer K. (Ring EFJ, Ammer K. The Technique of Infra red Imaging in Medicine // Thermology international 10/1 (2000) – Р. 7-14.): «Every image or block of images must carry the indication of temperature range, with color code/temperature scale. The color scale itself should be standardized. The so-called rainbow or spectral order of colors is more widely recognized, especially by colleagues who are not used to the other color scales used by engineers. А false color finely graded scale is also possible, this can be ranged from dark blue at the cold end through green to red, and will convey a similar degree of image contrast to a monochrome black and white picture». The Smart ThermoGraph device has an infrared sensor that receives thermal (infrared) radiation in the same wavelength range as the other thermal imagers: from 5 to 14 microns (5-14 µm), which is analogical to IR-thermographs recommended by FDA for medical purposes (see above). Temperature resolution of IR-sensor is ≤ 0.2ºС. 8 It measures the intensity of thermal radiation only in specific locations, the area of which corresponds to the working surface of the device (diameter is 0.5 cm, diameter with a nozzle is 1.3 cm). Fig. 5. Grid with maximum amount of points for temperature measurement, and example demonstrating how to place it on the photographic image of the knee-joint. Fig. 6. Thermograms in case of osteoarthritis of knee joint 9 The computer program “Smart ThermoGraph”, linked with the Smart ThermoGraph device, offers to the user several patterns of rectangular-shaped grid of points (from 2x2 to 6x6) with the possibility of changing the number of points and the distance between them in such a way that the final grid does not extend beyond the area of interest but covers it in maximum way. The grid of points for temperature measurement with the Smart ThermoGraph must be plotted with taking into consideration well-known sizes and localization of hyperthermia centers for example at inflammatory diseases (Fig.5). Points for temperature measurement in the area of interest should be situated at the distance of 2-2.5 cm from each other, which ensures plotting of sufficiently detailed thermogram with clearly (probability is close to 100%) visible centers of hyperthermia (Fig.6). The computer program processes temperature data from measurements and draws thermograms basing on the data. Thus, the device Smart ThermoGraph produces results similar to medical imagers, provided the user observes the standard conditions for implementing the medical thermography set forth later. The Smart ThermoGraph can be used at home not for primary/differential diagnostics, but for monitoring chronic diseases. The computer program Smart ThermoGraph generates automatic conclusions about the main temperature parameters (the maximal temperature value, the average temperature value), and its changes. There are several mathematical methods of modeling and processing of the results of skin temperature measurements (Titova A.Y. Specialized computer system of processing of thermo-mammographic images // Informational control systems and technologies and computer monitoring (IUS and KM 2012). – p. 544-548), major of which are used in the computer program of the Smart ThermoGraph: interpolation and averaging of temperatures; detection of edges of anomalous zones; identification of gradients, confidence intervals of temperature distribution; plotting of histograms and isotherms; smoothing filtration, contrasting, framing, and others. Generally known methods of processing of temperature data are used in Smart ThermoGraph program: - thermogram is plotted by interpolation method, - average temperature in the area of examination is calculated, - maximum temperature in the area of examination is calculated. All calculated values are compared with the respective values received in the previous session of self-examination. According to the results of such comparison, the user is given the conclusion that includes the calculated values and the result of their comparison with previous values, for example: - T maximum = 30.8ºС, increased for 0.6ºС, - T average = 29.4ºС, increased for 0.2ºС. Through application of the Smart ThermoGraph device in combination with the computer program “Smart ThermoGraph”, and observing at the same time the standard conditions of examination by means of the medical thermography, the user may carry out thermal monitoring of vast range of diseases. Inflammation diseases and thermosigns Inflammation (Latin, īnflammō, "I ignite, set alight") is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammatory diseases account for about 80% of all human diseases. Inflammation plays a fundamental role in host defenses and the progression of immunemediated diseases. The inflammatory response is initiated in response to tissue injury 10 (e.g., trauma, ischemia, and foreign particles) and infection by a complex cascade of events, including chemical mediators (e.g., cytokines and prostaglandins) and inflammatory cells (e.g., leukocytes). The inflammatory response is characterized by increased blood flow, increased capillary permeability, and the accumulate of phagocytic cells at the site of injury. These events result in swelling, redness, warmth (altered heat patterns), and pus formation at the site of injury. Parakrama Chandrasoma, Clive R. Taylor. Concise Pathology, 3e, Los Angeles, Appleton & Lange, 1998. Acute inflammation is the early (almost immediate) response of a tissue to injury. It is nonspecific and may be evoked by any injury short of one that is immediately lethal. Acute inflammation may be regarded as the first line of defense against injury and is characterized by changes in the microcirculation: exudation of fluid and emigration of leukocytes from blood vessels to the area of injury. Acute inflammation is typically of short duration, occurring before the immune response becomes established, and it is aimed primarily at removing the injurious agent. Clinically, acute inflammation is characterized by 5 cardinal signs: rubor (redness), calor (increased heat), tumor (swelling), dolor (pain), and functio laesa (loss of function). Redness and heat are due to increased blood flow to the inflamed area; swelling is due to accumulation of fluid; pain is due to release of chemicals that stimulate nerve endings; and loss of function is due to a combination of factors. These signs are manifested when acute inflammation occurs on the surface of the body, but not all of them will be apparent in acute inflammation of internal organs. The increased heat of inflamed skin is due to the entry of a large amount of blood at body core temperature into the normally cooler skin. When inflammation occurs internally—where tissue is normally at body core temperature—no increase in heat is apparent. Cardinal signs of acute inflammation. Note swelling and redness of the skin around an infected burn. Marked tenderness, increased local temperature, and loss of function were also present. The Editors of Encyclopædia Britannica. http://global.britannica.com/EBchecked/topic/287677/inflammation The inflammatory response is a defense mechanism that evolved in higher organisms to protect them from infection and injury. Its purpose is to localize and eliminate the injurious agent and to remove damaged tissue components so that the body can begin to heal. The response consists of changes in blood flow, an increase in permeability of blood vessels, and the migration of fluid, proteins, and white blood cells (leukocytes) from the circulation to the site of tissue damage. An inflammatory response that lasts only a few days is called acute inflammation. Acute inflammation usually of sudden onset, marked by the classical signs, in which vascular and exudative processes predominate. Chronic inflammation prolonged and persistent inflammation marked chiefly by new connective tissue formation; it may be a continuation of an acute form or a prolonged lowgrade form. Quanten P. The Inflammation Process. http://freespace.virgin.net/ahcare.qua/literature/medical/inflammationprocess.html Increasing levels of prostaglandin E2 in the brain induce an area called the hypothalamus to turn up the body's thermostat a notch. Suddenly, the same external temperature feels colder, and various means are employed to restore the subjective impression of warmth. These include involuntary processes such as shivering, which generates heat by 11 movement, and voluntary behaviour such as putting on more clothes, finding a warm radiator to sit next to, and so on. Like pain and swelling, fever plays a vital part in defending the body against infection. Many bacteria reproduce most effectively at normal body temperature. So by raising body temperature the rate at which the bacteria can divide is slowed down. Fever has the opposite effect on most immune cells, causing them to divide more quickly. So fever both slows down the spread of the infection and accelerates the counterattack by the immune system. All injuries and infections, as stated above, cause a fever. This might only manifest itself in a localised heat, and does not always produce an overall increase of the body temperature. Vinay Kumar, Abul K. Abbas, and Jon C. Aster. Robbins Basic Pathology, Ninth Edition. – 2013. Stimuli for Acute Inflammation: • Infections (bacterial, viral, fungal, parasitic) & microbial toxins • Tissue necrosis: ischemia, trauma, physical or chemical injury (e.g., thermal injury; irradiation; some environmental chemicals) • Foreign bodies (splinters, dirt, sutures) • Immune reactions (aka hypersensitivity reactions) Cardinal signs of inflammation: • Heat (calor) • Redness (rubor) • Swelling (tumor) • Pain (dolor) – Celsus, De Medicina, Roman encyclopedia of medicine, >2000 years ago • Loss of function – Rudolf Virchow (“father of modern pathology”), Late 19th century Vasodilation - Change in vessel flow: – NO, histamine vascular smooth muscle vasodilatione increased blood flow heat & redness. – Stasis: slowed blood flow, hyperviscosity. – Margination of circulating leukocytes & endothelial activation. Causes of chronic inflammation: • Persistent injury or infection (Ulcer, tuberculosis) • Prolonged exposure to a toxic agent (Pulmonary silicosis (silica in the lung)) • Autoimmune disease—self-perpetuating immune reaction that results in tissue damage and inflammation (Rheumatoid arthritis, Systemic lupus erythematosus, Multiple sclerosis) Features of chronic inflammation: • Chronic inflammation = long duration • Components: – Lymphocyte, plasma cell, macrophage (mononuclear cell) infiltration – Tissue destruction by inflammatory cells – Repair with fibrosis and angiogenesis (new vessel formation) In connection with the above signs of inflammation following group of inflammatory diseases are listed according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision: Chapter IV Endocrine, nutritional and metabolic diseases E10-E14 Diabetes mellitus Chapter VII Diseases of the eye and adnexa H00-H06 Disorders of eyelid, lacrimal system and orbit H10-H13 Disorders of conjunctiva H15-H22 Disorders of sclera, cornea, iris and ciliary body 12 H30-H36 Disorders of choroid and retina Chapter VIII Diseases of the ear and mastoid process H60 Otitis externa H65 Nonsuppurative otitis media H66 Suppurative otitis media H70 Mastoiditis and related conditions Chapter IX Diseases of the circulatory system I80 Phlebitis and thrombophlebitis I88 Nonspecific lymphadenitis I89 Other noninfective disorders of lymphatic vessels and lymph nodes Chapter X Diseases of the respiratory system J01 Acute sinusitis J02 Acute pharyngitis J03 Acute tonsillitis J04 Acute laryngitis and tracheitis J32 Chronic sinusitis J35 Chronic diseases of tonsils and adenoids J37 Chronic laryngitis and laryngotracheitis Chapter XI Diseases of the digestive system K04 Diseases of pulp and periapical tissues K05 Gingivitis and periodontal diseases K10 Other diseases of jaws K11 Diseases of salivary glands Chapter XII Diseases of the skin and subcutaneous tissue L02 Cutaneous abscess, furuncle and carbuncle L03 Cellulitis L04 Acute lymphadenitis L08 Other local infections of skin and subcutaneous tissue L20-L30 Dermatitis and eczema Chapter XIII Diseases of the musculoskeletal system and connective tissue M00-M03 Infectious arthropathies M05-M14 Inflammatory polyarthropathies M15-M19 Arthrosis М20-М25 Other joint diseases M65-M68 Disorders of synovium and tendon M70-M79 Other soft tissue disorders Chapter XIV Diseases of the genitourinary system N41 Inflammatory diseases of prostate N45 Orchitis and epididymitis N49 Inflammatory disorders of male genital organs, not elsewhere classified N61 Inflammatory disorders of breast Chapter XV Pregnancy, childbirth and the puerperium O91 Infections of breast associated with childbirth Chapter XIX Injury, poisoning and certain other consequences of external causes S00-S09 Injuries to the head S10-S19 Injuries to the neck S20-S29 Injuries to the thorax S30-S39 Injuries to the abdomen, lower back, lumbar spine and pelvis S40-S49 Injuries to the shoulder and upper arm S50-S59 Injuries to the elbow and forearm S60-S69 Injuries to the wrist and hand S70-S79 Injuries to the hip and thigh 13 S80-S89 Injuries to the knee and lower leg S90-S99 Injuries to the ankle and foot T00-T07 Injuries involving multiple body regions T08-T14 Injuries to unspecified part of trunk, limb or body region For each of the above listed group of diseases, below you may find short abstracts of major medical publications concerning capabilities of the thermography for treatment of these diseases. Publications, devoted to use of IR-thermography for different inflammation diseases Abstracts and quotations from the articles devoted to the results of thermographic studies for different diseases are presented below. IR-thermography can be successfully used for diagnostics as well as for monitoring of treatment process, as publication reviews indicate regarding to possibilities of IR-thermography. Chapter IV Endocrine, nutritional and metabolic diseases E10-E14 Diabetes mellitus The International Diabetes Federation (IDF) has estimated the World diabetes prevalence at 6% in the adult population (aged 20–79 years). Consequently, there are currently approximately 30 million people with diabetes in the EU-27 countries [The International Working Group on the Diabetic Foot and The International Diabetes Federation. Available from http://www.iwgdf.org/. Accessed 3 February 2009; Eurostat. Available from http://epp.eurostat.ec.europa.eu. Accessed 19 March 2009.]. Recent statistics by the American Diabetic Association suggest that the prevalence of diabetes in the United States is 18 million and the onset of type 2 diabetes mellitus preceded its diagnosis by a mean 7 years [O’Brien J, Patrick A, Caro J. Estimates of direct medical costs for microvascular and macrovascular complications resulting from type 2 diabetes mellitus in the United States in 2000. Clin Ther 2003;25:1017-38.]. The diabetic foot is a major long-term complication of type 2 diabetes mellitus [Armstrong D, Lavery L, Wunderlich R, Boulton A. Skin temperatures as a one-time screening tool do not predict future diabetic foot complications. J Am Podiatr Med Assoc 2003;93:443-7.]. The risk of hospital admission for PVD, neuropathy, and ulceration is greater for patients with diabetes [Currie C, Morgan C, Peters J. The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy and ulceration in diabetes. Diabetes Care 1998;21:42-8.]. The annual incidence of foot ulceration among people with diabetes is approximately 2% and approximately 15% of these will lead to a lower-limb amputation [Prompers L, Huijberts M, Schaper N, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 51(10), 1826-1834 (2008); Apelqvist J, Ragnarson Tennvall G. Counting the costs of the diabetic foot. Diabetes Voice. 50(Special Issue), 8-10 (2005).]. This would imply that 600,000 diabetic foot ulcers occur each year in the EU-27 countries, of which 90,000 will require an amputation. Foot ulcers are the main cause of lower extremity amputation in patients with diabetes, resulting in a huge economic burden for health services [Morbach S, Lutale J, Viswanathan V, Mollenberg J, Ochs H, Rajashekar S, et al. Regional differences in risk factors and clinical presentation of diabetic foot lesions. Diabet Med 2004;21:91-5.]. Studies show that there is a relationship between increased temperature and foot complications in diabetes [Sun PC, Lin HD, Jao SH, Ku YC, Chan RC, Cheng CK. Relationship of skin temperature to sympathetic dysfunction in diabetic at-risk feet. Diabetes Res. Clin. Pract. 73(1), 41-46 (2006).]. Increased temperature may be present 14 up to a week before a foot ulcer occurs [Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am. J. Med.. 120(12), 1042-1046 (2007).]. In this early stage of the disease, patients seldom feel pain because of neuropathic sensory loss, which indicates that increased temperature can be a useful predictive sign of foot ulceration and sub-clinical inflammation of the feet. Consequently, monitoring of foot temperature could be used for preventive purposes. Studies of at-home monitoring of foot temperature show that the incidence of foot ulcers in a risk group may be reduced by more than 60% [Lavery LA, Higgins KR, Lanctot DR, et al. Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool. Diabetes Care. 30(1),14-20 (2007); Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care. 27(11), 26422647 (2004).]. The concept of measuring body weight and foot temperature simultaneously can easily make the procedure into a daily routine, and thereby lead to better compliance with selfcare advice. Temperature monitoring could be a complementary therapy in the prevention of major foot complications but cannot replace any of the current steps in modern diabetes care. Adoption of temperature monitoring in standard care may lead to a more frequent referral of patients from primary care to specialists as further imaging studies will be needed to determine the cause of an increased temperature. Early diagnosis and early treatment is crucial for the healing of diabetic foot lesions, and resources for early interventions must therefore be available to take care of a higher number of suspected foot complications. Arad Y, Fonseca V, Peters A, Vinik A. Beyond the Monofilament for the Insensate Diabetic Foot: A systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes // Diabetes Care 34 (4) (2011): 1041–6. Lavery et al. reported an RCT of 85 subjects at high risk for foot ulceration (neuropathy and foot deformity or a history of ulceration or partial foot amputation). Standard therapy consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. Enhanced therapy included the addition of infrared skin thermometer to measure temperature at six locations on the sole of the feet twice per day. When a difference of >4°F between the same locations of the two feet was noted, subjects were instructed to contact the nurse and reduce activity of the involved foot (higher temperature) until the temperature gradient decreased to <4°F. During a 6-month period, new complications were found in 20% of the standard therapy group (seven ulcers and two Charcot fractures) versus 2% (one ulcer) in the intervention group (odds ratio 10.3, CI 1.2– 85.3, P = 0.01). The study was single blinded (physicians). Relevant baseline values were not well described. It is possible that temperature monitoring led to more intense interaction with caretakers and thus better monitoring and therapy. Otherwise, the study was well designed with a score of. A similar but larger study was subsequently reported by the same group. This was also physician blinded and a multicenter study of 173 individuals at high risk for foot ulcers. Randomization was computer-generated. To account for the possibility that effect of temperature monitoring may be due to more intense interaction with caregivers, the study was divided into three groups: 1) standard therapy; 2) structured foot examination twice daily by the patients using a mirror and a log book (The patient was instructed to call the nurse if any abnormality was noted.); and 3) enhanced therapy group consisting of the addition of temperature measurements to standard therapy. If temperature increased by 4°F compared with the corresponding site on the other foot, patients were instructed to call the nurse and decrease activity until the gradient decreased to <4°F. After 15 months, the incidence of foot ulcer decreased from 30% in the first two groups to 8.5% in the plantar foot temperature-guided avoidance therapy. The study was well conducted and scored. 15 The study by Armstrong et al. randomized 225 patients to two groups. Both groups received diabetic foot education and therapeutic footwear, and daily structured foot examinations were performed as described above. The intervention group also performed temperature-guided avoidance therapy as described above, although the patient’s physician was blinded to the randomization compliance and dropout rates were not described. Furthermore, it is not clear whether the analysis was based on intent to treat. Overall incidence of subsequent foot ulceration was lower than in other studies (total of 8.4%). Nonetheless, the incidence of ulcers decreased by 62% (from 12.2 to 4.7%) in the group using temperature monitoring. The study scored. David G Armstrong, Lawrence A Lavery, Paul J Liswood, William F Todd and Jeffrey A Tredwell. Infrared Dermal Thermometry for the High-Risk Diabetic Foot // Physical Therapy . Volume 77 . Number 2 . February 1997. – Р. 169-175. Background and Purpose. The purpose of this study was to compare skin temperatures in patients with asymptomatic peripheral sensory neuropathy, patients with neuropathic ulcers, and patients with Charcot's arthropathy using the contralateral limb as a control. Subiects. On a retrospective basis, patients with diabetes (N=143) were divided into three groups: patients with asymptomatic sensory neuropathy (n = 78), patients with neuropathic foot ulcers (n= 44), and patients with neuropathic fractures (Charcot's arthropathy) (n=21). Methods. We evaluated the subjects' skin temperatures with a portable handheld infrared skin temperature probe at the time pathology was initially identified and at subsequent clinical visits for an average of 22.1 months (SD=6.4). Skin temperatures of the contralateral foot were measured as a control. Results. There were differences in skin temperature between the affected foot and the contralateral (ie, nonaffected) foot among the patients with Charcot's arthropathy (8.3" F) and the patients with neuropathic ulcers (5.6"F), with no difference identified among the patients with asymptomatic sensory neuropathy. Five patients with neuropathic ulcers experienced reulceration a mean of 12.2 months (SD=6.4) after initial healing, with a corresponding increase in skin temperature (89.6°F±1.2°F versus 82.5°F±2.9°F) at the clinic visit immediately preceding reinjuiy. Conclusion and Discussion. The data suggest that monitoring of the corresponding contralateral foot site may provide clinical information before other clinical signs of injury can be identified. [Armstrong DG, Laveiy LA, Liswood PJ, et al. Infrared dermal thermometry for the high-risk diabetic foot. Phvs Ther. 1997;77:169-177.]. Bharara M., Schoess J., Armstrong D.G. Coming events cast their shadows before: detecting inflammation in the acute diabetic foot and the foot in remission // Diabetes Metab Res Rev 2012; 28(Suppl 1): 15–20. The incidence of diabetic foot complications, most notably wounds, is increasing worldwide. Most people who present for care of a foot wound will become infected. Globally, this results in one major amputation every 30 seconds with over 2500 limbs lost per day. Presently, clinicians assess circulation, neuropathy and plantar pressures to identify the risk of foot ulceration. Several studies have suggested prevention of foot ulcers by identifying individuals at high risk and treating for lower extremity complications. Our group has proposed several diagnostics as well as prevention strategies, especially thermography and thermometry for management of patients with diabetic foot complications. These strategies employ non-invasive assessment of inflammation for acute as well as chronic care for the foot, with the intent to prevent ulceration/re-ulceration and subsequent traumatic amputations. The authors’ review some important clinical studies and ongoing research in this area, with the long-term goal to further the role of thermography and thermometry in clinical care for the diabetic foot. 16 Bagavathiappan S., Philip J., Jayakumar T., Raj B. et al. Correlation between Plantar Foot Temperature and Diabetic Neuropathy: A Case Study by Using an Infrared // Journal of Diabetes Science and Technology. - Volume 4, Issue 6, November 2010. Background: Diabetic neuropathy consists of multiple clinical manifestations of which loss of sensation is most prominent. ТHigh temperatures under the foot coupled with reduced or complete loss of sensation can predispose the patient to foot ulceration. The aim of this study was to look at the correlation between plantar foot temperature and diabetic neuropathy using a noninvasive infrared thermal imaging technique. Methods: Infrared thermal imaging, a remote and noncontact experimental tool, was used to study the plantar foot temperatures of 112 subjects with type 2 diabetes selected from a tertiary diabetes centre in South India. Results: Patients with diabetic neuropathy (defined as vibration perception threshold (VPT) values on biothesiometry greater than 20 V) had a higher foot temperature (32–35 °C) compared to patients (27–30 °C). Diabetic subjects with neuropathy also had higher mean foot temperature (MFT) (p = .001) compared to non-neuropathic subjects. MFT also showed a positive correlation with right great toe (r = 0.301, p = .001) and left great toe VPT values (r = 0.292, p = .002). However, there was no correlation between glycated hemoglobin and MFT. Conclusion: Infrared thermal imaging may be used as an additional tool for evaluation of high risk diabetic feet. Kaabouch N., Wen-Chen Hu, Yi Chen. Alternative Technique to Asymmetry AnalysisBased Overlapping for Foot Ulcer Examination: Scalable Scanning // J Diabetes Metab 2011, S:5. Asymmetry analysis based on the overlapping of thermal images proved able to detect inflammation and, predict foot ulceration. This technique involves three main steps: segmentation, geometric transformation, and overlapping. However, the overlapping technique, which consists of subtracting the intensity levels of the right foot from those of the left foot, can also detect false abnormal areas if the projections of the left and right feet are not the same. In this paper, we present an alternative technique to asymmetry analysis-based overlapping. The proposed technique, scalable scanning, allows for an effective comparison even if the shapes and sizes of the feet projections appear differently in the image. The tested results show that asymmetry analysis- based scalable scanning provides fewer false abnormal areas than does asymmetry analysis -based overlapping. The experimental results show that the proposed technique gives fewer false abnormal areas and hence is more reliable to use to identify inflammation. In the future, our research objectives will include 1) studying the decay rates of temperature distributions over time for successive images that correspond to the same feet, and 2) combining temperature and pressure distributions to predict foot ulceration. Makoto Oe, Rie Roselyne Yotsu, Hiromi Sanada,Takashi Nagase, and Takeshi Tamaki. Screening for Osteomyelitis Using Thermography in Patients with Diabetic Foot. – Ulcers. - Volume 2013, Article ID 284294, 6 pages. One of the most serious complications of diabetic foot (DF) is osteomyelitis, and early detection is important. To assess the validity of thermography to screen for osteomyelitis, we investigated thermographic findings in patients with both DF and osteomyelitis. The subjects were 18 diabetic patients with 20 occurrences of DF who visited a dermatology department at a hospital in Tokyo and underwent evaluation by magnetic resonance imaging (MRI) and thermography between June 2010 and July 2012. Osteomyelitis was identified by MRI. Thermographs were taken of the wounds and legs after bed rest of more than 15 minutes. Two wound management researchers evaluated the range of increased skin temperature. There were three types of distribution of increased skin temperature: the 17 periwound, ankle, and knee patterns. Fisher’s exact test revealed that the ankle pattern was significantlymore common in the group with osteomyelitis than in the group without osteomyelitis (𝑃 = 0.011). The positive predictive value was 100%, and the negative predictive value was 71.4%. Our results suggest that an area of increased skin temperature extending to the ankle can be a sign of osteomyelitis.Thermography might therefore be useful for screening for osteomyelitis in patients with DF. Roback K. An overview of temperature monitoring devices for early detection of diabetic foot disorders // Expert Rev. Med. Devices 7(5), 711–718 (2010). Diabetic foot complications are associated with substantial costs and loss of quality of life. This article gives an overview of available and emerging devices for the monitoring of foot temperature as a means of early detection of foot disorders in diabetes. The aim is to describe the technologies and to summarize experiences from experimental use. Studies show that regular monitoring of foot temperature may limit the incidence of disabling conditions such as foot ulcers and lower limb amputations. Infrared thermometry and liquid crystal thermography were identified as the leading technologies in use today. Both technologies are feasible for temperature monitoring of the feet and could be used as a complement to current practices for foot examinations in diabetes. • Increased temperature may be detected as an early warning for foot complications in diabetes. This occurs at a reversible stage of the disease. • At home monitoring of foot temperature may reduce the incidence of foot ulcers by more than 60%. • There are currently three types of devices available for monitoring of foot temperature: a specially designed infrared thermometer, the Liquid Crystal Thermography (LCT) indicator plates and a body weighing scale with built-in thermistors. • The technologies may be used either for at-homecare or for screening in hospital scheduled diabetes care. • Scanning of foot temperature with an infrared thermometer is relatively time consuming, while the LCT technology offers rapid temperature imaging. However, the thermographs may sometimes be difficult to interpret. • The temperature-sensing weighing scale has a potential of making foot temperature monitoring into a daily routine but must be developed further. • Temperature monitoring could be a complement in the prevention of major foot complications but cannot replace any of the current steps in diabetes care. • Adoption of temperature monitoring in standard care may lead to a more frequent referral of patients from primary care to specialists but prevention of serious foot complication has a potential to save costs owing to avoided amputations and in-hospital care. • Early diagnosis and early treatment is crucial for the healing of diabetic foot lesions. The healthcare system must therefore be prepared to take care of a higher number of suspected foot complications. Veikutis V., Verkauskiene R., Jakuboniene N., Marciulionyte D., Morkunaite K., Raisutis R., Monstvilas E., Stankevicius E. Clinical identification of early „diabetic foot„ by infrared imaging // Conference “Biomedical Engineering“ Diabetic foot disease can occur in various stages of diabetes mellitus and consist from peripheral angiopathy, neuropathy, which in presence of infection and some other factors can lead to ulceration and in 15 % of cases to lower limb amputation. Early detection of ulceration risk is essential clinical and prognostic test for successful diabetic foot development control. The aim of the study was to determine optimal characteristics and clinical possibilities of thermography for early detection of lower leg peripheral vascular function changes. Therefore we tried evaluate foot temperature differences between 18 controls and diabetic patients. According to our studies, temperature monitoring could be a complementary therapy in the early prevention of mayor diabetic foot complications. Chapter VII Diseases of the eye and adnexa Kawali AA. Thermography in ocular inflammation. Indian J Radiol Imaging 2013;23:2813. Background and Objectives: The purpose of this study was to evaluate ocular inflammatory and non-inflammatory conditions using commercially available thermal camera. Materials and Methods: A non-contact thermographic camera (FLIR P 620) was used to take thermal pictures of seven cases of ocular inflammation, two cases of noninflammatory ocular pathology, and one healthy subject with mild refractive error only. Ocular inflammatory cases included five cases of scleritis, one case of postoperative anterior uveitis, and a case of meibomian gland dysfunction with keratitis (MGD-keratitis). Non-inflammatory conditions included a case of conjunctival benign reactive lymphoid hyperplasia (BRLH) and a case of central serous chorio-retinopathy. Thermal and nonthermal photographs were taken, and using analyzing software, the ocular surface temperature was calculated. Results: Patient with fresh episode of scleritis revealed high temperature. Eyes with MGDkeratitis depicted lower temperature in clinically more affected eye. Conjunctival BRLH showed a cold lesion on thermography at the site of involvement, in contrast to cases of scleritis with similar clinical presentation. The eye of the patient with a fresh episode of scleritis, which was not on treatment, showed hot colors on thermography indicating higher temperature in right eye compared to fellow healthy eye. Eyes with scleritis on treatment showed slightly higher temperature compared to the fellow eye. A case of resolved necrotizing scleritis showed lower temperature at the site of the necrosis surrounded by normal tissue temperature. Eye with postoperative anterior uveitis also revealed increased temperature, but paradoxically, eyes with MGD-keratitis depicted lower temperature in clinically more affected right eye (OD). Eye with conjunctival BRLH showed lower temperature at the site of the lesion. Eyes with only refractive error but no other pathology showed no temperature difference between both the eyes. is the temperature scale ranged between 31.5°C to 38.5°C. Discussion: Ocular thermography is a relatively newer imaging modality. Attempts to calculate normal eye temperature were made way back in 1950s using contact thermometry. In 1968, R. Mapstone introduced infrared thermometry using bolometer, a non-contact method of ocular thermometry. [Mapstone R. Determinants of corneal temperature. Br J Ophthalmol. 1968; 52: 729–41.] The normal corneal temperature measured by thermography ranges from 35.4±0.1°C [Stefanie PetrouBinder. Thermography shows enormous promise for diagnosis and treatment of eye diseases. Eurotimes. [Last accessed on 2003 Mar]. Available from:http://www.escrs.org/eurotimes/march2003/thermo.asp] to 34.01 ± 0.64°C, [Tan JH, Ng EY, Acharya UR. An efficient automated algorithm to detect ocular surface temperature on sequence of thermograms using snake and target tracing function. J Med Syst. 2011; 35: 949–58.] and the mean inter-ocular difference of OST in normal individuals was found to be 0.21 ± 0.18°C.[Tan JH, Ng EY, Acharya UR. An efficient automated algorithm to detect ocular surface temperature on sequence of thermograms using snake and target tracing function. J Med Syst.2011;35:949–58.] Our first patient, a fresh case of scleritis who was not on any treatment, had higher OST difference ( t) between the two eyes as compared to the eyes on treatment for more than a week. This may suggest that ocular temperature rapidly decreases with anti-inflammatory treatment and has a positive correlation with the signs and symptoms. In this study, the case of MGD-keratitis (case 6) 19 paradoxically showed low temperature in clinically more affected eye (OD). Rolando et al. also noted similar finding in dry eye and suggested that the ocular surface would be 0.10°C lesser in dry eyes due to the increased rate of evaporation.[ Rolando M, Refojo MF, Kenyon KR. Increased tear evaporation in eyes with keratoconjunctivitis sicca. Arch Ophthalmol. 1983;101:557–8. ] Hence, applying the same logic, it is clear that in case 6 in the present study, due to decreased tear film lipids owing to MGD, the worse eye (OD) was subjected to rapid evaporation of the tear film which resulted in a relatively colder eye on thermography. Thermography can also be used to distinguish between a cold lesion of non-inflammatory condition from a hot lesion of ocular inflammation. Conjunctival BRLH is a poorly vascularized tumor, and hence, case 8 in the present study showed low temperature at the site of the lesion. In contrast case 1 who came with similar clinical presentation showed high temperature, suggestive of inflammation due to scleritis. Our cases of posterior scleritis had “minimal” increase in temperature as compared to the non-affected eye, as they were on treatment. This may suggest that posterior segment inflammation can also cause increase in OST, which can be picked up on thermography when posterior segment examination is difficult as in the case of mature cataract or when it is normal as in the case of mild posterior scleritis. Conclusion: Ocular thermal imaging is an underutilized diagnostic tool which can be used to distinguish inflammatory ocular conditions from non-inflammatory conditions. It can also be utilized in the evaluation of tear film in dry eye syndrome. Its applications should be further explored in uveitis and other ocular disorders. Dedicated "ocular thermographic" camera is today's need of the hour. Morgan Philip B, Tullo Andrew B, Efron N. Infrared thermography of the tear film in dry eye. – Eye (1995) 9, 615–618. Infrared ocular thermograms were recorded for a group of 36 dry eye patients and for 27 age- and sex-matched controls. Mean ocular surface temperature was greater in the dry eye group (32.38 ± 0.69°C) compared with the control group (31.94 ± 0.54°C; P<0.01). In addition, there was a greater variation of temperatures across the ocular surface in the dry eye group, illustrated by the difference in temperature between the limbus and the centre of the cornea (0.64 ± 0.20 °C in dry eye patients compared with 0.41 ± 0.20°C in the control group; p<0.001). This parameter was also shown to be greater in dry eye patients who displayed either a fast tear break-up time or a poor Schirmer's test result. Infrared thermography is a non-invasive and objective technique that may prove a useful research tool for study of the tear film, its deficiencies and its various treatment modalities. Morgan, P. B. Ocular thermography in health and disease. - Thesis (Ph.D.). - The University of Manchester, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.507520#sthash.ulqVkAMV.dpuf There has been interest in ocular temperature for over a century, with the publication of a limited amount of literature over that time. This thesis reports on the development and utilisation of a system for the measurement of ocular surface temperature based on an advanced infrared detector. The development of a suitable protocol for the infrared imaging and temperature measurement of the eye was established. Results from the analysis of the ocular temperature of 98 normal subjects indicated that the temperature at the centre of the cornea was 31.68 ± 0.60°C (mean ± SD), and the mean ocular surface temperature (MOST) was 32.10 ± 0.53°C. This value rose with increasing room and oral temperature (both p< 0.0001) and decreased with corneal thickness (p< 0.05) and age (p< 0.01). Ninety five per cent of the subjects had an inter-ocular difference in MOST within 0.53°C. There was a positive relationship between the variation in temperature across the ocular surface and the distance between the corneal apex and a coronal plane through the 20 limbus (p< 0.001). The effect on eye temperature of changes in the ocular blood, nerve and tear supplies was studied. Three of nine patients (33%) with unilateral inflammatory disease had ocular temperature outside the established normal limits. For the group of patients as a whole, the temperature of the affected eye was warmer than the fellow (32.40 ± 0.81°C compared with 32.10 ± 0.70°C; p< 0.05). In the examination of two patients with Horner's syndrome, one demonstrated a difference in eye temperature (0.61°C) outside normal limits (0.53°C), with the affected eye being warmer. Tkáčová M., Živčák J., Foffová P. A Reference for Human Eye Surface Temperature Measurements in Diagnostic Process of Ophthalmologic Diseases. - MEASUREMENT 2011, Proceedings of the 8th International Conference, Smolenice, Slovakia. Introduction For many years temperature is the first measurement of a physical property for determination of diagnosis in the medicine. From electromagnetic theory it is a form of infrared energy being emitted from the first molecular surface of a body (skin). Infrared imaging is the detection and conversion of energy from a section of the infrared spectrum, into the visible spectrum. Surface energy levels are affected by the environment, operational conditions, heat transfer processes of a human body and the surface characteristics. Thermography is a non-invasive, contactless temperature measurement technique used to produce a colored visualization of thermal energy emitted by the measured surface. Each pixel in the image depicts the radiance falling on the focal plane array/ microbolometer– type detector used in an IR camera. Current applications infrared thermography in ophthalmology include: diagnosis of glaucoma, an eye disorder in which the optic nerve suffers damage, permanently impacting vision in the affected eye(s) and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye; monitoring surface temperature of a healthy eye; thermographic monitoring of tear ocular film; thermography and comparison of normal, ischemic and hyperaemic eye; the impact of contact lenses for the eye surface temperature and other. Our study is based on monitoring the temperature of the healthy eye to get the reference database for diagnostic process support of ophthalmologic diseases. Subject and Methods Skin temperature on human eyes from our database (n= 28) were measured with an infrared camera (ThermaCam Fluke Ti55/20, Fluke, USA) with 10,5 mm lens (10,5 mm F/0,8; 8-14 μm). The thermal sensitivity of the camera is 0.05°C at 30°C of a blackbody. Camera works in the spectral range from 8 to 14 μm (human body infrared radiation is highest in the spectral range around 9,66 μm) and the calibrated temperature range from 20 to 100 °C. Emissivity of the skin was set in the camera software to 0,98, the ambient temperature was measured by handheld thermometer (Testo 810). Before each recording the camera was calibrated using the system's internal calibration process. All thermograms (n=28) were processed by SmartView 2.1 software. Object of our measurements were volunteers, their average age was 24 years. Discussion Studies published worldwide indicate that thermography is a valuable diagnostic method in ophthalmology, in order to objective detection of some ophthalmologic diseases and conditions (monitoring of tear ocular film, ischemic and hyperaemic eye, diagnosis of glaucoma, etc.). The database of healthy eye surfaces temperature is important to differentiate the healthy eye and pathological condition of the eye in specific ophthalmologic diseases. 21 Conclusions In the study a methodology of thermographic measurements was assessed. After the processing of the thermograms, the average temperatures of the cornea in all measured subjects were calculated . Results show, that a total average temperature in the cornea of the eye in markers T1, T2 a T3 is 34,51 ± 0,82 oC. The minimum temperature of the cornea eye was 33,82 ± 1,10 oC and maximum temperature 35,41 ± 0,73 oC. Theresults show that the overall average temperature of the eye surface is 34,51 ± 0,82 oC. The bigger statistically significant group is planned to get the significant reference values. Chapter VIII Diseases of the ear and mastoid process Merkulov V.G. Comprehensive thermography diagnostics of some ear-nose-throat related diseases. // Russian otorhinolaringolagy. – 2000. – №3. – Pages 163-168. The research demonstrated sufficiently high specific of the infrared thermography: 91.4% during examination of the middle ear. The analysis of the results of thermography performed for the unilateral inflammatory pathology of the middle ear demonstrates that such diseases as mastoiditis (including the non-perforative middle otitis), chronic pus middle otitis with cholesteatoma are optimal and practically important factors for its application. For the mastoiditis the thermography’s diagnostic sensitivity is equal to 81.3%, for the chronic pus middle otitis with choleastoma – 79.6%. Jolin S.W., Howell J.M., Milzman D.P., Stair T.O., Butzin C.A. Infrared emission detection tympanic thermometry May be useful in diagnosing acute otitis media // American Journal of Emergency Medicine Volume 13, Issue 1, Pages 6-8, January 1995. To determine the utility of infrared emission detection (IRED) tympanic thermometry in diagnosing acute suppurative otitis media (ASOM), a prospective, nonblinded sampling of ear temperatures was performed. Children between the ages of 6 months and 6 years presenting to an urban emergency department were included in the study. Tympanic temperatures were determied in all subjects. Clinical data, tympanic audiometry, and telephone follow-up were used to define ASOM. Temperature differences were determined for children with unilateral ASOM and those without ear infection. Data from 48 patients were analyzed. The mean temperature difference in the control group, 0.23° ± 0.15°C (95% confidence interval [Cl], 0.17° to 0.29°C) differed from those with ASOM: 0.39° ± 0.29°C (95% Cl, 0.25° to 0.53° C, P = .047). Logistic regression was used to describe the predictive relationship between temperature difference and probability of ASOM. We conclude that IRED tympanic thermometry may be useful in diagnosing ASOM when used with other clinical data. Chapter IX Diseases of the circulatory system In his research Popov V.A. (1997) has defined the yearly and late emergent signs of thermal images of the acute vein thrombosis of legs. The research justified application of the thermal imaging for patients suffering from non-occlusive thrombosis in the inferior vena cava. For diagnostics of acute phlebothtombosis by the thermography the high sensitivity (98%), specificity (90%), and diagnostic accuracy (85%) was established. Also, the thermal-imaging signs for the congenital angiodysplasia of extremities were identified. Arteriovenous fistulas are characterized through local increase of irradiation intensity of the dysplastic area with the thermal asymmetry not exceeding 1°С. The thermal-imaging syndrome of the venous form of the congenital angiodysplasia is characterized through decrease of the skin temperature by 1°С, and more dysplastic area as compared to the unchanged surounding tissues. 22 Kelechi T.J., Michel Y. A Descriptive Study of Skin Temperature, Tissue Perfusion, and Tissue Oxygen in Patients With Chronic Venous Disease // Biol Res Nurs 2007 9: 70-80. Chronic inflammation and microcirculatory disturbances of the skin have been implicated as causative factors of complications associated with chronic venous disease (CVD). The purpose of this study is to describe the mean differences between and correlations among three measures of microcirculation: skin temperature (Tsk), tissue perfusion/blood flow (BF), and tissue oxygen (tcPO2) of CVD-inflamed skin compared to normal controls. In a convenience sample of 55 patients with CVD (n = 31) and without CVD (n = 24), Tsk was measured with an infrared thermometer, BF with a laser Doppler flowmeter, and tcPO2 with a transcutaneous oximeter across three measurements periods 1 week apart (Times 1, 2, and 3) at the medial aspect of both lower legs. Tsk was higher (1.2°C) across all measurement periods (p < .05), BF was higher at Times 1 and 3 (p = .002 and .012, respectively), and tcPO2 was lower at Times 1 and 3 (p = .013 and .050, respectively) in the CVD group as compared to the non-CVD group. BF and Tsk were positively correlated at Times 1 and 2 (r = .516, p < .005; r = 0.278, p = .04) but not at Time 3 (r = 0.235, p > .05). No consistently significant correlations were found between tcPO2 and BF or tcPO2 and Tsk (p > .05). Tsk and BF were higher in the skin of lower legs affected by CVD than in those not affected. Pathological processes in the skin produce heat detectable by an infrared thermometer. Measurement and monitoring of Tsk can augment clinical findings and guide treatment when localized inflammation is suspected. Future studies of Tsk should be directed toward the usefulness of infrared technology to develop a CVD leg ulcer prediction model. Steri N.A. Capabilities of the combined thermography for diagnostics of the varicose vein disease of lower extremities. – Abstract of thesis…Ph.D. (medical sciences) – Volgograd, 2008. The varicose disease is still one of the most common vascular diseases of the lower extremities. The report of the international compromissary committee for treatment of chronical vein diseases of lower extremities (1999 year) has stated, that the varicosity prevalence rate for the adult polulation of western countries is equal to 25-33% for women, and 10-20% for men. It is mentioned in the report, that 1% of population is suffering from open or cicatrized ulcers of the vein aetiology. Only half of total number of ulcers is cicatrized within 4 months, yet majority of ulcers are subject to recurrence at least once in a year. Such statistics convert the varicous disease from a purely medicinal issue to a severe social and economic problem. The modern diagnostics of vein diseases and control of treatment are based on noninvasive examination technologies, of which the ultrasonography is the main method. However, the ultrasonic examination does not allow evaluating to full extent the condition of the soft tissues of the lower extremities, as it examines mainly the blood circulation in the main vessels. It is not possible to examine the state of microcirculation of the shank’s lower part, which is the principal area of maximum disturbances of venous outflow of patients suffering from the leg varicous diseases. The author has developed the non-invasive evaluation technique of the condition of leg venous system by of multi-point combined thermography for diagnostics of vein pathologies. This technique may be used independently or in combination with the ultrasonography. The obtaind data allow evaluating efficiency of conservative or chirurgical treatment of patients with leg varicous disease. For obtaining the thermal images of the lower extermities it is possible to use the technique involving multi-point human shank thermal examination by means of 12 points on the shank’s reverse surface. For detection of pathological thermographic signs it is 23 necessary to compare two significantly different thermograms, one of a sound extremity and a thermogram of leg with varicous disease. It was established that when conducting the examination the patient’s posture (standing or lying) does not significantly impact on the thermal image. Thermal-imaging signs of the leg varicous disease include: detection of shank’s thermal disturbances from a normal value, detection of shank’s thermal assymetric arears, presence of an axial thermal gradient (temperature difference relatively an extremity’s axis), availability of a lateral-medial gradient (temperature difference from the outer to the inner shank surface). The thermogram’s sensitivity and specificity of the patients with leg varicous disease of the category С1-3 is equal to 63.6% and 76.4%, accordingly, for the С4-6 the sensitivity is 89%, the specificity is 91.5%, thus allowing to integrate and elaborate the varicous disease diagnostics, and to substantiate optimization of treatment in the preand after operational period. KHVOROSTUKHIN V.S. SIGNIFICANCE OF VALVE INSUFFICENCY OF PERFORATING VEINS, AND MINIMALLY INVASIVE SURGICAL TECHNIQUES FOR ITS TREATMENT FOR THE PATIENTS SUFFERING FROM THE LOWER EXTREMITIES VARICOUS DISEASE. – Abstract of thesis. …Ph.D. (medical sciences) – Saratov, 2006. Using the thermograph ТВ-03К with the temperature range of 25-40°С and sensitibity of 0.1°С, thermography of the lower extremities of 112 patients (49.6%) was conducted. The control group was composed of 15 apparently healthy persons without clinical implications of the chronical venous insufficiency of the lower extremities. For all the examined patients (100%) the thermography has discovered convolute linear focuses of hyperthermia in the projection of varicousities over their whole length with a uniform temperature increase of 0.8–1.8С (the average value is 1.4±0,1С) as compared to the surrounding tissues. Detection and localization of incapable perforating veins was performed by means of detection in the projection of superficial veins of warmer sections of various shapes with better manifesting hyperthermia focus in this area. The dimensions of these sections considerably exceeded diameters of the corresponding veins. The temperature gradient, as compared to the projection of other various veins, was in the range of 0.6 – 1.1С (averagely – 8.7±0.5С), in comparision with the surrounding tissues in the range of 1.0 – 2.4С (averagely – 1.8±0.5С). The sensitivity of the thermography study with respect to detection of incapable perforating veins was equal to 64.6%. When conducting the control thermography following the medical treatment, in the projection of remote varicous veins were detected linear sections of hyperthermia with the temperature gradients in the range of 0.4 – 0.8С (averagely – 0.6±0.2С), the varicousities were not identified. After the catheter and puncture scleral obliteration at the varicosities, 7 days following the treatment the isothermical sections and centers of insignificant temperature increase with the gradient of 0.3С were identified. In case of acute ssuperficial thrombophlebitis, the thermograms demonstrate for their projections wide centers of huperthermia involving the surrounding tissues into this process with the temperature rise in the range of 1.5 – 3.1С (averagely – 2.5±0.6С). Following the treatment the area of hyperthermia decreased significantly.The trophic ulcers were marked by availability in the ulcer’s projection of a cold zone of round geometry (the gradient in the range of 0.8 – 1.1С, averagely – 0.9±0.1С) with hyperthermia of the surrounding tissues of 1.1 – 1.3С (averagely – 1.2±0.1С), as compared to the symmetrical section of a sound extremity. Following the ulcer healing its projection retains a hyperthermia focus with gradient in the range 0.4 – 0.8С, averagely – 0.6±0.2С (the area of trophic abnormalities); the zone of hyperthermia was not identified. 24 This way, it appears expedient to apply the thermography for evaluating efficiency of the performed treatment, and dynamics of manifestation of the chronic venous insufficiency. Wild W.; Schütte S., Große M. Тhermal imaging as a non invasive application in the field of diagnostics and treatment of varicosis and succeeding symptoms // 6th INTERNATIONAL CONFERENCE ON QUANTITATIVE INFRARED THERMOGRAPHY QIRT 2002, DUBROVNIK, September 24-27, 2002 (www.fsb.unizg.hr/Qirt2002/abstract/60.doc) Introduction. Varicosis with all its succeeding symptoms is a serious and broad spread illness our civilization has to face. Nowadays approved diagnostic methods include non invasive duplex sonography and invasive angiography. This study evaluates the possibilities of thermal imaging as a new or supporting tool in the process of diagnostics and monitoring of treatment of varicosis and should raise information for a succeeding more detailed study. Patients and Methods. First of all 11 randomly chosen patients (7 female, 4 male) with a proven diagnostic suffering from varicosis and succeeding symptoms like postthrombotic symptom, Ulcus Cruris and phlebitis underwent thermal imaging at their regions of interest. The images were taken under equal circumstances with a FLIR / AGEMA Thermovision 550 infrared camera. For comparison to this, pictures of the same regions were taken with a commercial digital camera. The evaluation of the thermographic images was conducted with the Software ThermaCam Reporter 2000. Results. No technical problems occurred during the course of image reception. Infrared Imaging and the camera system itself prove to be an easy to handle and quick to apply recording installation. Thermal images show high detail and contrast with blood vessels located close below the skin. Resolution of skin temperature between the single outer extremities – fingers and toes, appears to be acceptable and correlates to the proven diagnosis. Problems of image detail resolution occur especially with male leghair coating and deeper position of the blood vessels below the skin because of bodyfat. Conclusion. The data collected during the study seem to be promising that thermal imaging may be suited as an additional and supporting non-invasive method of diagnosis in the field of varicosis and post symptoms. The succeeding study may also be spread out to general blood flow insufficiency symptoms like arteriosclerosis. Chapter X Diseases of the respiratory system Gauthier E., Marin T., Bodnar J-L. and Stubbe L. Assessment of the pertinence of infrared thermography as a diagnostic tool in sinusitis - Cases study // The 12th International Quantitative InfraRed Thermography Conference, At Bordeaux, FRANCE. Sinusitis is a frequent otorhinolaryngologic disease, often misdiagnosed. None of the usual imaging equipment is specific, quick or efficient enough for sinusitis diagnosis. Misdiagnosis induces unnecessary health expenditures as well as a risk of antibiotic resistant strain development. Our study (with one healthy control subject, two pathological subjects) shows that infrared thermography could be an efficient, low-cost and noninvasive diagnostic tool for clinical purposes. A cohort study is necessary to establish threshold values for systematic reliable diagnosis. Sinusitis is an otorhinolaryngologic disease that affects people of every age, with millions of consultations per year [Benson V, Marano MA. Current estimates from the National Health Interview Survey. 1995. Vital Health Stat. 1998;199:1-428.]; it is fifth in ranking for antibiotics prescription [Fagnan LJ. Acute sinusitis: a cost-effective approach to diagnosis and treatment. Am Fam Physician. 1998;58:1795-802,805-6., McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the Unites States. JAMA. 1995;273:214-9.]. Sinusitis is an inflammation of the mucous membrane of 25 one or several of the sinus cavities of the face, sometimes accompanied by suppuration. It is a common affliction, although its prevalence is difficult to assess; according to an american study, it affects 14% of the American population, adults and children combined [Poole MD. A focus on acute sinusitis in adults: changes in disease management. Am J Med. 1999;106:38S-47S.]. In this pathology, inflammation is materialized by a sinus temperature increase [Prasał M, Sawicka KM, Wysokiński A. Thermography in cardiology. Kardiol Pol. 2010;68(9):1052-6.]. In humans, a calorific exchange happens between the skin and the atmosphere through infrared, either emitted or absorbed. Previous studies have shown that human inflammation can be detected through thermography: infrared cameras allow for a noninvasive estimation of infrared radiation, which are the external manifestation of an internal process [Ring EFJ, Ammer K. Infrared thermal imaging in medicine. Physiological Measurement. 2012;33(3):R33., Lange KHW, Jansen T, Asghar S, Kristensen PL, Skjønnemand M, Nørgaard P. Skin temperature measured by infrared thermography after specific ultrasound-guided blocking of the musculocutaneous, radial, ulnar, and median nerves in the upper extremity. British journal of anaesthesia. 2011;106(6):887-95.]. The objective of this study is to assess the pertinence of infrared thermography as an efficient diagnostic tool for sinusitis. This study will only evaluate the anterior sinuses network: it is less deep than the other sinuses of the face and thus more pertinent for thermographic evaluation. Also, 90% of sinusitis affect the anterior sinuses network [Institut Français de Chirurgie du Nez et des Sinus. http://www.institutnez.fr/sinusite/sinusite-chronique-19.html. Dernière mise à jour le 26/04/2011.]. Infrared thermography seems to be an efficient, reliable, non-invasive and immediate diagnostic tool for sinusitis; it could be used with any patient, including children, pregnant women or immunodepressed people. Many thermal cameras are light, easy to use and inexpensive (under 1000€). For research purposes, a wider study is required to establish threshold values to precise the analysis protocol. Visual analysis crossed with clinical symptoms could be sufficient for clinical diagnosis. Merkulov V.G. Comprehensive thermography diagnostics of some ear-nose-throat related diseases. // Russian otorhinolaringolagy. – 2000. – №3. – Pages 163-168. The research demonstrated sufficiently high specific of the infrared thermography: 94.5% during examination of the paranasal sinus. The diagnostic sensitivity of thermography for the maxillary sinusitis is equal to 91.5%. Murawski P., Jung A., Kalicki B., Rustecki B. USEFULNESS OF LINEAR PREDICTIVE CODING COEFFICIENTS FOR THE QUALIFICATION HEALTHY PEOPLE AND PATIENTS WITH SINUSITIS BASED ON FACIAL THERMOGRAMS // 17th Congress of the Polish Association of Thermology and Certifying course: "Practical application of thermography in medical diagnostics" - Thermology international 23/2 (2013). 1.Application of LPC covariates in signals analysis marked from facial thermograms, allows qualification of patient to proper group healthy or sick. 2.Values of proper qualification probability are dependent on number of covariates and they are acceptable when nLPC _14. Plouzhnikov M. S., Ryabova M. A. Thermography: clinical significance in rhinology // SP1E Vol. 2106 Iconics and Thermovision Systems. 1. Thermographic picture in patients with operated sinuses during remission period essentially differs from those in normal patients with acute sinusitis. 2. Thermography may be helpful to differentiate the cause of different types of prosopalgia. 26 Torossian F, Giard A, Cereja F. Digital thermography for the evaluation of the effect of betamethasone in the treatment of acute sinusitis. Preliminary study // Presse Med. 1997 Oct 18;26(31):1482-7. OBJECTIVES: Heat emitted during the process of inflammation can be visualized by means of dynamic telethermography (DDT). In the case of sinusitis, it is possible to verify the efficacy of an anti-inflammatory treatment such as betamethasone. PATIENTS AND METHODS: Ten adult ambulatory patients with sinusitis were treated with 2 tablets of betamethasone (Celestene) 2 mg daily for 10 days without concomitant medications. DDT images were obtained on day 0, day 2, day 3, day 5 and day 10. A color chart indicated differences in temperature according to the selected sensitivity. Computer analysis of the images was then obtained. Clinical assessment of symptoms and tolerance were recorded at the same time-points as the DDt images. RESULTS: The effect of treatment was beneficial in all patients since cure of sinusitis was achieved in 5, with marked improvement in 4 others and fair improvement in 1. Pain was significantly reduced on day 10 compared with day 0 (Friedman's test p < 0.0001). There was a simultaneous reduction of sinusitis associated signs: rhinorrhea, lacrimation, photophobia and cutaneous hyperesthesia as well as of general signs. On the DDT images, right-sinus to right-side and left-sinus to left-side ratios both showed a significant decrease between day 0 and day 10 from 41.00 +/- 14.07 to 7.90 +/- 7.22 (ANOVA p < 0.0001) and from 30.70 +/- 5.20 +/- 6.49 (ANOVA p < 0.0001) respectively. DISCUSSION: Whereas in animal pharmacology inflammation can be evaluated by any number of objective methods, only a very few are applicable to clinical situations. Powerful computer image analysis may prove useful in establishing nature and severity based inflammation reduction standards. CONCLUSION: These preliminary findings demonstrated that in most cases single agent therapy provides adequate and rapid control of clinical and thermographic signs of acute sinusitis. Computer analysis corraborates clinical findings and thermogram interpretations. Wojaczyñska-Stanek K., Marszal E., Krzemieñ-Gabriel A., Mniszek J., Sitek-Gola M. Biostimulating Laser Treatment of Chronic Sinusitis in Children – Monitoring by Thermal Imaging // Thermology international 2005, 15: 140-145. Chronic inflammation of the paranasal sinuses is defined as a persistent process in the mucous skin of the nose and and the sinus that continues for at least 12 weeks despite appropriate treatment. Thermographic examination of the sinus area has become a recognized diagnostic method. Thermographic images of children presenting with sinusitis reveal warmer areas in the maxillar projection of the sinus and often higher temperatures in the periorbital region. The experimental group consisted of 20 children treated with biostomulating laser (10 laser therapy sessions) and 15 children who received a long term antibiotic treatment (14 days of antibiotic administration) for chronic sinusitis. A control group consisted of 20 healthy children. Thermographic examination was made under standard condition sbefore and at the end of the course of therapy using a THERMACAM PM595. After laser treatment 16 of 20 patients achieved normal temperature distribution in their thermal images, and after the prolonged antibiotic therapy 12 of 15 patients showed normal thermograms. Subjective improvement related to nasal congestion and headache was evaluated. In one patient, the thermographic image of the sinus indicated persistent inflammation and the patient required another antibiotic treatment. Thermography can be used to monitor the effects of both pharmacological treatment and biostimulating laser therapy. Biostimulating laser treatment appears to be an effective adjunct to long term pharmacological therapy in children with chronic sinusitis. Berman S.Z., Mathison D.A., Stevenson D.D., Usselman J.A., Shore S. Maxillary sinusitis and bronchial asthma: Correlation of roentgenograms, cultures, and thermograms // 27 Journal of Allergy and Clinical Immunology. – Volume 53, Issue 5, May 1974, Pages 311–317. Eng M. Tan. Chapter XI Diseases of the digestive system Biagioni P A, McGimpsey J G & Lamey P J. Electronic infrared thermography as a dental research technique. - British Dental Journal 180, 226 - 230 (1996). Electronic infrared thermography is an imaging modality for the accurate quantification of surface temperature. It has been used in medicine since the 1960s but its use in dentistry has been limited. Its use in dentistry could, however, be very useful, for example in objectively quantifying post-surgical inflammation and studying the effects of treatment with agents such as analgesics and anti-inflammatory drugs. Christensen J, Matzen LH, Vaeth M, Schou S, Wenzel A. Thermography as a quantitative imaging method for assessing postoperative inflammation. - Dentomaxillofac Radiol. Sep 2012; 41(6): 494–499. Objective To assess differences in skin temperature between the operated and control side of the face after mandibular third molar surgery using thermography. Methods 127 patients had 1 mandibular third molar removed. Before the surgery, standardized thermograms were taken of both sides of the patient's face using a Flir ThermaCam™ E320 (Precisions Teknik AB, Halmstad, Sweden). The imaging procedure was repeated 2 days and 7 days after surgery. A region of interest including the third molar region was marked on each image. The mean temperature within each region of interest was calculated. The difference between sides and over time were assessed using paired ttests. Results No significant difference was found between the operated side and the control side either before or 7 days after surgery (p > 0.3). The temperature of the operated side (mean: 32.39 °C, range: 28.9–35.3 °C) was higher than that of the control side (mean: 32.06 °C, range: 28.5–35.0 °C) 2 days after surgery [0.33 °C, 95% confidence interval (CI): 0.22– 0.44 °C, p < 0.001]. No significant difference was found between the pre-operative and the 7-day post-operative temperature (p > 0.1). After 2 days, the operated side was not significantly different from the temperature pre-operatively (p = 0.12), whereas the control side had a lower temperature (0.57 °C, 95% CI: 0.29–0.86 °C, p < 0.001). Conclusions Thermography seems useful for quantitative assessment of inflammation between the intervention side and the control side after surgical removal of mandibular third molars. However, thermography cannot be used to assess absolute temperature changes due to normal variations in skin temperature over time. Mostovoy A. Thermography and Oral Pathology. - This paper was presented in September of 2012 at the European Asociation of Thermography (EAT) in Porto, Portugal. - http://www.thermographyclinic.com/thermography/dental-oral Introduction: The purpose of this study is to illustrate the clinical use of thermography in identifying asymptomatic dental (oral) pathology. A common cause of dental (oral) infection and inflammation found in this study is in fact due to a common dental procedure, a root canal. Unless the region becomes abscessed, usually over a longer period of time, we are completely unaware that there is an issue. 28 For years, a debate has brewed between those, who are proponents of root canals, and those, who see root canals as a potential health threat. Current convention is to save a tooth at any cost. Despite multiple research studies that link root-canal treated teeth to cancer and other chronic disease, the majority of people, even health care professionals, do not pay enough attention to dental health. With thermographic imaging, we can identify areas of suspected inflammation and infection because they present with heat. Once an area of concern is identified, it needs further investigation and resolution. Materials and Methods: Study population consisted of 20 patients (2 males and 18 females, aged from 42 to 63 years) that visited Thermography Clinic in Toronto, Ontario, Canada with variable complaints. All patients were evaluated with IR imaging and followed up with dental examination that included x-ray and examination of the oral cavity. Patients were followed up with additional dental examinations for up to one year. Patients were evaluated with FLIR A-320 Infra Red camera, with examination guidelines followed, as set 1-2 detected spots, six subjects (42.9%) had confirmed results. Five out of six subjects (83.3%) with 3-4 spots received such confirmation. During the second followup dental exam, thermographic findings were confirmed in all 10 subjects evaluated. Notably, in 7 of these subjects results of the first dental evaluations were not confirmatory. When both first and second dental evaluations are take into account, thermographic findings when confirmed at least once in 18 our 20 subjects. The high confirmation rate (90%) indicates strong correlation between thermographic and dental exams. Discussion: Pain acts as a warning system that something is wrong. Unless the region becomes abscessed, usually over a longer period of time, we are completely unaware that something is going on. When a patient has no symptoms of pain or discomfort, the assumption is that all is well. If an infection in the area does develop, we have no way of knowing this, as the pain receptors in that area have been removed as in case of root canal treated teeth. If an abscess develops, it will be taken care of – usually as an emergency – but by then, infection could have been setting in for many years and could have already contributed to the development of other health issues. Chronic inflammation has been accepted as “the silent killer” that leads to chronic disease, heart disease, and cancer. Root canals are inherently susceptible to infection and inflammation. Over the years at our clinic, we have imaged thousands of women using infrared thermography. In many cases, we have clearly seen cases of inflammation in the dental area using this heat sensing technology. Many of forth by the International Academy of Clinical Thermology. The IR imaging finding results were summarized. Quantitative variables were described using summary statistics (means, medians, and standard deviations, minimum and maximum values). Categorical variables were summarized by giving frequency distributions. Percent of patients with at least one IR imaging finding confirmed by subsequent dental evaluations was the primary endpoint in this study. Results: Twenty patients with age ranging from 42 to 63 years (mean age ± SD is 52.4 ± 6.7 y.o.} participated in this study. Eighteen (90%) patients were females. Two patients (10%) had total body scan performed; thirteen patients (65%) had both breast and facial scans, and 5 patients (25%) had a facial scan only. Fourteen patients (70%) did not have any symptoms related to dental pathology. The number of oral cavity findings (“spots”) per patient ranged from 1 to 4 (mean ± SD is 2.1 ± 1.1}. Most of patients had 1 (40%) or 2 (30%) dental cavity findings. Following the thermography evaluations, eight subjects (40%) had a dental follow-up exam in less than a month, 12 subjects (40%) had such an exam in 29 1-2 months. Ten subjects (50%) subsequently had another dental exam; seven of these subjects saw the dentist within the following 6 months. In eleven subjects, (55%), thermographic findings were confirmed during the first follow-up dental exam. In fourteen subjects with these cases are caused by a low-grade infection and inflammation and have, through further testing, been attributed to dental or oral issues, such as issues related to root-canal treated teeth. Invariably, some cases are very subtle, even asymptomatic for many years, but these cases slowly and continuously affect peoples’ health. With thermographic imaging, we can identify areas of suspected inflammation and infection because they present with heat. Once an area of concern is identified, it needs further investigation and resolution. People living with a chronic source of infection and inflammation will eventually find that their immunity is affected. In some cases, this chronic inflammation and infection will actually promote the growth of malignancy. The natural defense mechanism to fight malignant development is impaired since their immune system is busy dealing with inflammation that has no chance of resolving on its own. The only way this problem can be resolved is by identifying and removing the cause. The infected area has to be properly dealt with before the body can be restored to health. Conclusion: The IR imaging procedure provided enormous information about the physiological processes through examining the temperature of the facial area that can be related to the internal process of inflammation or irritation. The early signs provided by the IR imaging can be used as a prognostic indicator in detecting oral and or dental pathology. The merits of a non-invasive IR imaging modality are important in identifying early stages of inflammation not visible by other imaging modalities. The high confirmation rate (90%) indicates strong correlation between thermographic and dental exams. Sarbani Deb Sikdar, Anshul Kjanddelwal, Savita Ghom, Rajkumar Diwan, FM Debta. Thermography: a new Diagnostic tool in Dentistry // Journal of Indian Academy of Oral Medicine and Radiology. – 2010; 22 (4): 206-210. 30 Sudhakar S., Bina kayshap, Sridhar reddy P. Thermography in dentistry-revisited // Int J Biol Med Res. 2011; 2(1): 461-465. Thermography is a method of measurement of skin temperature distribution on the body over a given period of time. For the past four decades, various devices have been used to measure the amount of heat dissipated by the body. The principle behind such application was built on the fact that, as the amount of blood circulation at different layers of the skin varies, the temperature also changes accordingly. Consequently, disorders that affect the blood flow too results in abnormalities in temperature distribution and these when evaluated will provide valid diagnostic informations. Thermography since its inception has provided numerous dental applications; however, its usage has been abridged when compared with other diagnostic modalities. This article highlights the basics of thermography and its role in dentistry. Additional applications of telethermography: - Evaluation of craniomandibular disorders. - Quantification of the effects of post-surgical inflammation. - Quantification of the effects of analgesics, anti-inflammatory drugs, etc. - In the diagnosis of myofacial symptoms. Thermography aids in the assessment and staging of various dysfunctions of the head and neck region. The unique significance of thermography is both qualitative and quantitative assessment which helps in estimation of progression of the disease in a systematic manner. With the innovation of novel equipments and the state of the art facility, thermography in the near future will certainly re-emerge as a unique research tool in dentistry. Durnovo Е.А., Potekhina Y.P., Marochkina M.S., Yanova N.А., Sahakyan М.Yu., Ryzhevsky D.V. Diagnostic Capabilities of Infrared Thermography in the Examination of Patients with Diseases of Maxillofacial Area // Modern Technologies in Medicine – N2, 2014. – P. 61-67. The aim of the investigation was to evaluate the possibility to apply infrared thermography for the diagnosis of pathological maxillofacial conditions. Materials and Methods. 250 patients with different maxillofacial pathological conditions underwent an examination, thermographic analysis and comprehensive treatment. All patients were divided into three groups: group 1 (n=114) — patients with inflammatory diseases of maxillofacial area; group 2 (n=40) — patients with traumatic maxillofacial 31 injuries; group 3 (n=96) — patients with benign (n=54) and malignant (n=42) neoplasms of the maxillofacial area. Results. Local temperature indices of the maxillofacial area were found to change significantly in inflammatory diseases. The decrease of temperature indices was revealed in the centre of radicular cysts (by 0.1–0.3°С), in central and peripheral (by 1.3–2.3°С) points over chronic osteomyelitis, in acute purulent periostitis (by 1.2–1.9°С), in acute osteomyelitis (by 1.5–1.9°С), in acute grandular abscess (by 2.0–2.3°С), in odontogenic phlegmon of maxillofacial area (by 1.4–3.0°С), and odontogenic abscess (by 1.8–2.4°С). We found significant increase of temperature indices in traumatic injuries: in lower type LeFort fractures (by 1.3–1.5°С), in medial type LeFort fractures (by 1.2–1.6°С), in mandibular fractures (by 0.2–0.6°С). Significant increase of temperature indices was observed over malignant neoplasms — in the range of 2.8–3.6°С, while temperature indices over benign tumors and tumor-like masses did not exceed 1.4°C. Conclusion. Infrared thermography is a reliable, highly informative, non-invasive and safe method, requiring no trained staff. It can be used for diagnosis, differential diagnosis and prognostic studies in various diseases of maxillofacial area. Chapter XII Diseases of the skin and subcutaneous tissue Juhee Park, Woo Sun Jang, Kui Young Park, Kapsok Li, Seong Jun Seo, Chang Kwun Hong, Jong Beum Lee. Тhermography as a predictor of postherpetic neuralgia in acute herpes zoster patients: a preliminary study // Skin Research and Technology. Volume 18, Issue 1, pages 88–93, February 2012. Background/purpose: Infrared thermal images in patients suffering from herpes zoster (HZ) may exhibit thermal asymmetry due to the unilateral distribution of HZ lesions. This study examined the usefulness of infrared thermography in acute HZ as a predictor for the development of postherpetic neuralgia (PHN). Methods: The authors collected demographic and clinical data including age, sex, onset of skin lesion, pain intensity by a visual analogue scale (VAS) and the development of PHN from a total of 55 patients diagnosed with HZ. We evaluated the body surface thermographic parameters between the lesion and contralateral normal skin: maximal difference in the temperature (ΔT) and the size of the body surface area (BSA) showing thermal asymmetry. Results: Temperatures of the lesions were found to be warmer than the control side in most patients with acute HZ. We compared the patient group who developed PHN with those who did not. In univariate analysis, patients with PHN were older (P=0.004), had a higher VAS score for pain (P<0.001), higher ΔT (P<0.001) and larger BSA (P=0.001). In logistic regression analysis to identify independent risk factors of PHN, older age (>60 years old) and ΔT more than 0.5 °C were found to be statistically significant. Barton M. Gratt. Electronic thermography for the assessment of mild and moderate temporomandibular joint dysfunction. - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. - Volume 79, Issue 6, June 1995, Pages 778–786. Today facial heat emission patterns may be rapidly obtained and quantified with the use of advanced electronic thermography units that have the promise of being a nonionizing, noninvasive, low-cost diagnostic alternative for the evaluation of temporomandibular joint disorders. This study design measured the use of electronic thermography as a tool to select between asymptomatic (control) subjects and a patient group with mild to moderate temporomandibular joint disorders. Study populations consisted of 24 asymptomatic (control) subjects and 20 patients with (1) either locked or unlocked temporomandibular joints, (2) varying degrees of limitation of mouth opening, (3) mild to moderate muscle pain, and (4) mild to moderate temporomandibular joint arthralgia. 32 The results indicated that the control group demonstrated a high level of thermal symmetry over the temporomandibular joint region. The patient group demonstrated a low level of thermal symmetry with a T value of 0.4°C. The control group was selected from the patient group with 85% sensitivity (17 of 20), and 92% specificity (22 of 24), and 89% overall accuracy (39 of 44), when selecting among the 44 subjects used in this study. The conclusion therefore is that electronic thermography shows promise as a method of diagnosing mild to moderate temporomandibular joint disorders. Lamey P.-J. Thermography as a method of measuring viral activity in a herpes labialis infection. - United States Patent 5666962. - Filing date: Apr 13, 1995. Issue date: Sep 16, 1997. Disclosed is a non-invasive method of measuring the progress of viral activity in a mammalian herpes labialis episode, the method comprising the step of measuring the temperature of the symptomatic area of the herpes labialis episode during the episode. Also disclosed is a non-invasive method of preventing the clinical effects of a herpes labialis episode, the method comprising the steps of: measuring the temperature of the symptomatic area during the herpes labialis episode; and treating the herpes labialis episode with an effective amount of an antiviral agent sufficient to prevent a herpetic lesion. Further disclosed is a non-invasive method of confirming the efficacy of an antiviral agent in the treatment of a herpes labialis episode, the method comprising the steps of: standardizing a subject having a herpes labialis episode; measuring the temperature of the symptomatic area during the herpes labialis episode; treating the herpes labialis episode with an effective amount of an antiviral agent sufficient to prevent a herpetic lesion; and remeasuring the temperature of the previously symptomatic area of the subject after treatment with the antiviral agent. Still further described is a kit for preventing the progression of a herpes labialis episode to a herpetic lesion, the kit comprising: a thermographic sensing device; and an antiviral medication. The kit comprises a thermographic sensing devise and an antiviral medication. Mikulska D, Maleszka R, Parafiniuk M. THE USEFULNESS OF THERMOGRAPHY AS A DIAGNOSTIC METHOD IN DERMATOLOGY ON THE BASIS OF CLINICAL TRIALS IN 2001-2005. Ann Acad Med Stetin. 2006;52(3):91-97. INTRODUCTION: Thermal imaging is a powerful tool for the study of temperature of the human body. Even though the skin lies superficially and as such is an ideal object for thermography, the method has not gained widespread acceptance as a diagnostic modality in dermatology. The aim of this study was to describe the methodology of thermography for applications in dermatology and to develop a method for computer processing ofthermograms. In addition, we searched for skin factors, which could be responsible for false results in thermography and errors during interpretation of thermal images. MATERIAL AND METHODS: Clinical trials were performed in 2001-2005. We enrolled 230 patients, including 70 who were hospitalized at the Department of Dermatology and Venereal Diseases, Pomeranian Medical University in Szczecin, and 160 who were referred from the Outpatient Dermatology Clinic. The control group consisted of 20 healthy volunteers. The skin was examined to disclose primary and secondary skin lesions. Thermography was performed according to recommendations of the European Association of Thermology. Therma CAM SC500 infrared camera was used and the thermograms were analyzed with Therma CAM 200 Professional software. RESULTS: 1. Areas of the skin with inflammatory reactions resulting from allergy, infection or other process causing local hyperthermia could be visualized. 2. Primary eruptions (papules, nodules) and secondary eruptions (scales) presenting as hypothermia in thermography were found in the skin of the patients and some individuals from the control 33 group. 3. Interpretation of thermograms in dermatoses can be done using various colour scales, like "rain", "iron", "medical", "grey", "greyred" and the threedimensional scale. CONCLUSIONS: 1. Thermography is a useful diagnostic method in dermatology. 2. The normal thermogram, as well as thermograms specific for various dermatoses need to be described. 3. Compliance is indispensable with rules and principles concerning the examination itself, as well as analysis and clinical interpretation of the results. 4. The person performing the examination and interpreting the thermograms should take part in history-taking and physical examination of the patient and should be familiar with photographic documentation of the examined regions of the skin. Nakagami G, Sanada H, Iizaka S, et al.Predicting delayed pressure ulcer healing using thermography: a prospective cohort study.// J Wound Care. 2010 Nov;19(11):465-6, 468, 470 passim. Nakagami et al. (2010) investigated whether thermography can be used to detect latent inflammation in pressure ulcers and predict pressure ulcer prognosis in a clinical setting. Thirtyfive patients with stage II-IV pressure ulcers on the torso, who underwent thermographic assessment on discovery of their pressure ulcer were included in the study. The patients were followed up for at least 3 weeks. Thermography was performed immediately after dressing removal. Pressure ulcers were classified into two groups depending on whether or not the wound site temperature was lower or higher than the periwound skin: the low temperature group and the high temperature group respectively. The relative risk for delayed healing in high temperature cases was 2.25. Sensitivity was 0.56, specificity was 0.82, positive predictive value was 0.75, and negative predictive value was 0.67. The investigators concluded that the results indicate that using thermography to classify pressure ulcers according to temperature could be a useful predictor of healing at 3 weeks, even though wound appearances may not differ at the point of thermographical assessment. The higher temperature in the wound site, when compared with periwound skin, may imply the presence of critical colonization, or other factors which disturb the wound healing. Chapter XIII Diseases of the musculoskeletal system and connective tissue Diseases of joints (arthritis, osteoarthritis, etc.) are widely spread amongst people all over the world. Osteoarthritis (osteoarthrosis) is the most common disease of joints that develops with age. 10% of all adults have this disease and more than half of people after 60 are diagnosed with it, which is a problem of health care systems around the world. Osteoarthritis is a degenerative disease of joints; it can be primary and secondary. Secondary osteoarthritis develops after trauma, infection arthritis, gout, and pseudo-gout, osteochondropathy, and epiphyseal separation of whirlbone (Murtagh J. General Practice, 5th Edition.-John Murtagh & Jill Rosenblatt McGraw Hill: 2010. – 1430 pp.). Disability of elderly is caused by diseases of joints in 25% of all the cases. Arthritis is the leading cause of physical disability in the United States. Arthritis comprises over 100 different disease and conditions. The most common types are osteoarthritis, rheumatoid arthritis, fibromyalgia, and gout. Arthritis is estimated to cost $51 billion in medical costs and $86 billion in total costs. Arthritis limits everyday activities for 8 million Americans. According to CDC’s Behavioral Risk Factor Surveillance System, which provides the main source of state arthritis data, 49 million American adults reported doctor-diagnosed arthritis and another 21 million reported chronic joint symptoms (CJS) in 2001. The number of people age 65 and older who have arthritis or chronic joint symptoms is projected to nearly double from 21.4 million in 2001 to 41.4 million in 2030 as the population ages. Adults 65 34 years of age or older have the highest risk of arthritis (58.8 percent), but two-thirds of all people with arthritis are younger than age 65 (http://www.newsmedical.net/news/2004/05/15/1586.aspx). Knee joints suffer the most, especially if there is a problem of excessive body weight. Prevalence of knee joint’s osteoarthritis in Western Europe is 18-25% for men and 24-40% for women at the age of 60 to 79 years (van Saase JL, van Romunde LK, Cats A, Vandenbroucke JP, Valkenburg HA. Epidemiology of osteoarthritis: Zoetermeer survey). 100 million people with osteoarthritis live in European Union. Direct costs associated with this disease have reached 1.64 billion Euro in France in 2001 (Le Pen C, Reygrobellet C, Gerentes I. Financial cost of osteoarthritis in France. The "COART" France Study. Joint Bone Spine 2005;72:567—70.). Even though arthritis is not as widely spread in Africa and Asia as in Europe, the number of people with this disease is growing on these continents (Akhter E, Bilal S, Haque U. Prevalence of arthritis in India and Pakistan: a review. – http://www.ncbi.nlm.nih.gov/pubmed/21331574). Because of such prevalence of arthritis, World Health Organization has announced the period from 2000 to 2010 as “Decade for fighting bone and joint diseases). However, the number of people with such diseases has not decreased yet. Woolf A.D., Pfleger B. Burden of major musculoskeletal conditions // Bulletin of the World Health Organization 2003, 81 (9). – Р. 646-656. Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000–2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged >60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3–1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4– 33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain. Joint diseases, as a rule, are chronic diseases that have phases of exacerbation and remission. As a result, patients frequently have to go to the doctor, their capacity for work and quality of life reduce. In these circumstances, is necessary to develop simple and safe methods of monitoring and controlling the effectiveness of treatment, which could be used not only doctors but also by patients at home. The use of these devices enables the development of telemedicine services. For example, in the USA, CDC currently funds 36 states to implement programs to improve the quality of life of people that have arthritis. Arthritis programs in funded state health departments are working with their state Arthritis Foundation partners to expand the 35 availability of: - Arthritis Self Help Course, a program to help people with arthritis better manage their condition. - People with Arthritis Can Exercise (PACE), a program that teaches people with arthritis how to safely increase their level of physical activity. (http://www.newsmedical.net/news/2004/05/15/1586.aspx). As non-invasive method of diagnostics, infra-red thermography is highly suitable for diagnostics and monitoring of joint conditions. It is shown that thermography data reflects the severity of the inflammatory process. (A.E. Denoble, N.Hall, C.F. Pieper and V.B. Kraus. Patellar Skin Surface Temperature by Thermography Reflects Knee Osteoarthritis Severity // Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders - 2010:3; рр. 69-75). This method allows giving objective characteristic of such subjective symptom as pain, including the diseases of knee joint. Median temperature difference between pain localization and localizations without pain was 0.7°C and ranged from 0.1°C to 1.7°C. In the receiver operating characteristic (ROC) analysis the sensitivity of this method was 1.0 and specificity was 0.917. The evidence of a significant increase in skin temperature on the painful sites opens up the possibility to localize and assess pain more precisely in patients with joint prosthesis. We consider this novel, rapid, inexpensive and non-invasive technology to posses the potential to become a useful and objective tool for diagnosis of pain and inflammation and to generate digital data that can be stored and analyzed in clinical practice (M Glehr et al. Thermal Imaging as a Noninvasive Diagnostic Tool for Anterior Knee Pain Following Implantation of Artificial Knee Joints // International Journal of Thermodynamics (IJoT). - Vol. 14 (No. 2), pp. 71-78, 2011). The use of thermography for examination of the joints is particularly informative, since fatty tissue does not prevent from obtaining the infra-red temperature. Joints generally have less fatty tissue on them. Thermography can detect signs of inflammation in the early stages of joint damage, when the temperature difference between healthy joint and the involved joint is at the beginning of rising. The method is particularly valuable in subclinical or latent form of joint damage, in cases of absence of cutaneous manifestations. In case of chronic arthritis it is possible to control the temperature in the projection of the joints, and timely start the treatment if the temperature rises. Thermographic study reveals the increase of local temperature in the projection of the affected joint, which usually occurs before other clinical manifestations and remains for a long time. When diagnosing one-sided affection (for example, right knee joint), thermal asymmetry of 0,6º C in comparison with the opposite area (left knee joint) has diagnostic value. Re-examination of the local temperature can objectively assess the results of treatment. With proper treatment temperature in the inflamed joint should be reduced. Thermography has been used worldwide for diagnosing, monitoring and evaluating of the effectiveness of treatment for diseases of joints. From early times physicians have used the cardinal signs of inflammation, i.e. pain, swelling, heat, redness and loss of function. When a joint is acutely inflamed, the increase in heat can be readily detected by touch. However, subtle changes in joint surface temperature occur, and increase and decrease in temperature can have a direct expression of reduction or exacerbation of inflammation. This means that changes due to treatment, whether pharmaceutical, physical or surgical, can be objectively measured [Ring E F J., Ammer K. Infrared thermal imaging in medicine // Physiol. Meas. 33 (2012) R33–R46]. Recently, a pilot study from the United States found a high coincidence between high temperature and swelling of finger joints detected by three-dimensional images. The authors created a heat distribution index which had a diagnostic of specificity 67% and a sensitivity of 100% for arthritic swelling (Spalding S J, Kwoh C K, Boudreau R, 36 Enama J, Lunich J, Huber D, Denes L and Hirsch R 2008 Three-dimensional and thermal surface imaging produces reliable measures of joint shape and temperature: a potential tool for quantifying arthritis // Arthritis Res. Ther. 10 R10). Lahiri B.B., Bagavathiappan S., Jayakumar T., Philip J. Medical applications of infrared thermography: A review // Infrared Physics & Technology 55 (2012) 221–235. IRT has been successfully used in the diagnosis and assessment of recovery after treatment in gout [M. Schiavenato, R.G. Thiele, Thermography detects subclinical inflammation in chronic tophaceous gout, Journal of Rheumatology 39 (2012) 182–183.] and arthritis [N.J. McHugh, D.M. Elvins, E.F.J. Ring, Elevated Anticardiolipin Antib Odies in a patient with vibration white-finger, valvular heart disease and psoriatic arthritis, Clinical Rheumatology 12 (1993) 70–73., E.F.J. Ring, A.J. Collins, P.A. Bacon, J.A. Cosh, Quantitation of thermography in arthritis using multi-isothermal analysis II. Effect of nonsteroidal anti-inflammatory therapy on the thermographic index, Annals of the Rheumatic Diseases 33 (1974) 353–356]. Arnold et al. reported that, IRT is an excellent technique for measurement of skin temperature over different joints [M.H. Arnold, S.J.L. Preston, E.M. Beller, W.W. Buchanan, Infra-red surface thermography. Evaluation of a new radiometry instrument for measuring skin temperature over joints, Clinical Rheumatology 8 (1989) 225–230]. Ring demonstrated that, the subjects suffering from rheumatoid arthritis, juvenile arthritis, osteoarthrosis, gout, etc. show abnormal temperature distributions over joints [E. Ring, Thermography and rheumatic diseases, Bibliotheca Radiologica 6 (1975) 97–106.]. Collins et al. developed a thermographic index based methodology for quantification of joint inflammation in human subjects [A. Collins, E. Ring, J. Cosh, P. Bacon, Quantitation of thermography in arthritis using multi-isothermal analysis. I. The thermographic index, Annals of the Rheumatic Diseases 33 (1974) 113– 115.]. Ring et al. have demonstrated the use of IRT to quantify the effects of non-steroidal anti-inflammatory drugs (aspirin, indomethacin and benorylate) in subjects with rheumatoid arthritis and gout [E.F.J. Ring, A.J. Collins, P.A. Bacon, J.A. Cosh, Quantitation of thermography in arthritis using multi-isothermal analysis II. Effect of nonsteroidal antiinflammatory therapy on the thermographic index, Annals of the Rheumatic Diseases 33 (1974) 353–356]. Based on their studies it has been concluded that, IRT is a suitable tool for assessment of the response to the anti-inflammatory treatment. Paterson et al. used IRT for assessment of rheumatoid inflammation in the knee joint, while using antiinflammatory steroid therapy [J. Paterson, W.S. Watson, E. Teasdale, A.L. Evans, P. Newman, W.B. James, D.A. Pitkeathly, Assessment of rheumatoid inflammation in the knee joint, Annals of the Rheumatic Diseases 37 (1978) 48–52.]. Frize et al. used IRT for diagnosis of rheumatoid arthritis in human subjects and found that, metacarpal phalangeal joints of the index, middle fingers and knee are the most suitable locations for IRT based studies [M. Frize, C. Adea, P. Payeur, G.D. Primio, J. Karsh, A. Ogungbemile, Detection of rheumatoid arthritis using infrared imaging, in: Proc. of SPIE, 7962 (2011) 9620M-9621– 79620M-79611.]. Wu et al. reported that, local skin temperature near the coccyx region decreases significantly after conservative therapy in subjects suffering from coccygodynia [C.L. Wu, K.L. Yu, H.Y. Chuang, M.H. Huang, T.W. Chen, C.H. Chen, The application of infrared thermography in the assessment of patients with coccygodynia before and after manual therapy combined with diathermy, Journal of Manipulative and Physiological Therapeutics 32 (2009) 287–293.]. Their studies concluded that IRT is as an effective tool for assessment of pain intensity after treatment of coccygodynia. Thermographic results were compared with other clinical findings and this study confirmed that, the decreased range of motion and hypothermic temperature patterns are correlated. Thomas et al. investigated unilateral and bilateral cases of tennis elbow using IRT and observed that in 94% unilateral and 100% bilateral cases, hot spots could be detected [D. Thomas, G. 37 Siahamis, M. Marion, C. Boyle, Computerised infrared thermography and isotopic bone scanning in tennis elbow, Annals of the Rheumatic Diseases 51 (1992) 103–107]. With the advent of newer generation infrared detectors, infrared thermal imaging is becoming a more accurate alternate medical diagnostic tool for abnormal temperature pattern measurements. Besides, better temperature sensitivity, spatial resolution and noncontact nature, IRT is an absolutely harmless imaging methodology. Thermal images can be stored digitally and post-processed using various software packages to obtain insight into the thermal pattern. Interpretation of pseudo-color coded thermograms is comparatively easier and faster. Bacon P.A., Ring E.F.J., Collins A.J. Thermography in the assessment of anti rheumatic agents Rheumatoid Arthritis ed. J L Gordon and B L Hazleman 1977 (Amsterdam: Elsevier/North Holland Biomedical Press) 105. This study found that small joints such as fingers and metacarpal joints increased in temperature quite rapidly while paracetamol (analgesic) treatment was given, even if pain was still suppressed. Larger joints, such as knees and ankles required more than 1 week off active anti-inflammatory treatment to register the same effect. Nevertheless, the commonly accepted protocol was to switch from analgesic to the new test antiinflammatory treatment after 1 week of washout therapy. In every case if the dose was ineffective the joint temperature was not reduced. At an effective dose, a fall in temperature was observed, first in the small joints, then later in the larger joints. Statistical studies were able to show an objective decrease in joint temperature by infrared imaging as a result of a new and successful treatment. BOROJEVIC N., KOLARIC D., GRAZIO S., GRUBIC F., ANTONINI S., NOLA I.A., HERCEG E. Thermography hand temperature distribution in rheumatoid arthritis and osteoarthritis // PERIODICUM BIOLOGORUM UDC 57:61 VOL. 113, No 4, 445–448, 2011. Background and Purpose: Earliest written medical text from ancient Egypt mentioned temperature as an indicator of a disease. Although already known, thermal imaging has not been routinely used in medicine. Inflammation of peripheral joints, close to skin surface, is the dominant type of presentation of rheumatoid arthritis and due to that, those joints are suitable for infrared thermal scanning. Considering the changes of the bones in the affected joints, as a control group, apart from healthy subjects, study was conducted on patients with osteoarthritis as well. Purpose of this paper was to investigate thermal images of the hands of patients with rheumatoid arthritis and osteoarthritis and analyze temperature distribution. Materials and Methods: Thermographic images of both hands of healthy subjects, patients with rheumatoid arthritis and patients with osteoarthritis were made. On thermal images obtained, temperature distribution of certain regionswas analyzed. Basic statistical analyses (minimum, maximum, standard deviation, mean, and variance) were performed. Results: There is a statistically significant difference in finger andmetacarpophalangeal joint mean temperature values on ventral and dorsal sides for both healthy patients and patients with rheumatoid arthritis and osteoarthritis. Mean surface skin temperature has also shown a statistically significant difference between the observed groups so that it was the highest in patients with rheumatoid arthritis, lower in patients with osteoarthritis and lowest among the healthy subjects (Fig. 8). Also, there is a statistically significant difference of mean temperature values between the aforementioned patient groups. Temperature distribution curves of patients with osteoarthritis have been narrower than those of subjects with rheumatoid arthritis and normal subjects. Temperature distribution curves of patients with rheumatoid arthritis have been shifted towards higher temperatures than those of subjects with osteoartritis and normal subjects. 38 Thermographic image of the dorsal side of the right hand of a healthy subject with marked areas for mean surface temperature measurements of the fingers I–V (labels 1–5) and metacarpophalangeal region (label 6). Thermographic image of the dorsal side of the right hand of a subject suffering from osteoarthritis with marked areas for mean surface temperature measurements of the fingers I–V (labels 1–5) and metacarpophalangeal region (label 6). Fig. 8. Conclusion: From the results obtained it was concluded that heat distribution over the skin surface apart from depending on the affected joint and on the intensity of the disease and given drug therapy also differs between the patients with rheumatoid arthritis and osteoarthritis, making the use of thermography a possible method of differentiating normal subjects and rheumatoid arthritis subjects and osteoarthritis subjects from each other. Brenner M, Braun C, Oster M, Gulko PS. THERMAL SIGNATURE ANALYSIS AS A NOVEL METHOD FOR EVALUATING INFLAMMATORY ARTHRITIS ACTIVITY // Ann Rheum Dis. 2006 Mar;65(3):306-11. OBJECTIVE: To examine the potential usefulness of a novel thermal imaging technique to evaluate and monitor inflammatory arthritis activity in small joints using rat models, and to determine whether thermal changes can be used to detect preclinical stages of synovitis. METHODS: Three different rat strains were studied in a model of inflammatory arthritis of the ankle induced by an intra-articular (IA) injection of complete Freund's adjuvant (CFA), compared with the contralateral ankle injected with normal saline. Arthritis activity and severity scores, ankle diameters, pain related posture scores, and thermal images were obtained at 10 different times between 0 h (before induction) and day 7. The pristane induced arthritis (PIA) model was used to study preclinical synovitis. Thermal images were obtained at each time point using the TSA ImagIR system and were digitally analysed. RESULTS: Rats developed similar ankle arthritis detected six hours after the IA injection of CFA, which persisted for seven days. All ankle clinical indices, including arthritis activity and severity scores, correlated significantly with ankle thermal imaging changes in the monoarthritis model (p<0.003). No thermal imaging changes were detected in preclinical stages of PIA. However, PIA onset coincided with increased ankle thermal signature. CONCLUSIONS: Thermal measurements correlated significantly with arthritis activity and severity indices. The technique was highly sensitive and could measure directly two cardinal signs of inflammation (warmth and oedema, based on ankle diameter) in an area (ankle) that is less than half the size of an h umaninterphalangeal joint, suggesting a potential use in drug trials or clinical practice. 39 Brioschi, M.L., Yeng, L.T., Pastor, E.M.H., Teixeira, M.J. Infrared imaging use in rheumatology // Revista Brasileira de Reumatologia. - Volume 47, Issue 1, 2007, Pages 42-51. Infrared thermography is unique objective imaging procedure for the quantitative assessment of local inflammatory reactions in parts of the locomotor system. For differential diagnosis the thermographic results should be evaluated in conjuction with clinical examination and other technical procedures. As a means of monitoring the course of the local inflammatory activity, however, quantitative infrared thermography is a useful tool in itself, particularly during the application of local and systemic anti-inflammatory therapy. COLLINS A. J., RING E. F. J., COSH J. A., BACON P. A. Quantitation of thermography in arthritis using multi-isothermal analysis (1. The thermographic index) // Ann. rheum. Dis. (1974), 33, 113-115. Thermography can be used for the assessment of joint involvement in inflammatory arthritis. The effect of anti-inflammatory compounds on joint inflammation in animals has been quantitated using radiometry (Collins and Ring, 1972). Thermography provides more information about the distribution of temperature. We wish to report a method for the quantitative measurement of joint inflammation in man, using thermography. PATIENTS: Patients with classical or definite rheumatoid arthritis, with current acute inflammation in one knee joint, were studied. Eight patients were studied before and after a single intra-articular injection of 100 mg. methyl prednisolone triacetate (Ultracortenol, Ciba). Four patients were followed by serial thermograms on four to eight occasions, for up to 20 days. Four other patients were thermogrammed at 7 days only. Data on the thermographic patterns of normal knees were obtained from 32 healthy male and female volunteers in the age range 20 to 56 years. Results: It can be appreciated from the analysis, that the inflamed knee shows a wide range of temperature zones, which contracts markedly after treatment. Also, the peak temperature of 32.5°C before treatment, which only occupies a small area, falls to 30.0°C after treatment. The thermographic index, which reflects both the range and the peak of temperature, falls with treatment. Initially, nine isotherms were present, but after treatment these were reduced to five, with nearly 50 per cent. of the area at 28.5°C. Discussion: This report has been confined to the demonstration of a method of quantitation of anti-inflammatory activity. Local steroid injection was chosen as an accepted potent anti-inflammatory against which to test the methodology. In our experience, the effect of oral non-steroidal anti-inflammatory agents can also be demonstrated with the thermographic index and this can be correlated with other clinical measurements. This will be the subject of a separate communication. Summary: A method for the quantitative measurement of joint inflammation in man is described. Multi-isothermal scans of joints are obtained by thermography. By analysis of the isothermal areas, a thermographic index is produced. This index is demonstrated by following the course of intra-articular steroid therapy. Frize Monique, Adéa Cynthia, Payeur Pierre, Di Primio Gina, Karsh Jacob, Ogungbemile Abiola. Detection of rheumatoid arthritis using infrared imaging. - Medical Imaging 2011: Image Processing, edited by Benoit M. Dawant, David R. Haynor, Proc. of SPIE Vol. 7962, 79620M Rheumatoid arthritis (RA) is an inflammatory disease causing pain, swelling, stiffness, and loss of function in joints; it is difficult to diagnose in early stages. An early diagnosis and treatment can delay the onset of severe disability. Infrared (IR) imaging offers a potential approach to detect changes in degree of inflammation. In 18 normal subjects and 13 patients diagnosed with Rheumatoid Arthritis (RA), thermal images were collected from 40 joints of hands, wrists, palms, and knees. Regions of interest (ROIs) were manually selected from all subjects and all parts imaged. For each subject, values were calculated from the temperature measurements: Mode/Max, Median/Max, Min/Max, Variance, MaxMin, (Mode-Mean)2, and Mean/Min. The data sets did not have a normal distribution, therefore non parametric tests (Kruskal-Wallis and Ranksum) were applied to assess if the data from the control group and the patient group were significantly different. Results indicate that: (i) thermal images can be detected on patients with the disease; (ii) the best joints to image are the metacarpophalangeal joints of the 2nd and 3rd fingers and the knees; the difference between the two groups was significant at the 0.05 level; (iii) the best calculations to differentiate between normal subjects and patients with RA are the Mode/Max, Variance, and Max-Min. We concluded that it is possible to reliably detect RA in patients using IR imaging. Future work will include a prospective study of normal subjects and patients that will compare IR results with Magnetic Resonance (MR) analysis. Denoble A., Hall N., Pieper C.F., Kraus V.B. Patellar Skin Surface Temperature by Thermography Reflects Knee Osteoarthritis Severity // Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders - 2010:3; рр. 69-75. Digital infrared thermal imaging is a means of measuring the heat radiated from the skin surface. Our goal was to develop and assess the reproducibility of serial infrared measurements of the knee and to assess the association of knee temperature by region of interest with radiographic severity of knee Osteoarthritis (rOA). A total of 30 women (15 Cases with symptomatic knee OA and 15 age-matched Controls without knee pain or knee OA) participated in this study. Infrared imaging was performed with a Meditherm Med2000™ Pro infrared camera. The reproducibility of infrared imaging of the knee was evaluated through determination of intraclass correlation coefficients (ICCs) for temperature measurements from two images performed 6 months apart in Controls whose knee status was not expected to change. The average cutaneous temperature for each of five knee regions of interest was extracted using WinTes software. Knee x-rays were scored for severity of rOA based on the global Kellgren-Lawrence grading scale. The knee infrared thermal imaging procedure used here demonstrated longterm reproducibility with high ICCs (0.50–0.72 for the various regions of interest) in Controls. Cutaneous temperature of the patella (knee cap) yielded a significant correlation with severity of knee rOA (R = 0.594, P = 0.02). The skin temperature of the patellar region correlated with x-ray severity of knee OA. This method of infrared knee imaging is reliable and as an objective measure of a sign of inflammation, temperature, indicates an interrelationship of inflammation and structural knee rOA damage. DEVEREAUX M. D., PARR G. R., LACHMANN S. M., PAGE THOMAS D. P., HAZLEMAN B. L. THERMOGRAPHIC DIAGNOSIS IN ATHLETES WITH PATELLOFEMORAL ARTHRALGIA // THE JOURNAL OF BONE AND JOINT SURGERY – No. I, JANUARY 1986. Pain in front of the knee is common in athletes and is often called patellofemoral arthralgia, but it is difficult to prove that the pain arises in that joint. Thermograms of 30 athletes clinically considered to have patellofemoral arthralgia were compared with those of a similar number of unaffected athletes matched for age and sex. A comparison was also made with thermograms of two older groups of 30 patients with knee involvement from either rheumatoid arthritis or osteoarthritis. Twenty-eight of the athletes with patellofemoral arthralgia had a diagnostic pattern on thermography. The anterior knee view showed a rise in temperature on the medial side of the patella and the medial knee view showed that this temperature rise radiated from the patellar insertion of the vastus medialis into the muscle itself. The possible aetiological role ofquadriceps muscle imbalance in athletes with patellofemoral arthralgia. 41 DEVEREAUX M.D., PARR G.R., PAGE THOMAS D.P., HAZLEMAN B.L. Disease activity indexes in rheumatoid arthritis; a prospective, comparative study with thermography // Annals of the Rheumatic Diseases, 1985, 44, 434-437. There are many difficulties associated with the assessment of disease activity in rheumatoid arthritis. Infrared thermography has been used to quantify joint inflammation. The heat distribution index (HDI) is reproducible, sensitive, quantifiable, and not subject to circadian variation or interobserver error. In this study the HDIs for both elbows, wrists, knees, and ankles were summated and compared with other parameters of disease activity. There were 167 sets of observations in 20 patients with classical, seropositive, rheumatoid arthritis followed up over 12 months. There was a significant correlation (p<0.001) for thermography with the Ritchie articular index, Mallya score, grip strength, morning stiffness, erythrocyte sedimentation rate, and pain score. Significant correlations (p<0.05) for thermography with these parameters were found in individual patients. The summated HDI is a suitable, objective method for the assessment of response to therapy in patients with rheumatoid arthritis. Thermographic assessment is objective, reproducible, accurate, and non-invasive. Thermography is non-stressful for the patient and appears to improve compliance during drug studies. The thermographic method is extremely suitable for the assessment of response to therapy in patients with rheumatoid arthritis. Edwards A.; Selvanayagam J.N.; Beach J.; Homik J.; Francisca dos Santos M.; Yacyshyn E. ASSESSMENT OF PATIENTS WITH INFLAMMATORY ARTHRITIS USING THERMOGRAPHY // http://rheum.ca/images/documents/Elaine_Yacyshyn_%282010_Grant_Competition%29.p df OBJECTIVE: Thermography is a novel and potentially useful tool for evaluating patients with inflammatory arthritis. As tender and swollen joint counts are liable to inter-observer variation, thermography may assist in the detection of active disease. Our objective was to determine the reliability of thermography measurements of patients with inflammatory arthritis and compare to clinical examination. METHODS: EQUIPMENT - Thermography camera “FLIR T300 Shortwave Thermovision System” (Figure 1) - Subjects rested for 15 minute acclimation period - Camera was maintained at fixed distance (0.5m) - Subjects used a resting hand splint (Figure 2) PARTICIPANTS - Control patients: healthy volunteers from University of Alberta - With no history of inflammatory or symptomatic joint disease - Inflammatory arthritis patients: recruited from Rheumatology outpatient clinic at University of Alberta - Patients taking vascular medications or with co-existing vascular disease excluded. RESULTS: In total, 2038 joints were analyzed in 29 control patients and 49 patients with inflammatory arthritis. Inflammatory arthritis patients have a mean temperature 1.58ºC warmer than controls of both area and spot temperatures (p ≤ 0.0001). During the patient assessments, overtly swollen joints did not show an increased temperature. Tender joints, however were colder on average, by 0.3ºC (p≤0.008). A secondary measure was to determine validity of thermography by correlating findings to other outcome measures. - For each unit increase (by 1 unit) of the DAS 28, the temperature reduced by 0.47ºC - For each unit increase (by 1 unit) of the clinHAQ, the temperature reduced by 0.67ºC. 42 CONCLUSIONS: This study established the ability to assess surface temperatures of MCP and PIP joints in control and inflammatory arthritis patients. It produced reliable, quantifiable measures of joint temperature to assist in the assessment of disease activity in arthritis. Further study would include prospective analysis of individual patients, as the thermography camera may be useful in longitudinal patient assessment. Edrich J, Smyth CJ. Arthritis inflammation monitored by subcutaneous millimeter wave thermography // J Rheumatol. – 1978 Spring; 5(1):59-67. A new technique for remote, noninvasive mapping of temperature elevations of the human joints is described; it uses the mm wave radiation emitted by the human body. A solid state switched scanner for 68 GHz is described which overcomes the depth limitations of conventional, infrared thermographs and can measure to subcutaneous depths of several mm with a temperature resolution of 0.25 degrees C. Measurements on rheumatoid arthritic knee joints are presented which show little correlation with simultaneously measured skin temperatures. Significant longterm thermographic changes induced by steroid injection indicate a potential for objective patient monitoring and development of new treatment methods. Engel JM. Quantitative thermography of the knee joint // Z Rheumatol. 1978 JulAug;37(7-8):242-53. Computer-assisted evaluation of thermography of the knee joints allows diagnosis and quantitation of inflammatory processes. This needs an adequate thermography camera, registration standards and a thermographic index. With the aid of this index normal knee joints and those with inflammatory changes can clearly be differentiated: an index of less than 3.5 is normal, values above 5.0 indicate an inflammation. The author proposes to correct the thermographic index with reference to actual rectal temperature in order to improve inter- and intra-individual comparability of thermograms. Apart from the thermographic index, the formal analysis of the line-scan over the joint space and the maximal temperature of the joint can be used as further diagnostic criteria. Gratt BM, Sickles EA, Ross JB, Wexler CE, Gornbein JA. Thermographic assessment of craniomandibular disorders: diagnostic interpretation versus temperature measurement analysis.- J Orofac Pain. 1994 Summer;8(3):278-88. This study assessed electronic thermography as a diagnostic alternative for evaluation of temporomandibular disorders. The study populations consisted of 50 temporomandibular joint patients having internal derangement or osteoarthrosis and 30 normal temporomandibular joint subjects. An Agema 870 thermovision unit was used for analysis. Diagnostic evaluations by expert interpreters were made using standard procedures. Thermography measurements included mean absolute temperature measurements and right-left temperature differences for five anatomic zones and four spot areas. Statistical analysis of data included both linear discriminant analysis and classification-tree analysis. Results indicated that when differentiating between "abnormal" and "normal" temporomandibular joints using classification-tree analysis, correct classifications were made in 89% of the cases and observer diagnostic accuracy was 84%. When evaluating for specific diagnoses (eg, osteoarthrosis, internal derangement, or normal temporomandibular joint), correct classifications using classification-tree analysis were made in 73% of the cases and observer evaluation was correct in 59%. The three best temperature measures found were: (1) delta T of the zone immediately overlying the temporomandibular joint; (2) the zone temperature of the half-face; and (3) the spot 43 temperature anterior to the external auditory meatus. Additional studies are needed before thermographic diagnosis of craniomandibular disorders is accepted clinically. Hegedűs B., Viharos L., Gervain M., Gálfi M. The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial // Photomedicine and Laser Surgery. - August 2009, 27(4): 577-584. Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the painrelieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA). Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded. In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment: 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5°C increase in temperature—and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur. Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area. Kang TG, Kim HJ, Sim HS, Kim SM, Youn DK, Park YK, Chang JA, Cho KH, Hong MH, Kim YC, Choi GH. Practicality of thermography in evaluation of osteoarthritis of knee joint. http://www.koreamed.org/SearchBasic.php?QY=%22J+Korean+Acad+Fam+ Med%22+%5BJTI%5D&DisplaySearchResult=1. About 80 percent of the Korean population over 55 years old show radiographic signs of osteoarthritis. Hence, osteoarthritis has become one of the most important public health problem among the old age. Despite the importance of this disease, proper methods for evaluation and diagnosis of osteoarthritis have not been developed. Authors have investigated the sensitivity and specificity of thermography in diagnosing osteoarthritis. KAVANAGH H.S., DUBRAVIС A., LIPIС T., SOVIС I., GRAZIO S. Computer supported thermography monitoring of hand strength evaluation by electronic dynamometer in rheumatoid arthritis – a pilot study // PERIODICUM BIOLOGORUM VOL. 113, No 4, 433– 437, 2011. This paper describes the implementation of a new dynamometer system with thermography monitoring of heat dissipation, and the implications of this new system in physiatry, rheumatology and neurology. The system includes a single data processing algorithm and the concept of motor hand function evaluation involving the determination of quantitative indicators. In rehabilitation medicine, muscle function is assessed during the physical examination of a patient. Although a simple computer- supported approved dynamometer instrument improves the assessment of static strength, it is rarely used in clinical practice where dynamic measurements are preferred. A computer-assisted electronic dynamometer has been developed to enable a clinician to measure dynamic muscle function in standardized manner. Dynamometer comprises a 44 force transducer and a movement transducer interfaced to a personal computer. In the study, dynamic measurement protocols were used that are based on biomechanical analysis. During the execution of test exercise used the method of thermographic recording of heat dissipation using dedicated software for analysis of characteristic parameters. The results obtained showed the possibility of objectification biomechanical properties and heat dissipative characteristics of the hand. The results of data analysis from calculated characteristic parameters show the correlationwith patients’ clinical status, i.e. the motor status of the hand and efficiency of temperature monitoring (standard deviation 0.92.). From the results of this pilot-study it can be concluded that computer supported dynamometer might be suitable for use in diagnostics in physical and rehabilitation medicine, possibily in conjuction with thermography. Further studies on larger numbers of participants are needed to evaluate these preliminary results. Kawano W1, Kawazoe T, Tanaka M, Hikida Y. Deep thermometry of temporomandibular joint and masticatory muscle regions. - J Prosthet Dent. 1993 Feb;69(2):216-21. A study was designed to measure noninvasively the deep temperature of the temporomandibular joint (TMJ) region and corresponding regions of the masticatory muscles at rest. With a transcutaneous probe, the deep thermometry of the right and left anterior (Ta) and the posterior portion (Tp) of the temporal muscles, the mid-portion of the superficial belly of the masseter muscles (Mm), and the TMJ regions were measured. In 20 normal male subjects, the deep temperature of the Ta region (mean 36.342 degrees C), the Tp region (mean 36.345 degrees C), and the TMJ region (mean 36.06 degrees C) was higher than that of the Mm region (mean 35.897 degrees C) at rest. In addition, no differences in the deep temperature were observed between the right and left Ta, Tp, Mm, and TMJ regions at rest. All of the normal subjects showed differences between the right and left TMJ region of less than 0.3 degrees C. In 10 patients with craniomandibular disorders, however, eight patients showed differences of more than 0.3 degrees C between the asymptomatic and asymptomatic TMJ region. Because of high sensitivity and specificity, the deep thermometry measurements can provide useful non-invasive information. MANGINE R.E., SIQUELAND K.A., NOYES F.R. The Use of Thermography for the Diagnosis and Management of Patellar Tendinitis // THE JOURNAL OF ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY. - October 1987, Vol. 9, No. 4. – P. 132-140. Computerized thermography was used to evaluate 17 patients diagnosed with patellar tendinitis. The intent of this study was to determine if a specific patellar tendinitis thermal pattern could be distinguished using infrared thermography. A specific thermal abnormality was found over the patellar tendon in 14 subjects (78%). Twelve subjects showed focal "hot" spots, while two showed focal "cold" spots. The thermal abnormalities appeared as specific focal areas directly overlaying the patellar tendon, without disruption to the thermal pattern of the remaining peripatellar regions. The thermal gradient slope over the patellar tendon was greater in symptomatic knees. Five subjects returned 2-4 weeks later for follow-up thermographic examination. Among the follow-up subject group, changes in thermal asymmetry correlated with changes in symptoms 80% of the time. Computerized thermography appears useful as a noninvasive, objective method of detecting inflammation of the soft tissues about the patellar tendon, and also helps to differentiate this disorder from other knee pathologies. Oblinger W, Engel JM, Franke M. Thermographic diagnosis of arthritis in peripheral joints // Z Rheumatol. - 1985 Mar-Apr;44(2):77-81. 45 The measurement of absolute temperatures on the surface of the human body using quantitative thermography allows this technique to be used in rheumatology, for the diagnosis and monitoring the course of inflammatory diseases of the locomotor system. The patient is exposed to a room temperature of 18 degrees C and the skin temperature measured over the joint for a defined area (region of interest). Inflamed joints show distinctly higher absolute temperatures than normal ones within the observation time of 40 minutes. Moreover, the skin over healthy joints cools faster and to a greater extent than skin over inflamed joints, whose temperatures remain the same or even rise minimally in more acute cases. Using two measurements, the determination of the absolute temperatures (static thermography), and the changes in these temperatures within a definite time interval (dynamic thermography) it is thus possible to establish a diagnosis of arthritis in the regions of the peripheral joints with the help of standardised nomograms with an accuracy of more than 90%, and to follow the course of the disease more exactly. Puzder A., Gworys K. Trial of thermal imaging in the evaluation of low level laser therapy effectiveness in patients with knee joint pain syndrome // Medicina Sportiva. - N3. – 2010. Aim of the study: The article presents trial of using thermal imagines parameters in monitoring gonarthrosis and low level laser therapy to alleviate the pain symptoms. Material and methods: The double-blind research involved 69 patients among whom 53 with confirmed gonarthrosis were treated. Group A n=24 knee joints, contact laser irradiations were applied with a semiconductor laser (400mW, wave length 810nm). Total surface energy density on therapeutic point consisted of fractionated doses of energy (9.5J/cm2 +4.8J/cm2) with 30 min. interval between the 6J dose and 3J dose application. One series of 10 procedures was performed, five times per week. Group B (n=84 knee joints) with placebo therapy was accomplished. Group C (n=32 knee joints) had no pain syndrome and any treatment, only thermal images were conducted. The intensity of the pain in group A and B were evaluated on the Visual Analogue Scale and a modified version of the Laitinen questionnaire. Thermal imaging parameters Knee-Leg Temperature Index (TI) were conducted in all patients. Results: There was statistically significant reduction in pain by VAS and Laitinen questionnaire after laser therapy. In group B there was no statistically significant changes in pain disorders and TI index. Conclusions: Pain reduction (VAS and Laitinen questionnaire) has been evaluated after laser fractionated doses of energy in patients with knee osteoarthrosis. There were not significant statistical changes in pain reduction and thermal imaging parameters in placebo group. A tendency to temperature indicators stabilization was observed in the treatment group. It is necessary to perform further investigations with the use of various radiation and thermal imaging modes in a more numerous groups of patients. Rusch D, Follmann M, Boss B, Neeck G. Dynamic thermography of the knee joints in rheumatoid arthritis (RA) in the course of the first therapy of the patient with methylprednisolone // Zeitschrift fur Rheumatologie (2000). – Volume: 59 Suppl 2, Pages: II/131-135. Thermography in rheumatology is most often used in a static manner: after having fulfilled the conditions of standardized preparation of the patient in a cold examination room one or more thermograms are taken in standard positions for the respective joints. In our hospital the thermograms are more or less supplementary. The main examination result is a rewarming curve of the skin over the knee joints. The rewarming is provoked by dry cooling of the skin for one minute. Calculation of the slope of the rewarming curve and plotting the slope on a logarithmic scale shows two different rewarming processes in the skin overlying inflamed joints. The faster one is the rewarming by the arterial blood flow in 46 the skin and the slower one is an additional rewarming by a pathological venous skin blood flow originating from deeper tissues under the skin. One has to suppose that the occurrence of excessive nitric oxide production in inflamed tissues is responsible for this pathological venous skin blood flow. Until now only nine patients receiving for the first time methylprednisolone could be included in a therapy study. Therefore only slight indications can be seen in the results. Whereas the erythrocyte sedimentation rate (ESR mm/h becomes more homogeneous (lower confidence interval CI 95) over the course of the treatment with decreasing drug dose, the thermal signs of inflammatory activity as measured by dynamic thermography have greater CI 95 values at the end than at the beginning of the treatment under study. This indicates that not all patients had sufficient antiinflammatory medication with the final 6 mg/d of methylprednisolone as measured by dynamic thermography but not by ESR or CRP. RYOICHI K. Osteoarthritis of the knee and nearby disease. III. Image analysis. 3. thermography. Disease state of the osteoarthritis of the knee from the viewpoint of the thermography. // Orthopedic Surgery. - VOL.; NO.42; PAGE.90-96(2002). We analyzed the thermographic finding of the leg mainly on the knee, and examined the disease state of the osteoarthritis of the knee. In diseased side and non-diseased side of osteoarthritis patient of 60 cases 120 knees, we displayed the distribution according to the grade of the temperature pattern of 6 regions, and it was compared with the normal person. Each grade was made into the score, and the tendency in the mean value was examined. The front of the knee showed the high temperature. Next, 10 hydrarthrosis cases with the high temperature were treated by centesis and drainage, or centesis and drainage combined with injection of steroid and hyaluronic acid. We measured the crosswise difference of skin temperature before and after the treatment, and examined the significance and the effect. The inflammation exists for the symptom stage of the osteoarthritis, and this shows the activity. We indicated that the low-temperature tendency of thigh and lower leg occurs by the effect of the osteoarthritis on the muscle. Samokhin A.V., Buryanov O.A., Kotiuk V.V., Karnauh Y.V. Quantitative Assessment of Thermal Images of the Hand Joints in Psoriatic Arthritis Patients // Radiation Diagnostics, Radiation Therapy, #1 / 2011. The detection of hyperthermia by the hand of the doctor has long been the standard of diagnosing the inflammatory changes in joints along with detection of other four signs of inflammation. The situation dramatically changed after the development of thermography. Exact localization of hyperthermic region in the hand is important to differentiate between arthritis, tendovaginitis, enthesitis and felon. It is of particular significance in psoriatic arthritis patients as far as enthesitis is a rather specific feature of the disease and may be utilized for the differential diagnosis. Hyperthermia in standard points of the hand in psoriatic arthritis patients with hand joints involvement was expectable. But hyperthermia was noted more or less markedly in all the hand joints, not only those with clinical manifestation. This may give evidence to the spread of the pathologic process on the majority of the hand joints, to the relevance of diagnosing psoriatic arthritis with hand joints involvement even if only few joints are clinically affected and in preclinical stages of the disease. Detection of hyperthermia of the nail plates in the presence of other symptoms of the disease also may indicate the presence of inflammation at the tendons insertions to the distal phalanges (enthesitis) which is a distinctive feature of psoriatic arthritis. Hyperthermia of the hand joints may be one of the additional confirmations of psoriatic arthritis in the lack or equivocality of the clinical symptoms and changes of laboratory values when it is necessary to confirm documentarily the diagnosis in early preradiological stages (particularly in conscripts or in the case of examination of working ability) or in persons that can’t be examined radiologically (pregnant women). The benefits of thermal 47 imaging are exceeding: relatively low cost, absence of ionizing radiation and electromagnetic fields, absolute noninvasiveness and safety, absence of contraindications, ability to diagnose and to objectify patients’ complaints at the early stages of the disease, before radiological and ultrasonographical changes appear. SALISBURY R.S., PARR G., DE SILVA M., HAZLEMAN B.L., PAGE-THOMAS D.P. Heat distribution over normal and abnormal joints: thermal pattern and quantification // Annals of the Rheumatic Diseases, 1983, 42, 494-499. We have identified regular thermal patterns over normal knee, ankle, and elbow joints and demonstrate how synovitis affecting these joints may be identified by alteration or loss of the thermal pattern. Sixty healthy volunteers were thermographed on a total of 190 occasions, and 614 out of 618 joints conformed to the normal thermal pattern. Eight-five patients with synovitis of at least one of the specified joints were thermographed on a total of 339 occasions, and 322 out of 1362 thermograms were abnormal. No joint with clinical evidence of synovitis had a normal thermal pattern. As temperature-based parameters have been found to show marked dermal variation and relative frequency distributions do not have this drawback, we suggest that quantification of synovitis by thermography should in future be based on abnormalities of thermal pattern rather than absolute skin temperature values. Sanchez BM, Lesch M, Brammer D, Bove SE, Thiel M, Kilgore KS. USE OF A PORTABLE THERMAL IMAGING UNIT AS A RAPID, QUANTITATIVE METHOD OF EVALUATING INFLAMMATION AND EXPERIMENTAL ARTHRITIS // J Pharmacol Toxicol Methods. 2008 May-Jun;57(3):169-75. INTRODUCTION: Thermal imaging has been utilized, both preclinically and clinically, as a tool for assessing inflammation and arthritis. However, previous studies have employed large, relatively im mobile devises to obtain the thermal signature of the tissue of interest. The present study describes the characterization of a hand-held thermal imaging device in a preclinical model of general inflammation and a model of rheumatoid arthritis (RA). METHODS: A hand-held ThermoView Ti30 portable thermal imager was utilized to detect the temporal changes in thermal signatures in rat model of carrageenan-induced paw edema (CFE) and a model of collagen-induced arthritis (CIA). In both in vivo models, the kinetics of the thermal changes were correlated to footpad swelling. In addition, the CFE model was utilized to examine the ability of this technology to delineate pharmacodynamic changes in thermal signature in response to the non-steroidal anti-inflammatory drug indomethacin (10 mg/kg; p.o.). RESULTS: Thermal analysis of rat paws in the CFE model demonstrated a significant increase in the mean temperature difference between the inflamed and contralateral control paw by two hours postcarrageenan (8.3 +/-0.5 degrees F). Indomethacin significantly decreased the mean temperature difference in treated animals as compared to vehicle. In the rat CIA model, increases in footpad temperature, as determined by thermal imaging, were significantly elevated by Day 11 and remained elevated throughout the duration of the 28 day protocol. Thermal changes were also found to precede increases in footpad edema (swelling). DISCUSSION: The results of this study demonstrate that the hand-held thermal imaging technology represents a rapid, highly-reproducible method by which to quantitate the degree of inflammation in rat models of general inflammation and rheumatoid arthritis. The ability to detect pharmacodynamic responses in paw temperature suggests that this technology may be a useful tool for the development of pharmacologic interventions for the treatment inflammation-related pathologies. 48 SHIGEYUKI K., NORIMASA T., RYUTARO S. Evaluation of Osteoarthropathy of Knee Monitored with Thermography // Orthopedics & Traumatology. - VOL.48; NO.1;PAGE.348-350(1999). Osteoarthropathy (OA) of the Knee occurs in the elderly and requires long term treatment. We investigated the degree of severity by X-ray and surface temperature using thermography for knee. The surface temperature of knees in the moderate severity group showed low temperatures compared with the normal group. The results of this study indicate the usefulness of thermography according to the degree of OA in patients with knee pain. Schiavenato M, Thiele RG. Thermography detects subclinical inflammation in chronic tophaceous gout. J Rheumatol. 2012 Jan; 39(1):182-3. Thermographic imaging is a noninvasive diagnostic tool used to document the inflammatory process in many species and may be useful in the detection of subclinical bumblefoot and other inflammatory diseases. Bumblefoot is a chronic inflammation of the plantar metatarsal or digital pads of the foot (pododermatitis), or both. It is one of the major health problems in birds including chickens and is responsible for significant economic losses in commercial poultry operations. Early diagnosis of bumblefoot is essential for the prevention of economical loss and the improvement of animal well-being. The object of this study was to determine the suitability of thermography for the identification of subclinical bumblefoot in chickens. Experiment 1 was designed to validate thermography as a tool for screening avian populations for bumblefoot. The plantar surface of the feet of 150 randomly selected hens was imaged using a thermal camera. The thermal images were identified as suspect, positive, or negative for bumblefoot based on thermal patterns of the plantar surface. Visual inspection of the feet identified as suspect followed 14 d later. A visual score of clinical, mildly clinical, or negative for bumblefoot was assigned, based on gross pathological changes in the plantar surface. A correlation between initial thermal images identified as suspect for bumblefoot and a visual score of positive 14 d later was 83% (P< 0.01). In experiment 2, hens whose feet were free of lesions were inoculated in the metatarsal foot pad with Staphylococcus aureus. Thermal images and visual clinical scores were taken, prechallenge and 1, 2, 3, 4, and 7 d postchallenge. The correlation between thermal images classified as clinical and a visual score of clinical for bumblefoot was 86.7% (P < 0.001). However, the correlation between the thermal images classified as mild (subclinical) and a visual score of mild was only 26.7%, suggesting that thermography is a more sensitive indicator of subclinical infection than visual appraisal. Thermography may thus provide a useful tool for screening avian populations for signs of bumblefoot, early in the course of the disease, which will improve recovery percentages and bird well-being. Shu-wang C., Cong-cong W. STUDY ON PATHOLOGICAL AREA OF KNEE BY INFRARED IMAGING // Optics in Health Care and Biomedical Optics IV, edited by Qingming Luo, Ying Gu, Xingde Li, Proc. of SPIE Vol. 7845, 784531 © 2010 (Downloaded from SPIE Digital Library on 17 Jun 2011 to 85.143.5.214. Terms of Use: http://spiedl.org/terms) The application of infrared imaging in biomedical fields has been very broad, but the research results of the lesion of knee by using of infrared imaging have seldom been reported at present. On the basis of infrared images research, we present the exploring image analysis and relate the programming optimum entropy algorithm about infrared imaging analysis. The paper demonstrates the comparative study on the infrared images contrast between the pathological knee and the reference normal group through the optimum entropy algorithm. The rule of variation between the normal image and pathological changes of level about knee lesion in patients is gained. The research results 49 provide a kind of methods for the clinical diagnosis of the pathological knee and also discuss the value of application about the optimum entropy algorithm in infrared imaging analysis. Contrasting the MRI or CT, the infrared imaging is cheap and harmless. So the method can be used in health care and prophylactic detection. Spalding S.J., Kwoh C.K., Boudreau R., Enama J., Lunich J., Huber D., Denes L., Hirsch R. Three-dimensional and thermal surface imaging produces reliable measures of joint shape and temperature: a potential tool for quantifying arthritis // Arthritis Research & Therapy 2008, 10:R10 - http://arthritis-research.com/content/10/1/R10 Introduction: The assessment of joints with active arthritis is a core component of widely used outcome measures. However, substantial variability exists within and across examiners in assessment of these active joint counts. Swelling and temperature changes, two qualities estimated during active joint counts, are amenable to quantification using noncontact digital imaging technologies. We sought to explore the ability of three dimensional (3D) and thermal imaging to reliably measure joint shape and temperature. Methods: A Minolta 910 Vivid non-contact 3D laser scanner and a Meditherm med2000 Pro Infrared camera were used to create digital representations of wrist and metacarpalphalangeal (MCP) joints. Specialized software generated 3 quantitative measures for each joint region: 1) Volume; 2) Surface Distribution Index (SDI), a marker of joint shape representing the standard deviation of vertical distances from points on the skin surface to a fixed reference plane; 3) Heat Distribution Index (HDI), representing the standard error of temperatures. Seven wrists and 6 MCP regions from 5 subjects with arthritis were used to develop and validate 3D image acquisition and processing techniques. HDI values from 18 wrist and 9 MCP regions were obtained from 17 patients with active arthritis and compared to data from 10 wrist and MCP regions from 5 controls. Standard deviation (SD), coefficient of variation (CV), and intraclass correlation coefficients (ICC) were calculated for each quantitative measure to establish their reliability. CVs for volume and SDI were <1.3% and ICCs were greater than 0.99. Results: Thermal measures were less reliable than 3D measures. However, significant differences were observed between control and arthritis HDI values. Two case studies of arthritic joints demonstrated quantifiable changes in swelling and temperature corresponding with changes in symptoms and physical exam findings. Thermal imaging differentiates patients with active arthritis from normal controls: To determine the reliability of thermal imaging of the wrist and MCP, 6 normal adult wrists and hands from 3 controls were imaged on 3 separate days. Three thermal scans were obtained at each session and the HDI was calculated for each ROI. Intra-session (that is, same day and time) HDIs were very similar, with SDs less than 0.05°C (data not shown). Pooled inter-session (that is, day-to-day) SD of wrist HDIs was 0.2°C (Figure 3a) whereas MCP HDI performed less well, with an inter-session SD of 0.4°C (Figure 3b). Pooled intersession CVs were 22.1% for the wrist and 29.7% for the MCP, indicating relatively large day-to-day variation. This was also reflected in the low HDI ICC [1,3] values for wrists (0.146) and MCPs (-0.295). However, no control wrist or MCP HDI exceeded 1.3°C, suggesting that an HDI above 1.3°C might be indicative of the presence of arthritis. To explore this further, we compared HDI values of 10 control wrists and 10 control MCPs to 18 wrists with active arthritis and 9 MCPs with active arthritis. As shown in Figure 3c, an HDI cutoff of 1.3°C discriminated well between controls and patients with active arthritis. The mean ± SD HDI in control joints was 1.0°C ±0.2°C compared with 1.7°C ± 0.6°C in joints with active arthritis (p < 0.0001). By ROC analysis, an HDI value of 1.3°C yielded a sensitivity of 67% and a specificity of 100%. The area under the ROC curve was 0.823. No significant differences in HDI were seen between control adults and children or between arthritic adults and children. Using thermal imaging, we determined that an HDI of greater than 1.3°C correlated with physician-assessed active arthritis (r = 0.68, p < 0.0001) 50 and displayed a specificity of 100% and a sensitivity of 67% when compared with normal controls. The poorer performance of the MCP HDI is likely a consequence of uncontrollable physiologic factors (metabolic rate, caloric intake, and so on) within each subject, suggesting that absolute changes in HDI may not be a reliable longitudinal measure of change in arthritis activity. However, the HDI could be employed in a dichotomous fashion to classify joints as active or inactive, which could simplify and improve the reproducibility of active joint counts. Conclusion: 3D and thermal imaging provide reliable measures of joint volume, shape, and thermal patterns. Further refinement may lead to the use of these technologies to improve the assessment of disease activity in arthritis. Trafarski A., Rózanski L., Straburzynska -Lupa A., Korman P. The Quality of Diagnosis by IR Thermography as a Function of Thermal Stimulation in Chosen Medical Applications // 9th International Conference on Quantitative InfraRed Thermography. - July 2-5, 2008, Krakow – Poland. The working of many physical procedures used in medical science is connected to changes in the temperature of tissue. A research has been carried out into the possibility of using the thermographic technique in evaluating the effectiveness of local cryotherapy procedure (local cryostimulation) in patients with rheumatoid arthritis. The aim of the research was to determine the degree of thermal stimulation intensity during the local cryotherapy procedure and duration of response of the organism to the applied stimulation. The research was based on comparison of temperature distribution on the surface of the hand prior to, immediately after, and at certain intervals after the procedure of local blast of liquid nitrogen vapours or cool air on the hand. All people taking part in the study suffered from rheumatoid arthritis, accompanying illnesses occurring in some of them. The study allowed optimizing thermal stimulation procedures used in rheumatology and cosmetology. The carried out research demonstrated that thermography is a measurement technique useful in analyzing thermal reaction of the organism connected with local cryostimulation, and monitoring and evaluating the progress of treatment. It was revealed that the stimulus produced by liquid nitrate vapours is a much stronger thermal stimulation for the patient than the stimulus produced by cool air. Duration of response to the stimulation in patients ill only with RA was longer in the case of stimulation with liquid nitrate vapours. A faster and bigger temperature rise, as well as longer duration of organism response to stimulation with cool air was observed in patients ill with RA and AH. Further research should be carried out which would be directed at discovering the proper diversification and adequate optimization of testing cryotherapy procedures applied in various morbid cases accompanying RA, as well as in various stages of progression of RA. Varjú G, Pieper CF, Renner JB, Kraus VB. Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods // Rheumatology (Oxford). - 2004 Jul;43(7):915-9. OBJECTIVE: Anatomical stages of digital osteoarthritis (OA) have been characterized radiographically as progressing through sequential phases from normal to osteophyte formation, progressive loss of joint space, joint erosion and joint remodelling. Our study was designed to evaluate a physiological parameter, joint surface temperature, measured with computerized digital infrared thermal imaging, and its association with sequential stages of radiographic OA (rOA). METHODS: Thermograms, radiographs and digital photographs were taken of both hands of 91 subjects with nodal hand OA. Temperature measurements were made on digits 2-5 at distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints and metacarpophalangeal (MCP) joints (2184 joints in total). We fitted a repeated measures 51 ANCOVA model to analyse the effects of rOA on temperature, with handedness, joint group, digit and NSAID use as covariates. RESULTS: The reliability of the thermoscanning procedure was high (generalizability coefficient 0.899 for two scans performed 3 h apart). The mean joint temperature decreased with increasing rOA severity, defined by the Kellgren-Lawrence (KL) scale. The mean temperature of KL0 joints was significantly different from that of each of the other KL grades (P </= 0.002). After adjustment for the other covariates, there was a strong association of rOA with joint surface temperature (P<0.001). The earliest discernible radiographic disease (KL1) was associated with a higher surface temperature than KL0 joints (P = 0.01) and a higher surface temperature than any other KL grade. Joint erosions were not associated with a change in joint temperature. CONCLUSION: Joint surface temperature varied with the severity of rOA. Joints were warmer than normal at the onset of OA. As the severity of rOA worsened, joint surface temperature declined. These data support the supposition that digital OA progresses in phases initiated by an inflammatory process. The cooler surface temperatures in later stages of the disease may in part explain the paucity of symptoms reported by patients with hand OA. Vujcic M, Nedeljkovic R. Thermography in the detection and follow up of chondromalacia patellae // Annals of the Rheumatic Diseases. - 1991; 50: 921-925. Although diagnostic criteria for chondromalacia patellae exist, the disease is often accompanied by physical signs which are limited or non-diagnostic. Thermographic examination was performed in 157 patients with clinical diagnosis of chondromalacia pateliae in 86 patients after surgical treatment for chondromalacia, and in 308 controls. Thermography can help the clinicians in establishing the diagnosis of chondromalacia patellae, but by itselfis not sufficiently specific. The specificity of thermography was dependent on age, ranging from 90% for the 15-24 year age group to 65% for the 45-54 year age group. Sensitivity of the method was 68%. Thermography can disclose other knee disorders which imitate chondromalacia pateliae. Warashina H, Hasegawa Y, Tsuchiya H, Kitamura S, Yamauchi K-I, Torii Y, Kawasaki M, Sakano S. Clinical, radiographic, and thermographic assessment of osteoarthritis in the knee joints // Annals of the Rheumatic Diseases.- 2002;61:852–854 In this study we evaluated the correlation between radiographic and clinical findings and skin temperature measured by thermography for the assessment of osteoarthritis in the knee joints in the Comprehensive Health Examination Programme at Y-town, Japan in 1999. The assessments were performed on 974 knees of 169 men and 318 women who had a mean (SD) age of 57.6 (4.3). In this study, thermography provided objective data of skin temperature that was compared with other physical parameters, showing a correlation between skin temperature and clinical and radiological evidence of OA in the knee joints. Cheung PP et al. Reliability of patient self-evaluation of swollen and tender joints in rheumatoid arthritis: A comparison study with ultrasonography, physician and nurse assessments. Arthritis Care Res 2010 Aug; 62(8): 1112-1119. Esselinckx W. Bacon P A, Ring E F, Crooke D, Collins A J, and Demottaz D. A thermographic assessment of three intra-articular prednisolone analogues given in rheumatoid synovitis. Br J Clin Pharmacol 1978 May; 5(5): 447-451. 1 Three intra-articular prednisolone analogues have been studied in a group of forty-six rheumatoid arthritic subjects. Each compound was tested at 50 mg and 100 mg dose over 3 weeks. 2 The anti-inflammatory effect was assessed by quantitative thermography. Systemic escape of the drug was monitored by plasma prednisolone and cortisol levels. 3 52 Both the systemic escape from the joint and the duration of effect on injected and uninjected knees were related to drug solubility. 4 Depression of plasma cortisol occurred with all three preparations and was most prolonged with the long-acting preparation. 5 Increasing the dose from 50 mg to 100 mg increased the antiflammatory effect only with the soluble acetate preparation. Spalding SJ et al. Three-dimensional and thermal surface imaging produces reliable measures of joint shape and temperature: a potential tool for quantifying arthritis. Arthritis Res Ther 2008; 10(1): R10. Schiavenato M, Thiele RG. Thermograph detects subclinical inflammation in chronic tophaceous gout. J Rheumatol. 2012 Jan; 39(1):182-3. Disorders of synovium and tendon and оther soft tissue disorders Muscle action is the most important source of increased metabolic heat. Therefore, contracting muscles contribute to the temperature distribution at the body’s surface of athletes (Tauchmannova et al 1993, Smith et al 1986). Pathological conditions such as muscle spasms or myofascial trigger points may become visible as regions of increased temperature (Fischer and Chang 1986). An anatomic study from Israel proposed that in the case of the levator scapulae muscle, the frequently seen hot spot on thermograms of the tender tendon insertion on the medial angle of the scapula could be caused by inflamed bursae and not by a taut band of muscle fibres (Menachem et al 1993). Acute muscle injuries may also be recognized by areas of increased temperature (Schmitt and Guillot 1984) due to inflammation in the early state of trauma. However, long lasting injuries and also scars appear as hypothermic areas caused by reduced muscle contraction, and therefore reduced heat production. Similar areas of decreased temperature have been found adjacent to peripheral joints with reduced range of motion due to inflammation or pain (Ammer 1995a). Muscle overuse or repetitive strain may lead to painful tendon insertions, or where the tendons are shielded by the tendon sheath or adjacent to bursae, with painful swelling. It has been shown that tendovaginitis in the hand was sucessfully diagnosed by skin temperature measurement (Graber 1980). Painful muscle insertion of the extensor muscles at the elbow is associated with hot areas on a thermogram (Binder et al 1983). Thermal imaging can detect persistent tendon insertion problems of the elbow region in a similar way as isotope bone scanning (Thomas and Savage 1989). Hot spots at the elbow have also been described as having a high association with a low threshold for pain on pressure (Ammer 1995b). Such hot areas have been sucessfully used as outcome measure for monitoring treatment (Devereaux et al 1985, Meknas et al 2008). In patients suffering from fibromyalgia, bilateral hot spots at the elbows are a common finding (Ammer et al 1995). Fibromyalgia. There are two terms used by physicians in the examination of muscular pain: tender points (important for the diagnosis of fibromyalgia) and trigger points (main feature of the myofascial pain syndrome). Tender points and trigger points may give a similar image on the thermogram. If this is true, patients suffering from fibromyalgia may present with a high number of hot spots in typical regions of the body. A study from Italy did not find different patterns of heat distribution in patients suffering from fibromyalgia and patients with osteoarthritis of the spine (Biasi et al 1994). However, they reported a correspondence of non-specific hyperthermic pattterns with painful muscle areas in both groups of patients. In an Austrian study, thermographic investigations in fibromyalgia revealed a diagnostic accuracy of 60% of hot spots for tender points (Ammer et al 1995). The number of hot spots found was greatest in fibromyalgia patients and least in healthy subjects. It was therefore concluded that more than seven hot spots could be predictive for 53 tenderness in 11 or more of 18 specific sites (Ammer K. Thermal imaging: a diagnostic aid for fibromyalgia? // Thermol. Int. 2008. 18 45–50). Based on the count of hot spots, 74.2% of 252 subjects (161 fibromyalgia, 71 with widespread pain, but less than 11 tender sites out of 18, and 20 healthy controls) were correctly diagnosed. Al-Nakhli, H.H., Petrofsky, J.S., Laymon, M.S., Berk, L.S. The Use of Thermal Infra-Red Imaging to Detect Delayed Onset Muscle Soreness. J. Vis. Exp. (59), e3551, DOI: 10.3791/3551 (2012). Delayed onset muscle soreness (DOMS), also known as exercise induced muscle damage (EIMD), is commonly experienced in individuals who have been physically inactive for prolonged periods of time, and begin with an unexpected bout of exercise1-4, but can also occur in athletes who exercise beyond their normal limits of training5. The symptoms associated with this painful phenomenon can range from slight muscle tenderness, to severe debilitating pain1, 3, 5. The intensity of these symptoms and the related discomfort increases within the first 24 hours following the termination of the exercise, and peaks between 24 to 72 hours post exercise1, 3. For this reason, DOMS is one of the most common recurrent forms of sports injury that can affect an individual’s performance, and become intimidating for many1, 4. For the last 3 decades, the DOMS phenomenon has gained a considerable amount of interest amongst researchers and specialists in exercise physiology, sports, and rehabilitation fields6. There has been a variety of published studies investigating this painful occurrence in regards to its underlying mechanisms, treatment interventions, and preventive strategies1-5, 7-12. However, it is evident from the literature that DOMS is not an easy pathology to quantify, as there is a wide amount of variability between the measurement tools and methods used to quantify this condition. It is obvious that no agreement has been made on one best evaluation measure for DOMS, which makes it difficult to verify whether a specific intervention really helps in decreasing the symptoms associated with this type of soreness or not. Thus, DOMS can be seen as somewhat ambiguous, because many studies depend on measuring soreness using a visual analog scale (VAS) 10, 13-15, which is a subjective rather than an objective measure. Even though needle biopsies of the muscle, and blood levels of myofibre proteins might be considered a gold standard to some6, large variations in some of these blood proteins have been documented 6, 16, in addition to the high risks sometimes associated with invasive techniques. Therefore, in the current investigation, we tested a thermal infra-red (IR) imaging technique of the skin above the exercised muscle to detect the associated muscle soreness. Infra-red thermography has been used, and found to be successful in detecting different types of diseases and infections since the 1950’s17. But surprisingly, near to nothing has been done on DOMS and changes in skin temperature. The main purpose of this investigation was to examine changes in DOMS using this safe and non-invasive technique. Selfe James, Hardaker Natalie, Whitaker Jonathan, Hayes Colin. Thermal imaging of an ice burn over the patella following clinically relevant cryotherapy application during a clinical research study // Physical Therapy in sport. – Volume 8, Issue 3, August 2007, Pages 153–158. The use of cryotherapy in soft tissue injury is still largely based on anecdotal rather than empirical evidence. The objective of this case report is to present thermal imaging data from a mild ice burn sustained during a clinical research project. Design Case report. Case description 54 A 43-year-old male participant recruited to take part in an ongoing cryotherapy research project sustained a mild ice burn, resulting in visible blanching of the skin over the affected area and a transient burning sensation. The burn occurred unexpectedly during a tightly controlled experimental procedure, employing protocol from current clinical practice. Three participants had already successfully completed the study with no adverse reactions when the ice burn occurred. Outcome measures Outcome measures were; patella skin-fold, modality temperature pre and post application, baseline thermal image, and thermal imaging data over the knee at a rate of 1 image min−1 during a 25-min re-warming period. Results The participant recorded a patella skin-fold of just 7 mm. Baseline skin surface temperature was 29.4 C. Skin surface temperature (Tsk) decreased by 17.9 C following cold application. During the 25-min re-warming period Tsk increased 11.8 C. Conclusions Twenty minutes of cryotherapy application may be too long over an anatomically bony area. Clinicians should consider thermal gradient as part of their clinical decision making process, which would be influenced by increased ambient temperature, pathology, and also lower modality temperature. Chapter XIV Diseases of the genitourinary system Daneliia EV, Gotsadze DT. Infrared telethermography in the diagnosis of testicular tumors. – Urol Nefrol (Mosk). 1995 Nov-Dec;(6):38-40. Diagnostic potential of infrared extracorporeal thermography (IET) was studied in 334 males: 167 with testicular tumors, 42 with acute or chronic epididimitis, 33 with orchitis, 17 with hydrocele and 75 controls. Gotsadze DT, Sepiashvili AO, Daneliia EV. Thermography in inflammatory and neoplastic diseases of the testis. – Vopr Onkol. 1990;36(4):476-9. Thermographic examination of the scrotum was performed in 55 healthy males, 64 patients with nonspecific inflammatory lesions of the testicles and 44 cases of testicular tumor. In thermograms of the normal scrotum, cold zones provided the background for homogeneous isothermic images corresponding to the testicles. Inflammatory lesions showed atypical diffuse zones of increased thermogenic activity which were in some cases associated with hyperthermic stem foci in the inguinal-scrotal area. Helen Potter , Robin Horne, Kristy Le May, John Seah. The sensitivity of thermography to temperature changes in breast tissue. - Australian Journal of Physiotherapy. - Volume 43, Issue 3, 1997, Pages 205–210. This study evaluates the ability of thermography to i) detect temperature changes in a lactating breast in response to the application of therapeutic ultrasound; ii) identify an area of raised temperature in a breast affected by mastitis; and iii) detect temperature changes in the affected area in response to the application of ultrasound. An area of raised temperature (38 degrees C), corresponding with the area of inflammation, was identified in a mastitic breast. Eighty-seveen per cent of this area had returned to normal resting breast temperature (33 degrees C) within 30 minutes of application of pulsed ultrasound. The use of thermography to evaluate temperature changes in mastitic breast tissue before and after the application of ultrasound is supported. 55 Jang H A, Kim T, Yoon S, Kim W, Lee S. THE CLINICAL APPLICATION OF SCROTAL INFRARED THERMOGRAPHY IN NORMAL AND PATIENTS WITH ACUTE EPIDIDYMITIS OR EPIDIDYMO-ORCHITIS. www.ics.org/Abstracts/Publish/180/000726.pdf Hypothesis / aims of study We evaluate the finding of scrotal infrared thermography in normal and patients with acute epididymitis/epididymo-orchitis, and try to assess its capability through the comparison with clinical parameters. Study design, materials and methods We performed the digital infrared thermography of scrotum in 15 normal male and 23 patients with acute epididymitis, and assessed the thermographic characteristics in normal male. Both thermographic patterns and thermal differences between normal and affected scrotum in acute epididymitis patients were retrospectively analyzed. Also we compared it with clinical parameters such as fever, pyuria and findings of doppler ultrasound. Interpretation of results In 15 normal male, thermal differences between bilateral hemiscrotums were average 0.30 ± 0.16 ℃, and they did not show statistical significance. By ROC curve analysis, diagnostic cut-off value, sensitivity and specificity were 0.6℃, 69.6%, 100% respectively. Sixteen of twenty-three patients presented significant thermal differences over 0.6℃. Also, the thermal differences of hot spot of patients were significantly increased comparing with that of normal scrotum. Thermography revealed that the temperature of affected hemiscrotum in patient with acute epididymitis was statistically higher than that of normal hemiscrotum as well. Concluding message Scrotal thermography had the capability as a diagnostic tool of acute epididymitis through both the comparison of thermal difference between normal and affected scrotum in patient, and ROC analysis. However, currently it was uncertain whether thermography could differentiate acute epididymitis from other intrascrotal disease. In the future, the advancement of thermographic device and more data accumulation may improve the clinical value of thermography. Novikova E.E. Possibilities of thermography in diagnostics of diseases of mammary gland: thesis. – Saratov, 1996. The following women were carefully examined: 800 healthy women and 1357 patients (726 women with dishormonal hyperplasia, 581 women with malignant tumors, 150 women with purulent and inflammatory processes). Thermographic symptoms for all diseases of the breast were the same type, but the degree of hyperthermia, area, shape and its location were different for various pathological processes. Purulent and septic diseases of mammary gland: expressed hyperthermic fibrotic folds along the vessels and channels, and centers of heating corresponding to projections of the affected areas were observed at serous form of mastitis. The difference of temperatures was from 1.0 to 1.5°С. Positive dynamics with subsequent normalization in three to four weeks was observed after the treatment course. The difference of temperature for patients with infiltrative and purulent-infiltrative mastitis was 3.0-5.0°С. The difference of temperatures of more than 5 degrees was observed for patients with obliterating mastitis. Tiktinskiĭ OL, Mel'nikova VP, Moshkalov AA, Novikov IF. The role of thermography in the diagnosis of testicular diseases. - Urologii͡a i nefrologii͡a:1 pg 23-6. http://www.unboundmedicine.com/medline/citation/2718279/[The_role_of_thermography_i n_the_diagnosis_of_testicular_diseases]_ 56 Combined clinical and thermovision investigation was carried out in 104 patients with various scrotal diseases. Acute epididymitis and orchidoepididymitis (42 patients) were associated with the following thermographic signs: thermo-asymmetric intensity of infrared emission with hyperthermia (0.6 to 2 degrees C) on the affected side, a greater glow area, as compared to actual anatomical size of the organ, "truncal" inguino-iliac hyperthermia in cases of ascending lymphangitis. Asymmetry of heat pattern diminished or disappeared altogether in cases of successful treatment. Hydrocele (32 patients) was associated with enlarged heat outlines on the affected side of the scrotum, without any apparent heat pattern asymmetry. Malignant testicular tumors (30 patients) were associated with enlarged outline of the affected scrotal side with a temperature difference of 1.2 degrees C and more, as compared to the normal side, persistent hyperthermia at repeated examinations, small- and medium-sized hyperthermic foci over the projected liver, lungs, mediastinum, meso- and hypogastrium, lumbar region and in the area of lateral neck surface in cases of metastatic growth. A clear-cut homogeneous hyperthermia over the anterior abdominal wall and in the lumbar region is registered as a post-gamma teletherapy condition. Thermovision is an effective instrument for the diagnosis of benign and malignant scrotal diseases; it makes possible early detection of complications (lymphangitis, lymphadenitis, metastases) providing for an objective assessment of treatment efficiency. The accuracy of thermovision diagnosis was 100% in cases of hydrocele and acute orchidoepididymitis, and 89.6% in cases of testicular tumors. YuHongKai. Infrared heat map for the diagnosis of chronic prostatitis clinical research. Master's thesis, 2004. - http://www.dissertationtopic.net/doc/839669 The chronic prostatitis research purposes is one of the most common diseases in the male. American Urological Andrology clinic patients, accounting for 9% to 14% of patients with chronic prostatitis. There are also a report chronic prostatitis accounted for 25% of urology, andrology outpatient, like a recent MI, unstable angina, active Crohn's disease, the impact of the disease on the quality of life is significant, and the psychological damage and even more serious than severe diabetes or chronic heart failure. Secretory dysfunction accompanied by chronic prostatitis, from adverse effect on sperm, resulting in reduced fertility. Chronic prostatitis is a serious impact on a disease of male physical and mental health, urology, andrology research focuses on diseases. Prostatitis diagnosis: prostate massage fluid examination, four cups positioning method, polymerase chain reaction technology (PCR), antibody detection, Determination of cytokines (IL-6, TNF-α), voiding pressure - flow rate - EMG measurement, cystoscopy, B ultrasound, voiding the bladder and urethra contrast, prostate tissue biopsy. These methods have their own advantages, but there are shortcomings. For example: prostate massage fluid examination with four cup positioning method requires digital rectal diagnosed prostate massage extracting solution, the patient is often very painful, and even refused to check; And often the extract failed. Chronic prostatitis often local glandular inflammation, prostate massage extracting solution is not necessarily the prostatic fluid extrusion glandular inflammation can cause check false negative. Voiding pressure - flow rate - EMG measurement, cystoscopy, the excretory bladder urethrography, prostate tissue biopsy are invasive or inspection fees, and is not suitable for general clinical examination. Medical infrared thermal imaging (infrared thermography, IRT) technology is an emerging hi-tech, human radiation source, the use of state-of-the-art infrared scanning technology to detect infrared radiation, after a series of signal processing, not visible The surface temperature changes into visibility and quantitative infrared heat map. Chronic prostatitis pathological manifestations of the same general inflammation, mainly to the posterior urethra, prostate tube and surrounding interstitial tissue congestion, edema, local temperature. High temperature parts of the deep, and its surface temperature is also higher. Based on the above principles, the study by medical infrared camera detection 57 around the male external genitalia infrared heat map to explore the diagnostic value of the infrared image of chronic prostatitis. Methods: This study selected Dongzhimen Hospital Urology chronic prostatitis outpatients, 30, normal subjects 30; symptom score table designed in accordance with the Beijing University Hospital, and 30 patients with chronic prostatitis improved symptom scores. Application DW-9100 medical infrared camera, temperature 20 ~ 24 ℃, 60% humidity environment, to ensure that no wall the reflection, indoor airflow, direct sunlight lens and subjects, the subjects undressing imaging pants shot five minutes later. Imaging method: subjects face the camera standing at 1.2 meters in front of the lens of the camera, at the same time exposed to the lower abdomen (below the navel) and thigh upper third start shooting system, adjust the focus to the screen image clarity, the image Save and analysis and inspection. Observed: (1) around the external genitalia of infrared heat map form. (2) the ambient temperature of the external genitalia hotter regions close to the region of the temperature difference. The results of the findings show that the the normal infrared image performance: the ambient temperature of the external genitalia basically equal on both sides of the basic symmetry, the temperature difference is less than 2°C. The infrared image showed chronic prostatitis patients: around the external genitalia (scrotum on both sides of the lower abdomen near the base of the penis) visible strip, sheet or groups like the hot zone of 2.5 to 4°C, and the immediate area of the temperature difference. The hotter the ambient temperature of the external genitalia of the normal subjects and patients with chronic prostatitis District and close to the region of the temperature difference between the existence of significant differences (P lt; 0.0001). Hotter regions around the external genitalia of the patient group close to the area of the temperature difference between its symptoms grading no correlation. Around the external genitalia of the patient group compared with the lt; WP = 4 gt; Chinese Abstract hot zone close to the area of the temperature difference between its duration of disease. Conclusion around the male external genitalia (scrotum on both sides of the lower abdomen near the base of the penis), infrared thermal images can be used as a census of the men with chronic prostatitis and auxiliary diagnostic one. Infrared thermal images can not be used to determine chronic prostatitis severity;, and the course of disease. Chapter XV Pregnancy, childbirth and the puerperium Mastitis is the inflammation of breast tissue.[1] S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well. Mastitis can be classified as milk stasis, non-infectious or infectious inflammation and abscess. It is impossible to correlate this classification with clinical symptoms. In particular, milk stasis, non-infectious and infectious inflammation can be distinguished only by leukocyte count and bacteria culturing. Symptoms like fever, intensity of pain, erythema or rapid onset of symptoms can not be used to distinguish these. Early stages of mastitis can present with local pain, redness, swelling, and warmth. Later stages also present with systemic symptoms like fever and flu-like symptoms and in rare cases an abscess can develop. However it is pretty common that symptoms develop very quickly without any warning [http://en.wikipedia.org/wiki/Mastitis]. 58 Anita Batista dos Santos Heberle, Marcos Antônio Muniz de Moura, Mauren Abreu de Souza, Percy Nohama. Assessment of techniques of massage and pumping in the treatment of breast engorgement by thermography. - Rev. Latino-Am. Enfermagem. vol.22, no.2. Ribeirão Preto. - Mar./Apr. 2014. - http://dx.doi.org/10.1590/01041169.3238.2413 Mammary engorgement, in the breastfeeding process, is the first symptom encountered by the mother in the self-regulation of the physiology of lactation. Sometimes, the breasts produce a quantity of milk secretion greater than the demand of the child, becoming so full and taut they are called "gable chest" [Almeida JAG. Amamentação: um híbrido naturezacultura. Rio de Janeiro: Fiocruz; 1999.], one of the factors of interruption of the exclusive breast feeding (EBF) in children under four months of life [Carvalhaes MABL, Parada CMGL, Costa MP. Fatores associados à condição do aleitamento materno exclusivo em crianças menores de 4 meses, em Botucatu, SP. Rev. Latino-Am. Enfermagem. 2007;15:62-9.]. Breast engorgement arises from the increased vascularity and accumulation of milk and, secondarily, by lymphatic and vascular congestion [Giugliani ERJ. Problemas comuns na lactação e seu manejo. J Pediatr. 2004;80(5) suppl: 147-54.]. Signals arise such as pain, interstitial edema, increase in the volume of the breasts [Book OR, Guralnik L, Keidar Z, Gaitini DE, Engel A. Pitfalls of the lactating breast on computed tomography. J Comput Assist Tomogr. 2004;28(5):647-9.], shiny skin, flattened nipples, with or without accompanying diffuse and reddened areas [Giugliani ERJ. Problemas comuns na lactação e seu manejo. J Pediatr. 2004;80(5) suppl: 147-54.], elevation of the body temperature including a febrile state. After the breasts are emptied [Shimo AKK. Mama Puerperal: aspectos preventivos e curativos do ingurgitamento mamário. [dissertação]. Ribeirão Preto: Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo; 1983. 163 p.], a reduction in temperature occurs. In the research literature, temperature changes in breasts of pregnant women have been observed [Birnbaum SJ. Breast temperature as a test for pregnancy. Obstet Gynecol. 1966;27(3): 378-80.], and hormone dosage in lactating women with engorged breasts, in which it was found that systems with high sensitivity could provide early diagnosis, both of postpartum breast discomfort as well as the evolution of breast engorgement (BE) [Menczer J, Eskin BA. Evaluation of post-partum breast by thermography. Obstet Gynecol. 1969;33(2):260-3.]. OBJECTIVE: to evaluate techniques of massage and pumping in the treatment of postpartum breast engorgement through thermography. METHOD: the study was conducted in the Human Milk Bank of a hospital in Curitiba, Brazil. We randomly selected 16 lactating women with engorgement with the classification lobar, ampullary and glandular, moderate and intense. We compared the differential patterns of temperature, before and after the treatment by means of massage and pumping. RESULTS: we found a negative gradient of 0.3°C of temperature between the pre- and post-treatment in the experimental group. Breasts with intense engorgement were 0.7°C warmer when compared with moderate engorgement. It was verified that the breasts with moderate engorgement had a mean temperature of 34.8°C versus 35.5°C for those with intense engorgement. It was found that, at the 5% level of significance, there was a significant difference between the temperature variations between the pre and post treatment in the experimental group. In the control group, there was no significant difference. CONCLUSION: massage and electromechanical pumping were superior to manual methods when evaluated by thermography. 59 Chapter XIX Injury, poisoning and certain other consequences of external causes Arfaoui A., Polidori G., Taiar R., Popa C. Infrared Thermography in Sports Activity // Infrared Thermography Edited by Dr. Raghu V Prakash 236 pages. Due to its non-intrusive feature, infrared thermography (IRT) is a powerful investigation tool to be applied as well in sports performance diagnostic (due to the relationship between muscular energy and thermoregulation process) as in sports pathology diagnostic. It is well known that sports activity induces a complex thermoregulation process where part of heat is given off by the skin of athletes. As not all the heat produced can be entirely given off, this follows a muscular heating resulting in an increase in the cutaneous temperature. For example, in sports activity, we have presented the usability of infrared thermography in swimming for the purpose of quantifying the influence of the swimming style on the cartographies of cutaneous temperatures of a swimmer similar analysis has concerned cycling activity. In particular, the IRT method will enable, in the long term, to quantify the heat loss according to the swimming style, and to consider the muscular and energy outputs during the stroke. In the field of pathology diagnostic, applied to sports activity, the application of infrared thermography (IRT) has a long history in musculoskeletal trauma. Infrared thermography is a diagnostic method providing information on the normal and abnormal sensory and nervous systems, trauma, or local and global inflammation. Infrared thermography shows physiological changes rather than anatomical changes and could be a new diagnostic tool to detect the pathology of the knee. For example, IRT appears to be a reliable diagnostic tool to detect quantifiable patterns of skin temperatures in participants with knee osteoarthritis. BenEliyahu D. Infrared Thermography and the Sports Injury Practice // Dynamic Chiropractic – March 27, 1992, Vol. 10, Issue 07. Infrared thermal imaging can be very useful to the sports injury practice. Infrared Thermography (IRT) measures cutaneous surface temperature which is reflective of the underlying sympathetics and local chemical mediators. Previous studies have shown that skin temperature from right to left sides only differ within a few tenths of a degree for homologous parts. In the case of the anterior calves, the normal mean temperature differential is 0.31 degrees C. Other studies have shown that temperature differentials over 0.65-0.80 degrees C are indicative of underlying pathology. IRT has been found to be useful by both the AMA Council on Scientific Affairs and the ACA Council on Diagnostic Imaging, which has its own American Chiropractic College of Thermology. IRT has been documented in the world scientific literature as an efficacious diagnostic tool, prognostic and treatment assessment tool. IRT has been shown to be useful for stress fractures, tibial stress syndromes (shin splints), patellofemoral disorders, shoulder impingement, reflex sympathetic dystrophy, Osgood Schlatter’s disease, epicondylitis, nerve entrapments, ankle injuries, foot disorders, and myofascial pain syndromes. In a study published by Goodman, et al., IRT was found to be a useful test to distinguish stress fractures and shin splints in a prospective blind study of runners. The athletes with hyperthermic calves had a poorer prognosis as opposed to those with a hypothermic/cold pattern. In a study by this author that was presented at the 17th Annual Symposium of the American College of Sports Medicine, and to be published in the JMPT, IRT was found to have a high sensitivity and specificity for patellofemoral pain syndrome (PFPS). PFPS will image as a global patellar hypothermia that will usually affect the patella region only. IRT is also helpful in the following conditions: 1. Shoulder impingement syndrome – focal hyperthermia of shoulder. 2. Achilles’ tendinitis – focal hyperthermia at Achilles’ tendon. 3. Morton’s neuroma/metatarsalgia – focal hyperthermia at plantar foot. 60 4. Tarsal tunnel syndrome – hypothermia at heel and big toe. 5. Osgood Schlatter’s disease – focal hyperthermia at tibial tubercle. 6. Myofascial pain syndrome – focal hyperthermia overlying involved muscle. 7. Facet syndrome – focal hyperthermia overlying involved facet. 8. Ankle sprains – typically hyperthermic 9. Tennis leg – hyperthermia over head of involved gastrocnemius as opposed to diffuse hyperthermia in phlebitis. IRT is also useful as a prescan team assessment tool, to determine areas of thermal asymmetry that may represent subclinical problems predisposing the athlete to injury. For example, in a study done by this author, it was found that 70 percent of a high school football team showed patellar thermal asymmetry. IRT can be used with follow-up studies to follow treatment response and as a prognostic indicator of when to best return the athlete to practice and/or competition. Conclusion. Infrared thermography has many applications in a sports injury practice and is valuable for diagnostic, prognostic, and treatment assessment purposes. Thermography should be utilized whenever possible by sports medicine doctors. Hildebrandt C., Raschner C., Ammer K. An Overview of Recent Application of Medical Infrared Thermography in Sports Medicine in Austria // Sensors 2010, 10, 4700-4715. Medical infrared thermography (MIT) is used for analyzing physiological functions related to skin temperature. Technological advances have made MIT a reliable medical measurement tool. This paper provides an overview of MIT´s technical requirements and usefulness in sports medicine, with a special focus on overuse and traumatic knee injuries. Case studies are used to illustrate the clinical applicability and limitations of MIT. It is concluded that MIT is a non-invasive, non-radiating, low cost detection tool which should be applied for pre-scanning athletes in sports medicine. A common problem in alpine skiing is the occurrence of overuse injuries such as patellae tendinopathy, which is characterized by swelling, pain and tenderness above the tibial tuberosity. This regional problem becomes apparent in the form of a hyperthermic pattern, as can be seen in Figure 4 in which the right knee is affected. The preseason training program includes excessive jumps, leading to mechanical strain and overuse of the patella tendon. In this study, a total of seven athletes showed symptoms of regional overuse reactions. The symptomatic athletes had a mean side temperature differences of 1.4°C. The normal temperature range of the eight non-injured athletes showed a side-to-side variation of 0.3°C. Thermal imaging in medicine is not new, but early investigation with old and insufficient techniques has led to work with dubious results. Recent work with modern 21st century technology has demonstrated the value of MIT in medical application when used as an auxiliary tool. Knowledge about thermoregulation, anatomy, physiology, morphology and pathophysiological processes is important to counteract inaccurate diagnoses. The aim of this technique is not to be a substitute for clinical examination but to enhance it. Further research and follow-up studies are warranted to create databases for clinical measurements and further determine its viability in real-world medical settings. Empirical evidence of correlation between pathology and infrared imaging is essential to further predict the value of MIR. It should be used as a multidisciplinary assessment tool by experts from different fields. Based on the advantages of MIT as a non-invasive, nonradiating, low cost first-line detection modality, it should be applied in the field of sports medicine as a pre-scan team assessment tool. The extension of sport specific databases may further contribute to the detection of high risk athletes and help them to start early intervention. 61 Nica AS, Mologhianu G, Murgu A, Mitoiu B, Lili M, Moise M. THERMOGRAPHIC EVALUATION OF A YOUNG PATIENT WITH POSTTRAUMATIC SEQUELAE OF LOWER LIMB.// Thermology international 22/2 (2012). A patient suffered from an injury by falling (during a football game)) on October 15, 2011 resulting in double fracture of the right ankle. He was admittted to the orthopaedic department, where fixation and osteosynthesis of the fractured medial and the lateral malleolus were performed the course of recovery from the injury was favourable due the surgical intervention and under the complex pharmacological treatment (antibiotic, anti inflammatory, anticoagulant.)The patientwas referred to the rehabilitation department one month after surgery. Patient, with a posttraumatic and post surgical history, was evaluated at the rehabilitation ward clinically from a functional point of view. The results of clinical and functional assessment have been completed with imaging investigations: such as ultrasound of the anterior-lateral right leg, radiographs of both legs including the ankle-foot complex, and thermography to detect changes of the peripheral temperature distribution. The patient underwent a comprehensive rehabilitation programme including electrotherapy for pain reduction andmuscle stimulation and adapted exercise therapy. Thermography was performed daily, before and after treatment, recording changes in thermal skin reaction possibly inducedb y the rehabilitative interventions. The dynamics of thermal activity were recorded and graphically and statistically analysed. Sands A. W., McNeal R. J., Stone H.M. THERMAL IMAGING AND GYMNASTICS INJURIES // Science of Gymnastics Journal. - Vol. 3 Issue 2: 5 – 12 Gymnasts have a relatively high injury rate and severity with highly qualified gymnasts suffering the most. One of the common injuries in gymnastics is the overuse-type that often remains latent until near the decisive moments of competition when the injury rises to the level of incapacitation. Is there a technology and methodology available to monitor gymnasts during development that can identify latent injuries and thus alert medical personnel to potential performance-limiting problems at the earliest possible time? Imaging consists of the use of a thermal camera to identify inflamed areas and asymmetric temperature patterns. Thermal asymmetries are determined via thermal image and pain is assessed with palpation, history, and subject identification. Video recordings are made of the involved areas and recorded electronically for transfer to physicians, physical therapists, and athletic trainers for further investigation and remediation. This is an ongoing descriptive study of the use of thermal imaging on inflammation and injury in gymnasts. Thermal differentiation of tissue areas is performed by visual inspection and bilateral comparison of the thermal images. Thermal images show bilateral and tissue area thermal differentials by differences in gray scale. This information discriminates injuries, inflammation, and other conditions without invasive procedures. The ability to identify and thus treat injuries while they are minor is a significant improvement over waiting until the injuries become increasingly symptomatic and performancelimiting. Thermal imaging has become a mainstay of our laboratory in assisting young athletes in remaining injury free, making return-to-activity decisions, and collaborating with medical personnel to identify, prevent and treat injuries and other conditions. Seok Won Kim, Seung Myung Lee, Seong Heon Jeong. Validation of Thermography in the Diagnosis of Acute Cervical Sprain // J Korean Neurosurg Soc 36: 297-301, 2004. Objective: The diagnosis of acute cervical sprain was done based on rigidity in the cervical area on X-ray and the symptoms reported by the patient so that it was difficult to differentiate those patients who complain of cervical sprain for a secondary gain. Thus, the present study is done for differential diagnosis of those fake patients who want the diagnosis of cervical sprain for the purposes of financial gain using the thermography, 62 which is effective for objectifying pain by detecting the change in body temperature in the area of pain. Methods: This study was done in 327 patients who were admitted to the neurosurgery department at Chosun University Hospital between January 1, 2001 to January 31, 2002, mainly complaining of cervical pain from traffic accidents. According to the previous methods of diagnosis, the presence of rigidity in the cervical region was determined on Xray and this result was compared with the result from thermal imaging. Results: When the verbal numerical rating scale of patient's subjective pain was classified into severe, moderate and mild, cold spot and disruption of normal thermographic shape increased significantly on thermal imaging as the severity of pain increases. Conclusion: Thermal imaging is not only effective for differentiating the presence or absence of cervical pain but also for determining the pain severity, fake patients, and pain recovery. Postoperation monitoring Thermal imaging was used to monitor patients after knee endoprosthesis (Lambiris and Stoboy 1981, Mayr 1995, Glehr et al 2011, Romano et al 2011). Lambiris et al claimed a high increase of temperature in case of infection after knee surgery and that the temporary elevation of temperatures returns to normal values within 4 to 6 weeks (Lambiris and Stoboy 1981). Mayr reported that the time to achieve normal temperatures after knee surgery is at minimum 120 days, but thermal symmetry over the knee joints was not achieved even after 10 months in some patients (Mayr 1995). A study from Italy observed identical anterior knee temperature 90 days after total knee replacement (Glehr et al 2011). Romano et al investigated patients with anterior knee pain which had developed after implantation of an artificial knee joint 1–9 years previously (Romano C L, Romano D, DellO´ ro F, Loguluso N and Drago L. Healing of surgical site after total hip and knee replacements show similar thermographic patterns // J. Orthop. Traumatol. 2011. 12 81–6). The study participants had to walk 3 km prior to acclimatization to a room temperature of 20ºC for 20 min. On the thermal image a reference temperature over the patella was compared with the temperature readings at the painful knee site. Mean temperature differences between painful and non-painful sites ranged between 0.8 and 0.9ºC. The authors claimed a diagnostic sensitivity of 100% and a specificity of 91.7% for painful sites at cut-off point of temperature difference between painful and nonpainful sites. Glehr M, Stibor A, Sadoghi P, Schuster C, Quehenberger F, Gruber G, Leithner A, Windhager R. Thermal Imaging as a Noninvasive Diagnostic Tool for Anterior Knee Pain Following Implantation of Artificial Knee Joints // International Journal of Thermodynamics. - Vol. 14 (No. 2), pp. 71-78, 2011. In this article we present for the first time a direct correlation between an increase in skin temperature and existent frontal (anterior) knee pain after implantation of artificial knee joints measured with thermography. In a standardised way 26 knees were analysed. Temperatures in locations with pain were significantly higher compared to the reference field in inner location (median 0.95°C, p=0.0043), as well as in outer location (median 0.5°C, p=0.032). Median temperature difference between pain localization and localizations without pain was 0.7°C and ranged from 0.1°C to 1.7°C. In the receiver operating characteristic (ROC) analysis the sensitivity of this method was 1.0 and specificity was 0.917. The evidence of a significant increase in skin temperature on the painful sites opens up the possibility to localize and assess pain more precisely in patients with joint prosthesis. We consider this novel, rapid, inexpensive and non-invasive technology to posses the potential to become a useful and objective tool for diagnosis of 63 pain and inflammation and to generate digital data that can be stored and analysed in clinical practice. Haidar S.G., Charity R.M., Bassi R.S., Nicolai P., Singh B.K. Knee skin temperature following uncomplicated total knee replacement // The Knee. - Volume 13, Issue 6, December 2006, Pages 422–426. (http://www.sciencedirect.com/science/article/pii/ S0968016006001384). This prospective study aimed to establish the pattern of knee skin temperature following uncomplicated primary total knee replacement. Thirty-two patients were included. The skin temperature of operated and contralateral knees was measured preoperatively and daily during the first 6 weeks postoperatively. Measurements were also taken at 3, 6, 12 and 24 months following surgery. The difference in temperature between the two knees had a mean value of +2.9°C at 7 days. This mean value decreased to +1.6°C at 6 weeks, +1.3°C at 3 months, +0.9°C at 6 months +0.3°C at 12 months and +0.0°C at 24 months. Following uncomplicated total knee replacement, the operated knee skin temperature increases compared to the contralateral knee. The difference decreases gradually but remains statistically significant up to at least 6 months following surgery. In the absence of other features of infection, local knee warmth should not cause concern. Honsawek S., Deepaisarnsakul B., Tanavalee A., Sakdinakiattikoon M., Ngarmukos S., Preativatanyou K., Bumrungpanichthaworn P. Relationship of serum IL-6, C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty: a prospective study // International Orthopaedics (SICOT) (2011) 35:31–35. Knee osteoarthritis is a common cause of severe pain and functional limitation. Total knee arthroplasty is an effective procedure to relieve pain, restore knee function, and improve quality of life for patients with end stage knee arthritis. The aim of this study was to investigate the inflammatory process in patients with primary knee osteoarthritis before surgery and in subsequent periods following total knee arthroplasty. A prospective study of 49 patients undergoing primary total knee replacements was conducted. The patients were evaluated by monitoring serum interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), knee skin temperature, and clinical status. Measurements were carried out preoperatively and postoperatively on day one and at two, six, 14, and 26 weeks during follow-up review in the knee clinic. The serum IL-6 and CRP were elevated on the first postoperative day but fell to preoperative values at two weeks postoperatively. Both returned to within the normal range by six weeks postoperatively. In addition, the postoperative ESR showed a slow rise with a peak two weeks after surgery and returned to the preoperative level at 26 weeks postoperatively. The difference in skin temperature between operated and contralateral knees had a mean value of +4.5°C at two weeks. The mean value decreased to +3.5°C at six weeks, +2.5°C at 14 weeks, and +1.0°C at 26 weeks. The difference in skin temperature decreased gradually and eventually there was no statistically significant difference at 26 weeks after surgery. A sustained elevation in serum IL-6, CRP, ESR and skin temperature must raise the concern of early complication and may suggest the development of postoperative complication such as haematoma and/or infection. Mehra A., Langkamer V.G., Day A., Harris S., Spencer R.F. C reactive protein and skin temperature post total kneereplacement // The Knee. – Volume 12, Issue 4, August 2005, Pages 297–300. (http://www.sciencedirect.com/science/article/pii/ S0968016004001954#SECX1) We prospectively assessed 20 patients following uncomplicated total knee replacement (TKR). Clinical status, skin temperature and C-reactive protein (CRP) were measured preoperatively and at intervals up to 18 weeks. The CRP rose postoperatively up to 5–7 64 days but returned to normal values by 6 weeks. The skin temperature remained elevated up to 18 weeks. We concluded that in uncomplicated cases, the CRP should be within normal limits by 6 weeks after operation, but skin temperature may remain elevated up to 18 weeks. Highly statistically significant differences were found across the category means of both knee (F(1,18)=40.06; p<0.001) and time (F(3,54)=11.94; p<0.001). In addition, a highly significant interaction effect was also found between knee and time (F(3,54)=31.65; p<0.001), indicating a different pattern of change in knee temperature over time for the operated knee compared with the control knee. A sustained rise in these values may indicate the development of a complication such as infection and the patient must be closely monitored. Piñonosa S., Sillero-Quintana M., Milanović L., Coterón J., Sampedro J. THERMAL EVOLUTION OF LOWER LIMBS DURING A REHABILITATION PROCESS AFTER ANTERIOR CRUCIATE LIGAMENT SURGERY. - Kinesiology 45(2013) 1:121-129. Infrared thermography (IRT) is a safe and non-invasive tool used for examining physiological functions based on skin temperature (Tsk) control. The aim of this paper was to establish the probable thermal difference between the beginning and the end of the anterior cruciate ligament (ACL) rehabilitation process after surgery. For this purpose thermograms from 25 ACL surgically operated patients (2 women, 23 men) were taken on the first and last day of a six-week rehabilitation program. A FLIR infrared camera according to the protocol established by the International Academy of Clinical Thermology (IACT). The results showed significant temperature increases in the posterior thigh area between the first and the last week of the rehabilitation process probably due to a compensatory mechanism. According to this, we can conclude that temperature of the posterior area of the injured and non-injured leg has increased from the first to the last day of the rehabilitation process. Romanò CL, Logoluso N, Dell'oro F, Elia A, Drago L. Telethermographic findings after uncomplicated and septic total knee replacement. // The Knee. – 2011 Mar 25. Thermal imaging with infrared thermography is a noninvasive approach to monitoring surgical site healing and detecting septic complications. The aim of this study was to set reference values for telethermographic patterns of wound healing after total knee replacement (TKR) not complicated by infection and to compare them against thermograms from patients with knee prosthesis infection. Forty consecutive patients operated for TKR underwent telethermography of the operated and the contralateral knee before and up to 12 months after uncomplicated surgery. The imaging data sets were then compared against those obtained starting 8months after TKR in 15 other patients with diagnosed periprosthetic infection. Presurgical assessment thermograms showed no difference between the affected and the healthy knees. At assessment 3days postoperative, the temperature of the operated knee had increased markedly, with a peak differential temperature (operated minus non-operated knee joint temperature) of 3.4±0.7°C; measurement at 90 days after surgery showed a return to baseline knee joint temperature in the patients with uncomplicated surgery. In the patients with septic complications, the mean differential temperature was 1.6±0.6°C (range, 1.1-2.5°C). Thermal imaging showed a measurable, reproducible telethermographic pattern of surgical site healing in patients with uncomplicated TKR and an elevated mean differential temperature >1.0°C in those with persistent prosthesis infection. 65 Thermo-monitoring conditions In the article, Ring E.F.J and Ammer K. (Ring EFJ, Ammer K. The Technique of Infra red Imaging in Medicine // Thermology international 10/1 (2000) – Р. 7-14.) describe the conditions that should be followed at thermovision examination. 1) A camera stand which provides vertical height adjustment is very important for medical thermography. Photographic tripod stands are inconvenient for frequent adjustment and often result in tilting the camera at an undefined angle to the patient. This is difficult to reproduce, and unless the patient is positioned so that the surface scanned is aligned at 90º to the camera lens, distortion of the image is unavoidable. Solution of the problem is point by point measurements, which can be realized with the Smart ThermoGraph device (Fig. 9). Fig. 9. 2) Human skin temperature is the product of heat dissipated from the vessels and organs within the body, and the effect of the environmental factors on heat loss or gain. There are a number of further influences which are controllable, such as cosmetics (Engel J-M. Physical and Physiological Influence of Medical Ointments of Infrared thermography. In: Ring EFJ Phillips B, editors, Recent Advances In Medical Thermology. New York.; Plenum Press,. 1984. p.177-184), alcohol intake (Mannara G; Salvatori GC; Pizzuti GP. Ethyl alcohol induced skin temperature changes evaluated by thermography. Preliminary results. Boll Soc Ital Biol Sper 1993 69/10:587-94) and smoking (Usuki K; Kanekura T; Aradono K; Kanzaki T Effects of nicotine on peripheral cutaneous blood flow and skin temperature. J Dermatol Sci 1998; 16/3:173-81). These should form part of the request made to the patient when calling him or her for examination. In general terms the patient attending for examination should be advised to avoid all topical applications such as ointments (Hejazi S, M.Anbar. Effects of topical skin treatment and of ambient light in infrared thermal images. Biomedical Thermology 1993, 12: 300-305) and cosmetics on the day of examination to all the relevant areas of the body. Large meals and above average intake of tea or coffee should also be excluded, although studies supporting this 66 recommendation are hard to find and the results are not conclusive (34,35,36). Patients should be asked to avoid tight fitting clothing, and to keep physical exertion to a minimum. This particularly applies to methods of physiotherapy such as electrotherapy (Mayr H, Thür H., Ammer K. Electrical Stimulation of the Stellate Ganglia. In: Ammer K., Ring EFJ, editors, : The Thermal Image in Medicine and Biology, Wien Uhlen, Verlag, 1995, p.206209.), ultrasound (40), heat treatment (Rathkolb O, Ammer K. Skin Temperature of the Fingers after Different Methods of Heating using aWaxBath. Thermol Österr 1996, 6: 125129), cryotherapy (Dachs E, Schartelmüller T, Ammer K: Temperatur zur Kryotherapie und Veränderungen der Hauttemperatur am Kniegelenk nach Kaltluftbehandlung. Thermol Österr 1991; 1: 9-14), massage (Eisenschenk A, Stoboy H: Thermographische Kontrolle physikalisch-therapeutischer Methoden. Krankengymnastik 1985; 37: 294) and hydrotherapy (Ring EFJ, Barker JR, HarrisonRAThermal Effects of Pool Therapy on the Lower Limbs. Thermology. 1989;3:127-131) because thermal effects from such treatment can last for 4-6 hours under certain conditions . Heat production by muscular exercise is a well documented phenomenon (Ammer K. Low muscular acitivity of the lower leg in patients with a painful ankle Thermol Österr 1995, 5: 103-107). Drug treatment can also affect the skin temperature. This phenomenon was used to evaluate the therapeutic effects of medicaments (Ring EFJ, Engel JM, Page -Thomas DP Thermologic methods in Clinical Pharmacology – Skin Temperature Measurement in Drug Trials, Int. J Clinical Pharmacol Therapy & Toxicology 1984; 22: 20-24.). Drugs affecting the cardiovascular system (Natsuda H; Shibui Y; Yuhara T; Akama T; Suzuki H, Yamane K; Kashiwagi H. Nitroglycerin tape for Raynaud’s phenomenon of rheumatic disease patients—an evaluation of skin temperature by thermography. Ryumachi 1994;34(5):849-53) must be reported to the thermographer, in order that the correct interpretation of thermal images will be given. On arrival at the department, the patient should be informed of the examination procedure, instructed to remove appropriate clothing and jewellery, and asked to sit or rest in the preparation cubicle for a fixed time. The time required to achieve adequate stability in blood pressure and skin temperature is generally considered to be 15 minutes, with 10 minutes as a minimum (Ring EFJ. Computerized thermography for osteoarticular diseases. Acta thermographica 1976, 1:166-173). A range of temperatures from 18°C to 25°C should be attainable. Good technique is essential with infra-red imaging, which is a physiological procedure. Attention to details as described will improve physicians ability to use the technique as a diagnostic aid and for monitoring change from treatment or from the natural course of the disease. Recommendations for the use of the Smart ThermoGraph device include all these facts, and the following minimal mandatory conditions of self-examination are listed for the user: The room temperature is from 20 to 24°C There are no air drafts in the room Air conditioner and/or heater are turned off or situated far enough and are not directed at me The examined area of the body has been freed from clothes or bandages for at least 10 minutes I'm in a comfortable and relaxed position I did not touch the examined area of the body with hands during the past 10 minutes The major problem with thermography is the requirement of a temperature controlled room for the 15 minutes patient cooling period (thermo-adaptation period) (DEVEREAUX M.D., PARR G.R., PAGE THOMAS D.P., HAZLEMAN B.L. Disease activity indexes in rheumatoid arthritis; a prospective, comparative study with thermography // Annals of the Rheumatic Diseases, 1985, 44, 434-437.). In home conditions, these requirements are met simpler than in the conditions of medical facility, especially if the 67 user conducts temperature measurements in the morning, before taking medications, application of ointments, and other. Conclusion Thus, the aggregate of collected and analyzed information makes it obvious that methods of using of the Smart ThermoGraph device with the Smart ThermoGraph software are based on previously known studies published in open sources (peer-reviewed medical journals). Therefore, there is no need for the additional medical tests of the Smart ThermoGraph device with the Smart ThermoGraph software.