John's Hopkin's Physics Lab Inquiry Concerning Medical Thermography, a response.

by William Cockburn, DC, FIACT, FABFE - June 18, 2009

The following is a response to an inquiry concerning research on medical thermography which was sent to me from the Physics Laboratory at John's Hopkins.   I am sharing this response with the reader as it provides insight into the current state of medical thermal imaging and answers many of the questions we receive from the general public and medical profession. 

Begin>>>

1)  I saw the FLIR Systems, Inc. website showcasing the 2006 article you wrote and pictures you took with your infrared camera:

The images on the FLIR website are NOT my images,   FLIR is an excellent company with a fine reputation and they had asked me to reprint an article I wrote on medical I.R.   I gave them permission.   They used FLIR images (not well done by the way) of the face to accompany the article.  

2)  We do NOT see the brain with medical I.R. as you indicated.    Thermal imaging of the human subject is a Topographical study only.  There are many non-certified and rogue thermography labs out there that make numerous spurious claims for thermal imaging in medicine without the proper knowledge of how I.R. works or why we apply it as a diagnostic / screening procedure.

The areas we do NOT see are:

a) intra-cranial  (inside the head)

b) Intra-thoracic   (inside the thorax to include lungs/heart/aorta, etc.

c) intra-abdominal (inside the abdomen to include stomach, gallbladder, liver, intestines etc.)

d) Intra-pelvic  (inside the pelvic cavity to include uterus, fallopian tubes, ovaries bladder etc.)

In addition, we do not see anything related to bones of the appendicular or axial skeleton or deep blood vessels.  (occasionally a bone infection such as osteomyelitis will produce significant heat that may conduct to the surface over thinner areas of the body such as the tibia or mandible) and we may see that heat.

What has the FDA approved thermal imaging for?

a)  Extra-cranial screening of the head and face for stroke screening, cranial nerve damage, possible dental

b)  Breast Cancer

c)  Peripheral Vascular Disease of the lower extremities

d)  Neuro-musculo-skeletal disorders.  This is a very large category which covers many conditions such as myofascial irritation, subluxation, effects of disc herniation and protrusion, neurologic conditions such as RSD, SMPS, Dermatome involvement, trigger point irritation, muscular component of faulty biomechanics.

In addition, a great deal of interest in utilizing thermal imaging for burn victims, open heart surgery and skin cancer detection is growing internationally.

3)  Functional neuro-imaging.   You asked about this in your email but this is too broad a category to cover without knowing which particular area of neurology you are interested in.   There are hundreds of published papers on many aspects of central and peripheral injuries and their sequel that can be visualized with thermal imaging, if you would be so kind as to be more specific I would be happy to provide more appropriate data.

4)  Camera Selection.  For your specific camera application I would use either a Flir or an ICI camera.   Both companies produce a very competitive camera with excellent functional software at a modest price.   In fact the advancements of medical I.R. in the past few years coupled with technological advancements has seen a lowering in price of I.R. systems to less than half of the retail price than they were 5 years ago,   Both of the systems mentioned above are in the 15K - 18K range, 

Incidentally, I make no royalty, commission or kick back of any kind from either of these companies. I recommend them specifically on their specifications, ease of use and reputation for service and warranty.

5) Have you had any success using any IR camera for medically imaging other parts of the body and if so, which parts?

I have been performing thermal imaging since 1983 and have imaged thousands of people topographically as indicated for the conditions above in section  2 & 3.   Many of these studies have been performed for medical-legal reasons in trauma cases with successful admittance as evidence in courts of law, and successful judgments for injured and disabled individuals.

Discussion:  I applaud Johns Hopkins for looking into thermal imaging.   There are serious constraint issues from organizations who are opposed to thermal imaging, typically due to monetary or perceived monetary loss if thermal imaging were more utilized.   A classic example of this is the patient who has spinal disc injury which is not seen on recumbent x-ray, including CT and MRI, only to have a neuralgic pathway abnormality visualized on medical I.R. performed in the weightbearing position.

As you continue your research, be advised that there is currently no regulation of the medical I.R. industry either active or passive at the present time.  While the FDA has approved medical I.R. since 1983 this is essentially the only official validation of the field from a legal standpoint.

As public demand for thermal imaging has grown significantly in the past 10 years, many less than scrupulous salesman have entered the field and many IR companies have set up shell training organizations that teach much of the basics of medical I.R. according to either the limitations of their systems (cameras and software) or on unsound business models designed to show how much money can be made to offset higher cost of their systems.  An example of this is the three position breast series vs. the standardized 6 position series.  While it does not take substantial time to perform or interpret the 6 series exam as compared to the three series exam, this is taught to doctors as a means of doubling their patient flow and thus revenue.  A sample of a complete breast thermographic series can be found in the image section of www.breastthermography.org

I estimate that less than 20% of the current medical I.R. field, including doctors and technicians are either non-certified or severely under-trained in a false paradigm of thermography.  The greatest example of which is the statement made on many websites and print marketing that thermography is a replacement for mammography.  This is untrue but drives many women who hate mammography into these sub-standard clinics.

Finally, many physicians speak authoritatively about medical I.R. but much of their information comes from these corrupt I.R. salesman, and as such animosity towards other thermographers they perceive as not using the correct standards or equipment has taken hold of the field nationally, and thus clinical thermographers seldom step outside of their own "users group" to share information and data.  The resentment has splintered the field dramatically and is now out of control.  A recent and successful indictment of a lab in the State of Oregon brought by the State Attorney General's office is testamentary to this fact.

When utilized properly, with high resolution and stable equipment and interpreted by true board certified and diplmate thermographers, I.R. imaging provides a component to the overall assessment of patients which can not be obtained in any other way.   This procedure is complimentary to all other imaging procedures and not competitive with them.  The science of thermography in medicine is solid; the anecdote however is harming the future research and on-going validity of this objective testing method.

It is my sincere wish that this information will be beneficial to you and to John's Hopkins and I look forward to an ongoing dialogue for quality control and guidance.

Kindest regards,

Dr William Cockburn, D.C., F.I.A.C.T., F.A.B.F.E.
Academic Dean:   Academy of Medical Infrared Training
Fellow International Academy of Clinical Thermology
Fellow American Board of Forensic Examiners

 
http://www.academy-of-medical-infrared-training.com
http://www.thermodoc.com
http://www.breastthermography.org

This article was reprinted with permission from www.BreastThermography.org