The following list is just some of the conditions that have associated infrared thermal emission markers:
Altered gait manifestations
Brachial Plexus Injury
Carotid Artery Stenosis
Carpal Tunnel Syndrome
Complex Regional Pain Syndrome (CRPS)
Diabetes (secondary complications)
Disc Syndromes (spinal discogenic pain)
Headache Evaluation (e.g. cervicogenic, migraine, sinus)
Herniated Disc/Ruptured Disc
Intervertebral Disc Disease
Lumbosacral Plexus Injury
Myofascial Pain Syndrome
Nerve Root Irritation
Nerve Stretch Injury
Peripheral Nerve Abnormalities
Referred Pain Syndromes
Reflex Sympathetic Dystrophy (RSD)
Repetitive Strain Injuries
Sacroiliac Ligament Tear
Sensory Nerve Abnormalities
Soft Tissue Injury
Spinal Cord Injury
Superficial Vascular Disease
Thoracic Outlet Syndrome
TMJ Dysfunction (TMD)
And many more …
Sources: Index Medicus - J Thermology, Acta Thermographica, J Breast
Board Certified Clinical Thermologist
Member -Diplomate, International Academy of Clinical Thermology
IEEE Engineering in Medicine and Biology Society
Diplomate, American Board of Clinical Thermography
International Academy of Clinical Thermology
Diplomate, American Board of Medical Infrared Imaging
International Thermographic Society
American Academy of Thermology
It is 2019, and the use of medical infrared imaging (thermography) is growing. This is incredibly good news for the health of many patients. However, it seems that we are also dealing with a growing misuse of this lifesaving tool. As a board certified thermologist, published author and researcher, thermography practice guidelines co-author, past president of the International Academy of Clinical Thermology, and with 27 years of clinical experience using this technology I am very concerned with what I am seeing. There is a large body of peer-reviewed research demonstrating the beneficial uses of thermography. As a functional imaging technology, thermography plays an important role as a specialized aid in differential diagnosis and treatment monitoring. However, if we don’t stop the promotion of thermography for things it cannot do we risk losing it all together. I hope that this letter will help to educate, increase awareness, and support the proper use of this lifesaving technology.
Can Thermography Offer Screening for Internal Disorders?
Before we dive into this question we need to address a basic problem. With all of the clinical applications of thermography, one of the first and foremost problems we are seeing is a lack of proper training of technicians and thermologists. When thermal images are taken without proper patient preparation, under strict imaging room requirements, and using acceptable imaging systems, the images are useless. Combine this with a thermologist who is not properly trained to interpret the images and this becomes a recipe for disaster.
Without proper training it is no wonder we are seeing so many problems in this field. One of the most glaring errors is the promotion of thermography in “screening” for certain conditions. Let’s start with the definition of screening in health care and what this means to the patient. Screening tests or procedures are designed to provide early detection and/or to identify people with increased risk for conditions or diseases before they have symptoms or even realize they may be at risk. Screening offers an early warning so that preventative measures can be taken or at least early detection before a condition becomes too serious.
In order to provide screening the test being used must have a high sensitivity. In other words, the test must have the ability to discover a problem at a very early stage to provide the patient with an early enough warning. What if you were told that a test or procedure was “screening”, but it didn’t have the needed sensitivity? Since you would not be receiving an early warning, could this be life threatening?
When you see a list of body areas to be imaged, what comes to mind? Are you thinking that thermography can look into the chest, abdomen and pelvis to see the heart, lungs, stomach, liver, colon, ovaries, uterus, cervix, prostate, etc.? Thermography is not CT, MRI, ultrasound, or any other imaging technology that actually visualizes internal organs and structures. Thermography has the ability to help patients who are suffering from many different conditions, but it does not have the ability to provide the type of screening being promoted. However, is there something related to all of this that has some offices promoting screening? The answer is yes. Thermography may be able to warn some patients that an underlying problem may exist through what is know as a viscerosomatic reflex. This is a nervous system message that is sent from an internal organ out to the surface of the skin. Can thermography detect this? Yes, but in the vast majority of cases this is far too late! Most patients already have symptoms and the underlying organ dysfunction has been going on for quite some time. And in some cases this viscerosomatic reflex can burn out leaving no signal at all for thermography to detect.
Now, the last thing I want to do is discourage anyone from using this technology. There are many areas where thermography can help you and your doctor to discover a health condition along with monitoring your treatment. The following list is just some of the conditions that have associated thermal emissions:
Altered gait manifestations Arteriosclerosis (peripheral) Brachial Plexus Injury Breast Disease Bursitis Carotid Artery Stenosis Carpal Tunnel Syndrome Chronic pain Compartment Syndromes Complex Regional Pain Syndrome (CRPS) Dental Irritation/Inflammation Diabetes (secondary complications) Disc Syndromes (spinal discogenic pain) Facet Syndrome Fibromyalgia Headache Evaluation (cervicogenic, migraine, sinus) Herniated Disc/Ruptured Disc Hypesthesia Hyperaesthesia Inflammation Intervertebral Disc Disease Ligament Tears Lumbosacral Plexus Injury Muscular Spasm Muscle Tears Myofascial Irritation Myofascial Pain Syndrome Nerve Entrapment Nerve Impingement/Pressure Nerve Root Irritation Nerve Stretch Injury Neuritis Neuropathy Neurovascular Compression Osteoarthritis Paresthesia Peripheral Nerve Abnormalities Pinched Nerves Referred Pain Syndromes Reflex Sympathetic Dystrophy (RSD) Repetitive Strain Injuries Reynauds Disease Rheumatoid Arthritis Sacroiliac Ligament Tear Sacroiliac Syndrome Sensory Nerve Abnormalities Sinus Irritation/Inflammation Skin Conditions Soft Tissue Injury Spinal Cord Injury Sports Injuries Strain/Sprains Superficial Vascular Disease Synovitis Temporal Arteritis Tendonitis Thoracic Outlet Syndrome Thyroid Conditions TMJ Dysfunction (TMD) Trigeminal Neuralgia Trigger Points Whiplash Conditions
And many more …
What about Special Cases?
What about the many cases in which we have been able to alert a patient’s doctor that further testing was needed for diabetes, thyroid dysfunction, gout, kidney disease, circulatory problems, and others? Would the majority of these conditions have been detected early if these patients had gone in for their yearly physical exam? Yes, but in some cases we have been able to encourage further testing to get to the bottom of a problem. This is especially common in thyroid conditions. This seems to be due to the use of limited blood chemistry profiles.
But let’s address the elephant in the room. What if these same patients had these conditions and the thermogram was normal? A screening test needs to be both very sensitive (able to detect a problem very early) and very specific (able to say that nothing is wrong). With internal pathologies like these, thermography is not specific enough to be a screening test. If the thermogram is normal it doesn’t mean you don’t have the condition.
Simply put, thermography cannot offer screening for the majority of internal disorders! There are so many better tests and procedures that offer true screening. For example, you wouldn’t want to use thermography to warn of impending liver disease when a blood test can provide screening that warns years in advance of significant liver damage. A pap smear will save your life long before a cancerous tumor grows large enough to irritate the nerves sufficiently to cause a thermal presentation.
What about Breast Thermography?
We need to be sure that we don’t throw out the baby with the bath water. Thermography is a lifesaving technology that has a great deal to offer when performed correctly and for the right purpose. When it comes to the application of the technology as an adjunctive risk assessment of the breast, there is ample research supporting its use. Thermography should be an essential part of every woman’s regular breast health care.
Unfortunately, there are offices informing patients that thermography is all they need and that no other imaging or tests are necessary. This is incredibly irresponsible and dangerous to the patient’s health. Thermography is a specialized functional imaging technology. It detects heat at the surface of the skin, which is a reflection of the body’s underlying biochemistry and neural control over the microdermal circulation. Mammography, ultrasound, MRI, CT, etc. are structural imaging technologies. They look into the body for changes to organs and other structures. Since thermography cannot do this, it cannot replace technologies that can. An EKG cannot replace an echocardiogram. The technologies are complementary, but completely different in what information they offer. Medical infrared imaging is a complementary adjunctive imaging technology. As such, it is to be used in combination with other imaging technologies, tests, and procedures.
Since there is no one breast imaging technology that is 100% sensitive (able to warn in 100% of all cases) and 100% specific (able to say all is well in 100% of cases), no single imaging tool should be used alone. All current imaging technologies are adjunctive. As an example, depending on a woman’s age she will be advised by her doctor to come in for a physical examination of her breast on an annual basis. Why is this necessary if current screening imaging technologies are enough? It is well known that a certain number of breast cancers will be found on physical examination and not detected by imaging. Therefore, current screening imaging is also adjunctive. Maintaining this line of thought, how many of you have gone in for your yearly physical exam of your breast, followed up with screening imaging, and then have had to have an additional imaging procedure on top of this. That adds up to three adjunctive procedures to provide screening. The bottom line here is that a multimodal (adding multiple procedures) approach to screening provides each woman with the best in early detection.
Medical infrared imaging is no exception. Thermography is a lifesaving technology. It offers women, and their doctors, a view of the breast that no other technology can. However, if you are ever told that all you need is a thermogram you need to stop, seek a properly trained medical infrared imaging center, and see your primary care physician. The combined use of breast self-exams, physical examination of the breast by your doctor, structural imaging as recommended by your doctor, and thermography provides the best approach to screening. And with thermography, a possible role in prevention!
So What Can We Do?
What can we do to stop this? Here is the challenge. If any office or website promotes any of the following:
Men’s Health Screening
Women’s Health Screening
Imaging for carotid inflammation
Imaging for heart and lung problems
Imaging for digestive and colon problems
Imaging for immune system dysfunction
Specifically calling out body regions such as the chest, abdomen or pelvis
You need to question this. Ask the office to provide you with at least one peer-reviewed study from a reputable journal that specifically shows that thermography provides “screening” for these specific conditions. This is a very reasonable request. If a study cannot be provided, you need to ask yourself why would you need a thermogram?
Offices that are promoting thermography for things it cannot do, or telling patients that thermography is the only test you need, are risking your health and causing significant damage to this lifesaving technology. Please be careful in choosing the right office or imaging center.
We also need your help. Please help us to promote the proper use of thermography. Feel free to make copies of this letter for your friends.
I would like to end by mentioning that if any person, imaging center, or educational institution has any quality peer-reviewed and published data demonstrating anything to the contrary please let me know. I look forward to hearing from you. Research is ongoing in this field. We are learning more and more each day about what medical infrared imaging can do. Those of us involved in the clinical use of this technology are open to any advancement that will help in patient care. The health of the patient is the primary concern.
For more information, please visit our educational training site at www.medicalinfraredimaging.com and select the FAQ area. You may also take a copy of the IACT Thermography Standards and Guidelines found on our home page link. These quality assurance guidelines cover a wide range of information including how you need to be properly prepared before you are imaged, under what strict parameters your images need to be taken, how your images are to be properly interpreted, and much more.
Thank you so much for your kind support,
William C. Amalu, DC, DABCT