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THE ANSWERS YOU NEED
WHAT IS THERMAL IMAGING
Digital Infrared thermal imaging, or DITI, is a totally non-invasive, painless procedure with no radiation and no contact with the body. DITI is a clinical imaging technique that records the thermal patterns of your body. Your thermal images are used by your healthcare practitioner to help diagnose and monitor pain or pathology in any part of your body.
WHAT IS THERMAL IMAGING USED FOR?
To help in determining the cause of pain.
-To aid in the early detection of disease and pathology
-To evaluate sensory-nerve irritation or significant soft-tissue injury
-To define a previously diagnosed injury or condition
-To identify an abnormal area for further diagnostic testing
-To follow progress of healing and rehabilitation
IS THERMAL IMAGING FDA REGISTERED?
Yes. DITI was FDA registered in 1982.
IS THERMAL IMAGING COVERED BY INSURANCE
Some insurance carriers cover thermal imaging. Please check with your individual carrier.
DO YOU HAVE A CUSTOMER REFERRAL PROGRAM?
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WHAT PARTS OF THE BODY CAN BE SCANNED?
Thermal images are taken of the whole body, or individual regions including breast, head, arm, leg, torso, etc. A lumbar assessment would typically include, low back, pelvis, and legs. A cervical assessment would typically include, head and neck, upper trunk, and arms.
Neurological testing can include a “cold stress test”; this involves placing a hand or foot into a bowl of cool water, or having a cool gel pad applied to any part of the body prior to scanning.
WHAT HAPPENS WHEN THERMAL IMAGING IS TAKEN?
A thermal scan takes approximately 10 — 45 minutes depending on which part of the body is being scanned. You will remove all jewelry and clothes from the part of the body being scanned (for full body scans you leave underpants on), and will be asked to wear a surgical gown. For a breast scan, you will be ask to disrobe from the waist up.
While your skin is equalizing with the room temperature, you will be asked to fill-out appropriate paper work.
WHAT DO I HAVE TO PREPARE FOR A THERMAL SCAN?
There are a few guidelines for preparing for a thermal scan:
-Do not have physical therapy, massage, or electromyography on the same day thermography is performed
-Do not participate in vigorous exercise 2 hours prior to the test.
-Do not smoke for 2 hours before the test
-Do not use lotions, deodorants, powder or liniments on day of test
-Stay out of strong sunlight on the day of test
-There are no dietary or medication restrictions on the day of your scan but no excessive hot or cold drinks prior to the test.
-Wear loose fitting clothes if possible.
*Do not come for a scan if you have a sunburn on your chest or the area of interest. You would need to wait until all the sunburned area has peeled off
WHO SHOULD INTERPRET MY SCAN AND WRITE THE REPORT?
All thermography interpretations should be reported by adequately trained and experienced doctors who hold board certification as Thermologists.
WHAT CERTIFICATION SHOULD A THERMOGRAPHER HAVE TO PERFORM THIS EXAM?
Thermographers should hold certification from a professional body with approved code of ethics and practice protocols that include quality control guidelines
WHY IS THERMAL IMAGING USEFUL FOR BREAST IMAGING?
Digital Infrared Thermal Imaging (DITI) offers the opportunity of earlier detection of breast disease than has been possible with breast self-examination, physician palpation or mammography alone.
Each individual has her own thermal pattern (normally symmetric) that is accurate and static throughout her lifetime. Any changes to her normal “thermal fingerprint” caused by early cell changes (pathology) will become increasingly apparent. Monitoring changes over periods of time with DITI is the most efficient means of identifying subjects who require further investigation.
DITI is a non-invasive test. There is no contact with the body of any kind, no radiation and the procedure is painless. The scanning system merely detects and records the infrared radiation that is emitting from the patient’s body.
Utilizing sophisticated infrared technology and innovative computer software, thermal imaging technicians simply capture a digitized image of the breast in the form of an infrared thermogram, or heat picture.
HOW ACCURATE IS THERMAL IMAGING FOR THE DETECTION OF BREAST CANCER?
Canadian researchers recently confirmed that infrared imaging of breast cancers could detect minute temperature variations related to blood flow and demonstrate abnormal patterns associated with the progression of tumors. These images, or thermograms of the breast, were positive for 83% of breast cancers compared to 61% for clinical breast examination alone and 84% for mammography. The 84% sensitivity rate of mammography alone was increased to 95% when infrared imaging was added.
IS A THERMAL SCAN DIFFERENT THAN A MAMMOGRAM OR ULTRASOUND?
Yes. Unlike mammography and ultrasound, Digital Infrared Thermal Imaging (DITI) is a test of physiology. It detects and records the infrared heat radiating from the surface of the body. It can help in early detection and monitoring of abnormal physiology and the establishment of risk factors for the development or existence of cancer.
Mammography and ultrasound are tests of anatomy. They look at structure. When a tumor has grown to a size that is large enough and dense enough to block an x-ray beam (mammography) or sound wave (ultrasound), it produces an image that can be detected by a trained radiologist.
Neither mammogram, ultrasound, nor DITI can diagnose cancer. Only a biopsy can diagnose cancer. But, when DITI, mammograms, ultrasounds, and clinical exams are used together, the best possible evaluation of breast health can be made.
IS THERMAL IMAGING A REPLACEMENT FOR MAMMOGRAMS OR ULTRASOUNDS?
No. While some women make a personal choice to use thermal imaging instead of mammography for breast screening, other women who cannot use mammography for a number of reasons can use thermography instead of mammography. Most women use thermal imaging in addition to mammography and/or ultrasound.
We believe that (DITI) should be viewed as a complementary, not competitive, tool to mammography and ultrasound. DITI has the ability to identify patients at the highest level of risk and actually increase the effective usage of mammograms and ultrasounds. Research confirms that DITI, when used with mammography, can improve the sensitivity of breast cancer detection.
The ultimate choice should be made on an individual basis with regard to clinical history, personal circumstances and medical advice.
IS THERE ANY HARMFUL RADIATION IN A THERMAL SCAN?
No. DITI detects and records the infrared heat radiating from the surface of the body. There is no contact with the body or harmful radiation.
DOES IT HURT TO HAVE A SCAN TAKEN?
No. There is no contact with the body or painful breast compression.
WHO SHOULD HAVE A THERMAL SCAN?
Any adult can have a thermal breast scan. This test is designed to improve chances for detecting fast growing tumors in the intervals between mammographic screenings or when mammography is not indicated by screening guidelines for women under 50.
DITI is especially appropriate for younger women under 50 years whose denser breast tissue makes it more difficult for mammography to pick up suspicious lesions. This test can provide a ‘clinical marker’ to the doctor or mammographer, indicating that a specific area of the breast needs closer examination.
Breast cancers tend to grow significantly faster in younger women (under 50 years). The average tumor doubling time for women under 50 is 80 days compared to 157 days for women between 50 – 70 years. Secondly, the faster a malignant tumor grows, the more infrared radiation it generates. Therefore, for younger women in particular, results from DITI screening can lead to earlier detection.
IF I HAVE A SUSPICIOUS MAMMOGRAM OR FIND A LUMP IN A BREAST, SHOULD I HAVE A THERMOGRAM?
Yes. The information provided by a thermography study can contribute useful additional information which ultimately helps your doctor with case management decisions. It is also important to establish a baseline for future comparison in order to monitor changes and the progress of any treatment.
HOW OFTEN SHOULD I HAVE A THERMAL SCAN?
Once a reliable baseline has been established, which normally requires two studies 3-months apart, you should have an on-going annual comparative study to detect any suspicious functional (physiological) changes, warranting further investigation. Depending on your personal history and risk for breast disease, your doctor can advise how often you should have a thermal scan repeated.
HAVE CLINCIAL TESTS BEEN DONE ON THERMAL IMAGING?
Yes! Over 800 peer-reviewed studies on breast thermography exist in the index medicus literature. In this database, well over 300,000 women have been included as study participants. The numbers of participants in many studies are very large (10,000, 37,000, 60,000, 85,000, etc.) Some of these studies have followed patients for up to 12 years.
These clinical trials have demonstrated that breast thermography:
Detects the first signs of a cancer up to 10 years before any other procedure can detect it.
Significantly augments the long-term survival rates of its recipients by as much as 61%.
When used as part of a multimodal approach (clinical examination + mammography + thermography), will detect 95% of early stage cancers.
IF BREAST THERMOGRAPHY IS SO GREAT, WHY ISN'T IT MORE READILY AVAIBLE AND WIDELY USED?
We asked the same question. The answer is somewhat political but this may help to explain:
When thermography was first explored for breast imaging, it was viewed as competitive to mammograms. It was tested and evaluated to see if it was safer and more diagnostically accurate than mammography. These comparisons should not have been made, as you can not compare tests of physiology and anatomy.
In particular, when thermography was tested on younger women, thermographic abnormalities were detected many times but mammograms did not detect any tumors. The results were considered “false positives”. The more patients of younger age screened with the so-called false positive, the more suspicion was placed on thermography. Years later, in re-call studies, a large percentage of these women had developed breast cancer or other breast disease, in the exact location of the abnormal “false-positive” thermogram, thus validating its early warning role. Thermography’s only “error” was that it was too accurate too early and the results couldn’t be corroborated at the time.
Secondly, thermography was being used in sports medicine, dentisty, podiatry, chiropractic, orthopedics rheumatology, and neurology in a variety of support or adjunctive diagnostic roles. It was soon realized that thermography could clearly, objectively, and easily demonstrate the physiological component of pain and injury, especially to the spinal column, due to car accidents, job injuries, and a host of other “tort” related law suits. Everyone involved had benefited from these positive test findings, which could be clearly shown to a jury. Everyone that is except the defendant insurance industry.
Needless to say, the insurance industry in the United States placed an all-out effort to diminish the value of thermography in courts of law due to high litigation costs. Eventually, lobbying efforts at the AMA’s House of Delegates and at Medicare, brought about the removal of thermographic coverage by most insurance companies and the greatly reduced utilization of thermography in the United States. This was most unfortunate for the patients who could clearly benefit from thermal imaging.
IS COLD STRESS TESTING OF THE BREAST NECESSARY?
Cold stress testing of the breast was performed on the assumption that thermography would identify angiogenesis and that angiogenesis could be correlated with the development and existence of breast cancer. This can be possible if a number of factors are present but there are too many variables that we now know make this an unreliable procedure. We don’t know at what stage angiogenisis begins but we do know that it does not continue throughout all stages of breast disease. No studies have been done to find out how long it takes for new (angiogenic) blood vessels to establish sympathetic fibers which then
let the vessel behave like a normal vessel (contract when cold stressed) but even if we did have a better understanding of this physiology it would still not be a reliable test as many patients would undoubtedly fall outside of the window of detectable angiogenesis.
Considerations, the logic and philosophy of performing a cold stress test:
1. If there are no suspicious thermal patterns to test, (negative thermogram) the test is not justified.
2. If there are suspicious patterns (positive thermogram) then the patterns remain suspicious irrespective
of the results of cold stress testing……. A cold stress test does not and should not affect the thermographic opinion and resulting report.
3. A cold stress test might offer results relating to a particular suspicious pattern but if there is no way of correlating this information to a clinically valid or plausible rational to act on this information then the test is not justified in the first place.
4. If a cold stress test is performed and the results are reported, this changes the status of the test and the report, both of which make claim to diagnostics and will carry the associated increase of liability and issues of scope of practice and medical licensure (practicing medicine without a license).
5. The disservice to patients who suffer unnecessary mammography, biopsy, and other tests as a result of positive thermography generated by the attempt to produce diagnostic results from a single study is unacceptable.
7. Reporting vascular change over extended periods of time by comparative analysis of thermal testing may be enhanced by the inclusion of a cold stress test if ordered specifically by a licensed physician who can integrate the results into decision making or a differential diagnosis. Historically, it was the way breast thermography was used with protocols that included cold stress testing (and the diagnostic claims that were made) which generated the criticism that thermographers still suffer from today. The accusations of unreliability and the clinical trial results showing false positives and false negatives were all generated by the protocols that included cold stress testing. Cold stress is a test of sympathetic function which has good utility in many areas of medicine and is the definitive diagnostic test for CRPS / RSD. These tests were used before it was tried in breast screening.
In the mid eighties many people, including myself got excited by the potential offered by breast thermography performed with cold stressing. I was lucky enough to be working in France where the concept originated and I did a lot of cold stress thermography with a liquid nitrogen cooled NEC Sani and a Hues Aircraft Probeye, both of which were excellent cameras at the time. My own observations regarding the low rates of correlation between the results of cold stress tests and case histories and the growing evidence of false positives and false negatives led me to abandon cold stressing of breasts in the early
nineties. I learned a more logical and more efficient approach which still relied on the detection of changes in the breast over time but was far more objective and reliable.
We have advanced significantly in our understanding of physiology and how thermography can be effectively used. No technology stands still, we expect science to advance, medical knowledge to improve and evolve and we have to be prepared to learn from experience….. both our own and others. I have no doubt that there will be ongoing advances in thermographic imaging and they may even include
new forms of stress testing but the best way to move forward is to learn from experience and then look ahead rather than back.
First published August 2003 ACCT Thermology Times.