|Overview of Digital Infrared Thermal Imaging|
Medical DITI is a noninvasive diagnostic technique that allows the examiner to visualise and quantify changes in skin surface temperature. An infrared scanning device is used to convert infrared radiation emitted from the skin surface into electrical impulses that are visualised in colour on a monitor. This visual image graphically maps the body temperature and is referred to as a thermogram. The spectrum of colours indicate an increase or decrease in the amount of infrared radiation being emitted from the body surface. Since there is a high degree of thermal symmetry in the normal body, subtle abnormal temperature asymmetry's can be easily identified.
Medical DITI's major clinical value is in its high sensitivity to pathology in the vascular, muscular, neural and skeletal systems and as such can contribute to the pathogenesis and diagnosis made by the clinician.
Medical DITI has been used extensively in human medicine in the U.S.A., Europe and Asia for the past 20 years. Until now, cumbersome equipment has hampered its diagnostic and economic viability. Current state of the art PC based IR technology designed specifically for clinical application has changed all this.
Clinical uses for DITI include:
|• To detect early lesions before they are clinically evident|
|• To localise an abnormal area not previously identified, so further diagnostic tests can be performed|
|• To define the extent of a lesion of which a diagnosis has previously been made|
|• To monitor the healing process before the patient is returned to work or training.|
Skin blood flow is under the control of the sympathetic nervous system. In normal people there is a symmetrical dermal pattern which is consistent and reproducible for any individual. This is recorded in precise detail with a temperature sensitivity of 0.01°C by DITI.
The neuro-thermography application of DITI measures the somatic component of the sympathetic nervous system by assessing dermal blood flow. The sympathetic nervous system is stimulated at the same anatomical location as its sensory counterpart and produces a 'somato sympathetic response'. The somato sympathetic response appears on DITI as a localised area of altered temperature with specific features for each anatomical lesion.
The mean temperature differential in peripheral nerve injury is 1.5°C. In sympathetic dysfunction's (RSD / SMP / CRPS) temperature differentials ranging from 1° C to 10° C depending on severity are not uncommon. Rheumatological processes generally appear as 'hot areas' with increased temperature patterns. The pathology is generally an inflammatory process, i.e. synovitis of joints and tendon sheaths, epicondylitis, capsular and muscle injuries, etc.
Both hot and cold responses may co exist if the pain associated with an inflammatory focus excites an increase in sympathetic activity. Also, vascular conditions are readily demonstrated by DITI including Raynauds, Vasculitis, Limb Ischemia, DVT, etc.
Medical DITI is filling the gap in clinical diagnosis ...
|• X ray, C.T. Ultrasound and M.R.I. etc., are tests of anatomy.|
|• E.M.G. is a test of motor physiology.|
|• DITI is unique in its capability to show physiological change and metabolic processes. It has also proven to be a very useful complementary procedure to other diagnostic modalities.|
Unlike most diagnostic modalities DITI is non invasive. It is a very sensitive and reliable means of graphically mapping and displaying skin surface temperature. With DITI you can diagnosis, evaluate, monitor and document a large number of injuries and conditions, including soft tissue injuries and sensory/autonomic nerve fibre dysfunction.
Medical DITI can offer considerable financial savings by avoiding the need for more expensive investigations.
Medical DITI can graphically display the very subjective feeling of pain by objectively displaying the changes in skin surface temperature that accompany pain states.
Medical DITI can show a combined effect of the autonomic nervous system and the vascular system, down to capillary dysfunctions. The effects of these changes show as asymmetry's in temperature distribution on the surface of the body.
Medical DITI is a monitor of thermal abnormalities present in a number of diseases and physical injuries. It is used as an aid for diagnosis and prognosis, as well as therapy follow up and rehabilitation monitoring, within clinical fields that include Rheumatology, neurology, physiotherapy, sports medicine, oncology, pediatrics, orthopedics and many others.
Results obtained with medical DITI systems are totally objective and show excellent correlation with other diagnostic tests.
See your patients in a different light!
|Short Case Histories|
Complex Regional Pain Syndrome right foot, significant increase in sympathetic motor tone right foot 3.7°c colder than left foot. A cold stress test was positive, (no sympathetic change).
CRPS developed in the right foot after a fractured calcaneum 18 months previously. Weight bearing was painful. The diagnosis of CRPS was missed initially since nuclear imaging was not typical of CRPS.
Some cases of CRPS are misdiagnosed as psychological or hysterical pain states. Thermography is able to show characteristic changes if utilised.
A 32 year old housewife and mother presented with acute back pain with right L2 and L3 sensory and motor nerve root involvement.
Thermography confirmed right L2/L3 root irritation and myelography and CT scan showed a large right L2/L3 prolapse with L4/L5 root involvement.
Thermography shows excellent correlation with CT, MRI and Myelography in radiculopathy.
Left lateral leg
Right lateral leg
Right knee medial
Right knee lateral
Right knee surgery was followed with a painful effusion in the early post operative period.
Thermography confirmed a significant inflammatory reaction. 30cc of blood-stained fluid was aspirated.
Thermography can quantify all grades of joint synovitis and is able to demonstrate minimal changes due to NSAID’s
Post-Traumatic Complex Regional Pain Syndrome. A 34 year old female supermarket worker injured her left wrist 3 years previously. There were typical features of CRPS including severe persistent pain and colour and temperature changes in the left wrist and hand.
There was a good initial response to a right cervical sympathectomy but a year later symptoms returned. Treatment with I.V. Guanethidine gave some relief and reduced the temperature differentials significantly from a deltaT of 6.2°c pre treatment to 0.8°c post treatment.
Thermographic monitoring of sympathetic blockade provides useful objective data to quantify effectiveness of previous blockade and prospective treatments.
A 28 year old male carpet layer presented with a clinical left carpal tunnel syndrome, The EMG was normal but the left median sensory nerve latency and amplitude suggested minimal dysfunction relative to the right side. Thermography during sympathetic challenge (cold stress test) showed sympathetic nerve dysfunction consistent with an early left carpal tunnel syndrome.
Thermographic sensitivity for detection of early carpal tunnel syndrome is improved by cold stressing both hands. Sympathetic nerve fibres in the symptomatic median nerve are hyperirritable producing a sustained response during cold stress.
JOINT COUNCIL OF STATE NEUROSURGICAL SOCIETIES of the AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS and the CONGRESS OF NEUROLOGICAL SURGEONS Neurological clinical procedure review; Thermography Lyle Leibrook, M.D. Abstract
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Thermography is a safe adjunctive physiological procedure which may be useful in the diagnosis of selected neurological and musculoskeletal conditions. Thermography is noninvasive and does not involve the use of ionizing radiation. Thermography may facilitate the determination of spinal nerve root and distal peripheral nerve dysfunction. Thermography also contributes to the evaluation of possible autonomic nervous system dysfunction and of spinal disorders.Thermography may be useful in documenting peripheral nerve and soft tissue injuries, such as muscle and ligament sprain, inflammation, muscle spasm, and myositis. Thermography is helpful in the diagnosis of reflex sympathetic dystrophy and can be used to follow the course of patients after spinal surgery. In those applications, thermography does not stand alone as a primary diagnostic tool. It is a test of physiological function that may aid in the interpretation of the significance of information obtained by other tests. return to top
JOINT COUNCIL OF STATE NEUROSURGICAL SOCIETIES of the AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS and the CONGRESS OF NEUROLOGICAL SURGEONS Neurological clinical procedure review; Thermography Lyle Leibrook, M.D.
AVAILABLE PROOF OF EFFICACY: Evidence of prospective studies. Prospective studies have shown the excellent sensitivity and good correlation of thermography with other imaging methods. A high correlation of 84% has been demonstrated in studies comparing thermography and CT scanning of patients with low back pain and sciatica. Surgical treatment has also shown similar high rates of sensitivity. A large study of 805 patients with upper and low back pain confirm good correlation between thermographic evaluation and myelography, CAT scanning and EMG. The two objective tests for documentation of sensory radiculopathy, thermography and somatosensory cortical evoked potential’s, show equal sensitivity in the diagnosis of clinical lumbosacral radiculopathy.
SAFETY: The procedure is totally non-invasive and does not involve ionising radiation. It is without patient risk.
CONCLUSION OF REVlEW: Thermography is a safe and effective means for evaluation of vasomotor instability due to irritation or injury of spinal roots, nerves or sympathetic fibres. It is to be considered an adjunctive test and not solely diagnostic except in cases of reflex sympathetic dystrophy. While one cannot extend the technique of thermography to indicate the central phenomena of perception of pain, it is useful in detecting associated vasomotor instability and complex pain states associated with arthritis, soft tissue injuries, low back disease or reflex sympathetic dystrophy and does provide objective data to identify dysfunction in roots that are irritated in the lumbar spine, peripheral nerves that are irritated, and damage to the sympathetic nervous system. return to top