By Dr.Nahla El gizawy.By Dr.Nahla El gizawy.MD.RadiodiagnosisMD.Radiodiagnosis

Thermography

ThermographyThermography

Total Thermal Imaging providing Early Detection, Non Total Thermal Imaging providing Early Detection, Non Radiation based Thermgraphy Breast and Body Screenings Radiation based Thermgraphy Breast and Body Screenings for Men, Women, Children, and Animals .for Men, Women, Children, and Animals .

Thermography, or DITI (Digital Infrared Thermal Imaging) is Thermography, or DITI (Digital Infrared Thermal Imaging) is the technology used by both Suzanne Somers to detect her the technology used by both Suzanne Somers to detect her breast cancer and Oprah Winfrey to detect her thyroid breast cancer and Oprah Winfrey to detect her thyroid disorder. disorder.

Conditions detected include inflammation, tumors, carpal Conditions detected include inflammation, tumors, carpal tunnel, heart disease, prostate health, migraines, thyroid tunnel, heart disease, prostate health, migraines, thyroid conditions, TMJ, periodontal disease,and many many more! conditions, TMJ, periodontal disease,and many many more!

What is breast thermographyWhat is breast thermography

Breast thermography is a diagnostic Breast thermography is a diagnostic procedure that images the breasts to aid in procedure that images the breasts to aid in the early detection of breast cancer . the early detection of breast cancer .

Infrared thermography, thermal imaging, and Infrared thermography, thermal imaging, and thermal video are examples of infrared imaging thermal video are examples of infrared imaging science. science.

Thermal imaging cameras detect radiation in the Thermal imaging cameras detect radiation in the infrared range of the electromagnetic spectrum infrared range of the electromagnetic spectrum (roughly 9000(roughly 9000––14,000 nanometers or 914,000 nanometers or 9––14 14 µµm) m) and produce images of that radiation, called and produce images of that radiation, called thermograms. thermograms.

Since infrared radiation is emitted by all objects Since infrared radiation is emitted by all objects near room temperature, according to the black near room temperature, according to the black body radiation law, thermography makes it body radiation law, thermography makes it possible to see one's environment. possible to see one's environment.

IntroductionIntroduction The first recorded use of thermobiological diagnostics can The first recorded use of thermobiological diagnostics can

be found in the writings of Hippocrates around 480 B.C.[1].be found in the writings of Hippocrates around 480 B.C.[1]. continued research and clinical observations proved that continued research and clinical observations proved that

certain temperatures related to the human body were indeed certain temperatures related to the human body were indeed indicative of normal and abnormal physiologic processes. indicative of normal and abnormal physiologic processes.

In the 1950's, military research into infrared monitoring In the 1950's, military research into infrared monitoring systems for night time troop movements shared in a new era systems for night time troop movements shared in a new era in thermal diagnostics.in thermal diagnostics.

The first use of diagnostic thermography came in 1957 The first use of diagnostic thermography came in 1957

when R. Lawson discovered that the skin temperature over when R. Lawson discovered that the skin temperature over a cancer in the breast was higher than that of normal tissue.a cancer in the breast was higher than that of normal tissue.

On January 29, 1982, the Food and Drug On January 29, 1982, the Food and Drug Administration published its approval and Administration published its approval and classification of thermography as an classification of thermography as an adjunctive diagnostic screening procedure for adjunctive diagnostic screening procedure for the detection of breast cancer. the detection of breast cancer.

Fundamentals of Infrared ImagingFundamentals of Infrared Imaging

PhysicsPhysics • All objects with a temperature above absolute zero (-All objects with a temperature above absolute zero (-

273 K) emit infrared radiation from their surface. 273 K) emit infrared radiation from their surface. • The Stefan-Boltzmann Law defines the relation The Stefan-Boltzmann Law defines the relation

between radiated energy and temperature by stating between radiated energy and temperature by stating that the total radiation emitted by an object is directly that the total radiation emitted by an object is directly proportional to the object's area and emissivity and proportional to the object's area and emissivity and the fourth power of its absolute temperature. Since the fourth power of its absolute temperature. Since the emissivity of human skin is extremely high the emissivity of human skin is extremely high (within 1% of that of a black body), measurements of (within 1% of that of a black body), measurements of infrared radiation emitted by the skin can be infrared radiation emitted by the skin can be converted directly into accurate temperature values.converted directly into accurate temperature values.

Equipment ConsiderationsEquipment Considerations –– Infrared rays are found Infrared rays are found in the electromagnetic spectrum within the in the electromagnetic spectrum within the

wavelengths of 0.75 micron - 1mmwavelengths of 0.75 micron - 1mm.. Human skin emits infrared radiation mainly in the 2 - Human skin emits infrared radiation mainly in the 2 -

20 micron wavelength range, with an average peak at 20 micron wavelength range, with an average peak at 9-10 microns. 9-10 microns.

The problems encountered with first generation The problems encountered with first generation infrared camera systems such as improper detector infrared camera systems such as improper detector sensitivity (low-band), thermal drift, calibration, analog sensitivity (low-band), thermal drift, calibration, analog interface, etc. have been solved for almost two decades.interface, etc. have been solved for almost two decades.

State-of-the-art breast thermography uses State-of-the-art breast thermography uses ultra-sensitive infrared cameras and ultra-sensitive infrared cameras and sophisticated computers to detect, analyze, sophisticated computers to detect, analyze, and produce high-resolution diagnostic and produce high-resolution diagnostic images of these temperature and vascular images of these temperature and vascular changes.changes.

• The procedure is based on :The procedure is based on :• The principle that chemical and blood vessel The principle that chemical and blood vessel

activity in both pre-cancerous tissue and the activity in both pre-cancerous tissue and the area surrounding a developing breast cancer is area surrounding a developing breast cancer is almost always higher than in the normal breast. almost always higher than in the normal breast.

• Since pre-cancerous and cancerous masses are Since pre-cancerous and cancerous masses are highly metabolic tissues, they need an abundant highly metabolic tissues, they need an abundant supply of nutrients to maintain their growth. In supply of nutrients to maintain their growth. In order to do this they increase circulation to their order to do this they increase circulation to their cells by sending out chemicals to keep existing cells by sending out chemicals to keep existing blood vessels open, recruit dormant vessels, and blood vessels open, recruit dormant vessels, and create new ones (neoangiogenesis). This create new ones (neoangiogenesis). This process results in an increase in regional surface process results in an increase in regional surface temperatures of the breast temperatures of the breast

• The concept of angiogenesis, as an integral part of The concept of angiogenesis, as an integral part of early breast cancer, was emphasized in 1996 by Guido early breast cancer, was emphasized in 1996 by Guido and Schnitt. and Schnitt.

• Their observations suggested that it is an early event Their observations suggested that it is an early event in the development of breast cancer and may occur in the development of breast cancer and may occur before tumor cells acquire the ability to invade the before tumor cells acquire the ability to invade the surrounding stroma and even before there is surrounding stroma and even before there is morphologic evidence of an in-situ carcinoma. morphologic evidence of an in-situ carcinoma.

• New Early Signs in Breast Cancer studied New Early Signs in Breast Cancer studied angiogenesis by infrared imaging and reported that angiogenesis by infrared imaging and reported that hypervascularity and hyperthermia could be shown in hypervascularity and hyperthermia could be shown in 86% of non-palpable breast cancers. also noted that in 86% of non-palpable breast cancers. also noted that in 15% of these cases infrared imaging helped to detect 15% of these cases infrared imaging helped to detect cancers that were not visible on mammography.cancers that were not visible on mammography.

Laboratory ConsiderationsLaboratory Considerations Thermographic examinations must be performed Thermographic examinations must be performed

in a controlled environment. The primary reason in a controlled environment. The primary reason for this is the nature of human physiology. for this is the nature of human physiology. Changes from a different external (non-clinical Changes from a different external (non-clinical controlled room) environment, clothing, etc. controlled room) environment, clothing, etc. produce thermal artifacts. Temperature and produce thermal artifacts. Temperature and humidity-controlled room maintained between 18-humidity-controlled room maintained between 18-22 degree C, and kept to within 1 degree C of 22 degree C, and kept to within 1 degree C of change during the examination, is necessary to change during the examination, is necessary to produce a physiologically neutral image free from produce a physiologically neutral image free from artifact.artifact.

The biomedical engineering evidence of The biomedical engineering evidence of

thermography's value, both in model in-vitro and thermography's value, both in model in-vitro and clinically in-vivo studies of various tissue growths, clinically in-vivo studies of various tissue growths, normal and neoplastic, has been establishednormal and neoplastic, has been established

A positive infrared scan may indicate the A positive infrared scan may indicate the presence of many different breast presence of many different breast abnormalities such as mastitis, benign abnormalities such as mastitis, benign tumors, fibrocystic breast disease, cancer, tumors, fibrocystic breast disease, cancer, and others.and others.

Just as unique as a fingerprint, Just as unique as a fingerprint, each patient has a particular infrared map of their breasts. Any each patient has a particular infrared map of their breasts. Any

modification of this infrared map on serial imaging (images modification of this infrared map on serial imaging (images taken over months to years) can constitute an early sign of an taken over months to years) can constitute an early sign of an abnormality. abnormality.

In patients without cancer, the examination results are used to In patients without cancer, the examination results are used to indicate the level of possible future cancer risk,indicate the level of possible future cancer risk,..

Consequently, in the absence of other positive tests, an abnormal Consequently, in the absence of other positive tests, an abnormal infrared image gives a woman an early warning. infrared image gives a woman an early warning.

By maintaining close monitoring of her breast health with serial By maintaining close monitoring of her breast health with serial infrared imaging, self breast exams, clinical examinations, and infrared imaging, self breast exams, clinical examinations, and other tests, a woman has a much better chance of detecting other tests, a woman has a much better chance of detecting cancer at its earliest stage and preventingcancer at its earliest stage and preventing invasive tumor invasive tumor growth.growth...

Breast thermogrphy guidlinesBreast thermogrphy guidlines

Age 20 Age 20 –– Baseline (15-20 percent of breast Baseline (15-20 percent of breast cancer occurs between the ages of 20-44.)cancer occurs between the ages of 20-44.)

20-30 yrs 20-30 yrs –– Every 3 yearsEvery 3 years 30 years and older - 30 years and older - YearlyYearly Additional thermograms may be performed Additional thermograms may be performed

more frequently for higher risk women or more frequently for higher risk women or based on suspicions from prior thermographic based on suspicions from prior thermographic examination at the doctor's discretion.examination at the doctor's discretion.

Breast Thermography ReportBreast Thermography Report

Breast thermograms were performed with patient in the seated Breast thermograms were performed with patient in the seated position. The basic thermographic pattern of the breast is: Vascular. position. The basic thermographic pattern of the breast is: Vascular. There is a mild asymmetry of the vascular patterns of the breast, with There is a mild asymmetry of the vascular patterns of the breast, with a somewhat more prominent vessel which proceeds obliquely across a somewhat more prominent vessel which proceeds obliquely across the lower quadrant of the left breast. No evidence of the lower quadrant of the left breast. No evidence of neovascularization is observed.neovascularization is observed.

Background breast temperatures are symmetrically decreased. The Background breast temperatures are symmetrically decreased. The thermographic edge sign is not observed. Periareolar temperatures are thermographic edge sign is not observed. Periareolar temperatures are symmetrical.symmetrical.

Impression:Impression: This study is slightly atypical because of the more prominent vessel This study is slightly atypical because of the more prominent vessel

over the lower inner quadrant of the left breast with some extension over the lower inner quadrant of the left breast with some extension toward the midline into the upper inner quadrant. As there is no toward the midline into the upper inner quadrant. As there is no associated neovascularization or vascular anarchy, this is probably associated neovascularization or vascular anarchy, this is probably within normal limits.within normal limits.

Breast thermography has an Breast thermography has an average sensitivity and specificity average sensitivity and specificity of 90%.of 90%.

Breast thermography has the ability to detect Breast thermography has the ability to detect the first signs that a cancer may be forming up the first signs that a cancer may be forming up to 10 years before any other procedure can to 10 years before any other procedure can detect it.detect it.

An abnormal thermogram is 10 times more An abnormal thermogram is 10 times more significant as a future risk indicator for breast significant as a future risk indicator for breast cancer than a first order family history of the cancer than a first order family history of the disease.disease.

The procedure is The procedure is

comfortablecomfortable

safe using safe using

no radiation or no radiation or

compressioncompression. .

Why Thermography is Why Thermography is NotNot a Replacement for Mammography a Replacement for Mammography There is no one test that can detect 99-100% of all cancers. There is no one test that can detect 99-100% of all cancers.

Therefore, no single test exists that can be used alone as an Therefore, no single test exists that can be used alone as an adequate screening or detection method for breast cancer.adequate screening or detection method for breast cancer.

A physiological imaging procedure (thermography) cannot replace A physiological imaging procedure (thermography) cannot replace an anatomical imaging procedure (mammography). The two tests an anatomical imaging procedure (mammography). The two tests are are ““lookinglooking”” for completely different pathological processes. for completely different pathological processes.

Thermography is far more sensitive than mammography. However, Thermography is far more sensitive than mammography. However, some slow growing non-aggressive cancers will only be detected some slow growing non-aggressive cancers will only be detected by mammography. by mammography.

conclusionconclusion Breast thermography's ability to detect a Breast thermography's ability to detect a

pre-cancerous state of the breast, or signs of pre-cancerous state of the breast, or signs of cancer at an extremely early stage, lies in its cancer at an extremely early stage, lies in its unique capability of monitoring the unique capability of monitoring the temperature variations and blood vessel temperature variations and blood vessel alterations produced by the earliest changes alterations produced by the earliest changes in tissue physiologyin tissue physiology (function)(function). .

When used as part of a multimodal approach When used as part of a multimodal approach (clinical examination + mammography + (clinical examination + mammography + thermography) 95% of early stage cancers will thermography) 95% of early stage cancers will be detected. be detected.

• Breast thermography is a Breast thermography is a complementary complementary screeningscreening and detection procedure, and detection procedure,

The procedure can also play a role in prognosis The procedure can also play a role in prognosis and as a method of and as a method of assisting in monitoringassisting in monitoring the the effects of treatment.effects of treatment.

The addition of breast thermography to the The addition of breast thermography to the frontline of early breast cancer detection frontline of early breast cancer detection

brings a great deal of good news for brings a great deal of good news for women.women.

THANK YOUTHANK YOU