Breast Thermal Imaging, the paradigm shift page 2

There are essentially two types of thermographic equipment utilized in medical practice.

One is LCT (liquid crystal thermography). These are essentially latex plates embedded with liquid crystals which react to surface heat of the body by giving off visible color. The mix of crystals used in the detector determines the detectors ability to differentiate heat ranges.

The other is Electronic Thermography also known as telethermography. The latter are camera\computer based systems which are highly accurate and function in real time with no contact to the subjects skin.

Many manufacturers modified thermographic equipment utilized for night vision or military applications. Some of these detectors were not of adequate quality to read heat patterns emitted from human skin. For example, a system with a sensitivity above 0.5 degrees C, did not provide consistent quantification (numeric measurement).

Systems which sensitivity of 1.0 degrees centigrade provide for errors ranging between 0.1 and 1.9 degrees. With pathology found at the .4 to 1.0 C range, it is obvious that such equipment is not appropriate for utilization, but none the less, these inappropriate systems were heavily utilized in the 70's and 80's for this purpose.

Early electronic thermographic systems utilized detectors made from indium antimonide which had a spectral range of 2-5 millimicrons. As heat patterns detectable from breast tissue fall into the 8-13 millimicron range the 2-5 millimicron detectors were not adequate and the more expensive mercury cadmium telluride detectors should have been used.(1). These detectors were much more costly to the average clinician or research facility and so they were not used. (focal plane array cameras in the modern era are aiding in the correction of this divergence.

Unaware physicians, who desired to use thermography in their practices purchased the less expensive systems and thus the basis for many of the false positive findings reported in the literature. Had they used the appropriate systems with the correct optical wave band, these false positives would have been eliminated or significantly reduced.

Many of the manufacturers of computer based systems designed software that caused the images to look fantastic, but these images were displaying information that was not necessarily complete and thus, the unwary physician found inconsistency in his studies as well as a high false positive rate which would not have occurred had the appropriate systems been utilized in breast cancer screening.

As with any medical device the appropriate technology, performed according to a consistent and established protocol by board certified individuals will result in more accurate studies and satisfactory scientific yields.

Though medicine as a whole cries out for less governmental control, the lack of regulation within the field of thermography is a significant problem. For example, in the United States, medical, chiropractic and podiatric licensing boards have adopted position statements regarding clinical utility of thermography and some have "accepted" various protocols for implementation, but that is all.

However, anyone can own and operate thermographic equipment. Only a licensed health care providers with portal of entry status, (MD, DC, DPM, etc.) can interpret or render a diagnostic opinion of the examination.

In addition, this also relates to the ability to bill an insurance carrier and receive payment for services. Thus entrepreneurs with no formal medical training often submitted studies to insurance companies which were of very poor quality. This resulted in not only denial of payment, but a doubt was rightfully cast on the legitimacy and quality of thermographic studies as they were being performed by inadequate personnel.

With this lack of regulation, a great many poorly performed studies found their way into the medical literature and the court system. (see personal injury model below).

A major factor related to the inconsistency of published works in the thermographic imaging field is the various protocols under which the procedures is performed. Although not difficult, the protocol of the examination, a with x-ray or any other diagnostic device, is essential to accurate and reliable outcome.

While the scope of this paper can not devote a great deal of space to protocol, it is important to note that most non-thermographic clinicians that the author has had opportunity to oppose in the legal system, have had no idea that such protocol exists or is important.

When I taught the diplomate course for thermography in California, physicians were asked to submit thermographic studies as part of their completion requirements. The vast majority of unacceptable studies (which incidentally, were used for diagnosis of patients in these clinicians practices) were found to contain errors created simply by poor protocol which would have been very easy and inexpensive to correct. For example, performing the procedure on tile flooring which by its cold temperature, caused abnormal sympathetic heating responses in the subject under evaluation. A carpeted floor is required.

Protocol is everything. Without an internationally accepted protocol, no comparison of accuracy, double blinded study, or evaluation of the technology and its effectiveness can be made. With the wide ranging opinion of thermographers and pseudo-thermographers concerning appropriate protocol, it is no wonder that many studies performed worldwide do not correlate, while other studies performed to a stringent protocol are so very consistent.