Thermography

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

High resolution vs. low resolution thermography...
you decide if high resolution is superior
when the patterns appear the same

High Resolution                                      Low Resolution
Thanks to Dr. Glenn Stillwagon for the use of these pictures.

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	What is Thermography? Thermography is a means of measuring the heat (thermo) coming from a body. The science of Thermography is the application of these heat readings to locate abnormal pathology or function in the body.
	Inter-examiner Reliability of the Interpretation of Paraspinal Thermographic Pattern Analysis J Can Chiropr Assoc 2015 (Jun); 59 (2): 157–164 ~ FULL TEXT Inter-examiner reliability demonstrated fair to good agreement for identifying comparable (full pattern) and disparate (adaptation) thermographic findings; agreement was poor for those with moderate similarity (partial). Further research is needed to determine whether thermographic findings should be used in clinical decision-making for spinal manipulation.
	Computer-assisted Skin Videothermography Is A Highly Sensitive Quality Tool in the Diagnosis and Monitoring of Complex Regional Pain Syndrome Type I Eur J Appl Physiol 2004 (May); 91 (5–6): 516–524 The use of thermography in the diagnosis and evaluation of complex regional pain syndrome type 1 (CRPS1) is based on the presence of temperature asymmetries between the involved area of the extremity and the corresponding area of the uninvolved extremity. The interpretation of thermographic images is, however, subjective and not validated for routine use. The objective of the present study was to develop a sensitive, specific and reproducible arithmetical model as the result of computer-assisted infrared thermography in patients with early stage CRPS1 in one hand.
	Paraspinal Skin Temperature Patterns: An Interexaminer and Intraexaminer Reliability Study J Manipulative Physiol Ther 2004 (Mar); 27 (3): 155–159 ~ FULL TEXT Intraexaminer and interexaminer reliability of paraspinal thermal scans using the TyTron C-3000 were found to be very high, with ICC values between 0.91 and 0.98. Changes seen in thermal scans when properly done are most likely due to actual physiological changes rather than equipment error.
	Stability of Paraspinal Thermal Patterns During Acclimation J Manipulative Physiol Ther 2004 (Feb); 27 (2): 109–117 ~ FULL TEXT Cervical spine temperatures remained constant while lower back temperatures, in general, decreased for the entire 31–minute recording period. Although the results varied among subjects, on the average, the patterns stabilized after 16 minutes.
	Correlations Between Paraspinal Temperature Variation and Health Status: From Manual Therapeutic Art to Objective Measurement Annual Meeting of the American Academy of Osteopathy ~ March 23, 2002 This study demonstrates that temperature imbalances in the spine are correlated with lower health quality of life, offering objective support for historical claims in the art of manual medicine.
	Comparative Effectiveness of Videothermography, Contact Thermography, and Infrared Beam Thermography for Scanning Relative Skin Temperature J Rehabil Res Dev 1996 (Oct); 33 (4): 377–386 Infrared Beam Thermography used in conjunction with a grid map of the body was the simplest and least expensive system to use for scanning and was as accurate as Video TRM.
	Advances in Paraspinal Thermographic Analysis Chiropractic Research Journal 1993; 2 (3) ~ FULL TEXT Paraspinal cutaneous thermal anomalies have long been held to be suggestive of vertebral subluxation. A review of analytical theories relating to thermography and its use in chiropractic indicated a need for a more complete understanding of the relationship between thermographic data and spinal health. In this study we completed an in-depth review of literature relating to cutaneous thermography, analyzed the basic theory of commonly used instrumentation and postulated new concepts relating to paraspinal thermoceptive neuronal sympathetic function.
	Clinical Application of Infrared Thermography in Diagnosis and Therapeutic Assessment of Vascular Ischemic Pain Ma Zui Xue Za Zhi 1990 (Dec); 28 (4): 493–501 Temperature is a very important and useful manifestation of various disease entities. The importance of body temperature as an indicator of disease has been known for centuries but in recent years attention has also been paid to how to conveniently and effectively make use of skin temperature as a diagnostic tool. Skin temperature can be measured with thermocouples, electronic thermistor-thermometers, electronic integrators, liquid crystal thermography, and infrared thermography. Of these, infrared thermography has the advantages of being noninvasive, remote from the patient when in use, and capable of producing multiple recordings at short time intervals. Here we present a case of vascular ischemic pain which was diagnosed and therapeutically assessed by thermography.
	Quantification of Thermal Asymmetry Part 1: Normal Values and Reproducibility J Neurosurg 1988 (Oct); 69 (4): 552–555 The use of thermography in evaluating nerve injury is based on the presence of temperature asymmetries between the involved area of innervation and the corresponding area on the opposite side of the body. However, interpretation of the thermographic image has been troubled by subjectivity. This paper describes a computer-calculated method of collecting data that eliminates subjective biases.
	Quantification of Thermal Asymmetry Part 2: Application in Low-back Pain and Sciatica J Neurosurg 1988 (Oct); 69 (4): 556–561 Temperature differences between the lower extremities were measured using a computerized thermometric scanning system in order to compare the degree of thermal asymmetry in 144 patients with low-back pain. The patients displayed highly significant thermal asymmetries, with the involved limb being cooler (p less than 0.001). When asymmetries exceeded 1 standard deviation from the mean temperature of homologous regions measured in 90 normal control subjects, the positive predictive value of thermometry in detecting root impingement was 94.7% and the specificity was 87.5%.
	Thermal Imaging -- The Paradigm Shift William Cockburn, DC, FIACT Dynamic Chiropractic (January 2, 1995) Because thermography is a noninvasive (no radiation) procedure, there is no specific legislation or regulatory act under which thermography can be scrutinized. Early thermographic pioneers created entrepreneurial training and certification programs for both physicians and technicians. These programs cultivated a host of new course instructors and a variety of organizations and certifications became available. Some courses offered thermographic certifications to people with no health care training at all. For example, injured workers could qualify under vocational rehabilitation laws to become certified and open their own labs. They found any doctor who was willing to read their studies, and few of those doctors were trained or certified in thermography.

Thermography:   Point/Counter-point

Thermography has been used by chiropractors since the 1930's to help detect the neurologic aspect of the subluxation complex.   There is still some debate over what thermography actually measures.   Please enjoy this series of articles on that topic!

	Thermography in Soft Tissue Trauma: Does It Have a Place? Arthur C. Croft, DC, MS, DABCO Dynamic Chiropractic (May 7, 1993) Several years ago I advocated the use of thermography in the evaluation of cervical acceleration/deceleration (CAD) trauma. Most of the research available in the early part of the 1980s favored thermography as a noninvasive method of evaluating a number of musculoskeletal disorders. More recently, in the evaluation of certain neuropathies, it was found to compare favorably, in terms of sensitivity and specificity, with CT, MRI, EMG and, in some cases, myelography. [1, 2] In the final analysis, however, thermography is generally found to be less specific than anatomical tests such as CT or MRI. [3, 4] Many proponents of thermography have been willing to accept its generally lower specificity on the grounds that it is relatively less expensive, noninvasive, safe, and easy. Some have argued that for certain conditions, such as reflex sympathetic dystrophy (RSD) and myofascitis, thermography offers the only objective means by which to evaluate them.
	Thermography in Clinical Practice: The Rebuttal David J. BenEliyahu, DC, CCSP, DNBCT Dynamic Chiropractic (July 2, 1993) Referring out for many studies and not being pleased with the interpretation is something that happens in all fields. I have referred out for hundreds of EMGs and auditory and visual evoked response testing, whose results often do not match the clinical picture or correlate with MRI/CT findings. Many doctors I speak to have made the same observation. With Dr. Croft's rationale, should we now discontinue the use of those tests as well?
	Dr. Croft's response to Dr. BenEliyahu's Rebuttal on Thermography Arthur C. Croft, DC, MS, DABCO Dynamic Chiropractic (September 1, 1993) In his rebuttal, Dr. BenEliyahu complains that my "review" of thermography was one-sided and limited to merely 21 references. I must point out to Dr. BenEliyahu that I specifically stated in that article that it was not meant as a review at all. My purpose was, in fact, merely to ask a question concerning the role of thermography in soft tissue trauma. I ask these questions not out of any ulterior motive but because I believe they are valid.

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