My name is Ann Stanger. I am a general practitioner and I have been practicing medicine in Madison for almost 20 years. The Human body is thermally symmetrical, and our normal thermal patterns are constant and repeatable. Pathology will cause sympathetic change and in most instances, thermal asymmetry. Digital Infrared Thermal Imaging is a highly sensitive and totally non-invasive clinical imaging procedure for objectively detecting and monitoring many injuries and conditions. Because the human body is thermally symmetrical we can use comparative views, left to right to detect physiological dysfunction.
Clinical Thermography is a simple test of physiology that relies on the sympathetic nerve control of skin blood flow and the ability of the sympathetic system to respond and react to pathology anywhere in the body. The Human body is thermally symmetrical, and our normal thermal patterns are constant and repeatable. Pathology will cause sympathetic change and in most instances, thermal asymmetry. Digital Infrared Thermal Imaging is a highly sensitive and totally non-invasive clinical imaging procedure for objectively detecting and monitoring many injuries and conditions. Because the human body is thermally symmetrical we can use comparative views, left to right to detect physiological dysfunction.
When we do thermal imaging of the breast now, it takes less than 5 minutes to take 5 views. The camera collects the image instantly.
Using DITI for breast screening provides a totally safe and non invasive method of detecting changes in the breasts that can result in the earliest possible detection of breast disease. DITI can detect and record physiological changes years before there is any clinical evidence of disease. Being able to detect and monitor suspicious changes at a very early stage gives us the opportunity for intervention and far greater treatment options. The complete test only takes ten minutes, there is no body contact, no radiation of any kind and once a baseline has been established a comparison study is performed annually.
Because pre-menopausal breast tissue is denser and more vascular than post menopausal breast tissue, any pathology taking place will have a better vascular supply and there will be increased cell changes and faster development of pathology in the younger women. The disadvantage with mammography is that with radiographically dense breasts it is difficult to differentiate between normal and abnormal density in the early stages of pathology. (It is also necessary to use more radiation to properly image dense breasts). Thermography is better suited to detect the physiological changes in the denser and more vascular pre-menopausal breast, with positive findings, months and sometimes years before the pathology becomes dense enough to be seen with mammography.
This 37 year old patient presented for routine thermographic breast screening, she was not in a high risk category and had no family history. No breast exams had been performed previously. The vascular asymmetry in the upper left breast and the local hypothermia at 11 O’clock was particularly suspicious and subsequent clinical investigation indicated a palpable mass at the position indicated. A biopsy was performed and a DCIS of 2 cm was diagnosed. Unfortunately this patient only survived for 12 months after diagnosis.
This patient was also age 37 when her first baseline thermogram showed a slight hyperthermic asymmetry in the upper right breast. The follow-up study showed the pattern had become more well defined and although clinical correlation did not find anything remarkable it was decided to repeat the exam again in a further 3 months, when again significant changes were seen. Mammography was performed at this stage with the thermographic guidance of the locally suspicious area at 1 O’clock to the right nipple. The mammographic findings were inconclusive and the patient was referred for a repeat mammogram in 12 months. Thermographic monitoring was continued and at the fifth comparative study at 12 months significant changes were still evident and the hyperthermic asymmetry (temperature differentials) had increased. Immediate further investigation was strongly recommended despite a scheduled mammogram in 6 months, and at the patients insistence a repeat mammogram was performed which clearly showed a small calcification (1 mm) at 1 O’clock. Within one week a lumpectomy had been performed with good margins and the pathology confirmed as a malignant carcinoma (DCIS). This patient has now had stable thermograms for the last 2 years and is expected to remain healthy.
This is the specific area of the small DCIS. We can see the vascular feed and the discreet area of hypothermia that is displacing the surrounding hyperthermia.
The results of this routine study led to the diagnosis of inflammatory carcinoma in the right breast. There were no clinical indications at this stage. (Thermography can show significant indicators several months before any of the clinical signs of inflammatory breast disease, skin discoloration, swelling and pain). Inflammatory breast disease cannot be detected by mammography and is most commonly seen in younger women, the prognosis is always poor. Early detection provides the best hope of survival.
This significant thermal asymmetry is caused by an early stage DCIS and was only just dense enough to be seen with thermography guided mammography. There was nothing palpable and this patient was 10 years away from her first routine mammogram.
Advanced angiogenesis in the upper left breast relating to a DCIS.
The very significant vascular activity in the left breast justified clinical correlation and close monitoring which returned an opinion of fibrocystic changes taking place. These changes can be monitored thermographically at regular intervals until a stable baseline is established and is reliable enough for annual comparison.
The increased vascular activity in both breasts is consistent with the hormonal changes in pregnancy. This patient was unaware that she was 4 weeks pregnant at the time of her scan. The thermography tech was an experienced operator who asked the patient….. “your not pregnant are you ?” The patient was amused and said that she wasn’t but phoned the clinic a few days later to tell them the good news.
The majority of suspicious findings are benign but it is important to identify anything that needs further investigation or to be monitored more closely until there are findings that can be used in the decision making process. The hyperthermic findings in this breast did not cause concern in conjunction with the history and clinical information relating to symptoms. These findings were consistent with this patients mastitis.
One per cent of breast cancers are found in men. The survival rate is much lower than in women as most breast cancers in men are only detected in advanced stages. This tumor was palpable at the time of imaging, there is a well established vascular feed which has even caused increased blood flow at the left brachial plexus and there is also drainage toward the sternum that extends to below the left breast. Metastasis were later found in other organs and this patient did not survive.
We can use DITI for the entire body looking for those asymmetries. I will quickly show some additional examples.
Detection and monitoring of all cancers with DITI relies on the body’s sympathetic response to the pathology. Early stage cell changes generally produce heat and vascular patterns caused by angiogenesis. Later stage pathologies that have become ‘structural’ or dense enough to displace the normally perfused surrounding tissue will show as locally cool areas.
MVA, Steering wheel impacted the low chest, subsequent x-ray as a result of thermal findings showed fractures in the low sternum and left last rib. This patient presented two days after accident with pain and breathing difficulty. Refused x-ray before thermography findings.
The skin as an organ (the largest) has specific regions that, through the autonomic system, relate to every internal organ and structure. This patient with a hypothermic asymmetry over the left lower chest has a history of CAD. “ He also has an abscess at the upper left 4 tooth” !
This patient presented with low back pain, there were no thermal findings in the back but the abdomen showed a well defined area of inflammation over the right kidney which could refer pain to the back. Subsequent tests confirmed a kidney infection.
The primary finding here is the local area of hyperthermia over the hepatic flexure of the colon. Diverticulitis was diagnosed after clinical correlation with thermographic findings.
The anterior view of the upper legs shows a patient who had unexplained pain in the right leg for over a year. The thermogram shows a varicosity with a perforator that a vascular surgeon was able to treat with minimal intervention due to the accuracy of the localization. The image showing the vascular pattern in the right lateral leg was of a patient who had a 3 year history of pain in the mid lateral thigh and knee. Nerve conduction tests and a full range of anatomical imaging tests failed to find any cause for the pain. This thermographic study led to a confirmed diagnosis of phlebitis.
Thermography uses the body's sympathetic control of skin blood flow as a window into the Autonomics ! A compromised immune function will always produce a distinct area of hypothermia over the T1 / T2 region.
100% of patients with positively diagnosed auto-immune related conditions exhibit local hypothermia over T1, T2. These patients all suffer from CFS and Fibromyalgia. The reliability of this phenomena allows us to monitor the response to treatment and rehabilitation over periods of time … days, weeks, or months.
We will be doing quick images of the neck tonight for those who are interested.
This thermogram shows the abdomen of a patient with hepatitis. The hepatic blood vessel (closed after birth) has now opened from the liver to the umbilicus.
This elderly lady had undergone a left hip replacement surgery 3 months previously and her continued leg pain raised a suspicion for DVT. The thermographic findings were not consistent with DVT, but showed a focal area of inflammation that guided a sonographer to a deep abscess near the bone. This was lanced and successfully treated with antibiotics.
TMJ can be difficult to diagnose. This patient had classic symptoms and also classic thermographic findings consistent with TMJ which helps to confirm a diagnosis.
Referred pain syndromes can also be difficult to diagnose. This patient presented with non specific pain in the lower right arm which had been investigated with a number of different modalities. Thermography showed thermal asymmetries that led to a positive diagnosis.
By using anatomical landmarks or placing IR markers on the patient, thermal asymmetries relating to specific structures can be included in reports.
This athlete had a history of a recurring ‘niggle’ and stiffness in his upper left shoulder…… one treatment guided by thermography resolved the problem permanently.
It can be reassuring and beneficial to both the patient and clinician to have objective conformation of a previous or new diagnosis.
A common problem in competitive swimmers. The Physiotherapists treating this Olympic swimmer were able to monitor the results of their treatments using thermography at regular intervals. Shorter recovery times and better end results can be achieved when treatments can be modified due to the information provided by thermography.
X-ray showed no abnormality, thermography correlated well with the patients report of pain and provided justification for the more invasive test of scintigraphy which clearly showed a stress fracture in the exact location indicated by the thermograms.
Although this hypothermic pattern resembles an S1 radiculopathy it is a sympathetic reaction to the pain caused by a bony spur on the left heel. The hyperthermia in the right plantar foot is likely to be a result of a long term weight transfer off the left heel.
Being in the right place at the right time resulted in this study taken within a few minutes of a fracture injury. A very significant sympathetic ‘shutdown’ occurred instantly with a hypothermic asymmetry of 11 ºc but within 3 hours inflammatory processes had reversed the asymmetry to one of a hyperthermia of 5 ºc.
This patient fell from a ladder. X-ray was inconclusive, Scintigraphy showed the fractures.
Thermographic evidence can positively influence decision making in case management. X-ray evidence confirmed complications with this ankle that required surgery.
Thermography was performed after cast removal, providing a baseline for comparative studies during the healing process. Indications of non healing fractures and other complications can be detected at an earlier stage during rehabilitation.
This Patient did not believe that the level of pain following his arthroscopy was reasonable to except. The thermography report of inflammation consistent with infection justified sending him back for further investigation which resulted in an appropriate anti-biotic being prescribed.
Very objective monitoring of the effects of treatment can be recorded. In this comparative study over time, (30 minutes) a significant change in the temperature differentials in the medial left leg is due to the acupuncture treatment. The entire region of interest is seen to cool but the local area of inflammation in the medial knee changes and reduces at a much greater rate.
Confirming a clinical diagnosis with objective evidence has many benefits. The vascular damage was not initially identified with this sporting injury.
This woman's basketball player had been carrying an injury to her right foot (stress fracture in the navicular). Thermography showed the effects of the weight transfer to her left knee.
Thermography is the most objective diagnostic test for CRPS. Treatment options and success rates depend on early detection, (in the first 3 months). The sympathetic ‘shutdown’ is so sever in this foot that the toes look thermally amputated.
RSD of the left hand. The return of normal sympathetic function after treatment was short term.
Temperature differentials are important when reporting…..the Objective evidence of thermography supports subjective opinion and can help in decision making.
DITI Thermography can even do CAT scans !
Digital Infrared Thermal Imaging
Ann E. Stanger, MD 2940 Chapel Valley Road Madison WI 53711 608-233-2378
The clinical applications of DIGITAL INFRARED THERMAL IMAGING American College of Clinical Thermology
Clinical Thermography is a test of physiology that relies on the sympathetic nerve control of skin blood flow and the ability of the sympathetic system to respond and react to pathology anywhere in the body.
The very first thermal image in 1948 took 40 minutes to to scan
DITI’s role in breast cancer and other breast disorders is to help in early detection and monitoring of abnormal physiology and the establishment of risk factors for the development or existence of cancer. When used with other procedures the best possible evaluation of breast health is made.
Normal Breast Study with no significant thermal asymmetries.
DITI detects the subtle physiologic changes that accompany breast pathology, whether it is cancer, fibrocystic disease, an infection or a vascular disease. Doctors can then plan accordingly and lay out a careful program to further diagnose and /or MONITOR until other standard testing becomes positive. This allows for the earliest possible treatment.
Breast Cancers tend to grow significantly faster in younger woman under 50 A VERAGE AGE TUMOUR DOUBLING TIME Under 50 80 days Age 50 - 70 157 days Over Age 70 188 days Source: Cancer 71:3547-3551, 1993
All women can benefit from DITI breast screening. However, it is especially appropriate for younger women (30 - 50) whose denser breast tissue makes it more difficult for mammography to be effective. Also for women of all ages who, for many reasons, are unable to undergo routine mammography. This test can provide a 'clinical marker' to the doctor or mammographer that a specific area of the breast needs particularly close examination. It takes years for a tumor to grow thus the earliest possible indication of abnormality is needed to allow for the earliest possible treatment and intervention. DITI’s role in monitoring breast health is to help in early detection and monitoring of abnormal physiology.
Early Detection DITI is especially appropriate for younger women between 30 & 50 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 that a specific area of the breast needs particularly close examination.