2012 - Medical - Applications - of - Infrared - Thermog
2012 - Medical - Applications - of - Infrared - Thermog
The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
and sharing with colleagues.
Other uses, including reproduction and distribution, or selling or
licensing copies, or posting to personal, institutional or third party
websites are prohibited.
In most cases authors are permitted to post their version of the
article (e.g. in Word or Tex form) to their personal website or
institutional repository. Authors requiring further information
regarding Elsevier’s archiving and manuscript policies are
encouraged to visit:
http://www.elsevier.com/copyright
Author's personal copy
Review
a r t i c l e i n f o a b s t r a c t
Article history: Abnormal body temperature is a natural indicator of illness. Infrared thermography (IRT) is a fast, passive,
Received 5 March 2012 non-contact and non-invasive alternative to conventional clinical thermometers for monitoring body tem-
Available online 13 April 2012 perature. Besides, IRT can also map body surface temperature remotely. Last five decades witnessed a
steady increase in the utility of thermal imaging cameras to obtain correlations between the thermal
Keywords: physiology and skin temperature. IRT has been successfully used in diagnosis of breast cancer, diabetes
Infrared thermography neuropathy and peripheral vascular disorders. It has also been used to detect problems associated with
Medical thermography
gynecology, kidney transplantation, dermatology, heart, neonatal physiology, fever screening and brain
Diabetes
Breast cancer
imaging. With the advent of modern infrared cameras, data acquisition and processing techniques, it is
Dentistry now possible to have real time high resolution thermographic images, which is likely to surge further
Fever screening research in this field. The present efforts are focused on automatic analysis of temperature distribution
of regions of interest and their statistical analysis for detection of abnormalities. This critical review focuses
on advances in the area of medical IRT. The basics of IRT, essential theoretical background, the procedures
adopted for various measurements and applications of IRT in various medical fields are discussed in this
review. Besides background information is provided for beginners for better understanding of the subject.
Ó 2012 Elsevier B.V. All rights reserved.
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
2. Experimental conditions for medical IRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
3. Emissivity of human skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
4. Instrumentation: infrared camera and detectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
5. Image processing, data analysis and numerical modeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
6. IRT in medical science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
6.1. Thermoregulation study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
6.2. Breast cancer detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
6.3. Diagnosis of diabetic neuropathy and vascular disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
6.4. Fever screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
6.5. Dental diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
6.6. Dermatological applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
6.7. Blood pressure monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
6.8. Diagnosis of rheumatic diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
6.9. Diagnosis of dry eye syndrome and ocular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
6.10. Diagnosis of liver diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
6.11. Treatment of kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
6.12. Heart operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
6.13. Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
6.14. Personality testing and brain imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
7. Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
⇑ Corresponding author. Tel.: +91 044 27480500x26447; fax: +91 044 27480356.
E-mail address: [email protected] (J. Philip).
1350-4495/$ - see front matter Ó 2012 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.infrared.2012.03.007
Author's personal copy
222 B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235
1. Introduction Table 1
Emissivity of various human tissues at 40 °C in infrared wave-
length [4,13].
Historically, temperature has been proved to be a very good
indicator of health [1,2]. Since 400 BC temperature has been used Tissue Emissivity
for clinical diagnosis [3]. Human, being a homeotherm, is capable Black skin (3–12 lm) 0.98 ± 0.01
of maintaining a constant temperature of the body, which may White skin (3–14 lm) 0.97 ± 0.02
Burnt skin (3–14 lm) 0.97 ± 0.02
be different from surrounding temperature [4]. The body of
Epicardium (fresh: 0.5 h) 3 lm 0.85
homeotherms can be divided into two parts, viz. the inner core Epicardium (fresh: 0.5 h) 5 lm 0.86
and the outer periphery [5]. The core temperature is preserved Epicardium (9 days at 20 °C) 0.99
within a narrow limit (approximately 42–33 °C) [5]. This regula- Pericardium (3 lm) 0.88
tion of inner core temperature is essential for normal performance Pericardium (5 lm) 0.94
Pericardium (9 lm) 0.95
of human body. Change of core temperature by a few degrees is
considered as a clear indication of probable illness [4]. The body
controls its temperature by a physiological process, called thermo-
regulation [5]. the advent of newer generations of detectors, NIR and MIR regions
Thermometers were developed around 17th century [2,6]. are also used in medical thermography [15,16]. The first modern
George Martine regularly used thermometers to measure diurnal infrared detector of lead-sulfide photo-detector, was originally
changes of temperature in normal subjects [7]. In 1868, Carl Wun- developed for military applications, around World War II [17].
derlich first systematically studied the temperature of subjects suf- But later the technology was released for civilian uses and thereaf-
fering from fever and compared with that of the normal subjects ter IRT has been used in medical sciences as well as in the field of
and thereby established temperature as a scientific indicator of ill- non-destructive testing (NDT). In the field of NDT, the application
ness [8]. He established that, temperature range between 36.3 and of IRT is mainly in surface and sub-surface defect detection and on-
37.5 °C could be considered as normal and temperature beyond line monitoring of processes [11,18]. In IRT, thermal patterns on
this range should be considered as an indication of possible illness. the surface of the test objects are monitored. Subsurface defects
During the initial days, liquid based thermometers were used [2]. cause abnormal thermal patterns, which indicate the presence of
The discovery of infrared radiation by Sir William Herschel in those defects. Similarly in medical applications, due to clinical
1800 was quickly followed by the recording of first thermal image illness abnormal thermal patterns on the skin surfaces are moni-
by his son, John Herschel, which opened new dimensions in the tored. A few typical applications of IRT are shown in Fig. 1.
field of temperature measurement [2]. Hardy, in 1934, described In 1963, Barnes demonstrated that thermograms can provide
the physiological role of infrared emission from human body and information of physical anomalies and thereby be useful for diag-
proposed that human skin can be considered as a blackbody radi- nosis of physical illness [19]. Sherman et al. used IRT for assess-
ator [9,10]. He established the diagnostic importance of tempera- ment of skin temperature asymmetries between paired limbs of
ture measurement by infrared technique which paved the way subjects and concluded that IRT along with grid map of body is
for using infrared thermography (IRT) in medical sciences. But the simplest method for scanning body temperature [20]. Fauci
the first use was reported in the year 1960 only, because of non- et al. reviewed the history of IRT, various detector systems and
availability of quality equipment and technical knowhow [6]. its application in medical diagnosis [21]. Jiang et al. reviewed the
All objects with temperature above absolute zero emit electro- perspective of IRT in medical thermography [22]. Ring et al. have
magnetic radiation, which is known as infrared (i.e. below red) highlighted the interesting opportunities for IRT in the medical
radiation or thermal radiation [4,11,12]. Wavelength of this radia- field [23]. Several applications of IRT in medical science has been
tion lies within a range of 0.75–1000 lm. This wide range can be highlighted by Jung et al. [24] and Ammer and Ring [25]. IRT has
further subdivided into three smaller groups, viz. near infrared or been extensively used for diabetic neuropathy [16,26–31], vascular
NIR (0.76–1.5 lm), medium infrared or MIR (1.5–5.6 lm) and far disorder [6,32,33], breast cancer detection [34–40], thermoregula-
infrared or FIR (5.6–1000 lm). According to thermal radiation the- tion study [4,5], fever screening [41–44], brain imaging (thermoen-
ory, blackbody is considered as a hypothetical object that absorbs cephaloscopy) [45], dentistry and dermatology [46–48], muscular
all incident radiation and radiates a continuous spectrum accord- pain and shoulder impingement syndrome study [49], diagnosis
ing to Planck’s law [12]. Integrating Planck’s law for all frequencies, of rheumatologic diseases [50–52], dry eye syndrome diagnosis
we get Stefan–Boltzman’s law (Eq. (1)), which describes the total [53], treatment of parasitic liver diseases [54], detection of meta-
emissive power from a blackbody [12]. static liver disease [55], bowel ischemia [56], renal transplantation
[57,58], heart treatment [59], and gynecology [60–62]. IRT has
E ¼ rT 4 ð1Þ been used in acupuncture treatment [63–65], cryotherapy [66],
2 forensic medicine [67,68] and assessment of radiation damage to
Here E is the total emissive power (W/m ), r is the Stefan Boltz-
human body [69] also. A comprehensive list of published literature
man’s constant (r = 5.676 108 W/m2 K4) and T is the absolute
(between 1989 and 2003) on various medical application of IRT
temperature (K). For real surfaces the Stefan Boltzman’s law is
and other relevant developments are reviewed by Ammer [70,71].
modified to the following form
On the basis of temperature sensing methodology, medical
E ¼ erT 4 ð2Þ thermography can be subdivided into four principal categories,
viz. electrical contact thermometry, cutaneous temperature dis-
where e is the emissivity of the emitting surface at a fixed wave- crimination, liquid crystal thermography and IRT [27]. In electrical
length and absolute temperature T. For a perfect blackbody emissiv- contact thermometry, a single element or arrays of transducers
ity is unity, but for real materials emissivity is always less than (generally made of semiconductor resistors) are used to measure
unity. Table 1 shows the emissivity of different human tissues at surface temperature of the subject in contact [27]. This technique
infrared wavelengths [4,13]. sometimes serves as a reference for IRT, though it must be consid-
Though the infrared emissions from human skin at 27 °C lies ered that excessive pressure from the sensor can alter the blood
within the wavelength range of 2–20 lm, it peaks around 10 lm. flow and thereby change the temperature [27]. Cutaneous temper-
For medical applications a very narrow wavelength band (8– ature discrimination threshold is a measure of small nerve fiber
12 lm), termed as body infrared rays, is in general used [14]. With function and Bertelsmann et al. have shown that it could be used
Author's personal copy
B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235 223
Fig. 1. Various applications of infrared thermography: (a) Outdoor monitoring during night time. The objects could be easily visualized due to infrared emissions from the
surfaces. (b) Non-destructive evaluation of materials, where delaminations appear as hot spots, in glass fiber reinforced polymer specimen. (c) Condition monitoring of three
phase electrical panel. Here local hot spots are developed due to loose contact. (d) Medical application: thermal image of lower limb of a diabetic subject.
224 B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235
Table 2
Experimental conditions used by various research groups for recording of infrared thermal images.
results in vasoconstriction aided cooling of skin which renders the described in detail by Zhang et al. [79] and Jones [80]. The first gen-
hot spots due to underlying abnormalities clearly visible [4]. Amalu eration cameras used a single element detector, and two scanning
et al. reported that, the temperature and the humidity of the exam- mirrors to produce images. They suffered from white out (i.e. sat-
ination room must be controlled in such a way that the physiology uration due to high intensity) problems. Two scanning mirrors
of the subjects is not ‘‘stressed into a condition of shivering or per- along with a large linear array or small 2-D array as detectors
spiring’’ [36]. It is advisable that the subjects should refrain from and time delay integration algorithm for image enhancement were
exposure to direct sunlight and uses of cosmetics, antiperspirants used in the second generation cameras. Third generation cameras
or deodorants immediately before the thermography examina- are without mirrors and had large focal plane array (FPA) detectors
tions. A thermal acclimation time is required for the subjects to and on-chip image processing, thereby increasing the reliability
achieve thermal equilibrium. The acclimation may be nude or nor- and sensitivity of such systems [14]. Thermal detectors are classi-
mal depending upon the parts of the body to be examined. Fig. 2 fied into two categories: cooled and uncooled. Modern develop-
shows the schematic of a typical experimental set-up. Experimen- ments in solid state systems have paved the way for production
tal conditions exercised by a few research-groups are summarized of newer types of detectors which have better accuracy and resolu-
in Table 2. Gratt et al. discussed the additional requirements for tion. Currently, thermal sensitivity of the uncooled cameras is
facial thermography as clear faces (free from make-up) and no about 0.05 °C compared to 0.01 °C of the cooled ones [14]. These
intervention from hairs [47]. Amalu et al. reported that, the exper- cameras have many advantages, viz. high spatial and temperature
iment-room must be free from any secondary infrared sources like resolutions, compactness and portability. Besides, these cameras
incandescent lamp or direct sun-light [36]. are light weight, manufactured by silicon wafer technology and
are cheap compared to the cooled infrared cameras [81–83]. Such
3. Emissivity of human skin modern digital uncooled infrared cameras improved medical ther-
mal imaging immensely. Ring reported that FPA based cameras
Emissivity of human skin is reported to be almost constant and have spatial resolution less than 2 mm over a range of distances
its value is 0.98 ± 0.01 for wavelength range of 2–14 lm [4,13]. and fields of view (200 200 mm to 500 500 mm at a distance
Steketee reported that the emissivity of black, white or burnt skin of 1 m) [84]. Cameras used by a few research-groups for medical
is the same and it is independent of the nature of the experiments, IRT experiments are tabulated in Table 3.
i.e. in vivo or in vitro [13]. It has also been reported that application
of cosmetics may cause skin emissivity to change [76]. Clark
reported that surface curvature plays a role in the value of surface 5. Image processing, data analysis and numerical modeling
emissivity [77]. His findings were in accordance with the results of
Watmough et al. that, the errors in surface temperature measure- In a review article in 2002, Jones and Plassmann, discussed
ment are small for viewing angles up to 45°. According to Watm- about the importance of image processing techniques in IRT [85].
ough et al., the emissivity of a surface at a wavelength k and Nowadays images acquired by a camera are directly fed to a digital
viewing angle / is given by the following equation [78] computer, where the images are post processed. The need to form a
" 2 !2 3
2 # 2 common database of normal thermal images of all possible parts of
1 b cos / 41 þ b cos / sin / 5 a human body has been identified [86]. Ring et al. have discussed
e/k ¼1 2
ð3Þ
2 b þ cos / b cos / þ sin / the technical challenges for constructing a digital medical IR image
database [87]. Fujimasa et al. developed an internet based image
2
where b ¼ ðn2k sin /Þ0:5 and nk is the refractive index of the material. database [88]. Ring et al. have developed an Anglo-Polish reference
For medical applications, surface curvature is not a problem except database of medical thermal images [89]. For comparison of multi-
for female breast imaging. In such cases, silvered mirrors, alumi- ple thermal images Vardasca has developed an interpolation based
nized mylar mirrors or copper mirrors have been used as front comparison methods of various regions of interest (ROI) in multi-
surface mirrors with necessary correction factors [76]. ple thermal images where the ROIs are semi automatically aligned
[90]. Data acquisition software plays an important role in IRT.
4. Instrumentation: infrared camera and detectors Plassmann and Ring have developed Bath thermal imaging soft-
ware (BTHERM), which can acquire, store and manipulate images
IRT experiments require an infrared camera, a tripod, a display from both older and modern digital cameras [91]. A modern ver-
device and an image processing unit. Nowadays display and image sion of the software, called CTHERM, has also been developed by
processing are done digitally using a personal computer and dedi- Plassmann and Murawski, which runs on a modern PC [92]. Mod-
cated software packages. ern high-end softwares like Altair and Matlab are much faster and
Since from its inception, the infrared cameras have undergone available with more options for automatic image processing. Image
three generations of advancements [14]. Development and basic acquisition may be standardized with the use of software masks
working principles of various infrared detectors and sensors are (automated or manual), which provide an outline of the regions
Author's personal copy
B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235 225
Table 3
Infrared cameras used for different studies by various research groups for medical thermography experiments.
of interest. A series of such automated masks were developed at form of mean ± S.D. (standard deviation). These deviations are
the University of Glamorgan [6]. due to unavoidable fluctuations in experimental conditions. Hence
Thermal waves attenuate exponentially in a medium and hence, statistical analyses are preferred for reducing experimental varia-
the thermal signatures of the abnormalities are often subtle [93]. tions and correlating the temperature data with other clinical data.
Thermal images also suffer from a comparatively low signal to Most common statistical approaches are analysis of variance (AN-
noise ratio (SNR). Hence image processing is of prime importance OVA), hypothesis testing (like Fischer’s exact test, Student’s t test,
in the field of IRT. Various filters (in both time and frequency do- etc.), v2 test and correlation analysis [26,49,107]. In general vari-
mains) and algorithms are used for minimizing noise, reducing ous software packages, like SPSS and SAS are used for data analysis.
blurring and edge preservation in thermal images [94]. Gulyaev Blood circulation is the principle mechanism of heat transfer in
et al. suggested four fundamental numerical operations on the human body. Heat emanating onto the skin surface and surround-
thermograms to increase accuracy of the data extracted from them ing blood flow can be described by the following equation, which is
[95]. These four operations are, (i) subtraction of background in known as Pennes bio-heat equation [108].
each frame of interest, (ii) construction of temperature time profile
at chosen point or regions, (iii) spatio-temporal projections of kD2 T cb wb ðT T a Þ þ qm ¼ 0 ð4Þ
image sequences and (iv) calculation of time derivative of temper-
Here k is the thermal conductivity of tissue material, qm is the
ature data. Fourier analysis is another very useful image processing
volumetric metabolic rate of the tissue, cbwb is the product of the
technique, which enables isolating signals of a particular fre-
specific heat capacity and the mass flow rate of blood per unit vol-
quency. Anbar developed dynamic area telethermography (DAT),
ume of tissue, T is the unknown tissue temperature and Ta is the
where FFT is performed over a large number of consecutive infra-
arterial temperature. Based on this bio-heat equation, various
red images acquired at 15–150 ms time intervals, to determine the
numerical models have been developed. Apart from basic under-
amplitudes of the various frequency components. Frequencies in
standing of the problem, such numerical models, in principle, serve
the range 8–815 mHz are ascribed to neuronal controlling effects
two purposes, viz. to predict skin temperature on the basis of inter-
whereas those above 815 mHz to hemodynamic effects [96,97].
nal heat generation and solving the inverse bio-heat equation to
Diakides and Bronzino described the recent advancements in the
estimate temperature of internal organs by observing skin temper-
image processing techniques relevant to the field of medical infra-
ature. Such numerical modeling also helps in optimization of the
red imaging [98]. Another aspect of medical image processing is
experimental parameters. Deng and Liu, based on predictions from
asymmetry analysis, where temperature differences between the
a similar numerical model, concluded that induced evaporation is
diseased and contralateral healthy body parts are analyzed. This
an effective method to improve the sensitivity of IRT images [35].
technique is particularly useful in female breast imaging. Kurugan-
In Fig. 3, typical IR images of the right hand of a normal subject,
ti and Qi have shown that higher order statistics (e.g. variance,
before and after 1 min of mild cold stimulation, are shown. Veins
skewness and kurtosis) and joint entropy are the most effective
could be clearly visualized after cold stimulation, as it increases
measures of asymmetry [99]. Qi et al. developed an automatic
the sensitivity of thermal images and renders subtle thermal signa-
asymmetry analysis approach based on Hough transform aided im-
tures to be clearly discernible.
age segmentation and pattern classification [100]. The latest devel-
opment in medical image processing is introduction of hitherto
strictly military oriented automatic target recognition (ATR) algo- 6. IRT in medical science
rithm [101,102]. Introduction of this highly sophisticated and
accurate technique is expected to result in a paradigm shift in As abnormal thermal patterns are easily recognizable by IRT, an
infrared image based computer aided diagnosis (CAD) [14]. Artifi- early diagnosis is possible from these thermal images. Thermo-
cial neural network (ANN) and fuzzy logic will play an important graphic findings are in general compared with other clinical findings
role in the development of this CAD technology [103]. Brioschi to assess for possible correlations. Though the technique is nonspe-
et al. developed a method for fusion of 2D infrared images, which cific and sometimes depends heavily on background and surround-
lack information about local anatomy, with 3D magnetic resonance ing environment, there are a number of reasons for which IRT has
imaging (MRI) for superior diagnosis [104–106]. Temperature data, found wide acceptance among the medical community. First of all,
derived from the thermograms, are in general presented in the IRT is a remote, non-contact and non-invasive technique. It is fast,
Author's personal copy
226 B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235
Fig. 3. Typical thermal images of right hand of a normal subject (a) before cold stimulation and (b) 1 min after mild cold stimulation. Cold stimulation was applied by placing
the hand on ice surface for 30 s. Application of such cold stimulations increases the sensitivity of the thermal images. Veins are clearly visible in the thermal image recorded
after cold stimulation.
Table 4 and blood flow, in the temperature profiles of hands and feet.
Contralateral (left vs. right) temperature differences of various body segments in Oscillations having period less than 4 min are related to capillaries
normal human subjects [4,109]. whereas those with higher periods are due to arterio-venous anas-
Body segment Mean temperature difference (°C) tomose. Vainer in his monograph on cutaneous perspiration, used
Forehead 0.12 short wave (about 3 lm) infrared radiation to study sweating pro-
Cheek 0.18 cedure [110]. He found that low temperature region surrounding
Chest 0.14 the secretory duct of each individual sweat gland is axisymmetric.
Abdomen 0.18 He studied kinetics of excretory function of individual cutaneous
Neck (posterior) 0.15
Lumbar (back) 0.25
glands, local sweating induced by excitation of central nervous sys-
Trunk average 0.17 tem and avalanche (abrupt) sweating due to metabolic and exter-
Arm (biceps) 0.13 nal overheating. An insightful discussion correlating sweating and
Palm (medial) 0.23 thermoregulatory mechanism is also presented by him. Bouzida
Thigh (anterior) 0.11
et al. studied thermoregulatory mechanism by two approaches,
Thigh (posterior) 0.15
Foot (dorsal) 0.30 viz. blood flow modulation and cold stress [5]. In the first approach,
Finger-tips average 0.38 blood pressure is modulated, within the systolic and diastolic val-
Toe-tips average 0.50 ues, by using a suitable mechanical arrangement. This modulation
creates a periodical variation of blood volume in the blood vessels,
which is manifested as a periodic change in temperature. Based on
and simultaneous large area monitoring is possible. Interpretations frequency analysis, these oscillations were categorized into three
from pseudo color coded thermograms are easier and faster. More- groups, viz. very low frequency (0.01–0.04 Hz) due to frequency
over, this technique records only the natural radiation emanating of breathing and parasympathetic control, low frequency (0.04–
from the skin surfaces and has no harmful radiation effects. So, it 0.15 Hz) due to myogenic mechanism and high frequency (0.15–
is suitable for prolonged and repeated use. Finally, IRT is a real time 0.30 Hz) due to thermoregulation. In the second approach, a cold
technique, which enables monitoring of dynamical variations of stress was applied by placing the left hand on a cold metal surface
temperature. Due to these advantages, thermography has been and temperature dynamics on both hands were observed using IRT.
established as an effective alternative diagnosis tool. Table 4 shows It was observed that, after a long steady state period of 85 s the
the contralateral temperature difference (between left and right temperature on the stimulated hand decreased while the temper-
sides) for a few body parts in normal subjects [4,109]. ature on the other hand increased. This phenomenon is attributed
to the fact that thermoregulatory mechanism responds in such a
6.1. Thermoregulation study way that the core temperature remains undisturbed. Using IRT,
Kargel monitored local heating in ear-skull regions of human sub-
Metabolism and flexing of muscles during exercise are the prin- jects while using different hand-held mobile phones [111]. They
cipal sources of heat in body core [4]. Thereafter, the heat is trans- observed that, while in operation, mobile phones with higher spe-
ferred from the core towards the outer periphery of the body by cific absorption rate (SAR) value caused higher temperature rise. It
blood flow through blood vessels. Blood gains heat from the core has also been reported that maximum temperature increase is at
of the body and loses heat at the peripheral parts, especially skin. the end of talking phase and its value increases with the duration
This monitoring process is called thermoregulation. Dynamics of of talking period [112]. Fig. 4 shows typical facial thermal images
surface temperature distribution is governed by a number of fac- of a subject using hand-held mobile phone. Fig. 4a shows the ther-
tors, viz. blood flow in the surface layer, heat conduction from dee- mal image after 1 min of talking and Fig. 4b shows the thermal im-
per blood vessels and sweat evaporation from surface [95]. age after 15 min of talking. The encircled region shows an increase
Thermography is an effective tool for monitoring thermoregulation in temperature of 4.59 °C after 15 min of talk.
processes. Gulyaev et al. observed that, in majority of healthy sub-
jects, temperature of the hands, feet and facial regions increases
after immobilization [95]. This is because immobilization is gener- 6.2. Breast cancer detection
ally followed by relaxation and blood redistribution, which causes
the surface skin temperature to increase. They further observed Breast cancer is the most commonly diagnosed cancer in female
spontaneous oscillations, due to changes in sympathetic system subjects accounting for about 30% cancers [113]. During 2003–2007,
Author's personal copy
B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235 227
Fig. 4. Typical thermal images of a subject talking on a hand-held mobile phone; (a) after 1 min of talking and (b) after 15 min of talking. After 15 min of talking the
temperature of the encircled region increased from 30.56 to 35.15 °C, whereas the temperature of the ear region (indicated by an arrow) increased from 33.35 to 34.82 °C.
average age for death due to breast cancer was 68 years. contrast in case of tumors underneath the skin [35]. They used
Approximately 0.0%, 0.9%, 6.0%, 15.0%, 20.8%, 19.7%, 22.6% and water and 75% medical ethanol solution as evaporant, which was
15.1% deaths occurred between the age groups of under 20, 20– sprayed over the skin surface and then images were acquired. Their
34, 35–44, 45–54, 55–64, 65–74, 75–84 and above 85 years respec- study shows an improved diagnostic accuracy especially in the early
tively [114]. It has been reported that 0% diagnosis was possible stages of deeply embedded tumors. Spitalier et al. screened 61,000
under age of 20 years, whereas 1.9%, 10.2%, 22.6%, 24.4%, 19.7%, women using thermography over a period of 10 years and found
15.5% and 5.6% diagnosis were possible within the age groups of that, thermography was the earliest indicator of breast cancer in
20–34, 34–44, 45–54, 55–64, 65–74, 75–84 and above 85 years 60% cases [118]. It has been confirmed that abnormal patterns in
respectively [114]. Studies show that, early detection can lead to the infrared images are the highest risk indicators of breast cancer
85% survival chance compared to 10% for late detection [115]. development in future [119]. Gamagami studied angiogenesis by
Therefore, early detection is the key factor for successful breast IRT and reported that in 15% cases IRT could detect cancers which
cancer treatments. In 1982, US Food and Drug Administration were not discernible by mammography [120]. He had also shown
(FDA) approved IRT as an adjunctive tool for diagnosis of breast that, hypervascularity and hyperthermia were visible in 86% cases
cancer. Kennedy et al., in a recent review, presented a comparative of nonpalpable breast cancers. Head et al. reported that, growth
study of IRT and other imaging techniques for breast screening and rate related prognostic indicators are strongly associated with
concluded that IRT provides additional functional information on the thermograms [121]. Thermovascular activities in breast are di-
the thermal and vascular condition of the tissues [116]. Ng pre- rectly related to prognosis and aggressiveness of the tumor. It has
sented an excellent review of IRT as a non-invasive breast tumor been reported that, hot cancers (most active cancer cells) show a
detection modality, where he described the basic methodology, poorer prognosis with 24% survival rate in 3 years, whereas for
standard practices, image capture and image analysis in detail cooler cancers prognosis is much better with 80% survival rate
[117]. He described that, abnormal breast thermogram indicate [36]. Aweda et al. has used IRT for cancer management and re-
significant biological risk. Tumors generally have an increased ported that, mean oxygen consumption and mean metabolic heat
blood supply and an increased metabolic rate which leads to local- production rate in controls are higher than in breast, head and
ized high temperature spots over such areas, rendering them to be neck, cervical and other types of cancer [38].
visualized by IRT. Apart from passive breast imaging, cold stimula- Apart from IRT many other techniques are available for breast
tion based imaging procedures are also in practice [36]. Blood ves- imaging, like mammography, MRI, CT, ultrasound, etc. Mammogra-
sels, produced by cancerous tumors are simple endothelial tubes phy is the most popular technique, but suffers from a few inherent
devoid of a muscular layer. Such blood vessels fail to constrict in problems, like exposure to X-ray radiation, relatively higher cost,
response to sympathetic stimulus like a sudden cold stress and problem in detecting tumors of smaller sizes and low sensitivity
show a hyperthermic pattern due to vasodilatation. Deng and Liu for firm breasts of younger women. IRT does not suffer from such
showed that, induced evaporation enhances thermographic problems and hence, it is a novel tool for investigation of breast
Fig. 5. Typical thermal images of a female subject suffering from breast cancer [123]; (a) left breast thermogram and (b) right breast thermogram. The encircled region in the
right breast thermogram shows higher temperature with respect to the surrounding normal regions. Later biopsy confirmed existence of cancer in the right breast.
Author's personal copy
228 B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235
cancer. Arora et al. observed that, IRT is an effective alternative the MFT values show a positive correlation with the right and left
diagnosis tool, especially in female subjects with dense breast great toe VPT values. Fig. 6 shows the MFT values as a function of
parenchyma [122]. mean VPT values. There are 28 subjects with VPT value less than
A typical case study, which demonstrates the effectiveness of 20 and MFT values within a temperature band of 27–30 °C, whereas
IRT as an early indicator of breast cancer, is discussed below there are 33 subjects with diabetic neuropathy (VPT values greater
[123]. A female subject reported a lump in the right breast, mam- than 20), whose MFT values were within a temperature band of
mography report of which was negative. Fig. 5 shows the thermo- 30–37 °C. Fig. 7 shows the thermal images of the lower extremities
grams of the left and right breasts respectively [123]. From Fig. 5b, of two diabetic subjects. The subject in Fig. 7a is a 44 year old neu-
it can be clearly seen that the lump region (encircled) is at an ele- ropathic male, whereas the subject in Fig. 7b is a 67 year old non-
vated temperature with respect to the surrounding normal tissues. neuropathic female. The average foot temperature in the encircled
Later biopsy confirmed the lump as a cancer. Kateb et al. used regions is 34.1 and 29.3 °C for the two cases respectively. Armstrong
intraoperative thermal imaging on a 76 years old female subject et al. compared skin temperatures of subjects with asymptomatic
suffering from metastatic intracortical melanoma [124]. The IR peripheral sensory neuropathy, neuropathic ulcers and Charcots’s
images of the tumor and the surrounding normal cortex regions anthropathy, using contralateral limb as a control [26]. They re-
show that, the former is at a higher temperature compared to ported significant differences in skin temperature between the af-
the later. fected foot and its contralateral part for subjects with Charcot’s
anthropathy and neuropathic ulcers, whereas there was no such
temperature difference observed for subjects with asymptomatic
6.3. Diagnosis of diabetic neuropathy and vascular disorder
peripheral sensory neuropathy.
In the earlier stages of arteriosclerosis obliterans (ASO), periph-
About 50% of diabetes subjects are hospitalized due to foot com-
eral circulation is one of the complications of diabetes mellitus
plications which are the most common problems with diabetes mel-
subjects. Hosaki et al. investigated peripheral circulation quantita-
litus subjects [125]. Principal causes of such foot complications are
tively by IRT in diabetes mellitus subjects [33]. They observed that,
decreased blood supply (vascular disorder) and loss of sensation
temperature gradients indicating abnormal blood flow in the af-
(neuropathy). An excellent review on role of IRT in foot complication
fected regions are correlated with clinical findings. Bagavathiappan
due to diabetes is presented by Bharara et al. [28]. Both vascular dis-
et al. investigated diabetes mellitus subjects with vascular disorder
order and diabetic neuropathy cause changes in skin surface tem-
and found that, temperature of the affected regions is higher than
perature, which makes IRT a suitable tool for diagnosing diabetic
that of the unaffected regions [32,128,129]. This abnormal temper-
neuropathy or vascular disorders. Jiang et al. analyzed metabolic
ature rise is attributed to slow blood circulation in the affected re-
parameters of diabetic subjects based on IRT [126]. Branemark
gions [129]. Fig. 8a shows the thermal image of left lower limb of a
et al. studied a number of diabetes subjects and found that, all of
28 year old male subject suffering from pain and varicosity of the
them had abnormal temperature patterns in feet and hands, like re-
long saphenous system of the left lower limb for 1 year. Clinical
duced temperature on the toes, metatarsal regions and fingers
examinations of the limb confirmed the existence of dilated tortu-
[127]. Sun et al. studied the relationship between plantar skin tem-
ous veins in the dorsal aspect of the foot. From the thermal image,
perature and sympathetic dysfunction in diabetic at-risk feet [107].
it can be clearly seen that the distal portion (indicated by an arrow)
They found that, diabetes at-risk subjects have significantly higher
of the foot is at a lower temperature, due to slow blood circulation
mean foot temperature (30.2 ± 1.3 °C) compared to the normal sub-
and varicosity induced inadequate venous drainage [32]. Fig. 8b
jects (26.8 ± 1.8 °C). Their studies indicated that, thermoregulatory
shows the temperature plot along the straight line shown in
sweating disorder signified early sympathetic damages in diabetic
Fig. 8a. Temperature of the encircled region, as shown in Fig. 8a,
feet, which can be detected in the initial stages using IRT. Bagava-
is 0.7–1.0 °C higher compared to the surrounding regions. This
thiappan et al. studied several randomly chosen type 2 diabetes sub-
abnormal temperature is attributed to the presence of varicose
jects without feet problems [16]. They established that, subjects
veins with mild inflammation [32].
with vibratory perception threshold (VPT) values greater than 20,
show a higher mean foot temperature (MFT) band. Neuropathic sub-
6.4. Fever screening
jects have higher MFT compared to the non-neuropathic ones and
Nguyen et al. studied the effectiveness of infrared thermal
imaging for mass screening of fever, where thermograms of the
neck and facial regions were recorded [130]. They observed that,
sensitivity of the thermal imaging methodology was similar to that
of self-reported fever cases and concluded that IRT is an effective
tool for fast and non-contact mass screening of fever. Chamberlain
et al. used infrared emission based thermometer for normal ear
temperature determination in various age groups [131]. The out-
break of pandemics like severe acute respiratory syndromes (SARS)
and avian influenza has paved the way for effective utilization of
IRT based techniques for mass screening of fever [42–
44,132,133]. Recently IRT was used successfully for mass screening
of fever in subjects with SARS, a highly infectious disease caused
by coronavirus [134]. Chiang et al. also reported similar results
[135]. Screening of potential infected subjects is a primary require-
ment for prevention of mass spreading of SARS. Ng studied the
effectiveness of IRT in mass screening of fever. He concluded that
elevated body temperature is one of the most common syndromes
Fig. 6. Mean foot temperature (MFT) of diabetic subjects as a function of their VPT
values [16]. For non-neuropathic subjects with VPT values less than 20, MFT values
of many infectious diseases, including SARS and hence IRT is a
are within 27–30 °C, whereas for neuropathic subjects with VPT values greater than powerful tool for initial mass screening of subjects during public
20, MFT values are within a temperature band 30–37 °C. health crisis [136]. Nishiura and Kamiya used IRT for entry
Author's personal copy
B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235 229
Fig. 7. Typical thermal images of plantar region for two diabetic subjects [16]; (a) 44 year old neuropathic male subject with HbA1c value of 9.6% and (b) 67 year old non-
neuropathic female subject with HbA1c value of 6.6%. Average temperature of the encircled regions in case of neuropathic and non-neuropathic subjects is 34.1 and 29.1 °C.
Fig. 8. (a) Thermal image of left lower limb of a 28 year old male diabetic subject suffering from vascular disorder [32]. The distal portion (indicated by an arrow) is at a lower
temperature due to slow blood circulation and varicosity induced inadequate venous drainage. The encircled region is at 0.7–1 °C higher temperature with respect to the
surrounding region. This elevated temperature is attributed to the presence of varicose veins, with probable mild inflammation. (b) Temperature profile along the line shown
in Fig. 8a. The lowest temperature is indicated with an arrow.
230 B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235
of 0.5 °C whereas subjects with no IAN deficit have symmetrical concluded that IRT is an effective tool for such applications. Costello
thermal patterns, which can be attributed to the blockage of vascu- et al. have used IRT for assessing decrease in skin temperature in hu-
lar neuronal vasoconstrictive messages [151]. man subjects following cryotherapy, which is therapeutic use of
In spite of its many advantages, electro-thermal debonding cold in various clinical settings [66].
(ETD), which is a popular technique for debonding of orthodontic
brackets, may cause thermal damage to the dental pulpal tissue. 6.7. Blood pressure monitoring
Cummings et al. performed in vitro study, using IRT, on extracted
human premolar teeth and found that, during ETD, pulpal temper- Arterial blood pressure and the corresponding thermograms, in
ature increases from 16.8 to 45.6 °C and thereby posing serious two different groups of hypertensive subjects, one treated with a
damage to the pulpal tissues [152]. Using IRT, Carson et al. studied combination of atenolol (b1 receptor antagonist) plus chlorthali-
the heat distribution pattern during high speed cavity preparation done and the other treated with labetalol (mixed a/b adrenergic
using both air–water spray and air spray and they found that, antagonist) plus chlorthalidone were monitored by Cesaris et al.
mean temperature increase in the two processes are 2.8 and [171]. Using IRT, hypothermia was observed on the hands of the
3.7 °C respectively [153]. Watanabe et al. investigated generation subjects in both the groups before treatment. After 1 month of
and spreading of heat during drilling of dental bone, using IRT treatment, no changes in peripheral vascular flow could be ob-
[154]. Benington et al. also used IRT for monitoring changes in served in the former group, whereas significant improvements in
bone temperature during drilling process for implant site prepara- vascular flow were observed in the second group.
tion [155]. Madura et al. used in vitro IRT for studying thermal
influence of Nd:YAG laser on a tooth root during sterilization pro- 6.8. Diagnosis of rheumatic diseases
cess [156]. Experiments were performed on an extracted single
rooted human tooth. They studied the influence of heat transmis- IRT has been successfully used in the diagnosis and assessment
sion, tissue thickness and irradiation time on the temperature rise of recovery after treatment in Raynaud’s phenomena [52,172–
of the tooth. Based on the above studies it can be concluded that, 174], gout [175] and arthritis [176,177]. Arnold et al. reported that,
IRT can be successfully used for temperature monitoring of the IRT is an excellent technique for measurement of skin temperature
dental tissue and optimization of sterilization process. Other appli- over different joints [178]. Ring demonstrated that, the subjects
cations of infrared thermography in dental sciences include evalu- suffering from rheumatoid arthritis, juvenile arthritis, osteoarthro-
ation of craniomandibular disorders [157], detection of carotid sis, gout, etc. show abnormal temperature distributions over joints
occlusal disease [158], quantification of the effects of post-surgical [179]. Collins et al. developed a thermographic index based meth-
inflammation [159,160]. odology for quantification of joint inflammation in human subjects
[180]. Ring et al. have demonstrated the use of IRT to quantify the
6.6. Dermatological applications effects of non-steroidal anti-inflammatory drugs (aspirin, indo-
methacin and benorylate) in subjects with rheumatoid arthritis
Skin diseases, in general, cause inflammation which in turn and gout [177]. Based on their studies it has been concluded that,
causes abnormal temperature pattern on skin surface. Hence, IRT IRT is a suitable tool for assessment of the response to the anti-
may be considered as a suitable technique for studying skin dis- inflammatory treatment. Paterson et al. used IRT for assessment
eases. IRT has been used for diagnosis of leprosy subjects and it of rheumatoid inflammation in the knee joint, while using anti-
has been reported that, cooler areas (like ear and nasal rim region) inflammatory steroid therapy [181]. Frize et al. used IRT for diag-
are heavily affected [161,162]. Vargas et al. developed a normalized nosis of rheumatoid arthritis in human subjects and found that,
thermography methodology, where they used dimensionless aver- metacarpal phalangeal joints of the index, middle fingers and knee
age temperature (i.e. ratio of measured average temperature to a are the most suitable locations for IRT based studies [182]. Wu
reference temperature), for leprosy diagnosis on a 50 year old male et al. reported that, local skin temperature near the coccyx region
subject with hepatitis-C history of 20 years [163]. They monitored decreases significantly after conservative therapy in subjects suf-
the subject for 587 days and found that, using thermal images effec- fering from coccygodynia [183]. Their studies concluded that IRT
tiveness of leprosy treatment is detectable in 87 days whereas is as an effective tool for assessment of pain intensity after treat-
repigmentation is visually detectable only after 182 days. Benko ment of coccygodynia. Park et al. highlighted the effectiveness of
et al. studied the thermal effects of exposure to beta radiation using infrared thermal imaging in subjects with shoulder impingement
IRT [69]. They observed that, the average temperature of the ex- syndrome [49]. Thermographic results were compared with other
posed region increases immediately after absorption of beta dose. clinical findings and this study confirmed that, the decreased range
Thomas et al. had highlighted the use of IRT in laser based skin of motion and hypothermic temperature patterns are correlated.
treatment especially in cases of vascular lesions and depilation, Shoulder immobility causes localized muscle atrophy, which in
where IRT was used for optimization of laser parameters [164]. Ma- turn induces apoptosis in the endothelial cells of the muscle capil-
son et al. used IRT for assessment of burn injury depth and con- laries, which eventually leads to a decreased blood flow in the cap-
cluded that thermographic findings are far more accurate than illary resulting in hypothermic patterns [184]. Vecchio et al.
clinical findings [165]. Cole et al. also reported similar results and reported that most of the subjects with unilateral frozen shoulder
concluded that, IRT might be helpful for selecting subject for early present anomalous temperature distribution [185]. Jeracitano et al.
surgery [166]. Schnell and Zaspel used IRT for cooling management found that, subjects with adhesive capsulitis show an abnormal
of extensive burns [167]. Mercer et al. have used IRT for monitoring temperature pattern which indicate sympathetic dysfunction in
the improvement of wound healing by water-filtered infrared-A the subserving pain from the affected shoulder [186]. Thomas
(WIRA) in human subjects with chronic venous stasis ulcers [168]. et al. investigated unilateral and bilateral cases of tennis elbow
Weerd et al. used IRT in autologous breast reconstruction with a using IRT and observed that in 94% unilateral and 100% bilateral
deep inferior epigastric perforator flap[169]. They described that, cases, hot spots could be detected [187].
this technique can be used for indirect monitoring of skin blood per-
fusion, pre-operative planning and post-operative monitoring. Re- 6.9. Diagnosis of dry eye syndrome and ocular diseases
cently Flores-Sahagun et al. used IRT for diagnosis and analysis of
basal cell carcinoma, which is the most common skin cancer malig- Using IRT, Morgan et al. recorded thermograms of ocular sur-
nancy [170]. They proposed a method of conjugated gradients and faces of dry eye subjects and controls [188]. It was found that,
Author's personal copy
B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235 231
Fig. 9. (a) Thermal image of left eye of a normal subject, where the cornea region is clearly discernible. Cornea appears to be at a lower temperature compared to the
surrounding region. (b) Temperature profile along the horizontal line shown in Fig. 9a. The line profile shows that, the temperature distribution across cornea is symmetric in
normal subjects and the coolest spot is little shifted from the geometrical center of the cornea. This may be attributed to the flow of tear fluid, which causes a decrease in
temperature of the cornea.
mean ocular surface temperature is greater in the dry eye subjects thermographic investigation can be a complementary test in kid-
(32.38 ± 0.69 °C) compared to the controls (31.94 ± 0.54 °C). Tan ney transplantation subjects for diagnosis of pathological intrare-
et al. have reviewed different methodologies, like manual, semi- nal or perirenal disorders and also for evaluating graft function
automatic and fully automatic methods, for studying ocular surface [58]. Oosterlinck and De reported that, IRT can be used to detect
temperature by IRT [3,189]. Chang et al. used IRT for diagnosis of different arterial areas in kidney and may be helpful in performing
inflammatory state of subjects with Graves’ ophthalmopathy avascular plane nephrotomies with minimum bleeding and renal
[190]. Temperature at different regions such as lateral orbit (refer- parenchyma loss [196].
ence point), upper and lower eyelids, caruncle, medial and lateral
conjunctiva and cornea was measured and it was observed that, 6.12. Heart operation
for subjects suffering from Graves’ ophthalmopathy, temperature
differences between the reference point and other regions are sig- Manginas et al. studied the feasibility of thermography in sub-
nificantly higher compared to the corresponding temperature dif- jects with coronary artery disease (CAD) and in subjects after heart
ferences in the controls. It has also been found that, IRT is useful transplantation (Tx) [59]. They performed IRT experiments in 16
in studying follow-up effects of methylprednisolone pulse therapy. subjects with CAD, 19 heart transplanted subjects and 6 subjects
Brunsmann et al. used IRT to evaluate thermal load during laser without structural heart diseases (control). They compared the left
corneal refractive surgery [191]. Ng et al. proposed that, enhanced and right ventricular temperature and found that, CAD subjects
eye temperature could be a possible indication of fever [192]. A have a significantly higher temperature difference (0.19 ± 0.11 °C)
typical thermal image of a normal eye is shown in Fig. 9. It can compared to the Tx subjects (0.10 ± 0.06 °C) and the controls
be seen from Fig. 9b that, the corneal temperature distribution is (0.07 ± 0.04 °C). It has also been reported that, thermography can
symmetric in normal subjects and the coolest point of the cornea detect earliest signs of atherosclerosis and thereby can act as an
is not at the geometrical center of the cornea but slightly shifted early indicator of heart attack [197]. In numerous heat operation
from the center. This can be attributed to the flow of tear fluid cases IRT has been used as an additional viewing technique
which can cause a decrease in temperature of the cornea and pres- [198]. Madjid et al. used intracoronary thermography for detection
ence of upper eyelid [3]. of high risk vulnerable plaques [199].
Mansfield et al. used IRT for detecting liver metastases, which Thermography has been extensively used in the field of
cause abnormal temperature patterns on the skin surface [55]. gynecology also [60,61]. Birnbaum and Kliot commented that,
Knobel et al. used IRT to measure body temperature of neonates gynecology may be the most potential field for application of ther-
housed in incubators to examine relationship between body tem- mography, as during pregnancy the internal female genitalia
perature and necrotizing enterocolitis (NEC) in premature infants undergoes significant changes in size and vascularity and increase
[193]. It was observed that, mean abdominal-thoracic temperature in uterine volume during pregnancy leads to increase in the num-
differential is greater in the premature infants suffering from NEC. ber and size of blood vessels [62]. Menczer and Eskin performed
Milonov et al. used thermography with electrothermometry in IRT experiments on female subjects, where temperature was mea-
subjects with parasitic liver diseases [54]. In this study, unilocular sured at the level of the nipples and at a fixed level above and be-
hydatid disease (unilocular echinococcosis, caused by Echinococcus low the nipples for 4 weeks prior to delivery and on the first four
granulosus) and multilocular hydatid disease (multilocular echino- postpartum days [200]. It was reported that, subjects complaining
coccosis caused by Echinococcus multilocularis) were detected. about postpartum pains have significantly higher temperature
Their studies show that, IRT is a useful tool for detecting suppurat- compared to the subjects without postpartum pain. They com-
ing cysts. Bhatia et al. investigated infants and children with acute mented that, postpartum pain is mainly caused by venous and
and chronic liver diseases using IRT and found that, for 96% sub- lymphatic engorgement or filling of the acini with milk and both
jects, thermograms of the abdominal regions are abnormal [194]. processes increase vascularity directly or indirectly causing an in-
crease in the temperature, which renders IRT as an effective tool
6.11. Treatment of kidney for diagnosis of postpartum pain. Ng et al. studied erectile dysfunc-
tion (ED) in subjects using IRT and reported that, subjects with psy-
Studies show that, IRT enables real-time visualization of flow chogenic ED showed higher surface temperature compared to
distribution of hemofilter [195]. Kopsa et al. concluded that, organic ED subjects [201].
Author's personal copy
232 B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235
6.14. Personality testing and brain imaging [18] B.B. Lahiri, S. Bagavathiappan, P.R. Reshmi, J. Philip, T. Jayakumar, B. Raj,
Quantification of defects in composites and rubber materials using active
thermography, Infrared Physics & Technology 55 (2012) 191–199.
Gulyaev et al. observed that, thermographic patterns are influ- [19] R.B. Barnes, Thermography of the Human body, Science 140 (1963) 870–877.
enced by the subject’s personality and psychological state of mind [20] R.A. Sherman, A.L. Wideman, K.W. Karstetter, Comparative effectiveness of
[95]. They observed that, temperature distributions depend on the videothermography, contact thermography, and infrared beam
thermography for scanning relative skin temperature, Journal of
level of stress, concentration and psychological activities. Shevelev, Rehabilitation Research and Development 33 (1996) 377–386.
in his monograph on functional brain imaging, described a new [21] M.A. Fauci, R. Breiter, W. Cabanski, W. Fick, R. Koch, J. Ziegler, S.D. Gunapala,
methodology for thermal imaging of brain cortex, called thermoen- Medical infrared imaging–differentiating facts from friction, and the impact
of high precision quantum well infrared photodetector camera systems, and
cephaloscopy (TES) [45]. He discussed the principal mechanisms other factors, in its reemergence, Infrared Physics & Technology 42 (2001)
behind TES process as neural activity, local metabolism and local 334–344.
cerebral blood flow, which produced detectable variations in [22] L.J. Jiang, E.Y. Ng, A.C. Yeo, S. Wu, F. Pan, W.Y. Yau, J.H. Chen, Y. Yang, A
perspective on medical infrared imaging, Journal of Medical Engineering &
temperature. This technique revealed activated (heated) and deac- Technology 29 (2005) 257–267.
tivated (cooled) zones of the cerebral cortex. He observed that, this [23] E.F.J. Ring, A. Jung, J. Zuber, New opportunities for infrared thermography in
technique is able to detect sequences of activation in the specific medicine, Acta Bio-Optika et Informatica Medica 15 (2009) 28–30.
[24] A. Jung, J. Zuber, F. Ring, A Case Book of Infrared Imaging in Clinical Medicine,
cortical zones. Studies indicate that, brain tumors of glial origins MedPress, Warszawa, 2003.
are at 0.5–2.0 °C higher temperature compared to the surrounding [25] K. Ammer, E.F.J. Ring, The Thermal Image in Medicine and Biology, Uhlen-
normal tissues [202]. Verlag, Vienna, 1995.
[26] D.G. Armstrong, L.A. Lavery, P.J. Liswood, W.F. Todd, J.A. Tredwell, Infrared
dermal thermometry for the high-risk diabetic foot, Physical Therapy 77
7. Conclusions (1997) 169–175.
[27] M. Bharara, J.E. Cobb, D.J. Claremont, Thermography and thermometry in the
assessment of diabetic neuropathic foot: a case for furthering the role of
With the advent of newer generation infrared detectors, infrared thermal techniques, International Journal of Lower Extremity Wounds 5
thermal imaging is becoming a more accurate alternate medical (2006) 250–260.
diagnostic tool for abnormal temperature pattern measurements. [28] M. Bharara, J. Schoess, D.G. Armstrong, Coming events cast their shadows
before: detecting inflammation in the acute diabetic foot and the foot in
Besides, better temperature sensitivity, spatial resolution and non- remission, Diabetes/Metabolism Research and Reviews 28 (Suppl. 1) (2012)
contact nature, IRT is an absolutely harmless imaging methodology. 15–20.
Thermal images can be stored digitally and post-processed using [29] S.J. Benbow, A.W. Chan, D.R. Bowsher, G. Williams, I.A. Macfarlane, The
prediction of diabetic neuropathic plantar foot ulceration by liquid-crystal
various software packages to obtain insight into the thermal pattern. contact thermography, Diabetes Care 17 (1994) 835–839.
Interpretation of pseudo-color coded thermograms is comparatively [30] H. Fushimi, T. Inoue, M. Nishikawa, Y. Matsuyama, J. Kitagawa, A new index of
easier and faster. Studies so far indicate that, IRT can be successfully autonomic neuropathy in diabetes mellitus: heat stimulated thermographic
patterns, Diabetes Research and Clinical Practice 1 (1985) 103–107.
used for diagnosis of breast cancer, diabetes, dentistry, diabetic
[31] L.A. Lavery, K.R. Higgins, D.R. Lanctot, G.P. Constantinides, R.G. Zamorano, K.A.
neuropathy, etc. In coming years use of IRT in medical field is likely Athanasiou, D.G. Armstrong, C.M. Agrawal, Preventing diabetic foot ulcer
to surge. recurrence in high-risk patients, Diabetes Care 30 (2007) 14–20.
[32] S. Bagavathiappan, T. Saravanan, J. Philip, T. Jayakumar, B. Raj, R. Karunanithi,
T. Panicker, M.P. Korath, K. Jagadeesan, Infrared thermal imaging for
References detection of peripheral vascular disorders, Journal of Medical Physics 34
(2009) 43–47.
[1] Y. Houdas, E.F.J. Ring, Human Body Temperature, Plenum Press, New York, [33] Y. Hosaki, F. Mitsunobu, K. Ashida, H. Tsugeno, M. Okamoto, N. Nishida, S.
1982. Takata, T. Yokoi, Y. Tanizaki, K. Ochi, T. Tsuji, Non-invasive study for
[2] E.F.J. Ring, The historical development of temperature measurement in peripheral circulation in patients with diabetes mellitus, Annual reports of
medicine, Infrared Physics & Technology 49 (2007) 297–301. Misasa Medical Branch 72 (2002) 31–37.
[3] J.H. Tan, E.Y.K. Ng, U.R. Acharya, C. Chee, Infrared thermography on ocular [34] J.E. Thompson, T.L. Simpson, J.B. Caulfield, Thermographic tumor detection
surface temperature: a review, Infrared Physics & Technology 52 (2009) 97– enhancement using microwave heating, IEEE Transactions on Microwave
108. Theory and Techniques, MTT-26 (1978).
[4] B.F. Jones, A reappraisal of the use of infrared thermal image analysis in [35] Z.S. Deng, J. Liu, Enhancement of thermal diagnostics on tumors underneath
medicine, IEEE Transactions on Medical Imaging 17 (1998) 1019–1027. the skin by induced evaporation, in: Proc. 27th Annual Conference of IEEE
[5] N. Bouzida, A. Bendada, X.P. Maldague, Visualization of body Engineering in Medicine and Biology, Sanghai, China, 2005.
thermoregulation by infrared imaging, Journal of Thermal Biology 34 (2009) [36] W.C. Amalu, W.B. Hobbins, J.F. Head, R.L. Elliot, Infrared imaging of the breast
120–126. – an overview, in: J.D. Bronzino (Ed.), Biomedical Engineering Handbook,
[6] F. Ring, Thermal imaging today and its relevance to diabetes, Journal of third ed., Medical Devices and Systems, CRC Press, 2006, pp. 20.
Diabetes Science and Technology 4 (2010) 857–862. [37] N. Kosus, A. Kosus, M. Duran, S. Simavli, N. Turhan, Comparison of standard
[7] G. Martine, Essays Medical and Philosophical, Millar, London, 1740. mammography with digital mammography and digital infrared thermal
[8] C. Wunderlich, W. Woodman, On the Temperature in Diseases, a Manual of imaging for breast cancer screening, Journal of the Turkish-German
Medical Thermometry, vol. 71, The New Sydenham Society, London, England, Gynecological Association 11 (2010) 152–157.
1871. [38] M.A. Aweda, K.K. Ketiku, A.T. Ajekigbe, A.A. Edi, Potential role of
[9] J.D. Hardy, The radiation of heat from the human body. I–IV, Journal of Clinical thermography in cancer management, Archives of Applied Science Research
Investigation 13 (1934) 593–620 & 817–883. 2 (2010) 300–312.
[10] J.D. Hardy, C. Muschenheim, The radiation of heat from the human body. V, [39] G.C. Wishart, M. Campisi, M. Boswell, D. Chapman, V. Shackleton, S. Iddles, A.
Journal of Clinical Investigation 15 (1936) 1–8. Hallett, P.D. Britton, The accuracy of digital infrared imaging for breast cancer
[11] X. Maldague, Theory and Practice of Infrared Technology for Nondestructive detection in women undergoing breast biopsy, European Journal of Surgical
Testing, first ed., John Wiley and Sons, New York, 2001. Oncology 36 (2010) 535–540.
[12] M.F. Modest, Radiative Heat Transfer, second ed., Academic Press, California, [40] E.Y.K. Ng, E.C. Kee, Advanced integrated technique in breast cancer thermo-
2003. graphy, Journal of Medical Engineering & Technology 32 (2008) 103–114.
[13] J. Steketee, Spectral emissivity of the skin and pericardium, Physics in [41] D. Bitar, A. Goubar, J.C. Desenclos, International travels and fever screening
Medicine & Biology 18 (1973) 686–694. during epidemics: a literature review on the effectiveness and potential use
[14] H. Qi, N.A. Diakides, Infrared Thermal Imaging. <http://aicip.ece.utk.edu/ of non-contact infrared thermometers, Eurosurveillance 14 (2009) 1–5.
publication/06thermography.pdf>. [42] F. Ring, J. Mercer, Thermal Imaging for fever screening, ISO Focus, February
[15] J.R. Mansfield, M.G. Sowa, J.R. Payette, B. Abdulrauf, M.F. Stranc, H.H. Mantsch, (2007) 33–35.
Tissue viability by multispectral near infrared imaging: a fuzzy C-means [43] F. Ring, Pandemic: thermography for fever screening of airport passengers,
clustering analysis, IEEE Transactions on Medical Imaging 17 (1998) 1011– Thermology International 17 (2007) 67.
1018. [44] E.Y.K. Ng, G. Kaw, W.M. Chang, Analysis of IR thermal imager for mass blind
[16] S. Bagavathiappan, J. Philip, T. Jayakumar, B. Raj, P.N.S. Rao, M. Varalakshmi, fever screening, Microvascular Research 68 (2004) 104–109.
V. Mohan, Correlation between plantar foot temperature and diabetic [45] I.A. Shevelev, Functional imaging of the brain by infrared radiation
neuropathy by using an infrared thermal imaging technique, Journal of (Thermoencephaloscopy), Progress in Neurobiology 56 (1998) 269–305.
Diabetes Science and Technology 4 (2010) 1386–1392. [46] H. Fikackova, E. Ekberg, Can infrared thermography be a diagnostic tool for
[17] A Historical Perspective of Thermography, Omega. <http://www.omega.com/ arthralgia of the temporomandibular joint?, Oral Surgery, Oral Medicine, Oral
literature/transactions/volume1/historical3.html>. Pathology, Oral Radiology and Endodontics 98 (2004) 643–650
Author's personal copy
B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235 233
[47] B. Gratt, M. Anbar, Thermology and facial telethermography: Part II. Current [78] D.J. Watmough, P.W. Fowler, R. Oliver, The thermal scanning of a curved
and future clinical applications in dentistry, Dentomaxillofacial Radiology 27 isothermal surface, Physics in Medicine & Biology 15 (1970) 1–8.
(1998) 68–74. [79] Z.M. Zhang, B.K. Tsai, G. Machin, Radiometric Temperature Measurements,
[48] A.D. Carlo, Thermography and the possibilities for its applications in clinical Academic Press, Oxford, 2010.
and experimental dermatology, Clinics in Dermatology 13 (1995) 329–336. [80] D.P. Jones, Biomedical Sensors, Momentum Press, New York, 2010.
[49] J. Park, J.K. Hyun, J. Seo, The effectiveness of digital infrared thermographic [81] N.A. Diakides, New developments in low cost infrared imaging system,
imaging in patients with shoulder impingement syndrome, Journal of European Journal on Thermology 7 (1997) 213–215.
Shoulder and Elbow Surgery 16 (2007) 548–554. [82] R. Balcerak, J.P. Jenkins, N.A. Diakides, Uncooled focal plane arrays, in: Proc.
[50] R.K. Will, E.F.J. Ring, A.K. Clarke, P.I. Maddison, Infrared thermography, what 18th International Conference of IEEE Engineering in Medicine and Biology
is its place in rheumatology in the 1990’s, British Journal of Rheumatology 31 Society, Amsterdam, Netherlands, 1996.
(1992) 337–344. [83] T. White, C. Marshall, N. Butler, Uncooled infrared sensor with digital focal
[51] J.A. Cosh, E.F.J. Ring, Thermography and rheumatology, Rheumatology 10 plane array for medical applications, in: Proc. 18th International Conference
(1970) 342–348. of IEEE Engineering in Medicine and Biology Society, Amsterdam,
[52] L.F. Cherkas, L. Carter, T.D. Spector, K.J. Howell, C.M. Black, A.J. MacGregor, Use Netherlands, 1996.
of thermographic criteria to identify Raynaud’s phenomenon in a population [84] E.F.J. Ring, High resolution infrared imaging, European Journal on Thermology
setting, Journal of Rheumatology 30 (2003) 720–722. 8 (1998) 121.
[53] B. Zelichowska, R. Rozycki, M. Tlustochowicz, A. Kujawa, B. Kalicki, P. [85] B. Jones, P. Plassmann, Digital infrared thermal imaging of human skin, IEEE
Murawski, The usefulness of the thermography in the dry eye syndrome, Engineering in Medicine and Biology Magazine 21 (2002) 41–48.
Klinika Oczna 107 (2005) 483–487. [86] C. Jones, E. Ring, P. Plassmann, K. Ammer, B. Wiecek, Standardization of
[54] O.B. Milonov, O.D. Lebedeva, L.A. Pomelova, The use of echography and infrared imaging: a reference atlas for clinical thermography-initial results,
thermography in patients with parasitic liver diseases, Sovetskaia Meditsina Thermology International 15 (2005) 157–158.
4 (1980) 62–67. [87] E.F.J. Ring, K. Ammer, B. Wiecek, P. Plassmann, Technical challenges for the
[55] C.M. Mansfield, C. Farrell, S.O. Asbell, The use of thermography in the construction of a medical IR digital image database, in: J.P. Chatard, P.N.J.
detection of metastatic liver disease, Radiology 95 (1970) 696–698. Dennis (Eds.), Proc. SPIE, Detectors and Associated Signal Processing II, 2005,
[56] J.P. Brooks, W.B. Perry, A.T. Putnam, R.E. Karulf, Thermal imaging in the pp. 191–198.
detection of bowel ischemia, Diseases of the Colon and Rectum 43 (2000) [88] I. Fujimasa, I. Saito, T. Chinzei, Far infrared medical image database on the
1319–1321. world wide web, in: Proc. 19th Int. Conf. IEEE/EMBS, Chicago, IL, 1997, pp.
[57] H. Kopsa, W. Czech, P. Schmidt, J. Zazgornik, P. Pils, P. Balcke, Diagnostic 652–653.
relevance of contact thermography in renal transplantation (author’s [89] E.F.J. Ring, K. Ammer, A. Jung, P. Murawski, B. Wiecek, J. Zuber, P. Plassmann,
translation), Medizinische Klinik 74 (1979) 1067–1070. C.D. Jones, Standardization of thermal imaging. The Anglo-Polish reference
[58] H. Kopsa, W. Czech, P. Schmidt, J. Zazgornik, P. Pils, P. Balcke, Use of database, in: 10th Congress of the European Association of Thermology,
thermography in kidney transplantation: two year follow up study in 75 Zakopane, Poland, 2006.
cases, Proceedings of the European Dialysis and Transplant Association 16 [90] R. Vardasca, Template based alignment and interpolation methods
(1979) 383–387. comparison of region of interest in thermal images, in: P. Plassmann, P.
[59] A. Manginas, E. Andreanides, E. Leontiadis, P. Sfyrakis, T. Maounis, D. Roach (Eds.), Proceedings of the 3rd Research Student Workshop, University
Degiannis, P. Alivizatos, D. Cokkinos, Right ventricular endocardial of Glamorgan, The Research Office, 2008, pp. 21–24.
thermography in transplanted and coronary artery disease patients: first [91] P. Plassmann, E.F.J. Ring, An open system for the acquisition and evaluation of
human application, Journal of Invasive Cardiology 22 (2010) 400–404. medical thermological images, European Journal on Thermology 7 (1997)
[60] Gershon-Cohen, Haberman-Brueschke, Obstetric and gynecologic 216–220.
thermography, Obstetrics and Gynecology 26 (1965) 842–847. [92] P. Plassmann, P. Murawski, CTHERM for standardized thermography, in: 9th
[61] C. Loriaux, Role of thermography in gynecology, Journal de Radiologie d European Congress of Medical Thermology, Krakow, Poland, 2003.
Electrologie et de Medecine Nucleaire 56 (Suppl.) (1975) 57–58. [93] N. Rajic, Principal component thermography for flaw contrast enhancement
[62] S.J. Birnbaum, D. Kliot, Thermography-obstetrical applications, Annals of the and flaw depth characterisation in composite structures, Composite
New York Academy of Sciences 121 (1964) 209–222. Structures 58 (2002) 521–528.
[63] S.-y. Lo, Meridians in acupuncture and infrared imaging, Medical Hypotheses [94] W.E. Snyder, H. Qi, L.E. Head, C.X. Wang, Increasing the effective resolution of
58 (2002) 72–76. thermal infrared images, IEEE Engineering in Medicine and Biology Magazine
[64] R. Rossi, E.G. Lluesma, Infrared thermography and acupuncture of the lobe of 19 (2000) 63–70.
the outer ear in patients with facial pain, in: A.E. Rozlosnik, R.B. Dinwiddie [95] Y.V. Gulyaev, A.G. Markov, L.G. Koreneva, P.V. Zakharav, Dynamical infrared
(Eds.), Thermosense XXIII, Proceedings 2001, pp. 652–658. thermography in humans, IEEE Engineering in Medicine and Biology
[65] M. Ernst, M.H.M. Lee, Sympathetic vasomotor changes induced by manual Magazine 14 (1995) 766–771.
and electrical acupuncture of the hoku point visualized by thermography, [96] M. Anbar, Quantitative Dynamic Telethermometry in Medical Diagnosis and
Pain 21 (1985) 25–33. Management, CRC Press, Boca Raton, FL, 1994.
[66] J.T. Costello, C.D. McInerney, C.M. Bleakley, J. Selfe, A.E. Donnelly, The use of [97] M. Anbar, L. Milescu, M.W. Grenn, K. Zamani, M.T. Marina, Study of Skin
thermal imaging in assessing skin temperature following cryotherapy: a hemodynamics with fast dynamic area telethermometry (DAT), in: Proc 19th
review, Journal of Thermal Biology 37 (2012) 103–110. Int. Conf. IEEE/EMBS, Chicago, IL, 1997, pp. 644–648.
[67] C. Cattaneo, A.D. Giancamillo, O. Campari, L. Martrille, C. Jouineau, Infrared [98] N.A. Diakides, J.D. Bronzino, Medical Infrared Imaging, CRC Press, 2007.
tympanic thermography as a substitute for a probe in the evaluation of ear [99] P.T. Kuruganti, H. Qi, Asymmetry analysis in breast cancer detection using
temperature for post-mortem interval determination: a pilot study, Journal of thermal infrared images, in: Proc. of the 2nd Joint EMBS-BMES Conference,
Forensic and Legal Medicine 16 (2009) 215–217. 2002, pp. 1129–1130.
[68] L.M. Al-Alousi, R.A. Anderson, D.M. Worster, D.D. Land, Multiple-probe [100] H. Qi, J. Head, Asymmetry analysis using automatic segmentation and classi-
thermography for estimating the postmortem interval: I. continuous fication for breast cancer detection in thermograms, in: Proc. 23rd Annual
monitoring and data analysis of brain, liver, rectal and environmental International Conference of the IEEE EMBS, Turkey, 2001, pp. 2866–2869.
temperatures in 117 forensic cases, Journal of Forensic Science 46 (2001) [101] J.M. Irvine, Targeting breast cancer detection with military technology, IEEE
317–322. Engineering in Medicine and Biology Magazine 21 (2002) 36–40.
[69] I. Benko, G.J. Koteles, G. Nemeth, Thermal Imaging of the effects of beta- [102] J.L. Paul, J.C. Lupo, From tanks to tumors, IEEE Engineering in Medicine and
irradiation on human body surfaces, in: QIRT 1996, Pisa, 1997. Biology Magazine 21 (2002) 34–35.
[70] K. Ammer, Published Papers on Thermology or Temperature Measurement [103] T.Z. Tan, C. Quek, G.S. Ng, E.Y.K. Ng, A novel cognitive interpretation of breast
Between 1989 and 2003. <http://www.lla.if.sc.usp.br/art/public1989- cancer thermography with complementary learning fuzzy neural memory
2003.pdf>. structure, Expert Systems with Applications 33 (2007) 652–666.
[71] K. Ammer, Thermology on the internet – an update, Thermology International [104] M.L. Brioschi, I. Sanches, F. Traple, 3D MRI/IR imaging fusion: a new medically
19 (2009) 15–28. useful computer tool, in: Inframation Proceedings, Las Vegas, 2007.
[72] F.W. Bertelsmann, J.J. Heismann, E.J. Weber, E.A.v.d. Veen, J.A. Schouten, [105] M.L. Brioschi, D. Colman, H.M. Neto, Fusing IR and magnetic resonance (MR)
Thermal discrimination thresholds in normal subjects and in patients with image, Journal of Korean Medical Thermology 2 (2002) 57–58.
diabetic neuropathy, Journal of Neurology Neurosurgery and Psychiatry 48 [106] M.L. Brioschi, J.V. Vargas, O. Malafaia, Review of recent developments in
(1985) 686–690. thermographic applications in health care, in: Inframation 2004 Proceedings,
[73] M. Anbar, B. Gratt, D. Hong, Thermology and facial telethermography. Part I: Las Vegas, 2004.
history and technical review, Dentomaxillofacial Radiology 27 (1998) 61–67. [107] P. Sun, H. Lin, S.E. Jao, Y. Ku, R. Chan, C. Cheng, Relationship of skin
[74] R.P. Clark, M.L.d. Calcina-Goff, International standardization in medical temperature to sympathetic dysfunction in diabetic at-risk feet, Diabetes
thermography, in: 18th Int. Conf. IEEE Engineering in Medicine and Biology Research and Clinical Practice 73 (2006) 41–46.
Society, Amsterdam, The Netherlands, 1996. [108] H.H. Pennes, Analysis of tissue and arterial blood temperatures in the resting
[75] E.F.J. Ring, K. Ammer, The technique of infrared imaging in medicine, human forearm, Journal of Applied Physiology 1 (1948) 93–122.
Thermology International 7 (2000) 7–14. [109] S. Uematsu, Symmetry of skin temperature comparing one side of the body to
[76] S. Webb, The Physics of Medical Imaging, first ed., Institute of Physics other, Thermology 1 (1986) 4–7.
Publishing, Bristol, 1988. [110] B.G. Vainer, FPA-based infrared thermography as applied to the study of
[77] J.A. Clark, Effects of surface emissivity and viewing angle on errors in cutaneous perspiration and stimulated vascular response in humans, Physics
thermography, ACTA Thermographica 1 (1976) 138–141. in Medicine & Biology 50 (2005) R63–R94.
Author's personal copy
234 B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235
[111] C. Kargel, Infrared thermal imaging to measure local temperature rises [140] J.B. Mercer, E.F.J. Ring, Fever screening and infrared thermal imaging:
caused by handheld mobile phones, IEEE Transactions on Instrumentation concerns and guidelines, Thermology International 19 (2009) 67–69.
and Measurement 54 (2005) 1513–1519. [141] E.F.J. Ring, H. Mcevoy, A. Jung, J. Zuber, G. Machin, New standards for devices
[112] M.D. Taurisano, A.V. Vorst, Experimental thermographic analysis of thermal used for the measurement of human body temperature, Journal of Medical
effects induced on a human head exposed to 900-MHz fields of mobile Engineering & Technology 34 (2010) 249–253.
phones, IEEE Transactions on Microwave Theory and Techniques 48 (2000) [142] Standards Technical reference for Thermal Imagers for Human Temperature
2022–2032. Screening Part 2: Users’ Implementation Guidelines, SPRING, Singapore, TR
[113] American Cancer Society: Cancer facts and Figures. <www.cancer.org/ 15–2 (2004).
docroot/STT/stt_0.asp>. [143] Standards Technical Reference for Thermal Imagers for Human Temperature
[114] National Cancer Institute: SEER Stat Fact Sheets: Breasts. <www.seer. Screening Part 1: Requirements and Test Methods, SPRING, Singapore, TR 15–
cancer.gov/statfacts/html/breast.html>. 1 (2003).
[115] E.Y.K. Ng, N.M. Sudarshan, Numerical computation as a tool to aid [144] ISO/TR 13154:2009. <http://www.iso.org/iso/catalogue_detail?csnumber=
thermographic Interpretation, Journal of Medical Engineering & Technology 51236>.
25 (2001) 53–60. [145] S. Weinstein, Standards for neuromuscular thermographic examination,
[116] D. Kennedy, T. Lee, D. Seely, A comparative review of thermography as a Modern Medicine: Supplement 1 (1986) 5–7.
breast screening technique, Integrative Cancer Therapies 8 (2009) 9–16. [146] B. Gratt, S. Graff-Radford, V. Shetty, W. Solberg, E. Sickles, A six year clinical
[117] E.Y.K. Ng, A review of thermography as promising non-invasive detection assessment of electronic facial thermography, Dentomaxillofacial Radiology
modality for breast tumor, International Journal of Thermal Sciences 48 25 (1996) 247–255.
(2009) 849–859. [147] B. Gratt, E. Sickles, Electronic facial thermography: an analysis of
[118] H. Spitalier, D. Giraud, Does infrared thermography truly have a role in present- asymptomatic adult subjects, Journal of Orofacial Pain 9 (1995) 255–265.
day breast cancer management?, Biomedical Thermology (1982) 269–278 [148] B. Gratt, E. Sickle, J. Ross, Wexler, Gornbein, Thermographic assessment of
[119] J.W.K. Louis, M. Gautherie, Long term assessment of breast cancer risk by craniomandibular disorders: diagnostic interpretation versus temperature
thermal imaging, Biomedical Thermology (1982) 279–301. measurement analysis, Journal of Orofacial Pain 8 (1994) 278–288.
[120] P. Gamagami, Atlas of Mammography: New Early Signs in Breast Cancer, [149] D. Canavan, B. Gratt, Electronic thermography for the assessment of mild and
Blackwell Science, United Kingdom, 1986. moderate temporomandibular joint dysfunction, Oral Surgery, Oral Medicine,
[121] J.F. Head, F. Wang, R.L. Elliot, Breast thermography is a noninvasive Oral Pathology 79 (1995) 778–786.
prognostic procedure that predicts tumor growth rate in breast cancer [150] B. Gratt, V. Shetty, M. Dent, M. Saiar, E. Sickles, Electronic thermography for
patients, Annals of the New York Academy of Sciences 698 (1993) 153–158. the assessment of inferior alveolar nerve deficit, Oral Surgery, Oral Medicine,
[122] N. Arora, D. Martins, D. Ruggerio, E. Tousimis, A.J. Swistel, M.P. Osborne, R.M. Oral Pathology 80 (1995) 153–160.
Simmons, Effectiveness of a noninvasive digital infrared thermal imaging [151] B. Gratt, E. Sickles, V. Shetty, Thermography for the clinical assessment of
system in the detection of breast cancer, The American Journal of Surgery 196 inferior alveolar nerve deficit: a pilot study, Journal of Orofacial Pain 8 (1994)
(2008) 523–526. 369–374.
[123] Breast Thermography, in: W.C. Amalu (Ed.), Redwood City, California 94063, [152] M. Cummings, P. Biagioni, P. Lamey, D. Burden, Thermal image analysis of
2011. <http://www.breastthermography.com/case_studies.htm>. electrothermal debonding of ceramic brackets: an in-vitro study, European
[124] B. Kateb, V. Yamamoto, C. Yu, W. Grundfest, J.P. Gruen, Infrared thermal Journal of Orthodontics 21 (1999) 111–118.
imaging: a review of the literature and case report, NeuroImage 47 (2009) [153] J. Carson, T. Rider, D. Nash, A thermographic study of heat distribution during
T154–T162. ultra-high speed cavity preparation, Journal of Dental Research 58 (1979)
[125] D. Sims, P. Cavanagh, J. Ulbrecht, Risk factors in the diabetic foot. Recognition 1681–1684.
and management, Physical Therapy 68 (1988) 1887–1902. [154] F. Watanabe, Y. Tawada, S. Komatsu, Y. Hata, Heat distribution in bone during
[126] G. Jiang, Z. Shang, M. Zhang, Metabolism parameter analysis of diabetics preparation of implant sites: heat analysis by real time thermography,
based on the thermography, in: Proceeding of the 24th Annual Conference International Journal of Oral and Maxillofacial Implants 7 (1992)
and the Annual Fall Meeting of the Biomedical Engineering Society EMBS/ 212–219.
BMES Conference, 2002, pp. 2226–2227. [155] I.C. Benington, P.A. Biagioni, P.J. Crossey, D.L. Hussey, S. Sheridan, P.J. Lamey,
[127] P. Branemark, S. Fagerberg, L. Langer, J.S. Soderbergh, Infrared thermography Temperature changes in bovine mandibular bone during implant site
in diabetes mellitus, Diabetologia 3 (1967) 529–532. preparation: an assessment using infra-red thermography, Journal of
[128] S. Bagavathiappan, J. Philip, T. Jayakumar, B. Raj, Infrared thermal imaging for Dentistry 24 (1996) 263–267.
medical diagnosis, Medical Equipment & Automation (2009) 65–67. [156] H. Madura, M. Dabrowski, R. Dulski, S. Zmuda, P. Zaborowski, Thermographic
[129] S. Bagavathiappan, T. Saravanan, J. Philip, T. Jayakumar, B. Raj, R. Karunanithi, method for evaluation of thermal influence of Nd:YAG laser on a tooth root
T.M. Panicker, P. Korath, K. Jagadeesan, Investigation of peripheral vascular during sterilization process, Infrared Physics & Technology 46 (2004) 167–
disorders using thermal imaging, The British Journal of Diabetes and Vascular 171.
Disease 8 (2008) 102–104. [157] P. Biagioni, R. Longmore, J. McGimpsey, P. Lamey, Infrared thermography: its
[130] A.V. Nguyen, N.J. Cohen, H. Lipman, C.M. Brown, N.A. Molinari, W.L. Jackson, role in dental research with particular reference to craniomandibular
H. Kirking, P. Szymanowski, T.W. Wilson, B.A. Salhi, R.R. Roberts, D.W. disorders, Dentomaxillofacial Radiology 25 (1996) 119–124.
Strykar, D.B. Fishbein, Comparison of 3 infrared thermal detection systems [158] A. Friedlander, B. Gratt, Panoramic dental radiography and thermography as
and self-report for mass fever screening, Emerging Infectious Diseases 16 an aid in detecting patients at risk for stroke, Journal of Oral and Maxillofacial
(2010) 1710–1717. Surgery 52 (1994) 1257–1262.
[131] J.M. Chamberlain, T.E. Terndrup, D.T. Alexander, F.A. Silverstone, G. Wolf- [159] P. Biagioni, J. McGimpsey, P. Lamey, Electronic infrared thermography as a
Klein, R. O’Doonell, J. Grandner, Determination of normal ear temperature dental research technique, British Dental Journal 180 (1996) 226–230.
with an infrared emission detection thermometer, Annals of Emergency [160] I. Venta, T. Hyrkas, I. Paakkari, P. Ylipaavalniemi, Thermographic imaging of
Medicine 25 (1995) 15–20. postoperative inflammation modified by anti-inflammatory pretreatment,
[132] J. Ohta, Case study: influenza pandemic countermeasures utilizing infrared Journal of Oral and Maxillofacial Surgery 59 (2001) 145–148.
thermography, NEC Technical Journal 5 (2010) 65–69. [161] R. Hastings, P. Brand, R. Mansfield, J. Ebner, Bacterial density in the skin in
[133] J. Ohta, E. Hamada, Detection of body surface temperature by infrared lepromatous leprosy as related to temperature, Leprosy Review 39 (1968)
thermography for prevention of influenza pandemic, NEC Technical Journal 71–74.
62 (2009) 88–92. [162] T. Sabin, J. Ebner, Patterns of sensory loss in lepromatous leprosy,
[134] W. Chiu, P. Lin, H.Y. Chiou, W.S. Lee, C.N. Lee, Y.Y. Yang, H.M. Lee, M.S. Hsieh, International Journal of Leprosy and Other Mycobacterial Diseases 37
C. Hu, Y.S. Ho, W.P. Deng, C.Y. Hsu, Infrared thermography to mass-screen (1969) 239–248.
suspected SARS patients with fever, Asia-Pacific Journal of Public Health 17 [163] J.V.C. Vargas, M.L. Brioschi, F.G. Dias, M.B. Parolin, F.A. Mulinari-Brenner, J.C.
(2005) 26–28. Ordonez, D. Colman, Normalized Methodology for medical infrared imaging,
[135] M.-F. Chiang, P.-W. Lin, L.-F. Lin, H.-Y. Chiou, C.-W. Chien, S.-F. Chu, W.-T. Infrared Physics & Technology 52 (2009) 42–47.
Chiu, Mass screening of suspected febrile patients with remote-sensing [164] R.A. Thomas, K.E. Donne, M. Clement, M.N. Kiernan, Optimized laser
infrared thermography: alarm temperature and optimal distance, Journal of application in dermatology using infrared thermography, in: Proc. of
the Formosan Medical Association 107 (2008) 937–944. Thermosense, vol. XXIV, 2002, pp. 424–435.
[136] E.Y.K. Ng, Is thermal scanner losing its bite in mass screening of fever due to [165] B.R. Mason, A.J. Graff, S.P. Pegg, Colour thermography in the diagnosis of the
SARS?, Medical Physics 32 (2005) 93–97 depth of burn injury, Burns 7 (1981) 197–202.
[137] H. Nishiura, K. Kamiya, Fever screening during the influenza (H1N1-2009) [166] R.P. Cole, S.G. Jones, P.G. Shakespeare, Thermographic assessment of hand
pandemic at Narita International Airport, Japan, BMC Infectious Diseases, burns, Burns 16 (1990) 60–63.
111–121 (2011). [167] H.M. Schnell, J.G. Zaspel, Cooling extensive burns: sprayed coolants can
[138] E.F.J. Ring, A. Jung, J. Zuber, P. Rutowski, B. Kalicki, U. Bajwa, Detecting fever in improve initial cooling management – a thermography-based study, Burns
polish children by infrared thermography, in: 9th International Conference 34 (2008) 505–508.
on Quantitative Infrared Thermography, Krakow, Poland, 2008. [168] J.B. Mercer, S.P. Nielsen, G. Hoffmann, Improvement of wound healing by
[139] D.D. Pascoe, E.F. Ring, J.B. Mercer, J. Snell, D. Osborn, J. Hedley-Whyte, water-filtered infrared-A (wIRA) in patients with chronic venous stasis ulcers
International standards for pandemic screening using infrared of the lower legs including evaluation using infrared thermography, German
thermography, in: R.C. Molthen, J.B. Weaver (Eds.), Medical Imaging 2010: Medical Science 6 (2008) 1–26.
Biomedical Applications in Molecular, Structural, and Functional Imaging, [169] L.D. Weerd, J.B. Mercer, S. Weum, Dynamic infrared thermography, Clinics in
SPIE, 2010, pp. 76261Z-76261–76261Z-76268. Plastic Surgery 38 (2011) 277–292.
Author's personal copy
B.B. Lahiri et al. / Infrared Physics & Technology 55 (2012) 221–235 235
[170] J.H. Flores-Sahagun, J.V.C. Vargas, F.A. Mulinari-Brenner, Analysis and [186] D. Jeracitano, R. Cooper, L. Lyon, M. Jayson, Abnormal temperature control
diagnosis of basal cell carcinoma (CCC) via infrared imaging, Infrared suggesting sympathetic dysfunction in the shoulder skin of patients with
Physics & Technology 54 (2011) 367–378. frozen shoulder, British Journal of Rheumatology 31 (1992) 539–542.
[171] R.D. Cesaris, A. Grimaldi, M. Balestrazzi, G. Ranieri, R. Chirappa, F. [187] D. Thomas, G. Siahamis, M. Marion, C. Boyle, Computerised infrared
Avantaggianto, Changes in blood pressure and thermographic values thermography and isotopic bone scanning in tennis elbow, Annals of the
resulting from use of a beta-blocker plus diuretic and of an alpha-beta- Rheumatic Diseases 51 (1992) 103–107.
blocker plus diuretic, Drugs Under Experimental and Clinical Research 11 [188] P. Morgan, A. Tullo, N. Efron, Infrared thermography of the tear film in dry
(1985) 725–729. eye, Eye (London) 9 (1995) 615–618.
[172] E.F.J. Ring, N.J.M. Aarts, C.M. Black, P. Bosiger, Raynaud’s phenomenon: [189] J.H. Tan, E.Y.K. Ng, U.R. Acharya, C. Chee, Study of normal ocular thermogram
assessment by thermography (EAT Report), Thermology 3 (1988) 69–73. using textural parameters, Infrared Physics & Technology 53 (2010) 120–126.
[173] M. Hirschl, R. Katzenschlager, C. Francesconi, M. Kundi, Low level laser [190] T.C. Chang, Y.L. Hsiao, S.L. Liao, Application of digital infrared thermal
therapy in primary Raynaud’s phenomenon – results of a placebo controlled, imaging in determining inflammatory state and follow-up effect of
double blind intervention study, Journal of Rheumatology 31 (2004) 2408– methylprednisolone pulse therapy in patients with Graves’ ophthalmopathy,
2412. Graefe’s Archive for Clinical and Experimental Ophthalmology 246 (2008)
[174] B. Chikura, T. Moore, J. Manning, A. Vail, A.L. Herrick, Thumb involvement in 45–49.
Raynaud’s phenomenon as an indicator of underlying connective tissue [191] U. Brunsmann, U. Sauer, S. Arba-Mosquera, T. Magnago, N. Triefenbach,
disease, Journal of Rheumatology 37 (2010) 783–786. Evaluation of thermal load during laser corneal refractive surgery using
[175] M. Schiavenato, R.G. Thiele, Thermography detects subclinical inflammation infrared thermography, Infrared Physics & Technology 53 (2010) 342–347.
in chronic tophaceous gout, Journal of Rheumatology 39 (2012) 182–183. [192] D.K. Ng, C.H. Chan, R.S. Lee, L.C. Leung, Non-contact infrared thermometry
[176] N.J. McHugh, D.M. Elvins, E.F.J. Ring, Elevated Anticardiolipin Antib Odies in a temperature measurement for screening fever in children, Annals of Tropical
patient with vibration white-finger, valvular heart disease and psoriatic Paediatrics 25 (2005) 267–275.
arthritis, Clinical Rheumatology 12 (1993) 70–73. [193] R.B. Knobel, B.D. Guenther, H.E. Rice, Thermoregulation and thermography in
[177] E.F.J. Ring, A.J. Collins, P.A. Bacon, J.A. Cosh, Quantitation of thermography in neonatal physiology and disease, Biological Research for Nursing 13 (2011)
arthritis using multi-isothermal analysis II. Effect of nonsteroidal anti- 274–282.
inflammatory therapy on the thermographic index, Annals of the [194] M. Bhatia, J.R. Poley, J.D. Haberman, D.J. Boon, Abdominal Thermography in
Rheumatic Diseases 33 (1974) 353–356. infantile and childhood liver diseases, Southern Medical Journal 69 (1976)
[178] M.H. Arnold, S.J.L. Preston, E.M. Beller, W.W. Buchanan, Infra-red surface 1045–1048.
thermography. Evaluation of a new radiometry instrument for measuring [195] J.K. Unger, A.J. Lemke, C.G. Siestrup, Thermography as potential real-time
skin temperature over joints, Clinical Rheumatology 8 (1989) 225–230. technique to assess changes in flow distribution in hemofiltration, Kidney
[179] E. Ring, Thermography and rheumatic diseases, Bibliotheca Radiologica 6 International 69 (2006) 520–525.
(1975) 97–106. [196] W. Oosterlinck, W.S. De, Avascular nephrotomy by means of thermography,
[180] A. Collins, E. Ring, J. Cosh, P. Bacon, Quantitation of thermography in arthritis European Urology 7 (1981) 25–26.
using multi-isothermal analysis. I. The thermographic index, Annals of the [197] Montana Thermography Centre: The Heart’s Thermoscape. <http://www.
Rheumatic Diseases 33 (1974) 113–115. thermographyofmontana.com/other/2.php?t=prevent_Heart+Disease+%26+
[181] J. Paterson, W.S. Watson, E. Teasdale, A.L. Evans, P. Newman, W.B. James, D.A. Stroke>.
Pitkeathly, Assessment of rheumatoid inflammation in the knee joint, Annals [198] A.M.D. Grand, J.V. Frangioni, An operational near-infrared fluorescence
of the Rheumatic Diseases 37 (1978) 48–52. imaging system prototype for large animal surgery, Technology in Cancer
[182] M. Frize, C. Adea, P. Payeur, G.D. Primio, J. Karsh, A. Ogungbemile, Detection Research and Treatment 2 (2003) 553–562.
of rheumatoid arthritis using infrared imaging, in: Proc. of SPIE, 7962 (2011) [199] M. Madjid, J.T. Willerson, S.W. Casscells, Intracoronary thermography for
9620M-9621–79620M-79611. detection of high-risk vulnerable plaques, Journal of the American College of
[183] C.L. Wu, K.L. Yu, H.Y. Chuang, M.H. Huang, T.W. Chen, C.H. Chen, The Cardiology 47 (2006) C80–C85.
application of infrared thermography in the assessment of patients with [200] J. Menczer, B.A. Eskin, Evaluation of postpartum breast engorgement by
coccygodynia before and after manual therapy combined with diathermy, thermography, Obstetrics and Gynecology 33 (1969).
Journal of Manipulative and Physiological Therapeutics 32 (2009) 287–293. [201] W.K. Ng, Y.K. Ng, Y.K. Tan, Qualitative study of sexual functioning in couples
[184] H. Fujino, H. Kohzuki, I. Takeda, T. Kiyooka, T. Miyasaka, S. Mohri, Regression with erectile dysfunction: prospective evaluation of the thermographic
of capillary network in atrophied soleus muscle induced by hindlimb diagnostic system, Journal of Reproductive Medicine 54 (2009) 698–705.
unweighting, Journal of Applied Physiology 98 (2005) 1407–1413. [202] A.M. Gorbach, J.D. Heiss, L. Kopylev, E.H. Oldfield, Intraoperative infrared
[185] P.C. Vecchio, A.O. Adebajo, M.D. Chard, P.P. Thomas, B.L. Hazleman, imaging of brain tumors, Journal of Neurosurgery 101 (2004) 960–969.
Thermography of frozen shoulder and rotator cuff tendinitis, Clinical
Rheumatology 11 (1992) 382–384.