The sympathetic control

of skin blood-flow.

Sensory (afferent) signals that drive

autonomic activity may originate
from (A) the viscera (visceral
sensory);
(B) the surface of the body
(somatic sensory); and the external
environment (special sensory).
Sympathetic preganglionic
neurons are located in the lateral
horn (intermediolateral cell
column) of the spinal cord (A).

Sympathetic postganglionic
neurons are located in the
paravertebral ganglia (B) and in
the preaortic ganglia.

The adrenal medulla is a specialized

sympathetic ganglion (D).
Thermography:
It has been shown that the surface temperature of the human body is
symmetrical.

It is a reflection of blood flow in the dermal microcirculation, and the

control of this microcirculation is autonomic and specifically,
sympathetic.

The major basis of clinical thermography is the correlation of temperature

recordings with various conditions from disease and injury as it relates to
autonomic function.
 Early Thermography
•400 BC – Hippocrates
•ADD CLIP ART –
That man’s
a
took the first little
thermograms using wet MARY nutsy

mud over the body.

(He is said to have stated
“should one part of the body be •MUD BATH ?
colder or hotter than the other
corresponding part, disease is
present in that part”)
•ANIMAL?
Sir William Herschel.
Who discovered
infrared radiation 1800.
One of Herschel’s experiments to detect heat in the spectrum.
Sir John Herschel.
who made the first
thermogram 1840.
The very first thermal image in 1948 took 40
minutes to to scan
Contact thermography
Henk van der Veen , Dutch general practitioner ,
pioneer in the use of videothermography as diagnostic
in painful diseases sitting in front of a large
videothermograph developed by Philips biomedical
systems in the early 80th .
2004
 2009
2009
Videothermography was used to measure skin temperature,
and activity was recorded with the Upper Limb Activity Monitor.
Both methods have recently been validated for use in patients
with CRPS.
250

200

150

100

50

0
1 963 1 967 197 1 1975 1979 19 83 198 7 1991 1995 1 999 200 3

Fig. 1. Number of articles listed in medline from 1963 to 2003(*expected).

1200 Breast
33.6% Nervous system
1000 Extremity
Vascular
800 Face
Dental
19.4% Endocrine
600
19.4% Spine
Cardiac
400
Gynecolocic
11.9% Urologic
200
Musculoskeletal

0 Breas t V as c ular Endoc rine 5.3%

Gynec oloc ic
2.9%
2.7% 2.1% 1.4% 0.4%
0.1% 0.1% 0.1%

Fig. 5. Number of published articles categorized according

to the organ system. (n=2993)
97.9% Diagnostic aid

3.6
%

Monitoring for therapeutic

effect & disease progression

Fig.4. Usage of infrared thermography : diagnostic aid vs.

monitoring for therapeutic effect and disease progression.
 28.2%
27.5%
600

500

400
동부
300

10.6%
200
7.0%
100
3.5%
0Canc er Peripheral n. Diabetes Headac he Radic ulopathy Hyperhidros is
3.0%
2.4%
2.2%1.5%
2.4% 1.4%1.8%1.5%1.1%
0.7%0.4%

Fig. 6. Number of published articles categorized according

to the clinical settings. (n=2113)
November 2008
Thermal Modeling of Snake Infrared Reception : Evidence
for Limited Detection Range
B . S . JONESa, W . F . LYNN b and M . O . STONE c, 1
a Department of Biomedical Engineering, Wright State University, Dayton, OH, 45435,
U.S.A.
b Veridian Engineering, 5200 Springfield Pike, Suite 200, Dayton, OH, 45431, U.S.A.
c Air Force Research Laboratory, Materials and Manufacturing Directorate, Wright-
Patterson Air Force Base, OH, 45433-7702, U.S.A.

Received 28 October 2000;  accepted 21 December 2000. ; Available online 28

February 2002.

Abstract
For more than 40 years, information has circulated with regard to the sensitivity
of infrared pit organs in both boid and crotaline snakes (pythons and pit vipers,
respectively). The most often quoted sensitivity is 0.003°C
Factors that influence the
reliability of thermographic
measurement in patients and
controls can be divided into:

Equipment-related

Subject-related and

Surrounding-related factors.
 Thermography
The stethoscope of pain medicine
Thalamus
Cervical Disc Herniation
at C4/5
Multiple sclerosis
Poliomielitis
Right Leg
Conclusion Published: 23 Jan 2008
In the present study, we have established the ability of 3D and thermal
surface imaging to produce reliable, quantifiable measures of joint
volume, shape, and temperature to aid in the assessment of disease
activity in arthritis.
Tendinosynovitis right hand
 Thermograms of a patient
subjected to restorative surgery,
ligamentoplastia of the cruciate ligament
 Thermogram
of the right leg of a
patient with medial tibial stress syndrome.
Thermogram of an athlete
with Grade I ankle sprain
Varicocele
 Case report
• HISTORY AND SUBJECTIVE COMPLAINTS:
•
• Patient 49, has a lot of radiating pain
starting from his right hip across the
lower abdomen into the testicles. Pain is
constant and started 2 years ago after
he had surgery of an inguinal hernia at
his right groin. He got several treatment
without any result, pain is still there. He
takes painkillers but they don’t help.
• History: has a L3 and L4 disc compression,
2 inguinal hernia (right and left). Is not a
smoker, has no high blood pressure and
is not a diabetic.
Inguinal Area: There is hyperthermia with hot spots in the inguinal area
wich seems more or less symmetrical and due to body habitus.
Scrotus seems thermographically normal, no signs of varicocele.
Case report continued
There is hypertermia
with hot spots in the
lower back which
might correlate with
Discopathy and a
radicular syndrome
which is in the L1 to L3
Dermatome.
This might be the cause
For his symptoms
Positive VAS Deference
 Treatment and Diagnosis
aids
• Full spine radiographs
• Film exposed to x rays or gamma rays
•Motion X Rays
•Surface EMG

•Digital thermography
Plantar Fasiitis
PLANTAR INFRARED THERMOGRAPHY MEASUREMENTS
AND LOW BACK PAIN INTENSITY
Nina Zaproudina, MD,a Zhiyong Ming, MD,b and Osmo O.P. Ha¨nninen, DMSc,
PhDc; Finland
 M yo fa scia l
Trig g e r Po in t
Trigger point in
upper part of
left
Rhomboid
Trigger points
Paracervical botox
injections
Abstract. Although thermography has been used
for a variety of abnormal conditions, extensive Skeletal Radiol (1984) 12:235-249
data on large, relatively asymptomatic populations liquid-crystal contact
has heretofore not been available. More specifically, thermography (LCT),
no data deal with the upper extremities and,
more particularly, no analyses are based on simultaneous
thermograms of the posterior neck and
shoulders. The current study undertook this task.
The results confirm the existence of thermal
symmetry in the overwhelming majority of 100
normal relatively asymptomatic, actively employed
factory workers. Conversely, if persistent, statistically
significant thermal asymmetry exists, as outlined
and correlates with patient symptomatology,
an organic basis for it should be sought.
Repeat the experiment but with
Digital Infrared Thermal
Imaging
• Attempt to define the full potential of
thermography as a medical
diagnostic aid
• Establish basic standarts and
protocols
• Utilizing DITI to investigate the range
of thermal variations in the upper torso and
upper extremities of an essentially
asymptomatic population
• Thermography serves predominantly to define
To summarize, this means that if a patient has a thermal
asymmetry with a temperature difference greater than _+
0.62 ~ C, then an abnormality is presumed to exist.
Clinical
Case
Circulatory loss in injured
fingers
Herpes Zoster
 Fo ca l h yp o th e rm ia re la tin g to
a m a lig n a n t cyst

S m a llm e ta sta tic tu m o rs

in d ica te d b y fo ca l a re a s o f
h yp o th e rm ia o ve r th e lu m b a r
sp in e
Image several weeks earlier

Chorioamnionitis

Biomed Instrum Technol. 1996 Nov-

Dec;30(6):526-30.
Application of telethermography
in the evaluation of preterm
premature rupture of the fetal
membranes.
Sheinberg M, Hayashi R,
Bromley J, Dormer L.

Image 2 weeks prior to image above

M V A , S te e rin g w h e e l
im p a cte d th e lo w ch e st,
su b se q u e n t x -ra y a s a
re su lt o f th e rm a lfin d in g s
sh o w e d fra ctu re s in th e
lo w ste rn u m a n d le ft la st
rib .
Pe rio d o n ta lD ise a se &
O th e r O ra lPa th o lo g ie s

There is mounting evidence that oral pathology is

also a major source of
breast cancer. Independent studies done over the
past 10 years have
produced evidence that oral pathology always
exists on the same side
of the body where the breast cancer appears.
Thermography after a root canal
treatment
H yp o th e rm i
c
a sym m e try
o ve r th e
le ft lo w e r
ch e st h a s a
h isto ry o f
CAD
 Thermal coronary angiography showing perfusion
of the anterior descending coronary artery and
heart muscle

J Vasc Br 2003;2(2):151-60
Search TRAM flap
at youtube.com
 Carotid
dysfunction
Iso th e rm 1 6 co lo r M e d ica lsca le

6 0 % o cclu sio n o f th e rig h t ca ro tid a rte ry

C a ro tid A rte ry o cclu sio n ( R ig h t sid e )
Inflammation over the right
kidney
Appendicitis
 Thalamus

Focal hypothermia over T1 / T2

Patients with diagnosed Chronic Fatigue Syndrome and Fibromyalgia
Hyperthermia over both lobes of the thyroid
Indicating thyroid ‘dysfunction’
Hyperthermia over both lobes of the thyroid
Indicating thyroid ‘dysfunction’
Visualizing sweat glands
(macro lens imaging)
p a tie n t w ith h e p a titis
A fo ca la re a o f in fla m m a tio n th a t g u id e d a so n o g ra p h e r to a d e e p
a b sce ss
TM
J
Fa cia l p a ra lysis ( b e lls p a lsy )
Occlusion of the left internal
carotid artery

Infarction of the left hemisphere

Total right side hemiparesis

 Infrared Thermography in the Diagnosis and Management of
Sports Injuries
valuable diagnostic tool in sports medicine and musculoskeletal
disorders.

Thermography not only helps confirm a diagnosis, but can be used as a

gauge to clinically assess progress and treatment response, as well as a
prognostic indicator.

Thermography is noninvasive, risk-free, and relatively portable, it is a

practical cost effective tool in the clinical setting.

Epicondylitis, patellofemoral syndromes, ankle injures, shin splints, stress

fractures, myofascial pain syndromes, spinal pain syndromes, shoulder
injures, and foot pain syndromes, sympathetic maintained pain, and reflex
sympathetic dysfunction.
“Clearly thermography will be a
powerful medical tool and its
contribution to health care Is at
its infancy stage of utilization”

Mathew H. M. Lee MD
Epicondylitis
isotopic bone scan
Thermograph of the feet of a
diabetic patient
 Diabetes Technol Ther. 2009 Oct;11(10):663-7.

Feasibility of a thermographic method for

early detection of foot disorders in diabetes.
Roback K, Johansson M, Starkhammar A.
Center for Medical Technology Assessment, Department of Medical and Health Sciences,
Linköping University, Linköping, Sweden. kerstin.roback@liu.se

CONCLUSIONS: The foot indicator detected a relatively high

share of the different types of complications but not all. It can
be used as a complement to current practices for foot
examination. The instrument provides rapid imaging of the foot
temperature, and the study indicates that it yields valuable
diagnostic information in early stages of foot disease.
Thermography in the clinical
settings
Thermography in the clinical
settings
 Assessment of microcirculatory
involvement and determination of
amputation level through skin
thermometry.

J Vasc Br 2003;2(2):151-60
 In the acute setting
Trauma in the ICU
Left Leg Right Leg
In the surgery ward
 B ra ch ia l
p lexu s
e n tra p m e n t
•R ig h t sid e
b ra ch ia lp lexu s
e n tra p m e n t

•Lo w e r rig h t a rm
sym p a th e tic
re a ctio n
 M yo fa scia lTrig g e r
Po in t - in semispinalis
ce rvicu s
 S tre ss
Fra ctu re
Fo o tb a llp la ye r
w ith stre ss
fra ctu re ,
co n firm e d w ith
scin tig ra p h y
 S ym p a th e tic
Pa in

S ym p a th e tic
irrita tio n in th e
h e e lo f th e le ft
fo o t
Fra ctu re
to le ft
a n kle

S ym p a th e ti
c sh u td o w n
in a ffe cte d
lim b
T h re e stre ss fra ctu re s o f th e
tra n sve rse p ro ce sse s o f th e
lu m b a r sp in e .
 S in u s H e a d a ch e s

All of these patients suffer with headaches. We can see by the patterns in
the forehead and sinuses that they are caused by sinus and/or allergies
Sinusitis and middle ear infection
Frey’s Syndrome – 50 year old
male

Minor’s starch iodine test (current

method foridentifying affected skin area)
Po st fra ctu re

Po o r h e a lin g
re sp o n se le ft
a n kle a fte r ca st
re m o va l
R ig h t a n kle
fra ctu re

•6 w e e ks p o st
fra ctu re rig h t
a n kle
•Weight transfer to
left shin
T 4
Syndrome
 Post surgery

•Right knee 3 weeks

post arthroscopy
Sympathetic Regional
Blocks
Am J Chin Med. 2007;35(6):967-75.

A method of selecting acupoints for acupuncture treatment of

peripheral facial paralysis by thermography.
Zhang D.
Department of Biomedical Engineering, Institute of Acupuncture and
Moxibustion, China Academy of Chinese Medical Sciences, Beijing
100700, China. zhangd112233@sina.com
 Monitoring the effects of
Acupuncture

Baseline Stabilized
before Sequential recording at 5 minute intervals with result after
needle needles in place needle
placement Removal
 Posterior
cruciate
•Posterior cruciate
strain left knee

•Vascular damage
below knee
 Right Lung Cancer
Lung cancer is an organ disease and
in the later stages can be seen as a
malfunctioning lung as evidenced by
the relatively colder pattern.

Fibromyalgia
(an autoimmune disease)

Fibromyalgia is an immune deficiency, evidenced by the

hypothermia at T-2 and the trigger points which are more
inflammatory.
 The Ability to Monitor a Patients Progress
During Treatment
October 19, 2006 November 9, 2006

This patient was diagnosed with IBC. After only three weeks of continued
treatment with herceptin and a naturopathic protocol suggested by her
doctor she was rescanned to see if there was any regression in her
symptoms. As you can see, the improvement was remarkable.
Mother Breastfeeding only with the right breast
Perforated Breast Implant
Abces right breast
Patient known with asthma
 Medial
ligament

Left knee
medial
ligament
strain
Complex Regional Pain
Syndrome

• RSD left toes

RSD of the right foot
Neuropathy in the fingers of the
right hand
Early stage bilateral carpal Chronic right carpal tunnel
tunnel syndrome syndrome
RSD (CRPS) of the left hand.
Glove-like hypothermia.

The return of normal sympathetic

function after treatment was short
term.
“Hunting phenomenon”
Subclavian artery steal
syndrome
 Carpal tunnel
Pre- surgery

Post-surgery
Bulging Disc, L5/S1 Nerve Root Irritation: Before and After
Treatment
  

Scorpion bite right thumb

 Disadvantages related to
thermographic
measurements.
• The lack of standardization in the manner
in
• which thermographic measurements are
performed
• The sparse analyzing methods available
• to analyse thermographic data,
• The lack of knowledge regarding the
underlying mechanisms that result in
temperature differences
• The need for a dynamic measurement.
BREATHING
The human mind is like a parachute

It is of no use unless it is open

Thank you for

listening