Wireless Temporal Artery Bandage Thermometer

Ivars G. Finvers, James W. Haslett and Graham Jullien

Department of Electrical and Computer Engineering
University of Calgary
Calgary, Alberta, Canada T2N 1N4
Email: invers@ucalgary.ca
AbstractA bandage based thermometer placed on the tem-
ple region of the forehead provides an non-invasive means of
measuring a patients core body temperature. An array of
temperature sensors spaced along the length of the bandage is
used to determine the skin temperature over the temporal artery.
Temperature sensors buried within the bandage allow the direct
measurement of the heat ow leaving the skin over the temporal
artery. By using the method of heat balance in conjunction
with the skin temperature and heat ux measurements, the
temperature of the blood within the temporal artery, which
is at the core body temperature, can be estimated. Compared
to the traditional hand-held Temporal Artery Thermometer,
this approach decreases the sensitivity of the core temperature
estimation to errors arising from air ow across the forehead,
perspiration, and the local environment. A wireless link transmits
the data to a remote monitoring station, allowing long term
monitoring of patient temperature.
I. INTRODUCTION
Wireless patient vital sign monitoring systems are under de-
velopment with the goal of improving patient health and safety,
while minimizing health care costs by reducing medical staff
workload. Body temperature was perhaps the rst vital sign
used by physicians to evaluate a patients health. Despite this,
the accurate non-invasive measurement of body temperature in
a continuous fashion remains a difcult problem. Traditional
methods such as oral, rectal, or tympanic (ear) thermometers
are not easily adapted to long term monitoring, while other
techniques such as axillary (armpit) thermometers suffer from
poor accuracy.
A relatively new method of non-invasively measuring body
temperature is the Temporal Artery Thermometer (TAT) which
was invented by Pompei in 1998 [1][3]. A hand-held infrared
temperature probe, similar in physical construction to an ear
thermometer, is scanned across the temporal artery on the
forehead and core body temperature is estimated from the skin
temperature measured directly over the artery.
The skin acts as a radiator element within the bodys
thermoregulation system. The blood ow (perfusion) to the
capillary layer underlying the skin is increased to cool the
body or decreased to help conserve heat. As a result, skin
temperature, especially in the extremities, is a poor measure
of core temperature. The skin above the temporal artery in the
temple region of the forehead provides an exception. Located
just under the skin, the temporal artery provides a location in
which the intervening tissue layer between the skin surface and
an arterial blood vessel is thin. In addition, since the temporal
artery branches off the carotid artery supplying the brain, its
Receiver
Fig. 1: Bandage based thermometer is afxed to the temporal
region of the forehead. A wireless link allows remote moni-
toring of patient temperature.
blood ow remains relatively constant and its temperature is
close to the core temperature.
The basic operating principle of the TAT is to measure the
heat ux leaving the skin in the temporal artery region along
with the skin temperature at that point. Fouriers law of heat
conduction and the requirement for heat balance (heat ux
out of the skin must be equal to the heat ux emanating from
within the body) is then used to estimate the arterial blood
temperature and hence the core temperature.
To measure skin temperature, the hand-held TAT uses an
infrared (IR) imager. The user scans the IR sensor across the
forehead region and the device picks the highest reading as the
skin temperature over the temporal artery. In our approach, see
Figs. 12, an array of temperature sensors (thermistors) located
along the length of the bandage is afxed to the temple region.
The array is electrically scanned and the highest temperature
reading is used in subsequent calculations. It should be noted
that the bandage will alter the skin temperature, but the system
accounts for this.
The second parameter that must be determined is the heat
ux leaving the head in the region of the temporal artery. One
approach, as used in the hand-held TAT, is to estimate the
heat ux from temperature difference between the skin and
the ambient air temperature. With the hand-held TAT, ambient
temperature is relatively straight forward to measure since
the instrument is relatively large and the ambient temperature
sensor can be located sufciently far from the forehead sensor
1-4244-0437-1/06/$20.00 2006 IEEE. 166
Sensor Interface
Electronics
RF Link
Electronics
Flex PCB
(Upper Portion)
Flex PCB
(Lower Portion)
Heat Flux Foam Spacer
Battery
Buried Thermistors
Skin Thermistors
Top Foam
Middle Foam
Bottom Foam
Fig. 2: Exploded view of bandage thermometer construction.
location so that its reading will be unaffected by the heat
emitted by the head.
For the bandage based TAT, ambient temperature measure-
ment is a signicant problem since the device is afxed to
the head for long periods of time. Any ambient sensor located
on the bandage measures not the ambient room temperature
but the micro-climate surrounding the head. The solution
to this problem is to realize that the ambient temperature
measurement is used only to estimate the heat ux out of
the skin. By burying a temperature sensor within the body
of the bandage TAT, as shown in Fig. 2, heat ux through
the bandage (and hence out of the skin) can be determined
directly. Ambient temperature in no longer needed.
An important advantage of using a buried temperature sen-
sor measurement for the heat ux calculation is that it depends
only on locally measured temperatures and the physical and
thermal characteristics of the bandage and not the external
environment. For example, if the patient is sleeping with
their temple on a pillow, an ambient temperature based heat
ux calculation would lead to an erroneous core temperature
estimation. The insulating effect of the pillow (and the bandage
itself) is automatically accommodated by the new approach.
II. ESTIMATING CORE BODY TEMPERATURE
The temporal artery, carrying blood at core temperature, lies
close to the skin surface in the temple region of the forehead.
Some of the heat transported by the blood will be lost into
the surrounding tissue and ow outward through the skin into
the environment. To simplify the discussion, we consider the
temporal artery to behave as a heat source maintained at the
core temperature of T
c
, and that the tissue layer overlying
the artery has a conductive heat transfer coefcient of h
tissue
[W/(m
2
K)]. Using Fouriers law of heat conduction, the heat
ux density owing out of the skin, q
skin
[W/m
2
], due to heat
lost from the temporal artery, can be modelled as
q
skin
= h
tissue
(T
c
T
s
) (1)
where T
s
is the skin temperature. The heat transfer coefcient
of the tissue, h
tissue
, will depend on the tissue thickness, tissue
composition, and the level of perfusion.
The heat owing out of the skin must be balanced by the
heat lost to the environment q
env
, or
q
skin
= q
env
. (2)
Heat is lost from the skin into the environment by a mixture
of four mechanisms [4][6]
q
env
= q
cond
+q
conv
+q
rad
+q
e
, (3)
consisting of q
cond
, the conductive heat loss to objects in
contact with the skin; q
conv
, the convective heat loss due to air
owing across the skin; q
rad
, the radiative heat loss; and q
e
, the
evaporative heat loss due to sweating. For bare skin in a cool
environment, radiative and convective heat losses dominate.
As the temperature rises, heat loss due to evaporation of sweat
becomes increasingly important.
If an object is in contact with the skin, with its outer surface
at the ambient temperature, T
a
, the conductive heat loss to the
object will be
q
cond
= h
cond
(T
s
T
a
), (4)
where h
cond
is the coefcient of thermal conductivity of the
object. Air ow across the skin can induce a signicant
convective heat loss
q
conv
= h
conv
(T
s
T
a
), (5)
where the convective heat loss coefcient h
conv
is empirically
determined and dependent on air ow. For exposed skin,
signicant heat can be lost (or gained) through electromagnetic
radiation. Assuming that the surfaces seen by exposed skin are
at a mean surface temperature of T
a
, the net radiative heat loss
will be
q
rad
= (T
4
s
T
4
a
), (6)
where is the Stefan-Boltzmann constant (5.6704
10
8
J/(s m
2
K
4
)), is the surface emissivity, and the tem-
peratures are in kelvin. On the kelvin scale, the skin and
ambient temperatures are typically close together for indoor
conditions, therefore (6) can be approximated by
q
r
h
r
(T
s
T
a
). (7)
where h
r
= 4T
3
a
. The evaporative heat loss depends on
the water vapor pressure difference between the skin and the
environment [7]
q
e
= h
e
w
e
(P
s
P
a
). (8)
where h
e
is the coefcient of evaporation (dependent on air
ow), w
e
is skin humidity [6], P
s
is the saturated water vapor
pressure at the skin (depends on skin temperature), and P
a
is
167
Fig. 3: Temporal artery bandage thermometer prototype.
the vapor pressure of the surrounding air (depends on relative
humidity and ambient temperature).
To estimate the core temperature, the TAT must solve the
heat balance equation (2). If the conductive, convective, and
radiative heat transfer coefcients are amalgamated, the heat
balance equation can be rewritten as
h
tissue
(T
c
T
s
) = h(T
s
T
a
) +h
e
w
e
(P
s
P
a
) (9)
where h = h
cond
+ h
conv
+ h
r
. The TAT cannot account for
evaporative heat loss since the skin wetness is unknown, so a
further approximation is made
h
tissue
(T
c
T
s
) h(T
s
T
a
). (10)
From this the core temperature can be estimated using
T
c

h
h
tissue
(T
s
T
a
) + T
s
. (11)
The apparent simplicity of (11) hides a number of issues.
First, sweating can introduce signicant error since the
evaporative heat loss term is neglected. For the hand-held TAT,
it is recommend that the temperature measurement be made
behind the ear if sweating is observed on the forehead [8],
since this area has little perspiration and the arteries in this
area will be fully dilated under these conditions.
Second, the amalgamated heat transfer coefcient h is not
a constant, but depends on air ow and temperature.
Finally, the heat transfer coefcient of the tissue, h
tissue
,
overlying the temporal artery depends on thickness, compo-
sition, and perfusion rate. This variability is unavoidable, but
the tissue layer overlaying the temporal artery is relatively
thin, consistent, and with relatively constant perfusion, thereby
reducing this uncertainty.
Therefore, for the hand-held TAT to make a reasonable
estimate of the core temperature, a number of conditions must
be met: no sweating, no air ow across the skin, variation
of the heat transfer coefcient with temperature must be
accommodated, and the instrument must be acclimatized to
the environment immediately surrounding the forehead.
By covering the temporal artery region with an insulating
bandage, the bandage TAT completely alters the signicant
terms in the heat balance equation. Because the skin is covered
by the bandage, radiative loss from the skin is negligible, since
only the outer surface of the bandage radiates. Evaporative
heat loss is also negligible since the bandage is impervious
to moisture. Convective heat loss at the skin is non-existent
since the skin is covered. Instead, conductive heat loss is the
dominant term, in contrast to the hand-held TAT where it is
the only negligible term.
The outside of the bandage experiences convective, ra-
diative, and even evaporative heat loss (if wetted by sweat
dripping on it), but this is unimportant, since the bandage
TAT uses a buried temperature sensor to directly measure the
heat ux out of the skin surface. Therefore the bandage TAT
signicantly reduces the variability of the coefcients in the
heat balance equation. The core temperature can be estimated
using
T
c

h
bandage
h
tissue
(T
s
T
b
) + T
s
(12)
where h
bandage
is the heat transfer coefcient which is de-
pendent on thermal characteristics of the bandage (well con-
trolled), and T
b
is the buried temperature within the bandage.
III. PROTOTYPE
A prototype of the bandage TAT has been constructed, as
shown in Fig. 3. This device replicates the key ideas of the
design shown Fig. 2, but does not include such features as a
exible PCB for wiring.
A small commercial very low power RF transceiver module
operating at 2.4GHz is used to provide the wireless link,
and a low-power micro-controller with an 8-channel ADC
provides the sensor interface. Temperature sensing is provided
by an array of four 0.1

C accurate thermistors arranged
along the bottom surface of the bandage. Each thermistor
is mounted in a 5mm diameter copper disk to increase the
thermal capture area. To ease construction and to minimize the
thermal shadowing caused by the skin sensor array, the array
of three buried temperature sensors is offset from the skin
sensors. The bandage is attached to the skin using adhesive
tape. The entire bandage is powered by a CR2032 battery (3V,
220mAh).
IV. MEASUREMENTS
Validation of the bandage TAT is an enormous challenge.
One of the fundamental ideas of the bandage TAT is the use of
the two arrays of temperature sensors to allow a direct measure
of heat ow out of the temple region. This provides the
bandage with the ability to adapt to changes in the environment
near the head, for example, when a patient is sleeping with
their head on a pillow such that the bandage TAT is covered. To
verify this, the bandage was afxed to the temple of a healthy
male (with an orally measured temperature of approximately
37

C). Initially the person was sitting; after a period of time

he placed his head (bandage side down) on a pillow, nally
he returned to the sitting position. For each core temperature
calculation, the temperature readings of two skin temperature
sensors anking each of the buried temperature sensors was
averaged before being applied to Eq. 12. Fig. 4 shows the
core temperature predicted by each grouping of sensors. In
practice, the core temperature predicted by the skin sensors
with the highest average reading would be used.
The core body temperature predicted by Sensor Group #2
(the sensors in the middle of the bandage) fall within the range
of 37 37.5

C. However, the absolute value of the predicted

temperature should not be considered accurate since sufcient
168
Time (hours)
Sensor Group #1
B
a
n
d
a
g
e

A
p
p
l
i
e
d
B
a
n
d
a
g
e

R
e
m
o
v
e
d
B
a
n
d
a
g
e

A
p
p
l
i
e
d
B
a
n
d
a
g
e

R
e
m
o
v
e
d
B
a
n
d
a
g
e

A
p
p
l
i
e
d
B
a
n
d
a
g
e

R
e
m
o
v
e
d
Sensor Group #2 Sensor Group #3
T
e
m
p
e
r
a
t
u
r
e
(

C
)
13 14 15 16
30
32
34
36
38
40
13 14 15 16 13 14 15 16
Head on Pillow Head on Pillow
Core
Skin
Buried
Core
Skin
Buried
Core
Skin
Buried
Head on Pillow
Fig. 4: Raw and core temperature measurements. Each calculated core temperature is based on the average readings of two
adjacent skin temperature sensors and the intervening buried temperature sensor. Initially the person is in the sitting position,
at time of approximately 13.5 hours, the person places their head on a pillow (bandage TAT is covered by the pillow) and
remains in that position until approximately 14.25 hours, when the person sits up again.
data has not yet been gathered to allow the factor
h
bandage
h
tissue
in
Eq. 12 to be properly calibrated. What is more important in
these results is the minimal variation in core temperature that
is observed between the subject in the sitting and head on
pillow positions.
Observe the signicant increase in skin temperature
recorded when the head is placed on the pillow. This is
expected as the pillow insulates the head. Consider the middle
set of sensor data shown in Fig. 4. Except for a transient, the
predicted core temperature remains relatively constant between
the sitting and head on pillow positions, even though the
skin temperature has signicantly changed between these two
positions. As the skin temperature rises during the head on
pillow time, so does the buried temperature, but with a decreas-
ing difference. This reects the reduced heat ow out of the
temple region due to the insulating effect of the pillow, clearly
demonstrating the ability of the technique to accommodate
local variation in the environment. After the subject returns
to the sitting position, the skin and buried temperatures drop,
and a small increase in predicted core temperature is observed.
We believe this occurs due to the improved thermal contact
between the skin temperature sensors that results from the
pressure applied to the bandage while the head was on the
pillow. Ensuring consistent thermal contact of the sensors with
the skin is one of the on-going design challenges for this
project. The two outer sensor groups show a larger variation
in predicted core temperature between the sitting and head on
pillow positions. One possible explanation for this is that in
the prototype used, the two PCBs for the wireless link and
the sensor interface circuitry overlay these two other sensor
groupings and alter the thermal characteristics of the bandage
in these regions.
The results demonstrate that the fundamental operating
principle of the bandage TAT appears promising. More ex-
tensive testing with patients presenting with a range of core
temperatures is required to validate the clinical accuracy of
the device. A next generation bandage TAT is in development
that will be suitable for limited clinical trials.
V. CONCLUSIONS
A bandage based Temporal Artery Thermometer has been
constructed that provides a means of wirelessly monitoring
a patients core body temperature in a continuous and non-
invasive fashion. A heat-ux sensor system incorporated into
the bandage makes it less sensitive to errors induced by
perspiration, convection, and radiative heat loss than a standard
hand-held Temporal Artery Thermometer.
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