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Our association occasionally receives calls and emails from concerned patients who have been to a thermography lab and describe their experience as less than favorable. Unfortunately, there exists individuals who offer thermographic services although they are not qualified to do so. The easiest way to avoid this problem is to simply choose a center that is qualified to perform breast thermography.
If you are curious about the problems we have seen from unqualified labs, you are welcome to read the information below.
The most common errors found in unqualified labs
- The examination room is not maintained at a proper temperature. The room temperature should be between 18-23 degrees centigrade (approximately 68-73 degrees F) and held steady to within 1 degree during the examination period. If the room temperature is not controlled to this level, and you are not acclimated to the room temperature for 10-15 minutes while loosely gowned (disrobed for 10-15 min. with your arms over your head for at least the last 5 minutes for a breast exam), the lab will produce nice "looking" thermograms with questionable diagnostic value.
- There are uncovered windows in the examination room. There can be no windows in the examination room which are not draped or shielded so that infrared heat cannot heat up the patient or the air between the patient and the camera. The floor should be carpeted so that your feet do not contact a cold surface such as tiles (wearing thick slippers or shoes on a tile floor is acceptable).
- The patient can feel air blowing or a draft in the examination room. The air conditioning and heating vents must be baffled or redirected so that you do not feel any air blowing across your body.
- Sloppy procedures and inappropriate equipment. If you receive lab literature or visit a website that displays 3-4 color thermograms, the quality of the equipment used is in question. Many unsuspecting "practitioners" have been sold industrial infrared cameras or low quality systems and told that they will work for human physiological analysis. This couldn’t be more untrue. Many of these cameras also lack the resolution necessary for clinical use. This means that the camera does not take enough temperature samples (sort of like pixels) to form meaningful data. There are many more problems encountered with the use of substandard infrared camera systems.
You can also be assured that a lab is performing poor quality thermography if you notice background heat in their images (the area surrounding the body part is in a color other than black -- the room is too hot), visible background objects (chairs, tables, etc.) or the patient is wearing jewelry like watches, necklaces, or earrings in the view of the body part under analysis.
- The images taken of the patient show a colored background. If your thermographic images show a color in the background (the background should be black or white), this is an indicator that the room was too warm for an appropriate thermal examination. The camera is picking up either the room air temperature or the temperature of the surrounding walls. There are some rare exceptions to this rule due to normal color choices in a system's software, but the vast majority of the time it is due to the reasons mentioned.
- Improper cold water autonomic challenge tests. This test is often missed by unqualified technicians or doctors who are either untrained, under-trained, lacking in knowledge of human physiology, or just don't care about the quality of the studies they are performing.
Usually, a cold water autonomic challenge test is performed when a baseline or follow up study needs further clarification (However, this is up to the discretion of the doctor, not the technician). The test is designed to cool your skin by a central nervous system reflex, which is prompted by the placing of your hands or feet in ICE COLD water for a period of generally 1 minute (Again, this is up to the discretion of the doctor. Some patients challenge better with longer periods, but 1 minute is generally ample). This response is critical to accurate dynamic diagnostic thermography. It cannot be performed by putting you in front of fans, air conditioners, or blowers, or by spraying the body with cold water or alcohol. We have been informed that some labs just have the patient run their hands under tap water (This is absolutely inadequate).
- Lack of qualified image interpretation. It is vital that your images are interpreted by well-trained and experienced personnel in the health care field (MD, DC, DO, etc.). Interpretation of thermographic images for a clinical impression should only be made by health care providers who are licensed to diagnose. The doctor should also be board certified as a clinical thermographer, diplomate, or fellow from a reputable authority.
The only currently active and recognized organizations are as follows:
• International Academy of Clinical Thermology
• International Thermographic Society
• American Academy of Medical Infrared Imaging
• American Academy of Thermology.
Additionally, in the case of breast thermography, advanced post-graduate training specifically addressing breast imaging is necessary due to the level of complexity associated with this region of the body. If you visit a lab that does not have a qualified doctor on site, please ask who is reading your exam and what qualifications they have. This doctor should also regularly test or participate in the quality control of the lab you have visited. We occasionally see examination reports with no physician name or signature. These reports are suspicious and recommend that you exercise caution with regard to clinical decisions based on such a thermogram.
Any individual wishing to perform thermography in their office – with the images sent for outside interpretation – should be certified as an clinical thermographic technician by one of the organizations listed above.
A listing of the criteria currently required by the IACT for the various levels of certification in thermography may be found at the following link: IACT Certification
If you ever have doubts and want a second opinion on a previously performed thermogram, visit our qualified thermographic centers section and contact one of the doctors listed there.
- Other “forms of” thermography. Over the last few years our association has watched as many questionable thermographic procedures have emerged. The most dangerous aspect of some of these procedures is that women are being told that this type of testing is breast thermography. Only thermal imaging systems that meet minimum accepted standards are adequate for proper thermographic imaging of the breast. Those who are using these other forms of equipment or procedures, and informing the public that it is adequate for thermographic breast imaging, are placing women at risk. These practitioners are also damaging the reputation of board certified clinical thermographers who are providing a quality service to the community.
Some of these procedures consist of using a single point hand-held sensor which is touched to the body in various places. The information is then read out on an analog meter, liquid crystal display, or sent to a computer for analysis. This is the loosest definition of thermography to be found. The errors in using this form of testing are numerous. For example, using single or multiple hand-held temperature probe measurements is similar to placing your eye directly on your television screen. You can make out a few points, even some colors, but what can you see? You need to back away and take thousands of smaller samples to get the whole picture. Modern clinical thermographic systems take tens of thousands of temperature samples in order to produce a quality image. Then with proper computer processing procedures a doctor can assess any area, perform quantitative vascular analysis, direct and differential temperature measurements, dynamic digital subtraction, and other forms of thermal assessments which are considered accepted procedures in the thermographic analysis of the breast.
There are also physical problems with any sensor that contacts the body. First of all, touching the surface of the body with anything that is not the exact temperature of the skin changes the actual temperature of the skin being analyzed (Zeroeth Law of Thermodynamics). Consequently, factual temperature data is lost in this process. Secondly, the act of touching the body elicits a neurophysiologic feedback response. This is especially true when certain sensitive areas, such as the nipples of the breast, are contacted. This feedback response has been shown to alter skin surface temperatures, thus changing the factual baseline temperature values.
We have also heard statements about older thermographic equipment being discarded due to so-called high false-positive rates. This is blatantly untrue. Some also claim the support of thousands of research studies for their "new" equipment. Interestingly, the studies they claim support their products were performed using the same equipment they claim was discarded (i.e. high-resolution equipment used by qualified infrared imaging laboratories) and NOT the "new" type they are promoting.
This is just a small sample of the many problems involved with the use of these "other forms" of thermography. Please do not trust your health to anyone not using a thermal imaging system that meets minimum accepted standards under the guidance of a qualified board certified clinical thermographer or technician.
- Thermography is an alternative to mammography. Several websites, magazine articles, radio programs, and imaging labs have recently made claims that thermography is an alternative to mammography. Anyone making this claim is seriously misinformed.
There is a growing movement in this country (U.S.A.) against mammography.
While we all want to see the non-judicious use of any radiographic imaging eliminated, mammography is still a valuable diagnostic tool. Thermography does not medically, scientifically, or legally replace mammography. It has an entirely different place in the monitoring of a woman's breast health.
We hope that this information has been helpful. If you have any further questions, please feel free to contact us at info@iact-org.org.
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