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by Dr. William Cockburn, Isabella Tracey Breast Health Foundation
Background
Breast thermography is a clinical diagnostic procedure which uses highly
specialized infra red cameras to measure the heat coming from the body, in this
case, the breast. Thermography has been approved for this purpose for many years
by the US FDA (United States Food and Drug Administration) and in the past two
years (2001-2002) many new doctors and technicians have entered the field. With
the rise in breast thermography popularity comes the chance of your having an
examination performed by non-certified or properly trained practitioners. There
are also many individuals who are promoting thermography simply to build there
practices, sell vitamins or other health services, and so care must be exercised
when selecting a thermographic lab. Why the fuss? Because thermography is an
unregulated industry with no mandatory certification requirements. This brief
papers has been written to assist you in separating the what from the chaff and
finding the truths behind thermal imaging.
How is Breast Thermography Performed?
It is very important that proper protocols are used when performing breast
thermograms. Because thermography, or Thermal Imaging, measures heat, it is
important that the patient (subject) be in a thermal "Steady-State" to insure
that extraneous heat is removed from the body prior to the examination.
While different academies of thermal imaging vary to one degree or another, all
have protocols which help us to obtain quality imaging, without extraneous heat
on the patient or in the background of the image. Here are some examples of
these protocols
The Examination Room Protocols
The room in which a thermogram is performed should be large enough to
accommodate the patient, the technician, the equipment with ample room to move
about the room. Thermography is performed on other body parts as well, such as
arms and legs, so most labs have a room large enough for this purpose as well.
The exam room should be carpeted, there should be no windows or open doors, and
if there are windows they should be properly draped and shaded to block outside
light from coming into the room.
The room should be climate and humidity controlled and their should be no air
blowing directly on the patient.
There should be no change in the room temperature during the time it takes to
perform the examination, and the room temperature should be "comfortable" so the
patient is neither perspiring or shivering, which causes thermal artifacts. Most
thermogarphy labs use a 19C-23C range. These are the basic and essential
protocols to be aware of.
What About Patient Protocols?
It is critical to the outcome of quality thermal imaging, that the patient be
given adequate instructions and protocols prior to their examination date as
there are many factors which can create false findings on the thermogram.
The patient should be given instructions at least 24 hours prior to the
examination and should not do the following:
A cool bath or shower is permissible but not a hot one for at least two hours
prior to the examination.
The arm pits or other parts of the body to be examined can not be shaved the day
of the examination,
Beverages which contain caffeine or alcohol should not be consumed for 24 hours
prior to the examination.
The use of lotions, creams, deodorant, antiperspirant, perfume or talcum powders
must also be avoided.
The patient can not be sunburned, not have had chiropractic, physical therapy or
massage therapy for 24 hours prior to the thermal examination, unless
contraindicated by a physician.
The patient should make up a list of all medications, herbs and supplements
taken that day, and should make this list available to the technician who MUST
then pass this information along to the interpreting physician. You should NEVER
stop taking your medications based on a thermography lab requirement without
first obtaining written approval from your physician,
These are the basic protocols for the patient to follow.
How Then is the Test Performed?
You should complete standard intake paperwork about your health history, your
birthing and nursing history and your menstrual cycle, sign an informed consent,
and follow the protocols provided you.
You are then taken to a changing area (sometimes this is the thermographic room)
where you disrobe from the waist up, including all jewelry around your neck, and
you are placed in an examination gown until it is time for you to begin to
acclimate. The acclimation process is simple but very, very important.
You must come to equilibrium with the temperature of the room in which the
thermogram is performed so that artifact heat is not recorded in the image. This
would be for example, the heat under the breast from a constrictive bra. Most
all labs have the patients put their hands on top of their heads with their
elbows extended outward to lift the breast and cool the arm pit region, other
labs have bars for the patient to hold, Both are acceptable methods.
You will cool in the room for approximately 10-15 minutes and then images will
be captured, with your arms up, of both breasts from the front, the sides, the
underneath and from an angle (45 degrees also called an oblique).
After this series is completed, you are either asked to place your hands or feet
in ice water, or given an ice cold gel pack to hold, for one minute. This
produces a neurologic response in the breast which cools them (cancer as a rule,
does not cool healthy breasts do) and then a second set of images are made along
with measurements. That s all there is to it. You either dress and leave, or a
doctor in some facilities, will give you a report of findings on the spot
followed by a written report.
These are the basic and essential ingredients to a quality thermal examination
of the breast
How Accurate is Thermography of the Breast?
Breast thermography is very accurate, but only in the hands of trained personnel
using the correct type of thermography cameras. The accuracy of the examination
varies around the world but varies from 87%-96% depending on old the literature
is. The 96% reference is from 1999, the most recent published approved study. (USC
Norris Cancer Center, Parisky, MD et al)
Where Can I Get More Information on Quality Breast Thermography?
It is vital, that you get good information and quality study if you are to be
properly evaluated and if the thermal imaging industry is to survive the current
wave of interest, and accompanying unqualified people entering the field simply
to make money. Until such time as regulatory methods have been put in place, you
must be careful of who performs and interprets thermographic studies.
The following two web sites have many articles, papers and quality assurance
guidelines for both doctors and patients and those interested in properly
entering the field.
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