18-20 June, 2003, Budapest, Hungary OSSKICenter (Törley Palace)

with Exhibition and Pre-Session on Thermal Energy in Hungarian
"THERMO-BRIDGE"
between East and West for technology transfer and information exchange

The association between disease and human body temperature is as old as medicine itself. Hippocrates defined fever in different forms e.g. malignant, benign, and acute. It was claimed that if wet mud was applied to the skin, and one area dried rapidly while the remainder was still moist, that an underlying tumour may be suspected.

It was not until Gallileo Gallilei developed his simple thermoscope in 1595 that attempts to measure temperature really began, and some hundred years later before closed thermometers and calibrated scales were used. Carl Wunderlich made the greatest progress in medicine by his development of the clinical thermometer and systematically recorded the progression of temperature in a large number of sick patients in 1871¹. His treatise, “On the Temperature in Disease” carries a substantial section on temperature graphs from diseased patients, some with “Rheumatic fever”. He argued for the routine measurement of temperature and the graphic record be established for every patient.

Following the work of Horvath and Hollander in the late 1940’s², temperature measurements were used as a means of monitoring intra-articular steroid therapy by a number of authors. Intra-articular temperature and isotope clearance techniques were however, invasive, unlike the infra red remote sensing techniques, which were available from the late 1950’s.

The story of infra red radiation began in 1800, when Sir William Herschel, the astronomer, detected heating rays beyond the visible red of the spectrum. After his death in 1840, his son John Herschel, made the first thermal image from sunlight using the evaporograph technique. He used the term thermogram to describe the image, which is still in common use today ³.

Early infra red imaging systems were developed during the 1940’s and became available for industry and medicine first in 1959. The Pyroscan, (a 1942 instrument) was first used in Bath in 1959 and was used to image the increased heat over arthritic joints. Picture quality improved with the Mark 2 instrument, although each image took 3-4 minutes to acquire, and were almost impossible to quantify. Attempts were made to apply densitometric measurement to the Mufax paper print out. A bank of standard temperature reference sources were imaged with the subject. The paper images were unstable, and unable to reproduce enough grey tones for temperature estimation. Later with improved equipment better dynamic (and objective images) were obtained which could usefully supplement radiological investigation ⁴.
 

During the 1960’ and 1970’s a new generation of thermal imaging systems were developed in Europe, the U.S. and Japan. Oscilloscope displays were introduced, and electronic isotherms were added to the image. A bright-line isotherm which was adjustable for temperature level was shown on the monochrome oscilloscope screen. By multiple exposure colour photography, the first colour thermograms were produced in the 1960’s. At first, Polaroid photographs of the isotherms were taken from the screen and area measuremnts were manually made by the use of a planimeter.

Mini-computers for image processing arrived in the mid to late 1970’s providing colour displays, image analysis, and importantly, data and image storage. In Bath we installed a pdp8e computer for image analysis in 1972, and were able to calculate a thermal index from thermograms of patients with inflammatory arthritis, by digital image analysis.⁵

Quantitative thermography opened up the possibilities for clinical trials of drug therapy. In the drive to standardisation for clinical trial assessment each stage of the thermographic investigation was documented.

1. Adequate preparation of the patients, both physically and physiologically
2. Use of a suitable examination room and patient preparation cubicle
3. standardisation of the ambient conditions
4. quality assurance checks on the imaging equipment, calibration, focus, field of view etc.
5. Measurement from regions of interest, and archiving of all data.

Our Thermal index, described in 1974 was applied to a number od controlled clinical studies involving anti-inflammatory treatment, Raynaud’s Phenomenon and Paget’s Disease of Bone. All the thermal imaging systems at that time were cooled single element detector devices, and speed of scan was inversely related to spatial and thermal resolution. The introduction of the SPRITE detector brought high speed and high resolution together. This allowed the use of dynamic and macro thermography for clinical medicine.
Modern systems introduced within the last three years use focal plane array detectors, with both high speed images at high thermal and spatial resolution. Image quality has dramatically improved, modern digital thermograms are now very different from the crude clinical images obtained 40 years ago.

Today applications in rheumatology include the quantitative study of inflammation and ant-inflammatory therapies, peripheral circulatory disorders related to connective tissue diseases, and Raynaud’s phenomenon, sympathetic disturbances, pain syndromes and locomotor injuries ⁶. Advances in image processing hold good prospects for improving standards in image capture and analysis. Our own software CTHERM (www.medimaging.org) now provides masks for each region of the body. This is part of a current study to develop an on-line reference of thermal images from normal subjects, which currently is not available to physicans using thermal imaging.
As hospitals across Europe progress to all digital records for their patients, infra red thermal imaging is virtually ready for assimilation into the new systems. The need is for all practising physicans and clinical investigators to seriously embrace the need for good technique and full standardisation of the images recorded ⁷.

1. Wunderlich C. 1871 On the temperature in Disease, A Manual of Medical Thermometry
English translation by W Bathurst Woodman. The New Sydenham Society, London.
2. Horvath SM. Hollander JL. 1949. Intra-articular temperature as a measure of joint reaction. Journal of Clinical Investigation 28. 469-473
3. Ring EFJ. 2000 The Discovery of Infra Red Radiation in 1800. The Imaging Science Journal 48. 1-8.
4. Collins AJ, Ring EFJ, Bacon PA, Brookshaw JD. 1976 Thermography and Radiology Complimentary Methods for the Study of Inflammatory Diseases. Clinical Radiology 27, 237- 243.. CRC press London
5. Ring EFJ. 1995 Thermal Imaging of Skin Temperature in Handbook of Non- Invasive Methods and the Skin, ed.J Serup, G Jemec p457-471
6. Will RK, Ring EFJ, Clarke AK, 1992 Maddison PJ. Infrared Thermography: What is its Place in Rheumatology in the 1990’s? British Journal of Rheumatology 31. 337-344.
7. Ring EFJ, Ammer K The Technique of Infra red Imaging in Medicine Thermology International 10:1 7-14 2000

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OSSKI Center (Törley Palace)
"Fodor József" National Center of Public Heath
"Frédéric Joliot-Curie" National Research Institute for
Radiobiology and Radiohygiene. (OKK-OSSKI)
www.osski.hu