- FAQ Thermography
- 1. Are All Thermographers Created Equal?
In our estimation, the Mikron Thermographic equipment which was the first equipment built for medical application is still the best and the only systems we use. Most other cameras were built for industrial application and have been modified for medical uses. Because medical thermography needs to be replicated, none of these other systems have been adequately able to control the “drift” factor. This allows for too much inconsistency.
Next, we are concerned that many thermographers are not taking enough images. We have seen as few as three images being called a complete study. The proper guidelines for breast thermography call for two sets of nine images each, taken in black and white and color with a cold challenge between sets. Thyroid/dental and neuromuscular studies vary in the number of images taken. It is imperative, however, that the interpreting physician measure contralateral regions of interest on the actual images for comparative purposes.
It is imperative that the study be done under the controlled conditions established by the international thermographic community. These include temperature controls, reduction of ambient light, and careful monitoring of air flow. The images should be taken by a trained technician and interpreted by a certified, licensed health care practitioner. We believe there needs to be a line of communication between the patient and the doctor reading the thermogram. Ours is the only local center where everything is done in house.
We are also aware of individuals performing “full body scans”. They claim to provide substantial information regarding abnormalities of many of the body’s systems (including the breast) with a single set of one dimensional temperature readings. This should not be confused with traditional medical thermography.
- 2. How Can I Learn More About Thermography?
In addition to the volume of information on the internet, Dr. Getson is available to speak to your group or association. Please contact the office at 856-596-5834 for more information or to schedule a lecture.
- 3. How Do I Understand My Thermographic Report?
Color Thermography is based upon the assumption that the body is symmetrical unto itself. We realize that NO ONE is completely symmetrical in terms of size, shape or temperature. For that reason we allow up to 1.5 degrees C and still consider it to be normal. The only exception is at the nipples where the maximum limit of normal is 1.0 degrees C.
As the patient faces the camera for the images to be taken, what is seen on the left side of the picture is on the right side of the body (in those images where both breasts are present on the same frame).
The circles that are drawn on the pictures are drawn by Dr. Getson and the data beneath each picture is calculated by the computer. The most important information on the data table is the second line, “average” which is the average temperature within the circle on the picture above.
When viewing the black and white images, circles are placed around blood vessels to highlight their presence. Having blood vessels is not necessarily abnormal, as the presence of vessels results from trauma to the breast. Once present these vessels will be evident forever. Trauma can occur in many forms such as seatbelt impact from a car accident, other types of contact injury, and even Mammograms. Some blood vessel configurations are worrisome and these will be discussed.
Following is a definition of some thermographic terms:
- VASCULAR COMPLETE: An uninterrupted blood vessel usually of two inches or more in length.
- FRAGMENTED VASCULAR ANARCHY: Bits and pieces of a blood vessel.
- INFERIOR VESSEL: A heat generating vessel that lies below the horizontal plane of the nipple.
- HOT SPOT: A solitary area of heat in one breast exceeding 1.5 degrees C.
- GLOBAL HEAT: A generalized area of heat exceeding 1.5 degrees C.
- PERIAREOLAR HEAT: Heat in excess of 1.5 degrees C in the area surrounding the nipple.
- 4. Is Thermography an Approved Procedure?
Yes, it was approved by the FDA in 1982. Also in 1984 the American Medical Association certified thermography as being “beyond the experimental and investigational stage.”
- 5. Is Thermography Costly?
Our fee for breast Thermography is $300.00. Approximately two weeks after the study the patient will receive a packet. The packet will include two sets of nine images each, one set in color and one set in black and white. A comprehensive report by Dr. Getson and a universal claim form will also be included. A copy of the report is provided to the clinician(s) of your choice. When applicable, a phone conference with Dr. Getson is provided at no additional cost.
The cost for a thyroid/dental thermogram is $125.00. This study consists of nine images which are a mixture of color and black and white images, Dr. Getson’s report, a universal claim form and when necessary a follow-up phone conference with Dr. Getson. A copy of the report is provided to the clinician(s) of your choice.
The cost of a neuromuscular thermogram depends upon the complexity of the study. Please call the office for more information regarding this study.
- 6. Is Thermography Covered by Insurance?
Payment is required at the time of service. For reimbursement purposes, each patient is provided with a universal claim form which includes CPT and ICD-9 codes for them to submit to insurer for reimbursement. In the case of breast thermography we have found that the insurers are more likely to reimburse individuals with dense breasts, scarring from prior surgery, history of breast disease be it themselves or a family member (particularly in women under 40 years of age), breast implants, neuropathic pain and in women with inconclusive anatomic studies. In these instances a physician’s prescription may be helpful in facilitating reimbursement.
- 7. My Doctor Doesn’t Know Much About Thermography
My doctor does not know much about thermography and isn’t sure it is a valid diagnostic tool. How should I respond to this?
- The camera is FDA approved.
- The AMA approved thermography as an adjunctive test for the diagnosis of breast disease in 1982.
- In 1984 the American Medical Association certified that thermography was “beyond the experimental and investigational stages.”
- Over the last ten years there have been great technological advances in thermal imaging cameras and their accompanying computer software.
- Part of the problem lies with the fact that thermography was inappropriately placed in the Detection Demonstration Project. Medical thermography has been available for over 50 years, predating mammography by a decade.
Once the study was completed it was apparent that it had serious flaws. Part of the problem with the confusion regarding thermography is that it was inappropriately placed in DATTA Study. Many of the testing sites were mobile trailers without any temperature or environmental controls. In a diagnostic test that depends primarily on temperature measurement, this was an inexcusable omission. Next, the “technicians” who performed the studies had little or no training. Finally, the interpreters were radiologists who had no expertise in the interpretation of thermal images, many of whom where operating under the misguided premise that the evaluation of thermograms was “simple.” Moreover, it was not until the 1980s that the thermographic community established standard protocols and formal training.
How then could the study with all of its inherent flaws have stood a chance of accurately evaluating thermography? And yet to this day critics of thermography still rely on this thirty-year-old study while choosing to ignore the monumental advances in thermal imaging.
Over the last ten years the incidence of breast cancer has doubled. Is it not incumbent upon us to use every proven diagnostic tool available for the earliest detection of breast disease?
The use of thermography in the diagnosis of neuropathic pain is best explained by reading Dr. Getson’s article titled “The Use of Thermography in the Diagnosis of CRPS: A Physician’s Opinion”. Click here to read this article.
- 8. Should I Have a Mammogram?
This is an individual decision which must be made by each patient. Due to the high number of false negatives inherent in mammograms, it is becoming increasingly apparent that no one diagnostic test is sufficient for the assessment of breast disease. Mammographers acknowledge a 15% to 20% false negative rate, a number made higher by women with dense breasts, implants, and scar tissue. Due to the fact that thermography is a physiologic study and the results are not affected by these anatomic issues, additional information can be provided which is not readily available on a mammogram. Further, it has been shown that a positive (abnormal) infra-red image is the single most important marker of increased risk for the development of breast cancer.1
- 9. What About Ultrasound and MRI?
We have found that the addition of Ultrasound to Thermography has been very useful. Because thermography can often localize an abnormality often to one quadrant of the breast, we are able to provide the ultrasound technician with a “road map” so that the study can be concentrated in a small area thereby increasing the effectiveness of this test.
With the increased usage of MRI’s there has been a natural segue between these two tests. The MRI has provided a “large screen” view of the breasts which when coupled with thermographic imaging has been found to be extremely effective in diagnosing breast disease. Breast MRI’s use a contrast dye called Gadolinium which is water soluble and excreted in the urine within 24 hours. In healthy individuals there have been very limited side effects to this drug.
Both of these studies have the added advantage of providing information without the use of radiation.
- 10. What Should I Expect from a Breast Thermogram?
The room is maintained at 68-70 degrees, the ideal temperature for thermographic testing. The patient disrobes from the waist up. The patient then equilibrates to the room temperature for ten minutes. The patient is standing about 3 feet from the camera with her arms resting on top of her head. There is no physical contact, no compression, or radiation. Two sets of nine thermographic images are taken by a female technician. After the first set of images are taken, the patient is asked to hold an ice pack for one minute. In Thermography this is called a “cold challenge.” The cold challenge provides additional information by determining whether blood vessels dilate or not, allowing us to better define suspicious vessels in the black and white views. The second set of images is taken, the patient dresses and departs. Usual time spent in the office is 30 minutes start to finish.
- 11. What Should I Expect from a Neuromuscular Study?
The room is maintained at 68-70 degrees, the ideal temperature for thermographic testing. The patient disrobes to their undergarments. We provide disposable undergarments for men and women. If you prefer to wear your own we ask women to wear a thong and our disposable bra and men are asked to wear an athletic supporter or bikini briefs. This level of exposure is necessary in order for us to image the buttocks which are an integral part of the study. Usual time spent in the office varies between thirty and sixty minutes depending upon the complexity of the study.
- 12. What Should I Expect from a Thyroid/Dental Study?
The room is maintained at 68-70 degrees, the ideal temperature for thermographic testing. We encourage attire that exposes the patient’s entire neck or they may be asked to remove their shirt only. Nine images are then taken of the face and neck. Usual time spent in the office is twenty minutes.
- 13. When Will I Get My Report?
A copy of the images and a written report of the findings will be sent to the patient within 14 days of the study. A copy of the report will be sent to the healthcare professional upon request.
- 14. Who Is Qualified to Take and Interpret Thermographic Images?
The performance of thermographic imaging should only be done by a board certified or board eligible technician. The interpretation of these images must be done by a licensed health care provider (D.O., M.D., D.C.) who has been certified by a recognized thermographic organization. These clinicians are the only ones trained to interpret and apply the information garnered from the thermogram.
1Gros, C.,Gautherie, M. Breast Thermography and Cancer Risk Prediction. Cancer 1980;45:51-6.