Thermal Imaging Interpretation

Absolutely! How could any medical imaging technology provide service without standards and guidelines? Quality peer-reviewed and published research studies performed in leading universities have established a normative database of objective topographic thermal gradients and temperature values. Almost 10,000 references exist in the literature using this normative database to examine for pathology.

With regard to breast thermography, over 800 references exist in the literature to support the standards and guidelines under which breast thermograms are interpreted. All breast thermogram reports should contain a TH (thermobiological) grading of each breast. If a report does not grade each breast into one of 5 TH grades, the competency of the interpreting thermologist comes into question. The TH grading system was devised in order to provide a method for the universal interpretation of both qualitative and quantitative thermal data and to use this data to convey the level of risk and concern. Without a grading system there would also be no way to objectively monitor the progression of possible pathology or provide an objective indicator of improvement of the health of the breasts under care.

The TH grading system has been in place since the early 1980’s. The American College of Radiology (ACR) established the BIRADS (Breast Imaging Reporting and Data System) grading system for mammography in order to provide the same information when interpreting a mammogram, MRI, or ultrasound of the breast. The ACR states the following: “The BI-RADS provides standardized breast imaging findings terminology, report organization, assessment structure and a classification system for mammography, ultrasound and MRI of the breast. The report organization enables radiologists to provide a succinct review of mammography, ultrasound and MRI findings and to communicate the results to the referring physician in a clear and consistent fashion with a final assessment and a specific course of action.” Thermography uses the TH grading system to accomplish the same objectives.

Absolutely not! It is the thermologist’s duty to NOT intervene in treatment. Your treatment must be directed by your doctor. 

Does the thermologist know your complete health history? Has he or she reviewed all of your recent and past laboratory exams? Does the thermologist know all of the medications, supplements, herbals, etc. you are taking? Has the thermologist consulted with or at least have your complete health history from all the other health care providers/specialists involved in your care? Has the thermologist provided you with a recent physical examination to be sure of certain health markers? Can you imagine the level of irresponsibility the thermologist would have to undertake to make treatment recommendations simply off the findings of a thermogram? There is a real possibility here that a patient could be seriously injured or worse.  

The findings and recommendations on the report are sufficient enough for your doctor to use in providing care. Have you ever seen a radiologist recommend anything other than further follow-up testing on a mammogram, X-ray, CT, ultrasound, or MRI report?

I think that we need to clarify this question first. If you are asking if there is an FDA approved computer program that will read the images and create a report without a board certified thermologist also reading the images, the answer is no. There is no place anywhere in health care where a machine provides interpretation of a test and creates a report without a doctor’s interpretation of the results. Have you ever seen a report from any imaging procedure that did not have a doctor’s signature (electronic or otherwise)? This is completely unacceptable in health care. Also, can you imagine the liability! No company would be foolish enough to want to accept this level of responsibility for their software program.

On the other hand, there are quite a few experimental programs currently being studied that are designed to aid thermologists when interpreting thermograms. However, we are not aware of any programs that have been proven to be accurate and approved by the FDA. As such, there is no adequate research proving that any of these programs are of value to the thermologist.

These programs are designed to work just like the FDA approved programs presently being used to aid radiologists when reading mammograms (e.g. ImageChecker). 

On a side note, research has shown that the skill level of radiologists in detecting suspicious areas on a mammogram is far greater than that of the CAD programs designed to aid them. It’s nice to know that we humans are still better than machines.

The use of the cold-challenge (placing the patient’s hands in ice-water, using ice mitts, or using ice packs placed on the mid-back) was stopped in the late 1980’s. The research at the time showed that using the cold-challenge did not increase the sensitivity or specificity of breast thermography. What we are finding is that some offices have websites telling women that they should never go to any office or imaging center that is not doing the cold-challenge. We have no idea why they are doing this as this is simply false information. Fortunately, the number of offices we see doing this is decreasing.

Back in the late 1990’s and early 2000’s the problem was so bad that Dr. William Hobbins (the leading expert in breast thermography at the time) encouraged Dr. William Amalu, DC, DABCT, FIACT (Board certified clinical thermologist) to review his database of cold-challenges and present a paper at the yearly symposium of the American Academy of Thermology (AAT). Dr. Hobbins and other experts in this field were concerned that these misleading offices were claiming that experts in this field were missing things by not performing breast thermography correctly. The paper went on to be presented at the international conference of the IEEE Engineering in Medicine and Biology Society. The end result was acceptance of the paper for peer-review and publication (click here or go to Medline/PubMed). As recently as 2013, the AAT formed a standards and guidelines committee that included Dr. Amalu, along with Dr. William Hobbins and a group of experts in this field, to review the current status of breast thermography and create an updated internationally peer-reviewed standards and guidelines document. With regard to the cold-challenge, a review of the literature along with a consensus among the experts reaffirmed that the cold-challenge did not improve the sensitivity or specificity of breast thermography; and as such, its use was not necessary to provide accurate infrared imaging of the breast.