Unsound Thermography Practices

General Warning to Practitioners and the General Public

by William Cockburn, DC, FIACT, FABFE

It has been brought to our attention by many email and telephone inquiries, that some thermography labs are promoting and advertising services which are not acceptable.

 This is happening in large measure in offices that have purchased thermography equipment from a manufacturer and then rely solely on the manufacturer for training and education in medical thermography.   Often this training is biased towards the particular instrument purchased or to corner cutting to provide more patient services per day at the expense of quality control.  Unhappily, this comes at great cost to the patient, and often to the chagrin of the unwary thermography technician or physicians who have bought into these mis-deeds.

 This short paper has been written to address the three most important of these errors that we are currently asked by the general public to help correct.

 1)  Thermography centers offering full body thermography. (A mis-nomer)

 In the old days of thermography there were codes for upper and lower body thermography.  These codes were used for neck or low back injuries and indicated that the cervical spine region and arms, or the low back region and legs were being imaged.   Some people had both neck and low back injuries and as such the "full body thermography code" was established.   Later in the late 80's early 90's we perfected CT scan and media advertising for Full Body CT scans wee seen on TV and heard on the radio nationally.

 The problem:  Thermography does NOT see inside the body.  We do not see inside the skull, chest, abdomen or pelvis and we do not see bone.   A full body thermography is a topographical Scan" meaning that only the surface of the body is being evaluated.  In fact, all of the labs who have been trained by the AMIA, AMIA< IACT< AMIT or ThermoDoc Network have forms that say Full Body Topographical Exam or Study.

 If a thermal imaging laboratory or doctor tells you that thermography can see organs, they are gravely mistaken.   You should not, under any circumstance, rely on thermography or thermal imaging for internal organ diagnosis.   This is the domain of anatomical or structural testing such as CT scan or MRI.

 2)  The double BASELINE evaluation.

 Many patients are told that they have to come back for a second examination in 90 days following their very first thermogram.   This is especially true for breast thermography labs.    This is a fundamental marketing tool and is not reliable and sound medical practice.

 When you have your very first thermography, also called a baseline thermographic examination, your exam will either be within normal limits, or there will be one or more abnormalities detected that require the follow-up of your physician.   The follow up examination may be anywhere from 6 weeks, to 90 days to 6 months.

 ONLY abnormal thermographic examinations require a thermographic follow-up in addition to structural testing (palpation, ultrasound, and mammography)

 To tell a patient that they need to have two baseline thermographic examinations, is in the opinion of this author, a misrepresentation of the actual baseline thermographic series.    Some manufacturers and their sales representatives may have told doctors that two exams are necessary to complete the baseline exam, in order to "help" the physician or technician buying the camera to see how to make more money.

 Establishing the "Medical Necessity" for a second baseline in these cases would be a very hard thing to validate and could be considered a fraudulent misrepresentation.

 3)   A statement is often made that the camera that is utilized is built specifically for the human body and as such, the protocols under which many thermography labs operate are no longer necessary.   This is factually untrue.

Some companies are selling their equipment and telling doctors and technicians that because the camera is specifically made to measure human skin, or is a highly accurate camera, or has a special lens - that they do not need to disrobe patients and acclimate them to a standard medical room temperature for thermography.

 What happens is that patients do not have time to come to a physiologic thermal equilibrium with the appropriate room temperature and artifice can be introduced into the image.   For example, if you were to disrobe and then scratch your breast vigorously without the technician seeing this, a heat signature would be produced that you cause the interpreting physician to think there was an infection in the breast or a cancer.

 The thermographic protocol of patient equilibration, often called acclimation in a standard draft free set of conditions is mandatory for the appropriate imaging of the human body.  The accuracy or speed of the camera has absolutely nothing to do with this important stem in the exam process.

 Of course, if a lab does not have to take the time to acclimate a patient they can move more patients through the office in a day.

Dr William Cockburn, D.C., F.I.A.C.T., F.A.B.F.E.
Academic Dean:   Academy of Medical Infrared Training
Fellow International Academy of Clinical Thermology
Fellow American Board of Forensic Examiners
http://www.academy-of-medical-infrared-training.com
http://www.thermodoc.com
http://www.breastthermography.org