Download II. Thermography in Biomedicine

Thermography – Breakthrough in Biomedicine
Iskra A. Nola1, Darko Kolarić2
1
University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Zagreb, Croatia
2
Ruđer Bošković Institute, Centre for Informatics and Computing, Zagreb, Croatia
[email protected]
Abstract - In 1956th Lawson used infrared imaging in breast
cancer patients and discovered higher skin temperature above
cancer spot than of normal tissue. After his achievements
thermography started its development and exceeds the
experimental state as a diagnostic procedure being used for over
40 years. Once biological basis were established many other areas
were opened for biomedical thermography like breast cancer,
varicocele, inflammatory diseases, skin abnormalities etc.
introduced with different types of studies. The most of them are
dealing with breast cancer, and other with ophthalmology;
melanoma diagnosis; the complex regional pain syndrome;
Raynaud's phenomenon and systemic sclerosis; the diagnosis and
monitoring of rheumatoid arthritis; inflammation in the acute
diabetic foot and the foot in remission. In all of these areas
different approach could be seen: some of researchers are
interested in thermography as a treatment tool, and others see its
value as a diagnostic tool. However, essential technique – digital
infrared imaging and its images – needs improvement in order to
provide more useful anatomical information associated with it
which will be the best help for doctors.
Keywords – Thermography; Biomedicine; Angiogenesis; Nitric
oxide
I.
INTRODUCTION
The physical basis of infrared emission was only the
beginning. Military researches elevated the technology on
higher level and discovering why some body parts have
different temperature become a mission for many scientists.
They initiated continued research and clinical observations
that finally proved that certain temperatures of different body
parts could be related to normal and abnormal physiologic
processes.
In 1956th Lawson used infrared imaging in breast cancer
patients and discovered higher skin temperature above cancer
spot than of normal tissue [1, 2, 3]. His researches also reveal
that the venous blood draining the cancer is often warmer than
its arterial supply. After his achievements thermography
started its development and exceeds the experimental state as a
diagnostic procedure being used for over 40 years as an
adjunctive screening procedure in the evaluation of the breast
cancer. Also, numerous medical centers and independent
clinics have used thermography for a variety of diagnostic
purposes. Likewise, at the same time significant advances
have been made in the application of sophisticated
computerized image processing. Thus the Food and Drug
Administration on January 29, 1982, published its approval
and classification of thermography as an adjunctive diagnostic
screening procedure for the detection of breast cancer.
II.
THERMOGRAPHY IN BIOMEDICINE
A. Angiogenesis
Advanced technology enabled evolution in biomedically
applied thermography. As body heat is generated by
metabolism and by muscular activity and keeps the core
temperature at a defined, slightly oscillating level (about
37°C) thermographic advanced technologies allowed precise
measurements of it. The organism’s heat loss depends on
ambient factors and results of conduction, convection, IR
radiation, and skin evaporation. Inside the organism heat is
transported by convection (blood flow) and by conduction.
But, despite the explanations of physical base of the body
temperature and technology progress, finding the new
connections between the temperature differences and
pathophysiological status of the body still remains puzzle.
The largest evidence of physiologic mechanism by which
infrared imaging detects precancerous and malignant states
raised from the repetitive breast thermography through many
studies that showed the recruitment of existing blood vessels
and the formation of new ones (angiogenesis). Angiogenesis
begins with the release of angiogenesis factors (AF) from
precancerous or cancerous cells. In the early stages of tumor
growth, the majority of neoplasm show lower cellular
metabolic demand. Once the AF is released, the existing
vessels will try to resist constriction for maintaining
continuous supply of nutrients to the growing mass. The
growth of the tumor increases the need for nutrients and AF
starts opening the dormant vessels in the breast. After a while
weak blood supply hampers the growth of the neoplasm, and
AF causes the formation of new blood vessels. New vessels
are simple endothelial tubes that connect the tumor to existing
nearby arteries and arterioles. When time blood supply is
augmented, the increase in heat and vascular asymmetry could
be seen in infrared images. The concept of angiogenesis, as an
integral part of early breast cancer, was emphasized in 1996
by Guidi and Schnitt [4]. They suggested that it is
angiogenesis that precedes development of breast cancer and
may occur before tumor cells expand into the surrounding
stroma. This process is important because happens even before
morphologic evidence of an in situ carcinoma.
Simultaneously, in 1996, Gamagami studied angiogenesis by
infrared imaging and reported that hypervascularity and
hyperthermia could be shown in 86% of no palpable tumor
which were not visible on mammography [5].
Expansion of biomedical thermo imaging application in
biomedicine is very important as it is non-invasive method and
thus harmlessly repetitive. Even more important, pre-cancerous
tissues increased blood supply starts before the cells becoming
malignant causing an abnormal heat pattern in the breast
enabling thermography early detection. Consequently, it is
detection method that could be used as an early warning system
in breast screening.
B. Nitric-Oxide
The angiogenesis is a result of some precise biochemical
mechanisms. Nitric oxide (NO), major intermediary
messenger produced in the vascular endothelium in response
to nervous stimuli, induces vascular smooth muscle relaxation
resulting in vasodilatation. NO, unlike most other neuronal
messengers, can also be generated in the extravascular space
by pathways that do not involve the nervous system.
Extravascular NO is often produced in larger quantities than
intravascular NO neuronally induced. Extravascular NO can
diffuse into the vasculature and cause vasodilatation [6]. NO,
by saturating its receptor sites in the vasculature, can override
the physiological regulation of perfusion in the affected
region, and if that effect is close to the skin, it will decrease or
eliminate the thermoregulation of skin [7,8]. The
microhomogeneity of skin temperature will reach a maximal
value and can be detected as a different from other parts where
such process does not appear.
Many studies showed the production of NO in many
cancer cell lines such as breast cancer, melanoma, colorectal
cancer and squamous cell carcinoma [9-16]. The lymphocytes
generation of NO, especially by macrophages, is part of the
immune response, where NO can be cytotoxic. Cytotoxic
effect of NO on cancerous cells in vitro and its possibility to
enhance tumor growth in vivo can explain the similarity
between the immune response of macrophages to bacteria and
to cancer cells [17-21]. This anomalous effect of NO can be
explained by the fact that cancer-produced extravascular NO
causes regional vasodilatation, and thus enhances nutrient and
oxygen supply to the malignant lesion before enhanced
angiogenesis takes place.
III.
thermography as a cancer risk prediction tool is more likely to
be accepted than using it as a screening or diagnostic test. But,
a lot pro and contra attitudes still remains [31,32]. That could
be explained by researchers’ awareness of not having (jet)
reliable causal data.
Other areas were thermography was used are field of
ophthalmology [34,35]; melanoma diagnosis [36]; the
complex regional pain syndrome [37,38,39]; Raynaud's
phenomenon and systemic sclerosis [40]; for the diagnosis and
monitoring of rheumatoid arthritis [41]; inflammation in the
acute diabetic foot and the foot in remission [42]. In all of
these areas different approach could be seen: some of
researchers are interested in thermography as a treatment tool,
and others see its value as a diagnostic tool. A lot of papers
[29,36,37,40] stressed the needs for detection of thermography
potentials at different levels (patient, primary care, specialized
care) and they debate on its features.
CONCLUSION
Studies that were conducted during past time are not
conclusive either unanimous. Only one area, breast cancer,
divided scientist regarding the importance and usefulness of
thermography. In some other area, dermatology, complex
regional pain syndrome, Raynaud’s phenomenon, etc., there
are studies that are pointing on the benefits but all of them
suggest more research.
Overall, we can say that the breast cancer is growing area
for thermography testing and we can expect some conclusive
data probably very soon. But, despite great expectations,
today’s results show that thermography could be a good
management tool, especially for risk assessment but more
technological advances are needed to “push” this technic
forward.
Best studies, those that compare several techniques on
same group of patients, enhance progress. Also, using the
same technique in different fields can make a big difference.
However, essential technique – digital infrared imaging
and its images – obviously needs improvement in order to
provide more useful anatomical information associated with it.
If we overcome technological difficulty and provide additional
information for diagnosis purposes it will help medical doctors
in better diagnosing.
BREAKTHROUG INTO BIOMEDICINE
Once biological basis were established many other areas
were opened for biomedical thermography, like breast cancer,
varicocele, inflammatory diseases, skin abnormalities etc.
[22]. The most of them are dealing with breast cancer, either
as a research papers either as a review papers, often in
comparison with already established methods like ultrasound
or mammography [23-33]. Regarding the breast thermography
we can say that so much research done should provide a lot
results that could be interpreted. But, a lot of authors are still
very careful of giving the final conclusions or even are very
determined to defend mammography. Also, the use of
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