thermography is the pictorial 

representation of the 

infrared radiation emitted from the human 

body.

Medical thermography had its beginnings in about 

1956.

Due to the or as a result of 

some observations by dr ray Lawson of 

Montreal Canada 

to speak.

On the subject of thermography.

We must first review some of the 

basic principles of infrared radiation 

and I will attempt to going through this 

related to the 

medical applications of this technique.

Infrared radiation was first discovered by 

Sir William Herschel in about the year 

1800.

Okay.

This photograph depicts 

the original experiment which was 

performed by Sir 

William Herschel,

in which he first demonstrated the uh 

the existence of infrared radiations in 

this particular experiment 

he used or allowed 

sunlight to come through a 

split and fall upon a prism.

This prison then dispersed this sunlight 

into the well known 

rainbow,

so to speak,

or the electromagnetic spectrum in the visible 

region.

Having seen this before,

he then placed various 

thermometers within are 

over the various colors of this spectrum 

and found that when the thermometers were 

placed just below are just 

outside of the visible region on the red end of the 

spectrum,

um heat was manifested.

That is the thermometers begin to 

indicate a rise in temperature.

Thus,

he discovered the 

existence of these invisible infrared 

radiations.

The technique by which heat is transmitted From one 

body to another.

Mhm.

When talking of infrared 

radiation and we now have learned 

to uh speak of it in terms of its 

wavelength,

there is what we call the near infrared.

That is the infrared radiations which are very near the 

red end of the spectrum.

The middle infrared radiations which are about 

3-6 microns.

The far infrared determined as 

six to 15 microns and the extreme 

infrared,

15 to 1000 microns.

In wavelength infrared photography 

operates in the near 

infrared region.

Medical thermography Is 

involved with the imaging of middle 

infrared radiation.

Too far infrared radiation,

something between 3-15 microns and 

wavelength to image 

such wavelengths,

we find that infrared 

photography or the photographic emotion 

itself is of no value.

Ah In the sense that these 

emotions are only sensitive to 

wavelengths up to about nine 

micron and wavelength.

So to image infrared radiation given off 

by the human body requires the development 

of further 

techniques.

This slide illustrates the spectra 

of radiation which are emitted from 

the human body at normal body 

temperature Here,

this is at 300° 

Kelvin are about 

37 C,

R 98°F. 

And you'll notice that the major portion or 

the maximum amount of radiation is given 

off at about nine microns,

wavelength 9.7.

While there is some given off 

below that in a large portion given off above that 

uh,

on this particular scale,

this direction is longer wavelength and 

less energetic photons.

While in the other direction,

we find the charter wavelengths and more 

energetic photons.

You'll note that 

the human body at this 

temperature or anybody at this temperature does 

Not give off radiation below one micron,

which means that infrared photographic 

plates would not respond to the radiations 

that are emitted by the human body.

Now,

that particular distribution that we showed you was called 

the plank distribution or the black 

body distribution of radiation from 

a heated source.

Uh further this slide goes to show 

the black body distribution 

and what we Call a selective radiator 

distribution,

one which might come from heated gases 

which are not necessarily considered black 

bodies.

And here is another distribution very similar to the 

black body.

However,

of less output,

indicating what we call a gray body 

distribution.

The area under any of 

these curves represents the power 

given off are the total energy given off by this 

body at a particular temperature.

Now,

the amount that it does give off is well 

defined by the Stephan Goldman Law,

which says That the amount of radiation 

given off by a body is proportional to the 

4th power of the temperature,

the absolute temperature of that body and 

proportional to also they 

are related to this temperature by 

what we call the emissivity.

When the emissivity is unity,

this means that we are looking at a black 

body radiator.

If it's less than unity,

we have a great body radiator,

the distribution is identical to the black body distribution,

however,

is less in amplitude.

Now in 

developing detectors for 

detecting infrared radiations,

it was first necessary to define this business of black 

body versus gray body versus versus 

selective radiators.

And uh in the development of detectors for 

these radiations,

it was necessary to to construct 

radiative radiation sources.

This is the general construction of what we call a black 

body radiator that is used for calibration of 

these detectors.

Um Sir Albert Einstein 

many years ago in one of his thought experiments 

defined his concept 

of a blackbody blackbody being one 

in which if a photon should enter 

this port and reflect 

from these walls,

the walls being either 

non absorbers or very having very little 

absorption.

This photon could reflect within these 

walls forever without ever 

coming back out the port.

Should we define some sort of cavity like this in 

which the probability of bouncing back out of the port 

is zero.

Then this aperture would be considered 

a black body source or a black 

body.

It would have properties of a black body 

in that a black body is a perfect 

absorber as well as a perfect 

radiator and 

uh the emission then coming from it would 

represent or be proportional to 

The uh 4th power of the absolute 

temperature of this body.

So such cavities have been constructed and as 

you well know,

uh this type of thing,

there is a finite probability of the photon 

bouncing back out.

So it would really not represent a a true black 

body but we have been able to simulate true 

black body sources by the use 

of cavities such as this and cylindrical 

cavities are spherical.

Now,

other aspects of radiation,

our infrared radiation which 

deal with the use of detectors.

The development of infrared detectors 

lies in some of the 

properties of our atmosphere.

And I'll explain why in the sense 

that infrared radiation had its beginnings 

with uh 

the uh applications to the 

Department of Defense.

That is applications to 

uh the 

conduct of war,

the the night vision,

the problems of night vision and such.

And so uh the utmost 

concern was the ability to look through 

large distances of atmosphere.

You will find that in medical thermography today there are 

two types of detectors which are very popular 

in medical thermography.

The first is the indium antenna mine 

detector,

the second,

the mercury cadmium telluride detector.

And it's very interesting to note why these two detectors 

are have attained the 

popularity that they now have the first 

indian antenna.

Mydd has a response as we will see a bit later 

in the 3-5 or 

somewhere in this region.

This window uh This series 

of wavelengths and as you see here,

this is transmission of the atmosphere 

in percent versus wavelength.

And you'll see that the atmosphere has a transmission 

window here Of 3 - five 

microns.

So much effort was placed in the development of infrared 

detectors which could detect infrared radiation 

in this wavelength range.

Uh There is another atmospheric window Here 

at 7 - 14 microns.

And this is exactly the 

response capability of the mercury 

telluride detector or mercury cadmium telluride 

detector.

And it is from from about 

6 to 15 microns.

So much effort was placed on the development of these two 

detectors simply because of the existence of these atmospheric 

windows which would allow them to be used 

for our defense purposes in 

imaging through cloud layers,

heavy fog,

dense fog,

whatever.

Here again,

we see the,

what we call the Detective Itty,

of these various detectors of the two 

detectors that I speak of and 

as regards to their wavelength 

over which they are sensitive 

here is the indian antenna.

My detector,

this dotted curve indicating the theoretical 

limit of Detective Itty.

Once you approach that you have reached the theoretical 

limit of the system,

the indian Montana.

My detector has been developed to the point that it has reached the 

theoretical limit.

However,

you notice that its range of responsive 

Itty is only from about 

two,

25 microns at most.

And if you recall the wavelengths given 

off by the human at 37 

C ranged from,

well,

the peak is at 9.7 micron 

and uh little most of the radiation 

emitted is above that 

here.

The indian and the Merck had telluride detector is shown 

to operate from anywhere around five out to 

about 15 microns.

The uh 

Detective itty is not as near the 

theoretical limit as an Indian 10 amid.

However,

since we recover most of the radiation given off by the 

human beings,

we have a much higher signal response using this 

detector than the other.

Both are what we call 

semiconductor devices.

They have very high response times.

Uh As compared to for instance,

the very early detector used an infrared 

work called the bill a meter.

The barometer was not an infrared 

radiation detector.

It was a thermal detector.

It is the mechanism by which it operated 

consisted of uh heat falling on 

a blackened surface,

heating the surface and then causing the 

the resistance of this barometer to change.

Consequently there was a heat transfer mechanism 

involved in the detection of this heat.

Um and uh the 

long response time here the response time of these 

photon type detectors or semiconductors is on 

the order of a few male microseconds.

Now to use these detectors,

These minute detectors which are all on the order of 

about 3000s of an inch on a side.

To use these detectors in the generation 

of an image,

one must employ some such 

simplified here optical system 

scanning optical system here 

radiations which are 

uh entering the system from this point 

reflect onto the scanning flat 

surface mirror here they're reflected from this 

flat service onto the collective collecting 

optics and from there focused 

onto the small radiation detector 

which is simply a chip.

Yeah.

Now to form an image 

then this scanning mirror 

is oscillating back and forth 

and uh in a raster 

formation such as in the television 

raster.

It starts at the upper left hand side 

of the field of view scans across.

Then it tilts a bit,

scans another line across.

And in this form in this way 

farms in a serial manner 

the infrared image.

Now one other way of looking at 

this is to consider 

the infrared detector here and the 

image of the infrared detector here,

this infrared detector or the image of this 

detector,

the size of the image out here is called the 

resolution element size.

This means that you are measuring temperatures 

over that particular dimension.

Now this has to do 

and bears upon the 

resolving capability of this 

scanner and its ability to resolve very 

small objects across the human body.

Other considerations are the field 

of view,

what we call field of view and this has to do 

with the angle over which this scanner Is 

moving.

Whether it be a 10° angle of 

scan or a 30° angle We 

say this is a 10° or 30 degree field of 

view.

Now.

Uh these have many 

implications.

For instance,

when you have a very wide field of view 

in a thermo graphic scanner,

there are many optical considerations such as 

f number or speed of the optical system 

in these faster optical systems,

the depth of field um 

is very narrow.

The depth of field is very narrow in this system.

However,

the advantage of The 30° field of view is 

that one may place the patient very close to the scanner 

head.

If you have a very narrow field of view to see 

the full patient in the scanner,

it requires that the patients set some 

further distance away from the scanner.

Hit itself many times.

This is on the order of 6-8 ft where this might 

be two ft and 

this is often a consideration 

in the clinical 

application of thermography in the sense that 

space is at a premium 

here we show the effects 

of this resolution element size 

as we focus out to various 

distances.

The optics can be arranged that we can 

focus at two ft or focus at six ft.

However,

since the speed of the optical system is the 

same than the resolution element size is going to 

get larger as we get further away from the machine 

here we have a plot of what we call the 

resolution element size and it's expressed in what we 

call the angular resolution or 

what we call the entrance pupil to the scanning 

system.

And you can see that as one Moves 

as one moves close 

to the patient here 

at two ft from the patient.

For a particular angular 

resolution you have 

down here,

you can read off the resolving 

power in cycles per centimeter are 

in uh 

millimeters.

That is the size of the structure.

That one may be able to resolve.

Uh the machine that I 

am using now in the clinic 

has about a 

75 miller 

degree or mila radian angular 

resolution.

This allows us to operate 

um at let's see,

75,

we can operate um 

at two ft we have some 

10 cycles per centimeter.

Or we can resolve one half millimeter 

objects separated by one half millimeters.

So we have very high resolution with this system.

Now this uh will 

illustrate how resolution affects or 

rather how the elements size affects the resolution of the 

system.

If you consider a 

resolution element size as depicted here.

Now this element,

this is an image of the detector is going to cross 

some vessel,

let's say some vessel on the the surface of 

the patient here we see it 

position one and now it positioned 

to as its sweeping across this vessel.

The size of the signal.

The electronic signal that is generated is shown 

here as as the 

element resolution element crosses this vessel and you will 

see that at no time.

Is the resolution element 

completely filled?

That is is it 

sampling or is the 

entrance pupil completely flooded with the 

radiation?

So the amplitude of the signal which 

results from this is much less than 

the actual temperature of the vessel 

That is,

he indicated are 

the manifested temperature of the 

scanner never does reach the actual 

temperature of the vessel.

Whereas if the resolution element were 

small and crossing a vessel,

you see that it is soon 

completely filled and 

the electronic signal or the video 

signal coming off from this uh coming out of this 

amplifier then saturates holds a 

particular level and then begins to fall this 

signal or the amplitude of the signal then truly 

represents the temperature of that vessel.

This is one of the important aspects of high 

resolution and why we 

would want high resolution.

We must always consider the fact 

that the temperatures that we see 

in these images may or may not be the 

absolute temperature of the vessel are the part,

body part that we're speaking of depending 

upon whether the resolution element 

size was smaller or 

larger than the body part 

in that particular field of view or that plane.

Yeah,

by means of the scanning technique then 

we can generate images such as this.

This is a high resolution thermo graphic 

image of breast 

patient.

The scanner that he was 

used to generate this image.

was laying down some 

535,

scan lions per frame 

and Scan these lines in 

approximately 3.5 seconds.

There are many types of machines are 

many types of machines available on the market today 

and it should be very clear to the,

to the user or the 

prospective purchaser of one of these machines 

that each of these machines represent 

state of the art.

They differ only in the 

parameters that were available 

to the engineer.

That is.

Should you want high resolution,

you must give up something In certain 

instruments that are of very high 

resolution.

We have long scan times.

That is something on the order of three seconds two seconds.

Three seconds.

If you want very high frame rates such 

as real time viewing then you must give up 

resolution.

The machines with 5 25 lines 

have a three second scan.

As I said before.

Those that have 16 frames per 

second have only 100 

scan lines.

This then limits the 

resolution of the system.

So all of these things are 

parameters which the engineer must 

weigh must uh Yeah,

give and take as it were to design the machine for 

your needs.

Mhm.

As I stated very early,

the whole field of medical 

thermography came from some of the early work of 

DR Lawson.

Dr Lawson performed some experiments in 

1955 and 56 

and was the first note document 

an increase in temperature over a tumor 

involved breast.

After documenting this data,

he went further,

he went on then to make some 

measurements of the blood flowing 

through vessels of this of these 

patients harbouring breast cancers.

And here you can see he embedded a 

small needle for MR into the tumors 

and measured the temperature of the tumors.

We want to compare these temperatures with the temperature of the 

blood flowing in the lateral thoracic artery 

as shown here 

and the lateral thoracic vein 

here is the corresponding temperatures of the 

internal memory and internal memory 

vein.

You'll note that Number 

one.

The Venus blood temperatures 

are higher than the arterial blood temperatures.

This told DR.

Lawson and was interpreted by DR 

Lawson has meaning that this blood was 

draining the tumor site that 

is it was draining or carrying heat away from the 

tumor site.

The tumor being the site of the genesis of 

heat and the arterial blood coming in rather 

cool and leaving by means of the veins 

at an increased temperature.

So this has helped 

us in the interpretation of thermal grams as I'll show you in a 

little bit.

And there are other considerations 

before we speak of interpretation.

There are other considerations of the architecture of the breast which we 

must take into consideration 

And some of these have some physical base is 

# one.

Should you consider a tumor are 

a heat generating 

source deep within the breast.

We must consider the fact that the breast is covered 

by a sheath of adipose tissue,

adipose tissue,

fatty tissue being a very good insulator of heat.

There is no way or there is little evidence 

to show that heat generated from a 

tumor deep within the breast can be 

propagated to the surface and thus seen 

by a thermo graphic scanner.

Now this brings out an additional point and that 

is that thermography images 

the infrared radiation as I said before,

emanated by the patients are admitted by the patient.

However,

it maps the temperature of the surface of the 

patient only.

This is what we're talking about the temperatures as 

seen on the surface of the patient.

So,

going back then to the structure of the breast,

one can see that a deep lying tumor 

cannot propagate this heat to the surface.

The only way does he can get to the surface is by means 

of what we call venus conviction.

This is where arterial blood bays the 

tumor are the lesion and this 

venus blood carrying the heat away.

Now wherever these vessels happen to surface,

this is where we're going to see increased heat.

And a bit later,

as we go through some of the thermal grams and the patterns we see.

We'll see venus displays of increased heat.

And this is the reason for that.

Um There are a number of other considerations.

First one recalls the thinning of the 

adipose tissue in the region of the a realer 

and also the rather a vascular structure 

of the nipple itself.

These will show up Now there is 

indeed in the region of the a realer 

an area of rich anastomosis 

of the deep and the 

superficial venus networks.

One would expect then,

that should a deep 

lying tumor exist.

That heat would 

eventually show up in the a realer 

as it makes its way from the deep 

vascular to into the 

superficial vessels.

And this does show up indeed in this 

region of anastomosis and 

this network 

now um 

in looking at thermography and attempting to 

uh assess its value 

as a diagnostic technique.

Very early in the game,

we realized that there were some 

changes going on that other factors had 

to be taken into consideration.

This is a picture of a patient 

harboring a cancer 

in which we mounted a very small transmitter 

which had to thir misters Coming out.

one measuring one which was 

placed over the tumor in 

the I believe the tumor was in the left 

breast and then another for mr placed over the 

contra lateral area in the right breast.

And we measure the temperature of the surface temperature 

of this breast for a period 

of a few days,

perhaps a week or so.

And this is what we 

found.

First of all,

we see,

the left breast is the solid line.

The left breast temperature was rather 

stable and at a much elevated 

temperature over the right.

There were no changes at all.

While the right breast,

which was the diseased free breast,

demonstrated this a 

circadian rhythm.

It is the mean temperature being below the temperature 

of the tumor involved.

Rest.

And uh beyond that,

having this circadian fluctuation 

are variations.

There was much 

consideration of this data.

We would note first of all 

that if thermography is going to be 

used to diagnose breast cancer 

and if a symmetry is going to 

be our principal 

criterion for interpretation,

that is a difference in temperature of the right breast versus left 

breast are some structure on the right breast versus a structure 

on the left.

Why then this would tend to indicate that 

the difference in temperature would be dependent upon the time of 

day,

that one made the the images 

strictly due to the circadian rhythms.

Now these are variations within one patient 

and you know 

well enough that there are patient to patient 

variations.

Beyond that.

However,

there was some speculation as to the 

the interpretation of this here.

We call the circadian rhythms.

The tumor involved breast has lost its circadian 

rhythms,

attempting to to interpret the 

meaning of such things.

We found some data in 

a in the literature.

This was a published by Dr 

franz Hallberg and his work on 

circadian rhythms 

here.

He has plotted mitosis 

per 500 fields.

This is my topic index 

of a tumor.

Well,

my topic index period 

of tissue versus the time of 

day.

This top line which has very little 

variation and is very high.

Was this was a my topic index of a 

tumor that had been transplanted or rather 

implanted in the back of this uh 

small rodent.

And he took the metadata really took specimens from 

this tumor every so many hours and showed that the main topic 

index not only was higher than normal tissue has 

shown here.

However,

not only higher,

but very stable and not very 

much.

Whereas the mitten topic index in normal 

tissue seem to very 

over a large range and the mean 

value being much lower than the cancerous 

tissue.

This went on and became circadian 

rhythms in the normal 

rodent.

We still do not know the essence 

of heat or what we call now 

call the thermal genesis in breast 

cancer.

We have little idea as to 

where this heat comes from,

Why some cancers are taught 

by some cancers are cold,

Why some small cancers give off more 

heat than some large cancers?

This is an area which is 

presently being investigated and much work is 

being conducted.

Yeah.

Now we will move on into some thermal grams or thermo 

graphic studies and show you 

some of the variations that you 

find.

This is considered a normal thermal graham,

I should say.

And 

is what we call the splotchy pattern.

The patient is covered with little venus 

knuckles all over 

torso and such.

Um This occurs in about 

4% of asymptomatic women 

that we screen.

Uh There is a little asymmetry in the sense 

that there's a cool area here which is not seen 

here.

However,

uh This is not considered an abnormal thermal 

graham as such.

This is a normal thermal graham And the splotchy 

pattern are splotchy Appearance occurs.

As I said in about 4% of the patients we screen 

here's another image ah of a 

woman.

And I should note to at this point that black 

represents areas of increased heat.

Black is hot here.

Um Here we're beginning to 

see.

Now some asymmetry here is a very large vessel 

on uh this woman's breast which is not 

seen on the right breast.

This would be considered an abnormal therm a gram 

of the left breast.

That we can't say,

a positive thermal graham for cancer.

Uh This technique is is 

non specific for breast cancer.

It would be considered more 

specific for breast disease 

and particularly 

asymmetric breast 

disease.

However,

this does represent a significant 

asymmetry in lieu of the rather in 

view of the fact that the right breast is 

rather a vascular and cool in 

appearance.

Here is a therm a gram of a woman which 

has more vascular breasts.

However,

you can see here very a large 

area of increased heat in the upper outer 

quadrant.

Also,

you will again note the perry realer heat are 

increased.

Perry realer heat here as compared to 

the left.

A realer this would be considered 

also an abnormal thermal graham.

Yeah.

Again,

this is a 17 year old girl with a very large 

abnormality or asymmetry in heat 

distribution.

Again,

symmetry being the the major 

criterion in thermography.

This is an abnormal thermal graham 

abnormal for the right breast.

Okay,

I'm going on through here.

These are more dramatic and more 

uh 

well easily interpreted thermal grams.

Very few in 

screening large populations of women.

Very few thermal grams.

Come up quite this dramatically.

But here again,

you see a very large difference in 

symmetry here.

The vessels.

Not only are there more vessels,

they seem to be engorged and 

very warm as compared to the vessels of the 

left breast.

This picture was taken in 

1972.

The same woman was scanned again in 

1973.

Uh The uh 

aspect of this picture has changed a little bit due 

to some technical adjustments 

of the machine.

However,

this is the same patient.

You see.

The pattern has not changed significantly 

and 

uh 

the patient did receive uh ma'am a 

graphic examination in 72 nothing was 

found and in 73 the same image.

However,

nothing has been found there either.

This woman is presently being 

followed.

Okay,

here we have a therm a gram of which is not so 

dramatic.

However,

there are a number of things.

First one sees the asymmetry and 

vascular charity here.

More linear vessels of increased 

heat.

You see the perry realer heat of the left breast 

based on that one would consider this an abnormal 

thermal graham of the left breast.

When you look at the right breast,

it's relatively a vascular.

With the exception of this tortuous looking vessel 

here,

which is rather abnormal.

This particular patient presented with 

bilateral carcinoma of the breast.

Okay,

again,

we get into the more difficult cases.

This woman was an elderly woman.

Ah The only 

a sign of abnormality here is the difference in 

size of breast and one would wonder then if this size 

had to do with retraction,

our distortion of the breast itself.

However,

I'm looking very closely,

since there is no thermal asymmetry to speak 

of That is that is significant 

one.

If you look very closely,

there is a bulge in this outer 

aspect of the breast in which 

there was a very large and clinically 

palpable mass which did turn out 

to be a breast cancer.

But thermal graphically this would have to be called 

a negative thermal graham.

Yeah.

Yeah.

And going on,

we here is a therm a gram of a very 

young girl.

And along with the corresponding infrared 

photograph,

the infrared photograph now simply 

demonstrates the venus network across her 

breast.

These vessels you are able to see not 

because of their temperature but because of the 

absorption of the near infrared radiation which is 

falling on her.

And uh simply allows you to see 

the superficial vasculature much much easier.

And the thermal graham of course,

is very dramatic.

Both breasts are very hot,

however symmetric and this 

thermal graham them 

demonstrates the appearance 

of a young girl in her first trimester 

of pregnancy.

Again,

this is a normal condition.

It's the beginning of lactation.

This thermal graham um 

again presents what we call the normal 

thermal pattern 

that being the cool breast that 

is a vascular uh no 

vessels over the breast.

However,

one may use high resolution thermography 

again to interpret or rather 

to detect abnormalities of the breast.

If you look at the curvature of the breast 

here as compared to the curvature of the breast here.

You see a very flat region here 

and this distortion in the 

contour of the breast,

now called the edge sign is considered 

one of the criterion for 

criteria for interpretation 

and this edge sign or distortion of the 

breast was used to consider this as an 

abnormal thermal graham of the left breast.

And indeed she did have a carcinoma 

of the breast.

Yeah.

Now to do proper 

medical thermography are breast 

thermography.

There are certain 

established 

protocol and techniques.

Number one.

The patient is first disrobed In a room 

of about 68-70° 

Fahrenheit.

We allow this room this woman then to cool in 

such a room for about about 10 

minutes,

anywhere From 6 to 10 minutes.

This is indicative or whether is required 

to increase what we call the subject 

contrast of the patient.

Upon first disrobing,

this woman has little range of 

temperatures displayed over her torso.

After she cools a while,

the areas of increased heat are much more 

highly delineated and 

detail over the surface of the patient is 

much easily,

much more easily recognized.

So uh this shows 

schematically what a mass screening 

installation should have as if you're 

going to screen many women,

you would have a number of cooling booths where the patients are 

put into these booths allowed to Sit for anywhere from 

8 to 10 minutes and brought out from behind their 

curtains placed in front of the scanner 

thermal grams are performed while the 

others are being cooled.

One can then rotate patients through 

these cooling booths and uh 

uh the throughput time will 

be uh that dictated by the time 

to take the pictures itself.

Each image taking on the are taking on the 

order of about A minute.

uh some 3-4 

seconds for the scan and 

45 seconds or so perhaps for 

positioning.

And that 

should be the only consideration there.

Now.

As far as operating the machine,

there are certain things that a 

person should know.

Uh the thermo graph machine.

While it is a very complicated and 

sophisticated electro optical system,

actually only has two knobs that you should be considered 

with in performing medical 

thermography.

There are three really,

there is a focus control.

However,

if you place the patient at the same distance for 

each study,

the focal plane need not be changed.

One can do this by using a small measuring 

stick set.

The patient in front of the machine used the stick to adjust her 

to where she is in the focal plane and then 

start the scan.

However,

Beyond that there are two knobs.

One is called the range control and the 

other the temperature level control.

Now,

what do we mean by range and level control?

Well,

if we consider a thermometer here 

and we say 

that all right on our screen or in our 

image.

If we're going to use black for hot.

Why then black we want black to represent 

85° and white To represent 

75°. Well,

this means we have A 10 degree window.

That's our range control.

The range control adjusts the thermal window 

going in what we're going to represent on the image 

from black to white.

This is determined by the range 

control.

The level control simply Moves this 10 

degree window up and down the temperature 

scale.

Yeah.

In making these adjustments.

Well,

here we show A five degree 

window uh 

compared to a very wide 

window perhaps Uh 15 or 

20° mm.

Mhm.

This becomes important when you consider 

the temperatures which are displayed 

by the patient themselves,

himself or herself.

For instance,

if this be this these 

solid lines represent the temperatures 

which are emitted are seen on the patient.

If you were to measure temperatures across the 

patient's torso.

If this is the range of temperatures which the patient 

exhibits.

Why.

Uh And this is the 

sensitivity.

The window of your thermo 

graphic scanner.

You can see that the patient is emitting 

radiation which your machine is not picking 

up.

Now if this is the black end of their spectrum and 

this is the white,

you can see that much of the patient is going to be 

saturated in the black end,

totally saturated,

much of the patient will not be seen at all.

It'll be white or whiter than white and we will not 

have on the photograph.

So this range control is improperly set,

The range control should be adjusted such that it 

encompasses the temperatures given off 

by the are emitted by the patient as seen by 

the patient here again,

the temperature range control is properly adjusted.

However,

the level control is a little too high in 

this case.

Then there will be no part of the patient 

which will be truly black on the film.

Yet there will be much of the patient which is 

invisible that is in the whiter than white region 

and simply 

not seen 

Now.

The effects of mala adjustment of 

these controls 

on the quality of a 

thermal graham can be demonstrated here.

Here we have a thermal graham and 

I like to have part of the super club vehicular 

area as well as the mouth in this region 

visible on each thermal grams so that I have an 

idea of the 

significance of temperature of other parts of the body that I 

see for instance,

here we see an asymmetry.

A definite asymmetry.

A vessel under the left breast which is not seen on the right.

Um The significance of this temperature of this 

vessel is can be judged when we 

compare the temperature here as to the 

temperature of other parts of the body such as this.

Now I can see that the temperature here is not very 

significant in comparison to other temperatures of the 

body.

However,

there is a slight asymmetry.

So,

I would call this a slight asymmetry 

now should the level 

control be maladjusted.

This is what one sees then 

the temperature of this vessel is exaggerated.

I can no longer tell the significance of this 

vessel in comparison to other parts of the body.

Since this is saturated and in the blacker than black region 

many times are false positive 

rates can be affected by 

a bad photography and 

bad technique.

This is the picture of the thermo graphic unit which 

we have installed at the breast cancer detection 

center here at ST joe's 

ah breast cancer detection center.

And you see a motorized chair 

motorized and remote control stand 

here is the control console.

We can present images in the black hot.

Are the white hot mode?

Yeah the images are 

processed and drop out of the chute.

They're mounted up in a what we call an aperture 

card.

This is processed within about 45 seconds 

after the completion of the examination 

And nine images are obtained on one 

chip.

The images maybe 

interpreted.

Uh huh by means of a 

projector.

Uh The advantage of this technique is 

first of all the compactness of the data.

Uh and the fact that one may view all nine 

images at the same time without having 

to shuffle things in and out of envelopes and whatever.

So this is,

it gives us an idea of 

the instruments we are now using at ST 

Josephs that you will have an opportunity to 

see.

And many of the 

slides and many of the studies coming from this 

center will be available 

for you to review,

as well as assist in the 

interpretation.

Thank you.