FAQs

What is Thermography?

Digital Infrared Thermal Imaging (DITI, hereafter referred to as “thermography”) is a clinical imaging technique that uses skin surface temperature gradients to gauge the body’s proper functioning over time. In a DITI thermography scan, a technician takes images of a patient’s body with a medical grade infrared camera to create a visual representation of a patient’s skin surface temperatures. Images are read by physicians (MDs and DOs) specifically trained in thermography interpretation (Brandt, 2022). Thermography is painless, non-invasive, does not come into contact with the body, and has no radioactive component.

How does Thermography work?

Skin surface temperature is controlled by the sympathetic nervous system. A healthy body displays certain predictable patterns of temperature gradients across the skin surface. In general, these patterns are symmetrical from the left to right side, consistent over time, and typical when compared to other healthy people. Certain pathologies can lead to changes in autonomic functioning, which can lead to loss of normal temperature gradients, and in some cases increased vascularity (blood supply) as the body attempts to compensate for autonomic changes in sympathetic control of skin blood flow. Thermography compares skin temperature patterns from the left and right sides of the body, from past to present, and from one patient as compared to general healthy patients in order to gauge the presence of normal or abnormal functioning (EMI, n.d.) (Brandt, 2022).

How long has Thermography been around?

It has been known since ancient times that internal inflammation was detectable with skin surface temperature. The classical Greek physician Hippocrates, father of the Hippocratic oath, spread earth-soaked cloth on skin and monitored areas that dried faster for developing pathology (Brandt, 2022). The first infrared camera was developed in 1840, and by the early 1900s, infrared technology became classified for military use (Horowitz, 2008). It later became declassified and available for medical use in 1956 (Rakhunde et al, 2022).

Thermography was approved by the FDA as an adjunctive modality to screen for breast abnormalities, including breast cancer, in 1982 (Singh et al, 2021), but was not widely implemented for breast cancer screening at the time because it had a high rate of false positives, thought to be related to human error in manual detection. Since then, better thermal sensors, improved algorithms and support from computer correlation has improved the technology considerably. Some research also suggests that what previously were thought to be thermography “false positives” may sometimes correspond to early detection made possible because physiologic changes in tissue occur prior to pathological changes (Rakhunde et al, 2022).

What conditions can Thermography detect?

Thermography is a test of physiology, which means it can detect functional changes such as inflammation, vascular changes, lymphatic changes and other physiological findings which can be used adjunctively with other tests for a full picture of the current state of the body’s functioning (EMI, n.d.). A list of the conditions resulting in physiological changes that may be detectable with thermography can be found at the bottom of this page (see Indications for Thermographic Exam below).

Can Thermography diagnose cancer?

Thermography is not considered a diagnostic test and does not detect or diagnose cancer (or any other condition, for that matter). It also cannot see structural changes such as lumps, lesions, calcifications or densities. What thermography can detect is changes in skin surface temperature patterns that can be correlated with certain physiological conditions.

Because thermography is a non-invasive, do-no-harm technique, and because research shows abnormal thermograms are associated with changes that can predate or co-occur with cancer, it can be a helpful adjunct screening method for changes suggestive of cancer (Horowitz, 2008). It is important to note that to date, the only diagnostic test that can accurately diagnose cancer is a biopsy with a pathology report (Rakhunde, 2022).

How does Thermography compare to mammography, and what are the advantages of adding it to routine breast cancer screening?

Mammogram is a test of anatomy; it detects structures of varying densities. Thermography is a test of physiology; it detects function. Since the two detect different things, they can’t be directly compared to one another. However, they can be combined, as they boost the other’s accuracy.

Clinical breast examination has a sensitivity of 65% for breast cancer. This means that 35% of cancers will go unnoticed with clinical breast palpation alone (EMI, n.d.). Mammography can detect lesions in the breast tissue small enough as to be undetectable by feel, and its rate of accuracy rises to about 85% (Keyserlingk, 1998). However, by the time a lesion is found, a tumor or calcification is already present (Kennedy et al, 2009). This means that prevention must occur at an earlier stage.

A 1998 study demonstrated the benefits of combining mammography and thermography. In new cases of ductal carcinoma, stage I and stage II breast cancer, mammography was demonstrated to have a sensitivity of 85% and thermography a sensitivity of 83%. When these two modalities were combined, their sensitivity increased to 95% (Keyserlingk, 1998).

Thermography detects thermal changes that are believed to occur early, before the structural changes associated with cancer take place (Kennedy et al, 2009). Abnormal thermographic readings prior to a cancer diagnosis may provide opportunities for a patient to modify their lifestyle practices to shift the body away from abnormal functioning and into a state of better health. For more information, see “I have my results…” below.

How accurate is Thermography?

A 2023 review of thermography research showed that between 2007 and 2021, thermography screening research showed a mean (average) sensitivity and specificity of 83% and 80% for physiologic changes suggestive of breast cancer, and a mean sensitivity and specificity of 82% each for a wider range of conditions (Kesztyüs et al, 2023). Newer research tends to show increasing sensitivity and specificity as thermography technology advances. As of 2024, EMI reports that in terms of breast cancer screening, thermography will show positive physiological findings in 83% of cancers, leaving 17% of cancers that present as thermographically silent (EMI, n.d.). For more information about thermographically silent cancers, see What changes is thermography less likely to detect?, below.

What changes is Thermography less likely to detect?

Cancers that create changes that thermography cannot detect may be encapsulated, or so slow-growing or longstanding that the body is no longer physiologically responding to them (EMI, 2024). Age of the patient may also play a role. In young people, hormonal and developmental changes may mask breast thermographic readings. Children up to the age of 18 (for full-body screenings) and females under the age of 24 (for breast screenings) must have a doctor’s note for thermal imaging that includes reason for referral (EMI, n.d.).

Other conditions are not associated with physiological changes reflected in skin temperature or new blood vessel development. For example, the colon and visceral organs have their own specific blood supplies (which in turn would be supplying a tumor); therefore, thermography cannot perceive blood supply to a tumor in the colon, for example. Lung and heart dysfunction is also unlikely to be perceived by thermography with acceptable sensitivity or specificity, though thermography may detect inflammatory changes associated with elevated CRP levels. Thermography is also not applicable to testicular, scrotal, and prostate screenings (EMI, n.d.).

Because skin surface temperature is controlled by the autonomic nervous system, conditions which disrupt the autonomic functioning of the body, such as dysautonomia, will affect the accuracy of thermography (EMI, n.d.). Thermography cannot detect pathology; in other words, whether changes seen are or aren’t cancerous is a question only a biopsy can answer. Thermography also cannot detect metastasis and is not reliable as a stand-alone method of monitoring changes in diagnosed cancer (EMI, n.d.). Because not all health conditions present thermally, the absence of thermal findings does not preclude disease.

Who can benefit from Thermography?

Anyone can benefit from thermography. Breast thermography may especially benefit those for whom mammography is less effective or more risky. For example, younger women (age 30-50), women taking hormone replacement therapy, or others with dense breast tissue; those with fibrocystic breasts; those with breast implants (Rakhunde et al, 2022); BRCA gene mutation carriers (Evans et al, 2018); and those with previous mastectomies are less likely to personally benefit from mammography because of decreased detection abilities and/or greater risks (Rakhunde et al, 2022). Thermography has no such decreased detection abilities or risks based on these characteristics, and thus can offer even greater benefits to these populations.

According to the Association for the Advancement of Diagnostic Thermal Imaging, women age 30 and older should get an annual breast thermogram (Horowitz, 2008).

What happens during a scan?

When you come in for a thermography scan, a technician will take a brief health history and note any health changes you’ve noticed since your last scan. They will then leave the room to allow you to disrobe and let your body adjust to room temperature (we keep our office at 74 degrees). After a few minutes, the thermography technician will return and guide you in a series of specific images that capture the skin temperature of your region(s) of interest. A breast scan involves a series of 6 images of the breast area, and a full-body scan is 20 images. Afterward, you will be able to view your images with the technician before they are sent for interpretation. You should plan for your entire appointment to last about 30 minutes. Your detailed thermography report will arrive to you by email within a week of your scan.

Who interprets the scans, and how are they trained?

Biothermal Imaging is trained by the American College of Clinical Thermography, or ACCT, the preeminent association created to establish and maintain accredited standards of practice in the field of thermography. We work with ACCT-trained physicians specifically trained by ACCT to interpret thermography scans through EMI, the Electronic Medical Interpretation service, to read scans and deliver detailed and accurate thermography reports to our patients (ACCT, 2020).

What should I look for in a Thermographer?

One reason thermography research can be so variable in accuracy is that there is no universal standard for quality of infrared imaging equipment or training of its thermographers. Digital infrared thermographic imaging has improved exponentially in the last 20 years, and the accuracy of thermography is largely based on the quality of the equipment used. When seeking a thermographer, we suggest asking how old a thermographer’s equipment is! Our camera is an IRIS 640 Thermal Camera purchased from Meditherm, manufacturer of top-of-the-line medical grade thermographic cameras, in 2022. Meditherm is also among the top 6 producers of medical-grade thermographic cameras used for research in the world (Kesztyüs et al, 2023). Our camera measures 50 temperatures and is accurate to 1/100th of a degree. 

The training of thermography technicians and the protocols for image taking also affect accuracy. Our thermography technicians are all trained by the American College of Clinical Thermography to take full-body and breast scans using a standard protocol. This makes your scans easily comparable to each other for greater accuracy in detection of changes. Additionally, ACCT and EMI require a protocol of two breast scans, 3 months apart, to set a baseline for the “thermal fingerprint” of the breasts. The 3-month, two-scan protocol takes into account the time it takes for new abnormal vasculature to establish sympathetic fibers, ensuring we do not get a false negative reading for someone with developing vascular changes.

How often should I get a Thermography scan?

When beginning thermography for monitoring breast changes, two scans 3 months apart are necessary in order to establish a thermal baseline. Once a baseline has been established, annual thermographic screenings are recommended. If any deviations from your thermal baseline are detected, interpreting physicians may recommend you come back in 3 or 6 months for an additional scan. Depending on your personal and family health history, you and your primary care doctor can decide how often you get scanned (EMI, n.d.).

In the absence of any major changes to health status, full-body scans are recommended every 5 years.

Why get a full-body scan?

Thermography excels at seeing more than just breast physiology. A full-body scan includes details about five additional regions of the body, as well as the breast.

Head and neck thermography can detect signs of dental and periodontal inflammation, thyroid gland function, C-reactive protein levels, atherosclerotic plaque formation, vascular occlusion of the carotid arteries, TMJ dysfunction, sinus irritation and function, lymphatic congestion, and myofascial and musculoskeletal issues. Back thermography can detect myofascial and musculoskeletal issues, degenerative joint disease, joint inflammation, nerve root irritation, and cardiac and pulmonary dysfunction. Abdominal thermography can detect signs of liver, stomach, colon and gynecological functioning and intestinal irritation. Upper extremity thermography can detect signs of arthritic changes, myofascial and musculoskeletal issues, and Reynaud’s syndrome. Lower extremity thermography can detect signs of varicosities, arthritic changes, myofascial and musculoskeletal issues, and Reynaud’s syndrome. Breast thermography can detect fibrocystic changes, lymphatic congestion, and signs of angiogenesis (EMI, 2024).

I’m ready to schedule my Thermography exam!

Crane Holistic is the new home of Biothermal Imaging. Reach out to schedule your thermography exam today!

I have my results and I’d like to work on what I’m seeing. How should I do this?

For our thermography patients only, we offer $50 off an initial holistic health consultation with Dr. Jennifer Crane, DACM, L.Ac, if you wish to review your thermogram report and dig deeper into any other health concerns or goals using Chinese medicine, herbs, and acupuncture. Reach out to schedule your initial appointment today!

Indications for a Thermographic Evaluation

  • Altered Ambulatory Kinetics

  • Altered Biokinetics

  • Arteriosclerosis

  • Biomechanical Impropriety

  • Brachial Plexus Injury

  • Breast Disease

  • Bursitis

  • Carpal Tunnel Syndrome

  • Causalgia

  • Compartment Syndromes

  • Cord Pain/Injury

  • Deep Vascular Disease

  • Derniated Nucleus Pulposis

  • Disc Disease

  • Disc Syndromes

  • Dystrophy

  • External Carotid Insufficiency

  • Facet Syndromes

  • Grafts

  • Headache Evaluation

  • Herniated Disc

  • Hyperaesthesia

  • Hyperextension Injury

  • Hyperflexion Injury

  • Infectious Disease (Shingles, Leprosy)

  • Inflammatory Disease

  • Internal Carotid Insufficiency

  • Ligament Tear

  • Lower Motor Neuron Disease

  • Lumbosacral Plexus Injury

  • Lupus

  • Median Nerve Neuropathy

  • Morton's Neuroma

  • Muscle Tear

  • Musculoligamentous Spasm

  • Myofascial Irritation

  • Neoplasia (melanoma, squamous cell, basal)

  • Nerve Entrapment

  • Nerve Impingement

  • Nerve Pressure

  • Nerve Root Irritation

  • Nerve Stretch Injury

  • Nerve Trauma

  • Neuralgia

  • Neuritis

  • Neuropathy

  • Neuropraxia

  • Neurovascular Compression

  • Nutritional Disease (Alcoholism, Diabetes)

  • Peripheral Axon Disease

  • Peripheral Nerve Injury

  • Raynaud's

  • Referred Pain Syndrome

  • Reflex Sympathetic Dystrophy

  • Ruptured Disc

  • Sensory Loss

  • Sensory Nerve Abnormality

  • Skin Abnormalities

  • Soft Tissue Injury

  • Somatic Abnormality

  • Somatization Disorders

  • Sprain/Strain

  • Stroke Screening

  • Superficial Vascular Disease

  • Synovitis

  • Tendonitis

  • Termporal Arteritis

  • Thoracic Outlet Syndrome

  • TMJ Dysfunction

  • Trigeminal Neuralgia

  • Trigger Points

  • Ulnar Nerve Entrapment

  • Whiplash

    References

    American College of Clinical Thermology. (2020). About ACCT. Thermology Online. https://thermologyonline.org/about-acct/

    American College of Clinical Thermology. (2020). What is Thermology? Thermology Online. https://thermologyonline.org/about-thermology/

    Biller-Andorno, N., Jüni, P. (2014). Abolishing Mammogram Screening Programs? A View from the Swiss Medical Board. New England Journal of Medicine 370:21, 1965-7. DOI: 10.1056/NEJMp1401875

    Brandt, T. (2022, October 22nd). Certified clinical thermographer training [Course presentation]. American College of Clinical Thermology.

    Ebell, M. H., Thai, T. N., & Royalty, K. J. (2018). Cancer screening recommendations: an international comparison of high income countries. Public health reviews 39:7. https://doi.org/10.1186/s40985-018-0080-0

    Electronic Medical Interpretation (n.d.) Q+A. https://www.emi-interp.com/QA.aspx

    Electronic Medical Interpretation (2024). Thermography reports.

    European Commission. (n.d.) European guidelines on breast cancer screening and diagnosis. Cancer Screening, Diagnosis and Care. https://cancer-screening-and-care.jrc.ec.europa.eu/en/ecibc/european-breast-cancer-guidelines?topic=63&usertype=60&filter_1=96&filter_2=79&updatef2=0

    Evans, A., Trimboli, R. M., Athanasiou, A., Balleyguier, C., Baltzer, P. A., Bick, U., Camps Herrero, J., Clauser, P., Colin, C., Cornford, E., Fallenberg, E. M., Fuchsjaeger, M. H., Gilbert, F. J., Helbich, T. H., Kinkel, K., Heywang-Köbrunner, S. H., Kuhl, C. K., Mann, R. M., Martincich, L., Panizza, P., … European Society of Breast Imaging (EUSOBI) , with language review by Europa Donna–The European Breast Cancer Coalition (2018). Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights into imaging, 9:4, 449–461. https://doi.org/10.1007/s13244-018-0636-z

    Gram, E.G., Siersma, V., Brodersen, J.B. (2023). Long-term psychosocial consequences of false-positive screening mammography: a cohort study with follow-up of 12–14 years in Denmark. BMJ Open 13:e072188. doi: 10.1136/bmjopen-2023-072188

    Horowitz, E. (2008). Thermography: A Preventative Screening Tool for Breast Health. Naturopathic Doctor News & Review. https://ndnr.com/oncology/thermography-a-preventive-screening-tool-for-breast-health/

    Kennedy, D.A., Lee, T., & Seely, D. (2009). A Comparative Review of Thermography as Breast Cancer Screening Technique. Integrative Cancer Therapies, 8(1), 9-16.

    Kesztyüs, D., Brucher, S., Wilson, C., & Kesztyüs, T. (2023). Use of Infrared Thermography in Medical Diagnosis, Screening, and Disease Monitoring: A Scoping Review. Medicina (Kaunas, Lithuania), 59(12), 2139. https://doi.org/10.3390/medicina59122139

    Keyserlingk, J. R., Ahlgren, P. D., Yu, E., & Belliveau, N. (1998). Infrared Imaging of the Breast: Initial Reappraisal Using High-Resolution Digital Technology in 100 Successive Cases of Stage I and II Breast Cancer. The breast journal, 4(4), 245–251. https://doi.org/10.1046/j.1524-4741.1998.440245.x

    Rakhunde, M. B., Gotarkar, S., & Choudhari, S. G. (2022). Thermography as a Breast Cancer Screening Technique: A Review Article. Cureus, 14(11), e31251. https://doi.org/10.7759/cureus.31251

    Singh, A., Bhat, V., Sudhakar, S., Namachivayam, A., Gangadharan, C., Pulchan, C., & Sigamani, A. (2021). Multicentric study to evaluate the effectiveness of Thermalytix as compared with standard screening modalities in subjects who show possible symptoms of suspected breast cancer. BMJ open, 11(10), e052098. https://doi.org/10.1136/bmjopen-2021-052098