Breast Thermography - Protocols for Capturing Thermal Images
INTRODUCTION
Nowadays in developing countries, Breast cancer is considered a major cause of mortality in young women. In the case of breast cancer, early diagnosis is the key to increase the survival rate of cancer patients. There are different techniques that are used for early detection of breast cancer, which involve ultrasound, MRI, mammography, thermography, biopsy. Among these, mammography is considered the gold standard method, and this is also the most used tool used to detect breast cancer. Mammography also has certain disadvantages like it is a painful method and the necessity of exposure to ionizing radiation and less accuracy in dense breasts. As we know Breast thermography is a diagnostic procedure that is non-invasive also and it takes images of the infrared emissions from the breast surface that helps in the early detection of breast cancer. There are some limitations in the imaging protocol, which makes it a challenging task to detect abnormality by conventional breast thermography.
PROTOCOLS FOR CAPTURING THERMAL IMAGES
A Standard imaging protocol for breast thermography and a set of instructions has to be followed so that we can achieve a better result and to get an error-free result.
Instructions for the patient:
24 hours prior to exam the patient should avoid chiropractic care, any type of physical therapy, body massage therapy, steam baths, hot tubs, magnets, acupuncture, saunas, use of heating pads, hot water bottles, analgesic creams and balms, poultices, and do not shave also.
12 hours prior to exam every activity should be avoided that causes stimulation of the nipple.
4 hours prior to the exam, coffee, tea, soda, or other beverages or medications containing caffeine should not be taken. Alcoholic beverages should be avoided. HOT water shower, any type of rigorous exercise should be avoided that can cause temperature variation in the breast area. The patient should not touch or rub anywhere near the breasts.
On the day of the exam do not use creams, lotions, powders, ointments, deodorants, antiperspirants, or any other skin product. Do not smoke cigarettes or do not use any kind of product which contains nicotine. Avoid the use of any type of medication or natural supplement that causes flushing (i.e. Niacin). Inform the doctors if a breast biopsy was done within 1 month, or had any breast surgery, radiation treatment, or chemotherapy within the last 2 months. Remove all piercings and any metal wearing prior to the exam. Do not discontinue any medication or therapy without the permission of the doctor.
In case one has a sunburn or fever they should reschedule.
Room Design: The design and environmental conditions of the room should be maintained in a proper way just to conform to the thermodynamic attributes required for the thermal image acquisition, as a part of image quality control. The room should be of sufficient size to maintain a congruent temperature. The patient should be able to be placed relatively equidistant and sufficiently spaced from each wall of the room during the exam. The room should be covered with carpet.
A complete infrared survey should be performed just to make sure there is no infrared sources and leakage in the room. Any significant findings need to be fixed. All windows and doors must be shielded or covered to prevent outside infrared radiation from entering the room. Shades may be required to prevent contact of unnecessary infrared radiation purposes depending on the amount of direct infrared radiation.
The windows and doors should be completely sealed in order to prevent airflow in the area where the patient is positioned. Heat and air conditioning sources must be minimized and kept away from the patient in the room. Vents should be directed away and thoroughly diffused or turned off during the examination. Due to the amount of infrared radiation produced by Incandescent lighting, we should use standard fluorescent lighting during the examination.
Environmental Controls: The temperature of the room should be maintained in such a way that it will not change the patient’s physiology to the point of shivering or perspiring. The temperature range of the room should be maintained between 18 to 23 degrees C. The changes in Room temperature during the examination must be gradual so that steady-state physiology can be maintained and all parts of the patient’s body can adjust uniformly.
The room temperature variation during the examination should not be more than one degree Celsius. The humidity of the room must be controlled in such a way that there will be no air moisture build-up on the skin, perspiration, or vapour levels which interacts with radiant infrared energy. An ambient temperature thermometer should be there in the room to accurately monitor the temperature of the room.
Equipment Guidelines: In order to achieve a quality image for accurate clinical interpretations, certain minimum equipment standards should be maintained. Infrared Thermography equipment includes single or multiple infrared detectors that sample the field-of-view in two directions simultaneously. As it is a non-invasive process that does not involve contact with the surface of the skin. According to the current review of the literature suggests that to produce accurate and reproducible diagnostic images the following minimum specifications should be applied in the design of clinical Infrared Thermography hardware and software systems:
• Detectors’ response is greater than 5 microns and less than 15 microns with the spectral bandwidth encompassing the 8–10 micron region.
• Accuracy of 2% or less.
• Spatial resolution of 1 sq. mm at 40 cm from the detector.
• The temperature of windows must be limited from 5 to 10 degrees C.
• Significantly variable contrast settings.
• The maximum scanning time period of 4 seconds or less with real-time capture preferred.
• Ability to perform accurate quantitative differential temperature analysis with a precision of 0.1 degrees C.
• Ability to capture images in hi-resolution grayscale.
• High-resolution image display for interpretation.
• It has the ability to archive images for future reference and image comparison.
• Software manipulation of the images should be maintained within strict parameters to ensure that the diagnostic qualities of the images are not compromised.
Patient Acclimation: The patient’s body must be given sufficient time so that the physiologic state of the body should equilibrate with the surrounding conditions of the laboratory such that an approximate steady physiologic state of thermodynamic equilibrium can be reached before the imaging process begins. A minimum equilibration period of 15 minutes should be maintained and observed. The area to be imaged should remain completely uncovered of clothing or jewellery during the equilibration period, and the subsequent examination, A loose-fitting gown may be worn during the equilibration period provided to provide a level of modesty and it does not restrict airflow or constrict the skin surface in any way that would produce an artifactual result on the thermogram.
As we know each individual has different anatomy, special positioning during the equilibration period, an examination is needed for better results. In order to lift the breasts for adequate surface area exposure, the last 5–10 minutes of the equilibration period should be spent with the patient placing their hands over their head. In the breast imaging technique, multiple views from different angles are necessary to get perfect imaging of the differing surface aspects of the breast and relevant anatomic areas. In the case of some patients, additional views may be necessary to image specific surface areas according to the individual’s anatomy.
Imaging protocol: To achieve accurate infrared images of the breast cancer combined positioning of the equipment and the patient is necessary. For Electronic infrared thermography imaging, there should be detectors placed perpendicular to the surface to be viewed, and the angle must be kept exactly the same for comparable bilateral views in case other than perpendicular views are required, The body parts of interest should be brought close enough to the detectors to fill the viewable image area to maintain required spatial resolution and interpretation accuracy, The equipment settings must not be altered for the two views while multiple views are taken for bilaterally equivalent areas of the body.
REFERENCES
1. Garduño-Ramón MA, Vega-Mancilla SG, Morales-Henández LA, Osornio-Rios RA. Supportive Noninvasive Tool for the Diagnosis of Breast Cancer Using a Thermographic Camera as Sensor. Sensors (Basel). 2017;17(3):497. Published 2017 Mar 3. doi:10.3390/s17030497
2. https://www.picturemyhealth.com/wp-content/uploads/Protocols-and-Preparations-Checklist.pdf
4. Mrinal Kanti Bhowmik, Usha Rani Gogoi, Kakali Das, Anjan Kumar Ghosh, Debotosh Bhattacharjee, and Gautam Majumdar “Standardization of infrared breast thermogram acquisition protocols and abnormality analysis of breast thermograms”, Proc. SPIE 9861, Thermosense: Thermal Infrared Applications XXXVIII, 986115 (11 May 2016); https://doi.org/10.1117/12.2223421
5. Lozano, A., Hayes, J.C., Compton, L.M. et al. Determining the thermal characteristics of breast cancer based on high-resolution infrared imaging, 3D breast scans, and magnetic resonance imaging. Sci Rep 10, 10105 (2020). https://doi.org/10.1038/s41598-020-66926-6
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