Interest in brown adipose tissue has increased in recent years as a potential target for novel obesity, diabetes and metabolic disease treatments. One of the significant limitations to rapid progress has been the difficulty in measuring brown adipose tissue activity, especially in humans. Infrared thermography (IRT) is being increasingly recognized as a valid and complementary method to standard imaging modalities, such as positron emission tomography-computed tomography (PET/CT). In contrast to PET/CT, it is non-invasive, cheap and quick, allowing, for the first time, the possibility of large studies of brown adipose tissue (BAT) on healthy populations and children. Variations in study protocols and analysis methods currently limit direct comparison between studies but IRT following appropriate BAT stimulation consistently shows a change in supraclavicular skin temperature and a close association with results from BAT measurements from other methods.

The use of infrared thermography in the measurement and characterization of brown adipose tissue activation.

Infrared thermography (IRT) is a non-invasive tool to measure the body surface radiation temperature (Tsr). IRT is an upcoming technology as a result of recent advancements in camera lenses, detector technique and data processing capabilities. The purpose of this review is to determine the potential and applicability of IRT in the context of dynamic measurements in exercise physiology. We searched PubMed and Google Scholar to identify appropriate articles, and conducted six case experiments with a high-resolution IRT camera (640 × 480 pixels) for complementary illustration. Ten articles for endurance exercise, 12 articles for incremental exercise testing and 11 articles for resistance exercise were identified. Specific Tsr changes were detected for different exercise types. Close to physical exertion or during prolonged exercise six recent studies described “tree-shaped” or “hyper-thermal” surface radiation pattern (Psr) without further specification. For the first time, we describe the Tsr and Psr dynamics and how these may relate to physiological adaptations during exercise and illustrate the differential responsiveness of Psr to resistance or endurance exercise. We discuss how bias related to individual factors, such as skin blood flow, or related to environmental factors could be resolved by innovative technological approaches. We specify why IRT seems to be increasingly capable of differentiating physiological traits relevant for exercise physiologists from various forms of environmental, technical and individual bias. For refined analysis, it will be necessary to develop and implement standardized and accurate pattern recognition technology capable of differentiating exercise modalities to support the evaluation of thermographic data by means of radiomics.

Infrared Thermography in Exercise Physiology: The Dawning of Exercise Radiomics.

Context Infrared thermography has been used to detect skeletal muscle overload and fatigue in athletes, but its use in injury prevention in professional soccer has not been studied to date. Objectives To establish a novel injury prevention program based on infrared thermography and to determine its influence on the injury incidence in professional soccer players in the preseason. Design A cross-sectional, prospective study design was used to compare a conventional injury prevention program (CPP) applied over the first preseason and an infrared thermography injury prevention program (IRTPP) carried out in the following preseason. Setting Soccer training ground. Participants Twenty-four players belonging to a first division soccer team from Spain. Main outcome measures Injury incidences of each player were recorded according to the Orchard Sports Injury Classification System (version 10.0) convention to determine the injury classification, location, and type. Results The incidence of injuries decreased from 15 injuries in the CPP preseason (0.63 [0.77] injuries per player) to 6 injuries in the second preseason when the IRTPP was applied (0.25 [0.53] injuries per player). The days of absence due to injuries also decreased from the CPP preseason (156 d, 10.4 [11.0] d per injury) to the IRTPP preseason (14 d, 2.3 [2.8] d per injury). The injury severity also decreased from the first preseason to the second preseason, and fewer musculoskeletal injuries in the thigh, hip, and groin were reported. Conclusions The implementation of an IRTPP can reduce the presence of injuries by identifying players potentially at risk and as a result, reducing the injury severity and days lost as a consequence.

/pdf/infrared-thermography-protocol-on-reducing-the-incidence-of-4h8edb98ay.pdf

Infrared Thermography Protocol on Reducing the Incidence of Soccer Injuries.

INTRODUCTION: Despite being widely used as a screening tool, a rigorous scientific evaluation of infrared thermography for the diagnosis of minimally symptomatic patients suspected of having COVID-19 infection has not been performed. METHODS: A consecutive sample of 60 adult individuals with a history of close contact with COVID-19 infected individuals and mild respiratory symptoms for less than 7 days and 20 confirmed COVID-19 negative healthy volunteers were enrolled in the study. Infrared thermograms of the face were obtained with a mobile camera, and RT-PCR was used as the reference standard test to diagnose COVID-19 infection. Temperature values and distribution of the face of healthy volunteers and patients with and without COVID-19 infection were then compared. RESULTS: Thirty-four patients had an RT-PCR confirmed diagnosis of COVID-19 and 26 had negative test results. The temperature asymmetry between the lacrimal caruncles and the forehead was significantly higher in COVID-19 positive individuals. Through a random forest analysis, a cut-off value of 0.55°C was found to discriminate with an 82% accuracy between patients with and without COVID-19 confirmed infection. CONCLUSIONS: Among adults with a history of COVID-19 exposure and mild respiratory symptoms, a temperature asymmetry of ≥ 0.55°C between the lacrimal caruncle and the forehead is highly suggestive of COVID-19 infection. This finding questions the widespread use of the measurement of absolute temperature values of the forehead as a COVID-19 screening tool.

Diagnostic accuracy of infrared thermal imaging for detecting COVID-19 infection in minimally symptomatic patients.

Background 
The clinical evaluation of a burn wound alone may not be adequate to predict the severity of the injury nor to guide clinical decision making. Infrared thermography provides information about soft tissue viability and has previously been used to assess burn depth. The objective of this study was to determine if temperature differences in burns assessed by infrared thermography could be used predict the treatment modality of either healing by re-epithelization, requiring skin grafts, or requiring amputations, and to validate the clinical predication algorithm in an independent cohort.


Methods and findings 
Temperature difference (ΔT) between injured and healthy skin were recorded within the first three days after injury in previously healthy burn patients. After discharge, the treatment modality was categorized as re-epithelization, skin graft or amputation. Potential confounding factors were assessed through multiple linear regression models, and a prediction algorithm based on the ΔT was developed using a predictive model using a recursive partitioning Random Forest machine learning algorithm. Finally, the prediction accuracy of the algorithm was compared in the development cohort and an independent validation cohort. Significant differences were found in the ΔT between treatment modality groups. The developed algorithm correctly predicts into which treatment category the patient will fall with 85.35% accuracy. Agreement between predicted and actual treatment for both cohorts was weighted kappa 90%.


Conclusion 
Infrared thermograms obtained at first contact with a wounded patient can be used to accurately predict the definitive treatment modality for burn patients. This method can be used to rationalize treatment and streamline early wound closure.

/pdf/development-and-validation-of-an-algorithm-to-predict-the-3fgqt5g2ed.pdf

Development and validation of an algorithm to predict the treatment modality of burn wounds using thermographic scans: Prospective cohort study.

https://researchportal.port.ac.uk/portal/files/7474773/Thermographic_imaging_in_sports_and_exercise_medicine.pdf

Thermographic imaging in sports and exercise medicine: A Delphi study and consensus statement on the measurement of human skin temperature

Infrared thermography is a non-invasive technique that records temperature patterns of the body which can be used as an adjunct method for the detection of diverse medical pathologies. One limitation of medical thermology is incomplete coherence to a standardized interpretation procedure which can lead to disparity of results given by different interpreters. Artificial Intelligence and deep learning models have been used for pattern recognition and classification of objects and have been adopted elsewhere as an adjunct methodology in medical imaging diagnosis. To perform deep learning algorithms a large database of infrared thermographic images must be put together. These images likely will come from different clinics, use different imaging systems, and they are saved in different proprietary formats depending on the imager used. To circumvent these difficulties a standard format for saving medical thermology studies must be implemented. In this talk the efforts of the American Academy of Thermology (AAT) are presented to standardize a Digital Imaging and Communication in Medicine (DICOM) file format for medical thermology. Also, efforts to implement a Picture Archiving and Communication System (PACS) Software to handle large number of images for thermography big data applications will be presented. Artificial Intelligence applications towards adjunct detection of breast pathologies using infrared thermography will be discussed.

Robert G. Schwartz

Papers

Thermographic imaging in sports and exercise medicine: A Delphi study and consensus statement on the measurement of human skin temperature

Artificial intelligence applications in medical thermography using PACS and DICOM file formats