General Warning to Practitioners and the General Public
by William Cockburn, DC, FIACT, FABFE
It has been brought to our
attention by many email and telephone inquiries, that some thermography labs
are promoting and advertising services which are not acceptable.
This is happening in large
measure in offices that have purchased thermography equipment from a
manufacturer and then rely solely on the manufacturer for training and
education in medical thermography.Often this training is biased towards the particular instrument
purchased or to corner cutting to provide more patient services per day at the
expense of quality control.Unhappily,
this comes at great cost to the patient, and often to the chagrin of the unwary
thermography technician or physicians who have bought into these mis-deeds.
This short paper has been
written to address the three most important of these errors that we are
currently asked by the general public to help correct.
1) Thermography centers
offering full body thermography. (A mis-nomer)
In the old days of
thermography there were codes for upper and lower body thermography.
These codes were used for neck or low back injuries and indicated that the
cervical spine region and arms, or the low back region and legs were being
imaged. Some people had both neck and low back injuries and as such
the "full body thermography code" was established. Later
in the late 80's early 90's we perfected CT scan and media advertising for Full
Body CT scans wee seen on TV and heard on the radio nationally.
The problem:
Thermography does NOT see inside the body. We do not see inside the
skull, chest, abdomen or pelvis and we do not see bone. A full body
thermography is a topographical Scan" meaning that only the surface of the
body is being evaluated. In fact, all of the labs who have been trained
by the AMIA, AMIA< IACT< AMIT or ThermoDoc Network have forms that say
Full Body Topographical Exam or Study.
If a thermal imaging
laboratory or doctor tells you that thermography can see organs, they are
gravely mistaken. You should not, under any circumstance, rely on
thermography or thermal imaging for internal organ diagnosis.
This is the domain of anatomical or structural testing such as CT scan or MRI.
2) The double BASELINE
evaluation.
Many patients are told that
they have to come back for a second examination in 90 days following their very
first thermogram. This is especially true for breast thermography
labs. This is a fundamental marketing tool and is not
reliable and sound medical practice.
When you have your very first
thermography, also called a baseline thermographic examination, your exam will
either be within normal limits, or there will be one or more abnormalities
detected that require the follow-up of your physician. The follow
up examination may be anywhere from 6 weeks, to 90 days to 6 months.
ONLY abnormal thermographic
examinations require a thermographic follow-up in addition to structural
testing (palpation, ultrasound, and mammography)
To tell a patient that they
need to have two baseline thermographic examinations, is in the opinion of this
author, a misrepresentation of the actual baseline thermographic
series. Some manufacturers and their sales representatives
may have told doctors that two exams are necessary to complete the baseline
exam, in order to "help" the physician or technician buying the
camera to see how to make more money.
Establishing the
"Medical Necessity" for a second baseline in these cases would be a
very hard thing to validate and could be considered a fraudulent
misrepresentation.
3) A statement is
often made that the camera that is utilized is built specifically for the human
body and as such, the protocols under which many thermography labs operate are
no longer necessary. This is factually untrue.
Some companies are selling
their equipment and telling doctors and technicians that because the camera is
specifically made to measure human skin, or is a highly accurate camera, or has
a special lens - that they do not need to disrobe patients and acclimate them
to a standard medical room temperature for thermography.
What happens is that patients
do not have time to come to a physiologic thermal equilibrium with the
appropriate room temperature and artifice can be introduced into the
image. For example, if you were to disrobe and then scratch your
breast vigorously without the technician seeing this, a heat signature would be
produced that you cause the interpreting physician to think there was an
infection in the breast or a cancer.
The thermographic protocol of
patient equilibration, often called acclimation in a standard draft free
set of conditions is mandatory for the appropriate imaging of the human
body. The accuracy or speed of the camera has absolutely nothing to do
with this important stem in the exam process.
Of course, if a lab does not
have to take the time to acclimate a patient they can move more patients
through the office in a day.
Protect yourself and your
loved ones by being properly informed about the appropriate uses of thermal
imaging and the protocols under which they are performed. The
websites below will be helpful in providing additional information.