From Big Medical Encyclopedia

TERMOGRAFIYA (Greek therme warmth, heat of +grapho to write, represent; synonym: thermovision, infraskopiya) — the method of registration of infrared radiation from a body surface of the person used for diagnosis of various diseases and morbid conditions. T. it is for the first time applied in 1956 by R. Lawson to diagnosis of diseases of mammary glands.

T., being a harmless, noninvasive diagnostic method, finds in a crust, time use in oncology for differential diagnosis of tumors milk, salivary and thyroid glands, melanomas, sarcomas of bones, metastasises of cancer in bones and soft tissues, etc.

T. is one of ways of identification of focal high-quality processes in a mammary gland (the localized fibrosing adenosis, a fibroadenoma, a cyst, papilloma of a channel) and their differential diagnosis from malignant tumors (see tsvetn. the tab. to St. Mammary gland ). The thermographic research found application at mass surveys for identification of risk groups and is one of components of comprehensive examination of mammary glands. The role of T is especially considerable. in detection of not palpated tumors, including cancer of in situ. In traumatology and surgery of T. apply at diagnosis of the closed fractures, bruises, arthritises, a bursitis, to delimitation of burn defeats and freezing injuries (see tsvetn. the tab. to St. Freezing injuries ); in urgent differential diagnosis of an acute appendicitis, pancreatitis, cholecystitis, etc. T. use for objective assessment of extent of disturbance of cerebral circulation, it allows to diagnose occlusal defeats of the general and internal carotid arteries, etc. (see. Blood vessels ).

Diagnostic value of T. it is established at various diseases of a female genital, in obstetrics (diagnosis of pregnancy), stomatology, neurology and neurosurgery (see tsvetn. the tab. to St. Neuritis , fig. 1 — 4), ophthalmology, dermatology, at assessment of results of microsurgeries, prosthetics and shunting of large arteries at reconstructive operations on large vessels, vessels of heart, at renal transplantation, as a way of control of efficiency of nek-ry types of conservative treatment, etc.

For carrying out T. use special devices — thermographs (see).

Surface temperature of a body of the person represents the total temperature of all bodies and fabrics located in the field of measurement (see. Body temperature ). Normal each area of a surface of a human body gives a characteristic thermographic picture. So, on thermograms of the head and neck of the healthy person zones of more high temperature over large blood vessels (e.g., in supraclavicular area), in circumoral area are allocated, in a forehead and eye-sockets while temperature on the surface of cheeks, a tip of a nose, auricle, eyeglobes, over eyebrows and a pilar part of the head rather smaller. Temperature of upper parts of not changed mammary glands at women is higher, than lower; temperature of an areola (a peripapillary circle) is stablest; temperature of lower parts of mammary glands more postoyain, than upper. Change in normal distribution of temperatures is a sign patol. process.

Physiological basis of T. increase in intensity of infrared radiation over patol is. the centers in connection with strengthening in them of blood supply and metabolic processes or reduction of its intensity in areas with the reduced regional blood-groove and the accompanying changes in fabrics and bodies.

Carrying out a contact termografiya by means of the films containing liquid crystal connections: the light zone on a film corresponds to the center of a hyperthermia on the back of the left foot

In addition to contactless T., carried out by means of thermographs, there is a contact (liquid crystal) T., K-ruyu carry out by means of liquid crystals (see. Liquid crystals ), having optical anisotropy and changing color depending on temperature (see. Thermometry ). Contact thermograms receive by applying to a body surface in the explored area of a film or pastes with liquid crystal connection (fig). The contactless research can be executed as a termoskopiya (visualization of the thermal field of a body or its part on the screen of the thermal imager), thermometry (measurement of surface temperature of a body by means of the graduated or color scale and a reference radiator), a termografiya (registration of the thermal field on a film or electrochemical paper in the form of the monochromatic or color thermogram).

The indication to T. are patol. the states changing distribution of temperatures to surfaces of the studied body or area of a body. Preparation for T. provides an exception within 10 days before a research of reception of hormonal drugs, medicinal sredstvg the vessels influencing a tone, and also imposing of any ointments in the explored area of a body. T. abdominal organs it is necessary to make on an empty stomach, and a research of mammary glands — on 8 — the 10th day of a menstrual cycle. Contraindications to T. no, the research can repeatedly repeat.

T. carry out in special offices, in to-rykh constant temperature +22,5±1 ° and humidity 60 ± 5% of air is maintained. Before carrying out T. the body of the patient in whole or in part (the explored area) is bared. Adaptation of the patient to ambient temperature is obligatory. Thermal balance between a body of the person and the environment comes in 15 — 20 min. generally due to physical thermal control.

Depending on tasks and area of a research T. carry out in different projections and at different provisions of a body of the patient (standing, lying, etc.).

Analysis of these T. includes quality standard of thermotopography of the explored area (studying of distribution of «hot» and «cold» sites), quantitative assessment with definition of indicators of temperature difference (gradients) of the explored site in comparison with the symmetric zone of a body, surrounding fabrics which is conditionally chosen as area and also processing of the image by means of the COMPUTER.

Existence patol. process it is shown by one of three qualitative thermographic characters: emergence of abnormal zones of a hyperthermia or hypothermia, disturbance of normal thermotopography of the vascular drawing, and also change of such quantitative character, as a gradient of temperature in the studied zone. So, e.g., inflammatory processes, as a rule, cause change of sizes of a gradient of temperatures between a zone of defeat and surrounding fabrics: at chronic inflammatory process to 0,7 — 1 °; at acute — to 1 — 1,5 °; at it is purulent - destruktiv - number — 1,5 — 2 °.

At inflammatory processes, in addition to change of gradients of temperatures, on thermograms the zone of a hyperthermia, in a form, the sizes and an arrangement corresponding to area the most expressed patol is registered. changes. More often this zone has heterogeneous structure, moderate or high intensity of a luminescence.

Important thermographic criteria of absence patol. changes in mammary glands (see. A mammary gland) are: similarity and symmetry of basic elements of the vascular drawing in both mammary glands, lack of abnormal sites of a hyperthermia, compliance of degree of manifestation of the vascular drawing on thermograms of extent of development of the ferruterous tissue of mammary glands defined radiological (see. Mammography ). It is established that decrease in degree of a differentiation of cells of a tumor is followed by increase in thermoactivity for the majority of histologic forms of a breast cancer (an adenocarcinoma, undifferentiated cancer) and is shown on thermograms by abnormal sites of a hyperthermia.

Fig. 1 — 4. Color thermograms are normal also at various forms of pathology. The size of temperature is designated in different flowers: from white and light yellow (the maximum temperature) to dark blue (the minimum temperature), distribution of flowers is shown on a step scale in the bottom of each thermogram; temperature gradation of the next steps of a scale on decrease from left to right — 0,1 °. Fig. 1. The thermogram of the person, neck and a front surface of a breast is normal. Fig. 2. The thermogram of the person and neck at cancer of a thyroid gland; the zone of a hyperthermia on a front surface of a neck is connected with existence of a tumor; some expansion of zones of a hyperthermia on a face is caused by a hyperthyroidism. Fig. 3. The thermogram of brushes and distal departments of forearms is normal. Fig. 4. The thermogram of brushes and distal departments of forearms at a Raynaud's disease: lack of the image of fingers owing to considerable decrease in their temperature („thermal amputation"), fall of temperature of distal departments of brushes and forearms.

At malignant tumors and their metastasises in bones and soft tissues the zone of a hyperthermia on thermograms has an intensive luminescence, the rounded or irregular form, sharp contours, homogeneous structure (tsvetn. tab., Art. 48, fig. 1 and 2). Note asymmetric hyper vascularization of area patol. the center with existence of the expanded and randomly located vessels.

The gradient of temperatures of a zone of a hyperthermia and symmetric area exceeds 2 — 2,5 °, the gradient of temperatures in relation to surrounding fabrics does not exceed 2 °.

The thermographic representation of area of a stomach is normal characterized by spottiness of the drawing. In view of a considerable variety patol. processes in an abdominal cavity their thermographic semiotics is difficult and variable.

It is normal of the thermogram of top and bottom extremities, on to-rykh the hl is traced. obr. an arrangement of vessels, differ in the expressed symmetry of the drawing, at the same time temperature of distal departments of extremities is lower than temperature of their proximal departments. Disturbances of blood circulation in extremities on thermograms can be presented: a zone of a hyperthermia, in a form, the sizes and topography of the respective area of the broken blood circulation owing to thrombosis of venous vessels and thrombophlebitis; a zone of a hypothermia, in a form, the sizes and topography of the respective area of falloff of a blood-groove connected with a vasomotor spasm or organic lesion of arterial vessels (tsvetn. tab., Art. 48, fig. 3 and 4); the disturbance of the vascular drawing in a zone of defeat connected with a varicosity of venous vessels (see fig. 6 — 13 to St. Blood vessels ).

In a crust, time of T. as the independent diagnostic method gives still high percent of false positive and false-negative answers (especially in oncology) therefore comparison of data of a termografiya to data both clinical, and radiological, radionuclide and other ways of inspection of the patient is obligatory.

Bibliography: 3avrazhina I. N. Thermographic diagnosis of a breast cancer, Medical radio-gramophones., t. 23, No. 10, page 61, 1978, bibliogr.; 3 and r e c to and y V. V. and Vykhovskaya A. G. Clinical termografiya, M., 1976, bibliogr.; To and r about the h - to and B. B. N, etc. The thermal field of mammary glands of healthy women (according to a termografiya), Medical radio-gramophones., t. 22, No. 3, page 31, 1977; Kondratyev of V. B. Termografiya in oncology, Vopr. onkol., t. 18, No. 3, page 101, 1972; L of an ikhterm of N of L. B. An ultrasonic tomography and thermovision in neurosurgery, M., 1983; M and r about sh-nikovm.m. idr. Thermovision and its use in medicine, M., 1981; Shekh-ter A. I., etc. Diagnosis of diseases of mammary glands with use of a termografiya and hyperbaric oxygenation, Medical, radio-gramophones., t. 27, No. 5, page 24, 1982; Lawson R. Implications of surface temperatures in the diagnosis of breast cancer, Canad. med. Ass. J., v. 75, p. 309, 1956.

A. I. Shekhter; G. I. Zenovko, V. A. Romanov (tsvetn. fig.).