Frequently Asked Questions
Different Breast Screening Options
Tests of anatomy or structure.
Mammography is the most widely used breast test and is considered the gold standard in the medical profession. It uses compression and radiation to take an x-ray of the breast. Recently the effectiveness of routine mammograms has been the subject of major studies and is being questioned. Mammography can find calcifications and breast masses earlier than manual exam. The Canadian study (add link) questioned if this saved lives. Mammography may be more effective for older women with less dense breasts. New 3-D mammography has twice the radiation of 2-D mammograms and does not replace the regular mammogram screening. It is an addition. Only a biopsy can detect cancer. It is a test of anatomy.
Ultrasound utilizes sound waves that create an image. Ultrasound does not use compression or radiation. Several states have passed legislation that women with dense breasts on mammography should be notified that additional testing may be necessary. Ultrasound is commonly utilized. Usually it is done only to an area of suspicion although sometimes screening ultrasound is available, especially in young women or women with dense breasts. It is a test of anatomy.
CT scans visualize the area of concern well. They do not use compression. Best suited for bone injuries, Lung and Chest imaging, cancer detection. The radiation levels in CT scans are higher than mammograms. Test of anatomy.
MRI breast scans do not use radiation or compression. They are less available and more expensive. Usually not the first screening done. MRI’s are good at showing soft tissue. Test of anatomy.
Tests of physiology or function.
Digital Infrared Thermal Imaging (DITI). Modern thermography uses a thermal (infrared) camera and computerized digital images. The scans are interpreted using special software. There is no radiation or compression. DITI looks at very early changes on a cellular level, infection and inflammation. Tests of function and anatomy are complementary.
Computerized Regulation Thermography (CRT) is not the same as DITI. It uses limited breast contact points to determine if the body is out of balance.
Why Do I Need to Develop a Breast Baseline?
Everyone has an individual “thermal fingerprint” in their breast tissue. Thermography looks at change over time, and the function of the body. To establish a baseline, we need to repeat your initial scans in about three months. This is the optimum amount of time to see if there are changes in cell growth. These two series of images are compared, and if there is no change, a stable baseline is established. Then, the patient can follow their breast health with one annual thermography appointment a year. All future annual scans are compared to your baseline. If you do not return to establish your thermal fingerprint, you will not have the full benefit that digital infrared thermal imaging can offer.
Some practitioners of thermography may tell the woman she only needs to come once annually and does not need to develop a baseline in the first year. We see most of the early changes in the three month follow up. How can you really know your true picture with one look.
Thermography screenings are so helpful is revealing early changes and giving the woman he opportunity to adjust and monitor her hormones, environment, medical interventions and diet. Only looking at one moment in time is the same old paradigm. Looking for a cancer that already is. Of course, if the initial exam is highly suspicious, our MD. Thermologist colleagues will recommend clinical correlation and we will not wait three months.
If you went to a physician and your blood pressure was 200/150 they may recommend immediate medication. This is life threatening and you don’t want to wait. I would equate this to finding cancer on a mammogram. But what if you had slightly high blood pressure. Wouldn’t your Doctor recheck it before diagnosing you? And if it was still slightly high, maybe you would make lifestyle changes and recheck it before medications. That is how we use screenings to preserve our health, not just diagnose disease.
Is Cold Stress Testing Necessary for Brest Screening?
Cold Stressing breasts and why don’t we do it anymore.
A Position Paper and Discussion.
By Peter Leando
Cold stress testing of the breast was performed on the assumption that thermography would identify angiogenesis and that angiogenesis could be correlated with the development and existence of breast cancer. This can be possible if a number of factors are present but there are too many variables that we now know make this an unreliable procedure. We don’t know at what stage angiogenisis begins but we do know that it does not continue throughout all stages of breast disease. No studies have been done to find out how long it takes for new (angiogenic) blood vessels to establish sympathetic fibers which then let the vessel behave like a normal vessel (contract when cold stressed) but even if we did have a better understanding of this physiology it would still not be a reliable test as many patients would undoubtedly fall outside of the window of detectable angiogenesis.
Considerations, the logic and philosophy of performing a cold stress test:
- If there are no suspicious thermal patterns to test, (negative thermogram) the test is not justified.
- If there are suspicious patterns (positive thermogram) then the patterns remain suspicious irrespective of the results of cold stress testing. A cold stress test does not and should not affect the thermographic opinion and resulting report.
- A cold stress test might offer results relating to a particular suspicious pattern but if there is no way of correlating this information to a clinically valid or plausible rational to act on this information then the test is not justified in the first place.
- If a cold stress test is performed and the results are reported, this changes the status of the test and the report, both of which make claim to diagnostics and will carry the associated increase of liability and issues of scope of practice and medical licensure (practicing medicine without a license).
- The disservice to patients who suffer unnecessary mammography, biopsy, and other tests as a result of positive thermography generated by the attempt to produce diagnostic results from a single study is unacceptable.
- Reporting vascular change over extended periods of time by comparative analysis of thermal testing may be enhanced by the inclusion of a cold stress test if ordered specifically by a licensed physician who can integrate the results into decision making or a differential diagnosis. Historically, it was the way breast thermography was used with protocols that included cold stress testing (and the diagnostic claims that were made) which generated the criticism that thermographers still suffer from today. The accusations of unreliability and the clinical trial results showing false positives and false negatives were all generated by the protocols that included cold stress testing. Cold stress is a test of sympathetic function which has good utility in many areas of medicine and is the definitive diagnostic test for CRPS / RSD. These tests were used before it was tried in breast screening.
In the mid eighties many people, including myself got excited by the potential offered by breast thermography performed with cold stressing. I was lucky enough to be working in France where the concept originated and I did a lot of cold stress thermography with a liquid nitrogen cooled NEC Sani and a Hues Aircraft Probeye, both of which were excellent cameras at the time. My own observations regarding the low rates of correlation between the results of cold stress tests and case histories and the growing evidence of false positives and false negatives led me to abandon cold stressing of breasts in the early nineties. I learned a more logical and more efficient approach which still relied on the detection of changes in the breast over time but was far more objective and reliable.
We have advanced significantly in our understanding of physiology and how thermography can be effectively used. No technology stands still, we expect science to advance, medical knowledge to improve and evolve and we have to be prepared to learn from experience….. both our own and others. I have no doubt that there will be ongoing advances in thermographic imaging and they may even include new forms of stress testing but the best way to move forward is to learn from experience and then look ahead rather than back.
First published August 2003 ACCT Thermology Times.
Have Clinical Tests Been Done on Thermal Imaging?
Yes! Over 800 peer-reviewed studies on breast thermography exist in the index medicus literature. In this database, well over 300,000 women have been included as study participants. The numbers of participants in many studies are very large (10,000, 37,000, 60,000, 85,000, etc.) Some of these studies have followed patients for up to 12 years.
These clinical trials have demonstrated that breast thermography:
- detects the first signs of a cancer up to 10 years before any other procedure can detect it
- significantly augments the long-term survival rates of its recipients by as much as 61%
- when used as part of a multimodal approach (clinical examination + mammography + thermography), will detect 95% of early stage cancers
How Often Should I Have a Thermal Scan?
Once a reliable baseline has been established, which normally requires two studies 3-months apart, you should have an on-going annual comparative study to detect any suspicious functional (physiological) changes, warranting further investigation. Depending on your personal history and risk for breast disease, your doctor can advise how often you should have a thermal scan repeated.
If I have a Suspicious Mammogram or find a Lump in My Breast, Should I Still Have a Thermogram?
Yes. The information provided by a thermography study can contribute useful additional information which ultimately helps your doctor with case management decisions. It is also important to establish a baseline for future comparison in order to monitor changes and the progress of any treatment.
Who should Have a Thermal Scan?
Any adult can have a thermal breast scan. This test is designed to improve chances for detecting fast growing tumors in the intervals between mammographic screenings or when mammography is not indicated by screening guidelines for women under 40.
DITI is especially appropriate for younger women under 40 years whose denser breast tissue makes it more difficult for mammography to pick up suspicious lesions. This test can provide a “clinical marker” to the doctor or mammographer, indicating that a specific area of the breast needs closer examination.
Breast cancers tend to grow significantly faster in younger women (under 40 years). The average tumor doubling time for women under 50 is 80 days compared to 157 days for women between 40 – 70 years. Secondly, the faster a malignant tumor grows the more infrared radiation it generates. Therefore, for younger women in particular, results from DITI screening can lead to earlier detection.
Does it Hurt to Have a Scan Taken?
No. There is no contact with the body or painful breast compression.
Is There Any Harmful Radiation in a Thermal Scan?
No. DITI detects and records the infrared heat radiating from the surface of the body. There is no contact with the body or harmful radiation.
Is a Thermal Scan Different than a Mammogram or Ultrasound?
Yes. Unlike mammography and ultrasound, Digital Infrared Thermal Imaging (DITI) is a test of physiology. It detects and records the infrared heat radiating from the surface of the body. It can help in early detection and monitoring of abnormal physiology and the establishment of risk factors for the development or existence of cancer.
Mammography and ultrasound are tests of anatomy. They look at structure. When a tumor has grown to a size that is large enough and dense enough to block an x-ray beam (mammography) or sound wave (ultrasound), it produces an image that can be detected by a trained radiologist.
Neither mammogram, ultrasound, nor DITI can diagnose cancer. Only a biopsy can diagnose cancer. But, when DITI, mammograms, ultrasounds, and clinical exams are used together, the best possible evaluation of breast health can be made.
Why is Thermal Imaging Useful for Breast Imaging?
Digital Infrared Thermal Imaging (DITI) offers the opportunity of earlier detection of breast disease than has been possible with breast self-examination, physician palpation or mammography alone.
Each individual has her own thermal pattern (normally symmetric) that is accurate and static throughout her lifetime. Any changes to her normal “thermal fingerprint” caused by early cell changes (pathology) will become increasingly apparent. Monitoring changes over periods of time with DITI is the most efficient means of identifying subjects who require further investigation.
DITI is a non-invasive test. There is no contact with the body of any kind, no radiation and the procedure is painless. The scanning system merely detects and records the infrared radiation that is emitting from the patient’s body.
Utilizing sophisticated infrared technology and innovative computer software, thermal imaging technicians simply capture a digitized image of the breast in the form of an infrared thermogram, or heat picture.
General Thermography FAQs
What Certification Should a Thermographer Have to Perform this Exam?
Thermographers should hold certification from a professional body with approved code of ethics and practice protocols that include quality control guidelines. All reports should be reviewed with the patient by a Licensed Healthcare Practitioner.
Who Should Interpret My Sans and Write the Report?
All thermography interpretations should be reported by adequately trained and experienced doctors who hold board certification as Thermologists.
What Do I Have to Do to Prepare for a Thermal Scan?
Thermography is a temperature gradient study. To achieve optimal scans, we do not want to create or block the natural heat of the body.
Please fill out your patient forms prior to your appointment. Please contact our office (818-769-4045) for information on the specific forms you need to fill out. You can also fill out the forms in our office, as needed.
Do inform our office if you are now pregnant or have been in the last three months, are lactating, or have had surgery or biopsies in the last three months. Thermography may not be appropriate for you at this time.
- No powder, lotion, or deodorant on the area to be scanned.
- No smoking for a minimum of 2 hours before the test.
- No excessive hot or cold drinks prior to the test.
- Please do not take nutritional supplements containing large doses of niacin on your scan day.
- No vigorous exercise 2 hours prior to the test.
- No massage, chiropractic adjustments, acupuncture or physical therapy the day of the scan. It is preferable to refrain from these treatments the day before a full body scan also.
- Avoid strong sunlight the day of the scan. Refrain from tanning booths and sunbathing for several days prior to the scan date, especially on the area being scanned.
- Long hair should be worn up. Hair accessories will be provided.
- Please wear loose fitting clothing if possible. Please fill out your patient forms prior to your appointment. Please contact our office for the required forms.
What Parts of the Body Can Be Scanned?
Thermal images are taken of the whole body, or individual regions including breast, head, arm, leg, torso, etc. A lumbar assessment would typically include, low back, pelvis, and legs. A cervical assessment would typically include, head and neck, upper trunk, and arms.
Is Thermal Imaging Covered by Insurance?
Every insurance company is different. We ask for payment at the time of service and will issue you a medical receipt to submit to your company.
We have found some companies to reimburse or give partial reimbursement. With many insurance companies, thermography is an out of pocket expense.
In our experience, Health Savings Plans through an employer have accepted thermography charges.
We do accept credit cards.
What is Thermal Imaging Used for?
To help in determining the cause of pain.
- To aid in the early detection of disease and pathology
- To evaluate sensory-nerve irritation or significant soft-tissue injury
- To define a previously diagnosed injury or condition
- To identify an abnormal area for further diagnostic testing
- To follow progress of healing and rehabilitation
What is Thermal Imaging?
Digital Infrared thermal imaging, or DITI, is a totally non-invasive, painless procedure with no radiation and no contact with the body. DITI is a clinical imaging technique that records the thermal patterns of your body. Your thermal images are used by your healthcare practitioner to help diagnose and monitor pain or pathology in any part of your body.