The study aimed to evaluate the impact of BEMER (Physical Vascular Therapy) on body surface temperature using infrared thermography (IRT) in the distal parts of the forelimbs in Thoroughbreds. The study tested the hypothesis that BEMER therapy leads to an increase in body surface temperature and blood vessel diameter in the distal parts of the forelimbs. The study involved 16 horses, split into 2 groups: active BEMER (n = 8) and sham (n = 8). The active BEMER group had BEMER boots applied to the distal parts of the forelimbs, whereas the sham group had BEMER boots applied without activation of the device. Both groups underwent IRT examination to detect changes in body surface temperature, followed by ultrasonographic examination to assess changes in vein and artery diameter before (BT) and just after (JAT) therapy. The IRT examination was repeated 15 min after BEMER therapy (15AT). There were no significant body surface temperature differences between BT and JAT in any regions of interest (ROIs) in either group. In the active BEMER group, the ROIs did not change significantly at 15AT, compared to the temperatures measured at BT (except for the hooves). At 15AT the temperature of all the ROIs (except the fetlock bone) dropped significantly in the sham group. In the ultrasonographic examination, there was a significant increase in vein and artery diameter in the study group JAT, whereas the sham group had a significant increase only in artery diameter JAT. These results suggest an effect of BEMER on stimulating blood circulation in the distal parts of the forelimbs in clinically healthy horses. IRT did not identify changes in skin surface temperature after BEMER therapy at the distal parts of the forelimbs.

Purpose/Objective(s) We aim to assess changes in cervical cancer and subtype incidence with respect to the introduction of a human papilloma virus (HPV) vaccine in the United States (USA). We hypothesize a decrease in cervical cancer incidence in an age group with highest anticipated vaccine uptake (18-25 years) versus all ages. We also anticipate altered incidence of squamous cell and adenocarcinoma in the 18-25 age group. Materials/Methods We conducted a retrospective population based cross-sectional study using data recorded from the USCS Public Use Database from 2000-2020 of SEER 22. Vaccination rates were obtained from the NIS-Teen, which includes adolescents aged 13-17, from 2006-2022. SEER*Stat software was queried for cervical cancer incidence, and stratified by histology. Joinpoint Regression 5.0.2 and Prism 10.1.1 were used to calculate trends. Data from 2020 were plotted but excluded from regression analysis due to the impact of COVID-19 on cancer diagnoses. Results There was rapid uptake of HPV vaccine in the USA after its introduction in 2006. Female teens aged 13-17 receiving at least 1 dose of HPV vaccine began at 25% in 2007, surpassed 50% by 2011, and rose to 73% in 2019. Regarding cervical cancer, incidence among all ages was in decline from 2000-2011, with 2011 identified by Joinpoint regression as a significant point suggesting a change in trend. From 2000-2011 cervical cancer rates declined from 9.95 per 100,000 to 7.71, with an average annual change (AAC) of -0.162 (P < 0.05). From 2011-2019 rates stabilized with an AAC of 0.023, not statistically significant from zero. In contrast, among 18-25 year olds, we find stable rates of cervical cancer diagnosis from 2000-2009 (Joinpoint 1) with an AAC of 0.005, not significant from zero. From 2009-2019, rates down trended from 1.55 to 0.51, with an AAC of -0.088 (P < 0.05). On subtype analysis in 18-25 year olds, only squamous cell histology had a significant Joinpoint, identified at 2011. AAC from 2000-2011 was -0.014, and from 2011-2019 was -0.055 (P < 0.05), representing a decline in incidence from 0.74 in 2011 to 0.32 in 2019. Adenocarcinoma subtype did not have any Joinpoints to signal a change in trend, with an AAC from 2000-2019 of -0.003. Conclusion We find rapid HPV vaccine uptake from 2007-2011, and continued steady rise through 2020. Concurrently there was significant downward trend in cervical cancer incidence among women aged 18-25 beginning in 2009, contrasting stable cervical cancer rates in all women since 2011. On subtype analysis, squamous histology in 18-25 year olds had a significant downward trend beginning in 2011. Adenocarcinoma subtype had no change in trend from 2000-2019. There appears to be decreasing cervical cancer incidence in an age group likely to have significant HPV vaccine uptake. There may be a preferential benefit for squamous histology, which may lead to eventual changes in the distribution of cervical cancer subtypes. Future population-based analyses are warranted as the impact of HPV vaccination continues to mature.

Paediatric case series of en coup de sabre with comparative age of presentation and treatment outcomes.

The largest world-wide vaccination rollout ever is currently underway to tackle the covid-19 pandemic. We report a case of diffuse cutaneous systemic sclerosis (SSc) in a 70-year-old male with rapidly progressive skin thickening which developed two weeks after receiving the first dose of the ChAdOx1 nCOV-19 vaccine. As the onset of SSc skin was in close temporal proximity to the administration of the first dose vaccine with no other triggers, we suspected a possible adverse reaction to the ChAdOx1 nCOV-19 vaccine. We hypothesise that the recombinant adenoviral vector encoding the spike protein antigen of SARS-CoV-2 triggered an unexpected immune activation resulting in an atypical presentation of late-onset SSc, within the well-recognised ANA positive, ENA negative subgroup of patients.We review the possible mechanisms underlying autoimmunity when provoked by vaccination and other published rheumatological phenomenon occurring shortly after COVID vaccination.

The aim of this study was to evaluate the influence of training on body surface temperature over the joints in racehorses, measured by infrared thermography. The study involved monitoring of 14 Thoroughbred racehorses in 6 imaging sessions over a period of 3 months. Temperature measurements of the forelimb and hindlimb joints were made before and just after training. Joint temperature of limbs increased significantly after training. Environmental temperature had a statistically significant influence on surface temperature over the joints. The lowest surface temperatures were recorded over the metacarpophalangeal and metatarsophalangeal joint and the highest temperatures in the shoulder, elbow, hip and stifle joint The metacarpophalangeal and metatarsophalangeal joints warmed the least during training, but were influenced the most by differences in environmental temperature. The surface temperature difference before and after training is an important indicator of the thermoregulatory response to exercise in racing horses. Understanding surface temperature changes in response to regular training is necessary for future studies on diagnosing injuries of joints.

The aim of the present study was to assess the photothermal effects of high-intensity laser therapy (HILT) on the superficial digital flexor tendon (SDFT) of the hindlimb in racehorses. It was conducted on 18 clinically healthy thoroughbreds that were subjected to thermographic examination to measure surface temperature changes in the SDFT. This was performed before and immediately after HILT. This revealed statistically significant differences in the temperature of the skin surface overlying the flexor tendons (p < 0.001). The surface temperature of the area examined was higher by an average of 3.5 °C after HILT, compared with the temperature measured before HILT. Our results prove that HILT has a photothermal effect in treating soft tissue. This finding can be helpful in determining the appropriate parameters for monitoring the short- and long-term effects of HILT.

The aim of the study was to determine the utility of maximum eye temperature measured by infrared thermography (IRT) as a stress indicator compared with plasma cortisol concentration in Thoroughbred and Arabian racehorses. The study included thirty racehorses undergoing standard training for racing. Measurements of maximum eye temperature and blood collection for plasma cortisol concentration were carried out before training (BT), and within 5 (5AT) and 120 minutes (120AT) after the end of the each training session in three repetitions, with a monthly interval. Both parameters were elevated at 5AT compared to BT (p⟨0.001). Compared to BT, at 120AT the maximum eye temperature remained elevated (p⟨0.001) and plasma cortisol concentration decreased (p⟨0.001). The study indicated significant weak correlations (r=0.220; p⟨0.001) between both measurements at all time points. The results support the use of IRT technique to monitor the response of horses to stress, potentially improving animal management and welfare.

The aim of the study was to assess differences in the influence of high-intensity laser therapy (HILT) on the skin surface temperature and vein diameter of the lateral fetlock joint region in a group of racehorses with pigmented and non-pigmented skin in the treatment area. Twenty Thoroughbreds were divided into two equal groups: pigmented and non-pigmented skin groups. Each horse received the same HILT treatment. Just before and immediately after HILT, thermographic examination was performed to measure the skin surface temperature and ultrasonographic examination assessed the lateral digital palmar vein diameter. After HILT, the pigmented skin surface temperature increased, while the non-pigmented skin surface temperature decreased, and the difference between both groups was significant (p < 0.001). The vein diameter increased after HILT in horses with pigmented and non-pigmented skin, but the difference between both groups was not significant (p = 0.14). In conclusion, melanin content in the epidermis plays an important role in light energy absorption and photothermal effects. The vein diameter changes after HILT application indicated that the increase in vessel diameter may partly depend on photothermal mechanisms occurring in irradiated tissue. Further research is necessary to describe the physiological and clinical effects of HILT performed on pigmented and non-pigmented skin.

We read with interest the Comment by Devon E McMahon and colleagues1McMahon DE Gallman AE Hruza GJ et al.Long COVID in the skin: a registry analysis of COVID-19 dermatological duration.Lancet Infect Dis. 2021; (published online Jan 15.)https://doi.org/10.1016/S1473-3099(20)30986-5Summary Full Text Full Text PDF PubMed Scopus (85) Google Scholar describing the range of cutaneous manifestations of COVID-19. We agree that most acral chilblain-like or pernio-like lesions (commonly referred to as COVID toes) occur in young, previously healthy patients with relatively mild COVID-19 and frequently negative tests for SARS-CoV-2. Most resolve spontaneously without any treatment approximately 2 weeks from onset, particularly in children and adolescent patients. However, in our multidisciplinary post-COVID-19 follow-up clinic of adult patients and specialist tertiary referral centre for paediatric and adolescent rheumatology, we have observed a subgroup of patients with persistent chilblain lesions, similar to McMahon and colleagues' report. Clinically these chilblain-like lesions resemble the digital vasculopathy of connective tissue disease. If the lesions do not resolve within 30 days of onset, we recommend screening for other underlying causes (which might have been triggered by COVID-19) and therapeutic options including aspirin, topical corticosteroids (with oral prednisolone in severe cases), hydroxychloroquine and vasodilators, and prostacyclin analogues (eg, iloprost) if refractory (appendix). Our recommended management framework is based on the UK and British Society for Rheumatology guidelines for the management of Raynaud's phenomenon and digital ischaemia in systemic sclerosis.2Denton CP Hughes M Gak N et al.BSR and BHPR guideline for the treatment of systemic sclerosis.Rheumatology (Oxford). 2016; 55: 1906-1910Crossref PubMed Scopus (136) Google Scholar, 3Hughes M Ong VH Anderson ME et al.Consensus best practice pathway of the UK Scleroderma Study Group: digital vasculopathy in systemic sclerosis.Rheumatology (Oxford). 2015; 54: 2015-2024Crossref PubMed Scopus (88) Google Scholar The optimal management, including treatment duration, of chilblain-like lesions in patients with long COVID is currently unclear and will probably evolve as clinical experience and data accumulate for this new disease. As the COVID-19 pandemic continues unabated, attention is now turning to the considerable proportion of patients with multiorgan morbidity, including unexplained symptoms such as dyspnoea and fatigue, that persist well beyond the initial viraemic phase, exerting pressure on already strained health-care resources. Endothelial cell dysfunction, hypercoagulability, and inflammation are considered central to the aetiopathogenesis in acute COVID-19, but there is a growing need to characterise the clinical course of symptoms and disease mechanisms of long COVID to facilitate prognostication and targeted interventions. Nailfold capillaroscopy enables identification of microcirculatory morphological alterations and is widely used in rheumatological practice. There is emerging evidence to support the utility of nailfold capillaroscopy to detect and quantify endothelial alteration in COVID-19.4Natalello G De Luca G Gigante L et al.Nailfold capillaroscopy findings in patients with coronavirus disease 2019: broadening the spectrum of COVID-19 microvascular involvement.Microvasc Res. 2021; 133104071Crossref PubMed Scopus (51) Google Scholar Microvascular abnormalities have been observed on nailfold capillaroscopy in both fingers and toes of patients with COVID-19, even when lesions are confined to the toes, suggesting that chilblains might be an overt manifestation of a systemic process.5El Hachem M Diociaiuti A Concato C et al.A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection.J Eur Acad Dermatol Venereol. 2020; 34: 2620-2629Crossref PubMed Scopus (114) Google Scholar We propose that nailfold microangiopathy, as assessed by capillaroscopy, might represent a peripheral measure of central pathology. Nailfold capillaroscopy might provide a surrogate, non-invasive digital window to the lung to investigate unexplained dyspnoea. We call for further research to investigate microangiopathy in long COVID and advocate prospective, longitudinal data capture for patients with persistent chilblain-like lesions in COVID-19, including nailfold capillaroscopy where available, to better understand pathomechanisms and inform evidence-based guidelines. PM is an MRC-GSK EMINENT clinical training fellow with project funding outside the submitted work. PM has served on an advisory board for SOBI and receives co-funding by the NIHR University College London Hospitals Biomedical Research Centre (UCLH BRC). RCC reports grants from UKRI MRC, GlaxoSmithKline, and NIHR ULCH BRC, during the conduct of the study. CPD reports grants and personal fees from GlaxoSmithKline, Roche, CSL Behring, and Arxx Therapeutics, and personal fees from Galapagos, Boehringer Ingelheim, Corbus, and Horizon, outside the submitted work. All other authors declare no competing interests. Download .pdf (.29 MB) Help with pdf files Supplementary appendix Long COVID in the skin: a registry analysis of COVID-19 dermatological durationSince the start of the COVID-19 pandemic, multiple studies have reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with dermatological manifestations.1 However, data on duration of signs and symptoms for the myriad dermatological manifestations of COVID-19 are lacking. Patients infected with SARS-CoV-2 who experience prolonged symptoms have been termed "long-haulers"2 or are said to have "long Covid",3 with studies reporting that 66–87% of patients continued to have one or more COVID-19 symptoms 60 days after PCR positivity. Full-Text PDF

Evaluation of body surface temperature change in response to exercise is important for monitoring physiological status. The aim of the study was to assess the influence of high-speed treadmill exercise on body surface temperature using infrared thermography (IRT) in selected body regions of healthy Beagle dogs, taking into account gait and recovery time. Thermographic images of the dogs were taken before exercise (BE), after walk (AW), after trot (AT), after canter (AC), just after second walk (JAE), 5 min after exercise (5 AE), 15 min after exercise (15 AE), 30 min after exercise (30 AE), 45 min after exercise (45 AE), and 120 min after exercise (120 AE). Body surface temperature was measured at the neck, shoulder, upper forearm, back, chest, croup, and thigh. Statistical analysis indicated the highest temperature at the upper forearm, shoulder, and thigh, and the lowest on the croup, back, and neck. The peak values of surface temperature in all ROIs were at AC and JAE and the lowest at 120 AE. The study demonstrated that body surface temperature was influenced by high-speed physical exercise on a treadmill and IRT was a viable imaging modality that provided temperature data from specific body regions. The proximal forelimb and hindlimb were the most influenced by exercise.

Background Paediatric localized scleroderma is a severe inflammatory disorder associated with tissue atrophy, often leading to disability. Assessing disease activity and response to treatment has always been challenging and remains an important difficulty in clinical practice. Objectives To investigate prospectively the efficacy of systemic treatment with corticosteroids and methotrexate in children with localized scleroderma and the validity of infrared thermography, laser Doppler flowmetry and high-frequency ultrasound in assessing disease activity. Methods Children with localized scleroderma were prospectively treated with corticosteroids (initially pulsed IV methylprednisolone 30 mg/kg/day, maximum 500 mg/day and/or oral prednisolone 0.5-1 mg/kg/day) and methotrexate (15 mg/m(2) weekly). Treatment response was evaluated using a clinical activity score. Skin temperature, blood flow, dermal thickness and dermal echogenicity of clinically active skin lesions were determined in relation to the unaffected contralateral site at baseline and after 3, 6, 12 and 18 months. Patient charts were later reviewed for long-term follow-up. Results Twenty-two patients were included [age 6.0 (0.2-14.4] years; female-to-male ratio 3.4 : 1) All responded well to therapy. Disease reversibility was demonstrated in the majority of children with partial resolution of skin sclerosis and regrowth of hair. Laser Doppler flowmetry and high-frequency ultrasound findings correlated with disease activity at baseline. Thermography had no added value in this cohort. The recurrence rate was 36% in the follow-up period. Conclusions Corticosteroids and methotrexate are highly effective as first-line therapy in paediatric localized scleroderma, leading to partial reversal of skin manifestations. However, the recurrence rate is substantial and affected children require long-term follow-up. Laser Doppler flowmetry and high-frequency ultrasound correlate with disease activity in the acute phase and may assist decision-making in these patients.

Infrared thermography is a non-invasive and non-ionizing imaging technique for recording body surface temperature. Considerable research efforts have been made to ensure that thermography in human medicine is performed to consistent standards so that measurements are traceable, reliable and valid, but interest in understanding sources of measurement uncertainty has developed less rapidly in veterinary thermography. The objective of our study was to understand the influence of variability in thermal imager performance, and the contribution to measurement variance of operator-dependent factors, in a practical equine thermography setting. The study employed five different models of thermal imager, which were all quality assured against a blackbody source prior to equine measurements. Three standard thermographic views were then obtained from nine clinically healthy horses using all five thermal imagers, with each imager capturing all views twice. On every thermographic image, regions of interest (ROIs) were then determined by two analyzers. The thermograms from each imager were assessed for their clinical utility. Agreement between analyzers of the same images, and between pairs of repeated images for the same analyzer, was assessed by Bland Altman plots. The contribution to the total variance in temperature measurements from analyzers and from camera-dependent factors was evaluated by ANOVA gauge R&R (reliability and reproducibility) analysis. Two of the thermal imagers produced readings during quality assurance which were outside of their stated specifications for accuracy. There were notable differences in the ability of the imagers to produce clinically useful thermograms, and it was difficult to compare the thermograms from different manufacturers due to the varied color palettes employed. Assessing agreement between analyzers, the bias was -0.05 degrees C and limits of agreement were 0.11 degrees C (upper) and -0.21 degrees C (lower). Agreement between repeated images was less good than between analyzers: the bias was 0.17 degrees C and limits of agreement were 1.55 degrees C (upper) and -1.21 degrees C (lower) for the first analyzer. Across all horses, the contribution by the analyzers to variance in temperature measurement at the ROIs from the lateral whole-body view was 9.8 +/- 4.2% (Mean +/- SD), for the lateral and medial aspects of the limbs was 26.5 +/- 18.2%, and for the dorsal aspect of the limbs was 11.2 +/- 9.2%. Across all ROIs and horses, the mean contribution to variance in the measurements from camera factors was 82.7 +/- 15.3%. The work shows the importance of specifying an appropriate thermal imager for equine studies, and ensuring there is a programme of quality assurance in place for all devices used.

Radiation oncology is one of few fields in medicine to incorporate a formal peer-review process, though no studies exist that validate the effectiveness of weekly physician chart rounds (C-R) as a quality assurance measure. We conducted a prospective blinded study to evaluate and quantify the efficacy of physician peer review during C-R as a method of detecting treatment planning errors. Sham plans were generated for select cases incorporating deliberate errors that were anticipated to be identifiable at weekly peer-reviewed C-R. An error rate of 7.3% (12/164 total cases) was introduced randomly into C-R over four weeks at an NCI designated Comprehensive Cancer Center. Sham plans were shown by the chief therapist in lieu of actual plans during clinical case presentations. All physicians were unaware of the study except the first and senior authors, chief physicist, and chief therapist. Actual plans chosen for sham replacement underwent peer review using a specialized QA process to ensure clinical quality and correct plan delivery. An error was scored as detected if a physician identified the error incorporated into the sham plan at C-R. Initial study design was to have 60 cases with an anticipated error-detection rate of 70%. The study was stopped early after the first 25% of sham case presentations revealed an unexpectedly low detection rate. Sham cases included various disease sites, treatment intent, and techniques, while incorporating errors of target verification (laterality, spine level, intact versus postop) and dose. 16.7% (2/12) of the presented sham cases were detected. The 2 detected errors included a right lung SBRT case where a plan treating the contralateral lung was shown and a brain SRS plan depicting a lesion in the contralateral side of the brain. Physician attendance did not correlate with error detection rates as 7 physicians were present when both errors were detected; between 4 and 8 were present during the remaining sham presentations. The treating physician was present during 75% (9/12) of sham presentations. In both detections, the treating physician identified the error, not their peers. This is the first prospective study attempting to quantify and validate radiation oncology C-R as an effective component of the quality assurance process. In this study, the error detection rate was substantially lower than anticipated. All errors were identified by the treating physician rather than by their peers. Subsequent study to evaluate the impact of a planned intervention to improve the integrity of C-R as a peer review process is underway.Abstract 2445; TableDetails of Sham CasesDisease SiteIncorporated ErrorDetection RateBreastLaterality0/4ProstateIntact vs Postop0/4Lung SBRTLaterality1/2SpineVertebral level0/1Brain SRSLaterality1/1 Open table in a new tab

Background Myhre syndrome is a genetic disorder caused by gain of function mutations in the SMAD Family Member 4(SMAD4)gene, resulting in progressive, proliferative skin and organ fibrosis. Skin thickening and joint contractures are often the main presenting features of the disease and may be mistaken for juvenile scleroderma. Case presentation We report a case of a 13 year-old female presenting with widespread skin thickening and joint contractures from infancy. She was diagnosed with diffuse cutaneous systemic sclerosis, and treatment with corticosteroids and subcutaneous methotrexate recommended. There was however disease progression prompting genetic testing. This identified a rare heterozygous pathogenic variant c.1499 T > C (p.Ile500Thr) in theSMAD4gene, suggesting a diagnosis of Myhre syndrome. Securing a molecular diagnosis in this case allowed the cessation of immunosuppression, thus reducing the burden of unnecessary and potentially harmful treatment, and allowing genetic counselling. Conclusion Myhre Syndrome is a rare genetic mimic of scleroderma that should be considered alongside several other monogenic diseases presenting with pathological fibrosis from early in life. We highlight this case to provide an overview of these genetic mimics of scleroderma, and highlight the molecular pathways that can lead to pathological fibrosis. This may provide clues to the pathogenesis of sporadic juvenile scleroderma, and could suggest novel therapeutic targets.

Previous research demonstrated that the majority of radiation oncologists perceive online patient reviews to contribute to burnout. The purpose of this study was to analyze if demographic features of physicians were associated with the perception that online reviews contribute to burnout. An international survey was delivered to practicing radiation oncologists who are members of the American Society of Radiation Oncology (ASTRO). The survey evaluated physicians' perceptions of these rating websites. The association of gender or physician age with burnout was assessed using Fisher's Exact tests and multiple linear regressions. Criteria for statistical significance was p < 0.05. This study was approved by the IRB. A total of 445 survey responses were collected. Two-hundred (45%) respondents agreed that online physician rating websites contribute to burnout, 200 (45%) respondents were neutral, and 45 (10%) respondents disagreed. Of all respondents, 313 were men, 130 were women, and 2 were other gender. Both men and women were more likely to agree than disagree that online reviews contribute to burnout. Forty-one percent of men agreed and 12% disagreed, whereas 55% of women agreed and 7% disagreed (p = 0.03); these findings also indicate that men were more likely to be neutral than women. Of all respondents who agreed online reviews contribute to burnout, 84 (42.0%) were between the ages of 35 and 50 years, 60 (30.0%) were between the ages of 50 and 60 years, and 56 (28.0%) were above the age of 60 years. Of all respondents who disagreed that online reviews contribute to burnout, 14 (31.1%) were between the ages of 35 and 50 years, 11 (24.4%) were between the ages of 50 and 60 years, and 20 (44.4%) were above the age of 60 years. There was a linear trend in the relationship of ordinal burnout categories and age categories (p = 0.033). The relationship between perceived burnout and age did not differ by gender (p = 0.53), although there was some evidence that gender confounds the relationship of age with burnout. Younger physicians and women are more likely to perceive that online patient reviews contribute to burnout than older physicians and men. This suggests that online reviews may have an increasing effect on physician burnout in the future. Future research could investigate potential burnout secondary to online physician reviews and prevention strategies.

Welcome to this focus collection of Physiological Measurement on Thermal Imaging in Medicine. Thermal imaging had its origins in the Second World War, where scientists were trying to measure infrared signatures for target identification and recognition. In the decades immediately following the war, thermal imaging was almost exclusively confined to military applications. However, as the technology rapidly developed, system miniaturisation followed, and then, through the introduction of un-cooled focal plane detector arrays, the cost of thermal imagers quickly decreased. This resulted in thermal imaging becoming increasingly pervasive in non-destructive testing and other research disciplines, including a rapid uptake in the field of medicine. Thermal imaging is now routinely used in a variety of clinical and clinically related research settings; for example, it is now utilised in identifying and tracking the course of Raynaud’s phenomenon and other vasospastic disorders (Wilkinson et al 2018), and there has been a lot of interest in the widespread deployment of thermal imaging to help prevent diabetic foot ulceration (Machin et al 2017, MacDonald et al 2017). This focus collection of Physiological Measurement showcases, through ten papers, the diversity of contemporary clinical and clinically related applications for thermal imaging. These papers are a selection based on presentations given at the 14th European Association of Thermology (www.eurothermology.org/) Congress held at the UK’s National Physical Laboratory (www.npl.co.uk/), 4–7 July 2018. The scene is set by the review paper of Machin et al (2019) discussing the importance of standardisation and calibration in the context of clinical thermometry, not just for thermal imaging but for a variety of techniques including more exotic approaches such as magnetic resonance imaging spectroscopy (Babourina-Brooks et al 2015). Blackbody sources that can be used for the calibration and validation of thermal imagers in medicine have been described elsewhere (Machin et al 2009). Papers by MacDonald et al (2019) ‘Between visit variability of thermal imaging of feet in people attending podiatric clinics with diabetic neuropathy at high risk of developing foot ulcers’ and Seixas et al (2019) ‘Relationship between skin temperature and soft tissue hardness in diabetic patients: an exploratory study’ both relate to the deployment of thermal imaging to the feet of diabetic patients, with the aim of reducing and preventing ulceration and hence the many deleterious consequences that follow. The paper by Pokorná et al (2019) ‘Intestinal resection of the porcine model under thermographic monitoring’ demonstrates the use of thermal imaging as an essential adjunct to improving the outcome of surgical procedures. This has been powerfully demonstrated, for example, through the improved outcomes in breast reconstruction surgery by Weum, Mercer and de Weerd (2016), after thermal imaging was introduced into the clinical pathway. There is a growing interest in the deployment of thermal imaging in monitoring and optimising athletic performance and sports science more generally. This was reflected by the three contributions, by da Silva et al (2018) ‘Can exercise-induced muscle damage be related to changes in skin temperature?’, Pérez-Guarner et al (2019) ‘Association between physiological stress and skin temperature response after a half marathon’ and Gil-Calvo et al (2019) ‘Effects of prefabricated and custom-made foot orthoses on skin temperature of the foot soles after running’. The use of thermal imaging to monitor the presence of infection is discussed by Benavent Casanova et al (2019) in the ‘Application of infrared thermography in diagnosing peripherally inserted central venous catheter infections in children with cancer’. The use of thermal imaging to detect infection is of wider importance. For example, thermal imaging is widely deployed, especially in East Asia, to detect febrile individuals passing through airports (IEC/FDIS 80601-2-59 2017). The objective in this case is to try to prevent the spread of highly infectious diseases such as avian flu in potentially pandemic situations. Hence the paper by Vardasca et al (2019), ‘Bilateral assessment of body core temperature through axillar, tympanic and inner canthi thermometers in a young popuG Machin et al