Aim To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence. Methods People with diabetes (n = 110), neuropathy and history of >= 1 foot ulcer participated in a single-blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature >= 2.2 degrees C higher than the corresponding contralateral site) and acted upon as per local standards. Results After 12 months, 62% of participants were ulcer-free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively. Conclusions Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer-free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow-up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.

Thermal imaging is a useful modality for identifying preulcerative lesions (“hot spots”) in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet.

In this paper a description is given of the development, characterisation and first results of a thermal imaging device aimed at significantly reducing the incidence of diabetic foot ulceration (DFU). These devices will be used in three clinical centres and in two preliminary clinical trials. The first will be on healthy volunteers to set a robust baseline for the overall research aims and the second on  >100 patients at high risk of DFU. In the second phase of the project the objective is to demonstrate significant reduction in the incidence of DFU through a comparison of the results of standard care of high risk feet with standard care plus thermal imaging.

The Work-Related Upper Limb Disorders (WRULD) are the most common occupational condition at modern workplaces and can become chronic. WRULD needs an accurate quantitative and objective diagnostic test to aid clinicians in the judgment of the degree of injury and assess the adequate treatment, and to provide a permanent evidence record of the degree of injury. Medical thermography was used with a mechanical provocation test involving a computer mouse exercise, which was followed by a thermal provocation of the hand. The proposed method is objective and repeatable, can discriminate between asymptomatic controls and patients (p<0.05). Medical thermal imaging can be used as complementary diagnostic tool to provide evidence of WRULD in support to medical history in medico-legal liabilities.

Medical thermal imaging offers real time physiology monitoring, providing important information about the microcirculatory and autonomous nervous systems.The recording equipment has evolved over times, presenting actually very good definition, sensitive and image quality.Image capture procedures have been developed, published and tested.The use of computers and software facilitates the understanding of the images, although the current scenario in medical application is that there is no specific camera or software package designed and developed specifically for clinical use.This work outlines the features that a capture and analysis system needs to have to support the medical imaging modality.All this recent developments contributed to an important improvement of the technique and acceptance from the clinical professionals, however, work needs to be done for standardizing the images analysis.

The medical thermal images provide information about human body physiology.The images are analysed using regions of interest (ROI), which in human body are characterized of having a complex shape, differing slightly within subjects.Those differences such as size and position over time between different examinations affect an accurate analysis.A standardised method is needed to address comparison or average of several images.The proposed method is based in a geometrical template using triangles and barycentric coordinates.Despite an accuracy of 98% within the studied images, further research is needed in the automatic discovery of control points of the ROIs.

This work describes the investigation into a new 3D capture method for acquisition and subsequent forensic analysis of bite mark injuries on human skin. When documenting bite marks with standard 2D cameras, errors in photographic technique can occur if best practice is not followed. Subsequent forensic analysis of the mark is problematic when a 3D structure is recorded in a 2D space. A 3D image capture and processing system might avoid the problems resulting from the 2D reduction process, simplifying the guidelines and reducing errors. This paper reviews current 2D and three 3D capture methods and proposes a series of benchmarks for system assessment. This is followed by a series of performance evaluations of the existing current 2D and two 3D methods. Further proposed solutions include the design of a system specification for the practical reproducible acquisition of bite mark injuries and a review of the validation process for forensic evidence presented to the courts. The result of this work is that a 3D system is required to produce the correct 3D data of a bite mark and suspect dentition for forensic analysis. Such a system should be practical and consistent if it is to replace the current de facto 2D systems. The MAVIS hardware, for example, can be considered a practical and consistent solution for producing the required 3D image of a bite mark for analysis; however, the MAVIS hardware cannot produce a satisfactory 3D image of a dental cast. At present, a laser scanner is required to produce satisfactory results of a dental cast. Angular distortion and errors created by the user in 2D image capture can hinder the digital measurement process. 3D capture therefore introduces less operator error in the form of angular distortion.

Over the last decade tympanic (ear) thermometers, along with other new digital thermometers, have replaced traditional mercury-in-glass thermometers for measuring patient temperature in a medical environment. However, there has been concern among users over their performance and accuracy, leading to many clinicians distrusting them. Some of the problems are likely to be due to: calibration issues or the instrument performance (some of the less expensive instruments have shown a tendency to drift over periods of minutes, possibly due to heating by the hand); misuse (incorrect positioning within the ear, incorrect placement of probe covers, 1); or incomplete understanding of human body temperature regulation and normal temperature differences between different measurement sites.

This work describes the investigation of a new 3D capture method for acquisition and subsequent forensic analysis of bite mark injuries on human skin. When documenting the bite marks with standard 2D cameras, errors in photographic technique can occur if best practice is not strictly adhered to. Subsequent forensic analysis of the mark is problematic when a 3D structure is recorded in 2D space. Although strict guidelines from the British Association of Forensic Odontology (BAFO) exist, these are time consuming to follow and due to their complexity, may produce errors. A 3D capture and processing system might avoid the problems resulting from the 2D recording process, thus simplifying the guidelines and reducing errors. A series of experiments are described here that demonstrate the potential of a 3D system to produce suitable results. The experiments tested precision and accuracy of the traditional 2D and 3D methods. The results of the experiments demonstrate that distortion and errors created by 2D image capture can negatively affect the digital measurement process. A practical 3D image capture device minimizes the degree of angular distortion, and therefore has the potential to create more robust forensic evidence for use in courts.

By measuring the physical dimensions of wounds, clinicians receive feedback about the success of a selected treatment approach. This chapter reviews existing wound measurement techniques and highlights underlying principles and difficulties. As an example the performance of a new hand-held, non-contact, wound measurement device is analysed. The colour of a wound provides important clues about its status to the clinician. It can be used to assess the distribution of tissue types and potentially detect the onset of infection at an early stage. The underlying fundamentals of colour measurements by digital cameras are outlined and an example classification system is presented.

This paper describes the investigation of a new 3D capture method for acquiring and subsequent forensic analysis of bite mark injuries on human skin. When documenting bite marks with standard 2D cameras errors in photographic technique can occur if best practice is not followed. Subsequent forensic analysis of the mark is problematic when a 3D structure is recorded into a 2D space. Although strict guidelines (BAFO) exist, these are time-consuming to follow and, due to their complexity, may produce errors. A 3D image capture and processing system might avoid the problems resulting from the 2D reduction process, simplifying the guidelines and reducing errors. Proposed Solution: a series of experiments are described in this paper to demonstrate that the potential of a 3D system might produce suitable results. The experiments tested precision and accuracy of the traditional 2D and 3D methods. A 3D image capture device minimises the amount of angular distortion, therefore such a system has the potential to create more robust forensic evidence for use in courts. A first set of experiments tested and demonstrated which method of forensic analysis creates the least amount of intra-operator error. A second set tested and demonstrated which method of image capture creates the least amount of inter-operator error and visual distortion. In a third set the effects of angular distortion on 2D and 3D methods of image capture were evaluated.

In digital imaging, poor contrast between the target and its background can affect the extraction of the object of interest and increase the time used in its analysis. Medical thermal imaging requires the correct interpretation of the thermal values obtained from the region of interest. In this investigation, a subjective and objective comparison of currently available outlining techniques is performed to determine the optimal method. Results indicate that probability-based operators produce the best outcome especially after pre-processing with a noise removal filter. The findings of this study suggest that probability-based edge detection techniques in combination with homomorphic filtering and limited post-processing provide initial estimate delineations of areas. These delineations are of sufficient quality for subsequent automatic or semiautomatic post-processing so that a maximum of the original information inside the regions is preserved without loss or distortion of data.

Medical thermography has become ever more accessible to hospitals, medical research, and clinical centers with the new generation of thermal cameras, which are easier to use and lower in cost. Some diagnostic techniques using thermal cameras are now regarded as standardized, such as the cold challenge test for Raynaud’s phenomenon. The future for medical thermography appears to be improved accuracy, standardization, and establishment as a mainstream medical imaging methodology. Medical thermography standardization, quantitative measurements, image comparison, and multi-center research trials all require thermal cameras to provide a demonstrably traceable, accurate, and reliable temperature output. To this end, the National Physical Laboratory (NPL) has developed a multi-fixed-point source that serves as an in-image calibration system, thereby providing a reliable means for radiometric image validation. An in-field-of-view fixed-point validation system for thermal imaging has successfully been developed, tested, and validated at NPL and has undergone field trials at three clinical centers in the UK. The sources use the phase change plateaux of gallium–zinc eutectic, gallium, and ethylene carbonate. The fixed-point sources have an estimated cavity emissivity of greater than 0.998, a plateau longevity of nominally 3 h at ambient conditions, a stability of 0.1°C, or better, over that period, a repeatability of 0.1°C or better, and an estimated temperature uncertainty of  ±0.4°C (k = 2). In this article, the source specifications and design as well as testing, validation, and field trial results are described in detail.

Repetitive tasks such as keyboard typing increase hand and forearm temperature after a certain time due to muscular activity. This activity can be objectively quantified by the measurement of temperature changes over time. In this study changes in both hands were recorded while one hand was typing on a standard keyboard and the other one remained static. The temperatures of hands and forearms were recorded using thermal imaging. The infrared camera was positioned in a vertical static position recording an image once a minute over a period of 15 minutes. The thermograms of the 12 healthy volunteers participating in this study were analysed with the software package CTHERM. Results show that after 5 minutes the temperature of the typing forearm increased by 0.5°C compared to the other one. The hands over the same period of time show a difference of only 0.1°C. After 15 minutes the difference between both forearms was 1.2°C but between both hands only 0.4°C. In order to better assess thermal effects of keyboard stress on hands an additional vascular stress test immediately after the mechanical stress may produce increased discrimination. This investigation also shows that other factors such as handedness, age and Body Mass Index affect temperature changes caused by mechanical stress.