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SCOPE | MEETING REPORTS REPORT ON NPL CLINICAL TEMPERATURE MEASUREMENT MEETING ROSIE RICHARDS North London Consortium JASON BRITTON Leeds Teaching Hospitals NHS Trust NATIONAL PHYSICAL LABORATORY 30th January 2012 THE NATIONAL PHYSICS LABORATORY (NPL), AT their premises in Teddington, hosted a one-day scientific meeting on clinical temperature measurement with some excellent speakers and interesting discussions on the research and development presented. The meeting was jointly organised by the National Physical Laboratory and the IPEM Physiological Measurement Special Interest Group. The morning keynote speaker was Helen McEvoy (NPL, Teddington), who talked about clinical thermometry using tympanic thermometers. Helen has been investigating different approaches to the training of clinical staff in the appropriate use of the devices, such that the uncertainty associated with the technique may be reduced. She covered the factors to consider when measuring temperature and the risks to consider when using such a device. The risks include: (1) misdiagnosis due to an inaccurate reading which could be due to poor calibration, handling or storage, or (2) injury due to the probe being pushed too far into the ear or cross-contamination. A focussed 1-hour training programme has now been developed working with Oxford Radcliffe Hospitals NHS Trust which can now be purchased and is delivered by NPL. TIME FOR A CHANGE The second speaker was Martha Sund-Levander (Hoegland Hospital, Eksjo, Sweden), whose presentation entitled ‘Time for a change when assessing and evaluating body temperature in clinical practice’ looked at the variability of clinical temperature measurement and the factors that may affect the readings in different healthcare settings. She discussed a literature review carried out by her and colleagues reviewing the variability of temperature measurements made at different body sites and how this could impact on the clinical management of patients. Her work also looked at the effects of ageing on normal body temperature ranges. It has been identified that elderly patients with dementia may be at risk of hypothermia as slightly lower than normal temperature readings in this patient cohort may not be seen as clinically significant. The discussions following prompted Francis Ring (University of Glamorgan, Pontypridd) to comment that paracetamol (which Martha had discussed in relation to its effect on temperature) was not an anti-inflammatory drug, having only analgesic effects, and was not now routinely used in clinical practice. Following this, the programme moved onto an interesting presentation by Sheera Sutherland (Churchill Hospital, Oxford) who has researched the potential of monitoring the core temperature of patients (with established renal failure) during 30 | SEPTEMBER 2012 | SCOPE haemodialysis with a thermal imaging camera and establishing if this can have a positive impact on their overall clinical management. The research investigated the affects of lowering the dialysate temperature to less than 37°C (which is traditionally used in haemodialysis treatments). There is some evidence that this may be actively warming the patient with a statistically significant difference in preand post-dialysis temperatures shown at a level of p = 0.001. However, it has been found that some patients do not tolerate cooler dialysate. Thermal imaging was also used to investigate the possibility that changes in measured core body temperature could be correlated with a ‘crash’ or hypovolemic event that commonly occurs. Kevin Howell (Royal Free Hospital, London) commented that hypovolemia may be the main issue to consider. DENTAL THERMOGRAPHIC IMAGING The next speaker, Paula Lancaster (Leeds Dental Institute), showed her work on vital dental thermographic imaging. The aim of the work was to investigate the temperature of the tooth in the hope of using this as an objective method to measure the vitality of the tooth. Currently sensitivity tests are performed to subjectively assess the neural supply to the tooth but this does not tell the dentist anything about the blood supply. Alternatively an x-ray may be taken of the patient’s mouth; however, this carries concerns of the use of ionising radiation (albeit in very low doses). A dental x-ray will only provide anatomical rather than physiological information. The researchers tested the theory that the central core of the tooth is warmer than the rest of the crown by using a skeletal model. They found that a thermal gradient could be detected, when the tooth is subjected to external cooling. This may be promising for using a similar model in vivo once ethical approval is obtained. Paula suggested that possible applications of thermography may include: n assessment of vitality of the tooth in people with toothache and the provision of information on which to base treatment decisions, n assessment of the extent of trauma to the teeth, n assessment of the development of the root in tooth transplant (this is currently done using radiographs). Any methods developed need to be simple and need to give consistent results. The discussions that followed this talk brought up issues such as how to find the emissivity of enamel. Since the tests are looking for relative differences in temperature, it was suggested that this may not be too important.
The day’s presentations then moved on to research into thermal symmetry on the upper and lower extremities on normal healthy volunteers carried out at Glamorgan University by Ricardo Vardasca (University of Minho, Braga, Portugal). For this work high-resolution thermal imaging cameras were used to capture a large number of images of the upper and lower extremities. Unlike previous work in the area, the images were captured in a controlled environment and the analysis was not based on single points. The images were then collated and standardised using geometric models. The models were used to scale the images to the same shape and size for each subject. The final outcome showed a small difference of 0.5°C ± 0.3°C between left and right regions. A difference of 0.1°C was also found between ventral and dorsal regions. Francis Ring commented after the presentation that there is a measurement uncertainty associated with the cameras which must be accounted for when reviewing the results. It was also unclear how the results could be used in the management of patients and where this may be used in the care pathway. The next speaker, Ismael Fernandez Cuevas (Universidad Politecnica de Madrid), presented results of a pilot study looking at the effects of the circadian cycle on skin surface temperature. The measurements were conducted in a controlled thermal environment and were taken periodically over a 13-hour day with The Handhound voice-operated ‘hands-free’ hand monitor Designed for use in radioisotope handling situations where hands could be contaminated. �� Entirely voice operated. �� Sensitive Sensitive scintillation scintillation counter for for for gamma gamma gamma emitters. �� Fixed Fixed or dynamic alarm alar alarm thresholds. thresholds. �� Automatic Automatic record record keeping keeping against against user user names, to aid with HSE compliance. �� Automatic background updates. �� Stainless steel housing for ease of cleaning and decontamination. Tel: 01273 497600 MEETING REPORTS | SCOPE the subject standing in the same position. Although there was no obvious pattern resulting from the measurements at different times, the temperature fluctuations were fairly constant for all areas of the body that were analysed. After correcting the temperature using the calibration area, the data showed similarities with existing results in this field by Professor Ring et al. Since observations showed that when the body was expecting food intake the temperature increased, a member of the audience suggested that the glucose level could be monitored if the experiment was repeated. Discussion also took place about the ‘constant core-variable shell’ theory that is often applied to thermal regulation of the human body. THYROID-ASSOCIATED EYE DISEASE John Allen (Freeman Hospital, Newcastle upon Tyne) was the next speaker, presenting work on ‘Detecting inflammatory disease in patients with active (Graves) thyroid eye disease’. The treatment regimen used for thyroid-associated orbitopathy depends on the outcomes of subjective clinical assessment. John’s pilot investigation was aiming to develop a working protocol for thermal imaging of the eye and use it to explore a range of characteristics in patients with this pathology. Complications involved blinking, sweating and tearing which may be asymmetric. Before the Web: www.southernscientific.co.uk SCOPE | SEPTEMBER 2012 | 31 ▼
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