Rob Simpson

Traceability and calibration in temperature measurement: a clinical necessity

Patient temperature is a fundamental physiological measurement used primarily for observation and diagnosis, for example during surgery, intensive care, recuperation, or treatment. A variety of thermometers are used clinically and these can be separated into two categories, either contact (oral thermometers, rectal thermometers and temporal strips), or non-contact (ear thermometers, temporal thermometers and thermal imagers). To have the maximum confidence in the clinical performance of the temperature measurement instrument it is strongly desirable that the device be traceably calibrated to the International Temperature Scale of 1990 (ITS-90). Lack of traceable calibrations accredited to ISO17025 can lead to unreliability in temperature measurement and in some cases can have a deleterious effect on patient care. The National Physical Laboratory (NPL) maintains and disseminates the ITS-90 for contact and non-contact thermometry in the UK. The importance of accredited traceable calibrations and an outline of contact and non-contact thermometry standards are given here.

Calibration and validation of thermal imagers

This paper will consider how to improve confidence in the use of thermal imagers quantitatively, that is for actual temperature measurement. The proposed route will be through the implementation of best international measurement practice via calibration, traceability and accreditation. Reference blackbody standards that have been rigorously qualified will be described, with emphasis on developments in clinical thermography.

Thermal symmetry of healthy feet: a precursor to a thermal study of diabetic feet prior to skin breakdown

Early identification of areas of inflammation may aid prevention of diabetic foot ulcers. A new bespoke thermal camera system has been developed to thermally image feet at risk. Hotspots (areas at least 2.2 °C hotter than the contralateral site) may indicate areas of inflammation prior to any apparent visual signs. This article describes the thermal pattern and symmetry of 103 healthy pairs of feet. 68% of participants were thermally symmetric at the 33 foot sites measured. 32% of participants had at least one hotspot, but hotspots overall only accounted for 5% of the measurements made. Refinements to the definition of hotspots are proposed when considering feet at risk of ulceration.

Bilateral comparison of blackbody cavities for calibration of infrared ear thermometers between NPL and FE/LMK

The paper describes the comparison method and analyses the results of comparison in terms of agreement between the blackbody of the National Physical Laboratory (NPL), United Kingdom and four different blackbody cavities of the Laboratory of Metrology and Quality (LMK), at the University of Ljubljana, Faculty of Electrical Engineering (FE), Slovenia. Three cavity shapes are suggested in different standards as suitable for calibration of infrared ear thermometers (IRETs), while one cavity shape was proposed by the LMK. The agreement between blackbody cavities was determined with the help of platinum resistance thermometers. Two reference IRETs were used to check their stability and level of agreement between calibration results at different institutes and against different blackbody cavities. Measurements were performed with two IRETs, at the NPL in one cavity and at the LMK in four different cavities. The comparison was initiated to solve the problem of assuring proper traceability for IRETs and to present the solution to their users.

A medical thermal imaging device for the prevention of diabetic foot ulceration.

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.

Comparison of non-contact infrared skin thermometers

Abstract Non-contact infra-red skin thermometers (NCITs) are becoming more prevalent for use in medical diagnostics. Not only are they used as an alternative means of estimating core body temperature but also to assess the diabetic foot for signs of inflammation prior to ulceration. Previous investigations have compared the performance of NCITs in a clinical setting against other gold standard methods. However, there have been no previous investigations comparing the performance of NCITs in assessing temperature measurement capability traceable to the International Temperature Scale of 1990 (ITS-90). A metrological assessment of nine common NCITs was carried out over the temperature range of 15–45 °C using the National Physical Laboratory’s blackbody reference sources to identify their accuracy, repeatability, size-of-source and distance effects. The results are concerning in that five of the NCITs fell far outside the accuracy range stated by their manufacturers as well as the medical standard to which the NCITs are supposed to adhere. Furthermore, a 6 °C step change in measurement error over the temperature range of interest for the diabetic foot was found for one NCIT. These results have implications for all clinicians using NCITs for temperature measurement and demonstrate the need for traceable calibration to ITS-90.

Best practices for standardized performance testing of infrared thermographs intended for fever screening

Infrared (IR) modalities represent the only currently viable mass fever screening approaches for outbreaks of infectious disease pandemics such as Ebola virus disease and severe acute respiratory syndrome. Non-contact IR thermometers (NCITs) and IR thermographs (IRTs) have been used for fever screening in public areas such as airports. While NCITs remain a more popular choice than IRTs, there has been increasing evidences in the literature that IRTs can provide great accuracy in estimating body temperature if qualified systems are used and appropriate procedures are consistently applied. In this study, we addressed the issue of IRT qualification by implementing and evaluating a battery of test methods for objective, quantitative assessment of IRT performance based on a recent international standard (IEC 80601-2-59). We tested two commercial IRTs to evaluate their stability and drift, image uniformity, minimum resolvable temperature difference, and radiometric temperature laboratory accuracy. Based on these tests, we illustrated how experimental and data processing procedures could affect results, and suggested methods for clarifying and optimizing test methods. Overall, the insights into thermograph standardization and acquisition methods provided by this study may improve the utility of IR thermography and aid in comparing IRT performance, thus improving the potential for producing high quality disease pandemic countermeasures.

Reproducibility of Thermal Images: Some Healthy Examples

Thirty participants with healthy feet were imaged in the same way on two separate occasions (an average of 4 weeks apart). Overall, feet were found to be thermally symmetric although absolute temperature could vary considerably between visits. Temperature differences at specific sites on the foot sometimes exceeded the threshold of 2.2 °C regarded as clinically significant when looking for evidence of inflammation prior to skin breakdown in diabetes. At least one site exceeded this threshold in nine (30%) participants (the same figure for both visits). However, when looking for significant thermal asymmetry it is important to rule out transient changes by repeated imaging and to refer to baseline images.