Thermography 101

An interview with Dr. Robert Kane DC

 

Dr. Robert L. Kane brings over a decade of experience in the field of thermal image interpretation. He acquired his training through the International Thermographic Society and achieved Diplomate level certification through the American Board of Clinical Thermography (ABCT).

He later achieved Diplomate certification through the International Academy of Clinical Thermology (IACT) and was eventually recognized as a “Fellow” by IACT for contributions to the field of thermal imaging. Dr. Kane furthered his knowledge of breast applications under the tutelage of Dr. William Hobbins, one the world’s leading authorities.

Dr. Kane frequently lectures to physicians and laypersons on the role of thermal imaging in the clinical practice while serving on the board of IACT and ABCT.

His personal mission is to transform women’s fear of breast cancer into empowerment toward prevention.

Here is the interview:

 

BHP: Tell me a little bit about thermography and how you got involved with using thermography.

Robert: Okay. I will be happy to. Thermography is an imaging procedure where we take pictures of the heat coming off the body. We use the temperature of the body in certain regions to try to look for signs of disease or signs of injury. I got involved with this in the early 1990s as an adjunct to my chiropractic practice. I was using it to look for nerve entrapments and trigger points, which show fairly clearly on those types of examinations.

During my practice tenure, I had two patients in a six-month period of time who left my care because they had been recently diagnosed with breast cancer. Knowing that the technology was particularly suited for breast cancer detection and risk assessment, I then took the initiative to get the additional training in breast applications for thermography.

 

BHP: How does it compare to mammography?

Robert: Well, we are really looking at two sides of the same coin when we are looking at mammogram and thermogram. A mammogram is a structural test. It looks at basically the anatomy of the breasts and looks for density changes and lumps, masses, and calcifications.

Thermography is a functional test; how active is the tissue. So, for an example, a woman may have a lump but the question is whether that lump is very active like cancer is or if it is very inactive like a benign lump is. The mammogram could show the lump and the thermogram could show the activity level. So they really work hand in hand.

Daya: So they are not mutually exclusive?

Robert: Exactly.

BHP: Mammography isn’t necessarily effective sometimes with younger women, women under 50, because of density of their breast tissue?   So, is that as much of an issue with thermography?

Robert: Well with thermography, we are really looking at changes in the surface of the skin. The literature has very clearly shown that even deeper tumors have a surface presentation in the vast majority of the situations. So because we have got over 90% of tumors having changes at the surface of the body, the density of the tissue is not even an issue. We don’t need to get down that deep in order to get the readings.

BHP: Would that be true with a benign lump as well as a cancerous lump?

Robert: Well with benign lumps, generally there are no surface changes associated with that. Every once in a while, we will see cooling if it is displacing a blood vessel but for the most part, it just blends in with the rest of the tissue. It looks like there is nothing there.

BHP: So just like a mammographic picture, you are looking for a change, something different than the other side; something unusual.

Robert: Exactly.

BHP: How effective is it compared with mammography?

Robert: Well, you know, the statistics are showing that, you know, it is about 90% accurate on its own, in terms of detecting cancer.

BHP: Really?

Robert: Yeah. Now when it is used in combination with mammogram and physical examination, the statistics go up to about 97%, which is pretty unbelievable as far as detection rates go.

BHP: And that is across the board, age-wise?

Robert: Yes.

BHP: Oh. Wow! And how about compared to like ultrasound, which has been getting more efficient in terms of finding calcifications?

Robert: Well, again, I mean, you know, we have to be careful when we are comparing these types of technologies, even mammogram and thermogram. Thermography still generally will be the first sign of a possible problem. It tends to pick up things earlier because it actually picks up changes that precede cancer. But it can’t identify the lump. It can’t identify the calcification. So you know, to say that one is more effective than the other becomes very difficult because what ends up happening is that we find that each is highly effective at what it does but it is highly ineffective at doing what the other test is supposed to do.

BHP: Using the tools that you have for what you need.

Robert: Exactly. It is like saying, “What is more effective, a screwdriver or a hammer?” And the answer is that it depends. You know if I am trying to tighten a screw, well the screwdriver is more effective but if I am trying to drive a nail into the wall, well it is going to be a hammer.

BHP: That makes a lot of sense. With a 90% effective rate, why aren’t more breast centers using thermography?

Robert: Well there are a lot of dimensions to that question and I think the biggest answer, the best answer, is really that they just don’t understand how it is to be used. There is a very clear-cut diagnostic algorithm that a clinician uses in order to work in a diagnostic test and in medicine, one does not deviate from those algorithms because those algorithms are proven based on a certain amount of evidence and they are also insurance against malpractice. And when a technology like thermography comes along, they are just not quite sure what to do with it.

Now to complicate matters, because thermography can detect changes that precede cancer, often what could happen is someone would come in with an abnormal thermogram and no other test could actually find a problem. The information would be discarded as a false positive but in fact what it really was doing was being predictive as to who was more likely to develop cancer in the future.

So they just don’t know what to do with the information and those aspects of the technology have to be addressed in the medical arena before we are going to see widespread adoption.

BHP: How do we use this and then what is the protocol if you find something that is not cancerous but could be predictive?

Robert: Well, the protocols right now are being ironed out so there is no standard of care. Basically, what we do from a protection standpoint is that if we see any sort of unusual temperature change, we refer the patient to a doctor to make sure that some sort of screening is going on. If there is absolutely no indication of cancer via standard testing, and we just have one isolated thermogram, I think what we now have is the basis for risk management rather than cancer treatment.

So just as if somebody had high cholesterol, one would seek methods to lower their cholesterol as a means to preventing heart disease, when someone sees an isolated, unusual thermogram, it needs to be taken in that same kind of context and this is what is opening up the door in some of the functional medicine community towards creating protocols that are really designed at lowering breast cancer risk.

BHP: So that is where you would look at some of the dietary changes, supplements, Vitex, or breast massage for that matter and acupoints; some of the stuff that we teach at the project.

Robert: Precisely. You know, I think that at this stage in the game there is preliminary research out there that suggests that all these things could be beneficial. There is certainly enough that it is worth trying with a patient. My vision is that we are going to start the process of doing some long-term testing of these different strategies to lower risk and watch the changes on the thermogram. Then we can correlate that with lab tests to see what we could do to iron out a real breast cancer prevention strategy.

BHP: What sort of lab tests could you do? Would you do blood testing?

Robert: But the laboratory testings that I do seem to think are of value are there are a lot of different women’s hormonal profiles. Looking at the balance of estrogen and progesterone in the body, and then specifically looking at the different estrogen metabolites. Things like the 2:16 hydroxy ratios for the hydroxylated metabolites of estrogen have strong literature support as being a systemic marker for breast cancer risk.

Now what is interesting is that if you combine that with thermography, we are getting two dimensions because the question that I have always asked of people that are using these systemic markers is how do we know how an individual woman’s breast will respond to a specific 2:16 hydroxy ratio?

So, you could have two women with the exact same hormonal values but because of genetic sensitivity of their breast receptors to estrogen and estrogen metabolites, they may be reacting in a more exaggerated fashion. So the ability to actually visualize those changes in the tissue through something like thermography could be invaluable. Just fine-tuning things based on genetic sensitivity.

BHP: So you could have a more precise picture of what is happening in that particular womans' breast tissue.

Robert: Exactly. So instead of saying, “Well, the 2:16 hydroxy ratio is a little low, the risk is lowered,” we could sit there and say, “There is the 2:16 hydroxy ratio. Here is the net effect on the breast tissue. And based upon the whole package, now we have a better more complete view of what that risk actually is.

BHP: So it is also very individualized care that way?

Robert: Precisely, because no two women are alike.

BHP: That is the truth. Now there are two types of thermography, one where they are sort of checking points and one where they are reading the heat off the body. Are they similar? Do they do the same thing?

Robert: Well, they both read heat but I think the system of analysis and the system of capture is completely different. With probe thermography, generally they are taking matched points in different areas of the body and drawing conclusions from that. Now, again, I am going to plead ignorance to that type of thermography to a certain extent but I have heard that some of this is being correlated through acupuncture points too. There is supposedly a body of literature that is available on that particular thermography but I have not reviewed it.

The thermography that I tend to do and that is considered more standard in the industry is what is known as telethermography and we are taking on an average of about 76,000 data points, running them through a computer, and then doing analysis. And when you do hear references in the literature from 35 years of research and large-scale studies, generally it is the telethermography that people are referring to.

BHP: So that is the more standard type?

Robert: Right and actually one caveat is to be very careful that if somebody was using a probe instrument, that they are making their claims based upon literature specific to that instrument and not literature specific to thermography in general because it is quite different in terms of how the data is being captured and also how the data is being interpreted.

BHP: And on that topic, with mammography the quality of the machine is an issue, in terms of how well it is going to read, and also who is reading the image, etc... Can you speak to that?

Robert: It is a tough question and it is particularly challenging in a new field like thermography because we don’t have national regulating boards that are setting standards and enforcing requirements but we have our individual associations trying to take that place, you know, until something large-scale can actually happen.

I think the only way to really investigate an interpreter is to, number one, make sure that they have been certified by an independent association that does not have a manufacturer affiliation. Meaning, rather than the training arm of the camera company that you bought the camera from, you want to be with some sort of outside, multidisciplinary association that just basically is dealing with the profession of thermography.

Certainly you want to look at how many years they have been experienced and who they interned or mentored under. You know, with something like breast imaging especially, there are a lot of nuances and even when you have gone through a training program, there is a certain period of time you want to have studied under someone else just to see how well you are correlating.

BHP: So it is important to ask questions.

Robert: Right. You want to ask, “Who trained you?” You know, “Who is the person? Have they published any papers? Who trained them? Who runs the association?” That kind of thing.

BHP: Okay. That is very helpful, I think, and hopefully practical for the people getting this information. When you go into get a thermography what do you expect?

Robert: Yeah. The procedure is actually a very easy procedure. Generally, you are put into a climate controlled room. It is usually kept at about 70 degrees so it is on the cool side but not horribly cool and you are in that room with the breasts exposed for about 15 minutes.

Many of the centers are offering privacy curtains and things to protect women’s modesty to make it a more comfortable experience, but the purpose of having her there disrobed is so that her breasts can actually equilibrate with the temperature of the laboratory and we don’t get heat build-up from bras and clothing and things like that.

Once she has gone through that process, then it is really as simple as taking a picture. And what we have are these cameras that are controlled by computers. Where the woman is just basically told to stand in a particular position in front of the camera and the image is just captured in that position.

There is no contact with the patient so there is no squishing or discomfort and there is absolutely no radiation. Nothing is done to the patient. It is the same type of a process as when we get a photograph taken. The detector in the camera just collects information rather than doing something to the patient that could potentially be harmful.

BHP: How much does a thermogram cost?

Robert: It really depends on your area of the country. We are finding the national averages are anywhere between $175 and $250 for a breast examination.

BHP: Is there funding out there for helping women gain access to thermography?

Robert: Nothing we are aware of. I know in Colorado, one of the centers did manage to get some grant money from the Susan G. Komen Foundation, but that is where we are going to need help. You know the doctors that are doing this are all kind of wrapped up in our own practices and trying to put this forward. We really need some grass root volunteers to try to handle some of the issues like insurance, funding for lower income women, politicking, and things of that sort.

BHP: That is where the associations come in.

Robert: Exactly.

BHP: How often should someone get a thermogram?

Robert: Well, we recommend them annually from age 30 and up just to be part of the yearly examination. We do recommend that women as early 20 get baselined because we have a very high likelihood that they will be normal and what we do is establish almost a thermal fingerprint of their breasts and we can look for deviations from that over time. Now, if a 20 year old came in and got her initial thermogram and everything was normal, I would say that she should probably follow up every three years. You know, unless something out of the ordinary was going on with her.

BHP: So, if you had some risk that you knew of, say family history or something like that, you could come more often without getting exposed to radiation.

Robert: Absolutely. And, you know, with the women over 30 too, one of the common scenarios is that a woman gets a mammogram and they find something that they think is normal but they want to track it for a while and they will tell her to come back every six months for a couple of years to see if it changes. What is nice is that she could also be doing three-to-six-month thermograms to see if the activity level is changing as well.

And we have had that happen where a finding that was thought to be basically benign on mammography, after six months, we saw two noticeable jumps in the heat so the woman was sent back to her doctor who chose to biopsy it and sure enough it was cancer.

BHP: That is great information. Thank you very much for talking with us. Is there anything else that you think that women should know about thermography that we did not ask you?

Robert: Yes. You know, I think that it is very important to have the proper perspective on what this test is. When women go in to have a mammogram, they go in to look for cancer and it is a scary exam. And the tendency is to do the same thing with a thermogram but with a thermogram, we are looking at really prevention more than anything else.

Certainly, there are times when we are going after detection but I think that the way to look at the thermogram is that, “I am going in to take control of my health. So I am going to find out what my level of risk is and then I am going to do what I can do change that level of risk. Knowing that I can work with doctors, I can work with my health care providers and I have got something to tell me if I am being inductive or not.”

So, this is a very powerful way to take control of your health back and I think every woman should really recognize that because, you know, there is something you can do and this is part of it.

BHP: What about for women who have had breast cancer? Because you always wonder if it is coming back.

Robert: Precisely. If a woman had breast cancer already, we can watch the lymphatic areas to see if there is any sign of additional spreading and we can also watch the other breast because certainly if one breast has cancer, the other one becomes significantly higher at risk and we can still be watching those changes very carefully to make sure that that breast is evaluated in a manner that will allow for the earliest detection.

BHP: That is great. We just published Ralph Moss’s 24-page report about mammography on the website so it will be nice to have information about thermography there too. We really appreciate your time.

Robert: Well, my pleasure.

Dr Kane currently maintains a busy thermal imaging interpretation practice for over 20 centers in the US and Canada. He can be reached at 650-599-2150 or at rk@robertkane.com


 



 

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