This review describes the features of modern infrared imaging technology and the standardization protocols for thermal imaging in medicine. The technique essentially uses naturally emitted infrared radiation from the skin surface. Recent studies have investigated the influence of equipment and the methods of image recording. The credibility and acceptance of thermal imaging in medicine is subject to critical use of the technology and proper understanding of thermal physiology. Finally, we review established and evolving medical applications for thermal imaging, including inflammatory diseases, complex regional pain syndrome and Raynaud's phenomenon. Recent interest in the potential applications for fever screening is described, and some other areas of medicine where some research papers have included thermal imaging as an assessment modality. In certain applications thermal imaging is shown to provide objective measurement of temperature changes that are clinically significant.

In early CRPS (type 1), visual input from a moving, unaffected limb re-establishes the pain-free relationship between sensory feedback and motor execution. Trophic changes and a less plastic neural pathway preclude this in chronic disease.

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Objective-To describe and quantify the

Intra-articular steroid therapy for osteoarthritis of the knee has been reassessed by two placebo-controlled trials of 20 mg of triamcinalone hexacetonide in 48 joints. Steroid injections caused a significantly greater reduction in pain and tenderness than placebo, and were preferred by patients. However, the benefits were small and transient. Maximum pain reduction occurred one week after injection, and was accompanied by a fall in the thermographic index suggesting an anti-inflammatory mode of action. Synovial fluid was unafffected by injections, and there was no correlation between synovial fluid cell counts or the radiological grading, and the degree of pain reduction.

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Thermography can be used for the assessment of joint involvement in inflammatory arthritis. Modem thermographic apparatus allows temperature to be measured to within 0-2°C. and simultaneously records the areas involved. It has been demonstrated that thermographic changes in skin temperature over areas of chronic inflammation properly reflect changes in other chemical and cellular processes in rheumatoid arthritis (Ring and Collins, 1970;Collins and Cosh, 1970). The method also agrees with the findings of joint scans after technetium injection (Cosh, Lindsay, Rhys-Davies, and Ring, 1970) and correlates with the intra-articular temperature taken by thermistor probe (Lloyd-Williams, Ring, and Cosh, 1970). Recently Pinder and Ring (1974) have shown that thermographic recordings accurately locate areas of inflamed synovial tissue as shown at synovectomy.The effect of anti-inflammatory compounds on joint inflammation in animals has been quantitated using radiometry (Collins and Ring, 1972). Thermography provides more information about the distribution of temperature. We wish to report a method for the quantitative measurement of joint inflammation in man, using thermography. Method THERMOGRAPHIC APPARATUSThe apparatus used was the Bofors Thermograph (Ring, 1971). The thermographic image was photographed from the cathode ray display tube on to 35 mm. colour film. Isothermal patterns, at 0 5°C. intervals, were photographed through coloured filters to produce a single multiisothermal picture of skin temperature. Each isothermal area was represented by a separate colour. All thermograms were taken in a special room which was draught-free, shielded from direct sunlight, and maintained at a constant temperature of 20°C. The patients were seated in this controlled environment, with the limb to be examined unclothed, for not less than 20 minutes before thermography. Patients having undergone recent physiotherapy were excluded. On each occasion, themagnification ofthe image

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