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• W2885677003 abstract "IlluminationsInsights on the use of thermography in human physiology practical classesFelipe P. Carpes, Pâmela B. Mello-Carpes, Jose Ignacio Priego Quesada, Pedro Pérez-Soriano, Rosario Salvador Palmer, and Rosa M. Cibrian Ortiz de AndaFelipe P. CarpesApplied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil, Pâmela B. Mello-CarpesPhysiology Research Group, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil, Jose Ignacio Priego QuesadaResearch Group in Sport Biomechanics, Department of Physical Education and Sports, University of Valencia, Valencia, SpainBiophysics and Medical Physics Group, Department of Physiology, University of Valencia, Valencia, Spain, Pedro Pérez-SorianoResearch Group in Sport Biomechanics, Department of Physical Education and Sports, University of Valencia, Valencia, Spain, Rosario Salvador PalmerBiophysics and Medical Physics Group, Department of Physiology, University of Valencia, Valencia, Spain, and Rosa M. Cibrian Ortiz de AndaBiophysics and Medical Physics Group, Department of Physiology, University of Valencia, Valencia, SpainPublished Online:16 Aug 2018https://doi.org/10.1152/advan.00118.2018MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat INTRODUCTIONWhat would be the impression of physiology students if a physiology professor were to enter the classroom and tell the class that he or she is going to use infrared thermography (IRT)? How many students would know thermographic applications and their association with human physiology? IRT has become popular in different fields, such as engineering, textile industry, sports, and medical sciences. Moreover, it allows the determination of surface temperature, including skin temperature. Therefore, it is important for human physiology professors to consider this technique as a tool for quantifying physiological phenomena, and it is equally important for students to learn about this technique and its applications. In this Illumination paper, we describe our experience in using IRT in human physiology classes. We also discuss how this imaging technique can be helpful in teaching and learning physiology contents, making classes more interactive and interesting to students from different backgrounds.In 1800, Herschel (11) described the calorific rays in an experiment showing that different spectrum zones of light have different temperatures. The first report of thermographic measurement in humans was in 1928, in Germany (5), followed by other records of thermographic applications in medicine published between 1959 and 1961 (21, 23). Nowadays, almost every person who is questioned as to what IRT is would say that “it might be something related to radiation/temperature/light,” which is not incorrect. IRT is an imaging technique that allows the determination of the surface temperature of an object, with greater accuracy when the object has a high-emissivity level (i.e., the capacity to emit its own infrared radiation) (12, 26). IRT is popular among the different fields of health sciences, and, with continuous technological development, low-cost cameras are now available. An IRT camera for educational use (with an infrared resolution of 80 × 60 or 120 × 90 pixels) may cost between $500 and 1,000 US dollars. IRT is a noninvasive technique that does not influence human thermoregulation (6, 20), and its results can be recorded and processed online using smartphone applications, facilitating its incorporation in classes.Physics of IRTIRT is derived from basic physics concepts (20). Any object at a temperature above absolute zero emits electromagnetic radiation. For the human body, the emitted energy is in the infrared region of the electromagnetic spectrum (thermal radiation) (according to Wien’s law). Stefan Boltzmann’s law (Eq. 1) relates the energy emitted by a body to the unit of surface area and time, total emissive power (E), and its temperature (T) in Kelvin:E = ε · σ · T4(1)where σ (Stefan Boltzmann’s constant) is 5.67 × 10−8 W·m−2·K−4, and ε is body emissivity. In the case of a black body, ε = 1. Human skin emissivity is ε = 0.98.Small changes in temperature can alter emissive power. Educational IRT cameras can register temperature variations of 0.1°C from the emissive power (with higher sensitivity for more advanced models). IRT cameras capture the thermal radiation both emitted and reflected by the body (Eq. 2). It is necessary to determine the reflected temperature value of the camera to obtain the body surface temperature (T) (Eq 3):Ereceived = ε · σ · T4+(1−ε) · σ · Treflected4(2) t={[Ereceived−(1−ε) · σ · Treflected]/ε · σ}1/4(3)where T is the surface temperature and σ is 5.67 × 10−8 W·m−2·K−4.IRT ProtocolThere are some significant ethical implications of using IRT in the classroom. While IRT is physically noninvasive, it can be very invasive to someone’s privacy. Personal privacy is particularly an issue as the image can be viewed, and therefore distributed, using apps on mobile devices. For this reason, we recommend deleting the images recorded during the class. Strategies that ensure the participant’s privacy while undergoing the IRT protocols include obtaining research board approval and acquiring completed informed consent forms. Moreover, we suggest taking images from body regions that protect personal identification.Technical considerations should also be observed when using IRT. As for other research techniques, it is important to follow the manufacturer instructions and perform the calibration procedures to ensure measurement accuracy (18). It is also important to know the factors that may influence measurement, for example, the environmental conditions regarding room temperature and humidity. In general, a room temperature between 18°C and 26°C with humidity around 60% is enough to ensure proper measurements (18). Some of the factors influencing the measurement of skin temperature with the use of IRT include previous sunbathing, use of skin cream, dehydration, and smoking. The choice of camera for recording the images is another matter to consider. Applications such as the “Photo Booth” app on an iPad can be fun to work with in “thermal” configuration, but such apps modify the colors of the image according to the light intensity, which is not related to the temperature. Currently, tablets or smartphones do not have incorporated IRT cameras; however, there are commercial IRT cameras that can be externally attached to these devices. For recording IRT images, uncooled cameras built with temperature control elements based on changes in resistance and voltage resulting in lower noise are the best option (26) compared with cooled cameras. It is also essential to ensure the highest resolution possible (9), because each pixel in the image will provide one thermal information, and this might play an indicative role in determining small regions of interest.The IRT camera must be turned on at least 10 min before measurement to allow for the stabilization of the electronic components of the camera relative to the environmental conditions (18). In the classroom, the camera can be turned on while the theoretical contents are delivered to the students; in the laboratory, however, the camera can be kept turned on for a few hours before conducting the experiments.The proper positioning of the camera is fundamental to image recording. The camera lens has to be 1) positioned in parallel to the plane of interest, 2) oriented perpendicularly to the plane, and 3) at the lowest angle of inclination possible. These adjustments can be done using a tripod. The relative humidity and room temperature can influence the IRT measurement (22); thus care should be taken to control for these variables. This general guideline will require the professor or assistants/tutors to prepare the classroom before the activity commences. Recently, a checklist was developed to ensure that the correct protocol in measuring IRT in humans is implemented (16). Full details on the procedures for camera management can be found elsewhere (18).Recommendations for the Use of IRT in Human Physiology Practical ClassesThe technical and methodological aspects of IRT data acquisition should be uniform, regardless of the application or course content. IRT courses can be uni- or multidisciplinary, depending on departmental needs (e.g., merging biophysics and imaging diagnostic courses), where partnerships and introductory classes can be implemented across study topics. Otherwise, the general implementation of IRT in human physiology classes is straightforward.Traditionally, physiology classes about thermoregulation include only a few options for practical activities due to instrumental limitations. As a result, students are unable to “observe” concepts such as heat transmission by conduction, without being able to record them empirically. Thermography allows us to revolutionize this approach by facilitating the implementation of simple experiments. For example, the simple act of increasing the temperature of a cold wall by mere hand contact is easily visualized by IRT, demonstrating heat transmission by conduction. The fact that thermography is more visual than other thermal techniques, such as thermal contact sensors, makes IRT very attractive to students, potentially enhancing the learning experience.The practical classes could involve the use of an uncooled camera, calibrated and positioned according to the factory standards to reduce data error and improve accuracy (18). Data can be processed using an IRT commercial software from the camera manufacturer to obtain information regarding absolute temperature, mean, maximal, and minimum values, as well as to determine the temperature variation in the comparison between conditions. Based on our experience and recent scientific literature (16, 18), we propose the following practical activities to be performed using IRT in human physiology classes.To use thermal images in illustrating the physiological basis of heat transference processes and circulatory changes in the human body.Records of basal IRT images can help explore physiological concepts related to heat transference and thermoregulation (4). For instance, it is possible to observe the effect of warm blood vessels that become visible in a thermal record (Fig. 1A). In some cases, it is also possible to visualize circulatory alterations such as varicose veins (Fig. 1B). IRT can be used in the discussion of the anatomical and physiological functions of arteries and veins, as well as the alterations observed in skin blood flow in different conditions (e.g., in response to exercise or blood flow restriction), in addition to the practical approaches to explain the different responses to the interruption of arterial and venous blood flow proposed by Altermann et al. (1), and radial artery blood flow as described by Djelic et al. (7). Furthermore, it is also possible to observe the insulating effect of subcutaneous fat, resulting in lower temperatures in the abdominal region (Fig. 2) (17). Thermal images can also be used to demonstrate that skin temperature has a multifactorial dependence, being influenced by body circulation, surface area-to-volume ratio, or counter-concurrent exchange systems in the different body regions. There are some unpublished reports describing the use of IRT for screening fever in waiting rooms of clinics and hospitals.Fig. 1.Thermal images used to visualize blood vessels in the arm (see the black ellipses; A), and the presence of a varicose vein (see the black ellipse; B). Thermal images were taken with an infrared camera with resolution of 320 × 240 pixels.Download figureDownload PowerPointFig. 2.Thermal images used to visualize the lower temperatures of a region with a higher fat tissue proportion. It is possible to visualize differences between people with different body fat proportions. A: the image was taken from an individual with an abdominal skinfold of 6.3 mm. B: the individual had an abdominal skinfold of 24.2 mm. Thermal images were taken with an infrared camera with resolution of 320 × 240 pixels.Download figureDownload PowerPointTo illustrate thermoregulation during/after physical exercise and feedback loops.IRT can be used to demonstrate thermoregulation in response to exercises such as running or cycling (Fig. 3) (19). IRT thermal patterns can easily be explained, as the hotspots appearing after aerobic exercise are related to increased blood perfusion, as observed by the hotspots in Fig. 3. Temperature changes recorded using IRT can be contextualized to the theoretical content of the discussion, such as skin vasodilation/vasoconstriction to explain heat convection, heat production by the different regions of the muscles, heat conduction in body tissues from the core to the skin, and heat dissipation by sweat evaporation (4, 19). The nonuniform changes in the skin temperature when different sides of the body are observed can be also discussed in regard to differences in convection, vasodilation/vasoconstriction, and level of effort (20). The convergence of theoretical and practice-acquired knowledge also facilitates the discussion of thermoregulatory feedback loops whereby physical exercise induces muscular temperature increases. The increase in muscle temperature is perceived by sensory receptors, and information is sent to the central nervous system, which facilitates the necessary changes to maintain homeostasis (13). Once these concepts are discussed, the professor can ask the students what specific components of the feedback loop are involved with thermoregulation after exercise (stimulus, sensor, afferent pathway, central nervous system component, efferent pathway, target organ, and response). An additional IRT image can be recorded after a rest period to visualize the recovery to a basal condition. However, it is important to consider that changes in skin temperature as a result of exercise can be a very complex concept, which may be beyond the scope of some physiology courses. The role of multiple factors determining changes in temperature, including increased evaporative heat loss, increased convective heat loss due to wind or body movements, decreased blood flow, and clothing, can be discussed.Fig. 3.Thermal images used to visualize the acute effects of exercise on skin temperature (T). Body regions of interest are delimited, and the descriptive values of temperature are provided. Thermal images were taken with an infrared camera with resolution of 320 × 240 pixels.Download figureDownload PowerPointTo explore skin temperature responses to heat stress and to assess pathologies.The skin’s response to thermal stress can be tested by applying cold or heat stimuli to the skin. The class could begin with a debate on the Raynaud syndrome, which is characterized by a lower skin temperature response after exposure to cold stress due to arterial vasoconstriction (22). This pathology can be explored by immersing the hands in cold water and assessing the thermal gradient from the dorsum of the hand to the fingers (22). Data can be recorded to register the temperature of each finger. In addition, an index to the diagnosis of this pathology can be used (15). This type of stress test with IRT measurements can also be used for other pathologies, such as diabetes-related vasoconstriction (2).To determine the heart rate and the breathing rate in different conditions.IRT can be used to determine the heart rate and the breathing rate (3) at rest and during physical exercise; cardiovascular and respiratory physiology classes are ideal environments for using IRT. To determine the heart rate, IRT can be recorded from the carotid arteriovenous complex, frontotemporal region, or wrist. IRT measurements can be performed at rest and after doing some physical exercise that increases heart rate (e.g., squats or vertical jumps). Once the images are recorded, heart rate variability, autonomic nervous system function, and feedback loops can be discussed (8). As suggested in a previous example, the professor could ask the students to identify the specific components of each physiological mechanism related to heart rate and breathing variability during exercise.To relate skin temperature changes with psychobiological variables.IRT can be used to record thermal images from the nose, forehead, orofacial head, and cheeks to stimulate discussions about the influence of negative and positive emotions. Emotional changes can be stimulated as described elsewhere (24). The facial temperature can also be used as an indicator of enjoyment during exercise, and students could relate the changes in temperature to changes in the perceived effort during the activity (14). Both responses are related to autonomic responses to exercise that are triggered by the onset of sensations (10).IRT in the physiology classroom can easily be implemented, and the thermal images are a good stimuli to keep the students interested and focused on the areas of study. The other advantages of IRT are as follows: 1) IRT is noninvasive; 2) there is no requirement for other supplies than the camera and data analysis software; 3) the cameras mostly come with a user-friendly basic software for data analysis; and 4) it serves an alternative to traditional class strategies that use animal models. However, the need for environmental control (humidity around 30–70% and temperature around 18–23°C in the classroom) and the high cost of the IRT camera can be limiting factors.Final RemarksThe use of IRT in physiology classes can help students visualize and learn complex physiological concepts that are challenging in the traditional theoretical course format. Furthermore, it allows students and professors to discuss concepts from other disciplines, such as physics, biophysics, and image processing, facilitating the translation of knowledge from the classroom to daily life applications.GRANTSThe invited researcher 2018 program from the University of Valencia supported P. B. Mello-Carpes and F. P. Carpes.DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the authors.AUTHOR CONTRIBUTIONSF.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. conceived and designed research; F.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. performed experiments; F.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. analyzed data; F.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. interpreted results of experiments; F.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. prepared figures; F.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. drafted manuscript; F.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. edited and revised manuscript; F.P.C., P.B.M.-C., J.I.P.Q., P.P.S., R.S.P., and R.M.C.O.d.A. approved final version of manuscript.ACKNOWLEDGMENTSAuthors thank Dr. Matheus J. Wiest for the critical review of the early draft of the manuscript.REFERENCES1. 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Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Collections More from this issue > Volume 42Issue 3September 2018Pages 521-525 Copyright & PermissionsCopyright © 2018 the American Physiological Societyhttps://doi.org/10.1152/advan.00118.2018PubMed30113221History Received 20 June 2018 Accepted 24 July 2018 Published online 16 August 2018 Published in print 1 September 2018 Metrics" @default.
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