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Challenges to Global 
Implementation of Infrared 
Thermography Technology: 
Current Perspective 
 
Michael Shterenshis1 

 
1Department of Sciences, Alexander 
Muss Institute for Israel Education  

 
 
 
 
 
 
 
 

 
Vol. 6, No. 1 (2017)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2017.289 |   http://cajgh.pitt.edu 

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SHTERENSHIS 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.289|http://cajgh.pitt.edu 

 
 

Abstract 

Medical infrared thermography (IT) produces an image of the infrared waves emitted by the human body as part of the 
thermoregulation process that can vary in intensity based on the health of the person. This review analyzes recent developments in 
the use of infrared thermography as a screening and diagnostic tool in clinical and nonclinical settings, and identifies possible future 
routes for improvement of the method. Currently, infrared thermography is not considered to be a fully reliable diagnostic method. 
If standard infrared protocol is established and a normative database is available, infrared thermography may become a reliable 
method for detecting inflammatory processes. 

Keywords: Infrared Thermography; Mass Screening; Epidemics

Challenges to Global Implementation 
of Infrared Thermography 
Technology: Current Perspective 
 
Michael Shterenshis1 

 
1Department of Sciences, Alexander Muss 
Institute for Israel Education  

Research 

  Medical infrared thermography (IT) 
produces an image of the infrared waves emitted by the 
human body as part of the thermoregulation process that 
can vary in intensity based on the health of the patient.1 
While the technology was originally developed in the 
1950s, its development was much slower than 
ultrasonography, despite the fact that both methods are 
potentially highly informative, non invasive, and 
radiation free. On PubMed, there are 1,820 articles on the 
term “infrared thermography” dating from May 1963 to 
2017, while 398,932 articles on “ultrasound” were 
published during the same period. The IT finally gained 
more attention in the 2000s with the emergence of avian, 
swine, and H1N1- influenza outbreaks, and other similar 
pandemics. The first articles describing IT 
implementation for mass blind fever screening in 
international airports appeared in 2004.2,3  Detection of 
febrile passengers by IT scanning in airports became a 

common trend and several more reports supporting the 
use of this technology were published.4-6 However, other 
published reports questioned reliability of the IT 
technology as a fever screening procedure, specifically 
citing technical errors leading to low sensitivity of the 
screening procedure.7,8  

  Recent progress in improvement of infrared 
camera technology sensitivity, excellent time resolution, 
as well as calibration according to heat emissivity, room 
temperature, humidity, and distance to the object of 
interest, caught practitioners unprepared to take full 
advantage of the IT capacities that exist today.  

Currently published research papers on IT do 
not provide complete and detailed descriptions of how 
the camera and/or the software were calibrated and what 
settings have been used. In 2013, Choi et al. detected the 
mean temperature of healthy cheeks to be 26-27°C,11 
which is about 4°C lower than normal. The article does 
not report room humidity or the distance between the 
camera and the investigated face.  

Another study reported the surface skin 
temperature of a healthy knee as median 36°C and 
maximum of 38.1°C. 12 This reading is about 6-7°C 
higher than normal and the article provides minimal 
detail about the data acquisition process (including room 
temperature, humidity, distance to object, and heat 
emissivity preset).13 While some papers clearly report 
laboratory room temperature and a relative air humidity, 
they may omit other important variables.13,14 For 

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.289|http://cajgh.pitt.edu 

 
 

example, an article describing the IT assessment of joints 
with active arthritis reported ambient room temperature 
and skin emissivity, but did not indicate the precise 
distance to the object ("the camera was positioned 
directly over the hands") and the room humidity.15  

Out of 200 recently published (May 2013-May 
2017) PubMed research on IT implementation as a 
screening and diagnostic tool for various clinical 
conditions, only 13 articles (6.5 percent of total articles) 
have complete data acquisition methodology (correct 
calibration of the IT device and/or software for skin heat 
emissivity, distance to object, air humidity, air 
temperature, etc.). 

General thermography guidelines, standards, 
and protocols, were introduced in 2002 and were 
followed by specific guidelines for 
neuromusculoskeletal, dental-oral, and systemic 
disorders in 2015 and 2016.16-18 These guidelines 
articulate that the room temperature range should be 
maintained between 18 and 23°C during the investigation 
and that a minimum equilibration period of 15 minutes 
should be observed for patient acclimation to the room. 
Given varying temperatures at airports and inability to 
achieve 15 minutes acclimation periods for every 
passenger, the guidelines may suggest that IT cannot be 
used as an accurate screening method at the airports. The 
guidelines do not indicate that an IT technician or a 
practitioner must calibrate the camera for human skin 
heat emissivity (0.98), existing room temperature and 
humidity, and distance between the camera and the 
region of interest. Most modern IT cameras have the 
program for this preset in their menu.19-21 Even without 
proper camera calibration, the data for these variables can 
be put into software program directly before image 
analysis. The time of day during investigation should be 
indicated as well to accommodate human temperature 
changes due to circadian rhythm.22-25 With normal 
circadian rhythm, the human body has its lowest 
temperature at 4 AM and its highest temperature at 6 PM. 
This variation needs to be adjusted for with proper 

correction index in order to correctly interpret 
measurement results.   

An individual approach to each subject is 
warranted if IT is used for screening. The necessary 
primary step in any proper IT investigation is to establish 
a normative range of surface skin temperature changes of 
a given person because of interpersonal 
vasoconstriction/vasodilatation variations. This scale 
will provide an IT practitioner with an understanding of 
what is normal and what is abnormal for a given patient. 
Sympathetic skin response and the vasomotor reflex vary 
in different cases and these variations can be detected by 
the IT.26    

Review articles on IT provide either 
favorable27,28 or unfavorable29,30 feedback about its 
applicability for mass screening. The favorable reviews 
suggest that for certain applications, thermal imaging is 
shown to provide objective measurement of temperature 
changes that are clinically significant for the detection of 
local inflammatory processes, skin lesions, benign and 
malignant tumors, vasoactivity, and vascular diseases. 
With properly calibrated IT cameras and improved 
knowledge of normative skin temperatures on various 
body surfaces, practitioners will be able to assess 
cutaneous vasoactivity.  Thus, the IT method might be 
reliable in the clinical settings but not recommended as a 
screening procedure at the airports. A portable, radiation-
free, inexpensive, non-contact, and non-invasive IT 
device could become a welcomed addition to the hospital 
armamentarium in many developing countries assuming 
the development and implementation of proper standard 
guidelines. 

 

References  
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2. Chan LS, Cheung GT, Lauder IJ, Kumana CR, Lauder IJ. 
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SHTERENSHIS 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.289|http://cajgh.pitt.edu 

 
 

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	Challenges to Global Implementation of Infrared Thermography Technology: Current Perspective
	Abstract
	Keywords: Infrared Thermography; Mass Screening; Epidemics
	Research

