By: Robert L. Bard, MD | Edited by: Graciella Davi
The patient is a 65-year-old military veteran who sustained a fall, leading to a concussion that required a three-day hospital observation period. Upon discharge, he reported persistent shoulder pain. Ultrasound imaging of the shoulder revealed an inflamed biceps tendon, which was appropriately treated with physical therapy or targeted injection—avoiding unnecessary rotator cuff surgery, which had initially been planned. Given the patient’s recent concussion, ultrasound assessment was extended to the optic nerve, which was imaged within minutes and confirmed as normal, ruling out increased intracranial pressure.
Optic nerve swelling is also another a critical indicator of elevated intracranial pressure and is widely used in emergency medicine for concussion assessment. While hospital concussion screenings may clear a patient, they do not eliminate the risk of delayed-onset intracranial bleeding. Subdural hematomas, for example, can develop over days, weeks, or even months post-injury, gradually increasing intracranial pressure. Early detection using noninvasive imaging techniques is therefore essential and timely.
Case Study: Post-Concussion
Symptoms / Cerebrovascular Blood Flow and 3D Ultrasound Imaging  Findings: Head: There are signs of reduced blood flow—by about 50%—in the right and left ophthalmic arteries (which supply blood to the eyes and surrounding areas). Further testing suggests that the main arteries supplying the brain (the carotid arteries) may be partially narrowed (by about 50-70%). To compensate for this, smaller blood vessels in the face have grown larger to help maintain circulation. Neck: The thermal scan suggests that the thyroid gland (located in the front of the neck) may be functioning at a lower-than-normal level. There are also signs of increased activity in lymph nodes under the jaw on both sides of the neck, which may be a reaction to an infection, inflammation, or exposure to toxins. These findings are not definitive for a specific disease but could indicate an underlying issue that may need further evaluation. |
This report examines the application of quantitative thermal measurement in assessing cerebrovascular blood flow, utilizing the science of thermometry corroborated by 3D ultrasound imaging. This approach is significant because conventional carotid ultrasound primarily focuses on the carotid arteries, while transcranial Doppler imaging targets intracranial circulation. Similarly, ocular ultrasound is highly effective for evaluating the optic nerve, retinal vascular patterns, and temporal artery blood flow. However, a comprehensive, functional assessment of cerebrovascular circulation (considering dynamic blood flow changes due to factors such as physiological state, trauma, or medication) requires an integrative imaging approach.
The ability to predict abnormal flow patterns is crucial for early prognosis in conditions such as stroke. The cerebrovascular system comprises multiple collateral circulatory pathways, both inside and outside the brain, that can compensate for major vascular obstructions. An individual’s survival following a massive stroke is heavily influenced by the presence and functionality of these collateral pathways.
The ability to perform noninvasive cerebrovascular screening allows for early detection of arterial supply abnormalities, which may warrant further evaluation using arteriography, vascular MRI, or targeted ultrasound imaging. This predictive capability is particularly relevant for stroke prevention.
Beyond cerebrovascular applications, noninvasive thermal imaging is also emerging as a valuable predictor of cardiovascular disease, particularly in women, who often exhibit fewer symptoms before experiencing a catastrophic vascular event. Moreover, inflammatory skin conditions such as rosacea and psoriasis are systemic disorders with vascular implications. Quantitative thermal imaging can assess localized arterial involvement and track treatment response more effectively than visual monitoring of redness reduction, which is the conventional clinical endpoint.
A potential application of this technology in menopausal health screening involves assessing extracranial carotid blood flow in the face and neck. Given the increased cardiovascular risk in postmenopausal women, thermal imaging could serve as an early indicator of cerebrovascular and cardiovascular abnormalities.
Part 2:
DEFINING MEDICAL-GRADE THERMAL IMAGING
Transcribed from an interview with Dr. Phil Hoekstra (from Feb 22, 2025)
MEDICAL-GRADE THERMAL IMAGING is a term I use with a level of precision that differs from many others in the field. Let me clarify what I mean by it. Thermographic instruments were already in use before the FDA gained oversight over medical devices. Initially, they were grandfathered in as medical devices when the FDA assumed regulatory authority, but the standards set at the time were quite limited. Over the years, thermographic technology has advanced at a pace similar to personal computers. Just as we wouldn’t want to rely on a 1980s-era computer today, we shouldn't be using outdated thermal imaging standards for medical applications. Unfortunately, the FDA still maintains the original 1980s standards for medical thermographs. If a camera meets these older benchmarks, it can be FDA-approved—but this does not necessarily mean it is suitable for modern medical diagnostics. The performance of such cameras is inadequate for properly distinguishing breast cancer from benign conditions that may present with similar thermal patterns. (See Full report)
