All the latest news in thermology, plus the EAT President's blog items...

Graham Machin

Guest blog 18 SEP 2020: The issue IS body temperature measurement

From Graham Machin, founder member of the UK National Body Temperature Measurement Group and inaugural chair of CCT TG BTM. Email: [email protected]

Events in the last few years have repeatedly highlighted how poor body temperature measurement could be contributing to serious global health issues.

Unreliable temperature measurement is linked, for example, to avoidable deaths through undetected early stage sepsis (because fever is missed), and the growth of resistant “superbugs” due to over-use of antibiotics. The more recent claims by less scrupulous manufacturers and suppliers of being able to detect COVID-19 by a range of non-contact thermometry approaches is also a concern.

In response to this growing challenge a UK national and also international initiative has been launched, with the aim of improving body temperature measurement in the UK NHS and in health services across the world.

In the UK on 26 April 2019 the National Body Temperature Measurement Group (NBTMG) was formed at the National Physical Laboratory (NPL).

Its founder members were; Professor Mark Tooley FREng, Chief Scientific Officer’s office, NHS England, Professor Graham Machin FREng, Head, Temperature Standards, NPL, Dr Rob Simpson, Head of Thermal Imaging, NPL, Professor David Brettle, Medical Physics, Leeds Teaching Hospitals NHS Trust and Dr Rebecca Nutbrown, Head of Medical Physics, Royal Surrey NHS Foundation Trust, Surrey. These were later joined by Professor Richard Stevens and Susannah Fleming of Nuffield Department of Primary Care, Health Sciences, Oxford University.

The aim of the NBTMG is to ensure robust and reliable body temperature measurement throughout the NHS and wider community, to gather case studies, share stories and study data, as well as to propose ways of solving the problem.

The UK Medicines and Healthcare Products Regulatory Agency recently released a newsflash warning of the misuse of infra-red methods for detecting COVID-19. Although not directly arising from the work of the NBTMG, this sort of statement is in line with its objectives.

On the international front a global initiative was launched in June 2020. The initiative is led from the Consultative Committee of Thermometry (CCT). The CCT is a Consultative Committee of the International Committee of Weights and Measures (CIPM), which is responsible for the supervision of the International System of Units (SI) on a global basis. The CCT consists of leading temperature metrologists from around the world.

The CCT has established a Task Group for Body Temperature Measurement (TG BTM), whose objective is to establish reliable clinical thermometry on a global basis, and whose initial focus will be to improve infra-red methods of body temperature measurement (ear, forehead, and thermal imaging). See Machin, G., et. al. “Letter: Global initiative to improve infra-red based body temperature measurements”, Thermology Int., 30, p. 96, (2020) for more details.

The task group will aim to achieve this objective through the following five actions:

  • Lead a global comparison of calibrators for infra-red body temperature thermometers (ear/forehead/thermal imagers)
  • Collect current best practice/standards of body temperature thermal imaging in a) health services and b) airport and other screening situations around the world, and develop best practice recommendations
  • Collect current best practice of infra-red body temperature measurement (ear, forehead) and develop best practice recommendations
  • Review standards, and work with appropriate standardisation bodies (e.g. ISO/IEC) concerned with producing standards for body temperature measurement devices
  • Establish metrology, medical and manufacturer forums within the metrology regions to identify the problems with the current approaches to body temperature measurement and develop practical solutions and establish appropriate links to the World Health Organisation

It is anticipated that regional forums (Europe, Americas, Asia-Pacific, Africa etc.) will be established consisting of users, measurement specialists and thermometer suppliers/manufacturers to improve the situation regionally. If you are a medical professional or have a strong interest in being involved in the work of the CCT TG, particularly the regional activities, please contact Graham Machin.

A paper more fully describing the work of the group will be published in Thermology International in due course. It is hoped to have best practice guidance for the use of forehead, ear and thermal imaging for fever detection ready within a year.

It is hoped through the activities of these Groups, and others like them, that poor body temperature measurement and fever screening will be a thing of the past by the mid-2020s.

Kevin Howell

President's blog 04 SEP 2020: A global initiative to improve infrared body temperature measurement

Many of you will have read the news item in the latest issue of Thermology International, in which Machin et. al. announce a global initiative to improve infrared body temperature measurement.

I am delighted that Prof. Graham Machin, who is Head of Temperature Standards at the UK's National Physical Laboratory, and was our host for the XIV EAT Congress in 2018, will be contributing a guest blog to our "news" page later this month to describe the initiative in more detail.

In the meantime, if you are a user of infrared thermometry equipment for measuring body temperature (ear/forehead/thermal imaging) or a manufacturer or supplier of such devices, the Consultative Committee of Thermometry requires your help....

Wherever you are in the world, please give a few minutes of your time to answer a short questionnaire about your infrared equipment and working practices.

You can find more information about the questionnaire, and link to it here.

Thanks for contributing to this important initiative!

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Kevin Howell

President's blog 22 DEC 2019: Review of the year, and looking forward to 2020

January is named after Janus, the Roman god of transition, who is often depicted with two faces looking both forward and back. As we transition into a new year, it is time for the EAT to look back at the events of 2019, and also consider what lies ahead…

The past year saw another successful congress in Zakopane, hosted by our friends at the Polish Association of Thermology in April. This continues to showcase a wide range of thermology research, particularly from colleagues in Poland and eastern European countries. It is also an important opportunity for the EAT Board to meet in the springtime.

Our journal, Thermology International, was again published four times in the year under the guidance of the Editor-in-Chief, the EAT’s own Prof. Kurt Ammer. Seven original articles were accepted, along with the inclusion of reviews of other papers and books, editorial items, and the journal’s indispensable meetings diary. Many thanks to the members who contribute content for the journal, act as reviewers, and read and support this important publication. I urge all researchers in thermology to consider our journal for publication of your biomedical temperature papers.

Sadly for the thermology community, 2019 was of course dominated by the passing in July of Prof. Francis Ring at the age of 83. We will all miss this warm, humble and most knowledgeable gentleman. The EAT will continue to honour Francis’ memory through the Francis Ring Prize at our triennial Congress, and through the Francis Ring Memorial Library, which you can read about here.

Francis final book, "The Thermal Human Body" (authored with Kurt Ammer), was published in the spring. This is an excellent primer in modern thermological techniques, a thoroughly recommended read, and I am proud that the EAT has a close association with both authors.

We were disappointed to have to postpone the 1st INEF-EAT Symposium on Thermography in Physical Activity and Sports in Madrid in November due to insufficient delegates. We remain enthusiastic about this meeting and will seek to reschedule it during 2020 at an appropriate time.

Throughout 2019, we have continued to expand our online presence using our website, which was redeveloped back in January. Feedback on the new design has been good, and gradually we are including more content. It is encouraging to see that we receive page visits from all over the world, and that many visitors remain on the site to browse through more than one section. Interest in our Twitter account has grown throughout the year, and we now have 150 followers. If you are not yet one of them, please join us using the link at the bottom of the page and retweet the EAT’s content to your own followers to spread the word about our work.

Looking forward to 2020, I hope to meet many of you at the 24th meeting of the Polish Association in Zakopane, 17th – 19th April. The other major meeting of 2020 will be the QIRT Congress in Porto in July. EAT Board member Ricardo Vardasca and Adérito Seixas sit on the local organising committee for QIRT 2020, and I am sure EAT members will also be strongly represented on the scientific programme.

Our thoughts now also turn to the next EAT Congress in 2021, which will be our 15th. In November we were excited to announce the XV Congress of the EAT will be staged at Wrocław University of Environmental and Life Sciences, 1st – 4th September 2021. Chair of the local organising committee will be Dr. Maria Soroko, who many of you will have met at our past meetings. Please save the date, and look out for much more information during the first months of 2020 on our website.

Finally, wherever you are across Europe or indeed the world, I send you my warmest greetings for a Merry Christmas and a peaceful and prosperous New Year.

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Francis Ring

President's blog 19 JUL 2019: A Life Scientific

When I joined the Royal Free Hospital in London in 1992, with a new physics degree from the University of Birmingham, I was immediately set the task of helping the Rheumatology Department develop their fledgling clinical measurement service.

The department was fortunate to possess some rudimentary infrared thermography equipment, with the intention that this would help us to assess conditions such as Raynaud's phenomenon in both clinical and research settings. At the time of my arrival, we had made only limited progress with the apparatus, and it certainly wasn't clear to me how we could use the technique reproducibly and reliably. The Head of Department in those days, Dr. Carol Black (now Dame Prof. Carol Black), suggested I travel to Bath in the west of England to seek the advice of a Consultant Clinical Scientist who already had around 30 years of experience in thermography. This was how I came to meet Francis Ring for the first time.

When I arrived at the Royal National Hospital for Rheumatic Diseases for my appointment with Francis, I was amazed to discover that he had cleared most of his diary commitments for the next two days in order to ensure I could receive personal tuition from him about every possible aspect of infrared thermography. Every question I asked was answered patiently by supplying reading material from Francis' vast collection of published research, or directing me to the work of others. I returned to London with a bag full of books and papers, and a new confidence that we could develop a successful thermography service in London.

Many of us in thermology have stories like this to share about Francis. He had the rare quality in a busy person of finding the time to help everyone. He was a true polymath, with passionate interests which included astronomy, music, photography and the history of science (in particular, the life of infrared discoverer William Herschel).

Away from the field of thermology, Francis developed notable professional expertise in other areas of clinical measurement. He ran a well-regarded and successful bone densitometry service in Bath, for example. But, of course, within the EAT we remember best of all his lifetime of contribution to the discipline of infrared thermography.

Francis and his team in Bath were the first to demonstrate that thermography could be a reliable outcome measure in studies of anti-inflammatory medication, and also performed some of the earliest work in the quantitative evaluation of peripheral vascular disorders such as Raynaud's phenomenon.

It was Francis who fully recognised the need for good quality-assurance and reproducible protocols, and normative data in thermography. Without these elements in place, he understood that the technique would not be accepted by the medical profession. He served two terms as President of the EAT, and his experience in evidence-based thermological methods, and ability to communicate to both scientists and clinicians, was vital to the success of our organisation.

At an age when many consultants turn permanently to gardening, the ever-energetic Francis moved from the NHS to found the Medical Imaging Group at the University of Glamorgan with Peter Plassmann. Here was an environment where many of the outstanding research questions in thermography could finally be addressed. Many of us benefited from the PhD programme at Glamorgan, and Francis was rightly proud of the huge impact the Group had on the training of the next generation of thermologists. Just a few weeks ago, Francis wrote to me to point out (politely, as always) that what we now call the "EAT Short Course in Medical Thermography" was really a syllabus developed and refined at Glamorgan.

In later life, Francis was still traveling regularly to congresses: many of you will remember his presentation in London in July 2018, reinforcing the important message that fever screening could only be performed reliably by adhering to the ISO standards he had played such a large role in developing. Despite his obvious failing health, he was as full of anecdotes and good humour at the congress gala dinner as always.

Francis’ first book, “Human Body Temperature” written with Y. Houdas and published in 1982, grew to be recognised as a key textbook on thermal physiology. His last, “The Thermal Human Body” written with his friend of many years, the EAT’s Kurt Ammer, was published just last month and will definitely come to be regarded as highly as the work with Houdas. A copy arrived at my laboratory on the morning I heard from Peter of Francis’ passing.

Francis death, peacefully on 15th July at the age of 83, is a loss to the EAT of our greatest scientific influence and closest friend. He would probably be proud of some comparison of his career to that of his beloved William Herschel, but I would personally prefer to liken Francis to an even earlier British thinker, the scientist, architect and astronomer Sir Christopher Wren. Wren's masterpiece, St. Paul's Cathedral in London, bears the inscription "si monumentum requiris, circumspice" - "if you require his monument, look around."

The next time we all meet at a thermology congress, look around. The researchers from across the world who are working to produce quantifiable, evidence-based medical thermography are Francis' legacy.

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Kevin Howell

President's blog 31 DEC 2018: Review of the year, and looking forward to 2019

2018 was a busy year for the EAT, as we would expect of any year in which the EAT Congress falls. Over 80 delegates attended the XIV Congress at the National Physical Laboratory in Teddington, UK in July. This was one of our strongest meetings yet, with over 50 abstracts for posters and oral presentations accepted. Our friends at NPL provided a world-class venue, and delegates also enjoyed an excellent social programme, attending the EAT Gala Dinner, and also touring the historic Hampton Court Palace.

NPL was also the venue for our "Short Course in Medical Thermography," the syllabus for which was extensively revised by the teaching Faculty during the first half of 2018. For the first time, the Course was approved for CPD credits by the London Royal College of Physicians. All of this hard work paid off, with the Course being fully subscribed, and well-received by all 12 students.

Once again, our Polish friends ran a very successful meeting in April 2018 in Zakopane. Congratulations are due to Armand Cholewka, who takes over the Presidency of the Polish Association. Anna Jung has kindly agreed to remain on the EAT Board as our Vice-President.

Our journal, Thermology International, continues to attract some important articles in thermology, and remains free to all EAT members.

The EAT Board met in Zakopane in April, and then again at NPL in July. I also met with the NPL Events team on several occasions to assist in the planning of the XIV Congress. The EAT General Assembly took place at NPL at the conclusion of the XIV Congress. There were some very helpful discussions at this meeting on the future direction of the EAT, and the requirements of members.

The EAT also sent a survey after the XIV Congress to all delegates who had attended the meeting, and other members of the Association. One of the key findings from the survey was that members wanted the EAT to have a stronger online presence, with an up-to-date website that can be viewed on all browsers and devices. The Board has listened to these views, and we hope you like the result! The revised website will be expanded gradually over time, but now provides a strong and versatile platform for publicising the activities of the EAT. I am interested to hear your views on any further content you would like to see included online.

You can also now interact with the EAT via Twitter, and a new dedicated e-mail address: just click on the links at the foot of each web page.

I would like to place on record my thanks to all my colleagues on the EAT Board for their hard work and support during 2018. A big thank you also to all the EAT members, Congress delegates and students who made our activities during 2018 such a success.

Our focus now turns to 2019, with our next thermology meeting in Zakopane in April, and a decision due in the next few months on the venue for the XV Congress of the EAT in 2021.

Happy New Year, and I look forward to seeing you all during 2019.