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Advanced Thermal Clinical Imaging

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Thermographic Imaging Patient Protocol 

·        No sun bathing of the area to be imaged five days prior to the exam.

·        No use of lotions, creams, powders or makeup on the body area to be imaged the day of the exam.

·        For upper body imaging, no use of deodorants or antiperspirants the day of the exam.

·        If any body area included in the images are to be shaved, this should be done the evening before the exam or at least six hours prior to examination.

·        No physical therapy, EMS, TENS, CT, ultrasound treatment, acupuncture, chiropractic, physical stimulation, hot or cold pack use for 24 hours prior to the exam.

·        No exercise six hours prior to the exam.

·        Avoid eating (or drinking anything but water) for at least two hours prior to the exam.

·        If bathing, it must be at least two hours prior to the exam.

·        When possible and if not contraindicated by your doctor, avoid the use of pain medications and vasoactive drugs, i.e. alfa-blockers the day of the exam.  You must consult with your doctor before changing the use of any medications.

·        For breast imaging: if you are nursing, please try to nurse as far from one hour prior to the exam as possible. 

Thermographic Informed Consent

Please read the following consent agreement carefully and in its entirety. By scheduling this appointment, you acknowledge that you are in agreement with this consent form.  

Thermography is simply a procedure utilizing liquid crystal latex detectors or electronic thermal imaging cameras, or a combination of both, to visualize and obtain an image of the infrared radiation (HEAT) coming from the surface of the skin.  The theomorphic procedure is performed as an aid to diagnosis of abnormal temperature patterns, which may or may not indicate the presence of a disease process of pathology. 

The thermographic procedure is not a stand along diagnostic tool, but an adjunct to be used with other clinical or diagnostic findings. This office provides only the thermographic component.

I understand that I will be disrobed to allow for the surface temperature of my body to cool to an ambient room temperature.  I understand that this procedure does not use radiation, and is not harmful to me.

The information provided will be available to my personal physician, HMO, PPO or other health care provider for further diagnosis should an abnormality be detected.

I also understand that this procedure may or may not be covered by insurance and that the office fee is due and payable at the time of service, unless special provisions have been made with this office.

Having understood the above, concerning the purpose, outcome, risk factors and benefits of the thermographic examination, as well as the utilization of the procedure, I consent to this examination.