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Is Thermography covered by insurance?
Payment is required at the time of service. For reimbursement purposes, each patient is provided with a universal claim form which includes CPT and ICD-9 codes for them to submit to insurer for reimbursement. In the case of breast thermography we have found that the insurers are more likely to reimburse individuals with dense breasts, scarring from prior surgery, history of breast disease be it themselves or a family member (particularly in women under 40 years of age), breast implants, neuropathic pain and in women with inconclusive anatomic studies. In these instances a physician's prescription may be helpful in facilitating reimbursement. We have found that Medicare has refused reimbursement for thermography.
Should I have a mammogram?
This is an individual decision which must be made by each patient. Due to the high number of false negatives inherent in mammograms it is becoming increasingly apparent that no one diagnostic test is sufficient for the diagnosis of breast disease. Mammographers acknowledge a 15% to 20 % false negative rate, a number made higher by women with dense breasts, implants and scar tissue. Due to the fact that thermography is a physiologic study who's results are not affected by these anatomic issues, additional information can be provided which is not readily available on a mammogram. Further it has been shown that a positive (abnormal) infra-red image is the single most important marker of increased risk for the development of breast cancer.
What about Ultrasound and MRI?
We have found that the addition of Ultrasound to Thermography has been very useful. Because thermography can localize an abnormality often to one quadrant of the breast, we are able to provide the ultrasound technician with a "road map" so that the study can be concentrated in a small area thereby increasing the effectiveness of this test.
With the increased usage of MRI's there has been a natural segue way between these two tests. The MRI has provided a "large screen" view of the breasts which when coupled with thermographic imaging has been found to be extremely effective in diagnosing breast disease. Of course, due to its very high cost, insurers are reluctant to pay fro MRI's.
Both of these studies have the added advantage of providing information without the use of radiation.
Is Thermography costly?
Our fee for breast Thermography in our Marlton office is $275.00, at one of our satellite offices the cost is $300.00. Approximately two weeks after the study the patient will receive a packet. The packet will include two sets of nine images each, one set in color and one set in black and white. A comprehensive report by doctor Getson and a universal claim form will also be included. A copy of the report is provided to the clinician(s) of your choice. When necessary, a phone conference with Dr. Getson is provided at no additional cost.
The cost for a thyroid/dental study in our Marlton office is $100.00 and $115.00 at one of our satellite offices. This study consists of nine images which are a mixture of color and black and white images, Dr. Getson's report, a universal claim form and when necessary a follow up phone conference with Dr. Getson. A copy of the report is provided to the clinician(s) of your choice.
The cost of neuromuscular thermogram depends upon the complexity of the study. Please call the office for more information regarding this study.
What should I expect for a breast thermogram?
The room is set at 70 degrees, the ideal temperature for THERMOGRAPHIC testing. The patient disrobes from the waist up. The patient then equilibrates to the room temperature for ten minutes. Two sets of nine THERMOGRAPHIC images are taken by a certified female technician. After the first set of images the patient is asked to hold an ice pack for one minute, in Thermography this is called a "cold challenge." The cold challenge provides additional information by deterring whether blood vessels dilate or not, allowing us to better define suspicious vessels in the black and white views. The second set of images is taken, the patient dresses and departs. Usual time spent in the office is 30 minutes start to finish.
What should I expect for a Thyroid/Dental study?
The room is set at 70 degrees, the ideal temperature for THERMOGRAPHIC testing. We encourage attire that exposes the patient's entire neck or they may be asked to remove their shirt only. Nine images are then taken of the face and neck. Usual time spent in the office is twenty minutes.
What should I expect for a Neuromuscular study?
The room is set at 70 degrees, the ideal temperature for thermographic testing. The patient disrobes, the extent of which is governed by the areas which are studied. It is customary to study the entire body, in which case the patient would disrobe to their underwear. We provide disposable undergarments for men and women. If you prefer to wear your own we ask women to wear a thong and our disposable bra and men are asked to wear an athletic supporter or bikini briefs. This level of exposure is necessary in order for us to image the buttocks which are an integral part of the study.
Is thermography an approved procedure?
Yes, it was approved by the FDA in 1982. Also in 1984 the American Medical Association certified thermography as being "beyond the experimental and investigational stage."
Who is qualified to take and interpret thermographic images?
The performance of thermographic imaging should only be done by a certified technician. The interpretation of these images must be done by a licensed health care provider (D.O., M.D., D.C.) who has been certified by a recognized thermographic organization. These clinicians are the only ones trained to interpret and apply the information garnered form the thermogram.
When will I get my
report?
Reports are generated by Dr.
Getson with a copy sent to the patient and any medical Health Care
professional of her choosing. Reports are generated within 14 days after
the completion of the study. After receipt of the report and the images,
the patient calls the office to set up a phone conference done at a
mutually convenient time at which point Dr. Getson will explain the images
and make recommendations for other diagnostic testing (where
applicable), repeat thermal imaging and other recommendations as deemed
necessary for each individual patient.
How can I learn more about thermography?
Dr. Getson is available to speak to your group or association. Please contact the office at 856-596-5834 for more information or to schedule a lecture.
My doctor does not know much about thermography and isn't sure it is a valid diagnostic tool. How should I respond to this?
- The camera is FDA approved
- The FDA approved thermography as an adjunctive test for the diagnosis of breast disease in 1982
- In 1984 the American Medical Association certified that thermography was "beyond the experimental and investigational stages."
- The technological advances in thermal imaging cameras and their accompanying computer software over the last ten years greatly exceed changes in mammography or other radiologic equipment during the same time frame.
- Medical themography actually predates mammography.
- Thermography got a "bad name" as a result of a biased study which occurred in the 1970's. This study proported to evaluate thermography as compared to mammography and clinical exam. Prior to the study it had been suggested that thermography might replace mammography as a screening tool for breast disease. From a scientific standpoint this was an erroneous assumption since thermography being a physiologic study is not meant to replace mammography, an anotomic study.
Once the study was completed it was apparent that it had serious flaws. Many of the testing sites were mobile trailers without any temperature or environmental controls. In a diagnostic test that depends primarily on temperature measurement this was an inexcusable omission. Next the "technicians" who performed the studies had little or no training. Finally the interpreters were radiologists who had no expertise in the interpretation of thermal images, many of whom where operating under the misguided premise that the evaluation of themograms was "simple." Moreover, it was not until the 1980s that the thermographic community established standard protocols and formal training.
How then could the study with all of its inherent flaws have stood a chance of accurately evaluating thermography? And yet to this day critics of thermography still rely on this thirty year old study while choosing to ignore the monumental advances in thermal imaging. The effects of this study are so far reaching that even to this day Medicare refuses to reimburse based upon the findings. (link to Amalou article)
Over the last ten years the incidence of breast cancer has doubled. Is it not incumbent upon us to use every proven diagnostic tool available for the earliest detection of breast disease?
The use of thermography is the diagnosis of chronic pain is best explained by viewing the attached link.( see link).
What about other types of themography?
There is only one system specifically designed for medical application - Micro Health Systems (MHS) which is the only system we use. Other cameras were built for industrial application and have been modified for medical uses. Because medical thermography needs to be replicated none of these other systems have been adequately able to control the "drift" factor. This allows for to much inconsistencey.
Next we are concerned that many thermographers are not taking enough images. We have seen as few as three images being called a complete study. The proper guidlines for breast thermography call for two sets of nine images each, taken in black and white and color with a cold challenge between sets. Thyroid/dental and neuromuscular studies vary in the number of images taken. Imperative however is that the interpreting physician measures contralateral regions of interest on the actual images for comparative purposes.
We are also aware of individual performing "full body scans". They claim to provide substantial information regarding abnormalities of many of the body's systems (including the breast) with a single set of one dimensional temperature readings. This should not be confused with traditional medical thermography. In our estimation the validity of this study remains questionable.
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