ࡱ> tvs~bjbjyy Ā;Hdd4~$=~~~~YYY= = = = = = =$\@C-=i#YY##-=~~='''#~~='#=''S:C<~p$3 a$j[;<=0=u;C$C4C<CC<Yi '+!!YYY-=-=&<YYY=####CYYYYYYYYYd :Thermography  Breakthrough in Biomedicine Iskra A. Nola1, Darko Kolari2 1University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Zagreb, Croatia 2 Ruer Boakovi Institute, Centre for Informatics and Computing, Zagreb, Croatia ianola@snz.hr Abstract - In 1956th Lawson used infrared imaging in breast cancer patients and discovered higher skin temperature above cancer spot than of normal tissue. After his achievements thermography started its development and exceeds the experimental state as a diagnostic procedure being used for over 40 years. Once biological basis were established many other areas were opened for biomedical thermography like breast cancer, varicocele, inflammatory diseases, skin abnormalities etc. introduced with different types of studies. The most of them are dealing with breast cancer, and other with ophthalmology; melanoma diagnosis; the complex regional pain syndrome; Raynaud's phenomenon and systemic sclerosis; the diagnosis and monitoring of rheumatoid arthritis; inflammation in the acute diabetic foot and the foot in remission. In all of these areas different approach could be seen: some of researchers are interested in thermography as a treatment tool, and others see its value as a diagnostic tool. However, essential technique digital infrared imaging and its images needs improvement in order to provide more useful anatomical information associated with it which will be the best help for doctors. Keywords Thermography; Biomedicine; Angiogenesis; Nitric oxide Introduction The physical basis of infrared emission was only the beginning. Military researches elevated the technology on higher level and discovering why some body parts have different temperature become a mission for many scientists. They initiated continued research and clinical observations that finally proved that certain temperatures of different body parts could be related to normal and abnormal physiologic processes. In 1956th Lawson used infrared imaging in breast cancer patients and discovered higher skin temperature above cancer spot than of normal tissue [1, 2, 3]. His researches also reveal that the venous blood draining the cancer is often warmer than its arterial supply. After his achievements thermography started its development and exceeds the experimental state as a diagnostic procedure being used for over 40 years as an adjunctive screening procedure in the evaluation of the breast cancer. Also, numerous medical centers and independent clinics have used thermography for a variety of diagnostic purposes. Likewise, at the same time significant advances have been made in the application of sophisticated computerized image processing. Thus the Food and Drug Administration on January 29, 1982, published its approval and classification of thermography as an adjunctive diagnostic screening procedure for the detection of breast cancer. Thermography in Biomedicine Angiogenesis Advanced technology enabled evolution in biomedically applied thermography. As body heat is generated by metabolism and by muscular activity and keeps the core temperature at a defined, slightly oscillating level (about 37C) thermographic advanced technologies allowed precise measurements of it. The organisms heat loss depends on ambient factors and results of conduction, convection, IR radiation, and skin evaporation. Inside the organism heat is transported by convection (blood flow) and by conduction. But, despite the explanations of physical base of the body temperature and technology progress, finding the new connections between the temperature differences and pathophysiological status of the body still remains puzzle. The largest evidence of physiologic mechanism by which infrared imaging detects precancerous and malignant states raised from the repetitive breast thermography through many studies that showed the recruitment of existing blood vessels and the formation of new ones (angiogenesis). Angiogenesis begins with the release of angiogenesis factors (AF) from precancerous or cancerous cells. In the early stages of tumor growth, the majority of neoplasm show lower cellular metabolic demand. Once the AF is released, the existing vessels will try to resist constriction for maintaining continuous supply of nutrients to the growing mass. The growth of the tumor increases the need for nutrients and AF starts opening the dormant vessels in the breast. After a while weak blood supply hampers the growth of the neoplasm, and AF causes the formation of new blood vessels. New vessels are simple endothelial tubes that connect the tumor to existing nearby arteries and arterioles. When time blood supply is augmented, the increase in heat and vascular asymmetry could be seen in infrared images. The concept of angiogenesis, as an integral part of early breast cancer, was emphasized in 1996 by Guidi and Schnitt [4]. They suggested that it is angiogenesis that precedes development of breast cancer and may occur before tumor cells expand into the surrounding stroma. This process is important because happens even before morphologic evidence of an in situ carcinoma. Simultaneously, in 1996, Gamagami studied angiogenesis by infrared imaging and reported that hypervascularity and hyperthermia could be shown in 86% of no palpable tumor which were not visible on mammography [5]. Expansion of biomedical thermo imaging application in biomedicine is very important as it is non-invasive method and thus harmlessly repetitive. Even more important, pre-cancerous tissues increased blood supply starts before the cells becoming malignant causing an abnormal heat pattern in the breast enabling thermography early detection. Consequently, it is detection method that could be used as an early warning system in breast screening. Nitric-Oxide The angiogenesis is a result of some precise biochemical mechanisms. Nitric oxide (NO), major intermediary messenger produced in the vascular endothelium in response to nervous stimuli, induces vascular smooth muscle relaxation resulting in vasodilatation. NO, unlike most other neuronal messengers, can also be generated in the extravascular space by pathways that do not involve the nervous system. Extravascular NO is often produced in larger quantities than intravascular NO neuronally induced. Extravascular NO can diffuse into the vasculature and cause vasodilatation [6]. NO, by saturating its receptor sites in the vasculature, can override the physiological regulation of perfusion in the affected region, and if that effect is close to the skin, it will decrease or eliminate the thermoregulation of skin [7,8]. The microhomogeneity of skin temperature will reach a maximal value and can be detected as a different from other parts where such process does not appear. Many studies showed the production of NO in many cancer cell lines such as breast cancer, melanoma, colorectal cancer and squamous cell carcinoma [9-16]. The lymphocytes generation of NO, especially by macrophages, is part of the immune response, where NO can be cytotoxic. Cytotoxic effect of NO on cancerous cells in vitro and its possibility to enhance tumor growth in vivo can explain the similarity between the immune response of macrophages to bacteria and to cancer cells [17-21]. This anomalous effect of NO can be explained by the fact that cancer-produced extravascular NO causes regional vasodilatation, and thus enhances nutrient and oxygen supply to the malignant lesion before enhanced angiogenesis takes place. Breakthroug Into Biomedicine Once biological basis were established many other areas were opened for biomedical thermography, like breast cancer, varicocele, inflammatory diseases, skin abnormalities etc. [22]. The most of them are dealing with breast cancer, either as a research papers either as a review papers, often in comparison with already established methods like ultrasound or mammography [23-33]. Regarding the breast thermography we can say that so much research done should provide a lot results that could be interpreted. But, a lot of authors are still very careful of giving the final conclusions or even are very determined to defend mammography. Also, the use of thermography as a cancer risk prediction tool is more likely to be accepted than using it as a screening or diagnostic test. But, a lot pro and contra attitudes still remains [31,32]. That could be explained by researchers awareness of not having (jet) reliable causal data. Other areas were thermography was used are field of ophthalmology [34,35]; melanoma diagnosis [36]; the complex regional pain syndrome [37,38,39]; Raynaud's phenomenon and systemic sclerosis [40]; for the diagnosis and monitoring of rheumatoid arthritis [41]; inflammation in the acute diabetic foot and the foot in remission [42]. In all of these areas different approach could be seen: some of researchers are interested in thermography as a treatment tool, and others see its value as a diagnostic tool. A lot of papers [29,36,37,40] stressed the needs for detection of thermography potentials at different levels (patient, primary care, specialized care) and they debate on its features. Conclusion Studies that were conducted during past time are not conclusive either unanimous. Only one area, breast cancer, divided scientist regarding the importance and usefulness of thermography. In some other area, dermatology, complex regional pain syndrome, Raynauds phenomenon, etc., there are studies that are pointing on the benefits but all of them suggest more research. Overall, we can say that the breast cancer is growing area for thermography testing and we can expect some conclusive data probably very soon. But, despite great expectations, todays results show that thermography could be a good management tool, especially for risk assessment but more technological advances are needed to push this technic forward. Best studies, those that compare several techniques on same group of patients, enhance progress. Also, using the same technique in different fields can make a big difference. However, essential technique digital infrared imaging and its images obviously needs improvement in order to provide more useful anatomical information associated with it. If we overcome technological difficulty and provide additional information for diagnosis purposes it will help medical doctors in better diagnosing. References Lawson RN. Implications of surface temperatures in the diagnosis of breast cancer. CanMed Assoc J 75:309, 1956 Lawson RN. Thermography a new tool in the investigation of breast lesions. Can Serv Med 13:517, 1957 Lawson RN. A new infrared imaging device. Ca Med Assoc J 79:402, 1958 Guidi AJ, Schnitt SJ. Angiogenesis in pre-invasive lesions of the breast. The Breast Journal 2:364, 1996. Gamagami P. Indirect signs of breast cancer: Angiogenesis study. In: Atlas of Mammography, Cambridge, Mass.: Blackwell Science, 231236, 1996 Anbar M. Thermological implication of vasodilation mediated by nitric oxide. EurJ Thermology (Thermologie Usterreich) 5:15-27, 1995 Anbar M. The role of nitric oxide in thermoregulatory processes and their clinical applications in thermology. In: The Thermal Image in Medicine and Biology, Ammer K, Ring F, Eds, Vienna: Uhlen Verlag, 140-145, 1995 Anbar M. Dynamic area telethermometry and its clinical applications. SPIE Puoc 1995;2473: 312-322 Thomsen LL, Miles DW, Happerfield L, Bobrnw LG, Knowles RG et al. Nitric oxide synthase activity in human breast cancer. Br J of Cancer 72(1): 41-44, 1995 Cendan JC, Topping DL, Pruitt J, Snowdy S. et al. Inflammatory mediators stimulate arginine transport and arginine derived nitric oxide production in a murine breast cancer cell line. J Surgical Res 60(2):284-288, 1996 Bani D, Masini E, Bello MG, Bigazzi M, Sacchi TB. Relaxin activates the L-argininenitric oxide pathway in human breast cancer cells. Cancer Research 55(22):5272-5275, 1995 Bani D. Relaxin: a pleiotropic hormone. General Pharmacol 28:13-22, 1997 Joshi M. The importance of L-arginine metabolism in melanoma: an hypothesis for the role of nitric oxide and polyamines in tumor angiogenesis. Free Radical Biol Med 22:573-578, 1997 Moochhala S, Chhatwal VJ, Chan ST, Ngoi SS, Chia YW et al. Nitric oxide synthase activity and expression in human colorectal cancer. Carcinogenesis 17:1171-1174, 1996 Cendan JC, Souba WW, Copeland EM 3rd, Lind DS. Increased L-arginine transport in a nitric oxide-producing metastatic colon cancer cell line. Annals Surg Oncology 3501-3508, 1996 Villiotou V, Deliconstantinos G. Nitric oxide, peroxynitrite and nitroso-compounds formation by ultraviolet A (UVA) irradiated human squamous cell carcinoma: potential role of nitric oxide in cancer prognosis. Anticancer Res 15:931-942, 1995 Okada M, Sagawa T, Tominaga A, Kodama T, Hitsumoto Y. Two mechanisms for platelet-mediated killing of tumour cells: one cyclo-oxygenase dependent and the other nitric oxide dependent. Immunology 89:158-164, 1996 Umansky V, Schirrmacher V, Rocha M. New insights into tumor-host interactions in lymphoma metastasis. J Molecular Medicine 74:353-363, 1996 Farias-Eisner R, Sherman MP, Aeberhard E, Chaudhuri G. Nitric oxide is an important mediator for tumoricidal activity in vivo. Proc National Acad Sci USA 91:9407-9411, 1994 Maeda H, Akaike T, Wu J, Noguchi Y, Sakata Y. Bradykinin and nitric oxide in infectious disease and cancer. Immunopharmacology 33:222-230, 1996 Edwards P, Cendan JC, Topping DB et al. Tumor cell nitric oxide inhibits cell growth in vitro, but stimulates tumorigenesis and experimental lung metastasis in vivo. J Surg Res 63:49-52, 1996 Hodge M. Chiropractic and Thermography. Breast Thermography. Full Body Scan. Available at:  HYPERLINK "http://www.reddingthermography.com/about-dii/full-body-scan/" http://www.reddingthermography.com/about-dii/full-body-scan/. Horowitz E. Thermography - A preventive screening tool for breast health. Naturopathic Doctor News&Review 4(2), 2008 Kolaric D, Herceg Z, Nola IA et al.  Thermography  A Feasible Method for Screening Breast Cancer? . Coll Antropol 37(2):583-588, 2013 Poljak-Bla~i M, Kolari D, Jaganjac M, }arkovi K, Skala K, }arkovi N.  Specific thermographic changes during Walker 256 carcinoma development: Differential infrared imaging of tumour, inflammation and haematoma. Cancer detection and prevention 32(5/6):431-436, 2009  HYPERLINK "http://ict.sagepub.com/search?author1=Deborah+A.+Kennedy&sortspec=date&submit=Submit" Kennedy DA. A Comparative Review of Thermography as a Breast Cancer Screening Technique. Integr Cancer Ther March 2009 8(1):9-16, 2009 Benson JR, Jatoi I.  Review The global breast cancer burden .  HYPERLINK "http://www.futuremedicine.com/loi/fon" Future Oncology 8(6):697-702, 2012 Mainiero MB, Lourenco A, Mahoney MC, Newell MS, Bailey L, Barke LD, D'Orsi C, Harvey JA, Hayes MK, Huynh PT et al: ACR Appropriateness Criteria Breast Cancer Screening.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/23290667" \o "Journal of the American College of Radiology : JACR." J Am Coll Radiol 10(1):11-14, 2013 Vreugdenburg TD, Willis CD, Mundy L, Hiller JE. A systematic review of elastography, electrical impedance scanning and digital infrared thermography for breast cancer screening and diagnosis. Breast Cancer Res Treat 137(3):665-676, 2013 Sella T, Sklair-Levy M, Cohen M, Rozin M, Shapiro-Feinberg M, Allweis TM, Libson E, Izhaky D. A novel functional infrared imaging system coupled with multiparametric computerised analysis for risk assessment of breast cancer.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/23223805" \o "European radiology." Eur Radiol 23(5):1191-1198, 2013 Fitzgerald A, Berentson-Shaw J. Thermography as a screening and diagnostic tool: a systematic review. NZMJ 125(1351):80-91, 2012 Godfrey ME. Breast thermography review. NZMJ 125(1354): 105-107, 2012 Gtzsche PC, Jrgensen KJ. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 6: CD001877, 2013  HYPERLINK "http://www.sciencedirect.com/science/article/pii/S1350449509000310" Tan JH,  HYPERLINK "http://www.sciencedirect.com/science/article/pii/S1350449509000310" Ng EYK,  HYPERLINK "http://www.sciencedirect.com/science/article/pii/S1350449509000310"  Acharya UR,  HYPERLINK "http://www.sciencedirect.com/science/article/pii/S1350449509000310" Chee C. Infrared thermography on ocular surface temperature: A review.  HYPERLINK "http://www.sciencedirect.com/science/journal/13504495" \o "Go to Infrared Physics & Technology on ScienceDirect" Infrared Physics & Technology, 52(4): 97-108, 2009 Klamann MK, Maier AK, Gonnermann J, Klein JP, Pleyer U. Measurement of dynamic ocular surface temperature in healthy subjects using a new thermography device. Curr Eye Res 37(8):678-683, 2012  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Herman C%5BAuthor%5D&cauthor=true&cauthor_uid=23204850" Herman C. Emerging technologies for the detection of melanoma: achieving better outcomes.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/23204850" \o "Clinical, cosmetic and investigational dermatology." Clin Cosmet Investig Dermatol 5:195-212, 2012 Peltz E, Seifert F, Maihfner C. Internationale Gesellschaft zum Studium des Schmerzes (IASP). [Diagnostic guidelines for complex regional pain syndrome]. [Article in German] Handchir Mikrochir Plast Chir 44(3):135-41, 2012 Zaproudina N, Airaksinen O, Nrhi M.  Are the infrared thermography findings skin temperature-dependent? A study on neck pain patients. Skin Res Technol 19(1):537-544, 2013 Koci M, Lazovi M, Dimitrijevi I, Manci D, Stankovi A.  Evaluation of low level laser anVXZtv> ` b d         % ( ǿ޳޸ެޜvj\jLhvhq;5CJaJmH sH hvhq;5CJH*aJhvhq;5CJaJhaVht??@BnC$Egd*VgdR gd ~ 222222222222333435373I3J3L3V3W3X3_3d3g333333~n_n_Qhl#h ~ ]mHnHtHh7xh ~ CJmHnHtHh7xh ~ ;CJmHnHtHh7xh ~ CJ h7xh ~ CJPJmHnHtH"hl#h ~ 6PJ]mHnHtHhl#h ~ PJ]mHnHtHh ~ PJmHnHtHhl#h ~ ;PJmHnHtHh ~ mHnHtHhl#h ~ mHnHtHhhl#h ~ PJmHnHtH333333344464E4F4^4h4l4m4n4r4u4v4w4444 5 5B5F5G5H5M5O5P5ʲʲʲscsP%hl#h ~ 5;PJ\mHnHtHhl#h ~ PJ\mHnHtH"hl#h ~ ;PJ\mHnHtHhl#h ~ 6]mHnHtHh ~ 5\mHnHtHhl#h ~ 5\mHnHtHhl#h ~ ]mHnHtHh ~ mHnHtHhl#h ~ mHnHtHh ~ \mHnHtHhl#h ~ \mHnHtHhl#h ~ ;\mHnHtHP5Q55555555555555555555555#6$6&646ਖ਼{naWaIhl#hR ]mHnHtHhR mHnHtHhl#hR mHnHtHhR 5\mHnHtHhl#hR 5\mHnHtHhl#hR \mHnHtHhl#hR ;\mHnHtH hR h ~ "hl#h ~ ;PJ\mHnHtH"hl#h ~ 6PJ]mHnHtHhR PJmHnHtHhl#h ~ PJmHnHtHhR 5;PJ\mHnHtH4656C6G6H6I6N6O6T6Z6`6e6j6p6s6z6{66777 7$7%7&7)7.73787<7B7H7M7R7U7մգ՘lZlZlZlZlZl#hl#hR PJ\mHnHsHtH&hl#hR ;PJ\mHnHsHtHhl#hR ]mHnHtHhR mHnHtHhR \mHnHtH!hl#hR 6;]mHnHtH!hl#hR 5;\mHnHtHhl#hR ;\mHnHtHhl#hR \mHnHtHhl#hR mHnHtHhl#hR 6]mHnHtH"U7W7X777777777777777788˿˯˟vg[g[gM=hl#hR 6]mHnHtHhl#hR ]mHnHtHhR mHnHsHtHhl#hR mHnHsHtHhl#hR \mHnHsHtH"hl#hR ;\mHnHsHtH hR hR hl#hR PJ\mHnHtHhl#hR PJ]mHnHtHhR PJmHnHtHhl#hR PJmHnHtH"h7xhR 5PJ\mHnHtH&hl#hR 5PJ\mHnHsHtH888$8&8'8(88888888888888888888999 9999Z9[9]9k9l9z9~999999999999ŸŸhl#hR ;mHnHtHhl#hR 6]mHnHtHhl#hR ]mHnHtHhR mHnHtHhR 5\mHnHtHhl#hR 5\mHnHtHhl#hR \mHnHtHhl#hR ;\mHnHtHhl#hR mHnHtH299 : ::":#:3:4:<:A:P:S:T:U:;;;;";&;';(;ξ欜{l`lPlI9hl#h*V;\mHnHtH h*VhR hl#h*VPJ]mHnHtHh'PJmHnHtHhl#h*VPJmHnHtHh'5PJ\mHnHtH"hl#h*V5PJ\mHnHtHhl#h*VPJ\mHnHtH"hl#h*V;PJ\mHnHtHhl#hR 6]mHnHtHhl#hR ]mHnHtHh'mHnHtHhl#hR mHnHtHh'5\mHnHtH(;,;1;6;;;B;G;L;Q;Y;];^;;;;;;;;;< <<<<!<"<b<c<e<y<z<<<< = = =&='=:=;=?=D=I=J=M=N=P=T=Z=_=d=ǽǯǽǯǽǯhl#h*V;mHnHtHh'\mHnHtHhl#h*V6]mHnHtHhl#h*V]mHnHtHh'mHnHtHhl#h*VmHnHtHh';\mHnHtHhl#h*V;\mHnHtHhl#h*V\mHnHtH4d=h=i=================q>r>t>~>>>>>>>>2?4?5?־𠐃־֠tdXtXdh*VPJmHnHtHjh*VPJUmHnHtHhl#h*VPJmHnHtHh'5\mHnHtHhl#h*V5\mHnHtHhl#h*V\mHnHtHhl#h*V6]mHnHtHhl#h*V]mHnHtHh'mHnHtHhl#h*VmHnHtHh';\mHnHtHhl#h*V;\mHnHtH 5?q?r?s?t?u?|??????????@ @@@@@AAAA,A6ADANAXA`ApAvAxAGBHBJBiB{BBBBBBBBBBТккЀ|h-jhl#h*VUhl#h*VPJ]mHnHtH h7xh' h7xh*Vhl#h*V]h' h'; hl#h*Vhl#h*V; h*Vh*Vhl#h*VPJmHnHtHjh*VPJUmHnHtH hph*V0J$PJmHnHtH0BBB=C>CmCnCDDDDjDlDpDrDDDDDFF:F;F=F>FFFFFFFGGG GGGGG$H%H&H'HHHHHHI I I"IAIBICIIIIIIIIII hl#h*VPJmHnHsH tHh-jhl#h*VUh\<h'mHnHsHh\<h*VmHnHsHhl#h*VPJmHnHtHh' hl#h*V?$EFG"IIIuJLMOOHQ|`}}~~~~~gdz & Fh^h`gd*V  & Fh^hgdvc gdvc gd*VII J J J J8J;JtJuJvJJJJJJJ#K$K&K'K-K.KKKKKKKKKKKKKKK(L)L+L,LLLLLLLMMMM}M~MMMNNNNNNNlNmNoNpNNNOOะะjhvc Uhvc h*VhojhoU'h'h*V5OJQJ^JmHnHsH h- hl#h*V'h'h'5OJQJ^JmHnHsH EO2O3O0P2P4P6PPPQQQQR|j|k|||||1}2}}}}}~~~~~~~~~~h hR h*V h*Vhvc Uh-hvc $d interferential current in the therapy of complex regional pain syndrome by infrared thermographic camera. Vojnosanit Pregl 67(9):755-760, 2010 Pauling JD, Shipley JA, Harris ND, McHugh NJ. Use of infrared thermography as an endpoint in therapeutic trials of Raynaud's phenomenon and systemic sclerosis. Clin Exp Rheumatol. 30(2)71:103-115, 2012 Mountz JM, Alavi A, Mountz JD. Emerging optical and nuclear medicine imaging methods in rheumatoid arthritis. Nat Rev Rheumatol 8(12):719-728, 2012 Bharara M, Schoess J, Armstrong DG. Coming events cast their shadows before: detecting inflammation in the acute diabetic foot and the foot in remission. Diabetes Metab Res Rev 28(1)1:15-20, 2012 = 0P&P 1h. A!"#8$ % DpD 0P&P 1h. A!"#8$ % P h*2Dp= 0P&P 1h. A!"#8$ % Dpb% 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~PJ_HmHnHsHtH>`> Normal$a$_HmH sH tH j@j Heading 1/$$ & F h@P@&`:mHnHun@n Heading 20$$$ & F x<@&^ `a$6]mHnHuh@h Heading 3*$ & F hd@&`a$6]mHnHuj@j Heading 4,$ & F hh((@&`ha$6]mHnHuP@P Heading 5 hP@&:mHnHuDA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List ToT "Abstract $a$5CJ\_HaJmH sH tH HoH Affiliation$a$_HmH sH tH VoVAuthor$h(a$CJ_HaJmHnHsH tH uJB@"J  Body Text$ dx` a$@T!2T bullet list# & F h^`ROBR equation  d OJQJ^JnoRn+figure caption$ & FPa$CJ_HaJmHnHsH tH ufobf footnote# & F(A&#$./CJ_HaJmH sH tH lorl key words$ x` a$+56CJ\]_HaJmHnHsH tH ufofpaper subtitle $xa$#CJPJ_HaJmHnHsH tH u`o` paper title $xa$#CJ0PJ_HaJ0mHnHsH tH ulol references$ & FdL2a$#CJPJ_HaJmHnHsH tH ufof sponsors# g$dN` CJ_HaJmH sH tH FOF table col head5CJ\aJLOL table col subhead6CJ]aJVoV table copy$a$CJ_HaJmHnHsH tH u^o^ table footnote$<a$CJ _HaJ mH sH tH non table head $ & F dxa$":CJ_HaJmHnHsH tH uTOT #zStyle Abstract + Italic! 6PJ]Po!P z Abstract Char5CJ\_HaJmH sH tH xo1x !zStyle Abstract + Italic Char(56CJPJ\]_HaJmH sH tH 6U`A6  ~ Hyperlink >*B*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] :H;H?(C'23P546U789(;d=5?BIO~)+-.0123456789:<=1$E~*,/;546q6888999:(;9;#=v==>>?B?H??????@W@\@@!A?ABBBBZCxC;HXXXXXXXXXXXX8@0(  B S  ?[cmw***#,#,#4#4=H     aiu~***),),&4&4=H   9 *urn:schemas-microsoft-com:office:smarttagsplace8*urn:schemas-microsoft-com:office:smarttagsCity=*urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceNameB *urn:schemas-microsoft-com:office:smarttagscountry-region9*urn:schemas-microsoft-com:office:smarttagsState G       &@H =HUV =#F#%.W...n99=H3333j p=D(()8)))))7*W***6+m+,,.///1312'222e33 4:4445r666J88@9n99 :);O;<?<w==>>H>g>>>"AVAAB[CC%DlDDEE FFFGGoG H:H=HV%W%_%b%5r6t688};;<<(>*>>>_@a@AABBCCDDDDTEVEaEbEEE5F7F;F`AjJTR~֮X,@lX}-lpd ^`5CJOJQJ^JaJph.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.h-^`5B*CJOJQJ^JaJo(phhH. ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH. ^`6]^Jo(.^`^J.pLp^p`L^J.@ @ ^@ `^J.^`^J.L^`L^J.^`^J.^`^J.PLP^P`L^J.> ` 56789;<CJH*OJQJS*TX\]^JaJo( ^`^J.pLp^p`L^J.@ @ ^@ `^J.^`^J.L^`L^J.^`^J.^`^J.PLP^P`L^J.  ^`OJQJo( ^`OJQJo(o pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo(^`^Jo(;@`789;<B*CJH*OJQJS*TX^JaJo(ph.GX^X`56789;<B*CJH*OJQJS*TX\]^JaJo(ph.G`56789;<B*CJH*OJQJS*TX\]^JaJo(ph)#h`h56CJOJQJ\]^JaJo()@  ^@ ^Jo(x^^Jo(()H^^Jo(()^^Jo(()^^Jo(()#hh^h`56CJOJQJ\]^JaJo([],56B*CJOJQJ\]^JaJo(ph Figure . ^`^J.pLp^p`L^J.@ @ ^@ `^J.^`^J.L^`L^J.^`^J.^`^J.PLP^P`L^J.#856CJOJQJ\]^JaJo( TABLE . 6f7X,@l&>`A>`A>`A>`AJTR-lO93 ^%6 .        `y        F        \        &o ~ aV7x'vc qg$X6M7q;\<#DK*V)a;H=H@d78w9w:wDwE;Hpp@p@p@pDp@pPp@Unknown G*Ax Times New Roman5Symbol3. *Cx Arial7.@CalibriO.  k9Lucida Sans Unicode;(SimSun[SOG=  jMS Mincho-3 fg?= *Cx Courier New;WingdingsA$BCambria Math"AhS6P7' t=$ t=$824HH3q ?2! xx $Paper Title (use style: paper title)IEEEToni4         Oh+'0x  4 @ LX`hp(Paper Title (use style: paper title)IEEENormalToni3Microsoft Office Word@d@*@  t=՜.+,D՜.+,T hp  IEEE$H %Paper Title (use style: paper title) Title 8@ _PID_HLINKSA<H-1!,http://www.ncbi.nlm.nih.gov/pubmed/23204850"Q_http://www.ncbi.nlm.nih.gov/pubmed?term=Herman C%5BAuthor%5D&cauthor=true&cauthor_uid=23204850I6http://www.sciencedirect.com/science/journal/13504495r,Chttp://www.sciencedirect.com/science/article/pii/S1350449509000310r,Chttp://www.sciencedirect.com/science/article/pii/S1350449509000310r,Chttp://www.sciencedirect.com/science/article/pii/S1350449509000310r,Chttp://www.sciencedirect.com/science/article/pii/S1350449509000310/3 ,http://www.ncbi.nlm.nih.gov/pubmed/23223805*6 ,http://www.ncbi.nlm.nih.gov/pubmed/23290667X&http://www.futuremedicine.com/loi/fonZRUhttp://ict.sagepub.com/search?author1=Deborah+A.+Kennedy&sortspec=date&submit=SubmitH=http://www.reddingthermography.com/about-dii/full-body-scan/  !"#$%&'()*+,-./0123456789:;<=>?@BCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abdefghijlmnopqruRoot Entry FJ w1TableACWordDocumentĀSummaryInformation(cDocumentSummaryInformation8kCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q