Examination Protocol

When the patient's presentation or the examination and its environment are not controlled, the diagnostic value of thermography suffers. Multiple internal and external factors have significant effect on the examination's integrity and credibility. To enhance and assure the accuracy of thermographic studies, particularly serial examinations, it is essential to minimize the effects of these variables.

ThermEval's ACT Examination protocol consists of thermograms recorded according to a strict examination criteria, using appropriate image capturing techniques, and interpreted by an objective procedure utilizing Thermogram Assessment Services' (TAS) proprietary ACT software program.

TAS's ACT Examination analysis software represents a major breakthrough in pathology detection, but the interpretive program by itself cannot obscure the errors inherent in improper testing procedures. The following examination protocol assures maximum accuracy of the recording of the thermogram and its interpretation, and should be adhered to as closely as possible. The reliability, accuracy and integrity of the thermographic examination can only be maintained if shortcuts are avoided. Proper patient scheduling, simple patient preparation requirements, attention to examination room conditions, camera positioning and correct image capturing are all required to meet the criteria for an accurate thermographic examination.


Relatively small areas are required for patient cooling and evaluation; a typical examination room has proven to be generally acceptable. Sources of heat or cold which significantly affect the ambient environment of the cooling and examination rooms should be eliminated. High energy lights or office equipment, warm window areas, or drafts caused by heating or cooling equipment should be particularly avoided. If more than one room is used for cooling and/or examination, the rooms must be maintained at the same temperature, and transition from the cooling area to the examination room should be performed as quickly as possible.

The temperature of the cooling/examination room should be 68°F - 72°F. Note that temperature stability, not only absolute temperature, is important. Thermograms performed in environments below 66°F or above 74°F are unsuitable for interpretation under the ACT requirements.


Proper patient scheduling and preparation prior to the test are necessary to assure adherence to the ACT Examination requirements.

Illnesses, with or without temperature elevation, may alter the patient's normal thermal characteristics; thus, patients suffering from colds, influenza, etc. should not be scheduled for an examination.

Patients must be instructed to follow the required ACT Examination protocol prior to the test. These requirements have been established to maximize the accuracy of the test by eliminating various factors which could alter the patient's thermal characteristics.

Alcoholic beverages, coffee, tea or colas containing caffeine should not be consumed for twelve hours prior to the test. Hot or cold beverages should be avoided for at least one full hour before a ACT Examination is performed.

If possible, aspirin, pain medications, vasodilators/constrictors and/or other similar medications should be avoided for 24 hours prior to the examination.

Cigarettes should not be smoked for two hours prior to the ACT Examination.

An ACT Examination should not be scheduled within two weeks after the patient has been subjected to sunburn. Lotions or ointments should not be applied to the face, neck or manubrium for 24 hours prior to the test.

Physical exercises that might affect circulation should be avoided for 24 hours prior to the examination.


Thermal equilibration is the process under which the patient's skin achieves thermal stability in a temperature-stabilized environment. Although sometimes required to increase the skin temperature, it is generally a cooling procedure. A ten to fifteen minute period of thermal equilibration is absolutely essential to the accuracy of the ACT Examination. Please, no shortcuts here - proper cooling cannot be overlooked or avoided!

Static and Fan cooling are two methods used in the cooling of patients. Fan cooling should be avoided in favor of the more acceptable static cooling, as fan cooling has increased potential for both asymmetrical cooling and over-cooling.

1. Static Cooling (preferred method): The patient disrobes from the solar plexus up and sits or stands for ten minutes. Cooling for less than ten minutes invalidates the examination.

2. Fan Cooling: The patient disrobes from the solar plexus up and stands five to six feet from a slowly rotating 20" area fan and positioned such that the air-flow from the fan is directed at the patient's chin. The air flow direction is important to avoid asymmetric cooling. Cooling time using this method should be approximately five minutes. Note that asymmetrical cooling yields thermal asymmetry, while over-cooling causes unstable thermal patterns.

It is extremely important that the face, neck, shoulders or manubrium are not touched during the cooling period by either the patient or examiner.


Patients are scheduled so as to conform to the requirements of the examination and are informed, prior to the scheduled examination, of the preparations required for the test (no alcohol, etc.).

When the patient arrives for the ACT Examination, they are asked to disrobe from the manubrium up, assume the position appropriate to the cooling method being utilized, and undergo equilibration. Following the cooling procedure, the thermogram should be recorded in accordance with instructions and training. Click here for Procedure instructions.


Analyzed properly, thermography can make a significant contribution to the overall evaluation of possible pathology. The information provided by the ACT Examination regarding the thermovascular patterns and thermal abnormalities informs the clinician which patients require more careful and continued evaluation.

Thermograms are by their very nature difficult to analyze and interpret and generally require a highly trained individual to perform the task. A brief glance at the thermogram provides instant information regarding the macroscopic thermal symmetry only...nothing else. To accurately interpret thermograms requires careful evaluation of twenty-five individual signs. Do not attempt analysis of the thermogram without prior training as misinterpreted results can be misleading and inaccurate. False examination results are a direct result of interpretative inaccuracies caused by untrained individuals rendering subjective analyses of thermograms.

Thermograms are objectively interpreted using TAS's proprietary evaluation software. The program is interactive and forces objective responses designed to evaluate the patient's thermal characteristics.

The generated report summarizes information regarding the observed thermal signs and then provides detailed explanations of the interpreted findings with recommended follow-up instructions. When the ACT Examination result is received by the practitioner, it should be correlated with physical and other diagnostic findings.


When performed in conformance with the above protocol, the ACT Examination is an extremely valuable test for the earliest detection of possible pathology. The examination is safe, easy to perform, and has patient acceptance; however, certain minimum requirements must be observed in order to enhance its integrity. For certification as a ABT Examination, the following must be adhered to:

  • Cooling/Examination Room Conditions. Maintain a constant ambient temperature between 68°F - 72°F.
  • Patient Thermal Equilibration. If static cooling is used, the minimum cooling time must be ten minutes. For fan cooling, five minutes minimum.
  • No drugs or other substances that might alter the patient's thermal characteristics should be used immediately prior to testing.
  • The patient's face, neck, shoulders and manubrium must not be touched by the patient or practitioner from the beginning of the cooling period until after the ACT Examination has been performed.

Follow these criteria avoiding the temptation to use shortcuts, take care to acquire the most suitable thermogram for evaluation, and your patients will enjoy the benefits inherent in early detection of pathology.