Wong Stephen, Bhide Nivrutti, Balay-Dustrude Erin, Sullivan Erin, Scheck Joshua, Muse Ian, Cain Kevin, Biswas Debosmita, Partridge Savannah C, Zhao Yongdong
Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
Pediatr Rheumatol Online J. 2025 Jul 31;23(1):84. doi: 10.1186/s12969-025-01096-1.
Telemedicine has improved access to pediatric rheumatology care. A disadvantage to using virtual modality for evaluation of children with arthritis is the lack of an in-person, hands-on physical exam. Thermal imaging has been studied in the clinical setting with promising results. This study aims to determine the feasibility of procuring at-home thermal imaging, measuring the variability of in-home skin temperature measurements over three consecutive days, and to compare these measurements at home to ones obtained in the clinic setting.
Children with knee pain and/or swelling for a week or longer were enrolled and imaged with a smartphone-attached FLIR ONE PRO and Fluke handheld cameras followed by imaging with a FLIR camera at home for 3 consecutive days. Joint exam performed in the office was used as gold standard for joint assessment. A previously validated metric of temperature after within-limb calibration (TAWiC), defined as the temperature differences between the knee joint and ipsilateral mid-tibia, was used for all imaging studies.
Fifty-three patients were enrolled and thirty-eight completed the imaging acquisition at home with analyzable images. When evaluating images of the knee and mid-tibia regions, images collected at home compared to in-office demonstrated consistently lower absolute temperatures. However, the calibrated temperatures (TAWiC) of the anterior and lateral views of the knee showed mild to moderate correlation across 3 days between home-acquired images and office-acquired images (r = 0.58, 0.26, 0.24 and r = 0.36, 0.41, 0.42, respectively). The sensitivity and specificity of detecting arthritis of the knee using TAWiC adjustments from previously defined thresholds were similar regardless of the setting of image acquisition (0.44 and 0.79).
This study demonstrates the feasibility of applying TAWiC for arthritis detection through a smartphone-based infrared thermal camera operated by families at home. Further investigation on a larger scale is needed prior to implementation of this process in the telemedicine setting.
远程医疗改善了儿童风湿病护理的可及性。使用虚拟模式评估关节炎患儿的一个缺点是缺乏面对面的、实际操作的体格检查。热成像已在临床环境中进行研究，结果令人鼓舞。本研究旨在确定在家中获取热成像的可行性，测量连续三天在家中皮肤温度测量的变异性，并将在家中的这些测量结果与在临床环境中获得的结果进行比较。
招募膝关节疼痛和/或肿胀一周或更长时间的儿童，先用连接智能手机的FLIR ONE PRO和福禄克手持式相机进行成像，然后在家中用FLIR相机连续3天成像。在办公室进行的关节检查用作关节评估的金标准。所有成像研究均使用先前验证的肢体校准后温度指标（TAWiC），该指标定义为膝关节与同侧胫骨中部之间的温度差。
53名患者入组，38名在家中完成了具有可分析图像的成像采集。在评估膝关节和胫骨中部区域的图像时，与办公室采集的图像相比，在家中采集的图像显示绝对温度始终较低。然而，膝关节前后视图的校准温度（TAWiC）在3天内，家庭采集图像与办公室采集图像之间显示出轻度至中度的相关性（分别为r = 0.58、0.26、0.24和r = 0.36、0.41、0.42）。无论图像采集的环境如何，使用从先前定义的阈值进行TAWiC调整来检测膝关节关节炎的敏感性和特异性相似（分别为0.44和0.79）。
本研究证明了通过家庭操作的基于智能手机的红外热像仪应用TAWiC进行关节炎检测的可行性。在远程医疗环境中实施此过程之前，需要进行更大规模的进一步研究。
