Exergen Scanner DT 1001 User Manual

EXERGEN

USER’S MANUAL

AND REFERENCE

BOOK

Unparalleled Accuracy

. . .at the Speed of Light

I. The Instruments

The DermaTemp is a high precision hand-held infrared thermographic

scanner designed to detect the subtle skin temperature variations caused

by underlying perfusion variations.

These instruments feature a patented automatic emissivity compensa-

tion system for absolute accuracy regardless of skin type or color, and

provide an instant temperature measurement on any surface location

on the human body without the need for tissue contact.

In those applications where tissue contact is desirable or cross-con-

tamination is an issue, the use of disposable wraps or sheaths allows

even moist or wet tissue to be measured with precision accuracy.

The models include:

DT-1001

the standard model

DT-1001 LT

DT-1001 LN

DT-1001 RS

has a conveniently angled stainless steel probe,

and can be used with or without disposable probe

wraps

has a longer probe than the DT-1001, and can

be used with or without a disposable sheath. The

sheath encases the entire instrument.

has a remote stainless steel sensor attached to

the instrument by cable, convenient for those es-

pecially hard to reach areas.

All instruments can be cleaned with any hospital approved disinfectant,

including bleach, and can be gas or plasma sterilized.

The DermaTemp is recommended for use in such areas as plastic and

vascular surgery, anesthesiology, pain management, rheumatology,

neurology, oncology, and wound management.

The Instruments Feature:

•

Full range resolution to 0.1°F/C

SCAN, MAX and/or MIN modes of operation, model specific

Fahrenheit/Celsius conversion

A 10-second display lock

An audible beeper to signal functional or conditional changes

Hermetically sealed sensing system to withstand gas and plasma

sterilization, and cleaning with any hospital approved disinfectant

including bleach and alcohol.

•

Pencil-like stainless steel sensor on the RS version.

Optional disposable cover usage:

Complete encasement with disposable sheaths for the LN

version.

Full probe covering with disposable wraps for the LT version.

Optional Disposable Covers

The use of disposable covers with the DT-1001 LT is optional, depend-

ing on the requirements of the application. Recommended guidelines

are as follows:

Use With Disposable Cover

For absolute accuracy, minimizing the effects of emissivity and

evaporative cooling, contact with the measurement site is recom-

mended. Accordingly, when direct contact is employed, use of a

disposable probe cover is recommended.

When touching moist tissue, use of a disposable cover is required

specifically to avoid a lower temperature from the effects of evapo-

rative cooling, and to protect against the risk of cross contamina-

tion.

Use Without Disposable Cover

If the measurement site is dry, direct contact can confidently be

made without the use of a disposable cover. When the site is dry

and the precise temperature is not a prerequisite, the measure-

ment can be made without even contacting the skin. The probe

can be cleaned with any hospital approved disinfectant, even bleach

solution.

Instructions for Applying Disposable Covers

Model 1001 LT Only

Start with film perforation at edge of

box tongue. Pinch bottom of white

ring, push ring over peg.

Stop at Perforation

Release pinch, gently pull box away

from probe to release film from box.

Pinch just below next ring, before per-

foration.

Rotate instrument into film until probe

faces opposite direction, push ring on

peg.

Release pinch. Pull box slightly away

until next white ring is visible. Pinch

ring, break film apart at perforation.

Contact vs. Non-Contact Measurements

In using any infrared temperature device, closer is always better, as the

field of view increases proportionately to the distance from the surface.

Accordingly, for maximum accuracy the probe must contact the sur-

face at the point of interest. It does not need to be tightly pressed to the

surface; a gentle touch is all that is required.

When contact with the surface is not an option, position the probe within

1/2 inch from the surface of interest. If using a non-contact protocol,

the relative temperature indication of the instrument will be accurate.

Operation and Controls

The DermaTemp infrared thermographic scanner models 1001, 1001

LN, LT and RS are all identical in performance and specifications. All

are maximized for ease of use. The remote sensor on the RS version

can either be left attached to the instrument for one-handed operation,

or separated for use in hard-to-reach areas of interest. The LN and LT

models can be used with or without disposable covers

Using the DermaTemp

The DermaTemp is equipped with an ON/OFF power button and a mode

selector switch, model specific. The mode selector switch allows you

to choose one of the three modes of operation, SCAN, MAX, or MIN.

The LT model is designed in a peak select mode, and automatically

selects and locks the highest reading when the ON/OFF button is

released.

ON/OFF:

To turn the instrument on, depress the red ON/OFF power push but-

ton. The single beep will audibly indicate that the instrument is on.

The display will momentarily read 8888,

an indication that the microprocessor is

performing a self-diagnostic check. Af-

ter the test, the unit will measure and dis-

play temperature in the selected operat-

ing mode for as long as the power button

is depressed.

To Lock Reading:

Release the red ON/OFF button to lock reading on display. The single

beep will audibly indicate that the display is locked. The DermaTemp

will hold the last reading on the display for 10 seconds before it auto-

matically turns off.

If you are using a DermaTemp 1001 LT, the highest temperature mea-

sured will be retained before automatic turn off.

To Restart:

Depress the button anytime to restart. It is not necessary to wait until

the display is clear. The DermaTemp automatically recalibrates each

time the button is depressed.

Operating Modes (Model Specific)

•

SCAN: In the SCAN mode, the target’s instantaneous tempera-

ture is continuously displayed and updated 10 times per second

for as long as you keep the button depressed. After the power

button is released, the display will lock on the last temperature

measured and hold that reading for 10 seconds.

•

MAX: In the MAX (peak hold) mode, the display will lock on the

highest temperature measured for as long as you hold the power

button down. Each time a new peak temperature is measured or

repeated, an audible beep will sound. After you release the power

button, the display will lock on the maximum recorded tempera-

ture and hold that reading for 10 seconds.

•

MIN: In the MIN (valley hold) mode, the display will lock on the

lowest temperature measured as long as the power button is de-

pressed. Each time a new low temperature is measured, a beep

will sound. After the power button is released, the display will lock

on the minimum recorded temperature and hold that reading for

10 seconds.

Non-Contact Scanning

For situations where even light contact is contraindicated, bring the

instrument nose as close to the measuring site as safely possible, keep-

ing the following in mind:

The instrument’s field-of-view, also referred to as the distance-to-

spot ratio, is 1:1. A 1:1 field-of-view means that the sensor sees

a circular area with a diameter equal to the distance between the

sensor and the target area.

For example, at a distance of 2 inches (5 cm), the sensor sees a 2

inch (5 cm) diameter spot. The minimum spot size is approxi-

mately 1/4 inch (6 mm) when touching.

The DermaTemp averages the temperature of everything in its

field-of-view.

A small hot spot may get lost in a large viewing area. The closer

you hold the instrument to a surface, the sharper its target resolu-

tion.

Changing the Battery

A standard 9-Volt alkaline battery will require replacement only once or

twice per year under normal use. To replace, loosen the four captive

screws and remove the cover. Disconnect the old battery and replace

with a new one in the same location. Replace the cover and tighten the

four screws. Use only high quality alkaline batteries or their equivalent.

Captive Screws

9-Volt Alkaline

Battery

Fahrenheit or Celsius Conversion

The DermaTemp can be used in either °F or °C. The only tool neces-

sary to convert from one scale to the other is a paper clip.

•

Find the small hole on the

left side of the red display

filter.

2. Push

•

Straighten the paper clip.

Insert the end of the pa-

per clip into the hole and

push to activate the small

switch underneath.

1. Push and hold

•

While holding the paper

clip pressed into the switch, turn the instrument on by pressing

the red button.

•

Remove the paper clip.

To return to the original setting, repeat the process.

Care and Maintenance

Handling

Your DermaTemp is designed and built to industrial durability stan-

dards in order to provide long and trouble-free service. However,

it is also a high precision optical instrument, and should be ac-

corded the same degree of care in handling as you would provide

other precision optical instruments, such as cameras or otoscopes.

Calibration

Factory calibration data is installed via a computer through an op-

tical link with the microprocessor. The instrument automatically

self-calibrates each time it is turned on using this data, and will

never require recalibration. If readings are not correct, the instru-

ment should be returned for repair.

Cleaning

The DermaTemp can be gas or plasma sterilized, or wiped down

with any hospital approved disinfectant, even bleach. With nor-

mal use, the only maintenance required is to keep the lens on the

end of the probe clean. It is made of special mirror-like, infrared-

transmitting material called Germanium.

Dirt, greasy films or moisture on the lens will interfere with the

passage of infrared heat and affect the accuracy of the instru-

ment. If necessary, clean the lens with an alcohol prep or a cotton

swab dipped in alcohol. Periodic cleaning is a good practice.

Self Diagnostics

Continuous Single Beeping

The high performance DermaTemp continuously monitors its abil-

ity to produce accurate temperature readings. If either the target’s

temperature or the unit’s ambient temperature exceeds the opera-

tional limits, the beeper will sound once per second and the LED

display will default to a display message.

When the target temperature is outside of the instrument’s oper-

ating range, the unit will display either HI or LO and will beep con-

tinuously at one beep per second. When the instrument’s own

temperature is outside operating limits for ambient temperature,

the display will show either HI A or LO A, and will beep continu-

ously at one beep per second.

Continuous Double Beeping

The battery voltage is also monitored. A low battery is indicated

by a continuous double beep per second. Temperatures will con-

tinue to be displayed as long as accuracy can be assured. If the

battery drops below 5.7 volts, it is considered “dead” and the dis-

play defaults to

(——).

Customer Service

If repair is required:

•

Contact Exergen for a Return Materials Authorization Num-

ber (RMA).

•

Mark the RMA number on the outside of your package and

packing slips.

•

Include a description of the fault if possible.

Send the instrument freight/postage prepaid to

Exergen Corporation

51 Water Street

Watertown, MA 02172

Attention: RMA_______

•

The instrument will be returned freight/postage prepaid.

Questions:

Should you have any clinical or technical questions, please con-

tact a customer service representative in the medical division at

Exergen Corporation. They may be contacted either by phone

(617-923-9900), fax (617-923-9911) or email to

[email protected].

II. Body Surface Temperature

History and Introduction

As early as 2800 BC, the Egyptians, using the scanning sensitivity of

the fingers over the surface of the body, recognized that the body pro-

duces heat, and that heat increases with disease. Further recognizing

the distinction between local inflammation and fever, the Egyptians set

the foundation for monitoring body surface temperature as a separate

and distinct diagnostic methodology from the monitoring of core body

temperature.

But the ancient diagnostic technique

of feeling for heat is highly subjec-

tive, and only as sensitive as the

hand of the feeler. The test of tem-

perature is relative to the detector.

A cold hand will indicate a warm

body surface that a warm hand will

Typical 19th Century Thermometer

indicate as cold. Certainly, the hand

of an experienced physician laid upon the skin could provide much use-

ful information about the temperature of the patient and the course of

an illness, but eventually a more objective assessment was possible

with the introduction of the clinical thermometer developed during the

last century.

One of the earliest references to actually quantifying body surface tem-

perature as a clinical diagnostic was in 1864 during the Civil War. Dr.

Jackson Chambliss, a surgeon in the Confederate Army, used a ther-

mometer to diagnose a traumatic femoral aneurysm by showing that

surface temperature was decreased distally in the affected leg. ¹

In more recent times, the measure-

ment of the surface temperature of

the human body has not been rou-

tinely undertaken in many clinical en-

vironments - not because the mea-

surement lacks clinical significance,

but because it has been difficult to

acquire. Conventional mercury or

electronic thermometers have gen-

erally been ineffective for surface

temperature measurements for three reasons: 1) they are difficult to

properly attach to the body surface, 2) they require a significant amount

of time for the sensor portion of the device to equilibrate to the body

surface temperature and 3) they are prone to low readings because it is

not always evident that the surface thermal connection is adequate.

Body Surface Temperature

Heat signatures vary considerably over the

surface of the human body, and physicians

have long appreciated the relationship be-

tween heat and disease. In fact as early as

400 BC, Hippocrates wrote “In whatever

part of the body excess of heat or cold is

felt, the disease is there to be discovered.”¹

Undoubtedly the earliest use of clinical ther-

mography, Hippocrates found when he cov-

ered his patient’s body with wet clay, the mud

dried quicker on the diseased area, thus pre-

senting a crude but dramatic demonstration

of the heat signatures.

Thermographic scan of

the patient with clay on

his body. (Dorex, Inc. CA)

It is impossible to define the surface tem-

perature by any single normal value, since it

is the result of a thermal balance between

energy supplied from the core via perfusion

and energy lost to the environment via radiation, conduction, convec-

tion, and evaporation. All objects, whether animate or inanimate, ho-

meothermic or poikilothermic, radiate electromagnetic energy (radia-

tion) to the surroundings at a rate dependent on its temperature. In

accordance with a basic law of physics, this invisible radiation is con-

stantly emitted, absorbed, and re-emitted by everything in our surround-

ings so that thermal equilibrium can be maintained. A simple example:

left in normal room temperature, a cup of hot coffee quickly cools and a

glass of iced tea quickly warms to the temperature of the room.

If the human eye had the optical power to see the emitted radiation,

which has all the same properties as a beam of light, but differing in

wavelength, all mankind would have an incandescent glow. Because

the temperature over the surface of the human body changes at a rapid

rate in response either to its external environment or to its internal con-

trol mechanism, the incandescence would be quite bright over some

areas and quite dark over others. This variability of the temperature

pattern gives question as to its significance, and yet it is a remarkable

indication of the underlying body physiology.

All biological tissue generates energy in proportion to the metabolic ac-

tivity occurring within the cells. About 80% of the energy developed by

the human body is converted into heat, with the balance converted into

external work or into tissue growth. The circulatory system, in addition

to circulating blood for its metabolic characteristics also distributes heat,

thus replacing the heat energy lost to the environment, as well as nour-

ishing the tissue. The resultant increase in heat energy delivered by the

blood causes the temperature to rise until the heat energy lost to the

environment again balances with the heat delivered.

It has long been recognized that where there is injury or infection, there

is inflammation, but injury or infection of itself does not create heat

energy. When there is trauma, whether an injury or abnormal stimula-

tion caused by a physical, chemical, or biologic agent, a pathologic

process of reactions occurs in the blood vessels and adjacent tissues

in response to the perturbation. The natural defense mechanism trig-

gered immediately increases the flow of blood to the area of concern,

causing the temperature to rise in proportion to the increase in blood

flow. However, the maximum temperature can be no higher than that

of the core arterial supply to the trauma tissue.

Consider as a simple analogy, the action of washing your hands in a

sink. If the water from the hot faucet were to be trickling in a small

stream, it is likely it would feel only lukewarm. However, if you were to

open that tap full force, the rushing water would feel quite hot. But, no

matter how intense the rush, the water could never be hotter than the

water from its source of heat, the furnace.

The ancient diagnostic technique of feeling for heat over the body is a

longtime indicator of inflammation. While localized temperature eleva-

tions may be felt merely by the touch of the hand, the technique is

highly subjective, and not sufficiently sensitive to detect the subtle

temperature rises indicative of increased cellular or metabolic activity.

With the introduction of infrared techniques, accurate surface tempera-

ture patterns are immediately quantifiable and any changes easily de-

tected. It is this knowledge that enables us to study any disease pro-

cess resulting in a change in heat generation or thermal properties of

the tissue.

Infrared Thermometry

Temperature is a fundamental property of all matter related to its en-

ergy content, and can be described by a numeric value expressed on a

scale of temperature. A human’s touch produces an instinctive sense

of hot or cold to judge the relative temperature of two objects. How-

ever, as a practical matter, clinicians must have a temperature scale

that is independent of the observer, by which unknown temperatures

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can be evaluated. With a proper temperature scale, measurements

taken at different times or places can be compared. Without a ther-

mometer, it would be impossible to measure the temperature of a hu-

man with respect to a fixed scale of reference. Remember, the human

test of temperature is relative to the detector. A cold hand will indicate

a warm body surface that a warm hand will indicate as cold.

Numerous techniques and devices are employed in the measurement

of temperature. Many of these techniques, such as the use of glass

mercury thermometers or electronic display devices using thermo-

couples or thermistors, are generally understood and as a result well

accepted in clinical medical practice. All three of the devices have one

very important characteristic: they measure their own temperature, not

the temperature of the object being measured, except in an indirect

way. In order to make an accurate temperature determination using

one of these measurement techniques, it is necessary for the device to

have intimate contact with the subject for sufficient time to raise the

temperature of the thermometer to the same, or close to the same,

temperature as that of the subject. Thermal contact thermometers re-

quire too much time to equilibrate, are sensitive to variations in contact

pressure resulting in changes in the thermal resistance between the

skin and the temperature detector, and tend to have too great a varia-

tion from reading to reading. If these devices are not properly located,

properly attached, or left in place for enough time to equilibrate, they all

will give incorrect readings.

The infrared method is fundamentally different from the other methods

in that there is no temperature device to heat. Like an eye, the infrared

instrument simply looks at the heat radiation naturally emitted from the

body surface. Since there is nothing to heat, the measurement can be

made very fast, orders of magnitude faster than the probe devices.

Historically, most of the published clinical data on body surface tem-

perature measurements are based on the use of infrared thermogra-

phy. Infrared thermography has long been recognized as a reliable,

highly technical diagnostic tool, and refers to the process of recording

and interpreting variations in temperature of the surface of the skin in

color or shades of gray. The clinical information is contained in the

relative temperature profiles. The technique is effective, but the equip-

ment is complex and expensive.

Decades ago, the common image of a computer was that of an enor-

mous, very expensive piece of equipment, something requiring an en-

vironmentally controlled room and complex installation. Today’s com-

puters have been reduced to hand held units. Infrared thermography

was not a lot different: large and expensive, requiring environmentally

controlled rooms, trained technicians, and exotic gases. Today’s ad-

vanced technology makes it possible to put the power of infrared ther-

mography in the palm of your hand, at a fraction of the cost of all previ-

ous techniques. While there are a variety of infrared thermometers avail-

able, only one is designed specifically to meet the stringent clinical re-

quirements, the DermaTemp Infrared Thermographic Scanner.

The DermaTemp Infrared Thermographic Scanner

The DermaTemp is a high precision hand-

held infrared thermographic scanner de-

signed to detect the subtle skin tempera-

ture variations caused by underlying per-

fusion variations. These instruments in-

stantly measure temperature on any sur-

face location on the human body without

the need for tissue contact.

The Dermatemp is highly recommended

for use in plastic and vascular

surgery,anesthesiology, pain manage-

DermaTemp DT 1001 and

DT 1001-RS

ment, rheumatology, neurology, oncology,

and wound management. Other applica-

tions follow this section.

Infrared thermometry is fast, stable, repeatable, and is relatively insen-

sitive to user technique. Skin temperature measurements with infrared

thermometry are attractive because they are objective, low cost, and

cause absolutely no trauma or discomfort to the patient. The versatility

of the products allows for absolute temperature measurement, surface

scanning, and comparative methods of temperature differential.

Method Impedimenta

Despite the tremendous benefits of using infrared technology for clini-

cal applications, there are several impediments which should cause

pause, such as variable skin characteristics, wet skin, and environ-

mental influences. Since the process of measuring temperature by view-

ing the infrared radiation of the surface is significantly faster than the

other techniques mentioned earlier, the user needs to be aware of sev-

eral important considerations. The surface temperature of the human

body is sensitive to the external environment and can vary by several

degrees in a short period of time. Drafts will lower the surface tem-

perature. A cold room environment will lower the surface temperature.

Any surface moisture will lower the surface temperature. Exercise will

raise the surface temperature due to increased perfusion as a ther

moregulatory response. Exposure to the sun or any other warm sur-

face will raise the surface temperature. The user needs to be aware of

these concepts and not be surprised in the event the temperature read-

ings are not as expected.

Ambient Effect on Body Surface Temperature

The cardinal rule of interpretation of skin temperature is that the same

environment will produce the same temperature if perfusion is the same.

If the environment is the same and the temperature is different, then

perfusion must be different. But body surface temperature can be

significantly influenced by the temperature of the surrounding environ-

ment as evidenced in the table.

Effect of Ambient Temperature on Skin¹

Ambient Hand

Forehead

13.7°C

4°C

8.9°C

23°C

27°C

26.9°C 29.2°C

33.2°C 33.2°C

Therefore, absolute temperature readings must be interpreted in rela-

tion to the environment, and the practitioner should be careful to protect

the patient from drafts or exposure to large cold surfaces, to position

the extremities to minimize pooling, and to allow time for the surface

temperature to equilibrate to its environment.

The distribution of the temperature on the body surface is generally

bilaterally symmetric. This symmetry can form the basis for clinical

interpretation of the surface temperature data. The temperature data

from the normal or reference area can also be used to adjust for the

circadian variations and for variations in the temperature environment.

In general, it is the relative readings between the body surface tem-

peratures that is of interest.

Solving the Problems

The DermaTemp is the result of many years of active

scientific research in both the technology and clinical

requirements. The patented reflective cup on the probe

of the DermaTemp provides accuracy heretofore un-

available for clinical use. The instrument is completely

unaffected by conditions prohibiting the use of other

Reflective cup

infrared devices. Because of its unique design, the

on probe tip

classical problems in producing accurate temperatures

have been solved.

Emissivity

An important concept needed to understand how temperature is mea-

sured using infrared radiation is the one of emissivity. Emissivity is a

surface property which determines just how well an object’s tempera-

ture can be measured by an infrared device. Emissivity (along with

background thermal radiation) is the primary source of errors in infra-

red temperature measurement. Emissivity can be more easily under-

stood if it is realized that infrared has similar properties to visible light.

Simply stated, emissivity is the opposite of reflectivity. A perfect mirror

has a reflectivity of unity and an emissivity

of zero. A perfect black body has an emis-

sivity of unity and a reflectivity of zero. In

actuality, all real bodies (including human

ones) have an emissivity between these two

limits.

It is not possible to accurately measure the

surface temperature of any body with an

emissivity of less than 1.0 without making

a correction for this source of error. Hu-

man skin is near but not equal to 1.0 and, if

Poor Emitter

Emissivity = 0.1

Reflectivity = 0.9

1.0

not accounted for, can introduce errors in

the order of one to two degrees. The cup-

like mirror used in the nosepiece of the DermaTemp scanner removes

this source of error by trapping all of the radiation from the skin surface

and in effect causing the skin surface to act like a black body with an

emissivity of 1.0.

Mirrors figure prominently in the discus-

sion of heat radiation and emissivity.

Since heat and light radiation behave the

same way, we can use what we see with

our eyes as examples of what the

DermaTemp sees. When you look in the

Blackbody

Emissivity =1.0

Reflectivity = 0.0

mirror, you see only reflections, nothing

of the mirror itself. If the mirror is per-

fect, it has 100% reflectivity. Because it

reflects everything, it emits nothing. For

this condition, the emissivity is zero.

1.0

If we consider an imperfect mirror, the eye then sees mostly reflection,

but also some of the imperfections on the mirror surface. If, for ex

ample, we saw 90% of the mirror as a perfect reflector and 10% as

imperfections, 90% of the mirror would reflect; the remaining 10% would

emit. Therefore, the emissivity equals 0.1.

Consider for a moment the exact opposite of

a perfect mirror, which is a perfect emitter.

The eye looks at a perfect emitter and sees

no reflection at all, only the emitting surface.

Since 100% of the surface emits, and 0%

reflects, the emissivity equals 1.0. This type

of object is called a blackbody.

And finally, consider a good emitter. The eye

sees a small amount of reflection interspersed

with the large amount emitting. If, for ex-

ample, 10% of the surface did not emit, and

Good Emitter

Emissivity = 0.9

Reflectivity = 0.1

1.0

instead reflected, then we would have 10%

reflecting and the remaining 90% emitting.

Therefore, the emissivity equals 0.9. Accordingly, we can state the

following rule of emissivity: The emissivity of the surface is simply

the percentage of the surface that emits. The remaining percent-

age of the surface reflects.

Alice’s Quest for Emissivity

Is it possible to see a mirror?

When the mirror is looked at, all other objects in the

room are seen.

Is it invisible?

No, if it were, the wall would show behind it.

So how can it be seen?

If crayon spots are painted on the mirror, then the

mirror can be seen.

Of course, it can only be seen where there are spots.

Everywhere else still reflects.

Thus, light is emitted from the spots

and reflected from the non-spots.

(Full reprint available from Exergen)

Correcting for Emissivity Automatically

Biological tissue has

high emissivity, i.e.

~0.95. Accordingly,

the reflected compo-

nent will be about 5%

of the energy mea-

No AECS

AECS active

sured

the

DermaTemp, which

translates to an abso-

lute error of ~1°F

When AECS is active, ambient radiation is excluded

and replaced by reflections of emitted radiation.

(0.5°C). In addition, skin emissivity varies due to color, texture, etc.

over the approximate range of 0.92 to 0.98. An uncertainty of approxi-

mately ±1°F (0.5°C) results from this emissivity variation, which can

appreciably influence the assessment of a subtle perfusion issue.

A more significant er-

ror is due to the re-

deg F

deg C

110

106

102

flected energy, which

can vary considerably

if the ambient radiation

includes sunlight, radi-

ant warmers, etc. To

solve this problem the

Conventional Infrared

DermaTemp

120

100

Ambient T (F)

DermaTemp

equipped with a unique

patented feature called

Automatic Emissivity

Compensation System

(AECS). The reflective

Effect of ambient temperature on infrared device

readings for a surface at 38ºC (100ºF) with

emissivity 0.9.

cup on the end of the probe automatically compensates for emissivity

when it is touching, or brought to within approximately 1mm of the sur-

face. By excluding ambient radiation, and replacing it with reflections

of emitted radiation, the emissivity is corrected, and the accurate tem-

perature indicated

Detection by Exception

The distribution of the temperature on the body surface varies appre-

ciably. For example, on a normal individual, the highest average skin

temperature is the forehead at 34.5°C (±0.73°C) and the lowest aver-

age temperature is the toes at 27.1°C (±2.72°C).¹Considering the

temperature of the skin is highly influenced by ambient temperature,

one could wonder what diagnostic role, if any, temperature would play.

The answer is that it plays a significant role, and the reason is the

bilateral symmetry. Skin temperature differences from one side of the

body compared to the other are not only extremely small, but also very

stable, and unaffected by the age of the patient. Data show differences

between sides at the forehead to be 0.12°C at the forehead, and 0.25°

at the lumbar region of the back. This symmetry forms the foundation

for clinical interpretation of the varying surface temperature data.

In general, it is the relative readings between the body surface tem-

peratures that are of interest. Hence, the general principle is all detec-

tion is by exception. Accordingly, the temperature data from the nor-

mal or reference area can then be used to adjust for the circadian varia-

tions and for variations in the ambient temperature.

The change in body surface temperature with compromised blood flow

is profound. A recent study was undertaken to mimic both partial and

complete occlusion of blood flow to an extremity. The results indicate

changes in skin surface temperature of an extremity reflect blood flow

interruption or alteration in blood flow to that extremity.

A baseline for systolic blood pressure was determined for each subject

and the manometer cuff inflated to three levels, 30 mmHg above sys-

tolic, 25 mmHg below systolic and 50 mmHg below systolic, with tem-

perature readings taken on the inside wrist at 15 second intervals. Even

at the lowest cuff pressure, there is a clear indication at the end of three

minutes of the surface temperature change due to the lowered tissue

perfusion caused by the reduction in arterial blood flow. The data also

indicate the time between occlusion or partial occlusion and a measur-

able temperature drop is very short, well under one minute.

The surface temperature read-

ings of the human body tend

to be quite close between the

bilaterally symmetric surfaces

of region because of perfusion

symmetry, but vary by several

degrees on different body lo-

cations because of perfusion

differences. Both the hands

and the feet can be substan-

tially colder than the rest of the

body surface due to vasomo-

tor constriction of arterio-

Effect of blood flow on body surface

venous shunts as a ther-

temperature

moregulatory response.

A striking example of perfusion effects can be demonstrated by com-

promise of circulation to the arm. A complete or partial occlusion of the

artery in the upper arm will result in an immediate drop in hand tem-

perature, and detectable in less than 30 seconds from the time of oc-

clusion. The rapid response and the simplicity of infrared measure-

ments make the technique effective in the hospital environment.

III. Clinical Applications

The following is a brief synopsis of a number of clinical applications for

surface temperature measurements. These subjects are not covered

in sufficient detail to be used for clinical protocols and are intended to

be general indications for the use of infrared temperature measure-

ments for clinical purposes. Because of the sensitivity of surface

temperatures to the environment, it is important that certain precau-

tions be followed in making surface temperature measurements. They

are:

1. Provide for adequate equilibration time in the room environment at

which the measurements will take place.

2. Protect the patient from drafts and exposure to cold surfaces (win-

dows in winter).

3. Consider the use of a skin surface marker to ensure the measure-

ment sites are repeatable.

Regional Blocks

The effectiveness of regional

blocks can be monitored using the

change in surface temperature

due to sympathetic vasodilation of

the tissue in the blocked area,

eliminating the subjective pin prick

assessment method. Depending

on the type and location of the

block, one can expect to see a

temperature increase in the order

Using the DermaTemp to verify the

of 1 to 1.5°C on the skin surface

geography of the block

of the blocked area in 10 to 30

minutes after the injection of the

blockade drug.

In a recent study on sympathetic blockade, Chamberlain et al (1986)¹

measured the dynamic pattern of skin changes during spinal anesthe

sia, concluding skin temperature increase to be a useful indicator of

sympathetic blockade, demonstrating that temperature elevation always

preceded the upper limits of sensory blockade, and had a similar pat-

tern of onset.

Epidural Catheter Positioning in Labor and Delivery

Foot temperature has successfully been demonstrated as an indicator

in the functional positioning of an epidural catheter. In a recent study

conducted at Georgetown University Medical Center involving 70 par-

turients, Shin et al¹confirmed the associated temperature changes

provided better and objective evidence compared to the sensory pin-

prick test or subjective pain scales. The rapid and differential rise of

foot temperature allowed early positioning of the patient with the un-

blocked cooler side down.

Joint Inflammation

Thermographic techniques have generally been used to demonstrate

that surface temperature variations are an effective means to assess

joint inflammation due to trauma and disease. Although the technique

is effective it is not readily available in most clinical situations. In almost

any clinical environment, infrared thermometry can provide the same

basic data rapidly and at low cost.

In a paper on skin tempera-

ture as an indicator of joint in-

flammation, Guadagni et al

(1974)²describe the surface

temperature elevation over ar-

thritic joints and the correla-

tion of this measurement with

the more conventional inflam-

matory index. They con-

cluded averaged joint skin

temperature not only offers

quantitative but as reliable and

Evidence of connective tissue disease

reproducible information

about the degree of joint inflammation as conventionally used param-

eters such as inflammatory index, grip strength, and joint size. Re-

corded temperature data provides an objective means for the evalua-

tion of the joint and its treatment modality over time. Both the magni-

tude of the temperature elevation and its profile across the joint may be

used in the evaluation.

Digital Perfusion Assessment

Levinsohn et al (1991)¹demonstrated that the infrared method of as-

sessing perfusion was as reliable as Doppler methods, but far less

expensive, much faster, and easier to use.

A: Venous congestion was induced

by placing a 28 mm wide cuff

on the proximal phalanx of the

long finger and then inflating the

cuff to 5 mm Hg above resting

diastolic pressure. With the aid

of a nitrogen pressure regula-

tor, cuff pressure was main-

tained for 60 minutes and as-

sessment of digital perfusion

was performed at 10 minute in-

tervals using:

B: Laser Doppler Flowmetry

C: Pulse Oximetry

D: Skin Surface Fluorescence

Evalutaion of methods of

E: Skin Surface Temperature Mea-

detecting perfusion impairment

surement via a DermaTemp

(Levinsohn et al 1991).

Reconstructive Surgery

Despite satisfactory technical replanta-

tion, patients may develop vascular per-

fusion problems postoperatively, which

lead to marginally perfused tissue or to

failure.

Because any significant

change in perfusion is reflected as a

change in body surface temperature,

temperature measurement is an effec-

tive method of monitoring the ongoing

viability of replants and flaps¹.

Stirrat et al (1978) study on the

effect of temperature on digital

replantation

A study by Stirrat et al (1978)²on the

effect of temperature monitoring in digi-

tal replantation demonstrated a decline

in perfusion may be recognized earlier via temperature monitoring and

improvement gained by clinical measures before the need for reoperation

occurs. The objective temperature measurements allow a nurse or

nurses aide to follow condition, especially where skin color cannot be

followed easily, e.g. dark-skinned patients or with severely trauma

tized or ecchymotic digits, calling the physician for significant changes.

The technique is atraumatic, and avoids patient anxiety which produces

unwanted peripheral vasoconstriction. Temperature monitoring is also

inexpensive and readily available.

Lower Back Pain

Lower back pain is one of the most common complaints of patients

seeing a physician. Many complaints originate from work related acci-

dents and contribute to a tremendously large number of hours lost from

work. A study of 800 patients presenting with lumbar complaints and

radicular asymptomatology

by Weinstein et al³com-

pared the relative value of five

diagnostic modalities and

confirmed the accuracy of

temperature as a method of

confirming the presence or

absence of root syndrome in

low back pathology to be well

above the 90th percentile.

Barkan demonstrated that lumbar radiculopathy can be detected by

temperature measurement with accuracy equal to CT Scan or myelo-

gram.⁴These studies support the findings of many other similar stud-

ies,⁵,⁶,⁷,⁸,⁹and clearly support the use of temperature measurement

as a non-invasive technique without radiation, capable of reducing the

number of invasive and uncomfortable myelograms and expensive CT

scans of the lumbar spine.

Diabetic Foot Screening

Pedal infection is the most common cause of hospital admissions for

diabetic patients in the United States and Great Britan¹,²,³, with more

than 50% of the 125,000 amputations

performed in the United States each

year directly attributable to their dis-

ease.⁴The American Diabetes As-

sociation estimates the costs of treat-

ing lower extremity amputations ap-

proaches $10 billion annually, but in-

terestingly, data from the Centers for

Disease Control demonstrate up to

85% of diabetic foot and leg amputa-

tions can be prevented.

Temperature is an early indicator of foot problems in diabetic patients⁵.

Long before any clinical manifestations, heat can be detected, and the

more sensitive the detection instrument, the earlier the warning.. As a

key indicator of complications from the disease, temperature has been

incorporated into routine diabetic foot screening protocols.⁶

Two foot problems of major concern are foot ulcers and neuropathic

fractures. Because of peripheral neuropathy, diabetic patients may not

feel pain, and can continue walking on the foot. If the problem is not

identified and treated in a timely fashion, they are at high risk for ulcer-

ation, infection, and deformities, with amputation of a lower limb always

a real and devastating complication.

Using the DermaTemp for temperature monitoring in diabetic foot screen-

ing can immediately determine the thermal geography of the area of

concern, identify hot spots, and locate cool areas. As a diagnostic

tool, it is objective and quantifiable. Because it is relatively insensitive

to user technique, many physicians have recommended their patients

monitor their own foot and leg temperatures with the DermaTemp as

part of their patient’s self-care program.

Peripheral Nerve Injury

Temperature monitoring can be used in the quantification of peripheral

nerve injury, differentiating among organic nerve damage, psychogenic

factors, or even malingering.⁷Skin temperature is altered in the field of

an impaired peripheral nerve due to sympathetic vasomotor disturbance.

Skin temperature in a normal individual differs between sides of the

body only 0.24 ± 0.073°C. In patients with peripheral nerve injury, the

temperature of the skin innervated by the damaged nerve deviates an

average of 1.55°C.⁸,⁹,¹⁰

Temperature monitoring has been found to be highly successful in iden-

tifying the difficult pain problems e.g., diabetic or ischemic radiculopathy,

facial pain syndrome, carpal tunnel, whiplash injuries of neck and up-

per back, and the phantom limb pain seen in amputees.

Cerebrovascular Disorders

Temperature monitoring is a useful method for screening for cerebrovas-

cular disease before subjecting the patient to the risk of invasive proce-

dures. In the evaluation of extracranial carotid complex, temperature

monitoring demonstrates a high degree of sensitivity in detection of

hemodynamically significant stenosis of the internal carotid artery.¹¹

Early detection allows the physician to institute appropriate therapy before

a stroke occurs.¹³

Neonatal Skin Temperature

The goal of neonatal thermal management is to establish an environ-

ment of thermoneutrality in which the metabolic heat production re-

quirement is minimal. Perlstein¹⁴indicates that both the core and sur-

face temperature of the neonate are required to quantify the rate of

heat loss. The greater the difference between core and surface tem-

peratures, the greater the heat loss from the infant. (This holds only if

vasomotor activity is absent, as is the case for a neonate.) A typical

surface temperature for minimum heat loss is indicated as 36.0-36.5°C

(96.8-97.7°F).

Conventional thermal sensor systems are sensitive to the thermal con-

tact resistance between the surface of the patient and the surface

mounted device. A large thermal resistance will result in inaccurate

surface temperature readings, tending to be on the low side of the ac-

tual surface temperature. This technique requires time for the sensor

to equilibrate and great care in the surface mounting methodology for

accurate measurements. As a consequence, conventional surface

detectors are usually used to monitor one location on the neonate and

multiple site readings are rarely taken.

Infrared thermometry provides a method

for accurate surface temperature mea-

surements on multiple skin surface loca-

tions. The infrared technology has a short

one-second time interval between read-

ings, is essentially independent of user

technique, and has no variable thermal

contact resistance problem. The capabil-

ity of rapid and accurate multi-surface temperature measurements pro-

vides the clinician a new and expanded method for the assessment of

heat loss from the body surface of the neonate.

Wound Management

Increased skin temperature has long been associated with infection,

thus measuring the changes in skin temperature in the area of incision

or trauma when compared to the surrounding tissue provide the neces-

sary quantifiable information for early recognition of such infections,

well before the process has caused any visible skin changes.

Temperature measurement is especially useful for early diagnosis of

postoperative wound infections¹, those at the IV site, and decubitus

ulcers, for example, and provides for routine quantification of the infec-

tion and subsequent monitoring of the healing process in an objective

manner by the clinical staff.

Thermal Assessment of Skin Diseases and Allergy

Temperature monitoring provides an objective assessment of skin dis-

eases²as well as allergy and vasomotor tests³since most of the skin

diseases, or the percutaneous injection of pharmacodynamic substances

used for testing, generate significant changes in the thermal pattern of

the skin.

Skin Temperature in Prognosis of the Critically Ill

Skin temperature has been the subject of several studies monitoring

blood flow in the critically ill.

Data from these studies in-

dicate increases in the tem-

perature of skin, especially

the big toe, were accompa-

nied by improvement in the

clinical status of the patient,

and significantly greater

survival. Boycks and Weil⁴

concluded toe temperature

provided the best correlation

with cardiac index and prog-

nosis of survival compared

to arm, finger, thigh, or rec-

tal temperatures.

Toe temperature vs. cardiac index

(Boycks et al)

Kholoussy et al (1980)⁵demon-

strated attainment of normal rec-

tal-toe temperature gradient con-

sistently coincided with hemody-

namic stabilization of the patient

as indicated by other simulta-

neously measured parameters

and by the clinical condition. In

all the patients that died, rectal-

toe temperature gradient gradu-

ally and progressively increased

Toe temperature as a prognosis

as the patient’s condition became

(Boycks et al)

terminal.

Monitoring central peripheral temperature gradient was determined can

accurately reflect the state of peripheral circulation, though may be lim-

ited by peripheral vascular disease, central hypothermia, and the use

of vasoactive drugs.

Temperature Gradients in Detection of Shock

Temperature monitoring of the gradient between forehead and sole tem-

peratures has been demonstrated to provide early detection of masked

symptoms during and after surgery. The effect of treatment and the

prognosis for the patient are predictable according to the trends of the

two temperatures as divergent or convergent. The dissociation when

the two temperature are more than 7°C apart from each other suggests

that the hemodynamical condition is worse than in the convergence

when they remain within 2°C.¹

The blood flow in finger skin is known to be very susceptible to sympa-

thetic nervous activity. Palm tissue temperature varies more with the

emotional stress than does sole tissue temperature. Assuming fore-

head and abdominal readings correspond to core temperature,²and

sole and palm readings to shell temperature, the hemodynamical con-

dition in convergence is usually better than in dissociation. If dissocia-

tion is observed in a post-op patient, the hemodynamical parameters

have to be checked. When the arterial systolic pressure is less than 90

mmHg and the urine output less than 1ml/min/mg, a state of shock can

be diagnosed based on the dissociation (difference >7°C).

A chilling sensation or shivering is common in dissociation, however,

the symptoms can be overlooked in the patient just after surgery be-

cause an intubated patient cannot complain of a chilling sensation, and

shivering does not occur in patients whose muscles are flaccid owing

to residual pharmacological effects of anesthesia. Monitoring of the

patient’s body surface temperature allows for early detection of shock

in postoperative patients with minimum discomfort and maximum safety

to the patient.

Raynaud’s Syndrome

Temperature monitoring of patients

with Raynaud’s Syndrome provides

a useful, non-invasive method of

quantifying temperature and heat

patterns in determining the underly-

ing pathogenesis of Raynaud’s at-

tacks, and in the evaluation of any

subsequent therapy. Temperature

Evidence of Raynaud’s Syndrome

monitoring may also be useful diag-

nostic tool in differentiating primary

from secondary Raynaud’s. Preliminary research data suggest

Raynaud’s may be a common denominator in certain sleep disorders.

Many patients with connective tissue diseases present with Raynaud’s

_{Download from Www.Somanuals.co}2_m7_{. All Manuals Search And Download.}

phenomenon, particularly those with scleroderma and progressive sys-

temic sclerosis where it is the first symptom in 90% of cases, and may

precede other manifestations by many years.^{3 ,4}

Other Areas or Applications of Interest

•

Bone Fractures

Diabetic Neuropathy

Oncology

Stress Fractures

Breast Cancer Screening

Diseases of Scrotum and/

or Testicles

Orthopedic Surgery

Trigger Points

Burn Injury

Hansen’s Disease

Pagets Disease

Tumor Screening

Carpal Tunnel Syndrome

•

Headache Clinic

Pain Management

Varicocele Detection

Cerebral Vascular Dis-

ease

•

Joint Trauma

Peripheral Nerve Injury

Vascular Obstruction

Nerve Root Compression

Soft Tissue Injuries

Dentistry

•

Neuromuscular Injury

Sports Medicine

_{Download from Www.Somanuals.com. Al}2_{l M}8_{anuals Search And Download.}

IV. References

Chambliss J. Case of traumatic femoral aneurism (sic) treated by digital compression-

ligation afterwards of the external iliac artery. Confederate States Med Surg J, 1:97-

99,1864.

²Coar T. The Aphorisms of Hippocrates with a Translation into Latin and English 88 (AJ

Valpy, London 1822).

³Robertson T. Clinical Temperature Measurement - Survey. CEC/Bell & Howell.

Uematsu S, Thermographic imaging of cutaneous sensory segment in patients with

peripheral nerve injury. J Neurosurg, Vol 62, 717-720, May 1985.

⁵Chamberlain DP, Chamberlain BDL. Changes in the skin temperature of the trunk and

their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology

65:139-143, 1986.

⁶Shin Y, Pearson L, Burnett M. Anesthesiology V77,No 3A,Sep 1992.

⁷Guadagni DN, Dreith F, Smyth CJ, Bartholomew BA. Skin temperature as an indicator of

joint inflammation, ISA BM 74321 (105-110), 1974.

⁸Levinsohn G, Gordon L, Sessler DI: Comparison of four objective methods of monitoring

digital venous congestion; J Hand Surgery, Vol 16, No 6, 1056-1062, Nov 1991.

Bloomenstein RB, Viability prediction in pedicle flaps by infrared thermograpy: Plast.

Reconstr. Surg. 421:452-461, 1968.

Sirrat CR, Seaber AV, Urbaniak JR, Bright DS. Temperature monitoring in digital

replantation. J of Hand Surg, Am Soc Surg of the Hand, 1978.

¹¹Weinstein SA, Weinstein G. Thermography, EMG, CT Scan, Myelography and Surgery in

800 Patients: Georgetown University Medical Center, 14th Ann Meeting, Am Acad of

Thermology.

Barkan I, Thermography: A useful adjunct to differential diagnosis: lumbar radiculopathy

versus plexopathy in 10 cases. Georgetown University Medical Center, 14th Ann Meeting,

Am Acad of Thermology

Albert SM, Glickman M, Kallish M: Thermography in orthopedics, Ann NY Academy of

Science 121, 157-170, 1964.

Heinz ER, Goldberg HI, Taveras JM: Experiences with thermography in neurologic

patients. Annual NY academy of Science 121:177-189, 1964.

Raskin M, Martinez-Lopez M, Sheldon JJ: Lumbar thermography in discogenic disease.

Radiology:119:149-152, 1976.

¹⁶Tischauer IR: The objective corroboration of back pain through thermography. J Occup

Med:19;727-731, 1977.

Ching C, Wexler CE: Peripheral thermographic manifestations of lumbar disc disease.

Appl Rad:100:53-58, 1978.

Levin ME: Pathophysiology of diabetic foot lesions. In Davidson JK (ed): Clinical

Diabetes Mellitus: A Problem-Oriented Approach, p504. Theime Medical, NY, 1991.

Gibbons G, Eliopoulos GM. Infection of the diabetic foot. In: Kozak GP, Hoar CS,

Rowbotham JL, (eds). Management of Diabetic Foot problems. 97-102, WB Saunders,

1984.

Pliskin MA, Todd WF, Edelson GW. Presentations of Diabetic Feet. Arch Fam Med,

3:273-279, 1994.

Most RS, Sinnock P. The epidemiology of lower extremity amputations in diabetic

individuals. Diabetes Care, 6:87-91, 1983.

Bergtholdt HT. Thermography on insensitive limbs: Medical Thermography, Theory and

Clinical Applications 69-79, ed Uematsu S, Brentwood Publishing Co., Los Angeles, 1976.

Dorgan MB, Birke JA, Moretto JA, Patout CA, Rehm BD: Performing foot screening for

diabetic patients. AJN 32-37, Nov 1995.

Uematsu S: Thermographic imaging of cutaneous sensory segment in patients with

peripheral nerve injury. J Neurosurg 62:716-720, 1985.

Rasmussen TB, Freedman H: Treatment of causalgia: analysis of 100 cases. J

Neurosurg 3:165-173, 1946.

Uematsu S, Shendler N, Hungerford D, et al: Thermography and electromyography in the

differential diagnosis of chronic pain syndromes and reflex sympathetic dystrophy.

Wexler CE, Small RB: Thermographic demonstration of a sensory nerve deficit. J Neurol

Orthoped Surg 3:73-75, 1981.

Ackerman RH, Noninvasive diagnosis of carotid disease in the era of digital subtraction

angiography; Neurol. Clin:1;70-85, 1983.

Abernathy M, Nichols R, Robinson C, Brandt M. Noninvasive testing for carotid stenosis:

Thermography’s place in the diagnostic profile. Thermology;1;61-66, 1985.

Abernathy M, Chang L, et al. Cerebrovascular thermograhy: technique and quality

control. Am Acad of Thermology Ann Mtg. Georgetown University Medical Center, 1985.

Perlstein P: Future directions for device design and infant management. Medical

Instrumentation 21:1;36-41;Feb, 1987.

Robicsck F, et al. The value of thermography in the early diagnosis of postoperative

sternal wound infections. Thorac. Cardiovasc. Surg. 32, 260-65, 1984.

Warshaw TG, Lopez F: Thermoregulatory function in skin: an aspect of psoriasis. Acta

Thermographica 5:22, 1980.

Stuttgen G: Thermographic evaluation of the benign diseases and reactive changes of

the skin: Biomedical Thermology, ed Gautherie M, Albert E. 397-411, Alan R Liss, Inc., NY,

1982.

Boycks E, Weil MH. Toe temperature as an indication of blood flow in the critically ill.

Biology and Medicine, Ch 190, 2073-2078.

Kholoussy AM, Sufian S, Pavlides C, Matsumoto T: Central peripheral temperature: its

value and limitations in the management of critically ill surgical patients. Am J of Surgery,

Vol 140:609-612, Nov, 1980.

³⁷Tsuji T: Patient monitoring during and after open heart surgery by an improved deep body

thermometer. Medical Progress Through Technology 12, 25-38, Martinus Nijhoff

Publishers, Boston, 1987.

Benzinger TH. Heat regulation; Homeostasis of central temperature in man. Physiol Rev

49:671-759, 1969.

Basset LW, Gold RH, Clements PJ, Furst D. Hand thermography in normal subjects and

scleroderma, Acta Thermographica:5:19-22, 1980.

Haberman JD, Ehrlich GE, Levenson C: Thermography in rheumatic diseases. Arch.

Phys. Med and Rehab 49:187-191, 1968.

V. Product Specifications

Clinical Accuracy

Temperature Range

Operating Environment

Resolution

± 0.2°F or 0.1°C

65 to 110°F (18 to 43°C)

60 to 110°F (16 to 43°C)

0.1°F or °C

Response Time

Emissivity Compensation

Approximately 0.1 second

Automatic

Time Displayed on Screen

Battery Life

10 Seconds

Approximately 5,000 readings

Case Dimensions

3.5" x 7" x 0.75"

(9 cm x 18 cm x 2 cm)

Weight

9 oz (255 gm)

Case Shielding

Complete copper coating for EMI and RFI

protection

Display Type and Size

Construction

Large, bright red LED’s, easily readable in

any lighting

Industrial duty, impact resistant casing, her-

metically sealed sensing system

NIST

Certifiable traceable calibrations

ASTM

Meets or exceeds standards for electronic

and radiation thermometers.

Patents

Protected by one or more of the following

US patents: 6056435, 6047205, 6045257,

5893833, 5874736, 5653238, 5628323,

5445158, 5381796, 5325863, 5199436,

5017019, 5012813, 4993419, 4874253,

4636091, RE035554, D03708. Other US

and foreign patents pending.

_{Download from Www.Somanuals.co}3_m1_{. All Manuals Search And Download.}

Five Year Warranty

Exergen Corporation warrants each new Exergen DermaTemp (ex-

cept battery) against defects in materials or workmanship for a

period of five years from the date of purchase, and agrees to repair

or replace any defective product without charge.

IMPORTANT: This warranty does not cover damage resulting from

accident, misuse or abuse, lack of reasonable care, the affixing of

any attachment no provided with the product or loss of parts or

subjecting the product to any but the specified battery.* Use of

unauthorized replacement parts will void this warranty.

Exergen Corporation will not pay for warranty service performed

by a non-authorized repair service and will not reimburse the cus-

tomer for damage resulting from warranty service performed by a

non-authorized repair service. No responsibility is assumed for

any special, incidental or consequential damages.

In order to obtain warranty service, simply call Exergen Corpora-

tion Customer Service, 617-923-9900, for an Return Material Au-

thorization number (RMA). Then send the product, postage or

shipping prepaid, to Exergen in accordance with the instructions

given with the RMA number. It is suggested that for your protec-

tion, you ship the product, insurance prepaid. Damage occurring

during shipment is not covered by this warranty.

NOTE: No other warranty, written or verbal, is authorized by

Exergen Corporation. This warranty gives you specific legal rights

and you may also have other rights which vary from state to state.

Some states do not allow the exclusion or limitation of incidental or

consequential damages, so the above exclusion and limitations

may not apply to you.

EXERGEN

Straight From the Heart°

EXERGEN CORPORATION . 51 WATER STREET . WATERTOWN, MA, 02472

PHONE: 617.923.9900 . FAX: 617.923.9911

WWW.EXERGEN.COM

P/N: 818511 Rev 1

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