Infrared thermography technology has improved dramatically in recent years and is gaining renewed interest in the medical community for applications in skin tissue identification applications. However, there is still a need for an optimized measurement setup and protocol to obtain the most appropriate images for decision making and further processing. Nowadays, various cooling methods, measurement setups and cameras are used, but a general optimized cooling and measurement protocol has not been defined yet. In this literature review, an overview of different measurement setups, thermal excitation techniques and infrared camera equipment is given. It is possible to improve thermal images of skin lesions by choosing an appropriate cooling method, infrared camera and optimized measurement setup.

Breast reconstruction with an autologous free Deep Inferior Epigastric Perforator (DIEP) flap is one of the preferred options following mastectomy. A challenging step in this procedure is the selection of a suitable perforator that provides sufficient blood supply for the flap. The current golden standard for perforator mapping is computed tomography angiography (CTA). However, this is a relatively expensive imaging modality that requires intravenous contrast injection and exposes patients to ionizing radiation. More recently, dynamic infrared thermography (DIRT) has been proposed as an alternative imaging modality for perforator identification. DIRT appears to be an ideal alternative technique not only for the identification of the dominant perforators, but also for the mapping of the individual influence of each perforator on the flap perfusion. Multiple studies have been performed with the use of DIRT, unfortunately without standardisation of the measurement set-up. In this technical note we propose a standardised and reproducible measurement set-up for the use of DIRT during breast reconstructions with a free DIEP flap. This set-up can be used pre-, intra- and postoperatively. A standardised measurement set-up will improve the quality of measured data and ensure reproducibility.

Skin cancer is a significant global health issue, placing a growing burden on individuals and society. Conventional diagnostic methods like visual examination and biopsy have limitations in invasiveness and accuracy. As a result, alternative tools such as infrared thermography have gained attention in skin cancer diagnosis. Tissue-mimicking phantoms have been instrumental in facilitating research in this field, offering controlled environments. While they do not fully replicate human skin complexity, physical skin models provide stability, ease of fabrication, and control over properties. Agarose phantoms are employed in this study. This research focused on testing and comparing cooling techniques for human skin in the context of skin cancer diagnosis using dynamic infrared thermography. Six cooling methods were investigated: a cool pack, an aluminum medal, ice, alcohol, a vortex cooler and a Zimmer Cryo 6 cooler. The experimental setup involved an infrared camera (Optris Xi400) with microscope optics positioned above an agar phantom mimicking flat skin and an ulcerating skin lesion. Based on experiments conducted on the skin phantom, it was observed that convective cooling methods offered more consistent and uniform cooling. Conversely, conductive methods proved effective for flat objects but posed challenges in achieving uniform cooling for bulging skin or ulcerated lesions. Ice or alcohol were deemed unsuitable due to artifacts influencing the infrared radiation and thermal camera view. A decision matrix assessed cooling techniques based on criteria such as uniformity, repeatability, view obstruction, efficiency, workload, patient comfort, clinical suitability, noise exposure, consumables, additional equipment, and price. The Zimmer Cryo 6 cooler emerged as the most suitable cooling method after evaluating various factors.