(CS-128) Trends Observed in the Application of Thermal and Fluorescence Imaging for Infection and Wound Healing Assessment

Danielle Dunham, MHSc; Hanna Varonina, MSc, CCRP; Ron Linden, MD, CCFP, DRCPSC

Introduction:

Infrared thermography and bacterial fluorescence imaging make a powerful duo for assessing and monitoring wound healing. Literature suggests that differences in temperatures between wound bed and periwound area are indicative of whether a wound is on the healing trajectory^1-4. Furthermore, increased temperature has been associated with wound infection/inflammation^5-7. Fluorescence imaging accurately detects bacteria at levels impeding wound healing, which can lead to infection, while thermal imaging evaluates temperature of wound components. This multi-site case series explores the practical application of a device that integrates both imaging technologies, showcasing its potential to enhance infection diagnosis and wound treatment.

Methods:

A multicenter case series illustrates the findings obtained through a novel handheld device* that combines both thermal and fluorescence imaging modalities. Thermal images were captured approximately 5 minutes after wound undressing (acclimatization period) but before cleansing/debridement. Fluorescence imaging was performed after thermal imaging including capturing a co-registered fluorescence and thermal dataset. Clinicians used the thermal and fluorescence imaging data with standard clinical signs and symptoms, to improve their diagnosis of whether the wound was healing, likely inflamed, or likely infected.

Results:

15 wounds were imaged using the multi-modal device across 2 wound care centers. The trends observed included: [1] healing wounds showed lower wound bed temperatures compared to the periwound with negative fluorescence, [2] likely inflamed wounds showed higher wound bed temperatures compared to the periwound with negative fluorescence, and [3] likely infected wounds showed positive fluorescence with higher wound bed temperatures compared to the. In a few cases, lower wound bed temperatures compared to higher periwound temperatures were accompanied by positive fluorescence. These cases also showed an overall elevated temperature of the affected limb, prompting clinicians to investigate a suspicion of infection when also considering clinical signs and symptoms.

Discussion: Thermal imaging provided insights into various physiological aspects of the wound and surrounding skin, while fluorescence offered a closer look at bioburden. Consistent trends were observed regarding thermal findings that point to specific clinical conditions.  This approach enhanced the clinician’s standard assessment and understanding of wound healing status and diagnosis of infection, significantly improving clinical decision making in wound treatment.