From state-of-the-art neurophysiologic imaging and radiographic analysis to adjustive procedures, AUCB is unique when compared to other upper cervical techniques. Its foundation is built upon Dr. Palmer's 15 years of unprecedented research into the effects of upper cervical technique on the global physiology of the human body. Since that time, decades of clinical research and recent advances in diagnostic technology have caused an evolution in Dr. Palmer’s procedures to form what we currently know as Applied Upper Cervical Biomechanics.

    For over 100 years the foundational premise of our profession has been that health and disease are nervous system dependent; and that the spinal adjustment restores the human nervous system to normal function. AUCB is the only upper cervical technique to maintain that objective neurophysiologic infrared imaging be used on every patient encounter both before and after an adjustment is rendered to substantiate this premise. Without an objective analysis of neurophysiology, it is impossible to determine if neuropathophysiology is present and if the adjustment has effectively restored normal nervous system function to the patient. The IUCCA was the first upper cervical association to incorporate peer-review research based normative data for the detection of abnormal neural function via paraspinal digital infrared imaging. We as a profession insist that we can improve nervous system function, those that practice AUCB can objectively prove it.

    To determine the adjustment listing capable of producing maximal neurologic benefits, AUCB uses a complex and unique form of upper cervical radiographic analysis. The entire cervical spine is analyzed arthrokinematically for aberrant function of the upper cervical articulations. This information is used to determine the precise line-of-drive for adjustment procedures to the first, second, or third cervical segments. Adjustments based on this system of analysis have consistently produced full body neurophysiologic benefits on patients, which has been objectively substantiated by both high-resolution camera and paraspinal infrared imaging.

    The adjusting procedures used in AUCB are a modified form of that which was used by Dr. Palmer. Research performed on over 3,000 individual case radiographs has shown that a reliable C1 transverse process contact point can only be achieved in approximately 5% of patients. With this in mind, AUCB uses a specialized adjusting table that allows for a precise contact on the osseous spinal structures in the upper cervical spine. The design of the table also facilitates joint cavitation and full control over all line-of-drive vectors (Modern arthroscopic and cineradiographic research has demonstrated the need for both precise line-of-drive and cavitation to resolve intra-articular adhesions in order to restore normal arthrokinematics). Consequently, lateral C1 transverse process approaches, drop table use, and the inadequate force transference used in many upper cervical techniques has demonstrated significantly lower reliability in resolving objective signs of neuropathophysiology.

    The main objective of AUCB is to increase the predictability of clinical results, thus improving the percentage of patients that respond to care. The IUCCA is constantly striving, through continued research, to increase this percentage. As such, we are always open to any new form of care that can objectively demonstrate consistent improvements in neurophysiologic responses over what we currently observe clinically. As health care providers, we should all be continuously seeking ways to provide better care for our patients – salus populi est suprema lex.

As published in the editorial section of the Journal Today’s Chiropractic; Vol 24, No 2: 8-11

     The following comments are in response to Dr. John F. Hart's rebuttal ("The Reliability of The Thermal Analysis") to the article ("The Evolution of Modern Paraspinal Thermography") in the Letters to the Editor section of the Volume 23, Number 5 issue of your journal.

     A colleague of ours recently brought Dr. Hart's letter to our attention as it pertained to our individual areas of expertise. We read with great interest both the original article on paraspinal thermography and Dr. Hart's rebuttal on thermocouple and infrared (IR) sensor technology. Since the debate over thermocouples and IR sensors should no longer be an issue, and certain errors were made in his rebuttal, we felt it necessary to respond to Dr. Hart's opinions on the reliability of paraspinal thermocouple instruments.

     A simple definition is in order before we begin this discussion: Thermometry is defined as "the measurement of temperatures", while Thermography is defined as "the technique of measuring and graphically recording variations in temperature" (Dorland's Medical Dictionary 27th Ed.). As it can be seen from these definitions, thermography (or the most up-to-date terminology – Digital Infrared Imaging) would be the correct term to use regarding the application of both camera and paraspinal instruments which measure and graphically record thermal variations.

     Dr. Hart mentioned that others were not aware that when performed on the same patient both thermocouple and infrared paraspinal thermographic instruments would "generally" obtain the same results. With many tests performed in this area it has been found that thermocouple and IR instruments would "generally" detect the same paraspinal thermal variations, but only if the emissions were of a fairly significant magnitude. This is extremely important as many diagnostic thermal patterns can be very subtle, thus necessitating the use of a very sensitive and stable imaging instrument.

     The most significant issue regarding the use of thermocouple instruments is the basic tenant under which the sensors must function. Thermocouples require contact with the skin thus invoking the Zeroth Law of Thermodynamics. The Zeroth Law basically states that when two objects of differing temperatures come into contact the temperature of both of these objects are now changed. This is the simple act of thermal conduction, the two objects of different temperatures are striving towards thermal equilibrium. Thus, when the thermocouples come into contact with the patient they change the actual temperature of the skin. The temperature, or differential, now recorded is a false representation of what is actually present. Since the actual temperature of the skin has been either cooled or warmed (depending upon the temperature of the detectors and the skin) the temperature differential will have to be fairly significant for the thermocouples to be able to detect and record this information. If the differential is subtle the thermocouples have the ability to change the temperatures enough to create a zero reading (a straight line graphic readout) when an actual differential is present. The technique of acclimating, or seasoning of the sensors before a scan is initiated (an attempt at equilibration), may slightly improve thermal detection, but the Zeroth Law is still in effect. Even though the sensors are now warmed, if a cooler or warmer area of the skin is encountered the sensors are still at a different temperature and will change the actual temperature of the skin.

     Thermocouples also necessitate a certain amount of pressure on the skin in order to ensure that every detector is in contact. This pressure alone can be significant enough to alter the temperature of the skin. Dr. Hart mentioned that thermocouples and IR sensors "generally" obtain the same results due to the body's use of hypothalamic (central) control of thermoregulation and not peripheral (Textbook of Medical Physiology 7th Ed. -- Guyton). It is true that the hypothalamus acts as the body's central thermal regulator, but unfortunately Dr. Hart must be unaware of the local mediators of skin temperature. Neural afferent/efferent feed back loops to and from the cord mediate aberrant sensory input from the skin, muscles, ligaments, and joints (Principles of Neural Science 3rd Ed. pgs. 387,771. Indexed references available upon request) which can change the vasoregulation of the dermis via the intermediolateral cell column (sympathetic NS control). Any pain and/or abnormal pressure sensation can also alter the dermal microcirculation. The liberation of substance P, histamines, bradykinins, prostaglandins, etc. in the tissues under the thermocouples will impart a vasodilatory effect in response to this insult. These inflammatory chemicals can also alter the dermal vasculature via the aberrant sensory feed back pathway mentioned above, thus further changing the temperature under the thermocouple sensors (Textbook of Medical Physiology 7th Ed. -- Guyton, pgs. 220,857. Principles of Neural Science 3rd Ed. pgs. 387,771. Indexed references available upon request). Anyone who has experience with the use of thermocouples has noted this effect when post scanning paraspinal hyperemia is produced on a patient's back. IR paraspinal instruments avoid all of these problems as they do not make contact with the skin.

     Another problem encountered with the use of thermocouple instruments is their lack of data presented for interpretation. As of this time we are unaware of any instruments of this type which yield readouts of direct paraspinal temperature data. It must be understood that it is possible to have the same differential readout on the same patient on different office visits with the direct paraspinal temperatures being absolutely opposite. For doctors using "pattern" analysis as an indicator for adjustive care, this would be critical. A patient presenting with the same established differential pattern, but with opposite direct temperatures would not be in "pattern". Current computerized IR paraspinal instruments display both the differential and direct thermal emissions while thermocouple instruments produce readouts of only the differentials.

     It is also interesting to note that some doctors today still purpose that the thermal emissions detected at the surface of the skin are from heat given off of the cord, nerve roots, and/or peripheral nerves. This idea dates back to theories espoused during the 1920's. Others have also hypothesized that differences in surface skin heat were directly from diseased organs (Hippocrates). Landmark research on the origin of skin surface temperature regulation has laid to rest all of these theories. In a single, but elegant study, an independent heat source of significant magnitude (just below tissue burn threshold) was placed under the skin and an attempt to detect it was made with sensitive thermal instruments. It was found that if a heat source was placed 5 mm or more under the skin it would not be detected (reference available upon request). Therefore, if a thermal emission is detected at the surface of the skin, it must be a direct reflection of the control factors involved (sympathetic nervous system) with the regulation of the dermal microvasculature.

     The debate over thermocouple and infrared paraspinal instruments should no longer be an issue. Not only do instruments which use thermocouple sensors not produce reliable thermal information, but they also do not provide enough thermal data to make a proper diagnostic interpretation (subluxation or otherwise). An adequate understanding of the thermodynamics involved in the two differing systems, and the neurophysiology entailed with their use, will lend the interested doctor more than enough information to make an educated decision. 

     The use of infrared sensors in the detection of minute thermal emissions from the human body, evolved out of the need to eliminate the problems inherent in thermocouple use. Consequently, thermocouples have become obsolete as IR technology has replaced their use for thermal detection in both industry and health care. The combination of these highly stable and reliable sensors, along with computer processing of thermal data, represents the state-of-the-art in autonomic neurophysiological diagnosis.

Joseph R. Titone, M.S. (M.E.)
Instrumentation Engineer
Thermal Instrumentation/Controls Specialist
Iowa City, IA

William N. Dudley, D.C., D.A.B.C.T.
Diplomate American Board of Clinical Thermographers
Clinical Thermography Diplomate Program Instructor 
Howell, MI

As submitted to the editorial section of the Journal Today’s Chiropractic

     A group of local chiropractors have brought to our attention your thermography debate. Their questioning over the past few months is consistent with what we noticed in your journal responses. There seems to be a great deal of confusion regarding thermography, thermometry, and instrumentation. These doctors hope that we may be able to shed some light on this debate.

     First of all we are not here to start another debate, but to help in your search for the truth. We have been asked to comment on thermography due to our background in this area. Our combined expertise includes mechanical, electrical, and thermal engineering, physics, and research. In order for us to fully understand the nature of your debate, we were provided with past articles and letters to the editor of Today’s Chiropractic Journal along with manufacturer contacts, instrument demonstrations, and schematics. Consequently, we have a good understanding of these instruments from the NCM (and its copies) and other surface contact devices (liquid crystal, NCGH, Thermoscribe, Analagraph, Syncrotherm, etc.) to infrared systems (Camera, Visi-Therm, Accolade, DTG, TyTron, Insight 7000, etc.). With these things in mind we have been able to make an objective analysis of your debate.

     By the nature of the articles we have read, we find that a few definitions are in order. It was stated in one letter that, "Thermometry includes all instrumentation systems without the capability of producing a thermogram". This statement is incorrect. Thermometry is the branch of science concerned with the measurement of temperatures. Since many instruments that produce thermograms, such as camera units, can also yield direct temperature measurements, they concomitantly produce a thermometric analysis. Any instrument which uses an ambient temperature reference during its analysis, and can read out in numerical fashion, is performing thermometry. Another article noted that, "Thermography is the category of skin temperature analysis by means of a thermogram, which is a color picture of heat". This is also incorrect. Thermography is defined as the graphic rendering of temperatures. Thus, any instrument which produces some form of "image", whether a hard copy graph or digitized display, is considered thermography. Of interest, the pre-colorized black and white images produced by camera units are more accurate than the color representations. The digitized black and white images denote discrete areas of thermal emissions, while the color images represent color bands which span a range of a given temperature. In summary, for an instrument to fall under the classification of thermography, thus producing a thermogram, it does not have to: "produce a color picture of heat", "map entire dermatomal distributions", "produce a regional temperature mapping of the studied surface area", and/or "compare like sides of the body for symmetry". All the instrument has to do is produce a graphic rendering of the thermal emissions detected.

     From the information we gleaned in the articles, your debate seems to be centered around proper use of billing codes. We can understand that no one should be billing fraudulently. With assistance from our local chiropractors, we looked into the current thermography codes and realized your dilemma. There seems to be only one code to use for thermography. May we suggest a possible solution to this problem. After examining the instruments and images under question we feel that billing may best be made based upon the type of instrument used and the level of clinical training needed to read the thermograms. We have inquired into the training necessary to interpret the images from these different instruments. While some of these systems involve simple training others require extensive course instruction. Also, many of these instruments are limited to use on specific body areas while others can take images of any region. However, keep in mind that it is incorrect to say that "The accepted standard for thermography includes thermograms of the body, including extremities". Any single (one body area – i.e. face, arm, paraspinal) view/thermogram is considered thermography. One cannot redefine the term thermography to suit their own needs. It seems that different codes could be developed to reflect the exact extent of thermography used.

     To summarize, any instrument which produces a graphic readout (i.e. Accolade, Visi-Therm, TyTron, DTG, etc.), thus a thermogram, is defined as a thermographic unit and is performing thermography. Perhaps efforts would be best spent creating billing codes that will define the appropriate level of thermography based upon the type of instrument (i.e. paraspinal, low resolution, high resolution, etc.) used and the expertise necessary for interpretation. We hope this information has been helpful in clearing up some of your questions.

Robert S. Toth, Ph.D (Physics)

Ronald Gabel, B.S. (Physics)

David C. Brissey, B.S. (Engineering) 

Infrared Imaging References

     The following is a selection of references on infrared imaging. These references were selected mainly from index medicus, but also include texts and reference materials. This selection is only a small sampling from the more than 8,000 peer-reviewed thermographic studies in current circulation. However, when read together, the following studies and texts will yield a fair understanding of the significance, validity, and clinical use of infrared imaging.

1. Abernathy M, Nichols R, Robinson C, Brandt M. Noninvasive testing for carotid stenosis: Thermography's place in the diagnostic profile. Thermology 1985;1:61-66.

2. Academy of Neuromuscular Thermography. Standards for neuromuscular ther- mography. Clin Thermography 1989 (Aug).

3. Adatto KN, Phillips Sl, Manale BL, Watermeir JJ, Brickman I, Dudek BK. Ther- mography – a useful tool in the diagnosis of post-traumatic sympathetic dystrophy. Academy of Neuromuscular Thermography. 2nd Annual Meeting, Sept 1986. Modern Med 1987;30-34.

4. Albert SM, Glickman M, Kallish M. Thermography in orthopedics. Ann NY Acad Sci 1964;121:157-170.

5. Ash CJ, Shealy CN, Young PA et al. Thermography and the sensory dermatome. Skeletal Radiol 1985;15:40-46.

6. Adatto KN, Phillips Sl, Manale Bl, et al. CT and thermogram, a comparison of 91 patients. Orthop Trans 1985;9:215.

7. AMA Council on Scientific Affairs. Thermography in neurological and musculoskeletal conditions. Thermology 1987;2:600-607.

8. American Academy of Physical Medicine and Rehabilitation. Subcommittee on Assessment of Diagnostic and Therapeutic Modalities. December 1990.

9. American Chiropractic College of Thermology and ACA Council on Diagnostic Imaging, ratified by ACA House of Delegates. Policy statement on thermography. 1988.

10. American Chiropractic College of Thermology. Neuromusculoskeletal Thermographic Protocol. March 1988.

11. Basset LW, Gold RH, Clements PJ, Furst D. Hand thermography in normal subjects and scleroderma. Acta Thermographica 1980;5:19-22.

12. BenEliyahu DJ. Thermography in clinical chiropractic practice. ACA J Chiropractic. 1989;26(8):59-72.

13. Binder A, et al. A clinical and thermographic study of lateral epicondylitis. Br J Rheumatol 1983;22:77-81.

14. Brown R, Bassett LW, Wexler CE, et al. Thermography as a screening modality for nerve fiber irritation in patients with low back pain: A pilot study. Modern Med special suppl, Academy of Neuro-Muscular Thermography, Clinical Proceedings, 1987;86-88.

15. Brelsford KL, Uematsu S. Thermographic presentation of cutaneous sensory and vasomotor activity in the injured peripheral nerve. J Neurosurg 1985;62:711-715.

16. Cabot W, Bothe B. A multi-disciplinary treatment program for back and neck injuries utilizing computerized electronic thermography as a diagnostic tool. Clin Thermography 1989;145-150.

17. Chafitz N, Wexler CE, Kaiser JA. Neuromuscular thermography of the lumbar spine with CT correlation. Spine 1988;13(8):922-925.

18. Chang L, Abernathy M, O'Rourke D, et al. The evaluation of posterior thoracic temperature by telethermography, thermocouple, thermistor, and liquid crystal

thermography. Thermology 1985;1:95-101.

19. Clark RP. Human skin temperature and its relevance in physiology and clinical assessment. In: Francis E, Ring J, Phillips B, eta, Recent Advances in Medical

Thermology, New York: Plenum Press, 1984:5-15.

20. Conwell TD. Thoracic outlet syndrome: Current diagnostic concepts and case management. DC Tracts 1990;2: 164-180.

21. Chafitz N, Wexler CE, Kaiser JA. Neuromuscular thermography of the lumbar spine with CT correlation. Radiology 185 ;157-178.

22. Ching C, Wexler CE. Peripheral thermographic manifestations of lumbar disc disease. Applied Radiology 1978;100:53-58.

23. Conwell TD. Thermography in diagnosing myofascial pain syndromes and localizing trigger points. DC Tracts 1990;2(4):207-220.

24. Dali TF, Abernathy M, Luessenhop AJ, Stotsky G. Electronic thermography in the diagnosis of lumbosacral radiculopathy. Proc Cong Neurol Surg, Oct 1983.

25. Devereaux MD, Parr GR, Lachmann SM, et al. Thermographic diagnosis in athletes with patellofemoral arthralgia. J Bone Joint Surg 1986;68:42-44.

26. Diakow PRP. Thermographic imaging of myofascial trigger points. JMPT 1988; 11(2):114-117.

27. Drummond PD, Lance JW. Thermographic changes in cluster headaches. Neurology 1984;34: 1292-1298.

28. Duensing F, Becker P, Rittmeyer K. Thermographisehe befunde bet lumbalen bandscheibenprolapsen. Arch Psychiatr Nervenkr 1973;217:53-70.

29. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns: A study in normal volunteers. Spine 1990;15(6):453-457.

30. Edeiken J, Shaber G. Thermography: A re-evaluation. Skeletal Radiol 1986;15:545-548

31. Edeiken J, Wallace JD, Curely RF. Thermography and herniated lumbar discs. Am J Roentgenol 1968;102:790-796.

32. Editorial comment. Thermography as a diagnostic aid in sciatica: A comment on experimental methods, data interpretation, and conclusions. Thermology

1985 ;1 :55-58.

33. Fischer AA. Thermography in neuromusculoskeletal disorders. Technique and interpredation. Medical Thermography, Theory and Clinical Applications, Great Neck, NY, 1982.

34. Fischer AA. Advances in documentation of pain and soft tissue pathology. J Fam Med 1983;24-31.

35. Fischer AA. The present status of neuromuscular thermography. Post grad Med 1986:26-33.

36. Fischer AA, Chang CH. Thermographic documentation of trigger points: corroboration by pressure threshold measurements. In: Abernathy M, Uematsu S, eds. Medical Thermology. Washington DC: American Academy of Thermology, 1986;115-119.

37. Fischer AA, Chang CH. Temperature and pressure threshold measurements in trigger points. Thermology 1986;1(4):212-215.

38. Feldman F, Nickoloff L. Normal thermographic standards for the cervical spine and upper extremities. Skeletal Radiol 1984;12:235-249.

39. Fischer AA. Correlation between site of pain and "hot spots" on thermogram in lower body. Post grad Med 1986:99.

40. Fischer AA, Chang CH, Kuo JC. The value of thermography in the diagnosis of radiculopathy as compared with electrodiagnosis. Arch Phys Med Rehabil

1983,64:526.

41. Fischer A, Rim A, Chang C. Correlation between thermographic findings and so- matosensory cortical evoked potentials in lumbosacral radiculopathies. Thermology 1986;2:29-33.

42. Gelfand DW, Ott DJ. Methodologlc considerations in comparing imaging methods. Am J Roentgenol 1985;144:1117-1121.

43. Gillstrom P. Thermography in low back pain and sciatica. Arch Orthop Trauma Surg.1985;104:31-36.

44. Green J, Coyle M, Becker C, Reilly A. Abnormal thermographic findings in asymptomatic volunteers. Thermology 1986;2:13-l5

45. Goldberg, GS. Correlation of the lumbar thermogram with other procedures in 60 patients. 13th Annual Meeting American Academy Thermology, Washington DC, June 1984.

46. Goldberg G. Thermography and magnetic resonance imaging correlated in 35 cases. Thermology 1986;1:207-211.

47. Goldberg GS. Infrared imaging and magnetic resonance imaging correlated in 31 cases. Academy of Neuromuscular Thermography, 1st Annual Meeting, May, 1985. Postgrad Med 1986;54-58.

48. Green J, Reilly A, Schnitzlein N, Clewell W. Comparison of neurothermography and contrast myelography. Orthopedics 1986;9:1699-1704.

49. Hamilton B. An overview of proposed mechanisms underlying thermal dysfunction. In: Abernathy M, Uematsu S, eta, Medical Thermography, Washington, DC, American Academy of Thermology, 1986:6-18.

50. Hamilton BL. An overview of proposed mechanisms underlying thermal dysfunction. Thermology 1985;1:81-87.

51. Heinz ER, Goldberg HI, Taveras JM. Experiences with thermography in neurologic patients. Ann NY Acad Sci 1964;121:177-189.

52. Hendler N, Uematsu S, Long D. Thermographic validation of physical complaints in psychogenic pain patients. Psychosomatics 1982:23.

53. Herrich RT. Thermography as a diagnostic tool for carpal tunnel syndrome. 13th Annual Meeting American Academy Thermology, Washington DC, June 1984.

54. Hobbins WB. Thermography in sports medicine. In: Appenzeller O, ed. Sports Medicine, ed 3, Baltimore: Urban & Schwarzenberg, 1988:395-403.

55. Hodge SD, ed. Thermography and personal injury litigation. New York: Wiley, 1987.

56. Howe JF, Loeser JD, Calvin WH. Mechanosensitivity of dorsal root ganglia and chronically injured axons: A physiological basis for the radicular pain of nerve

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57. Hubbard JE. Statistical review of thermography in a neurology practice. Proceedings of the Ist Annual Meeting of the Academy of Neuromuscular Thermography, May 1985. Post grad Med special ed, Mareh 1986:65-72.

58. Hubbard JE. Neuromuscular thermography: An analysis of criticisms. Thermology 1990;3:160-165.

59. Hubbard JE, Hoyt C. Pain evaluation in 805 patients studied by infrared imaging. Thermology 1986;1:161-166.

60. Hubbard J, Maultsby J, Wexler CE. Lumbar and cervical thermography for nerve fiber impingement: A critical review. Clin J Pain 1986-2:131-137.

61. Head H. On disturbances of sensation with special reference to the pain of visceral disease. Brain 1983;16:1-133.

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63. Hobbins WB. Thermography and pain. In: Gautherie M, ed, Biomedical Thermology. New York: Alan R. Liss, 1982:361-375 .

64. Hodges DL, McGuire TJ. Burning and pain after injury: Is it causalgia or reflex sympathetic dystrophy? Pain Syndromes 1988;83(2):185-192.

65. Hubbard JE, Hoyt C. Pain evaluation by electronic infrared thermography: Correlations with symptoms, EMG, myelogram and CT scan. Thermology 1985; 1(1):26-35.

66. Jablecki CH. Thermography in carpal tunnel syndrome. In: Abernathy M, Uematsu So eds, Medical Thermology. Washington DC: American Academy of Thermology, 1986:153-157.

67. Jenkins JR, Whittemore AR, Bradley WG. The anatomical basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disc extrusion. Am J

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68. Joint Council of State Neurosurgical Societies of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Neurosurgical Clinical Procedure Review. 1988.

69. Karpman HL, Knebel A, Semel CJ, et al. Clinical studies in thermography: II. Application of thermography in evaluating musculoligamentous injuries of the spine. Arch Environ Health 1970;20:412-417.

70. Kelso AF, Grant RG, Johnston WL. Use of thermograms to support assessment of somatic dysfunction or effects of osteopathic manipulative treatment: Preliminary report. J Am Osteopath Assoc 1982;82:182-188.

71. Kudrow L. A distinctive facial thermographic pattern in cluster headaches-the "Chai" sign. Headache 1985;25:33-36.

72. Kundel HL. Disease prevalence and radiological decision making. Invest Radiol 1982;17:107-109.

73. Kirkaldy-Willis WH, ed. Managing low back pain, ed 2, New York: Churchill Livingstone, 1988

74. LaBorde TC. Thermography in diagnosis of radiculopathies. Clin J Pain 1989;5:249-253.

75. Leroy P. Intraoperative thermography. In: Abernathy M, Uematsu S, eds, Medical Thermography. Washington DC: American Academy of Thermology, 1986:293-295.

76. Leroy PL, Bruner WM, Christian CR, Filasky R, Leroy S. Neurosurgical thermography. Proceedings of the American Academy of Thermology, 1983:19-21.

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81. Meek JB, Gilbert SK. The role of thermography in the evaluation of low back disorders. J Neurol Orth Surg 1983;4:235-239.

82. Meeker WC, Gahlinger PM. Neuromusculoskeletal thermography. A valuable diagnostic tool? JMPT 1986;9(4):256-266.

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