Infrared Physics and Technology 95 (2018) 203–212

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Infrared Physics & Technology

journal homepage: www.elsevier.com/locate/infrared

Regular article

Establishing the thermal patterns of healthy people from Medellín, T

Colombia☆
María Camila Henao-Higuitaa,b, Alexandra Benítez-Mesaa,b, Hermes Fandiño-Torob,
Adriana Guerrero-Peñac, Gloria Díaz-Londoñoa,
⁎

a
Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Calle 73 No. 76A-354, Vía al Volador, Medellín, Colombia
b
Grupo de Automática, Electrónica y Ciencias Computacionales, Instituto Tecnológico Metropolitano, Carrera 31 No. 54-22, Medellín, Colombia
c
Grupo de Investigación Didactica y Modelamiento en Ciencias DaVinci, Instituto Tecnológico Metropolitano, Carrera 31 No. 54-22, Medellín, Colombia

ARTICLE INFO ABSTRACT

Keywords: Infrared Thermography has been used in the medical field to diagnose illnesses that produce temperature variations.
Infrared thermography Furthermore, comparisons between the temperatures of contralateral regions or patients and healthy people are used as
Thermal patterns thermography diagnostic criteria. Under both approaches, the difference in temperature is calculated and, if it falls outside
Healthy people normal ranges, it is considered a sign and symptom of illness. In previous works, the thermal patterns of healthy in-
dividuals have been determined in populations from Finland, Portugal, Taiwan, Brazil, and Mexico. However, a com-
parison of such patterns reveals meaningful discrepancies since the emissivity of the human skin depends on ethnic
characteristics and age. Thus, it is necessary to estimate thermal patterns in healthy people from each population and
calculate the maximum and minimum temperature differences in their contralateral regions. Specifically, the thermal
patterns of healthy Colombian people have not been established so far. Therefore, this work aims to define the thermal
patterns of the population of Medellín-Colombia. Such patterns can later be used as reference values to diagnose illnesses
in different hospitals in the city. Thirty-seven healthy individuals participated in this study. Data was acquired from the
anterior, posterior, right, and left side of the body using a FLIR A655SC thermal camera, and the acquisition protocol was
defined in accordance with the method of previous work. The camera recorded twenty-four thermograms from each
subject, which were segmented by region-growing and a grid mask algorithm, thus obtaining 43 regions of interest (ROI).
The mean temperature and standard deviations of each ROI were also calculated. In most regions, the mean temperature
varied between 31.16 °C and 34.58 °C. The lowest mean temperature and highest variability were found in acral regions.
Independent samples were assumed in the statistical analysis, and the normality of the temperature of each ROI was
verified by the Shapiro–Wilk test. Moreover, Student’s t-test and Mann–Whitney U test were used in the comparison of
temperatures of contralateral regions with normal and non normal distributions, respectively. Finally, the temperature
difference was found to be insignificant.

1. Introduction
Objects with temperatures above absolute zero emit wavelengths in the
electromagnetic spectrum called infrared radiation [1]. Infrared Thermo-
graphy (IRT) allows to acquire 2D images of such radiation from a body,
which can be used to detect the temperature distribution of objects in real
time [2–8]. This is an advantage in the medical field because changes in
body temperature allow to identify physiological variations that are asso-
ciated with various pathologies. In addition, IRT does not induce any risk to
human health, it is non-invasive, low-cost, and portable.
For instance, the joints of knees, ankles, fingers, and elbows of patients
with acute rheumatoid arthritis and osteoarthritis show high temperatures
due to inflammation and pain. Enthesiopathies, fibromyalgia, tennis elbow,
and muscle spasm and injury also present hot spots and swelling in different
muscles [1,3,4,6,9]. Similarly, the eyes of patients with dry eye syndrome,
Graves ophthalmopathy, and ocular diseases exhibit temperatures higher
than those of healthy people [1,10–13]. Additionally, the temperature of the
eyes can be used for fever screening [1,3,9].
Areas with low temperature (caused by cold stimulation, muscle con-
traction, and reduced motion) can appear in cases of Raynaud’s phenomenon,
carpal tunnel syndrome, thoracic outlet syndrome, long lasting injuries, os-
teoarthritis of the hip, and frozen shoulder [3,14–17]. Furthermore, the

Fully documented templates are available in the elsarticle package on CTAN.

☆

Corresponding author.
⁎

E-mail addresses: mariahenao191248@correo.itm.edu.co (M.C. Henao-Higuita), alexandrabenitez176383@correo.itm.edu.co (A. Benítez-Mesa),

hermesfandino@itm.edu.co (H. Fandiño-Toro), adrianaguerrero@itm.edu.co (A. Guerrero-Peña), gloriadlondono@itm.edu.co (G. Díaz-Londoño).

https://doi.org/10.1016/j.infrared.2018.10.038
Received 28 February 2018; Received in revised form 17 September 2018; Accepted 30 October 2018
Available online 31 October 2018
1350-4495/ © 2018 Elsevier B.V. All rights reserved.
M.C. Henao-Higuita et al.
Fig. 1. Set-up to measure the temperature of healthy people.
Fig. 2. Region of interest analyzed in this work for Right (R) and Left (L) side. 1.
Forehead. 2. R Eye, 3. L Eye, 4. Nose, 5. R Cheekbone, 6. L Cheekbone, 7. Mouth, 8.
Chin, 9. Neck, 10. R Helix, 11. R Outer ear, 12. L Helix, 13. L Outer ear, 14. R Thorax
and abdomen, 15. L Thorax and abdomen, 16. R Shoulder, 17. L Shoulder, 18. R
Forearm, 19. L Forearm, 20. R Elbow, 21. L Elbow, 22. R Arm, 23. L Arm, 24. R Wrist,
25. L Wrist, 26. R Palm, 27. R Thumb, 28. R Index, 29. R Middle, 30. R Ring, 31. R
Little or Pinky, 32. L Palm, 33. L Thumb, 34. L Index, 35. L Middle, 36. L Ring, 37. L
Little or Pinky, 38. R Thigh, 39. L Thigh, 40. R Knee, 41. L Knee, 42. R Leg, 43. L Leg.
comparison of temperatures between the affected and non-affected region is
one of the diagnostic criteria for diseases such as complex regional pain
syndrome, localized scleroderma, breast cancer, and diabetes neuropathy
[3,18]. In the case of localized scleroderma, a temperature difference over
0.5 °C between contralateral regions indicates lesion activity [19,20]. In sport
and exercise medicine, the assessment of bilateral asymmetry assumes a re-
levance to determine potential risks of injury and functional deficits of un-
healthy athletes and non-athletes [21].
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Infrared Physics and Technology 95 (2018) 203–212
In the above-mentioned cases, temperature differences between
contralateral regions or between healthy people and patients are cal-
culated and used as diagnostic criteria. Furthermore, if the temperature
differences are significant, they are considered a sign and symptom of a
disease. Otherwise, these differences fall within the temperature range
of normal healthy people or measurement uncertainty.
Nonetheless, the emissivity of the human skin changes according to
ethnic characteristics [1,9,22,23] and age[9,22,23]. This indicates that the
thermal patterns of healthy people are specific to each population and,
therefore, they should be established independently. Moreover, maximum
and minimum temperature differences between contralateral regions should
be calculated for each community that exhibits comparable ethnic char-
acteristics.
Some previous studies have established thermal patterns in healthy
Brazilian [9], Finnish [9,24], Portuguese [25], Taiwanese [26], and
Mexican populations [22]. In the case of Colombia, no work about
thermal patterns has been reported. However, as this is a multi-ethnic
nation and the average humidity and temperature change from city to
city, said patterns should be determined in each region of the country.
In order to establish thermal patterns, the segmentation methods should
be properly selected for each Region of interest (ROI) since they can affect the
final thermal results [27]. Anterior and posterior regions of different limbs of
the body have been considered in previous studies on thermal patterns of
healthy people [9,24,26]. The images were segmented using the software of
the thermal cameras, which allows to define circular, rectangular, and square
ROIs; however, these procedures can include background pixels, other ROIs,
or not consider pixels of the ROI under analysis. As a result, average and
standard deviations can change due to these extreme data [28]. Other works
have used Otsu’s method to segment thermal images [29–31]. For example,
Barcelos et al. [31] analyzed thermal images of the lower limbs of soccer
players. However, they combined Otsu’s method with a correction method
because the former has been reported to find inaccurate thresholds in thermal
images with large variances in object and background intensities; thus, er-
roneous segmentation results can be generated [31,32].
This study aims to establish thermal patterns of the population of
Medellín, Colombia, because this information can be used to diagnose
illnesses. Thermal images were acquired from the anterior, posterior,
right, and left side of the entire body, and 24 thermograms were re-
corded. A total of 43 ROIs were defined in each subject, including the
eyes, nose, ears, and mouth. Although these organs were not studied in
previous works about the thermal patterns of healthy adults, they can
be used to evaluate emotions, feelings, and stress [33–36].
The thermal images were segmented using the region-growing (RG)
segmentation method [37] and a grid mask algorithm written in Matlab.
These segmentation methods have not been used in previous works about
the thermal patterns of healthy people. On the other hand, these methods
allow to obtain an accurate definition of anatomical regions and provide
thermal results with small standard deviations. The mean temperature (T )
and standard deviations (SD) of each ROI were calculated, and the nor-
mality in the ROIs was verified by the Shapiro–Wilk test. In addition, Stu-
dent’s t-test and Mann–Whitney U test were applied in the comparison
between contralateral regions with normal and non normal distributions,
respectively. Independent samples were assumed in the statistical analysis,
and IBM SPSS Statistics 24 software was used.
2. Materials and methods
Thirty-seven healthy people participated in this study [average age:
27 ± 5 years, average height: 1.68 ± 0.07 m, average weight:
66.52 ± 9.19 kg, and average Body Mass Index (BMI): 23.43 ± 2.89 kg/
m2 ]. The group was composed of 17 females and 20 males who were
residents of Medellín. The thermograms were acquired using a FLIR
A655SC thermal camera with a long wavelength infrared band (7.5 to
14 µ m), a spatial resolution of 640 × 480 pixels, an accuracy of ± 2 °C,
and a NETD under 30 mK. Said camera uses FLIR R&D software 3.3.
A total of 24 thermograms were recorded from different views (anterior,
M.C. Henao-Higuita et al.
Fig. 3. Region-growing segmentation of forehead and neck ROIs. (a) Example of a thermogram. (b) Superimposition of forehead and neck ROIs on the thermogram in (a).
Fig. 4. The grid mask algorithm applied onto the trunk. (a) Example of a thermogram. (b) Superimposition of the grid mask on the thermogram in (a).
posterior, right, and left side) of each person in standing position. During the
measurements, men wore boxer shorts and women wore shorts (topless). As
recommended by previous studies, the participants relaxed for 15 min before
the measurements were taken. In addition, the subjects could not engage in
physical activity or present pain in any part of the body 12 h prior to the
measurements [1,3,24]. The subjects answered a survey that contained ex-
clusion criteria such as any illness that could affect skin temperature, other
types of alteration in the metabolism (the thyroid or the peripheral nervous
system), or if they had suffered any bone fracture. The female survey in-
cluded additional questions about hormonal cycle (menstrual period) and
gynecological conditions and processes such as lactation, myomas, cysts,
polycystic ovaries, and gestation, which served as exclusion criteria for
women. Moreover, participants were instructed to avoid smoking, drinking
alcohol, and energy and stimulating beverages in order to prevent thermal
alterations; they were also informed that skin creams and lotions should not
be applied on the skin [28]. All the subjects signed an informed consent
approved by the Ethics Committee of Instituto Tecnológico Metropolitano
(ITM).
2.1. Set-up to measure the temperature of healthy people
All the measurements were carried out in the doctor’s office at ITM in
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Infrared Physics and Technology 95 (2018) 203–212
July 2017. The room (4.36 × 5.20 m2 ) was adapted to prevent sunlight pe-
netration. The mean distance between the subject and the camera was 2.15 ±
0.08 m. This distance (d) was calculated with Eq. (1), which determines the
area (A) required to visualize images with the camera’s field-of-view (FOV).
The latter is defined by and , which represent the vertical and horizontal
aperture angles of the camera lens, respectively (FOV = × ). For the FLIR
A655SC camera, these values are = 19° and = 25°.
1/2
A
d=
4 × tan ( ) × tan ( )
2 2 (1)
Additionally, a black wood screen (2.00 × 1.20 ) was designed to
m2
frame each subject and provide a uniform background in the thermograms;
this structure is lightweight and can be easily moved. Fig. 1 shows the geo-
metric configuration inside the doctor’s office and the black wood screen.
2.2. Acquisition protocol
Most of the settings for the acquisition protocol were defined according to
recommendations in previous works [1,3,24,38]. The ambient temperature
was 25.63 ± 0.35 °C and the relative humidity, 48.76 ± 5.50 %. These
M.C. Henao-Higuita et al. Infrared Physics and Technology 95 (2018) 203–212

parameters were first measured at different times of the day in order to
identify the period that presented the slightest fluctuations. As a result, data
were collected in the morning, when the lowest level of fluctuations occurred
[38]. Temperature and humidity were measured with a hygro-thermometer
and recorded for each acquisition. Based on the results of the reflector
method proposed by ASTM standard E1862 [39], in this case the value of
reflected temperature was equal to the ambient temperature.
2.3. Thermogram processing
A series of codes written in Matlab were programmed for processing the
acquired thermograms. Additionally, 43 ROIs of each subject were segmented
(Fig. 2). The segmentation was carried out using the RG segmentation
method [37] and a grid mask algorithm. RG segmentation starts with a pixel
chosen as the seed and a TH value set as the threshold; based on them,
neighboring pixels are added. Finally, the algorithm stops when the differ-
ences between the region’s mean and new pixels are higher than TH [40].
The forehead, eyes, noise, ears, joints, and phalanges were segmented
with this algorithm. Fig. 3 shows the results of the RG segmentation of
forehead and neck ROIs. For a better visualization, each ROI is framed by a
black rectangle whose centroid (white dot) is the corresponding seed pixel.
During the experiments, RG segmentation proved to be a suitable method
because the TH threshold guarantees that the segmented regions do not
include pixels from the background of the thermograms.
The function of the grid mask algorithm is to apply a grid that di-
vides thermograms into square regions, which helps in the segmenta-
tion of comparatively large body regions, such as the trunk and thighs.
Fig. 4 shows the segmentation of the posterior side of the trunk.
2.4. Statistical methods
In this work, the sample size was determined according to accuracy
data, which depends on the margin of error (e) and a 95% confidence
level. Furthermore, the following expression was used to calculate the
optimum sample size [41–43]:
Z12 /2 SD
2
n=
e2 (2)
where n is the sample size and Z1 /2 is the value of standard normal dis-
tribution for a 95% confidence level ( = 0.05). In this case, Z0.975 = 1.96.
A pilot experiment with six subjects enabled to calculate the SD of
the temperature(0.4435) and define e as a value lower than 1% of T of
the trunk in the pilot experiment (0.145 °C). At this point, the sample
size was 36 subjects.

Table 1
Mean temperature and standard deviations (T ± SD) in °C and p-values (p) of Shapiro–Wilk test in % of the right (R) and left (L) ROIs under analysis.
View

Region of interest Anterior Right side Left side Posterior

T ± SD p T ± SD p T ± SD p T ± SD p

Forehead 34.56 ± 0.49 7.20 34.58 ± 0.46 7.00 34.54 ± 0.57 5.40 – –
R Eye 34.32 ± 0.37 5.10 34.29 ± 0.56 52.50 – – – –
L Eye 34.32 ± 0.41 25.00 – – 34.09 ± 0.47 78.10 – –
R Cheekbone 33.80 ± 0.62 27.70 34.16 ± 0.73 8.40 – – – –
L Cheekbone 33.75 ± 0.64 63.10 – – 33.91 ± 0.70 27.40 – –
Nose 33.71 ± 1.11 4.20 32.99 ± 1.50 0.20 33.54 ± 0.94 4.20 – –
Mouth 34.36 ± 0.38 15.10 34.34 ± 0.53 56.00 34.09 ± 0.37 87.40 – –
Chin 34.23 ± 0.55 53.30 34.18 ± 0.42 13.30 34.14 ± 0.46 39.30 – –
R Helix – – 31.16 ± 0.67 99.40 – – – –
L Helix – – – – 31.69 ± 0.70 73.50 – –
R Outer Ear – – 34.64 ± 0.50 45.40 – – – –
L Outer Ear – – – – 34.54 ± 0.48 0.47 – –
Neck 34.39 ± 0.52 65.80 34.42 ± 0.50 60.50 34.46 ± 0.58 20.80 34.04 ± 0.61 70.90
R Thorax and Abdomen 33.29 ± 0.82 99.90 32.97 ± 0.88 84.40 – – 33.02 ± 0.92 28.50
L Thorax and Abdomen 33.29 ± 0.83 90.40 – – 32.98 ± 0.87 65.00 33.09 ± 0.97 28.50
R Shoulder 33.54 ± 0.71 93.80 – – – – 32.94 ± 0.78 6.90
L Shoulder 33.53 ± 0.69 75.10 – – – – 32.76 ± 0.76 4.30
R Arm 32.94 ± 0.68 43.50 – – – – 31.72 ± 0.71 94.70
L Arm 32.89 ± 0.70 84.80 – – – – 31.60 ± 0.66 64.70
R Elbow 32.72 ± 0.62 18.70 – – – – 32.19 ± 0.62 6.80
L Elbow 32.64 ± 0.69 2.60 – – – – 32.02 ± 0.62 48.10
R Forearm 32.81 ± 0.64 16.10 32.81 ± 0.62 49.90 32.55 ± 0.53 44.50 32.50 ± 0.51 10.20
L Forearm 32.77 ± 0.66 9.70 32.72 ± 0.64 12.70 32.42 ± 0.59 75.10 32.47 ± 0.56 36.60
R Wrist 32.99 ± 0.75 49.40 32.72 ± 0.69 44.20 32.05 ± 0.93 57.80 32.33 ± 0.87 59.60
L Wrist 32.85 ± 0.75 60.60 32.69 ± 0.69 45.20 31.98 ± 0.86 10.80 32.18 ± 0.82 86.00
R Palm or Back 32.58 ± 1.31 12.90 – – – – 32.26 ± 1.23 15.70
L Palm or Back 32.47 ± 1.27 10.60 – – – – 32.15 ± 1.27 61.80
R Thumb 32.20 ± 1.47 17.40 – – – – 32.22 ± 1.57 1.10
L Thumb 32.24 ± 1.38 7.10 – – – – 32.10 ± 1.65 1.00
R Index Finger 31.83 ± 1.94 2.70 – – – – 32.10 ± 1.71 2.80
L Index Finger 31.83 ± 1.75 1.90 – – – – 32.25 ± 1.48 7.20
R Middle Finger 31.98 ± 1.75 7.80 – – – – 31.96 ± 1.93 1.30
L Middle Finger 31.85 ± 1.78 0.70 – – – – 32.46 ± 1.38 9.40
R Ring Finger 31.63 ± 1.98 6.90 – – – – 32.26 ± 1.65 5.50
L Ring Finger 31.93 ± 1.55 15.50 – – – – 32.17 ± 1.73 0.60
R Pinky 31.23 ± 2.34 1.60 – – – – 31.75 ± 1.92 6.50
L Pinky 31.61 ± 1.87 14.80 – – – – 31.26 ± 2.38 0.60
R Thigh 32.27 ± 0.67 53.20 31.99 ± 0.96 99.70 32.38 ± 0.65 67.60 32.10 ± 0.78 98.60
L Thigh 32.26 ± 0.69 47.90 32.40 ± 0.75 82.10 31.90 ± 0.89 82.40 32.16 ± 0.83 96.70
R Knee 31.39 ± 0.72 71.60 31.78 ± 0.68 45.60 31.75 ± 0.64 96.20 32.40 ± 0.57 26.30
L Knee 31.36 ± 0.76 91.60 31.68 ± 0.69 100.00 31.74 ± 0.71 87.20 32.44 ± 0.60 80.30
R Leg 32.12 ± 0.63 12.00 32.08 ± 0.62 20.70 31.93 ± 0.67 47.40 31.75 ± 0.63 79.10
L Leg 32.08 ± 0.68 73.70 31.90 ± 0.71 38.20 32.13 ± 0.69 11.30 31.81 ± 0.63 28.30

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In addition, the authors ensured that the temperature was normally
distributed; therefore, a sample size above 30 individuals provided a
good estimation of temperature (central limit theorem) [41–44].
Based on the considerations above, 37 healthy people were studied. The
statistic sampling technique used simple random sampling with a con-
fidence level of 0.95 and a sampling error of 0.145 °C; in addition, in-
dependent samples were assumed. The software IBM SPSS Statistics 24 was
used to analyze the results. T and SD were calculated for each ROI and the
Shapiro–Wilk test [44] was applied to evaluate the normality of the data.
Parametric and non-parametric tests were carried out on contralateral
ROIs in order to define temperature differences between the latter. If the ROIs
exhibited a normal distribution, Levene’s test and Student’s t-test were used to
assess the equality of variances and T , respectively. If the ROIs did not show a
normal distribution, Mann–Whitney U test [45] was applied to estimate the
equality of T . In all the tests, the significance level was = 0.05.
3. Results and discussion
3.1. Average and standard deviations
Table 1 shows the results of T , SD, and the p-value normality test (p-
value) [44] of the anterior, posterior, right, and left lateral views of the
Table 2
Mean temperature and standard deviations (T ± SD) in °C and p-values (p) of Student’s t test and Mann–whitney U test in % of the comparison between contralateral
regions, right (R) and left (L).
regions under study. In most regions, T varied between 31.16 °C and
34.58 °C, but in the external outer ear, forehead, and neck it was over
34.54 °C. In the helix, knee, anterior view of the right pinky finger, posterior
view of the left pinky finger, and left arm, it ranged between 31.16 °C and
31.60 °C.
The SDs of all the ROIs were between 0.36 °C and 2.34 °C. The
highest values were found on the nose, hands, and phalanges because
these ROIs are acral regions of the body, they are less irrigated by blood
than central areas, and such irrigation presents higher variability.
Most regions exhibited a normal distribution because their p-value was
over 5 % , except for the nose, helix, left shoulder, left elbow, and fingers.
3.2. Analysis of contralateral regions
Table 2 shows the results of T and SD of the entire regions, as well as the
parametric and non-parametric tests of the comparison between contralateral
ROIs. In addition, the temperature differences between left and right regions
were calculated, TRL . The variances of most contralateral ROIs show no
significant differences. Furthermore, Student’s t-test for equality variance was
applied and the temperature difference was found to be insignificant.
Nonetheless, a significant difference between variances was found in the
eyes. Student’s t-test for unequal variance was applied and the p-values were
Parametric and Non-parametric test

Region of interest Student’s t-test Mann–Whitney U test

T ± SD TRL p p

Forehead 34.557 ± 0.512 – 98.900 –

R Eye 34.308 ± 0.473 0.102 ± 0.206 10.800 –
L Eye 34.206 ± 0.432 – – –
R Cheekbone 33.969 ± 0.675 0.123 ± 0.305 16.600 –
L Cheekbone 33.846 ± 0.663 – – –
Nose 33.311 ± 1.454 – – 10.900
Mouth 34.299 ± 0.418 – 22.700 –
Chin 34.193 ± 0.493 – 49.000 –
R Helix 31.392 ± 0.866 0.136 ± 0.367 53.300 –
L Helix 31.256 ± 0.741 – – –
R Outer Ear 34.566 ± 0.494 0.006 ± 0.217 99.000 –
L Outer Ear 34.572 ± 0.459 – – –
Neck 34.278 ± 0.615 – 3.400 –
R Thorax and Abdomen 33.154 ± 0.875 0.038 ± 0.401 75.800 –
L Thorax and Abdomen 33.192 ± 0.886 – – –
R Shoulder 33.179 ± 0.837 0.062 ± 0.384 65.800 –
L Shoulder 33.117 ± 0.847 – – –
R Arm 32.273 ± 0.971 0.103 ± 0.441 52.500 –
L Arm 32.170 ± 0.963 – – –
R Elbow 32.405 ± 0.728 0.116 ± 0.337 34.600 –
L Elbow 32.289 ± 0.751 – – –
R Forearm 32.674 ± 0.619 0.109 ± 0.284 15.400 –
L Forearm 32.565 ± 0.628 – – –
R Wrist 32.342 ± 1.022 0.120 ± 0.465 36.200 –
L Wrist 32.222 ± 1.019 – – –
R Palm and Back 32.417 ± 1.273 0.113 ± 0.580 – 59.100
L Palm and Back 32.304 ± 1.273 – – –
R Thumb 32.211 ± 1.509 0.025 ± 0.680 – 90.300
L Thumb 32.186 ± 1.476 – – –
R Index Finger 31.887 ± 1.908 0.169 ± 0.800 – 79.700
L Index Finger 32.056 ± 1.590 – – –
R Middle Finger 31.966 ± 1.827 0.136 ± 0.787 – 85.800
L Middle Finger 32.102 ± 1.622 – – –
R Ring Finger 31.934 ± 1.839 0.116 ± 0.792 – 82.300
L Ring Finger 32.050 ± 1.633 – – –
R Pinky 31.481 ± 2.149 0.056 ± 0.978 – 87.200
L Pinky 31.425 ± 2.142 – – –
R Thigh 32.182 ± 0.782 0.002 ± 0.361 98.400 –
L Thigh 32.184 ± 0.802 – – –
R Knee 31.828 ± 0.744 0.022 ± 0.350 80.900 –
L Knee 31.806 ± 0.790 – – –
R Leg 31.966 ± 0.647 0.013 ± 0.361 86.700 –
L Leg 31.979 ± 0.683 – – –

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Table 3
Mean temperature and standard deviation (T ± SD) in °C of the right (R) and left (L) ROIs of the populations of Medellín, Brazil, and Taiwan. The control group is
composed of females and males from Medellín, and the young group is comprised of Taiwanese people aged between 20 and 60.
Medellín Brazil Medellín Brazil Medellín Taiwan

Region of interest Female (n = 17) Female (n = 117) Male (n = 20) Male (n = 103) Control (n = 37) Young (n = 37)

T ± SD T ± SD T ± SD T ± SD T ± SD T ± SD

R Arm 32.66 ± 0.86 28.40 ± 2.20 33.07 ± 0.63 28.17 ± 2.61 – –

L Arm 32.63 ± 0.88 28.60 ± 2.20 32.99 ± 0.67 28.34 ± 2.62 – –
R Forearm 32.56 ± 0.77 30.39 ± 1.20 32.67 ± 0.50 30.75 ± 1.20 32.81 ± 0.64 31.70 ± 0.50
L Forearm 32.54 ± 0.89 30.59 ± 1.20 32.85 ± 0.62 30.96 ± 1.10 32.77 ± 0.66 31.60 ± 0.60
Anterior R Thigh 32.07 ± 0.47 28.62 ± 1.30 32.46 ± 0.78 29.70 ± 1.10 32.27 ± 0.67 32.20 ± 0.60
L Thigh 32.04 ± 0.62 28.72 ± 1.30 32.48 ± 0.71 29.75 ± 1.20 32.26 ± 0.69 32.20 ± 0.60
R Leg 32.00 ± 0.56 30.18 ± 1.20 32.21 ± 0.69 30.21 ± 1.40 32.12 ± 0.63 30.30 ± 0.80
L Leg 31.96 ± 0.52 30.11 ± 1.20 32.18 ± 0.79 30.19 ± 1.40 32.08 ± 0.68 30.40 ± 0.60
R Palm – – – – 32.58 ± 1.31 31.80 ± 1.10
L Palm – – – – 32.47 ± 1.27 31.40 ± 1.30

R arm 31.35 ± 0.81 28.59 ± 1.40 31.95 ± 0.64 29.36 ± 1.20 – –

L Arm 31.30 ± 0.79 28.48 ± 1.40 31.63 ± 0.53 29.22 ± 1.20 – –
R Forearm 32.45 ± 0, 69 30.20 ± 1, 20 32.67 ± 0.50 30.61 ± 1.10 32.50 ± 0.51 31, 00 ± 0.60
L Forearm 32.35 ± 0.77 29.95 ± 1.10 32.46 ± 0.46 30.30 ± 1.10 32.47 ± 0.56 30.50 ± 0.60
Posterior R Thigh 31.62 ± 0.90 29.26 ± 1.10 32, 60 ± 0.71 30.28 ± 1.10 32.10 ± 0.78 30.30 ± 0.60
L Thigh 31.71 ± 0.68 29.15 ± 1.10 32.52 ± 0.66 30.20 ± 1.20 32.16 ± 0.83 30.30 ± 0.70
R Leg – – – – 31.75 ± 0.63 29.90 ± 0.70
L Leg – – – – 31.81 ± 0.63 29.90 ± 0.70
R Dorsal Hand – – – – 32.26 ± 1.23 30.80 ± 0.70
L Dorsal Hand – – – – 32.15 ± 1.27 30.50 ± 0.60

over 5%, which indicates no significant difference in the T of the eyes.
Moreover, significant differences between T were found in the neck, because
the blood irrigation in lateral regions is higher than in anterior-posterior
areas.
Mann–Whitney U test was used to evaluate the equality of T in the
regions that did not show a normal distribution, and no significant
differences between T were found.
3.3. Comparison with previous works
The results obtained in this work were compared with those re-
ported by Marins et al. [9] and Niu et al. [26], who determined thermal
patterns of upper and lower limbs of healthy Brazilian and Taiwanese
people, respectively. Their methods and environmental conditions are
similar to those described in this study. In this work, the temperature of
the limbs varied between 31.30 °C and 33.07 °C; in Brazil, between
28.17 °C and 30.61 °C [9]; and in Taiwan, between 30.30 °C and
32.77 °C [26]. Therefore, the temperature range of the population of
Medellín is higher than that of individuals in Brazil and Taiwan.
Student’s t-test was applied to the comparison of temperatures
among young adults in the three cases: Medellín, Brazil, and Taiwan.
Table 3 shows the T and SD of this comparison. Significant differences
between populations were found due to the fact that the p-values were
below 5%. Such differences can be explained by the skin type of each
population and atmospheric conditions. These results reveal the need to
establish thermal patterns for each population.
these aspects. The collected images enabled to determine the temperature
value of 43 regions located throughout the body. Besides, statistical tests
allowed to establish that the contralateral areas present a normal distribution,
equal variance, and no significant differences, which makes such regions
useful for the medical diagnosis of pathologies that affect thermal patterns.
In order to correctly evaluate anatomically complex regions, such as
the hands or ears, their sections should be considered separately (e.g.,
phalanges, back of hand, auricle of the external auditory canal) due to
their variable thermal behavior.
RG segmentation and the grid mask algorithm were essential for this
study because they allowed to obtain, in a quick and effective way, data
from the areas under analysis. With the aim of properly and more
precisely selecting ROIs, future studies should implement software or
programming algorithms to automatically segment the image, as this
would enable to acquire more accurate thermal data.
The method implemented in this study should be replicated in future
works in other areas of Colombia where different ethnic characteristics are
found in order to obtain the thermal patterns of each region.
Finally, to determine a thermal difference that indicates a patho-
logical behavior, it is necessary to establish a significant difference in
each ROI using both parametric and non-parametric tests, which can be
further developed in future works.
Conflict of interest
The authors declared that there is no conflict of interest.

4. Conclusions and recommendations Acknowledgments

Conditions such as the technical characteristics of the camera and en- This work was supported by Instituto Tecnológico Metropolitano
vironmental and individual factors were essential to define the acquisition (ITM). Additionally, the authors would like to thank the medical service
protocol, since the quality of the images that were obtained depended on at ITM and the participants in this study.

Appendix A. Region of interest

This Appendix contains the thermograms and ROIs under analysis.

See Figs. A.1–A.4.

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Fig. A.1. Region-growing and grid mask algorithm segmentation of two ROIs: leg and thigh.

Fig. A.2. Region-growing segmentation of the ROIs of the arm.

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Fig. A.3. Region-growing segmentation of the ROIs of the hand.

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Fig. A.4. Region-growing segmentation of the ROIs of the head.
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