Application of Dynamic Thermogram

for Diagnosis of Hypertension

Jayashree Ramesh and Jayanthi Thiruvengadam

Abstract Hypertension (high blood pressure) is blood pressure above than 140
over 90 mmHg (millimeters of mercury). Diagnosis of hypertension is made when
one of the above readings is high. By the year 2025, the number of people living
with hypertension is about 1.56 billion all over the world. This paper aims at
developing a technique to diagnose hypertension noninvasively without using the
cuff. In this approach, the dynamic infrared (IR) thermogram of selected body
regions like hand (left and right) and neck (left and right) is obtained for about 60 s
using IR thermal camera from 50 subjects (normal = 25 and age and sex-matched
hypertensive = 25). The average temperature for every millisecond in these selected
body regions is measured using ResearchIR software. Correlation is performed
between the features extracted from dynamic thermogram and flow rate obtained
from carotid Doppler ultrasound scan. The statistical analysis shows that highest
correlation is obtained between the rate of temperature change (°C/min) in the neck
left side with systolic pressure and hand left side with diastolic pressure (mmHg)
(Pearson correlation r = −0.637 and 0.668 with p < 0.01, respectively). There also
exists a linear correlation coefficient between neck right rate of change in tem-
perature (°C/min) and right carotid artery flow rate (r = −0.358 with p < 0.05). An
automated classifier using SVM network was designed with features extracted from
dynamic thermogram for diagnosis of hypertension. The accuracy of the classifier
was about 80% with sensitivity and specificity values 76.9 and 83.3%, respectively.
The accuracy of the classifier when all the correlated features (n = 17) were
included was 93% (sensitivity 90% and specificity 94%), whereas when highly
correlated features (n = 15) were alone included, the sensitivity improved to 94%
(accuracy 90% and specificity 85%).

Keywords Dynamic thermal imaging SVM

Hypertension
Mean

Energy Kurtosis Statistical parameters

J. Ramesh (&)
J. Thiruvengadam

Department of Biomedical, SRM University, Chennai, India
e-mail: jayashree94music@gmail.com
J. Thiruvengadam
e-mail: Jayanthi.t@ktr.srmuniv.ac.in

© Springer Nature Singapore Pte Ltd. 2018 129

A. K. Nandi et al. (eds.), Computational Signal Processing
and Analysis, Lecture Notes in Electrical Engineering 490,
https://doi.org/10.1007/978-981-10-8354-9_12
130 J. Ramesh and J. Thiruvengadam

1 Introduction

Diagnosis of hypertension is made when the systolic reading (the pressure when the
heart pumps blood around the body) or diastolic reading (pressure when the heart
relaxes and refills with blood) is high. People predicted to be living with hyper-
tension would be 1.56 billion worldwide [1]. In India, hypertension has increased
from 20 to 40% in urban areas and 12 to 17% in rural areas [2]. In 2011–2012,
about one-third of all people living in low- and middle-income countries had
hypertension which was a great economic burden [3]. Hypertension is a disease that
paves the way for other cardiovascular diseases if left untreated. This work focuses
on the diagnosis of hypertension using dynamic thermal imaging. The current
method for hypertension diagnosis varies from operator to operator. There are no
standard techniques to predict hypertension with quondam. It needs repeated
measurements, to diagnose whether a person is hypertensive. The traditional pro-
cess of inflation, deflation and examining korotkoff sounds with a stethoscope can
be replaced by the technique of continuous dynamic thermal imaging. This setup
plays a vital role in ICU and CCU units where almost all patients are critical and do
not want any disturbance. Thus, this method can be used for mass and initial
screening. Chekmenev developed a model to match thermogram with pulse rate [4].
Hence, our work focuses on the diagnosis of hypertension using features measured
from dynamic thermal imaging. Thermal imaging is a noninvasive and non-contact
method where the heat patterns in the skin are studied using a thermal camera [5, 6].
Thermal imaging has a wide variety of application in the medical field that includes
inflammatory diseases, complex regional pain syndrome and Raynaud’s phe-
nomenon, breast cancer, various types of arthritis, injuries, and other traumas [7–9].

2 Materials and Methods

Study Population: A medical camp was conducted in a private hospital where

about 50 subjects registered both men and women participated. Normal and known
hypertensive subjects in the age-group of 39 ± 5.01 years were included in the
study. The following measurements like BP, ultrasound Doppler scan, SPO2, sex,
age, hip and waist circumference, and height and weight were obtained. The
consent form was obtained from all the subjects. And details of the procedure were
clearly explained. Institutional ethical clearance was obtained from the institutional
ethical clearance committee letter dated 1034/IEC/2016.
Pressure Measurement: The subject was made to relax in sitting position, and
his blood pressure both systole and diastole was measured using standard sphyg-
momanometer. Only a trained person took a measurement for all 50 subjects.
Thermal Imaging: The thermal camera was fixed on the stand, and it was
connected to the laptop. The initial setting for taking video was taken care.
A standard protocol as proposed by the International Association of Certified
Application of Dynamic Thermogram for Diagnosis of Hypertension 131

Fig. 1 Original and processed hand left signal

Thermographers was followed during the entire procedure [10]. The process was
carried out in a completely dark room which was fully air-conditioned wherein the
temperature was maintained at 25 °C. The subjects were made to wait in the room
for 15 min. The subject was asked to stand, and his left and right hands were
stretched and held in support, while the video signal was taken. Similarly, the
subject was made to turn his head left and right sides for the neck images. The data
were taken using thermal camera Therma Cam A305sc, FLIR Systems, USA. Then,
the average temperature was measured using FLIR tool. The process of removing
noise and decomposition of the thermal signal was done using wavelet transform
with a level of db4. Figure 1 shows the change in temperature signal for a minute
before and after noise removal.
After the noise removal, the rate of temperature change was calculated using
equation [11]:

C ¼ FAT  IAT =FRT  IRT ð C=minÞ ð1Þ

C Rate of change in temperature,

FAT Final average temperature,
IAT Initial average temperature,
FRT Final relative time,
IRT Initial relative time.
132 J. Ramesh and J. Thiruvengadam

Fig. 2 Overall block diagram

Ultrasound Doppler Scan: The subject was made to lie on the bed, and the
ultrasound images and flow patterns are obtained. The ultrasound Doppler scans of
right and left common carotid arteries were taken using MINDRAY DC-N3
Doppler machine. The rate of blood flow was calculated from mean velocity and
vessel diameter [12]. The formula to calculate flow rate was:

Q ¼ p  D2 =4  Vm  60 ðml=minÞ ð2Þ

Q Flow rate
p 3.14
D Vessel diameter (cm)
Vm Mean velocity (cm/s)
The overall block diagram showing the work flow is as given in Fig. 2.

3 Results

3.1 Correlation Between Rate of Temperature Change

with Flow Rate and Blood Pressure

As given in Table 1, the statistical analysis shows that the correlation obtained
between rate of temperature change (°C/min) in the neck left side showed negative
correlation with systolic pressure (Pearson correlation r = −0.637 with p < 0.01)
and positive correlation was obtained between hand left side with diastolic pressure
Application of Dynamic Thermogram for Diagnosis of Hypertension 133

Table 1 Pearson coefficient r value obtained between rate of temperature change with blood flow
rate and pressure
Rate of change Right flow rate Left flow rate Systolic Diastolic
of temperature (ml/min) (ml/min) pressure pressure
(°C/min) (mmHg) (mmHg)
Left Hand 0.543** 0.668**
Neck −0.356* −0.637**
Right Hand −0.622**
Neck −0.358* 0.319** 0.496**
*
Correlation is significant at the level p < 0.05
**
Correlation is significant at the level p < 0.01

Fig. 3 Correlation between

neck left rate of temperature
change and left carotid artery
flow rate

(mmHg) (Pearson correlation r = 0.668 with p < 0.01). There exists a negative
correlation coefficient between neck left rate of change in temperature (°C/min) and
left carotid artery flow rate (r = −0.356 with p < 0.05), and neck right rate of
change in temperature with right carotid artery flow rate (r = −0.358 with p < 0.05)
as shown in Figs. 3 and 4.

3.2 Correlation Between Features from Dynamic

Thermogram with Flow Rate and Blood Pressure

As given in Table 2, there exists a linear correlation between hand left mean and
neck right median with left and right carotid artery flow rates (r = −0.365
(p < 0.01) and −0.295 with p < 0.05) which is also negative. The analysis also
showed the correlation obtained between kurtosis in the hand right side with sys-
tolic was positive (Pearson correlation r = 0.8588 with p < 0.01) as shown in
134 J. Ramesh and J. Thiruvengadam

Fig. 4 Correlation between neck right rate of temperature change and right carotid artery flow rate

Fig. 5 and negative correlation between neck right side kurtosis with diastolic
pressure (mmHg) (Pearson correlation r = −0.6647 with p < 0.01) as shown in
Figs. 5 and 6.

Table 2 Pearson coefficient r value obtained between features from dynamic thermogram with
blood flow rate and pressure
Features obtained from Systolic Diastolic Carotid artery flow
dynamic thermogram pressure pressure rate (ml/min)
(mmHg) (mmHg) Left Right
Kurtosis Left Hand 0.712** 0.634**
Neck −0.337a −0.344*
Right Hand 0.855** 0.491**
Neck −0.516** -0.664**
Mean Left Hand 0.533** 0.309* −0.365**
Neck 0.614** 0.459**
Right Hand 0.615** 0.611** −0.293*
Median Left Neck 0.328* −0.289 *

Right Neck 0.461** −0.295*

Energy Left Hand 0.507**
Neck 0.648** 0.627**
Right Hand 0.594** 0.365*
Neck 0.658** 0.534**
*
Correlation is significant at the level p < 0.05
**
Correlation is significant at the level p < 0.01
Application of Dynamic Thermogram for Diagnosis of Hypertension 135

Fig. 5 Correlation between

hand right kurtosis and
systolic pressure

Fig. 6 Correlation between

neck right kurtosis and
diastolic pressure

Support Vector Machine: Data-based machine learning technique covers a

wide area from pattern recognition to functional regression and density estimation.
SVM is a supervised machine learning technique that has been used to classify the
rate of change in temperature and its features. It was used in MATLAB version
2012. SVM that produced an accuracy of 80%, the sensitivity of 76.9%, and
specificity of 83.3% for all features (n = 20). The correlated features (n = 17) were
classified with an accuracy of 93%, sensitivity of 90%, and specificity of 94% [13].
The highly correlated features (n = 15) were classified with an accuracy of 90%,
sensitivity of 94%, and specificity of 85.
136 J. Ramesh and J. Thiruvengadam

4 Discussions

Circulation and inspiration are related to each other. During inspiration and expi-
ration, the airflow regulates the temperature of blood by convection. The blood flow
depends on heart rate. Hence, change in flow rate and heart rate is reflected in
temperature of blood. According to Hirsch, heart rate increases during inspiration
and decreases during expiration. According to Jere Mead and James L.
Whittenberger, the temperature of the expired gas increases. So as flow rate
increases, the temperature decreases [14–16]. Likewise, in our study, there is a
correlation between flow rate and rate of temperature change in neck left and neck
right. Ziad et al. stated that blood flow in the cerebral region obeys Joule–Thomson
effect [17]. According to Joule–Thomson effect, the pressure is inversely propor-
tional to temperature. During systole, the blood gets pumped from the left ventricle
to the aorta through a small orifice called the mitral valve. When blood flows
through a small orifice (at high pressure), its temperature decreases. Likewise in our
study, the rate of change of temperature in the regions neck left and hand right
correlates negatively with temperature. According to Eugene Braunwald et al., the
blood fills the heart during diastole. According to Starling’s law, when the blood
gets filled, stroke volume increases which increase in the cardiac output [18, 19].
Further according to Frank–Starling mechanism, the cardiac output increases with
increase in temperature and positively correlates with diastolic pressure which is
stated by Shields et al. [20]. In our study as shown in the above tables, it is evident
that systolic and diastolic pressure correlates with all the regions of the body
considered for the study. As the sensitivity increases for highly correlated variables,
prediction of hypertension may be consequential. Hence, this work can make an
effective diagnosis of hypertension. To the best of our knowledge, there has not
been any approach to correlate dynamic thermogram with blood pressure and blood
flow rate.

5 Conclusion

The correlation obtained was highest for neck right kurtosis and diastolic pressure
and hand right kurtosis and systolic pressure. The flow rates showed the highest
correlation between hand left mean with left carotid artery flow rate and right neck
rate of temperature change and right carotid artery flow rate. From the above study,
it has been concluded that blood pressure could be measured without contact at an
accuracy of 80%, the sensitivity of 76.9%, and specificity of 83.3% and accuracy of
93%, sensitivity of 90%, and specificity of 94% with correlated parameters. As an
extension, there would be the development of a handheld device with an IR sensor
to diagnose hypertension which would be portable and contact-free.
Application of Dynamic Thermogram for Diagnosis of Hypertension 137

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