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SignificanceFar infrared (IR) has a long history in thermometry and febrile screening. Concerns have been raised recently over the accuracy of non-contact body thermometry. Clinical testing with febrile individuals constitutes the standard performance assessment. This is challenging to replicate, which may have inadvertently allowed approval of IR systems that are unable to detect fevers. The ability to test performance without relying on febrile participants would have ramifications for public health, especially if this discovered undisclosed differences in accuracy in widely used devices.AimTo identify foundational issues in, demonstrate principles of, and develop test methods for non-contact body thermometry.ApproachWe review foundational literature and identify confounds impeding performance of IR thermography (IRT) and non-contact IR thermometry (NCIT) for febrile screening and demonstrate corrections for their effects, which would otherwise be unacceptable. Almost none of the devices we are aware of compensate for these confounds. We reverse-engineer surface-to-body temperature relations for several FDA-cleared NCITs. We note their similarity to recently reported bias-to-normal behavior in other devices and determine range of body temperatures for which the device would produce a "normal" (non-febrile) output. Finally, we generate predictable elevated face temperatures in healthy subjects and demonstrate this in several devices.ResultsThe surface-to-body relationships for two IRT and one NCIT were linear, while all others exhibited nonlinear bias-to-normal behavior that produce normal temperatures when presented with surface temperatures ranging from hypothermia to moderate-to-severe fever. The test method was used in healthy, non-febrile subjects to generate elevated temperatures corresponding to body temperatures from 97.35F to 102.45F. Three out of five systems had negligible sensitivity.ConclusionsThis demonstrates an alternative evaluation method without the limitations and risks of febrile patients. These results indicate many devices may be unusable for body thermometry and may be providing a false sense of security for public health surveillance. |
