ThermoHuman Podcast 4: Paolo Minafra (Head of Medical Staff at Torino FC and Health Director and Head Radiologist at Affidea – Modena)
In the fourth episode of our ThermoHuman podcast “Thermography: Science, Health and Sport” we introduce Paolo Minafra, Head of Medical Staff at Torino FC. Paolo is Radioligst and Sports Medicine Doctor. He is an expert using different techniques as ultrasound or thermography.
He started using Infrared Thermography in 2012 at Palermo. Since then, thermal imaging is very important tool to support decisions regarding diagnosis and return to play.
He described us an interesting case where MRI and ultrasound didn’t detect a potential injury because they are more focused on muscle structure, and thermography did because it is more focused on the functionality (neuromuscular fatigue): two different aproaches.
Ismael Fernández-Cuevas (I): Welcome to the 4th episode of this podcast focus on thermography science sport and health and I’m very pleased to introduce you to Paolo Minafra, welcome Paolo.
Paolo Minafra (P): Hello, hello Ismael.
I: How are you doing? I’m very pleased because Paolo is a big institution for me, he’s actually a specialist in radiology, so he´s a sports medicine and a radiologist, but he´s also doing a lot of different things, he’s the head director of radiology of Affidea, and he’s also a member of the Radiology Society of North America and he gathers a lot of experience using different techniques for treatment and diagnosis, mainly ultrasound, and also thermography and the theme that is interesting for us is the different approaches that he has, and also his application on high performance with his experience in football, actually and currently with Torino, but also previously with other teams in Italia, as Spal, Swallow and Palermo, so we’re very pleased to have you onboard Paolo, thank you very much.
P: Thank you Ismael for your kind invitation, it’s a great pleasure for me to stay here at this discussion with you about these topics. Thank you again.
I: And as you might know, in this podcast our main intention is to talk with different professionals to see their approach regarding thermography and that’s why I would like to start asking you Paolo, how did you discover thermography?
P: Well, my first time with the thermography was in 2012, I was the in that period I was the doctor of Palermo football club and I have to say thank you to the physiotherapist that for first showed me this kind of devices and it was so hinted in the combination between thermography and ultrasound, as you have mentioned I have a radiologist so even in that period I was also a consultant radiologist of the football team, so that was my first situation using thermography.
I: From 2012 that is now far away because we started bringing for example in 2009, I think that we personally we met in isokinetic Congress some years ago, you already mentioned that we do we’re using this technology and you were interested, so from this first moment you discover this technology until today, how did you just learn and then how you let’s say, use in your daily basis, how is thermography part of your routine with the team and your practice?
P: Well, first of all, I searched everything on Pubmed, on Medline just to figure out the meaning of this kind of investigation, after that, I tried to understand normal subjects the use of thermography, I mean not only during a standard situation such as, during training sessions but also in a pathological situation and in all of this situation I combined the results obtained with the thermography together with the MRI and ultrasound because as you know thermography is not a diagnostic tool, you know? I found it very useful to detect the healthy condition of muscles and tendons, so for example at the beginning of the sports season with football clubs, I usually make a standard check of all the athletes so I can have the first point at the beginning of the season and then I have the possibility to have a daily routine in the thermographic evaluation so for example in static condition or after the training session and obviously it’s something goes wrong like muscle strains or something like that.
“… I use thermography not only during a standard situation such as, during training sessions but also in a pathological situation […] It´s very useful to detect the healthy condition of muscles and tendons…”Paolo Minafra
I: So, you mentioned that you start using that not with players, but also with normal patients right?
P: Yes, yes. For example, there are lots of situations the first that I think is rheumatology for example, in which we have a standard diagnostic evaluation with X-ray or MRI but I found it very useful to add on my daily diagnostic evaluation also the thermographic view because sometimes you can find some difference between for example during therapy or during rehabilitation period in which the standard examination with radiological examination is always the same but I found some interesting changing only with the thermographic evaluation.
I: So, as you mention, a diagnosis support, right?
P: Yes, yes
I: It´s important to highlight add we always focus on this message but it is interesting your approach and then I would like to ask you if you remember at that stage regardless of we’re speaking about football players or maybe a normal patient if you remember a special case where thermography really helps you to find something that was wrong but was not clear or in very special circumstances where thermography helps you out?
P: Well, yes. The first remember is we were two days before an important football match and our most important striker felt something strange in the back of the leg so you can imagine we were…
I: hamstring injury alarm, right?
P: yes, great alarm so, what’s happened? obviously, we made ultrasound and MRI examination, but no injuries were detected so I tried to see if the thermography examination allowed me to see something and only with thermography I was able to appreciate a focal area of overcharging suffering in his hamstring so, we were more confident in deciding what to do so, no injury, no rupture of fibers and a better therapeutic approach so, this was one of the best uses that I remember.
I: I have a good question regarding this case. As an expert on that, why do you think that there was not an alarm on such tests as MRI or ultrasound and you discover something significant on thermography?
P: well, I believe that this is a typical situation in which the neuromuscular fatigue is evident, sometimes with the ultrasound or also with MRI that as you know tends to overestimate an injury muscle injury, but with this kind of overcharging in muscle in which it’s not only the muscle fibers but is also the neuromuscular condition that is affected, I believe that thermography is a very good tool to appreciate this kind of injury because I think this is an alarm, so we need to see something, just to perform a better therapeutic approach. We are trying to make a study with other colleagues just to see if we can make some publication about it.
I: OK, so that is clear, but now is the time to ask you also about the limitation from the technology so we understand that thermography is adding value because he’s maybe giving some information regarding this neuromuscular fatigue or neuromuscular status from different and in that case muscle fibers but, what do you consider the main limitations of the technology?
P: I think that there are too many variables that can affect the thermogram response I mean, temperature, humidity can affect the performance of the examination, maybe we will be able to have rooms dedicated for thermography acquisition and management of phases is also very important to help that it will be soon possible to develop a software that can fully analyze, for example, moving images, I really believe in the dynamic examination. As you probably know I always perform also MRI in real movement or city and for a sure ultrasound so I think that we cannot lots of data you know that not only with thermography but in science, the main problem is data, we have to manage all of this data and I think that at this moment the main counts are did this kind of problems.
.”..temperature, humidity can affect the performance of the examination, maybe we will be able to have rooms dedicated for thermography […] is also very important to help that it will be soon possible to develop a software that can fully analyze, for example, moving images, I really believe in the dynamic examination…”Paolo Minafra
I: So because I was smiling because I think that you were somehow answered my next question because the next question is, what about the future?. OK, we have thermography, it has been developed obviously, we have a lot of still to do, a lot of research, a lot of cases and results to show and to published but, whether you think that thermography will go and should go so, what’s the to the future for this technology from your perspective?
P: I always remind myself like a mantra, “technology good servant bad master”, so I think that in next future we need to practice for first, so just see what does it mean thermographic evaluation in practice, and the second point for me is talking over and over with biology, the engineer just to develop altogether a platform in which is possible to collect all of this data and to use in an easy way.
“…technology good servant bad master…”Paolo Minafra
I: I like your approach from dynamic assessment as you perform with other techniques, I really love and admire your work, by the way, I know also Paolo because he is very active on social network and with his blog, he’s describing an showing different cases so I think that you are still very active so, please grow go ahead and just remember your blog, please?
P: Yes, I invite everyone to see on coachingultrasound.com in which you can find lots of real cases with ultrasound, MRI, and for sure tomography, all together combined in this diagnostic process.
I: That´s fantastic and I really think that from obvious science and their practical field we really need people like you, professionals like you that are just writing and making better at different technologies to make another job so, I really thank you for your time and obviously for all the information and your perspective and approach and I hope that you enjoy also this discussion, I don’t know if you want to mention something else just to finish this podcast?
P: I again want to thank you for your effort on thermography research, also with this blog. I really appreciate your invitation and I hope in next future after this pandemic situation maybe we will organize something together with all people that are interested in this beautiful topic.
I: Thank you very much.
P: Thank you and bye, bye.