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FBE supports clinicians in the objective assessment of tissue hardness with indurometers.
Indurometers measure the resistance of tissue to indentation (compression). This measurement is used widely in lymphoedema assessment. Indurometers are also being trialled to objectively measure the development of scar formation after burns and the progression of sclerosis.
The term tonometry has been used inaccurately to describe a measure of tissue indentation or hardness when tonometry is really a measure of tension or pressure. The term indurometer has been created to better describe what these devices measure: tissue hardness or induration.
Indurometers |
Lymphoedema |
Burns |
Sclerosis |
Research |
Mechanical tonometer
Limited stocks - No longer in production The original mechanical device was made by Flinders Medical Centre Biomedical Engineering and has been used extensively in Lymphoedema assessment (see the Lymphoedema tab for publications). It is a robust tonometer that worked well despite shortcomings with the mechanical design:
Electronic Tissue Indurometer
Undergoing clinical trial - expected 2011 This second generation indurometer is an electronic version of the mechanical tonometer with significant improvements. Advantages of this model include:
The electronic indurometer is under clinical trial and is expected to be available at the end of 2010, early 2011. For information contact Mark.McEwen@fbe.com.au
Viscoelastic Indurometer
Under development The next generation of indurometry under development is the viscoelastic indurometer. It measures the tissue’s resistance to indentation, like the electronic indurometer, as well as the fluid movement (viscoelastic properties) of the tissue. Fluid movement is particularly important in pitting lymphoedema. This indurometer is not currently available for purchase and is undergoing initial pilot trials. View the comparison chart on the side bar for a summary of the range of indurometers available and under development. |
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Indurometry (or tonometry) is widely used in lymphoedema assessment for an objective estimate of pitting and fibrotic induration. Pitting results when there is a displacement of extracellular fluid.
PublicationsPallotta O, Woolford R, Smith AL, Piller NB. Mechanical, electronic and viscoelastic tonometry. Presented at International Society of Lymphology Congress, Sydney 2009.
Moseley A, Piller N. Reliability of bioimpedance spectroscopy and tonometry after breast conserving cancer treatment. Lymphat Res Biol. 2008;6(2):85-7. (Abstract at PubMed)
Piller N. To measure or not to measure? What and when is the question. Journal of Lymphoedema, 2007;2(2):39-45. (Article)
Carati CJ, Anderson SN, Gannon BJ, Piller NB. Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial. Cancer. 2003 Sep 15;98(6):1114-22. (Abstract at PubMed)
Bates DO, Levick JR, Mortimer PS. Quantification of rate and depth of pitting in human edema using an electronic tonometer. Lymphology. 1994 Dec;27(4):159-72. (Abstract at PubMed)
Casley-Smith JR, Morgan RG, Piller NB. Treatment of lymphedema of the arms and legs with 5,6-benzo-[alpha]-pyrone. N Engl J Med. 1993 Oct 14;329(16):1158-63. (Abstract at PubMed)
Liu NF, Olszewski W. Use of tonometry to assess lower extremity lymphedema. Lymphology. 1992 Dec;25(4):155-8. (Abstract at PubMed)
Piller NB, Clodius L. The use of a tissue tonometer as a diagnostic aid in extremity lymphoedema: a determination of its conservative treatment with benzo-pyrones. Lymphology. 1976 Dec;9(4):127-32. (Abstract at PubMed)
Clodius L, Deak L, Piller NB. A new instrument for the evaluation fo tissue tonicity in lymphoedema. Lymphology. 1976 Mar;9(1):1-5. (Abstract at PubMed) |
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BurnsTrials have been conducted on burn scar assessment using a indurometer/tonometer modified for this purpose.
Corica GF, Wigger NC, Edgar DW, Wood FM, Carroll S. Objective measurement of scarring by multiple assessors: is the tissue tonometer a reliable option? J Burn Care Res. 2006 Jul-Aug;27(4):520-3. (Abstract at PubMed)
Lye I, Edgar DW, Wood FM, Carroll S. Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable? J Burn Care Res. 2006 Jan-Feb;27(1):82-5. (Abstract at PubMed)
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SclerosisA trial has been conducted on sclerosis assessment using a indurometer/tonometer modified for this purpose.
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Research devicesFlinders Biomedical Engineering have a history of tonometer development with many early prototypes measuring tissue properties in different ways.
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The original mechanical tonometer

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