Ocular

Ultrasonography
 Contents
1. INTRODUCTION 10. TYPES OF SCANS

2. HISTORY 11. INTERPRETATION

3. PRINCIPLE 12. B-SCAN REPORTS

4. WORKING OF B SCAN 13. USES

5. CONSIDERATION 14. ADVANTAGES

6. INSTRUMENTATION 15. DISADVANTAGES

7. INDICATION 16. CARE AND MAINTENANCE

8. 17. CLEANING
EXAMINATION TECHNIQUE

9. PROCEDURE 18. CALIBRATION

 INTRODUCTION
INTRODUCTION

● It is a two-dimensional imaging system which utilises high frequency

sound waves ranging from 8-10MHz. B stands for bright echoes.
● Sound waves can pass through opaque tissue. The sound to be
considered is ultrasound which has frequency of greater than 20KHz.
Frequency less than 20 KHz is audible to human. It propagates in
longitudinal manner.
 HISTORY
HISTORY
● It was first introduced by Baum and Greenwood in 1958. First
commercially available B-Scan is developed by Coleman et al in
seventies. The importance of instrument and technique is emphasised
by Karl Ossoinig.
● 1793 : Lazzaro Spallanzani (Italy) discovered that bats orient
themselves with the help of sound whistles while flying in darkness .
This was the basis of modern ultrasound application
● World War II : A device based on piezoelectric effect developed by
Bats use ultrasound to navigate
Paul Langevin (France), able of emitting and receiving ultrasound in the darkness
under water used as sonar.
● 1956: First documented use of ocular USG, Mundt and Hughes used A
Scan technique to detect intraocular tumor
● 1972 : First use of hand held B-Scan by Bronston and workers, which
was applied directly to the closed lid without a water bath
 PRINCIPLE
PRINCIPLE
● Longitudinal wave is an acoustic wave that consists of particles within the medium.
● Frequencies used in diagnostic ophthalmic ultrasound are in the range of 8-10 MHz.
● These high frequencies produce shorter wavelengths which allow good resolution of
minute ocular and orbital structures.
● Multiple short pulses are produced with a brief interval that allows the returning echoes
to be detected, processed and displayed.
● The basis of the ecosystem is a piezoelectric element which is a quartz or ceramic crystal
located near the face of the probe.
WORKING OF
WORKING B-SCAN
OF B-SCAN
Ophthalmic ultrasonography uses high frequency sound waves

transmitted from a probe into the eye

As the sound waves strike intraocular structures,

they are reflected back into the probe, and converted into electric signal

The signal is subsequently reconstructed as an image on a monitor

 CONSIDERATION
CONSIDERATION
1. VELOCITY - Depends on the density of the medium.
The speed of the sound wave is directly proportional to
the density of the medium. The speed of sound in
biological tissue is approximately 1500m/s.

2. FREQUENCY - Ophthalmic ultrasound waves uses

frequencies ranging from 8 to 50 MHz. High frequency
waves have short wavelength and vice versa.
Higher frequency(30-50 MHz)- Less penetration-
High resolution- used for anterior chamber
imaging upto 5mm

Lower frequency- High penetration- Low resolution-

used for imaging retina, vitreous, optic nerve and
orbit(extremely low frequency)
 CONSIDERATION
CONSIDERATION
3. Angle of Incidence: The strength of the reflecting echo depends
upon the angle of incidence. The more oblique the probe, weaker the
returning echo.

4. Reflectivity: Part of sound wave reflected back from the interface

between two medium is known as echo. Echo is created at the junction
of two medium with different acoustic impedence. The greater the
difference in the acoustic impedence of the two media stronger the
reflection of echo. Returning echoes are affected by:
(a) Size, shape and smoothness of the interface
(b) Angle of incident sound beam
(c) Absorption of sound waves
(d) Scattering

5. Absorption: Ultrasound is absorbed by all medium. More the

density of a medium, greater the amount of absorption.
 INSTRUMENTATION INSTRUMENTATION

● It produces two dimensional section.

● It uses both horizontal and vertical dimensions of screen to indicate configuration and location.
● A section of tissues is examined by an oscillating transducer (probe). The probe is filled inside with a fluid,
a crystal oscillates sending sound waves out in a fan like array called Sector scan .
● Probe marker: Indicates side of probe. It represents upper portion of the scan.
● Gain: It leads to amplification of echo signals. It does not change the amount of energy transmitted by
the probe. Increase in gain is associated with increase in tissue penetration and sensitivity but decrease in
resolution. Time Gain Compensation enhances echoes from deeper structures.
● Display Mode: It includes A-Scan/B-Scan or Both.

● Image Documentation Mode: There are two types stationary/static and moving/dynamic.
 INDICATION
INDICATION

ANTERIOR SEGMENT

1. Opaque ocular media(i.e. corneal opacities)

❖ Pupillary membrane
After cataract Dislocation of lens
❖ Dislocation/subluxation lens Pupillary
membrane
❖ Cataract/after cataract

❖ Posterior capsular tear

❖ Pupillary size/reaction

Cataract Posterior capsular tear

Pupillary size/reaction
 INDICATION
INDICATION

2. Clear ocular media

❖ Diagnosis of iris and ciliary body tumors

 INDICATION
INDICATION

POSTERIOR SEGMENT

1. Opaque ocular media

❖ Vitreous haemorrhage Vitreous haemorrhage
Vitreous exudation Retinal detachment
❖ Vitreous exudation

❖ Retinal detachment (type and extent)

❖ Posterior vitreous detachment(extent)

❖ Intraocular foreign body (size/site/type)

Posterior vitreous Intraocular foreign

detachment body
 INDICATION
INDICATION
B-Scanned Images of Opaque Ocular media

Retinal detachment Vitreous haemorrhage Vitreous exudation

Posterior vitreous detachment Intraocular foreign body

 INDICATION
INDICATION

2. Clear ocular media

❖ Tumor (size/site/post treatment follow up)

❖ Retinal detachment (solid/exudative)

❖ Optic disc anomalies Tumor

3. Ocular trauma

Optic disc anomalies

Retinal detachment
Ocular Trauma
 INDICATION
INDICATION

B-Scanned Images of Clear

Ocular Media and Ocular
Trauma
Retinal detachment Optic disc anomalies

Ocular Trauma Tumor

 EXAMINATION
EXAMINATION

TECHNIQUE
TECHNIQUE

The two types are:

• Basic screening technique
• Special examination technique
- Topographic- includes location, extension, shape

- Quantitative- includes reflectivity, internal structure, sound attenuation

- Kinetic- includes mobility and vascularity

 PROCEDURE
PROCEDURE

1. The examiner should be seated on the side of the patient and probe should
be held in the dominant hand
2. Methylcellulose or an ophthalmic gel is placed on the tip of the probe to act
as a coupling agent
3. Various scan beginning with axial scan followed by transverse scan is
performed. Longitudinal scans are performed only in cases of precise
monitoring of tumors, foreign bodies,etc.
 TYPES OF SCANS TYPES OF SCANS
1. AXIAL SCAN -
● Eye- in primary gaze
● Probe- centered on the cornea
● Probe marker- nasal (usually) or temporal normally

1. TRANSVERSE SCAN -
● Eye- Looking in the direction of observer’s interest
● Probe- Parallel to limbus and placed on the opposite
sclera
● Probe marker- Superior (if examining nasal or temporal)
or nasal (if examining superior and inferior). The probe is
swept from limbus to the fornix.
 TYPES OF SCANS TYPES OF SCANS

3. LONGITUDINAL SCAN
● Eye- Looking in the direction of observer’s interest
● Probe- Perpendicular to the limbus and placed on the
opposite sclera
● Probe marker- Directed towards the limbus or
towards the area of interest Note-Optic nerve
shadow always at the bottom on the right side
 INTERPRETATION
INTERPRETATION
Following are the types of echoes seen in normal report:

• Lens: Oval highly reflective structure with intralesional echoes with none to high reflective echoes.
• Vitreous is echolucent.

• Retina, choroid and sclera are seen as single high reflective structure.

• Optic nerve: Wedge shaped acoustic void in the retrobulbar region.

• Extraocular muscles are echoluscent to low reflective fusiform structures. The SR-LPS complex is the
thickest. IR is the thinnest. IO is generally not seen except in pathological conditions.

• Orbit: Highly reflective due to orbital fat. Always examine the other eye before coming to conclusion
regarding the lesion. Opacities produce dots or short lines. Membranous lesions produce an echogenic line.
Following is the normal B-Scan report
Normal B-Scan Report
 USES USES

Biometric studies using A-scan to Assessment of posterior

calculate power of intraocular 1. 2. segment in the presence of
lens to be implanted opaque media

Study of intraocular and orbital Localization of intraocular

tumors and other mass lesions 3. 4. and intraorbital foreign
bodies
 ADVANTAGES
ADVANTAGES

High resolution
Non-invasive
1. echography provides
reliable and accurate
measurement ∙

Performed in an office Does not expose to radiation

2.
setting
 DISADVANTAGES
DISADVANTAGES

High frequency sound

1.
waves have limited
penetration

2.
Low frequency have poorer
resolution
CARECARE
ANDANDMAINTENANCE
MAINTENANCE
Properly store the probes Avoid sharply bending, twisting or
when not in use. Most machines pinching th cable. Excessive bending or
have a designated storage place stress on the cable may result in damage
for probes, such as dedicated to its casing, causing an electrical shock
holder to the patient or operator

Avoid dropping the probe or subjecting Always inspect the probe, including
it to any kind of impact its lens and cable, before each use

Place the patient close Do not use damaged probes.

enough to the console to Cleaning or gel solutions may leak
avoid stretching and into the transducer, resulting in
damaging the probe’s cord electrical shock
 CLEANING
CLEANING
Use only approved gels and Do not immerse the probe
germicides and strictly follow connector
the instructions when
applying, cleaning and
disinfecting transducers

Do not steam, heat autoclave, or Air dry or dry with soft

use ethylene oxide gas cloth or gauze pad
processes on probes

Disconnect the probe from the Meticulously scrub the probe

ultrasound console and rinse the as needed with a soft brush,
probe with a warm, non abrasive sponge, or gauze pad to
soap and water solution remove all residues
 CALIBRATION
CALIBRATION

A plastic test block can be used as a reference for calibration verification

1.

2.
Thank You