EXAMINATIONN WITH B SCAN ULTRASONOGRAPHY

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1 CLINICAL OPHTHALMIC ULTRASOUND PROFESSOR OF OPTHALMOLGY FACULTY OF MEDICINE TANTA UNIVERSITY MEMBER OF INTERNATIONAL SOCIETY FOR OPHTHALMIC ULTRASOUND (SIDUO) EXAMINATIONN WITH B SCAN ULTRASONOGRAPHY THREE STEPS CLINICAL DATA SYSTEMATIC ULTRASONIC EXAMINATION DATA RECORDING LIKE OPHTHALMIC SHEET 1

2 THE INSTRUMENT FOLLOWS ALL THE LOWS OF SOUND PROPAGATION REFLECTION REFRACTION ATTENUATION HEIGHT &BRIGHTNESS * SOUND BEAM ANGLE * INTERFACE BETWEEN TISSUES 2

3 * INTERFACE BETWEEN TISSUES 3

4 ADVANTAGE CAN PASS THROUGH OPAQUE MEDIA & RETURN THROUGH THE TRANSDUCER TO THE DISPLAY DISADVANTAGE THE SAME TRANSDUCER TO SEND &RECEIVE SO THERE IS A DEAD ZONE DUE TO INTERFERENCE BETWEEN THE PROPAGATED ECHOES&RECEIVED ECHOES SO ABOUT ANTERIOR 7 MM OF THE GLOBE(CORNEA,AC&LENS) COULD NOT BE EVALUATED BY REGULAR B SCAN WITH CONTACT TECHNIQUE SO ULTAROUD BIOMICROSCOPY (UBM) MAY BE HELPFUL 4

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6 * SOUND BEAM CHARACTERISTICS SHAPE WIDTH B SCAN (TWO DIMENSIONS) 6

7 STANDARDIZED A SCAN A SCAN(BIOMETRY) 7

8 A SCAN ONE DIMENSION A-SCAN =AMPLITUDE B-SCAN =BRIGTHNESS 8

9 A SCAN B SCAN 9

10 EXAMINATION TECHNIQUES * CONTACT TECHNIQUE * IMMERSION TECHNIQUE CONTACT TECHNIQUE 10

11 IMMERSION TECHNIQUE 11

12 WHERE IS THE LESION & WHAT IS THE LESION? IMMERSION TECHNIQUE 12

13 CONTACT TECHNIQUE POSTERIOR SEGMENT EVALUATION B-SCAN SCREENING TECHNIQUE 13

14 BASIC SCREENING EXAMINATION A-SCAN B-SCAN 14

15 CONTACT TECHNIQUE * AXIAL * LONGITUDINAL * TRANSVERSE 15

16 AXIAL SCAN TRANSVERSE SCAN AT 12 O,CLOCK 16

17 LONGITUDINAL SCAN AT 12 O,CLOCK 17

18 TRANSVERSE SCAN AT 12 O,CLOCK 18

19 LONGITUDINAL SCAN AT 12 O,CLOCK TRANSVERSE SCAN AT 6 O,CLOCK 19

20 EVALUATION OF THE MACULA LONGITUDINAL MACULAR SCAN EVALUATION OF THE MACULA LONGITUDINAL MACULAR SCAN 20

21 AT THE END OF EXAMINATION WE SHOUD ANSWER TWO MAIN QUESTIONS 1- WHER IS THE LESION? (TOPOGRAPHIC EXAMINATION). 2-WHAT IS THE LESION? (QUNTITIVE&KINETIC TOPOGRAPHY). 21

22 TECHNIQUES TOPOGRAPHIC Location Extension Shape QUANTITATIVE 1. Reflectivity estimate (spike height) Structure ( internal architecture) Sound attenuation (absorption) 2. Reflectivity measurement (db comparison) KINETIC Mobility (aftermovement) Vascularity (blood flow) Pupillary reaction TOPOGRAPHIC TECHNIQUE * LOCATION * EXTENSION * SHAPE 22

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25 QUANTITATIVE TECHNIQUE * REFLECTIVITY ESTIMATE (SPIKE HEIGHT) STRUCTURE ( INTERNALARCHITECTURE) SOUND ATTENUATION (ABSORPTION) * REFLECTIVITY MEASUREMENT QUANTITATIVE TECHNIQUE * REFLECTIVITY ESTIMATE (SPIKE HEIGHT) STRUCTURE ( INTERNAL ARCHITECTURE) SOUND ATTENUATION (ABSORPTION) * REFLECTIVITY MEASUREMENT (DB COMPARISON) 25

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30 KINETIC TECHNIQUE * MOBILITY (AFTER MOVEMENT) * VASCULARITY (BLOOD FLOW) * PUPILLARY REACTION PUPILLARY REACTION 30

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33 * P = POSTERIOR (THE AREA JUST AS THE NERVE SHOWS ) * PE= POSTERIOR TO THE EQUATOR * EP= EQUATOR POSTERIOR (JUST BEHIND THE EQUATOR) * E= EQUATOR (A GOOD LANDMARK FOR THIS LABEL IS THE INSERTION OF A RECTUS MUSCLE) * EA = ANTERIOR TO THE EQUATOR * O= ORA * CB = CILIARY BODY LENS AREA EXAMINATION 33

34 IMMERSION TECHNIQUE DIFFICULT IN CASES OF OCULAR TRAUMA DUE TO THE PRESENCE +OF: * PAIN,TENDERNESS * LID EDEMA * CORNEAL ABRASIONS& WOUNDS TO BYPASS MACHINE DISABILTY TO EXAMINE LENS AREA YOU CAN USE VITREOUS AS A COUPLING FLUID 34

35 CONTACT TECHNIQUE * AXIAL * LONGITUDINAL * TRANSVERSE CONTACT B SCAN LONGITUDINAL AXIAL 35

36 CONTACT B SCAN LONGITUDINAL AXIAL CONTACT B SCAN LONGITUDINAL AXIAL CATARACTOUS LENS 36

37 CONTACT B SCAN LONGITUDINAL AXIAL SUBLUXATED LENS CONTACT B SCAN LONGITUDINAL AXIAL INTUMESCENT CATARACT 37

38 CONTACT B SCAN LONGITUDINAL AXIAL OPACIFIED POSTERIOR CAPSULE CONTACT B SCAN LONGITUDINAL AXIAL POSTERIOR SUBCAPSULAR CATARACT 38

39 CONTACT B SCAN LONGITUDINAL AXIAL POSTERIOR DISLOCATED LENS CONTACT B SCAN LONGITUDINAL RUPTURED POSTERIOR CAPSULE 39

40 CONTACT B SCAN LONGITUDINAL CATARACT+ ENCIRCLING CONTACT B SCAN LONGITUDINAL AXIAL POSTERIOR DISLOCATED LENS 40

41 CONTACT B SCAN LONGITUDINAL INTUMSCENT CATARACT CONTACT B SCAN LONGITUDINAL CATARACTOUS LENS&PERSISTANT HYALOID 41

42 CONTACT B SCAN LONGITUDINAL DISLOCATED LENS CONTACT B SCAN LONGITUDINAL CATARACTOUS LENS & CILOCHOROIDAL EDEMA 42

43 CONTACT B SCAN LONGITUDINAL SUBLUXATED LENS CONTACT B SCAN LONGITUDINAL CATARACTOUS LENS WITH SMALL NUCLEUS 43

44 CONTACT B SCAN LONGITUDINAL HYPERMATURE CATARACT CONTACT B SCAN LONGITUDINAL INTRALENTICULAR FB 44

45 CONTACT B SCAN LONGITUDINAL AXIAL RUPTURED POSTERIOR CAPSULE&POSTERIOR FB CONTACT B SCAN LONGITUDINAL OPACIFIED POSTERIOR CAPSULE 45

46 CONTACT B SCAN LONGITUDINAL AXIAL CONTACT B SCAN LONGITUDINAL INTRALENTICULAR FB 46

47 CONTACT B SCAN LONGITUDINAL CATARACTOUS LENS+ANTERIOR HGE CONTACT B SCAN LONGITUDINAL INTRALENTICULAR FB 47

48 CONTACT B SCAN LONGITUDINAL INTRALENTICULAR FB RELATED TO POSTERIOR CAPSULE 48

49 WHY CLINICAL EXAMINATION? 49

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60 60 THANK YOU