Ultrasonography A scan & B scan

A scan
 A scan or amplitude scan is a common method used for ocular assessment via
ultrasound .
 In A-scan, a single sound beam of frequency 8 – 10 MHz is sent from the
transducer into the eye ball.
 The sound wave maybe reflected off of ocular structures when the
encountered structure is different than the one the sound wave was traveling
in ; The reflection is partial where the rest is transmitted further .
 A scan is a contact technique which uses principles like “pulse echo” and
“piezoelectricity”.
 Pulse echo : A technique where an ultrasound wave is emitted into the area
of interest . Then the reflected & scattered waves so coming back are
analyzed for the time delay between emission and reception for the depth of
surface / structure that's reflecting the wave .
 Piezoelectricity : Ability of producing an electric current in response to a
mechanical stress .
 The probe on the A scan works on the combination of the above two
principles .
 A scan maybe performed with or without the help of a scleral shell .
 Sources of errors in A scan : corneal compression , angle of incidence of sound
, wrong selection of sound velocity etc , ..
 Advantages & Disadvantages :
 Adv:- 1. Easy to use and learn
2. Accurate measurements
3. Measures AC depth & crystalline legs thickness
4. Highly defined tissue differentiation
  Dis-Adv:-1. Variable corneal compression
2. Incorrect assumptions of sound velocity
3. Potential for incorrect measure of distance
 Indications of A scan :
1. To obtain axial length of eye ball
2. For visualization of lens dislocation
3. Visualization of RD
4. When other instruments fail due to media opacities like dense
cataract.
5. Detection of posterior globe tumors .
 Interpretation :

 As seen in the picture given is the normal A scan report with spikes
representing the different normal ocular structures .
 The majorly seen spikes are formed from these :
1. Probe/Cornea
2. Anterior lens surface
3. Posterior lens surface
4. Retina

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 5. Sclera
 Any abnormal condition maybe blame to missing / extra / varying
spikes compared to the normal , like below.

B scan
 B Scan or brightness scan is another ultrasound technique used very
commonly for assessment of orbital & ocular structures .
 It gives a 2D , cross sectional view .
 It can be performed directly on the anesthetized eye. In cases of trauma or
in children, B-scan can be performed over the eyelid with coupling jelly.
 Measurements derived from B-scan include visualization of the lesion,
including anatomic location, shape, borders, and size.
 It can be used for a detection of a wide-range of pathological structures,
including retinal or choroidal detachment, foreign bodies, calcium, and
tumors.
 Echoes in B-scan are converted to dots with brightness intensity that is
proportional to the echo amplitude.

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  For example, high amplitude echoes appear as hyperechoic (white), and
absent echoes appear black (anechoic).
 It is especially useful in imaging of tumors of the anterior and posterior
segment, EOM tendon thickening etc …
 Advantages & Disadvantages :
 Adv – 1. High sensitivity
2.Non – invasive
3.No ionizing radiation / harmless
4. Ideal for follow up assessment
 Dis-Adv :- 1.Low resolution
2. High frequency = low penetration.
 Indications :-
1. Retinal & choroidal detachment
2. Media opacities
3. Intraocular foreign bodies
4. Tumors
 Interpretation :-
 1

 As seen in 1. we look at a normal B scan report.

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  Anything abnormal will be seen very similar to a cross view of the same
with varying hyperechoic and anechoic areas .As seen below