History of Standardized Echography
Karl C. Ossoinig, MD
University of Iowa, USA
1. Introduction
“Standardized Echography” is a widely used ultrasonic diagnostic method in ophthalmology, which combines diagnostic A-scan, diagnostic B-scan, biometric A-scan and, at times, Doppler evaluations. Each of these applications is used for specific portions of the diagnostic effort according to each one’s optimal suitability:
Diagnostic B-scan is utilized for topographic evaluations such as the location of a lesion and its shape, insertions and relationship to neighboring structures, for an estimate of its dimensions across the sound beam, and for kinetic evaluations of some types of the lesion’s mobility and consistency. B-scan of 20-50 MHz is preferred for evaluations of the anterior eye segment, B-scan of 10 - 15 MHz is applied for the posterior eye segment, B-scan of 10 MHz is utilized for the orbit.
Diagnostic A-scan (8 MHz effective frequency, parallel beam) is applied for quantitative evaluations of a tissue’s structure, reflectivity and sound absorption, for some topographic evaluations such as the borders of orbital lesions or some peripheral insertions in the posterior eye segment, and for kinetic evaluations of a tissue’s vascularity, mobility and consistency.
Biometric A-scan (8 MHz effective frequency, parallel beam) serves precise measurements along the sound beam, for instance the maximal height of an intraocular tumor, the dimensions of an orbital mass lesion, the exact depth of a foreign body, the thickness of tissues such as the sclera, extraocular muscles and the optic nerve or the distension of its sheaths [103]. The same kind of biometric A-scan is used for most accurate and precise immersion axial eye length measurements for optimal IOL power calculations.
Pulsed Doppler (at least 9 MHz nominal frequency, preferably of a directional type) may be added for more specific evaluations of blood flow in larger vessels [49, 64].
For A-scans – in order to be diagnostically valid – one must use specifically (optimally) designed and standardized instrumentation [2, 75, 85, 205]. In addition to the instrumentation, all the examination techniques (A-scan, B-scan and Doppler) must also be specifically designed to allow for optimal results [1, 4, 8, 22, 35, 45, 46, 64, 138, 75, 150, 205]: a “Basic Examination” serves the detection of intraocular and (peri)orbital lesions; two types of “Quantitative Echography” help to evaluate structure, reflectivity, and sound absorption within a lesion; “Topographic Echography” reveals and documents the location, shape, borders and topographic relationships of lesions; various types of “Kinetic Echography” determine the vascularity, mobility and consistency of lesions.
Various types of “Echographic Tomography “ were introduced for immersion B-scan examinations [13, 15] when this B-scan method was still used for Standardized Echography: specific scanning techniques, i.e. transverse, longitudinal and axial scans are used with contact (posterior eye segment and orbit) and immersion (anterior eye segment) real-time B-scanning since the 1970's [75]. The fact that in Standardized Echography the A-scan instrumentation as well as all the examination techniques are optimally designed and standardized gives the method its name.
The primary goal of this optimal design of the A-scan instrumentation and of all examination techniques is a superior capacity for and efficacy in diagnosing, differentiating and measuring a great variety of normal and abnormal ocular tissues (anterior and posterior eye segment as well as orbit and periorbital region). The purpose of standardizing this design is to use a universal and optimal echographic language with superior, understandable, comparable and repeatable results.
2. Historical Background
The idea of Standardized Echography was conceived in 1963 in the II. Eye Department at the University of Vienna (Austria), when it became apparent to the author that even A-scan instruments with identical brand names produced very different results: while both intraocular and orbital tumors were successfully detected, measured and to some extent even differentiated by the author in the II.Eye Department as early as 1963 using the Kretz 7000 model, none of this was possible with the Kretz 7000 model purchased and used later the same year in the I. Eye Department at the University of Vienna.
This experience prompted phase I of the evolution of Standardized Echography which was undertaken in the 1960’s. Phase I included extensive experimental and clinical investigations testing all those instrument parameters which influence the appearance and diagnostic value of the A-scan echograms and arriving at optimal choices for each of them to be standardized for all subsequent A-scan devices for Standardized Echography. During phase I the author and his cooperators also undertook extensive experimental work with various biological materials including fixed and frozen tumor tissues and especially a variety of citrated blood samples to clarify the echo origin in living tissues, to reveal more acoustic criteria for the differential diagnosis of ocular and orbital lesions and to select a proper tissue model for setting the A-scan devices at the standardized Tissue Sensitivity [2, 4, 11, 18, 29, 33, 43, 205].
Beginning in 1964 the author also embarked in the development of B-scan instrumentation and techniques to augment the A-scans [3, 5, 7, 9, 10, 15, 16, 20, 35]. Progressively more efficient immersion B-scan devices with use of electromechanical guidance of the sound beam were developed by the author together with Kretztechnik. This cooperation resulted in the worldwide first commercially available A&B-scan unit [9, 13, 20, 25, 28, 29, 35] in 1966 (Kretztechnik 7900 S with the choice between a hand-guided probe or an automatic probe transport for B-scan tomography for immersion B-scanning incorporating the first commercially available standardized A-scan device) { not to be confused with a parallel development by W. Buschmann of an experimental unit for use with an arc-shaped array transducer for contact B-scanning bearing the same name, which, however, never became functional and therefore did not go into serial production }.
The A-scan part of the instrument's signal processing was standardized and served as prototype for the Kretztechnik 7200 MA [35, 40], which was developed by the author with Kretztechnik during the late 1960's as a stand-alone standardized A-scan unit which was clearly improved over the 7900 S standardized A-scan device. The Kretz 7200 MA was the first fully standardized A-scan device [44, 205]. It went into serial production in 1970; it was the only A-scan instrument available for Standardized Echography throughout in the 1970’s and early 1980’s. About 500 of these units were put into use by 1980 worldwide. Some of these units are still in use today.
In 1970, the author temporarily dropped immersion B-scan from use in Standardized Echography as it had become sufficiently apparent that the B-scan information, though impressive to any audience or readership, did not add anything significant to the acoustic information obtained by the superior standardized A-scan, but rather lacked reliability in the display of peripheral intraocular and orbital lesions and took way too much time in a busy clinical practice to remain feasible. When the author moved to Iowa City in 1971, he for a year applied only standardized A-scan utilizing the Kretztechnik 7200 MA [35, 40, 38]. When Nathaniel R. Bronson introduced contact real-time B-scan in 1972 [34, 47], B-scan once again became an integral part of Standardized Echography [43, 44, 48, 49, 52, 55, 57, 64, 69,70].
Early on, the method of Standardized Echography actually was referred to as “Clinical Echo-ophthalmography” [9, 29, 35, 40, 49, 55] since it did provide clinically extremely useful diagnoses already in those early years, in contrast to the experimental nature of other investigators' A-scan or B-scan applications. However, the specific description of the method as "Clinical" was dropped by the author in the mid-1970s when it became apparent, that contact real-time B-scan used without (standardized) A-scan also gained clinical significance. After designing special standardized examination techniques, i.e. transverse, axial and longitudinal scans for the contact real-time B-scan method, the author renamed this combined A-scan / B-scan / Doppler method“Standardized Echography” [75].
Phase I was completed by 1971, when the first commercially available standardized A-scan unit, the Kretz 7200 MA was introduced and the author moved to the Eye Department at the University of Iowa in the USA.
Phase II of the evolution of Standardized Echography took place during the 1970's, 1980's and into the early 1990's. Because of the availability of standardized instrumentation phase II brought an explosion of clinical investigations resulting in a rapid expansion of Standardized Echography [39 - 201; 212, 213, 215, 217, 220, 223, 225]. Also, early during phase II, a breakthrough regarding tissue models had been achieved: a solid tissue model for setting a standardized A-scan device at the (very high) standardized Tissue Sensitivity had been created by Peter Till to replace the previously used citrated blood samples [61, 68, 80, 91]. This solid tissue model continues to be an essential part of every fully standardized echography instrument; it is regularly furnished with fully standardized instruments upon their purchase.
Since the mid 1970's measurements of the extraocular muscles and the optic nerve were added to the armamentarium of Standardized Echography and were perfected during the following years. The author designed the "30 degree test" [86, 87, 150] to distinguish between solid and fluid optic nerve sheath widening, and later on the even more important technique of "exercising " the optic nerve to distinguish between intracranial hypertension and optic nerve compression [150]. Differential diagnoses of diseases affecting the optic nerve and the extraocular muscles including the most frequent orbital condition, i.e., Graves' orbitopathy were all defined and secured in phase II.
All in all, the diagnostic capacity of Standardized Echography was largely extended during phase II so that it further excelled over other diagnostic procedures (Fig. …) in safely providing more than 75 different intraocular as well as more than 65 different (peri)orbital diagnoses.
Although the advent of CT and MRI reduced the need for Standardized Echography for orbital evaluations, Standardized Echography remained superior in many areas of orbital diagnoses, e.g., in Graves' orbitopathy, orbital myositis, inflammatory disease, evaluations of the optic nerve such as clarification of unilateral papilledema, optic nerve compression, optic neuritis, optic atrophy etc., further in the detection and localization of foreign bodies, especially organic ones, and in the differential diagnosis of orbital tumors.
In 1984 the first combined standardized A-scan/B-scan instrument since the 7900 S unit of the 1960's became known as Ophthascan S (manufactured by Biophysic Medical, France). It was introduced at SIDUO X in St.Petersburg Beach, Florida [216]. Being the first digitized unit for Standardized Echography it had, however, some flaws (low image repetition hampering kinetic evaluations; poor high-frequency filtering rendering the A1sign worthless). A greatly advanced stand-alone standardized A-scan unit, the Mini-Ascan was developed subsequently by the author in cooperation with Biophysic Medical, France. This unit became available in the late 1980's. The Mini-A-scan offered a number of innovations that made operation faster, easier and more precise; its measuring resolution of 0.03 mm remained unparalleled until the year 2000, when the Cine-scan S was introduced during SIDUO XVIII. The Mini-A-scan was highly developed; its name contains an accidental understatement and was supposed to refer to its smaller size and lesser cost in comparison to a much more powerful digital A/B combination that was to follow instantly. The latter did not materialize, however, since Biophysic Medical was taken over by Alcon at that time. However, the previously so successful team of Biopysic Medical regrouped under the name of Biovision International (BVI) and, more recently, expanded to a combined US/French venture known as Quantel Medical/BVI (Bozeman, Mt, USA /Clermont-Fd / Paris, France). The cooperation of the author with Quantel Medical /BVI resulted in the development of progressively more sophisticated and advanced Standardized Echography instrumentation, i.e., the A/B system "B-scan S"(1994) and most recently its successor, the "Cine-scan S" (2000). The previous plan to create a superior A/B combination (see above) is finally being realized.
The great expansion of the applications and the increasing sophistication of Standardized Echography brought about in phase II not only enhanced this method over other diagnostic procedures but also incorporated a major obstacle for wider usage and faster spread of this unique method: it required lengthy training and major experience; it was time-consuming and for many applications difficult.
The advent of the digital revolution and modern software applications led to phase III of the evolution of Standardized Echography beginning in the early 1990's and continuing at an ever faster pace. These technological advances began to systematically transform Standardized Echography into a quick and easy, and at the same time more objective, more reliable and more accurate method which in addition requires much less training and experience. An example is presented by the author in another contribution to SIDUO XVIII (see Ossoinig KC: "Computer-assisted Echographic Tissue Diagnoses: differentiation between retinal and membranous surfaces"). This rapidly developing user-friendly automation of differential diagnoses and measurements has begun to rejuvenate Standardized Echography preparing it for a much wider usage in the years to come.
3. Phase I
During phase I of the evolution of Standardized Echography extensive experimental and clinical investigations were conducted to determine the optimal settings of each of the parameters of an A-scan instrument, which influence the appearance and diagnostic value of the A-scan echograms.
The results were usually optimal compromises between opposite requirements. For instance, the optimal frequency for the A-scan evaluations was found to be 8 MHz (effective, not just nominal, frequency). While higher frequencies would have been more desirable because of their greater resolution, they had to be ruled out because of their increased absorption in the ocular tissues. Thus 8 MHz was found to be the optimal compromise between resolution and penetration. Also, the 8 MHz frequency turned out to be optimal for the differentiation of tissue structures on the barely sub-macroscopical level. Higher frequencies become confusing by resolving too many microscopical elements.
The A-scan quality most productive in delivering diagnostically important information about tissues, is the amplitude of echo spikes. Echo signal amplitudes reveal internal structure, reflectivity, absorption and indirectly the vascularity and consistency of tissues. Amplitudes of echo signals are, however, influenced by a host of different instrument parameters and settings, especially the probe characteristics, the receiver bandwidth, the amplifier characteristics, the display height, the gain settings, and also to a great degree by the examination technique applied. If all of these parameters and the technique are optimized and standardized, tissue differentiation becomes successful to an astonishingly great degree.
There are other important steps of signal processing which are also indispensable for optimal diagnoses, e.g., the degree of high-frequency filtering (see Ossoinig KC: "Computer-assisted Echographic Tissue Diagnoses: differentiation between retinal and membranous surfaces" in the proceedings of SIDUO XVIII).
During phase I the optimal design and the standardization of instrumentation and techniqes were accomplished in cooperation with Kretztechnik (Austria) through clinical and experimental research performed at the 2nd University Eye Clinic in Vienna (Austria) coupled with stepwise corrections and adjustments of a Kretz 7000 instrument. This Kretz 7000 instrument became the prototype, first for the Kretz 7900 S, and then for the Kretz 7200 MA [2, 9, 28, 29, 40, 43, 44, 75 and 205 ff] (see also chapter 2: Historical Background). This cooperation resulted in the following specific design criteria:
8 MHz (± 0.2 MHz) effective frequency with a 5 mm crystal diameter and a parallel beam; narrow-band receiver with maximal response at 8 MHz; S-shaped amplifier characteristic curve with a total dynamic range of 33 db (5%-95% spike height) with a specific distribution; very high standardized system sensitivity setting (Tissue Sensitivity) obtained with a solid tissue model; fixed ratio between vertical and horizontal screen display; and specific (incomplete) filtering of the high frequency oscillations. This design was found to be optimal in the 1960's and required no change since.
Standardized examination techniques for the A-scan method were developed at the same time and termed “Quantitative Echography”, “Topographic Echography”, and “Kinetic Echography” [1, 4, 8, 22, 35, 45, 46, 64, 138, 75, 150, 205]. Extensive experiments were undertaken by the author and his cooperators studying the effects of biological tissue structures on echographic displays 1, 4, 11, 18, 43, 205]. The purpose as well as the outcome of these studies helped to explain the different acoustic behavior of ocular and orbital, normal and abnormal tissues, and guided the instrument design for optimal visual acoustic tissue differentiation.
Thus the groundwork for the clinical applications of Standardized Echography had been laid during phase I in the 1960s, when this method was still called “Clinical Echo-Ophthalmography” [9, 23, 29, 35, 40]. It was then that the basic principles for the diagnosis and differential diagnosis of intraocular and orbital lesions were set and many specific diagnoses were primed. These include:
retinal detachments vs. vitreous membranes and posterior vitreous detachments [3, 7, 16, 19, 35, 42]; choroidal detachments (serous vs. hemorrhagic) [3, 16, 22, 39]; retinopathia proliferans [38]; traumatic (hemorrhagic) retinal detachment [36]; asteroid hyalosis [7, 22]; choroidal melanomas [4, 16, 19, 20, 22, 35]; choroidal hemangiomas [41]; choroidal metastatic carcinomas [35]; disciform macula degeneration [22, 35, 41]; endophthalmitis [35]; (foreign bodies [3, 6, 16, 21, 35] and precise foreign body localization [5, 6, 7, 21], spherical foreign bodies [21], intrascleral foreign bodies [5, 6, 21]; retinoblastomas [22, 26, 35]; RLF [35]; posterior scleritis [35]; normal orbital tissues [10, 14]; detection of orbital tumors with 97% accuracy in 153 orbital cases (71 tumors) [12], which improved to 98.3% by 1969 in a total of 579 orbital patients (154 orbital tumors) [24]; cavernous hemangiomas [3, 16, 18, 19, 20, 25, 30, 35]; (pseudo)lymphomas [18, 19, 20, 25, 35]; orbital varix [30]; A-V fistulas [17, 19, 20, 30, 35]; dermoid cysts [3, 10, 16]; serous cysts [7, 19, 24, 25]; sphenoidal meningiomas [18, 19, 20, 35]; fibroneuroma [20]; orbital mucoceles [20, 24, 35]; remote orbital metastatic carcinomas [20,41]; maxillary/orbital carcinoma [37]; ethmoidal/orbital neoplasm [41]; scirrhous orbital metastatic carcinoma [27]; retrobulbar hematomas [7, 32]; optic nerve gliomas [3, 16, 20]; papilledema [35]; Graves' orbitopathy [31].
In essence, the author and his collaborators succeeded in laying the ground work for the method of Standardized Echography by making optimal standardized instrumentation and corresponding standardized examination techniques as well as acoustic criteria for the diagnosis and differential diagnosis of intraocular and (peri)orbital lesions available and by proving the effectiveness of the method through their clinical results.
4. Phase II
Phase II lasted almost three decades from the 1970's well into the 1990's. It represents a time period of continuous expansion and consolidation of the usage of, the indications for, and the performance and clinical results of Standardized Echography. This was effected by (1) the availability of excellent standardized instrumentation and techniques and (2) by intensive training efforts by the pioneers of the method.
At the heart of phase II was indeed the intensive training of scores of ophthalmologists and ophthalmic technicians at the Universities of Vienna (Austria) and of Iowa (USA), many of whom spread the method throughout the world by their teaching and training efforts of great numbers of their colleagues and who further improved and consolidated Standardized Echography through their own research and publications thus adding data to the already existing knowledge thereby confirming or enhancing the clinical usefulness and effectiveness of the method in the diagnosis and differential diagnosis of posterior as well as anterior eye segment lesions and of orbital and periorbital lesions, or by detailing acoustic differential criteria [50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 62, 66, 67, 71, 72, 73, 77, 79, 81, 83, 84, 86, 89, 90, 93, 95, 96, 98, 99, 100, 107, 110, 111, 112, 113, 114, 126, 128, 129, 131, 133, 137, 138, 139, 140, 142, 144, 145, 148, 149, 151, 153,160, 165, 169, 171, 177, 180, 184, 185, 186, 188, 193, 194, 195, 198, 199, 201, 223, 225]; by designing flow charts for the differentiation of intraocular and (peri)orbital lesions [47, 48, 51, 64]; by adding new differential diagnoses to the widening spectrum of application of Standardized Echography [41, 46, 47, 48, 55, 56, 57, 60, 65, 69, 70, 76, 78, 82, 84, 87, 89, 92, 93, 94, 96, 97, 101,102, 104, 105, 106, 108, 109, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 127, 130, 134, 135, 136, 141, 143, 147, 150, 152, 154, 156, 157, 158, 159, 161, 162, 163, 164, 166, 167, 168, 170, 172, 178, 179, 181, 182, 183, 187, 189, 190, 191, 192, 196, 212, 213, 215, 217, 220] and by providing statistically impressive results in larger patient populations for a variety of different disease processes [51, 56, 55, 58, 88, 89, 90, 93, 132, 146].
It is only fair to mention in this context at least the most important of these teachers and researchers emerging from those two training centers (in historic order): Peter Till, MD (Austria), Heinz Freyler, MD (Austria), Sandy F. Byrne, RDMS (USA), Leroy McNutt, MD (USA), Philip Corboy, MD (USA), Roberto Sampaolesi, MD (Argentina), Barton L. Hodes, MD (USA), Frank Goes, MD (Belgium), Atsushi Sawada, MD (Japan), Brian Conner, MD (USA), Dwain Fuller, MD (USA), Barry Kerman, MD (USA), Francis Bigar, MD (Switzerland), Wolfgang Hauff, MD (Austria),Harold W. Skalka, MD, (USA), Celso Antonio de Carvalho, MD (Brazil), Alberto Betinjane, MD (Brazil), Samir Salomon, MD (Lebanon), H.John Shammas, MD (USA), Ingeborg Stenström, MD (Sweden), Alex Papic, MD (Chile), Eduardo Moragrega, MD (Mexico), Stephen Miller, MD (USA), Gary W. Abrams, MD (USA), Robin Bosanquet, MD (UK), Robert Levine, MD (USA),Giovanni Cennamo, MD (Italy), Roger P. Harrie, MD (USA), Ronald L. Green, MD (USA), Pier Enrico Gallenga, MD (Italy), Peter Bischoff, MD (Switzerland), Wichard AJ Van Heuven, MD (USA), Gerhard Hasenfratz, MD (Germany), Elisabeth Frieling, MD (Germany), William M. Hart Jr., MD, PhD (USA), Rainer Rochels, MD (Germany), Tom C. Fisher (USA), Richard A. Lewis, MD (USA), Daniele Doro, MD (Italy), Enrique Meerhoff, MD (Uruguay), Jan Schutterman, MD (Sweden), Amin Nasr, MD (Lebanon), Kamel Itani, MD (USA), T.Mohamed Matheen, MD (Saudi-Arabia), Ciro Tamburrelli, MD (Italy), Gustavo Tamayo, MD (Columbia), Jo Fukiyama, MD (Japan), Irene Landau, MD (Sweden), Gilberto Islas, MD (Mexico), Yuanyao Du, MD (China), Maren Schilling, MD (Germany), Nicola Rosa, MD (Italy), Christian Mardin, MD (Germany), Robert Cinefro, MD (USA), Eytan Z. Blumenthal, MD (Israel), Georg F. von Arx, MD (Switzerland), Mario de la Torre MD (Peru), Agostino La Rana, MD (Italy).
By the same token the author wishes to acknowledge the tremendous merits of two electronic engineers who made the development and continuous perfection of Instrumentation for Standardized Echography possible through their enormous knowledge of, and skills in, the field of diagnostic ultrasound, and through their readiness and capability to accept and accommodate clinical necessities:
(1) Ing. Bernhard of Kretztechnik (Zipf, Austria); with his help the Kretz 7000 instrument of the II. Eye Department of the University in Vienna (Austria) was modified to become the prototype for all subsequent standardized A-scan instruments by 1964, and with his help the author developed the first commercially available immersion tomograph Kretztechnik 7900 S (combined standardized A-scan and B-scan) in 1966 as well as the Kretz 7200 MA by 1970 (the only standardized A-scan unit available throughout the 1970's and early 1980's).
(2) Jean Abascal of Biophysic Medical, later of Biovision International [BVI] (all in Clermont-Ferrand, France), and lastly of Quantel Medical (Bozeman, MT, USA and Clermont-Fd / Paris, France); together with Jean Abascal the author developed the Ophthascan S in the 1980's, the Mini-A-scan in the late 1980's, the B-scan S in the late 1990's, and most recently, its successor, theCine-scan S (all with progressively increasing digital capabilities and more numerous and powerful software programs).
The results of a collaborative international melanoma and retinoblastoma studies undertaken for publication during the International Congress of Ophthalmology in San Francisco in 1982 [93] demonstrate the effectiveness of Standardized Echography performed by a great number of echographers worldwide (all had been trained at the Universities of Iowa, USA or Vienna, Austria):
The diagnosis of malignant melanomas of the choroid and ciliary body accomplished with Standardized Echography by a total of 92 different examiners () in 33 different centers worldwide in a total of 1629 histological confirmed cases carried the unique sensitivity of 99% and a specificity of 97.9%.
Likewise the diagnosis of retinoblastomas achieved by 56 different echographers in 23 different centers worldwide in a total of 319 histological proven cases carried a sensitivity of 98.1% and a specificity of 97.8%.
Since the mid 1970's measurements of the optic nerve [64, 66, 69, 70, 150] and the extraocular muscles [63, 64, 69, 70, 74] were added to the armamentarium of Standardized Echography and were perfected during the following years [75, 87, 93, 94, 97, 104, 150]. The usage of the "30 degree test" [86, 87, 150] to distinguish between solid and fluid optic nerve sheath widening and the even more important technique of "exercising " the optic nerve to distinguish between intracranial hypertension and optic nerve compression [150, 173, 174, 175] were well accepted. Most reliable diagnoses of diseases affecting the optic nerve (e.g., gliomas, meningiomas, AION, PION, optic neuritis, optic atrophy, papilledema vs. dry optic nerve swelling, intracranial hypertension, compressive optic neuropathy) [150], and of diseases affecting any of the 6 extraocular muscles (e.g., Graves orbitopathy, orbital myositis, hyperemia, hematomas, neoplasms [94, 97, 101, 104,131, 155, 167, 176, 197, 200] were added to the widening scope of useful diagnostic application of Standardized Echography.
The following case illustrates the applicability and great sensitivity and accuracy of the acoustic differential criteria that have evolved over the years for each of these ocular and orbital conditions and which can reliably be applied because they are based on the optimal and standardized instrument parameters and techniques of Standardized Echography:
A 53-year old white male patient had been referred to the Echography Service in the Eye Department at the University Hospitals in Iowa City in 1990 with the (clinical and CT-scan) diagnosis of Graves' orbitopathy. He had undergone a previous ptosis operation OS, which was only temporally effective. The echograms obtained with a standardized Ascan device (Mini-A-scan) set at Tissue Sensitivity indicated medium to low reflectivity, internal vascularity and a large angle kappa of several tumors located within the sheaths of extraocular muscles in both orbits of this patient (Fig.1). On the basis of these criteria the author made the diagnosis of metastatic carcinoid, which was later confirmed by histopathology.
This diagnosis was made without having experienced this extremely rare kind of tumor within the sheaths of an extraocular muscle before, on the following three accounts: (1) the echographic findings in one case of carcinoid metastatic to the right lacrimal fossa of a 70-year old white female experienced 10 years earlier; her tumor echograms had shown an angle kappa of identical size, but a slightly higher internal reflectivity [92]. (2) The knowledge that tumors located within the sheaths of the extraocular muscles present with a slightly but clearly lower reflectivity than their counterparts located within orbital fat tissues. (3) That no other tumor tissue was known to produce the echographic features recorded in this male patient.
During phase II Standardized Echography evolved into the most potent, effective, reliable, accurate and diversified ultrasonographic method in ophthalmology offering the best results in detection, localization, measurement and differentiation of intraocular, orbital and periorbital lesions. This method allows, for instance, the differentiation of more than 75 intraocular, and of more than 65 orbital and periorbital, lesions. For many of these differential diagnoses Standardized Echography provides a sensitivity as well as specificity ranging above 95%, in several instances close to 100%.
5. Phase III
Since the mid 1990's a digital revolution began to drastically change the situation of Standardized Echography. Though some tasks of Standardized Echography always have been easy and quick, many of the differential diagnoses which made this method so superior to other echographic approaches required much time, skills and experience on the part of the echographers. Likewise the training for Standardized Echography was lengthy and training opportunities were lacking. This situation slowed the spread of this unique method.
With the advent of digitization and the development of powerful software programs the situation of Standardized Echography has changed drastically allowing for quick, easy, but still more reliable, more objective and more accurate diagnoses to be accomplished by less trained and less experienced echographers. This trend is just starting for Standardized Echography and promises a bright future for this diagnostic method.
A good example for this development is presented by the author in another contribution to SIDUO XVIII (see Ossoinig KC: "Computer-assisted Echographic Tissue Diagnoses: differentiation between retinal and membranous surfaces"): The A1 sign described there had been found to be the single most reliable and accurate acoustic criterium for differentiating retinal detachments from dense fibrovascular membranes. It's application was fairly quick for a well trained and skilled echographer. With new software already contained in the software package 2000 for the B-scan S instrument, the A1 evaluation has become so quick and easy that untrained participants in a recent workshop on Standardized Echography accomplished the correct diagnosis of a retinal detachment without exception within 5 to 15 seconds.
Other features of the software package 2000 are: an automatic setting of the Tissue Sensitivity, automatic calculations and digital readouts of the reflectivity and sound absorption of tumor tissues. For the first time this sound absorption can be measured and displayed in db/ mm tissue by simply setting two electronic gates at both opposite surface signals of the tissue or marking any section within the tissue echogram. The associated angle kappa is measured and displayed digitally in degrees and can be displayed schematically (Fig. 2).
This rapidly developing user-friendly automation of differential diagnoses and measurements has begun to rejuvenate Standardized Echography preparing it for a much wider usage in the years to come.
6. Conclusion
This paper starts with the definition of the term "Standardized Echography" (Introduction). The history of the origin of Standardized Echography in early 1963, its successes and worldwide expansion and its radical changes following the digital revolution, which started in the early 1990 and continue with increasing speed at the present, are narrated in Chapter 1 (Historical Background). Chapters 2-4 describe the special characteristics of each of the three stages in the evolution of Standardized Echography.
In the four decades of its existence, Standardized Echography has become the most potent and effective echographic method. Powerful software programs developed during the past few years and being added continuously begin to turn this sophisticated method into a quick and easy and ever so more reliable, objective and accurate diagnostic tool in ophthalmology, which will require much less training and experience than in the past.
7. Bibliography
A selection from the vast literature on Standardized Echography (scientific papers, book chapters, and books) is presented here including publications reporting instrumentation, techniques and specific diagnoses for the first time or confirming previous reports with more details or greater patient volumes, and publications containing concise and relevant bibliographical or summarizing reviews.
Scientific Papers & Book Chapters:
1. Ossoinig KC Ultrasonic Diagnosis of Tumors in the Eye and Orbit - experimental and clinical examinations with the A-scan method [German] in: Diagnostica Ultrasonica in ophthalmologia (Proceedings of SIDUO I, Berlin 1964, Buschmann W and Hildebrandt I, eds) pp 185-191, Math. Naturwiss. Reihe XIV der Humboldt-Universität Berlin, 1965
2. Ossoinig KC and Steiner H Standardization in Ultrasonic Diagnosis - a tissue model for the diagnosis of intraocular tumors [German] in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO I, Berlin 1964, Buschmann W and Hildebrandt I, eds) pp 129-133, Math. Naturwiss. Reihe XIV der Humboldt-Universität Berlin, 1965
3. Ossoinig KC Ultrasonic Diagnosis in Ophthalmology [German] 9. Verhandl Österr Ophthal Ges pp. 11-27, 1965
4. Ossoinig KC Acoustic Diagnosis of Ocular Tumors - Experimental and Clinical Examinations with the A-scan Method [German] Klin. Monatsbl. Augenheilk., 146:321-337, 1965
5. Ossoinig KC Echography of Intraocular Foreign Bodies [German] Ber 67. Zus Deutsch Ophthal Ges
Heidelberg67:288-294, 1965
6. Ossoinig KC Ultrasonic Diagnosis of Intraocular Foreign Bodies [German] Ber. Deutsch. Ophth. Ges. 67:288-296, 1966
7. Ossoinig KC Ultrasonic Diagnosis of the Eye - an Aid for the Clinic (Review) in: Ultrasonics in Ophthalmology (proceedings of Symposium Münster 1966; Oksala A. and Gernet, H.,eds ), pp.116-133, Karger Basel / New York 1967
8. Ossoinig KC Evaluation of Kinetic Properties of Echograms [German] in: Ultrasonics in Ophthalmology (proceedings of Symposium Münster 1966; Oksala A. and Gernet, H.,eds ), pp. 88-96, Karger Basel / New York 1967
9. Ossoinig KC A new Instrument for Clinical Echo-Ophthalmography [German] Graefe's Arch. Ophthalmol. 171:312-317, 1967
10. Ossoinig KC Ultrasonic Diagnosis of Orbital Tumors (A-scan and B-scan examinations) [German] Graefe's Arch. Klin. Exp.Ophthal. 172:364-382, 1967
11. Ossoinig KC and Seher K Some Findings about the Histological Basis of Echograms [German] in: Ultrasonics in Ophthalmology (Proceedings of Münster Symposium 1966, Oksala A and Gernet H, eds) pp 88-96, Karger 1967
12. Ossoinig KC and Seher K Results in the Echography of Orbital Tumors [German] Klin Mbl Augenheilk 151:519-524, 1967
13. Ossoinig KC and Valencak E Echo-tomography - a Method for the Diagnosis of Orbital Tumors [French} In: Neuro-Chir (Paris), 13:899-905, 1967
14. Ossoinig KC The Echographic Picture presented by Healthy Orbita (A-scan echograms) In: Diagnostica Ultrasonica in Ophthalmologia (proceedings of SIDUO II, 1967, Vanýsek, J, ed), Acta Fac. Med. Univ.Brunensis 35, pp. 101- 107, Brno 1968
15. Ossoinig KC Techniques of Echo-tomography of the Eye and Orbit [German] In: Diagnostica Ultrasonica in Ophthalmologia (proceedings of SIDUO II, 1967, Vanýsek, J, ed), Acta Fac. Med. Univ.Brunensis 35, pp. 117-123, Brno 1968
16. Ossoinig KC Echography in Ophthalmology [German] Wien.Med. Wschr. (Proceedings sterr. Ophthalmol. Ges. 1965) 118:362-367, 1968
17. Valencak E and Ossoinig KC A- and B-scan Echography of orbital A-V Fistulas [French] in: Neuro-Chirurgie, Paris,
14:951-956, 1968
18. Böck J and Ossoinig KC Relationship between Histological Structures and Echograms as the Basis for Non-traumatic Tissue Differentiation [German] Klin Mbl Augenheilk 155:687-695 1969
19. Ossoinig KC Routine Ultrasonography of the Orbit in: Ultrasonography in Ophthalmology, International Ophthalmology Clinics 9/3:613-642, Little, Brown and Company 1969
20. Ossoinig KC Basics, Methods, and Results of Ultrasonography used in the Diagnosis of
Intraocular Tumors in: Ophthalmic Ultrasound (Proceedings of International Symposium in Philadelphia 1968, Gitter KA, Keeney AH, Sarin LK, and Meyer D, eds) pp 282-293, The CV Mosby Company, St.Louis, 1969
21. Ossoinig KC and Seher K Ultrasonic Diagnosis of Intraocular Foreign Bodies in: Ophthalmic Ultrasound (Proceedings of International Symposium in Philadelphia 1968, Gitter KA, Keeney AH, Sarin LK, and Meyer D, eds) pp. 311-320, The CV Mosby Company, St.Louis, 1969
22. Ossoinig KC and Till P Methods and Results of Ultrasonography in Diagnosing Intraocular Tumors in: Ophthalmic Ultrasound (Proceedings of International Symposium in Philadelphia 1968, Gitter KA, Keeney AH, Sarin LK, and Meyer D, eds) pp294-300, The CV Mosby Company, St.Louis, 1969
23. Ossoinig KC and Till P Echo-Ophthalmography [German] Ber dtsch ophthal Ges 70:605-613, 1969
24. Ossoinig KC Echography of the Orbit - Method of Choice for the Diagnosis in Unilateral Exophthalmus [German]
Schweiz Med Wochenschr 99:1033-1039, 1969
25. Ossoinig KC and Valencak E Ultrasonography and Other Diagnostic Methods: Importance in Orbital Tumors in: Ophthalmic Ultrasound (Proceedings of International Symposium in Philadelphia 1968, Gitter KA, Keeney AH, Sarin LK, and Meyer D, eds) pp 301-305, The CV Mosby Company, St.Louis, 1969
26. Till P and Ossoinig KC Echographic Diagnosis of Retinoblastomas [German] Ber Dtsch Ophthalmol Ges 69:203-209, 1969
27. Ossoinig KC Enophthalmus - a Sign of an orbital Tumor[German] Ber. Deutsch Ophthal Ges Heidelberg 1969, JF Bergmann Verlag, München, 1970
28. Gerstner R. and Ossoinig KC A New High-frequency Ultrasonic Instrument for the Diagnosis and Differential Diagnosis of abnormal Tissues [German] in: Ultrasonographia Medica (Proceedings of 1st World Congress on Ultrasonic Diagnostics in Medicine and SIDUO III, Vienna 1969 (Böck J and Ossoinig KC, eds) Vol I, pp. 55-60, published by Wien. Med. Akad., Wien 1971.
29. Ossoinig KC Basics of Clinical Echo-Ophthalmography. Part IV: Clinical Standardization of Instrument and Examination Techniques [German] in: Ultrasonographia Medica (Proceedings of 1st World Congress on Ultrasonic Diagnostics in Medicine and SIDUO III, Vienna 1969 (Böck J and Ossoinig KC, eds) Vol II, pp. 83-118, published by Wien. Med. Akad., Wien 1971
30. Ossoinig KC Ultrasonic Diagnosis of Orbital Vascular Lesions [German] Klin Mbl Augenheilk 158:526-533 1971
31. Ossoinig KC Echo-Orbitography - a reliable method for the Differential Diagnosis of Endocrine Exophthalmus in: Further Advances in Thyroid Research (Proc of Vienna Conference on Endocrine Disorders 1968, Fellinger K and Höfer R, eds) pp 871-877, Verlag Wiener Med Akad, Vienna 1971
32. Till P Echography of Retrobulbar Hematomas [German] Klin Mbl. Augenheilk 158:723, 1971
33. Till P and Neumann A Reliability of Biological Standards [German] ] in: Ultrasonographia Medica (Proceedings of 1st World Congress on Ultrasonic Diagnostics in Medicine and SIDUO III, Vienna 1969 (Böck J and Ossoinig KC, eds) Vol II, pp. 119-124, published by Wien. Med. Akad., Wien 1971
34. Bronson NR Development of a Simple B-scan Ultrasonoscope. Trans. Amer. Ophthal. Soc. 70: 365-408, 1972
35. Ossoinig KC Clinical Echo-Ophthalmography in: Current Concepts in Ophthalmology (Blodi FC, ed) 8:101-130,
The CV Mosby Company, 1972
36. Ossoinig KC The Clinical Value of Echography in Traumatic Retinal Detachments [German] Mod Probl Ophthal
10:437-442, 1972
37. Till P and Ossoinig KC Echography in the Evaluation of periorbital Carcinomas invading the Orbit [German] Msch
Ohrh pp 442-448, 1972
38. Till P and Ossoinig KC Echographic Findings in Retinopathia Proliferans Klin Mbl Augenh 161: 297-301,
1972
39. Freyler H Echography in Hemorrhagic Choroidal Detachments [German] ] in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO IV, Paris 1971; Massin M. and Poujol J., eds) pp. 189-193, published by Centre National d'Ophtalmologie des Quinze-Vingts, Paris 1973
40. Ossoinig KC A New Instrument for Clinical Echo-Ophthalmography (proposals for the standardization of important instrument parameters) [German] in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO IV, Paris 1971; Massin M. and Poujol J., eds) pp. 131-137, published by Centre National d'Ophtalmologie des Quinze-Vingts, Paris 1973
41. Ossoinig KC Discussion of "Reliability of Ocular Tumor Diagnosis with Ultrasound" by Coleman DJ Trans Amer
Acad Ophthalmol Otolaryngol 77/5 OP: 684-686, 1973
42. Till P and Abel JO Results of Echography in Cases with Detached Retina [German] in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO IV, Paris 1971; Massin M. and Poujol J., eds) pp.195-198, published by Centre National d'Ophtalmologie des Quinze-Vingts, Paris 1973
43. Ossoinig KC Preoperative Differential Diagnosis of Tumors with Echography. I. Physical Principles and Morphological Background of Tissue Echograms In: Current Concepts in Ophthalmology (Blodi FC ed) 4:264-280. CV Mosby, St.Louis 1974
44. Ossoinig KC Preoperative Differential Diagnosis of Tumors with Echography. II. Instrumentation and Examination Techniques In: Current Concepts in Ophthalmology (Blodi FC ed) 4:280-296. CV Mosby, St.Louis 1974
45. Ossoinig KC Quantitative Echography - An Important Aid for the Acoustic Differentiation of Tissues in: Ultrasonics in Medicine (Proceedings of 2nd World Congress on Ultrasonics in Medicine, Rotterdam 1973, de Vlieger M, White DN and McCready VR, eds) pp 49-54, Excerpta Medica, Amsterdam 1974
46. Ossoinig KC Quantitative Echography - the basis of tissue differentiation J Clinical Ultrasound 2/1: 33-46, 1974
47. Ossoinig KC and Blodi FC Preoperative Differential Diagnosis of Tumors with Echography. III Diagnosis of Intraocular Tumors In: Current Concepts in Ophthalmology (Blodi FC ed) 4:296-313. CV Mosby, St.Louis 1974
48. Ossoinig KC and Blodi FC Preoperative Differential Diagnosis of Tumors with Echography . IV. Diagnosis of Orbital Tumors In: Current Concepts in Ophthalmology (Blodi FC ed) 4:313-341. CV Mosby, St.Louis 1974
49. Till P and Lessel MR Doppler-Sonography and Echo-Ophthalmography off Orbital Vascular Processes in: SIDUO Round Table 1974 (Massin M and Poujol J, eds) pp 51-58, Centre Nat d'Ophtalmol des Quinze-Vingts, Paris 1974
50. Freyler H and Arnfelser H Relation between Histological Structure and Ultrasonogram in Malignant Melanoma of the Choroid in: Ultrasonography in Ophthalmology (Proceedings of SIDUO V, Francois J and Goes F, eds) pp 163-171, S Karger 1975
51. Ossoinig KC A-scan Echography and Orbital Disease in: Modern Problems in Ophthalmology (Proceedings 2nd Int Symposium on Orbital Disorders, Amsterdam 1973 (Streiff EB, ed) Vol 14, pp 203-235, Karger 1975
52. Ossoinig KC, Bigar F and Kaefring S Malignant Melanoma of the Choroidand Ciliary Body. A differential diagnosis in Clinical Echography in: Ultrasonography in Ophthalmology (Proceedings of SIDUO V, Francois J and Goes F, eds) pp141-154, S Karger 1975
53. Ossoinig KC, Bigar F, Kaefring S and McNutt L Echographic Detection and Localization of BB Shots in the Eye and Orbit in: Ultrasonography in Ophthalmology (Proceedings of SIDUO V, Francois J and Goes F, eds) pp 109-118, S Karger 1975
54. Ossoinig KC, Keenan TP and Bigar F Cavernous Hemangioma of the Orbit in: Ultrasonography in Ophthalmology (Proceedings of SIDUO V, Francois J and Goes F, eds) pp 236-244, S Karger 1975
55. Ossoinig KC and Till P Ten-year Study on Clinical Echography in Orbital Disease Bibl Ophthalmol 83:200 1975
56. Ossoinig KC and Till P Clinical Echography of Tumors in the Eye and Orbit [German] in: Krebsbehandlung als Interdisziplinäre Aufgabe, Kärcher KH ed, pp 249-270, Springer Verlag 1975
57. Till P Echography in Rhinogenic Orbital Conditions in: Modern Problems in Ophthalmology: Orbital Disorders (Bleeker GM et al, eds) Vol 14, p 273, Karger (Basel) 1975
58. Till P and Ossoinig K Ten-year Study on Clinical Echography in Intraocular Disease Bibl Ophthalmol 83:49 1975
59. Wüstenberg L and Kohlhase R Echographic Findings in Unilateral Exophthalmus [German] in: Ultrasonography in Ophthalmology (Proceedings of SIDUO V, Francois J and Goes F, eds) pp 217-223, S Karger 1975
60. Ossoinig KC Clinical Echography of Orbital Tumors in: proc Sympos Amer Soc Plast Reconstr Surgeons, Dallas 1974, Tessier P, Callahan A, Mustarde JC and Salyer KE, eds; 12:307-315, CV Mosby 1976
61. Till P Solid Tissue Model for the Standardization of the Echo-Ophthalmograph 7200 MA (Kretztechnik) Docum Ophthalmol 41:205 1976
62. Hodes BC Standardized A-scan Echographic Diagnosis of Choroidal Malignant Melanomas Arch.Ophthal 95:593-597, 1977
63. McNutt LC, Kaefring SL, and Ossoinig KC Echographic Measurement of Extraocular Muscles in: Ultrasound in Medicine, Vol 3A (Proceedings of 1st Triennial Meeting [2nd World Congress] of the World Federation for Ultrasound in Medicine and Biology and SIDUO VI, San Francisco, 1976, White D. and Brown RE, eds) pp. 927-932, Plenum Press, New York 1977
64. Ossoinig KC Echography of the Eye, Orbit and Periorbital Region in: Orbit Roentgenology (Arger PH, ed), 224-269, John Wiley and Sons, New York 1977
65. Ossoinig KC Special Echographic Techniques for the Evaluation of Ocular Foreign Bodies [German] in: proc of "Intraokulärer Fremdkörper und Metallose", Symp DOG Köln 1976, Neubauer H,
Rüssman W and Kilp H, eds; pp 247-257, JF Bergmann Verlag, München 1977
66. Ossoinig KC, Kaefring SL, McNutt LC, and Weinstock SJ Echographic Measurement of the Optic Nerve in: Ultrasound in Medicine, Vol 3A (Proceedings of 1st Triennial Meeting [2nd World Congress] of the World Federation for Ultrasound in Medicine and Biology and SIDUO VI, San Francisco, 1976, White D. and Brown RE, eds) pp. 1065-1066, Plenum Press, New York 1977
67. Ossoinig KC, Frazier S, Watzke RC and Diamond JG Combined A-scan and B-scan Echography as a Diagnostic
Aid for Vitreoretinal Surgery in: New and Controversial Aspects of Vitreoretinal Surgery, Houston 1975, McPherson
A, ed; pp106-125, CV Mosby 1977
68. Till P and Ossoinig KC First Experiences with a Solid Tissue Model for the Standardization of A- and B-scan
Instruments in Tissue Diagnosis in: Ultrasound in Medicine (Proceedings of SIDUO VI, 1976, White D and Brown
RE, eds) Vol 3B, pp 2167-2174, Plenum Publishing Corp, 1977
69. Ossoinig KC Echography of Orbital Disorders in: Clinical Handbook of Ultrasound (M de Vlieger, ed) pp 881-904, John Wiley and Sons, Inc. (New York) 1978
70. Ossoinig KC The Role of Clinical Echography in Modern Diagnosis of Periorbital and Orbital Lesions in: Proceedings of 3rd Int Symposium on Orbital Disorders, Amsterdam 1977 Bleeker GM, ed) pp 496-540, Dr.W.Junk Publishers, The Hague 1978
71. Fuller DG, Snyder WB, Hutton WL and Vaiser A Ultrasonographic Features of Choroidal Malignant Melanomas Arch Ophthalmol 97:1465-1472, 1979
72. Hauff W and Till P Echographic Findings in Orbital Mucoceles in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO VII, Gernet H., ed) pp 151-154, R.A.Remy - Verlag, Münster 1979
73. Mazzeo V and Scorrano R Our Echographic Experience about Choroidal Melanomas in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO VII, Gernet H., ed) pp 119-122, R.A.Remy - Verlag, Münster 1979
74. Ossoinig KC The Technique of Measuring Extraocular Muscles in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO VII, Gernet H., ed) pp 166-172, R.A.Remy - Verlag, Münster 1979
75. Ossoinig KC Standardized Echography: Basic Principles, Clinical Applications, and Results
In: Ophthalmic Ultrasonography: Comparative Techniques (RL Dallow, editor), International Ophthalmology Clinics 19:No.4, pp.127-210, 1979
76. Scott W, Fabre J and Ossoinig KC Congenital Mucocele of the Lacrimal Sac Arch Ophthal 9/1, pp 1656-1658 1979
77. Till P Echography in Intraocular Tumors in: Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO VII, Gernet H., ed) R.A.Remy - Verlag, Münster 1979
78. Dagher G, Anderson R, Ossoinig KC and Baker J Adenoid Cystic Carcinoma of the Lacrimal Gland in a Child Arch Ophthal 98:1098-1100, 1980
79. Ossoinig KC and Blodi FC The Role of Echography in the Diagnosis of Orbital Disorders Palestra Oftalm Panamericana 4:12-19, 1980
80. Till P Testing of Ultrasonic Probes and their Suitability for Tissue Differentiation with the help of the Solid Tissue
Model [German] Klin Mbl Augenheilk 176: 337-340, 1980
81. Gallenga PE, Dalia T, Bellone G, Cennamo G, Mazzeo V and Rossi A The Role of Echography in the Conservative
Treatment of endobulbar Tumors in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 117-122, Dr. W. Junk Publishers 1981
82. Hauff W and Till P Echography in Unusual Orbital Complications of Parasinusal Diseases in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 317-322, Dr. W. Junk Publishers 1981
83. Nishimoto Y, Baba Y, Shibata H and Sawada A Combination of Echography with Coronal CT in the Diagnosis of Orbital Disorders in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 301-316, Dr. W. Junk Publishers 1981
84. Ossoinig KC Echographic Differentiation of Vascular Tumors in the Orbit in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 283-291, Dr. W. Junk Publishers 1981
85. Ossoinig KC The Significance of the S-shaped Amplifier characteristics in Echographic Tissue Diagnosis in:
Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek
AM, eds) pp 441-443, Dr. W. Junk Publishers 1981
86. Ossoinig KC The Significance of Standardized Echography for Neuro-ophthalmology in: "Aktuelle Ophthalmologische Probleme (Remke H, ed) pp 61-75, Ferdinand Enke Verlag, Stuttgart 1981
87. Ossoinig KC, Cennamo G and Byrne SF Echographic Differential Diagnosis of Optic-Nerve Lesions in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 327-332, Dr. W. Junk Publishers 1981
88. Ossoinig KC, Cennamo G, Green RL and Weyer, NL Echographic Results in the Diagnosis of Retinoblastoma in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 103-107, Dr. W. Junk Publishers 1981
89. Till P and Hauff W Differential Diagnostic Results of Clinical Echography in Intraocular Tumors in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 91-95, Dr. W. Junk Publishers 1981
90. Till P and Hauff W Differential Diagnostic Results of Clinical Echography in Orbital Tumors in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 277-282, Dr. W. Junk Publishers 1981
91. Till P and Scheiber V Reliability and Accuracy of TM (Tissue Model) for Calibration of Standardized A-scan Instrumentation in: Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) pp 457-461, Dr. W. Junk Publishers 1981
92. Divine RD, Anderson RL and Ossoinig KC Metastatic Carcinoid Unresponsive to Radiation Therapy presenting asa Lacrimal Fossa Mass Ophthalmology 89:516-520, 1982
93. Ossoinig KC Advances in Diagnostic Ultrasound in: Acta:XXIV International Congress of Ophthalmology, San Francisco1982 (Paul Henkind, ed.), J.B.Lippincott Comp., Vol1, pp.89-114, 1982.
94. Ossoinig KC A New Echographic Sign for a Reliable Differential Diagnosis of Graves' Orbitopathy [German] Klin Mbl Augenheilk 180:189-197, 1982
95. Phelps C, Thompson S and Ossoinig KC The Diagnosis and Prognosis of Atypical Carotid-Cavernous Fistula (Red-Eyed Shunt Syndrome) AJO 93:423-436, 1982
96. Ossoinig KC and Harrie RP Diagnosis of Intraocular Tumors with Standardized Echography in: Intraocular Tumors (Proceedings of International Symposium in Schwerin, 1981, Lommatzsch PK and Blodi FC, eds), pp. 154-175, Akademie Verlag Berlin, 1983
97. Ossoinig KC and Hasenfratz G The Role of Standardized Echography in the Diagnosis and Treatment of Orbital Myositis [German] Fortschr Ophthalmol 80:475-481 1983
98. Byrne SF Standardized Echography in the Diagnosis of Hemangioendothelioma in: Ophthalmic Ultrasonography (Documenta Ophthalmologica Proceedings Series 38, Hillman JS and Le May MM, eds) pp 347-356, Dr. W. Junk Publishers (The Hague/Boston/Lancaster) 1984
99. Hasenfratz G and Ossoinig KC The Diagnosis of Orbital Mucoceles and Pyoceles with Standardized Echography in: Ophthalmic Ultrasonography (Documenta Ophthalmologica Proceedings Series 38, Hillman JS and Le May MM, eds) pp 407-415, Dr. W. Junk Publishers (The Hague/Boston/Lancaster) 1984
1100. Hauff W and Till P Echography in Carotid-Cavernous Fistulas in: Ophthalmic Ultrasonography (Documenta Ophthalmologica Proceedings Series 38, Hillman JS and Le May MM, eds) pp 399-405, Dr. W. Junk Publishers (The Hague/Boston/Lancaster) 1984
1101. Ossoinig KC Ultrasonic Diagnosis of Graves' orbitopathy in: The Eye and Orbit in Thyroid Disease (Gorman CA, Waller RR, and Dyer JA, eds) Raven Press, New York, pp.185-211, 1984
1102. Ossoinig KC Echographic Detection and Classification of Posterior Hyphemas Ophthalmologica 189:2-11, 1984
103. Ossoinig KC How to obtain Maximum Measuring Accuracies with Standardized A-scan in: Ophthalmic Ultrasonography (Documenta Ophthalmologica Proceedings Series 38, Hillman JS and Le May MM, eds) pp 197-216, Dr. W. Junk Publishers (The Hague/Boston/Lancaster) 1984
104. Ossoinig KC and Hermsen VM Myositis of Extraocular Muscles diagnosed with Standardized Echography in: Ophthalmic Ultrasonography (Documenta Ophthalmologica Proceedings Series 38, Hillman JS and Le May MM, eds) pp 381-392, Dr. W. Junk Publishers (The Hague/Boston/Lancaster) 1984
105. Ossoinig KC and Tamayo G Ultrasonic Differential Diagnosis of Lacrimal-Gland Tumors in: Supplement to J. of Ultrasound in Medicine, Vol 4, No 10, pp 52- , 1985
106. Byrne SF and Byrne B Differential Diagnosis of orbital Neurolemmoma (schwannoma) with Standardized Echography in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 483-492, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
107. Byrne SF and Hughes JR Orbital Dermoid Cysts in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 465-475, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
108. Dixon PA, Abrams GW and Caya JG Acoustic analysis of the cytologic structure of malignant melanomas with Standardized Echography in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 347-356, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
109. Fishman M, Kerman B and Foxman S Intraocular Cysticercosis: migratory in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 285-287, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
110. Goes F Ultrasonographic and Clinical Characteristics of Orbital Pseudotumors in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 499-507, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
111. Green RL The Echographic Evaluation of Spontaneous Vitreous Hemorrhage in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 233-238, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
112. Green RL Echographic Diagnosis of Posterior Scleritis in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 515-519, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
113. Harrie RP Standardized Echography of the Orbit (review) in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 445-451, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
114. Hasenfratz G Standardized Echography in Graves' disease in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 557-564, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
115. Hughes JR and Byrne SF Detection of Posterior Ruptures in Opaque Media in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 333-342, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
116. Kerman BM and Fishman ML Non-melanomatous Collar-button Tumors in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 413-416, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
117. Ossoinig KC Early Detection of Compressive Optic Neuropathy in Graves' disease with Standardized A-scan in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) p 569, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
118. Ossoinig KC and Cody K How to differentiate intraocular air bubbles from intraocular foreign bodies using Standardized Echography in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 343-344, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
119. Ossoinig KC, Frieling E, Tamburrelli C and Warner L Superior Ophthalmic Vein Thrombosis - an echographic diagnosis in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 528-537, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
120. Ossoinig KC, Islas G, Tamayo GE and Tamburrelli C Detached Retina versus dense Fibrovascular Membrane. Standardized A-scan and B-scan criteria in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 275-284, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
121. Ossoinig KC and Itani KM The Echographic Diagnosis of Non-Calcified Retinoblastoma in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) p 444, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
122. Ossoinig, KC, Reshef DS, Weingeist TA, Folk JC and Packer AJ Echogrphic Findings in Terson's Syndrome in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 247-256, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
123. Ossoinig KC and Tamburrelli C Orbital Aerocele in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) p 497, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
124. Reshef DS, Ossoinig KC and Nerad JA Diagnosis and Intraoperative Localization of a Deep Orbital Organic Foreign Body Orbit: Vol 6/1, pp 3-15, 1987
125. Rochels R, Scherer U, Nover A and Lieb W Echographical Diagnosis of Lacrimal Sac Tumors in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 545-552, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
126. Sawada A, Masuyama Y, Kodama Y and Hayashida T Combined Echography and Fluorophotometry in the Detection od Vitreous Hemorrhage in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 239-246, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
127. Shammas HJ, Boyer DS and Miller JB Ultrasound Characteristics of posterior Uveal Melanomas treated with Cobalt Plaque Radiotherapy in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 379-383, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
128. Skalka HW Ultrasound Diagnoses of Orbital Masses and Intraocular Tumors in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 463-464, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
129. Stone RD Regression patterns of choroidal malignant melanoma: Standardized Echography (A-mode) and immersion tomography (B-mode). A comparative study in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp 233-238, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
130. Verbeek AM Uveal Melanomas before and after Ruthenium Application Therapy in: Ophthalmic Echography (Documenta Ophthalmologica Proceedings Series 48, Ossoinig KC, ed) pp. 385-389, Martinus Nijhoff / Dr. Junk Publishers (Dordrecht/Boston/Lancaster) 1987
131. Ossoinig KC The Role of Standardized Ophthalmic Echography in the Management of Graves' opthalmopathy in:
Graves' Ophthalmopathy (Pickardt CR and Boergen KP, eds) pp 28-37, Developments in ophthalmology, Karger
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132. Badia JA, Degregori W, Iribarren G and Sampaolesi R Reliability of Standardized Ultrasound in Pre-operative
Diagnosis for Vitreous Surgery in Diabetic Patients in: Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica Proceedings Series 53, Sampaolesi R, ed) pp. 233-237, Kluwer Academic Publishers 1990
133. Cennamo G, Tranfa F and Bonavolonta G Lesions of the Lacrimal Fossa: a retrospective echographic study in: Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica Proceedings Series 53, Sampaolesi R, ed) pp. 63-78, Kluwer Academic Publishers 1990
134. Lombardi A, Croxatto JO and Zambrano A Diffuse Lymphoid Infiltration of the Uvea and Periocular Tissues in: Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica Proceedings Series 53, Sampaolesi R, ed) pp. 427-437, Kluwer Academic Publishers 1990
135. Mazzeo V, Ravalli L and Perri P Echographic Findings in Lymphoid Hyperplasia of the Choroid in: Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica Proceedings Series 53, Sampaolesi R, ed) pp. 419-425, Kluwer Academic Publishers 1990
136. Ossoinig KC and Lohmeyer M Choroidal Nevi: diagnosis with Standardized Echography in: Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica Proceedings Series 53, Sampaolesi R, ed) pp. 173-180, Kluwer Academic Publishers 1990
137. Schutterman J A case with a macular granuloma seropositive for Toxocara canis examined with Standardized Echography in: Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica Proceedings Series 53, Sampaolesi R, ed) pp. 261-265, Kluwer Academic Publishers 1990
138. Zárate JO and Sampaolesi R Morphological Parameters in Intraocular Tumors taking part on Echographic Tracings in: Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica Proceedings Series 53, Sampaolesi R, ed) pp. 281-292, Kluwer Academic Publishers 1990
139. Ossoinig KC Detection of Wooden Foreign Bodies . Letter to the Editor, Ophthalmology 98/3 p 274, 1991
140. Atta HR Standardized Echography in a Case of Orbital Varix in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 199-203, Kluwer Academic Publishers 1993
141. Cennamo G, Loffredo A, Rosa N, Pezone A and Guida E Corneal Graft and Echography in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 415-420, Kluwer Academic Publishers 1993
142. Cennamo G, Rosa N, Foà T and Mele A Metastatic Choroidal Lesions - a retrospective study in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 277-283, Kluwer Academic Publishers 1993
143. Doro D, Mantovani E and Bergamo L Glomus Tumor of the Eye Lid and Anterior Orbit - echographic and histological features in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 233-237, Kluwer Academic Publishers 1993
144. Doro D, Midena E, Mantovani E, Sala M and Moro F Contribution of Standardized Echography to Diagnostic Work-up of Intraocular Lymphoma in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 319-326, Kluwer Academic Publishers 1993
145. Frieling E and Stanowsky A Standardized A-scan Examination of the Eye and Orbit in a Newborn Child after Forceps Delivery in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 221-226, Kluwer Academic Publishers 1993
146. Hasenfratz G and Lewan U Results of Standardized Echography in Orbital Diseases: a review of 311 cases in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 135-144, Kluwer Academic Publishers 1993
147. Lohmeyer M and Mellin KB Microphthalmus with Congenital Orbital Cyst in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 239-243, Kluwer Academic Publishers 1993
148. Marchini G and Tosi R Echographic Differential Diagnosis of small Choroidal Solid Lesions in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 313-317, Kluwer Academic Publishers 1993
149. McAdam J, Van Heuven WAJ and Held KS Unusual Orbital Mucocele in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 185-191, Kluwer Academic Publishers 1993
150. Ossoinig KC Standardized Echography of the Optic Nerve (Jules François Memorial Lecture 1990) in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 3-99, Kluwer Academic Publishers 1993
151. Perri P, Mazzeo V, Ravalli L, Chiarelli M and Monari P The Role of Echography in Small-sized Melanomas in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 251-256, Kluwer Academic Publishers 1993
152. Rosa N and Cennamo G Further Indications for the Evaluation of the Prescleral Layer in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 355-359, Kluwer Academic Publishers 1993
153. Sampaolesi R, Casiraghi JF and Zarate JO Choroidal Melanoma: zonal relationship between echographic tracing and cellularity in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 247-250, Kluwer Academic Publishers 1993
154. Sampaolesi R and Zarate JO Dysplastic Retina and Persistent Primary Vitreous simulating a Retinoblastoma in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 301-306, Kluwer Academic Publishers 1993
155. Tamburrelli C Functional Echographic Biometry of Extraocular Muscles Echography in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 111-115, Kluwer Academic Publishers 1993
156. Tamburrelli C, Anile C, Mangiola A, Falsini B and Palma P CSF Dynamic Parameters and Changes of the Optic Nerve Diameters measured with Standardized Echography in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 101-109, Kluwer Academic Publishers 1993
157. Till P Standardized Echography in Adenoid-cystic carcinomas of the orbit in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 151-159, Kluwer Academic Publishers 1993
158. Till P Standardized Echography in a Case of Congenital Oculodermal Melanocytosis with Orbital Melanoma in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 227-232, Kluwer Academic Publishers 1993
159. Verbeek AM Diagnostic Ultrasonography of the Anterior Segment of the Eye in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 421-430, Kluwer Academic Publishers 1993
160. Wolff-Kormann PG, Hasenfratz G, Stefani FH and Riedel KG Choroidal Malignant Melanoma Masquerading as Posterior Scleritis in: Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) pp. 265-271, Kluwer Academic Publishers 1993
161. Chuman T, Chuman H, Fukiyama J, Nao-I N and Sawada A Findings in Standardized Echography for Orbital Hemangioperycytoma ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 200-205, Kluwer Academic Publishers 1995
162. Cennamo G, Rosa N, De Crecchio G and Alfieri MC Intraocular Inflammation and Combined Annular Choroidal and Retinal Detachment ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 105-108, Kluwer Academic Publishers 1995
163. Cennamo G, Rosa N and Iaccarino G The Diagnosis and Management of Intraocular Inflammation with Standardized Echography with Emphasis on Macular Thickness ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 177-180, Kluwer Academic Publishers 1995
164. Fukiyama J, Futamai Y, Nakazaki S, Nao-I N and Sawada A Echographic Study of Severe Vogt-Koyanagi-Harada Syndrome with Bullous Retinal Detachment ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 109-112, Kluwer Academic Publishers 1995
165. Hauff W and Kuchar A Biometry with Mini-A-scan Instrument ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 89-92, Kluwer Academic Publishers 1995
166. Hershewe GL, Corbett JJ, Ossoinig KC and Thompson HS Optic Nerve Compression from a Basal Encephalocele. J Neuro-Ophthal 15:161-165, 1995
167. Ossoinig KC The Diagnosis and Differential Diagnosis of Neoplastic Lesions of the Extraocular Muscles with Standardized Echography (invited lecture) ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp.XXXIII-LVI, Kluwer Academic Publishers 1995
168. Rosa N, Cennamo G and La Rana A New Echographic Findings in Orbital Vascular Diseases ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 225-229, Kluwer Academic Publishers 1995
169. Schutterman J Posterior Scleritis Monitoring of Systemic Steroid Treatment with Standardized Echography: a case report ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 181-182, Kluwer Academic Publishers 1995
170. Tamburrelli C, Capobianco A, Anile C and Mangiola A Standardized A-scan Evaluation of the Ophthalmic Artery - Optic Nerve Sheath Complex ) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp. 230-235, Kluwer Academic Publishers 1995
171. Till P Standardized Echography: Quantitative Analysis (Jules François Memorial Lecture 1992) in: Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings Series 58, Thijssen JM, Fledelius HC and Tane S, eds) pp.XVII-XXXI, Kluwer Academic Publishers 1995
172. Chu TG, Lopez PF, Cano MR, Freeman WL, Lean JS, Ligget PE, Thomas EL and Green RL Posterior Vitreoschisis ( an echographic finding in proliferative diabetic retinopathy) Ophthalmology 103:315-322, 1996
173. Till P and Till M Combination of increased intracranial Pressure and optic nerve Compression in a patient with multiple meningiomas detected with Standardized Echography in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.565-570, Kluwer Academic Publishers 1997
174. Rosa N and Cennamo, G. Compressive Optic Neuropathy: echographic study in retrobulbar neuritis in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.571-573, Kluwer Academic Publishers 1997
175. Atta HR, Buimer R, Dick AD and Dees C Standardized Echography in Optic Neuritis in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.575-585, Kluwer Academic Publishers 1997
176. Bizzarro A, Mansi L, Rambaldi PF, Di Martino S, De Bellis A, Rosa N and Cennamo G A new approach to the study of Graves' ophthalmopathy: standardized A-scan echography and octreotide scintigraphy as possible parameters for disease activity in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.365-370, Kluwer Academic Publishers 1997
177. Cennamo G, Rosa N, Mele A, De Rosa P and La Rana A An Atypical Intraocular Tumor: echographic study in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.133-135, Kluwer Academic Publishers 1997
178. Doro D, Lorenzini S, Vaccaro M, Milizia E and Mantovani E Acoustic Features of two unusually elevated peripheral retinal capillary hemangiomas in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.147 -152, Kluwer Academic Publishers 1997
179. Doro D, Midena E and Mantovani E Standardized Echography in diagnosing Tumors: our experience with cases verified with echo-assisted fine needle aspiration in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.331-342, Kluwer Academic Publishers 1997
180. Frieling E and Lê-Ruppert K Two tumors of different origin in the anterior segment of a blind eye. Standardized Echography with the immersion technique and histological findings in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.169-177, Kluwer Academic Publishers 1997
181. Gallenga PE, Mastropasqua L, Mancini A, Ciancaglini M, Zuppardi E and Lobefalo L Thyroid-associated Ophthalmopathy: a new sign in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.371-376, Kluwer Academic Publishers 1997
182. Genovesi-Ebert F, Tranfa F, Rosa N, Bonovolonta G and Cennamo G Merkel Cell Carcinoma: an echographic study in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.293-302, Kluwer Academic Publishers 1997
183. Hasenfratz G, De La Torre MDJ and Haigis W New results about the echographic examination of the optic nerve. Experimental and clinical investigations in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.1-47, Kluwer Academic Publishers 1997
184. Maier H and Hasenfratz G Standardized Echography in Recklinghausen's Neurofibromatosis with Congenital Glaucoma in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.323-329, Kluwer Academic Publishers 1997
185. Marchini G, Tosi R and Ghimenton C Measurement of Tumor Height and Base Diameter in Choroidal Melanoma. Comparison between ultrasonography and histology in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.93-100, Kluwer Academic Publishers 1997
186. Mazzeo V, Perri P, Monari P and Degli Innocenti G Echographic Findings in "Brawny" Scleritis. A ten-year follow-up in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.269-275, Kluwer Academic Publishers 1997
187. Ossoinig KC Detached Retina vs. Dense Fibrovascular Membrane: A-scan and B-scan signs for the differential diagnosis with Standardized Echography in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.243-262, Kluwer Academic Publishers 1997
188. Perri P, Mazzeo V, Ravalli L, Brienza D, De Palma P and Rossi A Orbit Lymphoma: echographic findings - our experience in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.287-292, Kluwer Academic Publishers 1997
189. Rosa N, Cennamo G, La Rana A and Pasquariello A Chorioretinal Folds and Tumors: echographic study in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.65-67, Kluwer Academic Publishers 1997
190. Sampaolesi R Diagnosis, Treatment and Results in Congenital Glaucoma (Jules François Memorial Lecture 1994) in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.1-47, Kluwer Academic Publishers 1997
191. Schutterman J Preliminary report of echographic findings in a case believed to be a meningocele of the right orbit, examined with Standardized Echography in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.343, Kluwer Academic Publishers 1997
192. Van Heuven WAJ and McAdam J Echographic Diagnosis of Acute Retinal Necrosis in: Ultrasonography in Ophthalmology 15 (Proceedings of SIDUO XV, Cennamo G and Rosa N, eds) pp.277-283, Kluwer Academic Publishers 1997
193. Andrejčič KN and Sajko V Choroidal Osteoma presenting in Second Pregnancy in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 115-116, S. Roderer Verlag, Regensburg, Germany 2000
194. Doro D, Milizia E and Midena E Two Ciliary Body Melanocytic Tumors. Standardized Echography and Ultrasound Biomicroscopy Results in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 57-61, S. Roderer Verlag, Regensburg, Germany 2000
195. Genovesi F, Di Bartolo E, Lepri A, Poggi V, Romani A and Nardi M Early Diagnosis of Graves' Neuropathy in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 139-145, S. Roderer Verlag, Regensburg, Germany 2000
196. Moragrega E, Velasco C, Gómez A, González C and Angeles A Amyloidosis of the Lacrimal Gland. Case report. Ultrasonography Features in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 179-183, S. Roderer Verlag, Regensburg, Germany 2000
197. Ossoinig KC Diagnosis and Management of Graves' Orbitopathy (invited lecture) in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 125-140, S. Roderer Verlag, Regensburg, Germany 2000
198. Schilling M, Esser J and Schilling H Ultrasound - Guided Puncture of Orbital Pseudocysts in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 153-158, S. Roderer Verlag, Regensburg, Germany 2000
199. Schriever S Posterior Scleritis with a Nodular Appearance: MRI vs. Standardized Echography. A case report in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 95-99, S. Roderer Verlag, Regensburg, Germany 2000
200. Tamburrelli C, Palombi M, Burrato E and Bagolini B Echography of Extraocular Muscles after Strabismus Surgery Echography in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 159-166, S. Roderer Verlag, Regensburg, Germany 2000
201. Winder S, Fairhead A. Latinakis C. and Atta HR Echographic B.I.O. Scoring System in: Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) pp 111-114, S. Roderer Verlag, Regensburg, Germany 2000
Books:
202. SIDUO I (Berlin, Germany 1964) Diagnostica Ultrasonica in Ophthalmologia ((Proceedings of SIDUO I, Buschmann W and Hildebrandt I, eds) Math. Naturwiss. Reihe XIV der Humboldt-Universität Berlin, 1965
203. SIDUO II (Brno, Czech Republic 1967) Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO II, Vanysek J, ed), Acta Fac. Med. Univ.Brunensis 35, Brno 1968
204. Ophthalmic Ultrasound (Proceedings of International Symposium in Philadelphia 1968, Gitter KA, Keeney AH, Sarin LK, and Meyer D, eds) The CV Mosby Company, St.Louis, 1969
205. Ossoinig, KC Basics of Clinical Echo-Ophthalmography [German] published by Vienna Medical Academy, 1971
206. SIDUO III (Vienna, Austria 1969) Ultrasonographia Medica (Proceedings of 1st World Congress of Ultrasound in Medicine and SIDUO III, Böck J and Ossoinig KC, eds), Vol I-III, Verlag der Wiener Medizinischen Akademie, Vienna 1971
207. SIDUO IV (Paris, France 1971) Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO IV, Massin M, and Poujol J, eds) Centre National d'Ophtalmologie des Quinze-Vingts, Paris 1973
208. SIDUO V (Ghent, Belgium 1973) Ultrasonography in Ophthalmology (Proceedings of SIDUO V, Francois J and Goes F, eds) S Karger 1975
209. SIDUO VI (San Francisco, California, USA 1976) Ultrasound in Medicine (Proceedings of 1st Triennial Meeting [3rd World Congress] of the World Federation for Ultrasound in Medicine and Biology and SIDUO VI, White D. and Brown RE, eds) Vol 1-3, Plenum Press, New York 1977
210. SIDUO VII (Münster, Germany 1978) Diagnostica Ultrasonica in Ophthalmologia (Proceedings of SIDUO VII, Gernet H., ed) R.A.Remy - Verlag, Münster 1979
211. SIDUO VIII (Nijmegen, The Netherlands 1980) Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 29, Thijssen JM and Verbeek AM, eds) Dr. W. Junk Publishers 1981
212. Sampaolesi R Ultrasonidos en Oftalmologia [Spanish] published by Editorial Medica Panamericana Buenos Aires, 1984
213. Shammas HJ Ophthalmic Ultrasonography an Biometry (Atlas) The CV Mosby Company, 1984
214. SIDUO IX (Leeds, United Kingdom 1982) Ophthalmic Ultrasonography (Documenta Ophthalmologica Proceedings Series 38, Hillman JS and Le May MM, eds) Dr. W. Junk Publishers 1984
215. Rochels R Ultrasonic Diagnosis in Ophthalmology (German) published by Ecomed Publishers München/Landsberg (Germany) 1986
216. SIDUO X (St.Petersburg Beach, Florida, USA 1984) Ophthalmic Echography (Proceedings of SIDUO X, Ossoinig KC, ed) Documenta Ophthalmologica Proceedings Series 48, Kluwer Academic Publishers, Dordrecht / Boston / Lancaster, 1987
217. Stefani FH and Hasenfratz G Macroscopic Ocular Pathology (an Atlas including Correlations with Standardized Echography) Springer-Verlag, 1987
218. SIDUO XI (Capri, Italy 1986) Ultrasonography in Ophthalmology (Documenta Ophthalmologica Proceedings Series 51,Thijssen JM, Hillman JS, Gallenga PE and Cennamo G, eds) Kluwer Academic Publishers 1988
219. SIDUO XII (Iguazú, Argentina 1988) Ultrasonography in Ophthalmology 12 (Documenta Ophthalmologica
Proceedings Series 53, Sampaolesi R, ed) Kluwer Academic Publishers 1990
220. Byrne SF and Green RL Ultrasound of the Eye and the Orbit Mosby Year Book 1992
221. SIDUO XIII (Vienna, Austria 1990) Ophthalmic Echography 13 (Documenta Ophthalmologica Proceedings Series 55, Till P, ed) Kluwer Academic Publishers 1993
222. SIDUO XIV (Tokyo, Japan 1992) Ultrasonography in Ophthalmology 14 (Documenta Ophthalmologica Proceedings
Series 58, Thijssen JM, Fledelius HC and Tane S, eds) Kluwer Academic Publishers 1995
223. Atta HR Ophthalmic Ultrasound - a practical guide Churchill Livingstone 1996
224. SIDUO XV (Cortina, Italy 1994) Ultrasonography in Ophthalmology 15 (Documenta Ophthalmologica Proceedings
Series 61, Cennamo G and Rosa N, eds) Kluwer Academic Publishers 1997
225. DiBernardo C, Schachat AP and Fekrat S Ophthalmic Ultrasound - a diagnostic atlas Thieme 1998
226. SIDUO XVI (Munich, Germany 1996) Ultrasound in Ophthalmology (Proceedings of SIDUO 16, Hasenfratz, G, ed) S. Roderer Verlag, Regensburg, Germany 2000
227. SIDUO XVII (Los Angeles, California, USA 1998) ) Ultrasound in Ophthalmology (Proceedings of SIDUO 17, Shammas HJ and Hasenfratz G, eds) S. Roderer Verlag, Regensburg, Germany 2000