The temporal area is the thinnest portion of the skull and the squamous component with less cancellous bone provides ultrasound permeability. The transtemporal window is found between the angle of the eye and the pinna of the ear above the zygomatic ridge. Finding this window can be difficult because size and location vary with each patient (more difficult in elderly and females) and from one side to the other.
This window allows the insonation of the middle, anterior and posterior cerebral arteries, the anterior and posterior communicating, and the terminal internal carotid.

See also Transcranial Doppler.

The transforaminal or sub-occipital acoustic window is found in the space between the atlas and the base of the skull (through the foramen magnum insonated from the top of the neck below the occiput). Practiced in the prone position (or sitting).
This acoustic window allows the insonation of the vertebral arteries, basilar artery and some of the other branches of the posterior circulation (e.g. posterior inferior cerebellar artery).

See also Transcranial Doppler.

The transorbital window allow to insonate ophthalmic artery and ipsilateral carotid siphon through the eye. It is also possible to use the transorbital entrance to scan the middle and anterior cerebral arteries, if it is impossible through the transtemporal window.
The patient is asked to remove any contact lenses prior to examination and is instructed to close the eyes. The power output of the Doppler instrument has to be decreased to 10-20% to reduce the ultrasonic exposure of the eye.

See also Transcranial Doppler, Ultrasound Safety.

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