MR Brain Pre DBS - VIM and Thalamotomy Neuro Protocol

Scan notes:

  • If the target isn’t specified in the order for pre-DBS, contact the RDO to verify if the “GPI” or “STN” or "VIM" protocol should be used.
  • OK to use padding and headphones for all DBS patients.
  • No angles on any sequences.
  • No compressed sense
  • YOU MUST GET THE IMAGES CHECKED prior to letting the patient go. These need to be checked either by a radiologist or someone from Neurosurgery. If the motion is too excessive, we need to get the ball started for arranging to have the exam done with GA, as many of these patients have surgery scheduled within days of the MRI.
  • Only perform 64-direction DTI if specifically requested. Otherwise, do not run any DTI. 
  • All Pre- DBS exams are ordered with anxiolytics.  Radiology RNs are to evaluate the patient if you note that the patient cannot hold still.

Last updated: 6/13/2022
Charge as: Brain WO
Scanner preference: Only on MR3 (MR4 if GA is needed)
Coil: Head

RAD TO CHECK IMAGES AND TECH TO NOTIFY SURGEONS BEFORE PT LEAVES THE DEPARTMENT

  1. Neuro Radiologist must be paged to check the images. Make a note of the Rad's name.
  2. Page Dr. Burchiel x11292 and Antonia Gragg x16703 in the following format:
    • Patient last name, GPI, VIM or STM for study type, comment (Pass or fail) and the Radiologist name. 
      • Example if comment is "Pass": "Smith, GPI, Pass, Checked by neuro rad Hamilton"
      • Example if comment is "Fail": "Smith, GPI, Fail, Checked by neuro rad Hamilton, patient waiting in MRI"
    • If it fails, the patient needs to remain in department (add to page that patient is waiting). 
    • We are required to reschedule the patient with GA using a callback.

POSITIONING

  • Positioning is very important in obtaining a study that fuses. 
  • If the patient is laying with the head going too far backwards, it is important to raise the head so the chin is down.
  • The head coil can be tilted or a sponge can be used under the patients head, which allows for better coverage.
  • OK to add slices for coverage. Slices should be from top of vertex to as low as you can go. 
  • You need to be below the acoustic nerves for best outcome.
Plane Weighting Mode Slice Gap FAT SAT FOV Notes
AXIAL 3D T1 FFE None 26cm DO NOT ANGLE. Cover above the vertex of the brain at least 1 cm. Cover the nose.
optional
AXIAL 64-dir DTI Only perform 64-dir DTI if specifically requested. Otherwise, do not run DTI.

RAD TO CHECK IMAGES AND TECH TO NOTIFY SURGEONS BEFORE PT LEAVES THE DEPARTMENT

  1. Neuro Radiologist must be paged to check the images. Make a note of the Rad's name.
  2. Page Dr. Burchiel x11292 and Antonia Gragg x16703 in the following format:
    • Patient last name, GPI, VIM or STM for study type, comment (Pass or fail) and the Radiologist name. 
      • Example if comment is "Pass": "Smith, GPI, Pass, Checked by neuro rad Hamilton"
      • Example if comment is "Fail": "Smith, GPI, Fail, Checked by neuro rad Hamilton, patient waiting in MRI"
    • If it fails, the patient needs to remain in department (add to page that patient is waiting). 
    • We are required to reschedule the patient with GA using a callback.