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Cranial scans
This document contains guidance for developing imaging protocols for the SureTune™ 4
Software. Use the information in “
types of preoperative and postoperative scans), and then refer to the additional requirements for
each scan type starting with “Cranial MRI scans only” on page 2. Using the requirements for
preoperative and postoperative scans included in this document will help to provide scans that
are appropriate for use with SureTune™ 4 Software.
Note: The registration algorithms have been tested to perform accurately when using the
requirements described in this document.
For all scans, keep the patient as motionless as possible.
Cranial scan requirements
D00565102-IP-EN
Rev. B
2021-09
Imaging Protocols for
SureTune™ 4 Software
Cranial scan requirements” on page 1 (which applies to all
Contrast Contrast agents may be injected before scanning.
Slices For patient scans that will be used with the SureTune
into account.
• Use a constant slice thickness.
• Use a slice thickness of 1 mm or less, which usually produces the highest quality data set
for image segmentation, localizing a lead model, and planning stimulation with SureTune™ 4
Software.
• For preoperative images, axial or coronal slices are preferred (MRI scans can be acquired in
the axial orientation or reformatted into axial slices).
• Scan contiguous slices. (Slice spacing must equal slice thickness. Make sure that there is
no gap or overlap between slices).
1: Figure 1: Contiguous slice scan
Correct: contiguous slices with no gap and no overlap
1
Incorrect: gap between slices
2
Incorrect: overlap of slices
3
™
4 Software, take the following guidance
D00565102-IP-EN Rev. B Medtronic, Inc. 1
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Page 2
Size and pixels • Use a square image matrix of 256 x 256 pixels or 512 x 512 pixels.
• Use square pixels.
Cranial MRI scans only
Cranial CT scans only
For MRI scans, use the information in “Slices” on page 1 and “Size and pixels” on page 2 in conjunction
with the following information.
• Use axial or coronal slices for preoperative MR images. Scan along the axis of the magnet bore.
• Use single-echo scans. Do not use multi-echo scans.
• Any MR imaging sequence can be used to show anatomy. However, when registering an image to
a reference image, MR-T1 and MR-T2, and combinations thereof have been evaluated and found
effective for use with SureTune™ 4 Software. Other modalities, such as those listed in “Scans to
merge” on page 3, have not been evaluated.
• MR 3D volume acquisition is acceptable as long as the scan can be reconstructed in a way that
conforms to all requirements of the imaging protocol.
For CT scans, use the information in “Slices” on page 1 and “Size and pixels” on page 2 in conjunction
with the following information.
• Use a standard soft tissue algorithm.
• Use axial slices for postoperative CT or O-arm™ images.
• Do not use gantry tilt.
• Use a circular (or square) field of view (FOV). Use the smallest FOV to encompass the region of
interest, which is usually 28
• Include both anterior commissure (AC) and posterior commissure (PC) anatomy and the target
region within the scan.
• 8-bit or 16-bit reconstructions are supported (16-bit reconstructions are recommended to obtain a
higher image dynamic range).
cm to 32 cm (280 mm to 320 mm).
Cranial O-arm™ scans only
For O-arm™ scans, use the information in “Slices” on page 1 and “Size and pixels” on page 2 in
conjunction with the following information.
• For postoperative lead placement scans, use 20 cm FOV protocols (High Definition [HD],
Enhanced Cranial, Standard, Low Dose).
Patient position • Make sure that the patient anatomy is oriented as close as possible to LPS space (the left-right,
anterior-posterior, and inferior-superior axes).
• Separate the patient’s head from the scanner headrest with towels or foam.
• Use padding to prevent patient motion, but make sure that the padding does not distort any fiducial
markers or the skin.
• Make sure that the patient's ears do not touch the sides of the headrest, and that they are not
pushed away from their normal position.
2 Medtronic, Inc. D00565102-IP-EN Rev. B
710 Medtronic Parkway, Minneapolis, MN 55432 USA
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™
scans.
™
4 Software, ensure that multiple identifiable
Scans to merge If you intend to register two patient scans with SureTune
landmarks and the skull base are included in all of the scans to enable matching.
Note: Including multiple identifiable landmarks and the skull base is important for an O-arm™-to-MR
fusion due to lack of tissue contrast in O-arm
CT, O-arm™, MR-T1, and MR-T2 scans, and combinations thereof have been evaluated and found
effective for use with SureTune™ 4 Software. Other modalities such as CT angiography (CTA), fluidattenuated inversion recovery (FLAIR), magnetoencephalography (MEG), magnetization-prepared
rapid acquisition gradient echo (MPRAGE), MR angiography (MRA), MR proton density (MR-PD),
spoiled gradient echo (SPGR), and susceptibility weighted imaging (SWI) have not been evaluated.
Scan archive Archive the exam in an uncompressed DICOM format. Archive the exam from the scanner to media (a
CD, DVD or USB drive), or transfer to a SureTune™ 4 system via a PACS network or a StealthStation™
system.
Note: SureTune™ 4 Software does not accept JPEG (Joint Photographic Experts Group) compression,
3D scans, or NIfTI (Neuroimaging Informatics Technology Initiative) files.
Cranial scan examination
The physician or imaging technologist should examine the completed scan to verify the following quality
criteria:
• The patient image orientation is correct, and the patient anatomy is lined up with the left-right,
anterior-posterior, and inferior-superior X, Y, and Z axes.
• The total region of interest is visible.
• The anticipated surgical target and entry points are visible.
• The tip of the patient's nose is included in the scan and should be the most anterior point on the
scan.
• The slice thickness is constant throughout the scan.
• No motion artifact is present. Rapidly scroll through the images to make sure they all line up.
• Be aware of phase encoding (ghost) artifacts. If necessary, work with radiology to reduce artifacts.
• No gantry tilt was used.
• For preoperative images, the deep brain stimulation (DBS) target structure should be clearly
visible with enough tissue contrast to be able to delineate the structure.
Assistance
For further assistance with SureTune™ 4 Software imaging protocols, contact Medtronic using the
information on the back cover of this document. In the U.S., call 1 800 707 0933 for Medtronic Technical
Services. If a serious incident occurs in the European Union, also report it to the competent authority in
the Member State where the incident occurred.
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Manufacturer
*D00565102-IP-EN*
Medtronic, Inc.
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Tel. +1 763 514 5000
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