MRI Safety Protocol for Deep Brain Stimulation (DBS) Devices

Purpose: Deep Brain Stimulation (DBS) involves the implantation of electrodes into specific cortical targets to modulate neural circuitry in patients with Parkinson's disease, essential tremor, dystonia, and epilepsy [1]. The most well-studied risks of performing MRI with implanted DBS devices include device heating, induced currents, pulse generator dysfunction, and magnetic field-induced device movement [2]. Roughly 70% of the 200,000 patients with an implanted DBS device will require an MRI within ten years of implantation [3]. This warrants the development of standardized protocols to perform MRI outside the labeling guidelines of DBS manufacturers, which often have an excessive margin of safety that prevents the maximization of MRI benefits in DBS patients [4]. Herein, our objective is to describe a standardized protocol of assessing a patient for an MRI scan both within and outside of DBS device labeling guidelines. In our presentation, we will also address the benefits and risks of performing modified MRI exams on DBS patients as well as future directions for DBS and MRI safety.

Methods/Materials: We reviewed the current labeling guidelines for the manufacturers of the top three DBS devices, by market share. We also conducted an exhaustive literature search on current initiatives to improve MRI safety for DBS patients.

Results: Figure 1 outlines our proposed protocol, which can be used to standardize the workflow of MRI orders for DBS patients. Recent advancements in DBS and MRI safety include simulation models, DBS device changes, and MRI hardware and coil innovations.

Conclusions: There exists a need for a standard MRI protocol in DBS patients. Future directions include 1) implementing the protocol within our Radiology department and evaluating subsequent changes to our departmental workflow by measuring improvements in the rates of adverse events, schedule changes, and MRI utilization; 2) exploring the application of this protocol to other implanted metal devices; 3) providing a framework for implementation of the protocol in other Radiology departments.