The Zurich Checklist for Safety in the Intraoperative Magnetic Resonance Imaging Suite: Technical Note

Abstract

The use of an ioMRI-checklist promotes a zero-tolerance attitude for errors, can lower complications, and can help create an environment that is both efficient and safe for the patient and the OR personnel. We highly recommend the use of a surgical checklist when applying ioMRI.

Feasibility and safety of intraoperative BOLD functional MRI cerebrovascular reactivity to evaluate extracranial-to-intracranial bypass efficacy

“…6 Before the MRI transfer, a checklist was used to minimize any risk to the patient. 22 A sedated and intubated patient was transferred to the intraoperative MR suite (3T Skyra VD13 MRI, Siemens). 22 Whole-brain BOLD volumes were collected with an axial 7.20 min 2D EPI (echo planar imaging) BOLD sequence with voxel size 3 × 3 × 3 mm 3 , acquisition of matrix 64 × 64, 35 slices with ascending interleaved acquisition, slice gap 0.3 mm, GRAPPA (generalized autocalibrating partially parallel acquisitions) factor 2 with 32 reference lines, adaptive coil combination, auto coil selection, TR 2000 msec, TE 30 msec, flip angle 85°, bandwidth 2368 Hz/Px, 220 volumes, and field of view 192 × 192 mm.…”

“…22 A sedated and intubated patient was transferred to the intraoperative MR suite (3T Skyra VD13 MRI, Siemens). 22 Whole-brain BOLD volumes were collected with an axial 7.20 min 2D EPI (echo planar imaging) BOLD sequence with voxel size 3 × 3 × 3 mm 3 , acquisition of matrix 64 × 64, 35 slices with ascending interleaved acquisition, slice gap 0.3 mm, GRAPPA (generalized autocalibrating partially parallel acquisitions) factor 2 with 32 reference lines, adaptive coil combination, auto coil selection, TR 2000 msec, TE 30 msec, flip angle 85°, bandwidth 2368 Hz/Px, 220 volumes, and field of view 192 × 192 mm. For coregistration of the functional sequence, skull stripping, and overlay purposes, an anatomical T1-weighted MPRAGE (magnetization prepared rapid acquisition) sequence (voxel size 0.5 × 0.5 × 0.9 mm; field of view read 240 mm; slice thickness 0.90 mm; TR 1900.0 msec; TE 2.60 msec; filter: prescan normalize, flip angle 9°; base resolution 256; phase resolution 100%; interpolation to 512 × 512; and PAT [parallel acquisition techniques] mode GRAPPA) from the clinical protocol was used.…”

Establishing a magnetic resonance safety program

“…The screening process for intraoperative patients requires meticulous accounting of surgical and anesthesiology equipment prior to entry into zones 3 and 4. Checklists have been shown to be helpful in the intraoperative MRI environment [ 12 ]. But while checklists provide another layer of safety assurance, particularly in uncommon situations, there is no replacement for clear and methodical reasoning on the part of all team members.…”

Impact of additional resection on new ischemic lesions and their clinical relevance after intraoperative 3 Tesla MRI in neuro-oncological surgery

“…Our institution uses a 2-room intraoperative MRI suite concept with a 3 Tesla (T) high-field MRI (Siemens 3 T Skyra VD13, Siemens Healthineers, Erlangen, Germany) and a NORAS 8 channel head coil (NORAS MRI products GmbH, Hoechberg, Germany). The safety and quality of intraoperatively acquired MRI sequences were ensured by using a previously published institutional default ioMRI checklist [25].…”

“…Increasing experience has led to more sophisticated protocols and guidelines, which have improved the safety [1,19] and the robustness and quality of ioMRI sequences. This accounts not only for routinely used methods but also for advanced imaging methods such as diffusion-weighted imaging (DWI) [17,25]. DWI sequences acquired during surgery are used as an important tool for the early detection of ischemic brain injuries that might cause new neurological deficits for the patient.…”