Essential tremor is a neurologic disorder that causes rhythmic shaking with movement, most often in the hands, and it can interfere with eating, writing, and other daily tasks. One treatment option is MRI-guided focused ultrasound thalamotomy, which uses focused ultrasound energy to heat and destroy a small target in the brain without an incision. Targeting is typically planned in the ventral intermediate nucleus (VIM) of the thalamus on the side opposite the patient’s more affected hand.

Procedure planning can benefit from patient-specific “nerve pathway” mapping using diffusion MRI. A key pathway for tremor targeting is the dentato-rubro-thalamic tract (DRTT), which connects the cerebellum to the thalamus and helps regulate motor control. Stanford clinicians identified a workflow gap: there was no reliable internal method to generate and review these diffusion-based pathway maps in a standardized way for focused ultrasound planning.

Neuroradiology asked the Stanford 3DQ Lab to build a repeatable workflow that could produce these pathway maps and support the focused ultrasound planning and guidance process. A 3DQ Lab technologist attended an external conference to learn tract targeting approaches used by other institutions and field leaders, then worked with Stanford neuroradiologists to adapt the method to local imaging and review needs.