Boston Scientific ImageReady MRI Mode D'emploi page 15

B. Implant Configuration (All rows must be completed)
MRI Eligible
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Stimulator NOT implanted
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Lead extensions NOT implanted
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Leads capped with lead boot
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Lead fully implanted under the scalp on the
skull
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NO evidence of fractured leads
Note: The patient is NOT MRI Eligible if any of the "Not MRI Eligible" boxes are checked.
Not MRI Eligible
ImageReady™ MRI Guidelines for Boston Scientific Deep Brain Stimulation Systems
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Stimulator implanted
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Lead extensions implanted
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Leads NOT capped with lead boot
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Lead NOT fully implanted under the scalp on
the skull
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Evidence of fractured leads
91098813-02 Rev C
Appendix A
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