Windows and the Practical Approach: The MOTOr

This chapter provides an overview on how to perform transcranial color-coded sonography (TCCS). This is an evolution of the original transcranial Doppler (TCD) technique. TCD infers values related to flow direction and velocity from the numerical data obtained. TCCS allows for visualization of the vessel and examination of flow characteristics. The Mandibular Occipital Transtemporal Orbital (MOTOr) approach is outlined, which is a systematic way to interrogate four windows. Essential first steps are to gain confidence that an adequate acoustic window has been obtained, visualization of structures of interest, and performance of basic flow dynamic measurements. Individual patient pathophysiology and therapy intensity should also be incorporated into the interpretation of data and thus provide optimal information to inform patient management.