Functional imaging of the orbital tissue might improve strabismus surgery by providing new pathophysiological inside1 about the interlinked viscoelastic properties of the active and passive orbital tissues; which are impossible to predict from static images or ophthalmological tests. To enable a clinical use of high spatiotemporal resolution dynamic MR imaging of the orbit during eye movement, the patient ability to maintain a reproducible movement in regard to the position and speed timing is crucial. The relatively long scantime can be decreased by using higher B0 field strength, multichannel receive array for simultaneous scanning of both orbits, and kt-SENSE. All three are challenging for the orbit, due to the neighboring oral cavities, and therefore requiring good shimming. Further, a minimum water-fat shift is aimed. Despite these numerous challenges, we proceeded to several methodological improvements aiming clinical usability. Simultaneous eye tracking to control the reproducibility of the eye motion, and may be used for rejection and re-measurement of k-space profiles with wrong gaze direction.To help the patient to perform repetitive smooth-pursuit eye movements a gaze target in form of a horizontally sinusoidally moving red target (red dot, 2s period, peak velocity 64°/s, amplitude ±20°) is projected on a dark grey background using a laser and galvanically driven moving mirrors with 500Hz position update, which gives the impression of a continuously moving target, which strongly improved the presentation quality compared to a 50 or 60Hz video projection. The eye position tracking was recorded with an infrared camera at 500Hz (eyelink2000 system, SR Research, Mississauga, Ontario, Canada). Further, the segmented acquisition was synchronized with the gaze target motion2. B0 map based shimming was performed using a rectangular shim volume including both orbits. The subject was able to see through a two channel microscopy coil, 47 mm in diameter (Philips Research; Hamburg, Germany) one placed on each eye. On a 3T Philips Achieva scanner, kt SENSE with acceleration factor from 2 to 5 were used to decrease acquisition time. The flip angle (7.5°) of the segmented 3D T1 TFE sequence was signal optimized. Other scan parameters are: 14 time frames of 170 ms duration, 38 over-continuous axial slices, TE 4.8 ms, no signal averaging. A field of view of 120x120x30 mm3 was used to avoid foldover artifacts. Readout direction was AP and a scan percentage of 80% was used to shorten scantime: scan matrix 300x240x19.The smooth-pursuit reliability decreased sensibly with increasing scantime. The eye movements could successfully be tracked and the inconsistent data can be identified, see Figure1. The multichannel microscopy coil enables the simultaneous scanning of both orbit with a good SNR. The phase encoding in the RL direction was efficient in preventing motion artifacts from spreading over the orbit. Saturation bands occurring within the orbit need to be taken care with a slight f0-shift. The muscle path during eye movement can be followed accurately due to the high contrast with the (fatty) orbital connective tissue.We acquired high spatiotemporal resolution dynamic MRI of the orbit in a scantime comparable to a single static high resolution images, a reasonable smooth-pursuit duration for patient capabilities. Increasing the kt-SENSE acceleration factor does decrease the scantime and the SNR, but as the accuracy of eye movements is higher during the acquisition duration, the overall image quality is equivalent. To enable a clinical use of dynamic orbital MRI, the patient’s motivation and training to perform reproducible eye movement needs to be considered. Tracking eye position allows cycles with bad motion and speed accuracy to be discarded.Increasing the scantime of dynamic orbital MRI might not improve image quality due patient limited cooperation. Therefore, eye tracking during MRI acquisition is necessary for improving image quality.