Neuronavigation maximizes accuracy and precision in TMS positioning: Evidence from 11,230 distance, angle, and electric field modeling measurements.
International Clinical TMS Certification Course
The Academy of Brain Stimulation
Background
Researchers and clinicians have traditionally relied on elastic caps with markings to reposition the transcranial magnetic stimulation (TMS) coil between trains and sessions.
Newer neuronavigation technology co-registers the patient's head and structural magnetic resonance imaging (MRI) scan, providing the researcher with real-time feedback about how to adjust the coil to be on-target.
However, there has been no head to head comparison of accuracy and precision across treatment sessions.
Objective
In this two-part study, elastic cap and neuronavigation targeting methodologies were compared on distance, angle, and electric field (E-field) magnitude values.
Methods
In 42 participants receiving up to 50 total accelerated rTMS sessions in 5 days, cap and neuronavigation targeting approaches were compared in 3408 distance and 6816 angle measurements.
In Experiment 1, TMS administrators saved an on-target neuronavigation location at Beam F3, which served as the landmark for all other measurements.
Next, the operators placed the TMS coil based on cap markings or neuronavigation software to measure the distance and angle differences from the on-target sample.
In Experiment 2, each XYZ coordinate of the TMS coil from cap and neuronavigation targeting were saved in 12 participants to compare the E-field magnitude differences at the cortical prefrontal target in 1106 cap and neuronavigation models.
Results
Cap targeting was significantly off-target for distance, placing the coil an average of 10.66?mm off-target compared to 0.3?mm for neuronavigation.
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Cap targeting also significantly deviated for angles off-target, averaging 7.79 roll/pitch degrees off-target and 5.99 yaw degrees off-target; in comparison, neuronavigation targeting positioned the coil 0.34 roll/pitch degrees and 0.22 yaw degrees off-target.
Further analyses revealed that there were significant inter-operator differences on distance and angle positioning for F3, but not neuronavigation.
Lastly, cap targeting resulted in significantly lower E-fields at the intended prefrontal cortical target, with equivalent E-fields as 110.7% motor threshold stimulation vs. 119.9% MT from neuronavigated targeting with 120% MT stimulation applied.
Conclusions
Cap-based targeting is an inherent source of target variability compared to neuronavigation.
Additionally, cap-based coil placement is more prone to differences across operators.
Off-target coil placement secondary to cap-based measurements results in significantly lower amounts of stimulation reaching the cortical target, with some individuals receiving only 48.6% of the intended on-target E-field.
Neuronavigation technology enables more precise and accurate TMS positioning, resulting in the intended stimulation intensities at the targeted cortical level.
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Read the full publication here.
Caulfield K.A., Fleischmann H.H., Cox C.E., Wolf J.P., George M.S., McTeague L.M. Neuronavigation maximizes accuracy and precision in TMS positioning: Evidence from 11,230 distance, angle, and electric field modeling measurements. Brain Stimul. 2022;15(5):1192-1205. doi:10.1016/j.brs.2022.08.013
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1 年I m not sure its sorted out but I like the fanfare of Neuronavigation so I m on board.