Scaling Personalized TMS: A Scalp-Based MRI-guided Alternative to Neuronavigation

Abstract

BackgroundPersonalized transcranial magnetic stimulation (TMS) has shown promise in treating psychiatric and neurological disorders, but its accessibility is limited by reliance on costly and complex neuronavigation systems, particularly in resource-constrained clinical settings. ObjectiveTo develop and validate a scalp-based alternative to neuronavigation for personalized TMS targeting. MethodsWe developed a Continuous Proportional Coordinate (CPC) system-based approach for personalized TMS targeting and validated its performance through three operators across ten participants, using individualized DLPFC-SGC targets as an example. The validation framework included targeting consistency assessment, reproducibility evaluation, and cross-cortical generalizability analysis. ResultsThe CPC-based approach demonstrated comparable performance to neuronavigation, achieving 99.4% of its electric field strength (74.80 vs. 75.14 V/m; r = 0.962) and 93.9% of DLPFC-SGC functional connectivity (-0.216 vs. -0.230; r = 0.949), with high inter-operator reliability (ICC [≥] 0.903). Reproducibility analysis showed strong correlation between sessions (r = 0.948-0.957) with high reliability. Further simulations across 1,125 uniformly distributed cortical targets supported generalizability of this approach, with stable electric field preservation (99.07 {+/-} 1.54%) across different brain regions. ConclusionsThe CPC-based approach offers a practical alternative to neuronavigation, maintaining targeting accuracy and providing a more accessible option for personalized TMS implementation.