Clinical TMS Decision Support and Placement Tool · Version 0.2

From clinical review to reproducible targeting.

Record diagnosis and treatment history, review sourced options, document the clinician’s decision, and open the matching scalp locator.

For trained clinicians only. This workflow does not diagnose, establish TMS eligibility, or authorize treatment. Review current local guidance, the device instructions, and all positive or uncertain safety responses before proceeding. Do not use it for emergency triage or enter patient identifiers. Entries remain in this page session and are not saved by this site.

Initial assessmentDiagnosis, treatment history + adult safety screen

Primary diagnosis / indicationAdult patient?Current MDD episode confirmed?Care settingPatient age (years)GenderSex assigned at birth (optional)Pronouns (optional)Jurisdiction / local authorization contextGuideline basisCombined 2025 consensus is shown first; choose another source to compare its pathway.Previous antidepressant trialsTrial adequacy and duration reviewed?Psychotherapy historyPrior ECT course / outcomePrior TMS course / outcomeSymptom scale / severityPatient preference / practical modifiers

Psychiatric history and courseMedical comorbidities and neurological historyCurrent medications and recent changesSubstance use, intoxication, or withdrawal

Adult TMS safety screen · initial assessment

Adapted from the TMS Adult Safety Screen and newer pre-TMS guidance. “Yes” or “Unsure” means assess further; it is not an automatic exclusion.

Previous adverse reaction or unusual event during TMS?Personal history of epilepsy or seizure?Family history of epilepsy or seizure?Fainting, syncope, or unexplained loss of consciousness?Stroke, significant head injury/neurosurgery, brain tumour, or other brain/neurological illness?Metal or foreign material in the head/neck or near the planned coil position (for example clips, fragments, welding injury)?Implanted electronic/medical device or intracranial hardware (for example pacemaker, neurostimulator, cochlear implant, pump, or electrodes)?Hearing loss, tinnitus, ear symptoms, or ototoxic medication needing review?Frequent/severe headache or migraine, or current scalp/facial injury?Recent sleep deprivation, substance use/intoxication/withdrawal, or acute medical change that could affect seizure risk?Bipolar disorder, past mania/hypomania, or current manic symptoms?Psychosis or catatonia concern?Current suicidal intent/plan or immediate safety concern?Pregnant, possible pregnancy, or postpartum status needing individualized review?Prior EEG or MRI with a relevant finding that needs clinical review?I reviewed current medicines, doses, recent medication changes, and relevant substance use/withdrawal with the patient.

Add other relevant information to the generated summary Optional addendum. Do not enter names, record numbers, date of birth, or other identifiers.

Review and selectNo automatic protocol ranking

Workflow statusComplete the initial assessment

Confirm MDD, adult status, current episode, care setting, jurisdiction, and selected guideline before viewing protocol choices.

Guideline-linked options for clinician consideration

The sourced recommendation library in this release covers adult outpatient MDD only. This diagnosis is documented, but its protocol pathway is not enabled; use the relevant specialty guideline and local protocol.

History-based review prompt: Review response, dose, duration, adherence, tolerability, patient preference, and local indication criteria in the narrative history. This prompt does not determine treatment resistance or eligibility. Recorded: trial count not recorded antidepressant trials; trial adequacy not recorded; psychotherapy not recorded; prior TMS not recorded.

Protocol option selected by clinician

Options reflect differences across the supplied guidelines. There is no automatic ranking; verify the applicable local pathway and device label.

Left DLPFC · high-frequency rTMSAn initial adult MDD option in the 2025 combined consensus; Level A evidence in the IFCN 2020 evidence update. Confirm current device labeling.Left DLPFC · iTBSEqually supported as an initial MDD option in the 2025 combined consensus; CANMAT also lists TBS as first-line. Check local/device authorization.Right DLPFC · low-frequency rTMSCANMAT 2023 lists this as a first-line option; IFCN 2020 assigns Level B evidence. The 2025 consensus describes a weaker evidence base and different regulatory status by country.Sequential bilateralCANMAT 2023 lists this as second-line; IFCN 2020 rates bihemispheric evidence as Level B. The 2025 consensus reports no demonstrated superiority over unilateral treatment.

I checked the current clinic protocol and device instructions for this case.I am the responsible clinician and reviewed the safety responses.Risks, benefits, and alternatives were discussed with the patient.Informed consent is documented.

Complete the initial assessment and adult safety screen, select a protocol, choose “Proceed,” check local device guidance, and confirm responsible-clinician review to open targeting.

Setup noteReview before copying into the chart

Protocol not selectedSelect a protocol to see its target methodNo review flags selected

Generated clinical summary updates as fields change

CLINICAL ASSESSMENT SUMMARY — DRAFT FOR CLINICIAN REVIEW
Demographics: age not entered; gender not recorded; sex assigned at birth not recorded; pronouns not recorded.
Diagnosis and scope: Not confirmed; adult status unknown; current episode unknown; setting unknown; jurisdiction not selected.
Symptom measure/severity: not recorded.
Psychiatric history: not recorded. Medical comorbidities: not recorded.
Current medications and recent changes: not recorded. Medication review completed: no.
Substance use, intoxication, or withdrawal: not recorded.
Treatment history: antidepressant trials not recorded; trial adequacy/duration review not recorded; psychotherapy not recorded; prior ECT not recorded; prior TMS outcome not recorded.
Patient preference: not recorded.
Adult TMS safety screen: priorTms=not answered; seizure=not answered; familySeizure=not answered; syncope=not answered; neuro=not answered; metal=not answered; implant=not answered; hearing=not answered; headache=not answered; threshold=not answered; mania=not answered; psychosis=not answered; suicide=not answered; pregnancy=not answered; investigations=not answered.
Screen prompts to address: none recorded.
Guideline selected: Combined 2025 consensus · NNDC + Clinical TMS Society + IFCN; recommendation prompt: The sourced recommendation library in this release covers adult outpatient MDD only. This diagnosis is documented, but its protocol pathway is not enabled; use the relevant specialty guideline and local protocol.
Clinician decision: Not recorded. Selected protocol: not selected. Targeting plan: Not selected.
Device/metal item review confirmed: no positive screen response. Responsible clinician review: not confirmed.
Clinic/device protocol review not confirmed.
Risks/benefits discussion not recorded.
Informed consent not recorded.
This generated summary is a draft from entered fields. It does not diagnose, determine eligibility, or prescribe treatment. Verify the current guideline, local policy, device labeling, and patient-specific clinical context.

The copied note distinguishes clinician-entered decisions from calculated scalp coordinates. It is not saved in a patient record by this website.

Current release scope

Adult outpatient MDD workflow. Protocols listed: left high-frequency rTMS, left iTBS, right low-frequency rTMS, and optional sequential bilateral. Other indications and automated history extraction are outside this first release.

About, safeguards & sources

How to use this tool responsibly

Designed to make a clinician-led workflow easier to review and document. The recommendations and coordinates are aids for professional judgment, not a substitute for it.

About this tool

This first release brings structured clinical review, guideline-linked protocol options, scalp targeting, and setup notes into one workflow. Its protocol library is limited to adult outpatient MDD; other indications are outside the current pathway.

About the developer

Dr Jithin T Joseph is an interventional psychiatrist with clinical and research experience in India and Canada. His work includes clinical TMS, neurophysiology, and TMS research.

Safety precautions and use limits

Clinician responsibility: A qualified treating clinician must independently assess the patient, determine whether TMS is appropriate, select and verify the protocol, discuss risks and alternatives, and document consent.
Screening is not clearance: The safety questions are prompts for review. A “No” response or an empty review-flag list does not establish eligibility. Investigate every “Yes” or “Unsure” response and follow the clinic’s full screening process.
Escalate when needed: Possible mania, psychosis or catatonia, seizure or neurological complexity, uncertain implants or metal, and prior non-response require appropriate clinical review. Urgent suicidality or immediate danger needs the local urgent or emergency pathway; this page is not a crisis or triage service.
Check local and device requirements: Indications, authorization, contraindications, and protocols can vary by country and device. Follow current institutional policy and the exact manufacturer instructions for the machine and coil being used.
Interpret coordinates cautiously: Scalp measurements estimate a reproducible surface location; they do not identify an individualized cortical target or replace neuronavigation. Confirm landmarks and measurements at the point of care.
Protect privacy: Do not enter names, dates of birth, record numbers, or other identifying details. The form is held in the current page session and is not saved to a patient record by this site.

This is an early workflow prototype, not a validated clinical decision rule. The narrative history informs review prompts; it is not automatically interpreted to diagnose or score eligibility.

Guidelines and clinical evidence

These sources inform the adult MDD protocol options. The selectable guideline basis helps compare pathways; it does not determine which guideline or authorization applies to a particular patient.

Scalp localization methods and sources

The locator uses deterministic measurement geometry. Classic and modified Beam F3 are shown as separate conventions; modified Beam F3 should not be assumed to improve accuracy for every head. Inspect the method notes on the locator page and use the method required by your local protocol.

Sources are provided for transparency and should be checked for updates. They do not imply endorsement of this tool by the cited organizations.