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CTDS user guide

How to use CTDS

Use the tools sequentially for a complete workflow, or individually for a specific task. Review each output and retain the final report in your clinical record.

Before you begin

CTDS is for trained clinicians. Enter only relevant information and avoid patient identifiers. Entries are temporary drafts in this browser tab; review carried-forward information and export anything you need before clearing or closing the tab. The tool does not replace clinical assessment, device instructions or your patient record.

Assessment and planning

Review the indication, history, safety and guideline-linked treatment options.

  1. Choose the diagnosis and enter the key clinical context: adult status, care setting, jurisdiction and current MDD episode when applicable. Add the physician’s formulation and relevant symptom severity.
  2. Optionally record dated baseline symptom scores in Assessment; they link to the same baseline in Treatment & Follow-up. Record treatment history and adequacy, relevant comorbidities, current medications, recent changes and substance use. Complete the safety screen and review positive or uncertain findings.
  3. Review the case summary, treatment-resistance assessment, guideline basis and cautions. Choose and independently verify the protocol, target and course against local requirements and device instructions.
  4. Record the responsible clinician’s decision and review, discuss risks, benefits and alternatives, and document consent. Copy or print the report; continue only when the required checks are complete.

Scalp locator

Calculate and review scalp markings using EEG 10–20, EEG 10–10 or Beam F3.

  1. Choose EEG 10–20, EEG 10–10 or Beam F3. For Beam F3, select the classic or modified convention required by your protocol.
  2. Replace the example values with the measured nasion–inion arc, intertragal/preauricular arc and head circumference in centimetres. Confirm the anatomical landmarks and measurement convention.
  3. Choose the intended landmark and inspect the scalp figure, marking instructions and distances. For Beam F3, review the X and Y markings and the calculated F3 point.
  4. Recheck the measurements and limitations, then copy the placement summary. Scalp coordinates are measurement aids and do not identify an individualized cortical target or replace neuronavigation.

Motor threshold

Record responses with RR CTDS or ML-PEST CTDS, or document an external result.

  1. Choose RR CTDS, ML-PEST CTDS or the external-result pathway. Select the hand or leg, muscle and response method; record the relevant device and coil details.
  2. Confirm preparation, the motor hotspot and a clinician-set output ceiling. Resting EMG and visual responses are distinct methods; use the method permitted by the applicable device protocol.
  3. For RR CTDS, set the starting intensity and mark each delivered pulse Yes or No. Review the block count and search suggestion; untested pulses remain untested. Follow the displayed bracketing and refinement process.
  4. For ML-PEST CTDS, choose the start and review plan, then record each delivered intensity and response. The estimate, next suggestion and graphs update from the observations; checkpoints are review points rather than confidence-based stopping rules.
  5. Review the result, response history, cautions and method reference before retaining it. Independent clinical validation of ML-PEST CTDS is pending; confirm its estimate independently before treatment. For an external result, record its original application, method and clinician review.

Coil setup

Document the machine, coil, measured reference, target and orientation.

  1. Choose the machine, exact coil model and protocol. Select manual placement, neuronavigation or tracked positioning as appropriate.
  2. For a coil-specific pathway, confirm the measured motor reference and the coil used for threshold assessment. Follow its documented treatment displacement and current manufacturer instructions.
  3. Review the target, coil reference point, contact, tilt and orientation convention. For navigation or tracking, use the compatible system’s planned pose and calibration checks.
  4. Record any device-specific setup details, check the generated note and copy or print it. Published placement descriptions do not replace the current model-specific instructions.

After-session review

Compare pre-session and post-session symptoms and record clinical review.

  1. Record the session number and date. Before stimulation, review sleep, substance use, medication changes and other clinical concerns; document the clinician’s decision.
  2. Rate symptoms before and after the same session. Missing ratings are not negative findings; temporal changes do not establish causality. Retain the paired report before starting the next session; saved versions can be reopened or downloaded.
  3. Review possible causality, assess concerns clinically and document the action taken and decision about continuing treatment. The checklist does not independently establish safety.
  4. Check the session report, then copy or print it. The complete report includes the other CTDS sections that have been recorded in this browser tab.

Treatment and follow-up

Track baseline and weekly ratings, review trends and export course reports.

  1. Choose the disorder and review the baseline linked from Assessment, or record it here with its date. Do not create a second baseline. Use the appropriate disorder-specific scales and relevant clinical observations.
  2. Use supported online scoring or enter totals from authorized original forms. Follow the original scale anchors and versions; leave unassessed items blank. MADRS, YMRS and Y-BOCS remain original-form result entry.
  3. Add weekly or follow-up assessments and review trends against baseline. CGI improvement compares with pretreatment baseline; C-SSRS findings require a clinical assessment rather than a summed risk score.
  4. Document clinical decisions and any safety actions. Export the course backup to retain editable records, or print/save the complete clinical report as PDF.

Review and retain your work

Check the source basis, patient-specific findings, cautions and clinician decisions before retaining a report. Use Copy for text or Print / Save PDF for a printable record. Export the treatment course backup if you need editable follow-up records.

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