this is a video demonstrating how to use
the mag beta TMS therapy system the mag
Vita TMS therapy is indicated for the
treatment of major depressive disorder
in adult patients who have failed to
receive satisfactory improvement from
prior antidepressant medication in the
current episode
the magnetic TMS therapy system consists
of a magnetic stimulator type are 30 or
x 100 the stimulator is an all-in-one
standalone solution with a built-in
display for easy user interface the
stimulator is mounted on a trolley along
with the system's isolation transformer
vacuum pump and cooler unit the
isolation transformer provides power for
all components in the system including
the stimulator chair cooler and pump the
treatment chair is a fully adjustable
chair designed for the comfort of the
patient in combination with the vacuum
pillow it ensures a stable positioning
of the patient's head during the
treatment mounted to the trolley or
chair is an articulated stainless steel
arm for easy and flexible positioning of
the stimulation coil the three
articulations are released and fixed by
a single central control knob allowing
the user to fix the coil in place by
tightening a single mechanism the user
also has the option to mount the arm on
the back rest of the treatment chair or
to a table or wall using special
mounting ket the system comes with two
different coils one for the motor
threshold determination and one for the
actual repetitive transcranial magnetic
stimulation procedure
connect the cooling hoses if these have
been unplugged and check that the cooler
is turned on
place the handle of the cool b65 coil in
the holder on the flex arm tighten the
knob to hold the coil securely
please be aware of the contraindications
for Meg betta TMS therapy
contraindications include implanted
electronic devices and or conductive
objects in or near the head and
non-removable metallic objects within 12
inches corresponding to 30 centimeters
of the coil patients having implanted
devices that are activated or controlled
in any way by physiological signals and
or ferromagnetic or other magnetic
sensitive metals implanted in their head
must not receive mag Vita TMS therapy
examples are cochlear implants implanted
electrodes stimulators aneurysm clips or
coils stents and bullet fragments
failure to follow these restrictions
could result in serious injury or death
to identify if a patient has one or more
of the above-listed contraindications or
if any of the other precautions listed
in the user guide apply a standard
questionnaire is recommended please see
the safety information in the user guide
for an example please read the user
guide for a comprehensive explanation of
the safety guidelines
before initiation of any TMS treatment
the correct stimulation intensity for
the procedure needs to be established
the stimulation intensity of the
therapeutic procedure is based on each
patient's individual sensitivity also
known as the patient's motor threshold
with the magnetic TMS therapy system the
MT is measured by observance of a
visible muscle twitch of the right thumb
after stimulation of the motor hot spot
for the intrinsic hand muscles in the
motor area on the left hemisphere in
five out of ten stimulations the lowest
possible stimulation intensity needed to
get a visible twitch of the thumb
represents the patient's motor threshold
value because the motor threshold in any
given individual has been shown to be
state dependent and variable the mag
betta TMS therapy protocol specifies
that the motor threshold value must be
determined every two weeks during the
six-week course of treatment
in order to begin a motor threshold
determination procedure turn on the mag
Pro and attach the CB 60 coil
ensure that the marking plate is
attached
for the motor threshold determination
procedure one will need a treatment cap
for the patient earplugs a marking pen
and measuring tape for patients who are
anxious about the procedure applying a
few stimulations to the forum may be
helpful to get the patient familiar with
the stimulation
you
to start right the patient's ID on the
cap and place it on the patient's head
with the central same aligned to the
midline be sure the cap fits the
patient's head snugly
to find the area of the scalp above the
motor cortex first identify the location
of Nazy n and n en the knees ian is the
intersection of the frontal bone and to
nasal bones of the skull it is the
deepest depression on the mid line
between the nose and forehead right the
distance from the nays Ian to the edge
of the cap on the cap
the Indian is the most prominent
projection of the occipital bone at the
lower rear part of the skull measure the
distance between the Nazy and and in EN
along the midline of the head locate the
halfway point between these two
landmarks and market on the cap next
measure the distance between the tragus
of each year be careful to have the
imaginary line joining the triggy passed
through the halfway point between the
nays Ian and the na n find the halfway
point between the tray ghee and mark
this as the vertex the motor cortex for
the right thumb is located to the left
and front of the vertex
make a mark at the point on the left
side of the patient's head five
centimeters lateral to the vertex along
the imaginary line joining the tray of
the years make a mark at the point along
the midline five centimeter anterior to
the vertex draw a dotted line between
the two points along this line the motor
threshold spot for the right thumb is
located the optimal coil orientation for
finding the motor threshold is achieved
by keeping the coil at an angle of 45
degrees to the midline with the center
of the coil in contact with the scalp
such that the plane of the surface of
the coil is tangential to the curvature
of the head this orientation is obtained
by keeping the straight edge of the
marking plate parallel to the cap
midline place the center of the coil at
the midpoint of the dotted line and
start searching for the motor threshold
spot by delivering single stimulations
while moving the coil in small
increments along the line while
continuously observing the thumb for at
which start the stimulation and an
intensity of forty to fifty percent if
no response gradually increase the
intensity until a response is observed a
random interval between the single
stimulations of between six to nine
seconds is recommended once the location
of the most robust response is found
incrementally lower the intensity to
find the lowest possible value where at
which is still observed in five out of
ten stimulations the stimulation
intensity value is the individual
patients motor threshold
while holding the coil firmly in place
at this location trace the contour along
the front edge of the marking plate onto
the treatment cap this is to indicate
where the treatment coil is to be placed
record the motor threshold intensity
shown on the mag pro in the patient's
treatment records or on the side of the
cap
once the optimal motor threshold Loki
and intensity are found and the position
for aligning the treatment coil has been
marked on the cap the motor threshold
coil should be disconnected from the
stimulator and replaced by the cool b65
treatment coil
remember to also connect the small limo
connector
before the actual treatment starts it is
important to make sure the patient is
comfortably seated with his or her head
stabilized in a fixed position use the
remote control connected to the chair to
adjust the footrest the seat and
backrest to recline the patient into a
comfortable position
make sure the vacuum pump is on and
place the foot switch close to your foot
make sure the valve is open fit the
vacuum pillow around the patient's neck
to give the most support possible when
the pillow is in a good position depress
the foot switch to elevate the air in
the pillow stiffening it in the chosen
position close the valve
before starting check that the cap is
still in its correct position by
checking that the distance from the Navy
on to the edge of the cap hasn't changed
also check that the mid line is still
centered on the head
unlock the grip on the center joint of
the flex arm to freely move the coil to
the treatment spot it is a good idea to
make sure the arm in the lowest joint is
placed in a vertical position which
eases the operation of the coil align
the coil on the treatment location by
using the contoured line drawn on the
cap
the center of the coil should be in good
contact with the scalp make sure the
coil is placed tangentially to the head
once the patient is positioned and the
treatment coil is placed in the correct
location the operator can start the rtms
treatment protocol magnetic TMS therapy
systems come loaded with FDA and CEO
proved our TMS protocols as the default
setting upon boot up the stimulator
loads the default protocol automatically
the user should double check the
settings to confirm that the default
protocol has been loaded correctly after
verification the operator navigates the
software interface to the timing menu
enables the stimulator sets the correct
intensity the intensity corresponding to
one hundred twenty percent of motor
threshold and depresses the start button
once the our TMS treatment session has
been initiated the graphic display in
the lower left part of the timing menu
is populated with information about the
protocol
the total time and number of pulses in
the protocol is shown as well as a
progress bar that indicates how much of
the protocol has been delivered and how
much remains before the protocol reaches
completion
during the treatment it is possible to
pause the protocol and resume from the
point of pause using the pause button
you
if the stimulator does not boot up with
a default protocol loaded one can either
recall it or define it again to recall a
protocol that has previously been
defined and stored from the main menu
use the pulse wheel to select the
protocol to recall depress the recall
soft key the recalled protocol is now
loaded and information about the
protocol is displayed in the setup view
window to the left of the display
to define a protocol manually confirm
that the mode current direction and
waveform are set to the correct values
for the approved rtms depression
protocol the stimulator should operate
in standard mode with a normal current
direction and with a biphasic waveform
navigate to the timing page by
depressing the timing button on the
timing page set the actual protocol use
the arrow buttons to navigate through
the various data fields and use the
pulse wheel to select the appropriate
values the timing control should be set
to sequence and rest of the protocol
settings are defined according to the
user guide
once the correct settings have been
selected one can enable the stimulator
set the correct intensity which is 120
percent of the motor threshold value and
initiate a treatment session by
depressing the start button
you
a protocol first to find the mode
waveform and current direction on the
main page set the protocol parameters on
the timing page then navigate to the
configure menu using the configure
button navigate to the uppermost data
field in the configure menu and use the
pulse field to choose one of the
predefined headers for the protocol
depress the Save button the protocol is
then saved under the chosen header and
can be recalled from the main page by
using the pulse wheel to select a
protocol header from the different saved
setups in the setup data field recall
the protocol by depressing the recall
button the setup is thus loaded and the
information for the protocol is
populated in the protocol setup menu in
the left side of the display
when the protocol has reached completion
remove the coil from the patient's head
by loosening the joints on the
articulated flex arm and moving the coil
away from the patient release the vacuum
from the pillow by disconnecting the
tube connecting it to its pump and
opening the valve readjust the chair to
allow the patient to get off of it
without difficulty
you
when the patient returns for the
subsequent sessions make sure to
accurately reposition the cap in the
same position it was during the initial
session making sure that the distance
from the Navy on to the edge of the cap
is same as noted down from the first
session
make sure the cap is properly aligned
with the midline once the cap is
positioned correctly prepare the patient
for the treatment session
place the treatment coil on the tree
by using the contoured line marked on
the cap just as was done during the
first session
ensure the proper protocol is loaded
navigate to the timing menu enable a
stimulator set the intensity to one
hundred twenty percent of the patient's
motor threshold value and initiate the
our TMS session by pressing start
thank you for watching for further
information please turn to the user
guide or contact Meg venture
you