ZOOM TMS 101 – HOW TO START & BUILD A SUCCESSFUL TMS PRACTICE Learn more

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How to operate the CloudTMS device.

Hi, I’m Dr. Joe Jabre, I’m a board-certified Neurologist and I’d like to tell you about this transcranial magnetic stimulation unit. Transcranial magnetic stimulation is indicated for the drug resistent major depressive disorders. This device is manufactured by Neurosoft Ltd. and as you can see, it’s a modular device. It has three modules. The first module is the main unit which controls the entire unit. The second is the cooling unit which is very important because it keeps everything running smoothly and the coil stays cool. And the last is the additional power supply unit which boosts the output of the device. The other thing you see is that the device sits on a cart, and that cart can easily be wheeled from room to room. Essentially, you don’t have to hire movers to go from one room to another room in your office. Another thing you see is the arm that’s connected to the top shelf here. The arm holds the coil. The coil is what’s going to fit over the patient’s head and you can see that the arm is very flexible and can easily move. You move it in any position you want and then fix it and then the coil fits over the patient’s head. I want to point out to you that the coil is angulated, it’s not straight. In other words, it really fits snugly against the skull.

So let me introduce CloudTMS to you. The reason we call it CloudTMS is because every cloud has a silver lining. This transcranial magnetic stimulation, with the three units, is turned on from the back. There are three green buttons. So I will start by turning the main unit on, then the cooling unit on and then the additional power supply unit on. Now you can see that as soon as I turn it on, the power button of the main unit turns orange. You don’t see anything on the cooling unit on, yet, but you see that the additional power supply unit turns orange as well. As soon as I press this button to turn the unit on (the main unit power button), you’ll see that the cooling unit comes on and you see a snowflake to tell you that the coil is cool at this point and you see a picture of the coil here that tells you what the temperature of the coil is at all times to make sure that you’re monitoring this.

So, I want to go over these buttons that you have here to show you how to set the machine up. First, before doing this, I want to tell you that this machine can be run completely independently or through the laptop. I will go over the independent operation first. What you see here is the dial (the white dial on top) that sets up the intensity of the stimulation that you’re going to give to the patient and here (the white dial underneath), that will change the settings depending on which button you press. So let’s first of all press this button here, which is the frequency button and you see, whenever I push the frequency button here, this button here shows 4 Hertz (next to the settings dial) but in fact, when we’re doing the FDA protocol, it should be 10 Hertz. So now I’m going to set this to 10 Hz (by spinning the white dial), and now we are with the FDA protocol, so this is 10 Hertz frequency. Now the next one (button) is going to be for how long you apply it for and we’re going to apply it for 4 seconds, so I set it up at 4 seconds. So 10 Hertz duration of 4 seconds and then we’re going to give the patient a break and I press the third button here to tell me how long is the break and again, the FDA protocol, the break is 26 seconds between each 4 seconds of stimulation. The patient gets a break of 26 seconds and the length of the treatment for that is 37 and a half minutes. Again, that’s the FDA approved protocol. Here it shows 15 but I’m going to set it up to 37.5 minutes. As soon as I do this, whenever I press on this button here (the play button), the machine will start stimulating. That’s it, that’s all you need to do to set it up.

So, I’m going to press on this button (play button) and you’re going to hear a noise coming out of this coil right here, which means that it’s stimulating. Obviously, this coil is against the patient’s head but right now, all I’m showing you is how to turn the machine on and how to set it up. So now I’m going to show you, as soon as I press this, you’re going to hear 10 Hertz for 4 seconds, then it’s going to stop for 26 seconds, then take over again. Here we go.

Now this is stimulating for 4 seconds. It’s going to give the patient a break for 26 seconds and as soon as the 26 seconds are over, then it’s going to stimulate again at 10 Hertz for 4 seconds. Now note here that you will see that this is at 37.5 minutes. When it starts again, it’s going to go down to 37 minutes. That means half a minute has already elapsed. So as soon as it starts again, this will go down, it went down to 37 minutes and it’s given the second session. It gave 10 Hertz, 4 seconds, again 26 seconds break and then it will start again after 26 seconds and you will see that the time will go down. This will go off and on for the next 37 and a half minutes and then it stops at the end. So the last one I’m going to show you is when it starts again, which should be any second now and that the timing is going to go down. You see now it went down to 36.5 minutes and now I’m going to stop this because there’s no point in going through the whole thing, I’m going to stop it. So now, after we’ve done this 37 and a half minutes session with the machine operating independently, the patient is done, we take the coil off the patient’s head, the patient gets up and they can leave and the session is over.