Precision TMS targets, delivered to your clinic in 3 business days.
Your patient gets imaged locally. We process the structural and resting-state fMRI, compute the individualized target, and ship a neuronavigation-ready target package back to your team. You treat with confidence on day one.
Standard scalp landmarks miss the functional target by centimeters, not millimeters.
The 5-cm rule, the F3 site, and Beam-F3 all approximate group averages. Functional anatomy is idiosyncratic. Two patients with identical skull geometry can have DLPFC anti-correlation peaks more than 25mm apart, and TMS itself is only accurate to roughly 1cm under ideal navigation conditions.
AThe mechanism is circuit-based
Therapeutic effect of left-DLPFC stimulation in depression depends on negative functional connectivity to the subgenual anterior cingulate (sgACC). Coordinates with stronger anti-correlation produce larger antidepressant response. This relationship was first demonstrated by Fox and colleagues in 2012 and has since become the conceptual foundation for FDA-cleared accelerated protocols.
The therapeutic question is no longer "where is the DLPFC?" It is "where does this patient's DLPFC show the strongest functional anti-correlation with the sgACC node of the depression circuit?"
BThe signal is patient-specific
UK Biobank reproducibility data and Human Connectome Project analyses both confirm that the optimal stimulation coordinate varies meaningfully across individuals. Group-average targets sit close to a population centroid but routinely fall outside any one patient's anti-correlation peak.
Single-seed sgACC connectivity has weak test-retest reliability on its own. Network-based and core-network model approaches improve repeatability up to fivefold, bringing target stability into the spatial resolution of TMS itself.
Five steps from local scan to coil-on-target.
You acquire on a 1.5-3T scanner you trust. We handle the rest. The deliverable is a patient-specific target package your TMS technician imports into Visor2, Brainsight, Localite, or any neuronavigation system that accepts MNI coordinates and NIfTI overlays.
Local Scan
Patient scans localy using our acquisition protocol
DICOM Upload
Encrypted upload to our HIPAA-compliant intake portal
Processing
Our teams uses the most advanced pipeline to create the target.
Target Review
Clinical review of target stability, motion, and anatomical fit
Delivery
Neuronavigation file, MNI coordinates, sent to your clinic
Built for clinical and research workflows.
The processing core is the same. The deliverable, documentation, and data-handling expectations differ. Choose the workflow that fits your role.
CWhat clinicians get
Your patient is on the chair Monday morning. Your tech opens the neuronavigator, registers the patient to their MRI, and the cortical target is pre-loaded. No coordinate hunting, no manual placement, no F3 estimation.
Each patient package includes the patient-specific structural MRI in NIfTI, a target coordinate in both native and MNI space.
DWho this is for
TMS practices that want to offer fMRI-guided targeting without building an in-house neuroimaging team. Common scenarios include patients who failed scalp-targeted rTMS, patients pursuing accelerated iTBS protocols, complex comorbidity cases (depression with anxiety, post-TBI mood disturbance), and elective patients who specifically request precision targeting.
You retain medical authority. CFX does not provide clinical care or treatment decisions. We deliver the imaging-derived target; you treat.
RWhat investigators get
BIDS-compliant outputs, fMRIPrep-derived QC reports, motion summaries (mean FD, censored volumes), seed time series, and the full connectivity map for downstream analysis. Targets can be defined against the sgACC seed, a personalized core-network model, or a custom seed of your choice (anxiosomatic, ventromedial, OCD circuit, etc.).
We support multi-site studies with harmonized acquisition templates and per-scanner QC. Contracts can be structured per-subject or per-protocol.
SWho this is for
Academic medical centers, pharma-sponsored TMS adjunct trials, and DARPA/DOD/NIH-funded investigators running TMS studies in depression, PTSD, OCD, addiction, post-stroke depression, and traumatic brain injury. We routinely interface with IRBs, data safety monitoring boards, and study sponsors.
If you are designing a protocol and need help defining acquisition parameters or target selection criteria, we offer pre-study consultation.
What your scanner needs to send us.
Most modern scaners are capapable and meet these requirements out of the box. We provide a vendor-specific exam card and DICOM template at intake.
≤ 1mm isotropic. Whole-brain coverage including the vertex and the cerebellum. Typical parameters: TR 2300ms, TE 2.32ms, TI 900ms, flip 9°.2.5-3mm isotropic. TR ≤ 2000ms, TE 30ms, flip angle 77-90°. Eyes-open with fixation cross. Whole-brain coverage with adequate prefrontal signal.30 minutes retained after motion censoring. We recommend acquiring three 8-10-minute runs to allow for scrubbing. Longer acquisitions (24-32 minutes total) materially improve target reliability and are required for research applications using precision functional mapping.0.3mm for accepted runs. We re-scan reject if more than 30% of frames require censoring.Everything your team needs to start treating.
Neuronavigation file
Neuronavigation-ready target file with coordinates, trajectory orientation, and patient registration landmarks (nasion, LPA, RPA).
MNI and native coordinates
Target reported in MNI152 space and patient-native T1w space, with Euclidean distance to standard scalp landmarks (5cm rule, F3, Beam-F3) for clinical orientation.
Connectivity overlay
NIfTI volume of the seed-to-DLPFC connectivity map, z-scored and thresholded, that can be loaded as an overlay in your neuronavigation system for visual inspection.
Clinical brief (one page)
Structured PDF documenting target coordinates, motion metrics, connectivity strength, registration quality, seed strategy, and any clinical notes. Suitable for EMR upload.
Patient T1w MRI
Defaced, BIDS-organized structural MRI in NIfTI format for direct import into your neuronavigation system's patient registration step.
Provenance log
Full pipeline version log.
Why personalization changes outcomes.
The clinical case for fMRI-guided targeting rests on a decade of accumulated evidence from Stanford, Harvard, BIDMC, the Human Connectome Project, and UK Biobank. Three findings matter most.
Open-label remission rate, SAINT
The original Stanford SAINT open-label trial reported a 90.5% remission rate in 21 patients with treatment-resistant depression after a five-day accelerated iTBS protocol delivered to fMRI-defined targets.
Active vs sham, double-blind RCT
The pivotal Stanford Neuromodulation Therapy (SNT) sham-controlled trial showed mean MADRS reduction of 52.5% with active stimulation compared to 11.1% with sham at four weeks post-treatment. SNT received FDA clearance in 2022.
Network-based targeting reliability
Core network model targeting improves intra-individual repeatability of DLPFC targets fivefold compared to raw sgACC seed connectivity, addressing the test-retest reliability problem that has limited single-seed approaches.
Symptom-specific circuits, validated targets.
Different symptoms map onto different circuits. We support targeting for the full range of validated TMS indications and emerging investigational protocols. Each target uses a different seed and a different DLPFC search space.
Treatment-Resistant Depression
Left DLPFC most anti-correlated with sgACC. The validated SAINT/SNT target.
Anxiety in Depression
Anxiosomatic circuit target, shifted dorsolateral relative to the dysphoric target.
OCD
Right orbitofrontal or medial prefrontal targeting based on OCD-specific circuit mapping.
Post-TBI Depression
Personalized DAN/DMN mapping for patients where lesion or injury distorts standard targets.
PTSD (Investigational)
Amygdala-hippocampal circuit seed; supports research protocols and IRB-approved pilots.
Addiction (Investigational)
Reward circuit targeting via ventral striatum or VMPFC seed for substance use research.
Post-Stroke Depression
Lesion-aware preprocessing with stroke-specific masking to preserve targeting fidelity.
Custom Research Targets
Investigator-defined seeds, atlases, and effective connectivity methods on request.
Implementation details.
Ready to upgrade your TMS targeting?
Schedule a 30-minute call with our neuroimaging team to walk through your acquisition setup, sample volume, and integration with your TMS workflow.
Schedule a DemoSelected References
- Fox MD, Buckner RL, White MP, Greicius MD, Pascual-Leone A. Efficacy of transcranial magnetic stimulation targets for depression is related to intrinsic functional connectivity with the subgenual cingulate. Biol Psychiatry. 2012;72(7):595-603. PMID: 22658708. doi:10.1016/j.biopsych.2012.04.028
- Cole EJ, Stimpson KH, Bentzley BS, et al. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry. 2020;177(8):716-726. PMID: 32252538. doi:10.1176/appi.ajp.2019.19070720
- Cole EJ, Phillips AL, Bentzley BS, et al. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. Am J Psychiatry. 2022;179(2):132-141. PMID: 34711062. doi:10.1176/appi.ajp.2021.20101429
- Siddiqi SH, Taylor SF, Cooke D, Pascual-Leone A, George MS, Fox MD. Distinct Symptom-Specific Treatment Targets for Circuit-Based Neuromodulation. Am J Psychiatry. 2020;177(5):435-446. PMID: 32160765. doi:10.1176/appi.ajp.2019.19090915
- Siddiqi SH, Fox MD. Targeting Symptom-Specific Networks With Transcranial Magnetic Stimulation. Biol Psychiatry. 2024;95(6):502-509. PMID: 37979642. doi:10.1016/j.biopsych.2023.11.011
- Lynch CJ, Elbau IG, Ng T, et al. Precision mapping and transcranial magnetic stimulation of individual-specific functional brain networks in humans. STAR Protoc. 2022. PMID: 36113473.
- Esteban O, Markiewicz CJ, Blair RW, et al. fMRIPrep: a robust preprocessing pipeline for functional MRI. Nat Methods. 2019;16(1):111-116. doi:10.1038/s41592-018-0235-4
- Cash RFH, Cocchi L, Lv J, Wu Y, Fitzgerald PB, Zalesky A. Personalized connectivity-guided DLPFC-TMS for depression: Advancing computational feasibility, precision and reproducibility. Hum Brain Mapp. 2021;42(13):4155-4172.
- Clinical TMS Society. Press Release Regarding FDA Clearance of SAINT Neuromodulation System. September 2022.
References retrieved via PubMed. Citations verified as of publication. This page is informational and does not constitute medical advice. Cognitive FX provides imaging analysis services; treatment decisions are made by the patient's treating clinician.