Virtual reality headset geometry constrains dorsolateral prefrontal cortex targeting with transcranial magnetic stimulation

<jats:p>Background: The integration of virtual reality (VR) and non-invasive brain stimulation (NIBS), particularly transcranial magnetic stimulation (TMS), represents a promising approach for closed-loop neuromodulation. Yet the concurrent application remains limited, partly due to insufficient characterization of hardware compatibility of head-mounted displays with standard TMS coil placement protocols. Objective: To systematically quantify the coil-to-scalp distance constraints imposed by VR headsets across cortical targets and coil orientations and to determine feasible intensity compensation ranges based on stimulator output parameters. Methods: Neuronavigated coil positioning was performed on five anatomically realistic 3D-printed head models across 26 scalp positions in eight coil orientations based on the 10-10 EEG system and dorsolateral prefrontal cortex (DLPFC) using two VR headsets of notably different form factors (Meta Quest 2 and Bigscreen Beyond). The deviations of coil positions from intended targets were registered and quantified as coil-to-scalp distance displacement. Individual electric field (E-field) simulations were conducted in SimNIBS at the F3 position across 4-40 mm coil-to-scalp distance to characterize field decay and assess the limits of intensity compensation. Results: Both in the directed DLPFC targeting and in systematic scalp positions evaluation, the Meta Quest 2 headset substantially increased coil-to-scalp distance over prefrontal regions, exceeding the compensable range across all metrics. The Bigscreen Beyond headset produced significantly smaller coil-to-scalp distance displacement in prefrontal regions, remaining within feasible E-field intensity compensation limits. Single-pulse and iTBS protocols did not induce functional interference with the hardware under realistic targeting conditions. Conclusion: VR headset geometry is the primary determinant of concurrent VR-TMS feasibility. The findings define practical quantitative hardware design requirements and boundaries for future integrated VR-TMS systems and provide a practical framework for optimizing existing VR-TMS protocols.</jats:p>