w w w. a s e t . o r g
ASETnews
JUNE 2007
Volume 31, Number 2
w w w. a s e t . o r g
Representing the electroneurodiagnostic profession
New Publications
Available from ASET!
A
SET is pleased to offer
Intraoperative Neurophysiological Monitoring, 2nd Edition,
by Aage Moller, PhD. The book begins
with a discussion of the generation of
electrical activity by the nervous system
and the practical aspects of recording
evoked potentials from the nervous
system. The anatomy and physiology of
the sensory and motor systems and all
types of evoked potential monitoring, as
well as cranial nerve monitoring and
transcranial electrical motor evoked
potentials (TCeMEP) are described. Also
covered are peripheral nervous system
anatomy and physiology and the use of
techniques to map peripheral motor and
sensory nerves. There is a chapter
addressing anesthesia and it constraints
in monitoring motor and sensory
systems. General considerations of
working in the operating room (OR),
including electrical safety, electrical
noise, and troubleshooting are also
Continued on page 5 E
IN THIS ISSUE:
1
Item One
1
Item Two
1
Item Thress
1
Item Four
1
Item Five
A Closer Look at Degrees for END Professionals
By Sheila R. Navis, CAE, ASET Executive Director
A
SET participates in meetings held by the Health Professions Network [HPN], a
coalition of allied health organizations, governmental entities, credentialing
agencies and educators. The value of this organization for ASET is tremendous
in that we’re able to share information, discuss common problems and create a dialogue
for possible solutions or options for the health professions we represent. It’s also
“comforting” to know that we face many of the same issues that others face.
I recently had the opportunity to attend an HPN meeting held in Minneapolis that
featured some tremendous speakers. One panel discussion, in particular, was thoughtprovoking with tremendous implications for END technologists and for the profession.
The presentation title was, “Degree Creep – What is the Impact?” …I know what you’re
thinking – what in the world is degree creep!!? Basically, degree creep is increasing the
degree or credential requirements for entry into a field or profession.
The panel consisted of Charles Cooper, MBA, Director of Pharmacy from the
Hennepin County Medical Center in Minneapolis; David Gibson, PhD, Dean of the
School of Health Related Professions at the New Jersey University of Medicine and
Dentistry; and Barbara Jones, PhD, Dean of the Division of Arts and Sciences Louisiana
Continued on page 4 E
Creating a New Dynamic For Our Future
…2007 ASET Election Results
V
isionary and forward-thinking leaders are critical to any organization – and ASET is
no exception. The officers and board members lead the Society and help articulate
what services and activities are important to the membership and how we allocate
resources to meet those efforts. The ASET membership voted earlier this year with the
election results recently tabulated by the nominating committee chair, Anita Schneider, and
verified by Sherry Nehamkin.
As outlined in the ASET bylaws, Elizabeth Mullikin, MPA, MA, MNM, R. EEG/EP T.,
CNIM, who has served as president-elect automatically assumes the position of president.
She’ll take office at the July board meeting in Orlando. Elizabeth is executive director of the
Huntington Hospital Neurosciences Service Line in Pasadena, CA. [photo]
Leisha Osburn, MS, R. EEG/EP T., CNIM, from Indianapolis was elected as presidentelect. She will serve a two year term in this position. Leisha is a supervisor in the
Neurophysiology Lab at Methodist Hospital, Clarian Health Partners. [photo]
Kathy Johnson, R. EEG/EP T., RPSGT, will serve as secretary/treasurer. Kathy hails from
St. Mary’s Medical Center in Huntington, WV and is the Neurophysiology Department
Manager. Kathy served on the
ASET Board from 2002 until
2005. [photo]
All officers, including Sheila
Navis, Executive Director, serve
on the Executive Committee for
ASET.
Elizabeth Mullikin
Leisha Osburn
Kathy Johnson
Continued on page 31 E
Contents
BOARD OF TRUSTEES . . . . . . . . . . . . . . . . . . . . . 3
EXECUTIVE DIRECTOR MEMO . . . . . . . . . . . . . . 6
MEMBERSHIP NEWS AND SERVICES. . . . . . . . . . . 7
BURN INCIDENT REPORT . . . . . . . . . . . . . . . . . . 9
ASET FOUNDATION . . . . . . . . . . . . . . . . . . . . 11
TECH TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
EDUCATIONAL AND PROFESSIONAL
DEVELOPMENT . . . . . . . . . . . . . . . . . . . . . . . . . 13
EEG SEPTEMBER SEMINAR
REGISTRATION FORM . . . . . . . . . . . . . . . . . . . . 15
EEG NOVEMBER SEMINAR
REGISTRATION FORM . . . . . . . . . . . . . . . . . . . . 16
ASET PUBLICATON ORDER FORM . . . . . . . . . 17
2007 ANNUAL CONFERENCE . . . . . . . . . . . . . . 19
2007 ANNUAL CONFERENCE
REGISTRATION FORM . . . . . . . . . . . . . . . . . . . . 23
INTEREST SECTION BRIEFINGS . . . . . . . . . . . . . 24
THE NATIONAL SCENE . . . . . . . . . . . . . . . . . . . 30
ASETnews
Volume 31, Number 2 • JUNE 2007
ASET S TAFF
EXECUTIVE DIRECTOR
Sheila R. Navis, CAE
ASET Executive Office
6501 East Commerce Ave., Suite 120
Kansas City, MO 64120
816.931.1120 [1]; 816.931.1145 fax
[email protected]
MEMBERSHIP SERVICES ADMINISTRATOR
Sarah Ecker
ASET Executive Office
6501 East Commerce Ave, Suite 120
Kansas City, MO 64120
816.931.1120 [2]; 816.931.1145 fax
[email protected]
DIRECTOR OF EDUCATION
Faye McNall, MEd, R. EEG T.
319 Alewife Brook Pkwy
Somerville, MA 02144
617.764.5087; 617.628.7087 fax
[email protected]
MARKETING AND COMMUNICATIONS
COORDINATOR
Paul Aubrey
ASET Executive Office
6501 East Commerce Ave, Suite 120
Kansas City, MO 64120
816.931.1120 [3]; 816.931.1145 fax
[email protected]
MANAGING EDITOR
Lucy Sullivan, R. EEG T.
3350 S 198th St
Goodson, MO 65663
417.253.5838; 417.253.3069 fax
[email protected]
EDUCATION PROJECT COORDINATOR
Maggie Marsh-Nation,
R. EEG/EP T., CNIM
2013 Lime Creek Rd.
Kerrville, TX 78028
830.895.7460; 830.895.7461 fax
[email protected]
CREDENTIALING ORGANIZATIONS . . . . . . . . . . 31
READY REFERENCES . . . . . . . . . . . . . . . . . . . . . 32
WORKSHOPS, COURSES AND SEMINARS . . . . . . 33
CALENDAR OF EVENTS . . . . . . . . . . . . . . . . . . . 34
ASET Staff From left to right.
Back row, Maggie Marsh-Nation,
Paul Aubrey. Middle row, Sheila
Navis, Lucy Sullivan. Front row,
Faye McNall, Sarah Ecker.
O UR M ISSION
The ASET Newsletter [ISSN0886-5620] is published quarterly
by the American Society of Electroneurodiagnostic Technologists,
Inc., 6501 East Commerce Avenue, Suite 120, Kansas City, MO
64120, 816.931.1120.
Periodical postage paid at Kansas City, Mo.
The portion of the yearly dues required for subscription is $19.00.
Subscription by membership only.
Postmaster: Send address changes to ASET Newsletter,
6501 East Commerce Avenue, Suite 120,
Kansas City, MO 64120, USA
2
ASETnews
The American Society of Electroneurodiagnostic Technologists,
Inc. [ASET] provides leadership, advocacy and resources that
promote professional excellence and quality patient care in
electroneurodiagnostics. As a membership organization, ASET
advances the field of electroneurodiagnostics by serving member
needs, defining and endorsing standards of practice, providing
innovative educational opportunities, promoting the profession
and building coalitions in allied health and other
communities of interest.
Volume 31, Number 2
BOARD OF TRUSTEES
“HOLD FAST TO WHAT YOU
KNOW IS GOOD….”
– Rev. Lacy Rankin Harwell, benediction
A
SET has been in transition, sometimes painfully so, for
the 4 years I have served as President Elect and
President. Have you noticed? Do you support the
changes that have been made? Do you see more value in your membership in ASET?
Is what matters to you in this profession being addressed and supported? Did you vote
for candidates you really wanted to represent you? Did you even vote? Did you consider
how you could contribute to the betterment of the society, and thereby, the profession
and your own work situation? Did you ever ask the question “What does that board of
ours do, anyway?”
The board has clearly defined legal responsibilities. They are the duties of care,
loyalty, and obedience. Violations can lead to personal liability and liability of the
association and its members. So what does that mean?
The duty of care means that we must be honest, act in good faith and avoid conflicts
of interest and improper self-dealing that leads to personal gain. We must also protect
confidential society information indefinitely, not just during our terms of office. It
means we must make financially sound decisions that both protect ASET’s assets and
further the mission of the organization.
The duty of loyalty requires that we pursue the best interests of ASET rather than our
own personal or financial interests or those of some other individual or entity. We must
avoid acts that are fraudulent or that misrepresent who we are and what ASET is. We
must provide undivided allegiance to the mission of ASET. It would be a conflict of
interest if board members expropriated ASET’s opportunities for their own enrichment
or that of any other entity.
The duty of obedience requires that we consistently act within ASET’s Mission,
Vision, Values, Strategic Plan, Articles of Incorporation, bylaws, and all policies and
procedures. These are the rules for the board just as they are for you if you work in a
hospital setting.
When I install Elizabeth Mullikin as the new President in July, I will continue on the
board for one more year as Past President. It will be interesting, indeed, to see what
comes next! There will be just as many challenges for the board to consider. The Board
is learning to function at a higher level than ever to meet those challenges, and will
continue to get better at following process under Elizabeth’s leadership. They would
welcome input from any member who wishes to contribute comments, suggestions, or
ideas for ASET’s future.
I give great thanks to you, the membership, for having given me the opportunity to
serve you. As many of you know, I took office just 2 weeks after my beloved husband
died. He wanted me to go on or I would not have been able to do it. During the last year
I had to have a total hip replacement then lost my oldest brother in an automobile crash.
While I, personally, have had a very tough 2 years, our wonderful Administrative staff
lead by Sheila Navis, has been most helpful and supportive. I think that they never get
the praise they deserve for all that they do, day in and day out, to make ASET a better
organization and to serve the members! Elizabeth Mullikin and Scott Thurston have
been just incredible to work with, as well. I wish everyone in this organization knew how
very much Scott has done to keep the finances and the business of ASET stay on track!
His attention to detail and his thoughtful insights into issues have been most helpful to
me personally and to the society. I hope that some day he will be President of ASET!
“
ASET OFFICERS
PRESIDENT
Gail P. Hayden,
MBA, R. EEG/EP T., RPSGT, CNIM
Clarksville, GA
404.245.6025
[email protected]
PRESIDENT ELECT
L. Elizabeth Mullikin,
MPA, MA, MNM, R. EEG/EP T., CNIM
Pasadena, CA
626.710.0250
[email protected]
SECRETARY/TREASURER
Scott Thurston, R. EEG/EP T., CNIM
St. Paul, MN
651.241.8627
[email protected]
TRUSTEES
Lary R. Breeding, R. EEG/EP T., CNIM
Houston, TX
Janet K. James, R. EEG T., R. NCS T.
Ft. Walton Beach, FL
Sharyn Katz, R. EEG T.
Valhalla, NY
Diane Liesen, R. EEG T.
Springfield, IL
Brian Markley, R. EEG/EP T.,
R. NCS T.
Silver Spring, MD
Elizabeth Meng, R. EEG/EP T.
Surprise, AZ
Michelle L. Nagel, R. EEG/EP T., CNIM
Greenfield, IN
Sandra Nylund, R. EEG/EP T., CNIM
Great Falls, MT
Leisha L. Osburn, R. EEG/EP T., CNIM
Indianapolis, IN 46206
Sheila Shelton, R. EEG/EP T., R. NCS T.
Comer, GA
Barb Tetzlaff, R. EEG/EP T., CNIM
Wausau, WI
Jie Zhang, R. EEG/EP T., CNIM
Cincinnati, OH
Continued on page 5 E
June 2007
ASETnews
3
COVER STORIES
continued
A Closer Look at Degrees for END Professionals
Continued from Front Page
at Delta Community College. Their
comments were so thought provoking
and have such implications for the END
profession that I thought it might be
helpful in leading to more thoughtful
discussion and dialogue for us as a
professional society. Much of the
information in this article was presented
by the panelists.
ASET POSITION ON MINIMUM
EDUCATIONAL REQUIREMENTS
ASET has taken the position that the
minimum educational requirements for
performing
electroneurodiagnostic
procedures are as follows:
“Individuals performing routine
electroneurodiagnostic procedures must
have more than one year of END education
and a minimum of one year of clinical
experience to render testing without the
direct supervision of a senior END
technologist or physician. Competent
technical recording of END tests requires
the technologist to exercise a significant
degree of independent judgment. END
recordings are customized to meet the needs
of the patient, the referring physician and
the physician who will interpret the test.
The routine END investigation and
activating procedures conducted during the
recording are based on the patient’s
medical history and current complaints,
the
anticipated
waveforms,
the
abnormalities seen during the recording
and the reason for the referral. Both END
education and clinical experience are
necessary to attain sufficient knowledge
base and clinical expertise.
Any individual entering the END
profession must have earned an
associate degree or higher and have
successfully completed a program
reviewed by the Committee on
Accreditation for Education in
technology
Electroneurodiagnostic
(CoA-END) and accredited by the
Commission on Accreditation of Allied
Health Programs. Within two years of
graduation, individuals are strongly
encouraged to take and pass a
recognized, national examination for
professional credentials in an area of
Electroneurodiagnostic
specialty.
[Adopted by ASET Board of Trustees,
July 19, 2005]”
Health professions that have increased
degree requirements include:
I Audiology [Doctorate]
I Occupational Therapy [Masters]
I Pharmacy [Doctorate]
I Physical Therapy [Masters/Doctorate]
I Physician Assistant [Baccalaureate]
I Pharmacy Technician [Associate]
I Respiratory Therapy [Associate]
I Surgical Technology [Associate]
And other health professions are
considering
increasing
degree
requirements such as dental hygiene,
dietetics, nursing, respiratory therapy
and others. Health professions with
advanced practitioner clinical degrees
include the clinical laboratory sciences,
nursing, diagnostic medical sonography,
advanced certifications in radiography
and dental hygiene.
So, where is this push coming from?
In many cases, it’s coming from the
professional societies, but also from
employers recognizing the increased
skills needed to perform certain tasks and
ensuring quality patient care. The
impetus may also be from increased
access for patients, increased recognition
of the profession, increased salaries,
greater recognition for the profession and
accreditation. And of course, there are
always reimbursement issues.
I believe that ASET’s position on a
two year degree for individuals entering
the field is appropriate and valid, but I
have also heard discussions about a four
year degree needed for certain modalities
as well. As the END profession grows in
importance, this is where we need frank
and candid discussion that is thoughtful
and supported by good data, best
practices and yes…a dose of reality. Just
as there are positive effects of having a
better educated workforce, the panelists
also pointed out the adverse effects of
requiring higher degrees for professions –
a perspective I had not considered before.
A Workforce shortages exacerbated.
For lab managers trying to hire
qualified END technologists, this is no
surprise. I know of too many hospitals
that still have on-the-job training and
hiring someone even with a two-year
degree is a stretch.
B Lack of capacity in colleges and
universities [faculty, facilities, funds
& clinical sites]. During the five years
I have been with ASET, I have seen
two schools close and two schools
open. Since many of our programs are
based in two-year community colleges
and serve the geographic area, an
analysis is often conducted to
determine whether a program
actually meets the needs of a given
community. The logic often goes that
if hospitals within a certain area have
been able to hire these graduates and
retain them, then no critical need
exists to continue programs –
particularly at times when budgets
and programs are stretched thin at the
community college level.
C Lack of credentialed faculty to
deliver instruction. While the END
profession has very competent
technologists, many were trained onthe-job and never received a four year
degree. To serve as faculty in
accredited institutions, schools
typically require at least a four year
degree, if not a master’s. So, where I
ask, are the future educators for the
END profession? This was one area
that has been identified as a growing
problem at ASET meetings and by the
education committee.
D Decrease in workforce diversity as
education is inaccessible to
minorities
and
economically
disadvantaged. Increase in tuition.
Continued on page 5 E
4
ASETnews
Volume 31, Number 2
COVER STORIES
continued
PRESIDENT’S MESSAGE:
Hold Fast to What You Know is Good
New Publications
Available from ASET
Continued from Page 3
Continued from Front Page
I will be representing ASET at the OSET Congress in Italy, June 10-15. We will be
presenting an offer to host the next congress in 4 years in conjunction with our annual
meeting that year.
Michaelangelo Buonarroti, Italian Renaissance Master, said at the age of 87, “Ancora
imparo”, or “Still, I am learning”. I hope to say the same at that age. I am now going to
be able to get back to more of my love of learning through lecture series from The
Teaching Company, hiking in the mountains, being a volunteer firefighter, and enjoying
more peace and quiet in my life on a trout stream. I may even take up fly-fishing!
As benediction to my term of office, I offer this advice to the officers, board
members, staff and members of ASET: Hold fast to what you know is good, change
what needs to be changed without losing that goodness, help each other be better by
listening to each other and adhering to professional behaviors, pay attention to your
duties, serve with integrity and joy in our profession! P
addressed. This book is priced at $130.
The Clinical Site Handbook: A
Compilation of Documents helps you to
visualize and become a clinical site in
EEG, EP, NCS, PSG, and/or IONM. This
handbook can also be used by END Lab
Managers to document the assessment of
competencies during skill development
for staff technologists. This book was
designed by a group of technologists who
have experience as END Technology
Program Directors and clinical
instructors. It contains actual documents
used by existing END programs as well as
sample forms compiled from several
different programs. The Handbook is
also available in electronic format so the
documents can be edited to meet your
needs. This is priced at $65 for the book,
and $99 for the CD.
The Pediatric EEG reprint book has
been updated and revised to include the
2006 ACNS Guidelines, the excellent
“Juvenile Myoclonic Epilepsy” article by
Janet Ghigo, R. EEG/EP T., and Ernst
Niedermeyer, MD, and the thoughtprovoking “First Seizures in a Child”
article by Gerald M Fenichel, MD just to
name a few. Pediatric EEG includes
sections on Recording Techniques,
Normal Patterns, Clinical Correlations:
Epilepsy, and Clinical Correlations: Other
Disorders. This book is essential for
anyone performing EEGs on children in
any setting, i.e., a physician’s office, as
part of a hospital’s EEG services, or a
world-renowned Children’s Hospital.
This book is priced at $22.
A Closer Look at Degrees for END Professionals
Continued from Front Page
Increase time in college. As it takes longer to get a higher degree, the cost increases
too. The panelists noted that minorities are often reluctant to take out student loans
and go into debt for their education. At a time when healthcare is attempting to
bridge the gap between the patient population and creating a diverse workforce, this
issue becomes more problematic.
E Access to health care becomes limited in rural areas. It’s easy to work in a
university setting or large metropolitan area and to advocate for more advanced
degrees for a profession. It’s another to find qualified, educated personnel in small,
rural areas.
ASET has long supported the need for technologists – regardless of their educational
background – to obtain their professional credentials. This has served as the backbone
of the profession for many years. It is also true that insurance companies pay for service
provided, not the educational level of the provider. Hospitals pay for the skills and
credentials, and not necessarily for a degree.
As we continue discussions throughout ASET, we need to be mindful that even with
the best intentions, we may have unintended consequences that could prove negative.
The panelists recommended that we:
A Review data and evidence to support increased educational levels.
B Assess educational preparation and performance abilities and requirements.
C Assess job demands and requirements as prescribed by healthcare facilities.
D Determine demographic characteristics of health professions at various degree
levels.
E Consider career pathways and expanded functions gained through educational and
practical experience for transitional degrees.
Dr. Gibson ended his presentation with a statement – “We have met the enemy and
it is us!” As we discuss, debate and deliberate, let’s just make sure we’re not the enemy of
the END profession. P
June 2007
To order any of these
books, please use the
Publication Order form
located on page 16, or
visit www.aset.org.
ASETnews
5
EXECUTIVE DIRECTOR’S MEMO
Education Never Ends
By Sheila R. Navis, CAE
E
very day, it seems, I vow to make pivotal changes in my
workflow and processes at ASET. I commit to making
time for important long-term projects and other things
that keep getting pushed aside due to other priorities and
deadlines. Inevitably, however, email follow-ups, conference calls,
meetings and the typical flood of office minutia that has to be
handled “right now” derails my loftier plans. Sound familiar?
In
today’s
challenging
work
environments, many of us find it hard to
fully handle the myriad of responsibilities.
And working longer each day to get more
done is a far-from-appealing option. Let’s
face it – burned out employees rarely do
their best work.
So when faced with meetings out of the
office, I really have to think long and hard
about my priorities. How can I really take
the time necessary for continuing
education and professional development?
Guess what? I’m finding it’s one of the
best choices I can make for myself. There’s
something incredibly refreshing to step
back from the day-to-day business and get
re-charged and re-energized. I get excited
about learning and get curious about the
topic and learning even more. Connecting
with my peers in conversations – and even
playing with them - is like mind altering. I
gain new and different perspectives on my
career and how I can apply it to my day-today responsibilities. I swear I come back to
the office and get more done than I did
before.
I know that there are many ASET
members who have attended past annual
conferences that could write a few
thousand words about the many
extraordinary things they have learned and
experienced at this meeting. I believe we
have all learned the lesson that education
never ends. It’s not just okay to get out of
the lab and further your professional
development – in fact it’s vital to being the
best END professional you can be!
Ask yourself – Am I taking advantage of
the many professional development
opportunities available to me? It’s easy to
make excuses for not taking the time –
trust me, I’ve made them too – but
consider how you may be shortchanging
your career growth by failing to pursue
educational options provided by ASET.
And it’s not all about time either.
A long-time member of ASET has long
advocated that technologists need to own
their career and be responsible for their
own professional development. If this
means personally paying for a meeting
registration, hotel room or airfare to
attend, then so be it. If you’re in a situation
where your employer doesn’t cover
meetings for your continuing education,
have you ever thought about applying for
an ASET scholarship? Over the past four
years, there have been numerous times
when scholarships go unused. What I’m
saying is that we all have options to
participate in this quest for life long
learning.
It’s not too late to make arrangements
to attend the ASET Annual Conference in
Orlando. It’s never too late to check out
your regional END society schedule for
upcoming meetings. And it’s never too
late to register for an ASET Conference
Call Seminar or online course. The
educational content we offer continues to
be the very best there is for END
technologists. And as William Butler
Yeats is credited with saying, “Education
is not the filling of a pail, but the lighting
of a fire.” Light your fire! P
END Technology:
It’s More Than Magic
The ASET 2007 Annual Conference
July 18-21
Disney Coronado Springs Resort, Florida
See page 24 for more information about the
conference and registration information or
visit www.aset.org
6
ASETnews
Volume 31, Number 2
M EMBERSHIP N EWS & S ERVICES
ASET Member Wins
Award
ASET would like to congratulate
Cathy Boldery, R. EEG/EP T., RPSGT,
CNIM, and Joey Miller, and the
team at Neurodiagnostic TEX.
N
eurodiagnostic TEX, a Tyler based
medical testing service was presented
with an award at The Greater Dallas
Business Ethics Award Luncheon on May 1,
2007. Candidates are evaluated by an
independent panel of judges composed of
individuals with an expertise in business ethics
Joey Miller and Cathy Boldery
and are drawn from the business, academic,
public service, media and consulting communities. Companies entering the award
competition are judged in categories based on the number of employees. Prospective
nominees are companies that have demonstrated a commitment to high ethical
standards and corporate responsibility by the way in which they deal with their
customers, their employees, their suppliers and the public at large. Award recipients are
honored in a celebratory event at which time the crystal award is presented to the
recipient company president or CEO.
The Society of Financial Service Professionals established the American Business
Ethics Award to honor companies that demonstrate a firm commitment to ethical
business practices in everyday operations, management philosophies, and responses to
crises or challenges.
Neurodiagnostic TEX has been providing service to local hospitals and in the
Dallas/Fort Worth area since 2000. P
New Improved Website & Database Coming Soon!
I
t’s an exciting time as we upgrade some important features. We’re making
improvements to be more valuable and helpful to you with a new and improved
Website linked in real-time with our membership database. We’re upgrading and
revising all of the content with real search capabilities, including enhancing
employment opportunities and posting resumes, expanding Interest Section Forums,
streamlining the shopping cart and creating a more interactive membership directory
that will allow you to
modify your own record.
In addition, you’ll still
be able to download
your own ACE roster,
print out receipts online
and much more.
Watch for additional
announcements online
at www.aset.org P
June 2007
Finance Your
Education with an
ASET Scholarship
D
id you know that ASET has
scholarships for its educational
seminars
and
annual
conference? Don’t miss out on a great
opportunity! To apply for an ASET
scholarship, you must be an ASET
member for the current year. You can
apply by visiting www.aset.org/site/site_
files/Grant_Application_for_ASET_course
s_rev_11.30.04.doc.
Upcoming deadlines are:
July 6, 2007 . . . . . . . . . . . September Seminars
September 14, 2007 . . . November/December
Seminars
Please apply, and come join us for some
of the best educational opportunities for
END technologists. P
Ongoing Effort to
Collect Data on Burns
in the Operating Room
I
In March of 2006, ASET embarked on
an effort to collect data on burns in
the operating room. This effort was
spearheaded by Brett Netherton, MS,
CNIM and xxxx – others? . As part of this
initiative, a series of articles have been
and will appear in the American Journal of
Electroneurodiagnostic Technology dealing
with this topic. Because this has serious
implications for patient safety and care,
it’s important that we continue to
compile the data through burn incident
reports. ASET plans to publish the results
of these surveys so that our members can
be better informed about important
issues affecting our profession. If
significant safety issues prove to exist,
ASET will take a proactive role in making
our profession better.
We want to reemphasize that these
surveys will be confidential and only
the overall results will be released.
Refer to pages 9-10 for the Burn
Incident Report Form. P
ASETnews
7
H EADER
continued
Congratulations to Our New Members [as of 05.03.07]
Institutional Members
Janet Enriquez
Kathryn Ann Mananghaya
Luke Sorrick
Providence St Vincents Sleep
Disorder Center & EEG
Manuela Fat, RPSGT
Teresa Martin
Stephanie Thoe
Cheri Featheringill
Ken Maurer
Zachary Thompson
AO Fox Memorial Hospital
Akia Fields
Quinn May
Lisa Valdez
Robert Fisher
Cyndy McConnell
Kristen Valona
Roderick Foster
David McDonald, RN
Betzaida Vazquez
Linda Gagnon, R. EEG T.
Tom McGee
Mike Veloz
Steve Anderson, MD
Michele Galganski-Cleanthous,
MS
Xavier Melgoza
Mishelle Vislisel
Andreea Ardelean, MD, MS
Tammy Moore
Michelle Vlahogiannis
Susan Garey
Ernesto Arevalo
Olga H Morales
Shelly Walsh, R. EEG T.
Kimberly Gary, LVN
Eric Ayisi, R. EEG T.
Masanori Nagata
David Ward
Suzi Giles
Richie Cae Babaran
Heather Nehus
Joan White
Justin Gillis
Tammy Barclift
DeAnne Nelson, R. EEG T.
Sandra Whitehead
Martin Gizzi
John Basta, R. EP T.,CNIM
Joshua Netcott
Lorinda Wilkes
Peggy Gordon
Ray Beach
Misty Nispel
Amy Wingerson
Douglas Greco, MS, DC
Tolanda Beal, R. EEG T.
Kristy Nordstrom
Sheila Wurth, R. EEG T.
Pamella Hall, R. EEG T.
Julie Bieber, R. EEG T.
Richard O'Brien, MD, MBA
Kim Wys
Carol Hampton
Suzanne Bolger, R. EEG T.
Deborah Overton
Yvette Yanez
Tanya Hass, CNIM, MSE
Melanie Boyadjis
Renata Paciora, R. EEG T.
Cami Youngren
Jason Henry
Kenard Boyd
Andrew Patton
Kewei Yu, CNIM, MD, PhD
Fernando Hernandez
Mary Brown
Kenneth Perkins
Huijun Zhong
Sandra Herrera, R. EEG T., CNIM
Tri Bui
Rita Perry
Nikole Hicks
Srinivas Bulusu
James Persyn
Dana Hilgenberg
Lindsay Burks
Julie Peterson
Stephen Holmberg
Darline Burque
Elizabeth Pittman, R. EEG T.
Dawn Hosman
JaTawn Bush
Katie Powers
Matthew House
Christina Bush
Suganthini Premarajah
Rebecca Hubbs
Devin Calef
Debbie Prentiss
Robin Hutchin
Janet Campbell
Barbara Pudlo, R. EEG/EP T.
Faisal Jahangiri
Janet Campbell, R. EEG T.
Kimberly Quinones
Mark Jasper
Kimberly Catterall, R. EEG T.
Trisha Raether
Kimberly Jordan
Janet Childers
Kim Ramos
Stacy Kaber, DC, DACNB
Joyce Collins, R. EEG T., RPSGT
Maria Regis, CMA
John Contreras
Parichehr Kamali, R. NCS T., R.
EEG/EP T.
Sue Reynolds
Thelmond Cooper
Tamer Katamesh, MD
Christine Robinson, RPSGT,
RRT
Kelly Corrales
Jason Keller
Danette Rod
Timothy Cunningham
Karla Kidd
Cynthia Roraback
Alan Dabney
Erin Krewson
Sarbelio Ruiz-Portillo
Irene Dilworth, R. NCS T., LVN
Lynn Kuehn
Andrea Ruyle
Shannon Donaldson
Mui Lac
Denise Rys
Robert Dorsett
Maria Lansink
Jill Sadlier
Jamie Downton
Amanda Ledford
Ginger San Nicolas
Adrienne Duplechian
Lori Lehman
Tommy Sells
Abdul Durrani, R. EEG T., LLB
Krystal Liggett
David Sharp
Tracey Egeland
Michael Little, R. EEG T.
Nexhiana Shkullaku
Kayla Eibner
Glenn Livezey, CNIM, PhD
Daniel Elsasser
Sandra MacBrair
Seyed Vahid Soltani
Arabshahi
Individual Members
Loay Abukwedar
Linda Adams, CCT
8
ASETnews
2007 MEMBERSHIP
NUMBERS
(as of 05.03.07)
3,000
Currently at
2,403 Members
for 2007
2,500
2,000
1,500
1,000
500
2007
Membership
Numbers
Active . . . . . . . . . 2,143
Associate . . . . . . . . . 50
Honorary . . . . . . . . . . 7
Institutional . . . . . . 101
Lifetime . . . . . . . . . . 21
Student . . . . . . . . . . 81
Total
2,403
Volume 31, Number 2
AMERICAN SOCIETY OF ELECTRONEURODIAGNOSTIC TECHNOLOGISTS, INC.
ELECTRODE BURNS IN THE OR DURING INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING
REPORT FORM
The American Society of Electroneurodiagnostic Technologists, Inc.[ASET] is undertaking this important survey of its members
and others involved in intraoperative neurophysiologic monitoring to ascertain whether there is a significant problem with electrode burns/lesions in the IONM setting. Then, if necessary, we will attempt to define the problems or parameters that contribute to
burns so that they can be eliminated. This effort is part of the mission of ASET to “…promote professional excellence and quality
patient care in electroneurodiagnostics,” with findings published in a future issue of the American Journal of END Technology.
Please note that your participation will be held in confidence. No patient identifying data will be asked for or used. Your assistance in submitting this important information is greatly appreciated.
DIRECTIONS
The report form in two parts:
Part I General Information
Part II More Detailed Information.
[We realize that the burn you are reporting may not be a recent incident with details readily available, but please complete the form as much as possible.]
INCIDENT INFORMATION
PART I: GENERAL INFORMATION
Have you seen other burns before this incident? l Yes
If so, how many incidents have you seen? ____
l No
Were the burns you have seen before similar to the one you are
reporting? l Yes l No
If not, please report them separately using another copy of this form.
Patient Information Age ____
Height ____Weight ____
Sex
l Male l Female
Type of procedure being monitored _______________________________
_________________________________________________________
Statement of Incident _________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Location of lesion l Stimulation Site l Recording Site l Ground Site
l Other: _________________________________________________
_________________________________________________________
Describe the size. ___________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
What was the estimated depth? _________________________________
_________________________________________________________
How close was the burn/lesion site to the ESU/Bovie patient return path pad?
_________________________________________________________
Was the skin at the burn/lesion intact? l Yes l No
Was the burn site l Anode l Cathode l Other: ________________
Did the patient report pain? l Yes l No
How was the burn treated? _____________________________________
_________________________________________________________
_________________________________________________________
What was the outcome of that treatment? __________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Duration of Surgery __________________________________________
Was constant current or constant voltage stimulus setting used? __________
Maximal stimulus current/voltage used ____________________________
PART II: DETAILED INFORMATION
Did the patient have existing or history of skin problems?
l Yes l No
Other details on stimulus current/voltage (for example, were different levels
used throughout the case?) ____________________________________
_________________________________________________________
If so, please detail. __________________________________________
_________________________________________________________
Stimulus duration used ________________________________________
Please describe burn/lesion in as much detail as possible.
Other details on stimulus duration used ____________________________
_________________________________________________________
Describe the color. ___________________________________________
_________________________________________________________
_________________________________________________________
Describe the dimension/shape. __________________________________
_________________________________________________________
_________________________________________________________
Fraction of time during the case that the electrode was stimulated [Example,
100% if all the time, 10% if only 10% of the time] ____________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Continued on page 10
June 2007
ASETnews
9
AMERICAN SOCIETY OF ELECTRONEURODIAGNOSTIC TECHNOLOGISTS, INC.
ELECTRODE BURNS IN THE OR DURING INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING REPORT FORM
(continued)
NEUROPHYSIOLOGY EQUIPMENT
Which type of equipment was involved in the incident?
l EEG l EP l EMG/NCV l Other ________________________
Date of manufacture of the equipment involved ______________________
_________________________________________________________
_________________________________________________________
Was the equipment manufactured commercially or designed and built by your
facility? l Commercially built l Designed and built by facility
When was the list time the equipment was checked by Biomed prior to the
incident? __________________________________________________
The following information is information that Biomed often documents when
they check equipment. If available, please document below.
Value of last recorded ground resistance____________________________
Value of last reported leakage current _____________________________
Electrode types involved l EEG needle electrodes l EEG disc Electrodes
l Corkscrew Electrodes l Specialty electrodes l Hydrogel (wetgel)
l Hydrogel (solidgel)
Was any electrode paste/gel used? l Yes
l No
Age of the paste/gel at time of incident ____________________________
_________________________________________________________
Were the electrodes l Single use l Reusable
l Disposable self-stick electrodes
Please give a description of how many recording electrodes were attached to
the patient. ________________________________________________
_________________________________________________________
_________________________________________________________
How long was the electrode leadwire on the electrode where the burn
occurred?__________________________________________________
_________________________________________________________
Was the leadwire connector disconnected from the neurophysiology
equipment for any time period during the surgery? If so, please give details.
_________________________________________________________
_________________________________________________________
_________________________________________________________
Was the battery operated equipment connected to the patient using electrodes? l Yes l No
If yes, please explain what type of electrodes and how long they were on during the surgery _____________________________________________
_________________________________________________________
_________________________________________________________
Did you see the application of the ESU/Bovie patient return path pad?
l Yes l No
If yes, please detail how the OR staff applied the pad. [Example, did they
shave the site? Did they use any type of skin preparation such as alcohol
wipe?] Please be as detailed as possible.___________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
What was the location of the ESU/Bovie Patient Return Path Pad?
l Lower Back l Left Buttock l Right Buttock l Left Thigh l Right
Thigh l Other: ____________________________________________
Was any burn/lesion noted under the ESU/Bovie patient return path pad?
l Yes l No
If yes, please describe. ________________________________________
_________________________________________________________
ICU / ROOM / LAB EQUIPMENT
Equipment in use during the procedure
l Ventilator l IV Pump l Electric Bed l Dialysis machine
l Arterial Pump l Cooling Blanket l Balloon Pump l Blood Warmer
l LVAD l Other(s) _________________________________________
Were any of these devices working on battery? l Yes l No
If yes, which?_______________________________________________
_________________________________________________________
Where did burn occur? l Hand l Arm l Foot
Did the burn occur at the l EMG needle stick site
l NCV “shock site” l NCV ground
l Leg
l EMG ground
Please be sure to include the type of electrode(s) used in the appropriate area
above.
OPERATING ROOM EQUIPMENT
Equipment used during the surgery
l Electrosurgical Unit (ESU/Bovie) l Electrocautery (Bipolar)
Some equipment used in the operating room operates on batteries. An example is the train of 4 twitch stimulator used by anesthesia to control the level of
muscle relaxant.
Was battery operated equipment used? l Yes l No
If so, what? ________________________________________________
_________________________________________________________
_________________________________________________________
10
ASETnews
Thank you for participating in this important research.
Mail, fax, email or complete on-line at www.aset.org.
ASET Executive Office
6501 East Commerce Avenue, Suite 120
Kansas City, MO 64120
816.931.1145 fax
Volume 31, Number 2
ASET F OUNDATION
Third Annual Silent Auction
W
e are preparing once again for the ASET Foundation’s third annual silent
auction to be held at our Annual Conference in Orlando, FL on Friday, July
20. This event is a great way to do some early Christmas shopping, find
great items at bargain prices and help to raise funds for a worthy cause. Proceeds benefit
the ASET Foundation, which helps to fund scholarships and educational programming
throughout the year. Be sure to mark your calendars for this great event.
Purchasing items is not the only way to help out. The Foundation needs people to
donate items; anything from gift certificates and baskets to DVD players or iPods. The
only limit is your imagination!
To make a donation, contact Paul Aubrey at [email protected] or 816.931.1120. P
SILENT AUCTION DONATION FORM
The third annual silent auction on Friday, July 20, 2007 at the Disney Coronado Springs
Resort in Orlando, FL, is designed to raise money to support the Foundation’s scholarship
and educational programming efforts. The ASET Foundation [Fed. ID #77-0644963] is a
501(c)(3) organization and donations are tax deductible.
Complete this form in its entirety, including the signature. Return this form to the ASET
executive office no later than June 8, 2007. If you are donating more than one item, please
copy this form and return one form per item.
As Usual….
From A Gracious
Contributor
M
Margaret “Peggy” Henry
recently sent a note to the
ASET Foundation addressed
to Sheila Navis, Executive Director, which
simply read, “As usual….” and enclosed a
wonderful
contribution.
Peggy’s
contribution is used each year for a travel
award or to pay for meeting registration
fees to the annual conference given in her
name. Along with her husband, Dr.
Charles Henry, Peggy is one of the true
pioneers in the field and has devoted her
entire career of promoting and nurturing
END technologists. Her gift has already
created a lasting legacy and we recognize
and thank her for her generosity of
spirit.P
Name _____________________________________________________________________________
Company/Institution __________________________________________________________________
Address ___________________________________________________________________________
ASET Donors
Email _____________________________________________________________________________
The ASET Foundation gratefully
acknowledges donors who have made
contributions since February 2007
Item to be donated __________________________________________________________________
American Mobile Operator Service
__________________________________________________________________________________
DRM Diagnostics
Phone ____________________________________________________________________________
The J. Cohen Family
Estimated Retail Value $________________
National Neurolabs
Description of Item:
[Please be as complete as possible, note any restrictions of use or other information that will be helpful to a
bidder. This information will be used in the auction catalogue and other listings.]
Rhythmlink International, LLC
Sensory Testing Systems
__________________________________________________________________________________
__________________________________________________________________________________
The item is [please check one]:
l
l
Ann Bergin
Included with this form.
Cathy Clark
Will be mailed/shipped to the ASET Foundation office no later than June 8, 2007.
[6501 East Commerce Avenue, Suite 120, Kansas City, MO 64120]
l
Will bring to the ASET Annual Conference in Orlando, FL. [must have on site by July 19, 2007]
I do hereby agree to donate the item stated above to the ASET Foundation’s silent auction.
Signature ______________________________________________
Date ______________________
Return this form to:
ASET FOUNDATION,
6501 East Commerce Avenue, Suite 120 • Kansas City, MO 64120
816.931.1120 phone • 816.931.1145 fax
June 2007
Melba Addison
John Allan Hardy
Young Kim
Judy Pardee
Claire Peranteau
Dean Sarco
Anita Schneider
James York
ASETnews
11
T ECH T IPS
Calculating Frequency, Duration, Amplitude, and Voltage Using a Legend
By Bill Byrum, MBA, R. EEG/EP T., CNIM
N
L
ow that paper EEG instruments
are pretty much a thing of the
past, we no longer have the chart
paper printed with 6 millimeter (mm) and
30 mm gridlines. One second (sec) of EEG
data at a standard paper speed of 30
millimeters per second (mm/sec) is also a
thing of the past.
In this article I want to review with you
how simple it is to use a Legend. You will
need a measurement ruler graduated into
one mm segments. It would also be handy
to have a calculator that can be set to divide
to 3 decimal places. If you perform division
by hand, please be sure to carry the results
to 3 decimal places when calculating
waveform duration.
I strongly recommend whenever you
are doing calculation utilizing a Legend
that you use a referential montage and the
reference is not contaminated with EEG
activity. This is because in a bipolar
montage the waveforms are the result of
two inputs active with EEG activity. The
same can be said of a referential montage if
the reference is contaminated.
Sometimes you will see a horizontal
line drawn on an EEG sample. Beneath the
line is a ‘time’ indicator. The line length
represents how much distance, measured
in millimeters (mm), is needed to show
one second of data. By the way, every
second contains 1,000 milliseconds (ms).
Sometimes you will see a vertical line
drawn on an EEG sample. Next to the
vertical line is a number in microvolts (ÌV).
The most common Legend is
something called a gnomon. The g is silent
so it is pronounced ‘no man’. It looks like
the letter L rotated 90 degrees counter
).
clockwise (
Figure 1 shows a digital EEG sample.
The gnomon is the thicker line with time
and voltage indicators. Also placed upon
the EEG waveforms are several different
markers.
Take a mm ruler and measure the
gnomon’s horizontal line. Then measure
the gnomon’s vertical line.
On my print out, the horizontal line
measures about 55 mm and represents 1
12
ASETnews
sec of time as indicated. The vertical line
measures about 26 mm and represents 50
ÌV as indicated.
In this newsletter, I am certain the
gnomon measurements are different than
the numbers mentioned. This is one of the
valuable aspects of having a Legend.
Because regardless of the size of print out,
or a digital EEG display monitor’s size, so
long as there is a Legend all of the
calculations described within this article
are still applicable. Only the numbers
change.
Figure 1. Digital EEG Sample
Look at the waveform on the left. Two
vertical time line markers are placed. One
is at the start of the wave and the other is at
the end. I measure the distance, or
duration, between them at about 7 mm.
Duration is the amount of time it takes
a wave from when it starts to when it ends.
Let’s calculate this wave’s duration. If you
divide 7 mm by 55 mm the result is 0.127
sec, or 127 ms. This is the wave’s duration.
Frequency is the amount of time the
same size wave could repeat itself within 1
sec. Remember 1 sec equals 1000 ms. So if
you divide a wave’s duration into 1000 ms
you then know the frequency. 127 ms goes
into 1000 ms 7.874 times. Frequency’s unit
of measure is hertz (Hz). So this wave’s
frequency is 7.874 Hz.
If you know a waveform’s frequency in
Hz it is very easy to determine the duration
in ms. For example, if you divide 1 sec by
7.874 Hz the resultant duration is 0.127 sec
or 127 ms.
Now let’s look at how we could
calculate Amplitude and convert it into
Voltage. Note that whenever you are
calculating amplitude of a wave you should
use a referential montage with a reference
that is not contaminated with EEG activity.
Look at the waveform on the right.
There are two markers that look like +.
One is at the start of the wave. The other is
at the peak of the wave. This is an example
of where and how not to measure
amplitude.
Instead, look closely at the vertical line
extending downward from the peak to
even with the start of the waveform. The
amplitude of this wave measures about 12
mm.
To calculate the waveform’s Voltage you
would divide the amplitude by the
gnomon’s 26 mm distance that represents
50 ÌV. So 12 mm divided by 26 mm equals
0.462. Multiply 50 ÌV by this number 0.462
and the result is 23.1 ÌV.
I hope these tips help you learn how to
use a Legend to calculate frequency,
duration, amplitude, and voltage. That
said, you probably notice the word about
appears several times in the article and is in
italic format. When trying to use a mm
ruler, especially when the measurements
line up somewhere between ruler
markings, estimations become imprecise.
Wow, that was a lot of work utilizing a
legend to obtain imprecise results.
Fortunately, there is an easier way. Every
digital EEG instrument’s software contains
an assortment of different measurement
markers and tools. These are very precise,
easy to use and more accurate than
utilizing a Legend.
Calculating frequency, duration,
amplitude, and voltage using a Legend was
covered in an ASET conference call on
March 14, 2007. To learn more about
conference calls in general, including how
to participate in one real-time or how to
obtain the finished product after the fact,
like my conference call on this very topic,
simply follow this link.
http://www.aset.org/show/Education/
Conference_Call_Seminars
If you have any questions or comments
about this article, contact me by email at
[email protected]. P
Volume 31, Number 2
EDUCATION & PROFESSIONAL DEVELOPMENT
Upcoming ASET Fall & Winter Seminars
Submitted by Faye McNall, MEd, R. EEG T.
A
SET seminars and the annual conference are really two
different learning formats to aid in your professional
development and education. The annual conference topics
typically are delivered at more advanced levels, with the seminars more
“hands-on” with workshops built into the program. While both
formats offer outstanding faculties and programs, it’s important to pick
the best option to meet your needs. And because the seminars often
cover some fundamentals, we encourage you to go online and participate in some of our
online courses first.
It’s important to review the seminar descriptions to make sure it will meet your needs.
For more information on a specific program, contact Faye McNall, MEd, R. EEG T.,
Director of Education, at [email protected].
FUNDAMENTALS OF NERVE CONDUCTION
STUDIES
September 21 – 22, 2007
Kansas City, MO
Early Bird Registration Deadline 8.29.07
This is a basic level seminar for technologists
who have some experience in NCS, but need
knowledge about all aspects of recording NCS
studies. An in-depth explanation of the
theories and principles of NCS will be offered.
Workshops are a key part of this seminar, and
there will be ample opportunity for hands-on
practice with expert instructors.
By attending this seminar you will:
• Learn more about the basics of
performing NCS studies;
• Examine the anatomy of the peripheral
nervous system;
• Understand instrumentation, patient
safety and troubleshooting concepts; and
• Gain knowledge of clinical correlations
and disorders of the peripheral nervous
system.
Who should attend?
This seminar is designed for the technologist
with some exposure to NCS and who is
seeking basic knowledge to enhance their
skills.
FUNDAMENTALS OF EEG TECHNOLOGY
September 21 – 22, 2007
Kansas City, MO
Early Bird Registration Deadline 8.29.07
This is a basic level seminar, for technologists
who have some experience in EEG, but need
June 2007
knowledge about all aspects of EEG recording.
Topics include neuroanatomy, clinical
correlations, abnormal EEG findings,
instrumentation principles, and waveform
analysis techniques. During the 10/20
workshop participants may elect to place a full
set of electrodes on a “Sam” head and get tips
on placement from expert instructors. We will
cover the basics of EEG normal and abnormal
pattern recognition. Several workshops are
scheduled to supplement lecture material in
an informal setting.
By attending this seminar you will be able
to:
• Improve measurement and application
techniques and learn helpful tips to
increase accuracy and security of lead
placement;
• Understand waveform polarity and EEG
localization techniques;
• Understand the use of filters and
differential amplifiers;
• Learn digital EEG instrumentation
concepts;
• Learn appropriate EEG terminology to
describe EEG patterns;
• Apply instrumentation principles to your
recording techniques and
troubleshooting; and
• Gain pattern recognition skills.
Who should attend?
This seminar is designed for the technologist
who is new to working in the field of
electroneurodiagnostics. This course will
provide basic information and instruction,
and workshops will reinforce concepts
presented in lectures and give learners the
opportunity to practice head measurement
and lead placement. Technologists will have
the opportunity to improve their technical
skills and gain a better understanding of EEG
instrumentation, polarity and pattern
recognition.
EEG TECHNOLOGY: A COMPREHENSIVE
OVERVIEW
This Seminar is available in both
September and November
This is an intermediate level seminar intended
for technologists with some experience. The
seminar covers concepts that are appropriate
for technologists planning to take the EEG
registry exam. Topics include: neuroanatomy,
clinical correlations, abnormal EEG findings,
instrumentation principles, and waveform
analysis techniques. There is an emphasis on
pattern recognition and a record review
session. During the 10/20 workshop
participants may elect to place a full set of
electrodes on a “Sam” head and get tips on
placement from expert instructors. We will
cover the basics of EEG normal and abnormal
pattern recognition. This is a comprehensive
seminar that also reviews topics of interest to
technologists performing routine EEGs.
By attending this seminar you will be able
to:
• Improve measurement and application
techniques and develop critical skills in
evaluating the accuracy of electrode
placement;
• Understand waveform polarity and EEG
localization techniques;
• Understand the use of filters and
differential amplifiers;
• Critically evaluate recorded studies and
use appropriate terminology to describe
EEG patterns;
• Apply instrumentation principles to your
recording techniques; and
• Enhance your pattern recognition skills.
Who should attend?
This seminar is designed for technologists
with some experience and a basic
understanding of normal EEG patterns.
Technologists planning to take the written or
oral EEG Board Exam and experienced
technologists wishing to enhance or further
their knowledge and gain continuing
education credit for re-certification should
consider this course.
Continued on page 31 E
ASETnews
13
EDUCATION & PROFESSIONAL DEVELOPMENT
continued
Fall & Winter Seminars Hotel Information
September Seminars Hotel Information:
Hyatt Regency Crown Center
2345 McGee Street • Kansas City, MO 64108 • 816.421.1234 phone
The Hyatt Regency Crown Center will be offering a special room rate to
seminar attendees of $120.00 per night single/double. The cut-off date for this
rate is August 24, 2007.
The Hyatt is connected via the Link, a covered walkway, to the Crown Center
shopping center and Union Station. Crown Center offers many shops, restaurants
and theatres, while Union Station offers restaurants, a train exhibit, and Science
City. The Hyatt is also a short ride from The Plaza, an outdoor shopping area
featuring upscale shops and restaurants. It is designed with Spanish architecture
and plenty of fountains, and is the crown jewel of Kansas City.
November Seminars Hotel Information:
Hilton Sacramento Arden West
222 Harvard Street • Sacramento, CA 95815 • 916.922.4700 phone
The Hilton Sacramento Arden West is located minutes away from downtown
Sacramento, the state capitol of California. There is a special room rate of $119.00
per night single/double for seminar attendees. The cut-off date for this rate is
November 1, 2007.
The central location of the Hilton hotel is ideal for short trips. It is within an
hour and half drive to San Francisco, Napa Valley, Reno and Lake Tahoe.
Sacramento International Airport is just 12 miles away. Sacramento has many
entertainment options available like visiting historic Chinatown, attending a
concert at the Sleep Train Amphitheater or Mondovi Center at UC Davis, or paying
a short visit to the Amador County Wine Region which is close by.P
Conference Calls
ASET’s conference calls will be taking a
break during the summer months, but will
start up again on September 5. We have a
great line-up to help close out 2007! Visit
www.aset.org to register.
Sept. 5 . . . . . Pediatric Developmental
Milestones in EEG
Sept. 12. . . . . Digital EEG Concepts
Sept. 19. . . . . The Difference Between a
Technical Description & an
Interpretation
Sept. 26. . . . . The Cranial Nerves
Oct. 3 . . . . . . Long-Term Monitoring for
Epilepsy
Oct. 10 . . . . . Evaluation of Patients in
ICU with EEG & EP
Oct. 31 . . . . . Patient Care Issues in LTM &
ICU
Nov. 7 . . . . . . The Sleep Apnea Evaluation
Nov. 14 . . . . . MSLT & Narcolepsy
Nov. 28 . . . . . Sleep Staging & Scoring:
Old Rules, New Rules,
No Rules
What is new in ASET Online Education?
New Online Course in IONM:
IONM 101 Intro to IONM
by Aage Moller, PhD
This course is a comprehensive
introduction to IONM. The course text is
Dr Moller’s book “Intraoperative
Neurophysiological Monitoring, Second
Edition” and is available through the ASET
office (see page xx for a publication order
form). The course content includes
recordings of Dr Moller’s lectures along
with his PowerPoints and exams. The
course provides a foundation of knowledge
in the basics of monitoring and the
neurophysiological basis of the waveform
generation. Anatomy of the sensory and
motor pathways is included as well as
electrical safety and some troubleshooting
techniques. Basic recording techniques for
the various modalities of IONM are
14
ASETnews
introduced and discussed. This course is
useful to the beginner as well as the
seasoned veteran of IONM and is a
wonderful study aide for the IONM
credentialing exam. The course will be
offered for ACE credits; the number of
credits is to be determined. Price: $299.
(Dr Moller’s book is available through
ASET for $130)
Also coming soon:
• IONM 106 - Getting Started With
TCeMEP by Leisha Osburn, MA, R.
EEG/EP T., CNIM
• EEG 109 - EEG in Epilepsy
• EEG 110 - EEG in Neurological
Disorders
• EEG 111 - EEG in Pediatric and
Neonatal Patients
Planned development of online
courses for 2007-2008:
• IONM 102: Neuroanatomy and
Neurophysiology
• IONM 103: Communication, Documentation,
Medical-Legal and Ethical Issues in the OR
• IONM 104: Anesthesia and Its Effects on
IONM
• IONM 105: Troubleshooting in IONM
• IONM 107: IONM of the Spine and
Peripheral Nerves
• IONM 108: Surgical Techniques and
Monitoring in Vascular Surgery (Carotid
endarterectomy)
• IONM 109: IONM in Cortical and
Neurovascular Surgery (Aneurysm and AVM)
• IONM 110: Skull Base Surgery
• IONM 111: IONM of the Cranial Nerves
• IONM 112: Corticography and Functional
Mapping
Volume 31, Number 2
June 2007
ASETnews
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ASETnews
Volume 31, Number 2
June 2007
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ASETnews
Volume 31, Number 2
2007 ANNUAL CONFERENCE
Magic -
“
producing results through mysterious
influences, or unexplained powers
Submitted by Faye McNall, MEd, R. EEG T.
N
”
ow doesn’t that sound like what we do every
day? That happens to be a definition of
“magic” from Webster’s dictionary! But it seems
like a perfect description of how we manage to complete those
complex recordings, despite hostile conditions, unheard of clinical
conditions and other challenges!
We all need a little magic in our professional and personal lives.
Please consider joining us in Orlando for the 2007 ASET Annual
Conference. I guarantee you that we can work some magic for you, put the sparkle back
in your job, and renew your enthusiasm for a great profession.
We have included the schedule in this issue. Take a look at all of the fascinating
topics that will be presented as abstracts. To me, it is magical the way these abstracts
appear, just when I begin to wonder what the program will be like.
All of the course lectures promise to be very interesting and geared to provide you
with helpful information for your everyday work-life. I would like to highlight a few
topics from the courses.
Star Supporters!
T
he 2007 ASET Annual
Conference is a partnership
and collaboration from all
facets of the END profession. It
takes combined resources from so
many to make this meeting
possible. We’d like to offer a special
thanks to those companies who are
supporting this year’s conference –
and when in Orlando, be sure to
thank them as well.
DO Weaver & Company
Rhythmlink International, LLC
Cadwell Laboratories, Inc.
The Electrode Store
Grass Technologies, An AstroMed, Inc. Product Group
Impulse Monitoring, Inc.
VIASYS Healthcare
June 2007
I Quality Care Disney Style – It’s unlike
any presentation that ASET has ever
offered before! A real Disney trainer
will help us understand how to provide
customer service that makes a
difference. “If you have read “If Disney
Ran Your Hospital” then you will
appreciate finding ways to put a little
magic in our encounters with patients.
I Three Strikes & You’re Out - You’ll be
sitting on the edge of your seat, as if you
were watching the last inning of a ball
game during this discussion! You’ll
hear about all of those difficult
situations and tough questions you face
every day in IONM, and participate in
deciding “the right way” to handle these
issues.
I EEG of the Newborn from Isolette to
Bassinet – This has to be the most
fascinating EEG population there is,
with weekly EEG changes as the brain
matures, and a good understanding of
this topic is essential to pass the EEG
registry exam. If you don’t do neonatal
EEG every day, this will provide a
comprehensive overview.
I Electrodiagnostics in Critical Care
will cover the use of EMG/NCS in the
critically ill patient. This is the
“forgotten” modality when we think of
neurophysiology in the ICU, but it is
very important. Find out more about it!
I Survival Tips for END Technologists –
It’s a jungle out there! You are
exhausted at the end of the day, not by
the running of tests, but by all the other
stressful factors we encounter working
in health care. Find out how to set
priorities, work more efficiently, cope
with demands and cope with change.
I Spinal Cord Monitoring: Techniques,
Applications and Outcomes – Dr.
Nuwer has been trending the effective
use of IONM to prevent spinal cord
injury. He’ll have some interesting facts
and figures to share about why we are
there.
I Asleep at the Wheel: A Wake Up Call
for Sleepy Workers – The impact of
sleepy workers and drivers is now
recognized nationally. It does affect
END Technologists! We sometimes are
the sleepy workers. Managers must
take preventative measures when
staffing.
Sleep centers will be
conducting annual testing on pilots and
truckers.
I Status Epilepticus – Dr. Goodkin has a
special interest in this topic, and is
involved in research. His talk will cover
the current definition of status
epilepticus, long term and short term
effects on the patient, and share some
case studies. P
ASETnews
19
2007 ASET ANNUAL CONFERENCE
Schedule of Events
[Subject to modification and last minute cancellations.]
Wednesday, July 18
Thursday, July 19
10 am – 7 pm
Registration
7 am – 8 pm
Registration & Information
1:30 – 2 pm
Welcome & Opening Ceremonies
7:30 – 8:10 am
Poster Presentations & Continental
Breakfast
2 – 3:20 pm
Abstract Presentations
• Neurophysiologically Guided Brain
Tumor Resection with Intraoperative
MRI, Jack Connolly, R. EEG T.
• Vertebral Artery Anastomosis Case
from Santiago, Chile, and the
Efficacy of Intraoperative
Monitoring, Marie Tedesco, CNIM
• Techniques for Visual Pathway
Protection during Anterior Fossa
Surgeries, Samuel Johnson, CNIM,
DABNM
• A New Addition to College Debt:
Sleep Debt and a New Generation,
Timothy Cunningham, RPSGT
3:20 – 3:40 pm
Break
3:40 – 4:40 pm
Abstract Presentations
• Show Me the Money – An Analysis
of the ASET 2006 Salary Survey,
Sheila Navis, CAE
• Advanced Neuromonitoring
Specialists in the ICU: a Golden
Opportunity for our Profession,
Anita Schneider, R. EEG/EP T., CNIM
• Heinrich Rudlolf Hertz, the Father
of Frequency, Patricia Ramsay, MA,
R. EEG T.
4:45 – 5:45 pm
Ellen Grass Guest Lecture presented
by Timothy A. Pedley, MD
“Ellen Grass: Her Contributions and
Relevance to EEG and
Electroneurodiagnostic Technology”
5:45 – 5:55 pm
Closing Remarks
6:30 – 7:30 pm
Great Ideas Networking Reception
8:10 – 8:20 am
Opening Session & Announcements
8:20 – 9 am
Abstract Presentations
• Navigating the Obstacle Course:
How to Survive A Capital
Equipment Purchase, Gayle
Moriner,
R. EEG/EP T.,
CNIM
• Chronic Immune Mediated
Polyneuropathy in Four Cats,
Jeff Clarke, DMV
9 – 10 am
Kathleen Mears Memorial Lecture
presented by Walter Banoczi, R.
EEG/EP T., CNIM, RPSGT
“The Magic of Becoming an END
Technologist”
10 – 10:40 am
Break with Poster Presentation
Authors
10:40 am – 11:20
Abstract Presentations
• A Smile Begins in Your Brain, Diana
Estorino, R. EEG/EP T., R. NCS T
• Introperative Neuromonitoring in
Lumbar Sacral Conjoined Twins
Separation, James Persyn, CNIM
11:30 am – 1:15 pm.
Lunch & ASET Annual Business
Meeting
1:30 – 3 pm
Symposium “Why, Where, When &
How? Using Evidence Based Practice
to Improve END Technology”
Lewis L. Kull, MA, R. EEG/EP T.
Lucy Sullivan, R. EEG T.
Janice Walbert, R. EEG/EP T.
.3 – 3:20 pm
Break & Poster Viewing
3:20 – 4 pm
Abstract Presentations
• Using Web Cam Technology to
Enhance Communication in the
END Lab, Rose Burnite, R. EEG T.,
RPSGT
• ABRET Update 2007, Aatif Husain,
MD
4 - 5 pm
“Put Volunteer Work on Your
Resume”
Sponsored by the ASET Volunteer &
Leadership Development Committee
5 – 5:15 pm
Special Prize Drawing & Closing
Remarks
6 – 8:30 pm
Exhibit Hall Grand Opening
Friday, July 20
7 am – 5:30 pm
Registration & Information Desk
7:45 – 8 am
Announcements & Recognition of
2006-07 Credentialed Technologists
8 – 9:30 am
Keynote Address by the Disney
Institute
“Quality Care, Disney Style”
9:30 – 12 Noon
Exhibit Hall Open
10:15 – 11:15 am
Course Tracks
1. Multimodality IONM – Bobby
Taskey, R. EEG T., CNIM
2. Seizure Identification in the
Geriatric Population – William
Tosches, MD
3. A Recipe for a Stellar NCS
Technologist – Janet James, R. EEG
T., R. NCS T.
4. Q.I. Initiatives for END Labs
Kathy Johnson, R. EEG/EP T., RPSGT
Continued on page 21 E
20
ASETnews
Volume 31, Number 2
11:20 am – 12:20 pm
Course Tracks
1. IONM Discussion Groups
• TCeMEPS – Greg Niznik, CNIM
• Pedicle Screw Stimulation –
Bobby Taskey, R. EEG T., CNIM
• Cranial Nerve Monitoring – Chris
Slaymaker, R. EEG/EP T., CNIM
2. EEG of the Newborn from Isolette
to Bassinet – Monisha Goyal, MD
3. Anomalies: Real or Unreal? – Jerry
Morris, MS, R. NCS T.
4. Survival Tips for END TechnologistsTBA
12:20 – 1:15 pm
Lunch with Interest Section
Roundtable Discussions
1:20 – 2:15 pm
Course Tracks
1. Three Strikes & You’re Out! Billing
Fraud, Stark Law Violations and
Ethical Issues in IONM – Rebecca
Clark-Bash, R. EEG/EP T., CNIM
2. Clinical Correlations in EEG: An
Interactive Session – Bobby Taskey,
R. EEG T., CNIM
3. NCS Workshop: Basic & Board Prep
– Jerry Morris, MS, R. NCS T. &
Brian Markley, R. EEG/EP T., R. NCS
T.
4. How to Start Your Own Business –
Cathy Boldery, R. EEG/EP T., CNIM,
RPSGT
June 2007
2:20 – 3:15 pm
Course Tracks
1. Between Stimulating & Recording:
The Physiology of Sensory & Motor
Pathways – Chris Slaymaker, R.
EEG/EP T.
2. EEG Discussion Groups
• Waveform Analysis – Patti
Baumgartner, R. EEG/EP T., CNIM
• Digital Concepts – Jack Connolly,
R. EEG T.
• Activations – Diane Liesen,
R. EEG T.
3. Uncommon Nerve Conduction
Studies – Brian Markley, R. EEG/EP
T., R. NCS T.
4. Your Professional Portfolio: Charting
Your Future – Judy Ahn-Ewing, R.
EEG/EP T., CNIM
7 – 10 pm
ASET Foundation Silent Auction &
Special Event
3:15 – 4 pm
Break in Exhibit Hall
8 am – 8:55 pm
Course Tracks
1. Electrocorticography and Mapping
in the OR – Fernando Vale, MD
2. EEG Frequencies and the Special
Role of Digital EEG – Ernst
Niedermeyer, MD
3. 24/7: How to Edit and Manage LTM
Data – Lewis Kull, MA, R. EEG/EP T.
4 – 4:50 pm
Course Tracks
1. Using EMG in Cervical/Thoracic &
Lumbar IONM – Clare Gale,
R. EEG T., CNIM
2. The Electro-Clinical Spectrum of
Epilepsy – Bill Tatum, MD
3. Electroneurodiagnostics in Critical
Care – Bakkiam Sabbiah, MD
4. You’re Hired! Tips for Interviewing
and Being Interviewed – Janice
East, R. EEG T., RPSGT
5 – 6:30 pm
Sundown Seminars
1. EEG Board Prep – Bill Byrum,
R. EEG/EP T., CNIM
2. CNIM Board Prep –
Kevin McCarthy, MA,
CNIM
3. CPT Coding &
Billing - Lynn Bragg,
R. EEG/EP T.
4. Competency
Assessment for
END Educators &
Lab Managers –
Maureen Bendyna,
R. EEG/EP T., CNIM,
RPSGT
Saturday, July 21
7 am – 2 pm
Registration & Information Desk
7 – 7:55 am
Early Bird Course Track – For those
die-hard learners!
1. Anesthesia & TCeMEP – Leisha
Osburn, MS, R. EEG/EP T., CNIM
2. Ambulatory EEG Techniques & Case
Studies – Brian Markley, R. EEG/EP
T., R. NCS T.
3. Principals and Applications of LongTerm Monitoring for Epilepsy, Judy
Ahn-Ewing, R. EEG/EP T., CNIM
9 – 9:55 am
Course Tracks
1. Deep Brain Stimulation in Tourettes
Syndrome – Sherry Nehamkin,
R. EEG/EP T., CNIM
2. Asleep at the Wheel: A Wake-Up
Call for Sleepy Workers – Marietta
Bellamy Bibbs, RPSGT
3. Autonomic Nervous System
Disorders and Paroxysmal Events
Seen in Pediatric LTM – Monisha
Goyal, MD
10 – 10:55 am
Brunch in Exhibit Hall
Continued on page 22 E
ASETnews
21
2007 ANNUAL CONFERENCE
continued
2007 ASET ANNUAL CONFERENCE
Schedule of Events
Continued from Page 21)
11 – 11:55 am
Course Tracks
1. Spinal Cord Monitoring:
Techniques, Applications &
Outcomes - Marc Nuwer, MD
2. Collecting & Analyzing ICU
Monitoring Data with QEEG –
Mark Scheuer, MD
3. EEG Video Monitoring & The
Differential Diagnosis – Salim
Benhadis, MD
12 Noon – 12:55 pm
Course Tracks
1. To be Announced
2. EEG in the ICU and the E.R. –
Kenneth Jordan, MD
3. Status Epilepticus – Howard
Goodkin, MD
1 – 2 pm
Course Tracks
1. From IONM to the Court Room –
A Case Study – Donald York, PhD
2. Sedation Update & Discussion –
Marc Newer, MD
3. Imaging for Epilepsy: MEG, PET,
SPECT & Functional MRI –
Ed Carlson, R. EEG/EP T
4 – 8 pm
Explore the Magic of DisneyWorld
[Free time]
8 pm
An ASET Pleasure Island Gathering
Coming to the Orlando Exhibit Hall!
T
he ASET Exhibit Hall, held in conjunction with the annual conference in
Orlando, offers another great venue to learn more about the products
and services provided to END personnel. These displays and
demonstrations are often an incredible way of understanding the possibilities
made available through the newest technology.
This year, we’re pleased to showcase leading companies and hospitals that
help support ASET and our annual conference. Plan your time accordingly to
visit with these leading companies. Food, entertainment, prize drawings and
special activities are a traditional part of the exhibit hall, including a grand
opening on Thursday evening.
Ad-Tech Medical Instrument Corp.
ASNM
Axon Systems, Inc.
Bio-logic Systems Corp., a Natus
company
Board of Registered Polysomnographic
Technologists
Cadwell Laboratories, Inc.
Compumedics
Demos Medical Publishing, LLC
Electrical Geodesics, Inc. (EGI)
Electro-Cap International, Inc.
Electrode Store, The
Faith Medical, Inc.
Grass Technologies, An Astro-Med, Inc.
Product Group
Gulf Coast Billing
Illinois Neurological Institute at Saint
Francis Medical Center
Impulse Monitoring, Inc.
Knowledge Plus
Lee Memorial Health System
Lifelines Neurodiagnostic Systems, Inc
Maxim Travel Allied
Neurovirtual USA, Inc.
Nihon Kohden America
PMT Corporation
Rhythmlink International, LLC.
Rochester Electro-Medical, Inc.
SleepMed/Digitrace
Smiths Medical PM, Inc.
Stellate
Texas Children’s Hospital
VIASYS Healthcare
Weaver & Company
West Virginia University Hospitals
XLTEK
Exhibit Hall Hours
July 19. . . . . . . . . . . . . . 6 – 8:30 pm
July 20. . . . . . . . 9:30 am – 12 Noon
1 – 3:45 pm
July 21 . . . . . . . . . . . . . . . 8 – 11 am
Tips on Creating Your Own Schedule
S
imply take a highlighter and mark the sessions and activities you want to
attend. Better yet, email Paul at [email protected] for an electronic copy and create
your own customized schedule. Be sure to allow some time to explore the
Exhibit Hall and DisneyWorld too – or just visit with friends and colleagues P
22
ASETnews
Volume 31, Number 2
June 2007
ASETnews
23
I NTEREST S ECTION B RIEFINGS
INTEREST SECTION COORDINATOR
Margaret Hawkins, R. EEG/EP T., CNIM
Wausau, WI
[email protected]
INTEREST SECTION LEADERS
ACUTE/CRITICAL CARE END
Anita Schneider, R. EEG/EP T., CNIM
Redlands, CA
[email protected]
AMBULATORY MONITORING
Jennifer Carlile, R. EEG T.
Cleveland, OH
[email protected]
Brian Markley, R. EEG/EP T., R. NCS T.
Silver Spring, MD
[email protected]
CPT CODES
Lynn Bragg, R. EEG/EP T.
Canton, OH
[email protected]
Kristina Port, R. EEG/EP T., RPSGT
Novelty, OH
[email protected]
DEPARTMENT MANAGERS
Sharyn Katz, R. EEG T.
Danbury, CT
[email protected]
EDUCATION
Mark Ryland, MA, R. EP T., RPSGT
Parma, OH
[email protected]
EPILEPSY MONITORING
Cheryl Plummer, R. EEG T.
Pittsburgh, PA
[email protected]
Anthony Bell, R. EEG/EP T., CNIM
Redland, WA
[email protected]
INTRAOPERATIVE MONITORING
Paul Berry, R. EEG T., CNIM
Greenwood, IN
[email protected]
Lary Breeding, R. EEG/EP T., CNIM
Houston, TX
[email protected]
Continued on page 25 E
Welcome from the Interest Section Coordinator
By Margaret Hawkins, R. EEG/EP T., CNIM
W
hen I received my notification about this year's annual meeting in Orlando, I
was intrigued by the theme "It's More than Magic". When patients ask me
questions about how this test works, I may give my canned explanation about
electrical signals and body electricity and such, but often I end up exclaiming that much of
it is just plain magic! Even though we use sophisticated equipment, deal with huge amounts
of data and see patients with complicated medical problems, much of our success in the
electroneurodiagnostic laboratory depends on our people skills, sometimes the "spell" we
cast over our patient as we try to extract a best-possible test.
I asked our Special Interest Leaders this month to reflect on how these pieces of the END
puzzle (the technical, the scientific, the artistic, the emotional) come together in the
workplace. I hope you enjoy their individual glimpses into this magical world of END. See
you this summer in the "Magical Kingdom!”
ACUTE/CRITICAL CARE END
By Anita Schneider, R. EEG/EP T., CNIM
Our topic for this Interest Section focuses on the magic of practicing our craft. What part is science
and technology; what part finesse and skill? What magic do we practice to get a good quality recording
on the sickest patients – those in the ICU and emergency department (ED), where procedures are often
ordered stat? In this article, I focus on the finesse and skill portion of our profession.
What are the unique needs of the stat procedure? The patient is suspected to have a serious brain
problem and the referring physician needs the information quickly for accurate diagnosis and
management. “Time is Brain” and when a stat EEG is ordered, we do not have the luxury of time we
may have in other patient populations we serve. It is my belief that we succeed most often when we
leave little to chance. It is helpful to develop a protocol for stat procedures and follow the basics every
time. The following Tips for Success are part of the protocol we developed for stat procedures and it’s
all about relationships:
• Preparation and nurse relationship: When a stat order is received, act quickly. Immediately call the
nurses station where the patient is located, ask to speak with the nurse responsible for the patient.
Introduce yourself, identify your department and state that a stat EEG has been ordered on “Mr.
Smith in bed 12.” Ask if this is a good time to do the procedure. The nurse will appreciate being
contacted, will be expecting you and probably will have the patient ready for you when you arrive.
This is especially the case with the ICU nurse, who usually feels very protective and in control of
his/her patient. You have taken the first step for success by respecting the nurse’s time and role with
the patient.
• Patient/family relationship: Establishing this relationship is vital for success and must be done
quickly - but given enough time to gain cooperation from the patient and their family. Treat them
with utmost respect. Approach them with confidence and a smile. Look and act professional introduce yourself and the department you represent. Look them in the eye and shake their hand.
Think of yourself as an integral part of the patient care team, not just someone coming to do a
procedure.
During these first few seconds, they have already formed an opinion of you, good or
bad. Take the necessary minute or two to explain what you are going to do. In my
experience, in most cases in the ICU and ED, it is best to have the family leave the room
after this introduction. It is always a good idea to discuss this first with your new friend, the
nurse. She knows the family and situation best and may want to suggest this to the family
herself – or she will tell you why it is not a good idea for this patient.
Your next priority is to get the procedure underway quickly and accurately, without
interruption or distraction from family. Tell them approximately how long the procedure
will take. For ICU patients, suggest this is a good time for a cup of coffee or lunch. Families
are always concerned their loved one will be left alone. Tell them you will be with the
patient throughout the procedure and they can return in one hour, or that you will come
Continued on page 25 E
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Volume 31, Number 2
Acute/Critial Care END. . . Continued from Page 24
to the lobby to let them know when you are done. Most families appreciate your
communication and will do this willingly. Their primary concern is to do what is best for
the patient, so don’t be shy about asking them to leave. If they insist on staying, politely tell
them you will need to focus on your job to get the procedure done accurately and you will
be happy to answer questions after you are done. This is usually not the time or place for
small-talk. These patients are often very sick and the family is very concerned. They will
appreciate a friendly yet professional, serious approach.
Success in the ICU and ED is not really magic at all. It’s very much about developing good
relationships, having a good plan in place and following it.
AMBULATORY MONITORING
By Brian Markley, R. EEG/EP T., R. NCS T.
What goes into a good ambulatory EEG study? We are all very familiar with what it takes to obtain
a quality ambulatory EEG recording. Our focus naturally is in getting the electrodes securely affixed to
the patient’s scalp with impedances low. We take care to provide strain relief to the electrodes so that
no electrode is pulled off during the study.
To digress a little, our lab lately has had some success in providing extra strain relief by grouping
the electrodes and securing them with tape to the base of the patient’s neck. We have the patient bend
their head forward to provide slack between the electrode and this point. This can reduce tension on
the attachment point of electrodes.
Anyway, back to the question of how we get a good study. There are other elements in a successful
recording.
One of the advantages of the ambulatory technique is its ability to greatly increase recording time.
It is also possible to record in a patient’s normal environment with somewhat normal activities. One
downside of this is that there is no technologist to note the recording with observations. We
compensate for this with the event marker and diary system. As the intent of the study is to correlate
EEG activity with clinical signs or symptoms, we rely on the patient (or a caregiver) to mark the
recording and report changes in behavior. There has been for some time, some use of video recording
in conjunction with ambulatory EEG, although this isn’t widespread at the present time. For the most
part, ambulatory EEG is very reliant on patient compliance for adequate documentation.
Patient compliance is important in other aspects of ambulatory EEG. A patient chewing gum could
obscure the data for a large section of the recording. Getting either the recorder or electrodes wet could
ruin the study.
Patient compliance starts even before the patient gets to the lab. We have to repeatedly reinforce
with our scheduling staff the need to make sure patients wear a loose fitting button down shirt to the
study. Nothing is more frustrating than to put effort into electrode application and then have the study
fail because the patient doesn’t follow instructions. Whenever I set up an ambulatory I like to advise
the patient that as big a pain as the recording process is, it is even less fun to have it twice. I also try to
explain why certain instructions are given.
Of course I am sure we all have our own horror stories about patient non-compliance. My all time
worst came after I spent several hours creating a custom electrode harness for ambulatory EEG. The
very first patient on whom this technological wonder was used was a young psychiatric patient. The
patient ended up not appreciating the ambulatory procedure and out came the scissors. Needless to
say, I am no longer in the custom electrode business.
I would love to hear any stories about compliance issues or any suggestions for improving patient
compliance. Please e-mail anything along these lines to [email protected]. I will share these
in future interest section columns.
CPT CODING
By Lynn Bragg, R. EEG/EP T.
Imagine getting up one morning and you find that something just doesn’t seem right? You go to
work and there is a memo stating that there have been changes in coding and reimbursement for all
END procedures effective immediately. As you read on you find that routine EEG’s are billed by 5
minute increments, portable EEG’s are reimbursed double the routine rate, IOM procedures are also
billed in 5 minute increments and whatever your lab fees are billed, they are reimbursed by that fee,
not a stated fee set by Medicare or any other insurance carrier.
Continued from Page 24
NERVE CONDUCTION STUDIES
Jerry Morris, MS, R. NCS T.
Shreveport, LA
[email protected]
PEDIATRICS AND NEONATOLOGY
Shelly Gregory, R. EEG T.
Snohomish, WA
[email protected]
POLYSOMNOGRAPHY
Kathryn Johnson, R. EEG/EP T., RPSGT
Huntington, WV
[email protected]
Nancy Haferman, R. EEG/EP T., RPSGT
Marshfield, WI
[email protected]
NEW TECHNOLOGIES & RESEARCH
Leah Hanson, R. EEG/EP T.
New Glarus, WI
[email protected]
TECHNOLOGISTS WORKING ALONE
Sunday Dale, R. EEG/EP T., CNIM
Wichita, KS
[email protected]
Interest section leaders are a resource to
members. Please feel free to contact leaders
with questions, problems, suggestions or feedback of any kind. Professional affiliations are
listed to help avoid conflicts of interest. It is
the policy of ASET that interest section leaders not promote their services or products
through their role within the organization.
To prevent misunderstandings, especially for
those leaders that must “change hats” when
receiving calls at work, please initiate all calls
by identifying yourself as calling in regard to
ASET’s Interest Section.
Continued on page 26 E
June 2007
ASETnews
25
I NTEREST S ECTION B RIEFINGS
continued
CPT Coding. . . Continued from Page 25
Suddenly, you hear a loud noise, find out that it is your alarm and
you have been dreaming. What a bummer!!!
Unfortunately, getting a memo stating that reimbursement changes
have been made effective immediately is not always a dream. Currently,
it is being discussed that some ultrasound procedures reimbursements,
such as carotid vascular ultrasound, may be cut up to 20%.
Imagine if that were to happen to some of the END procedures done
in your lab. If you remember, it was not so long ago that portable EEG
procedures were a separate code but not anymore.
Letters to your Senators and Representatives are the best way for us
to let them know how these changes will affect our jobs. Many
administrators only see the bottom line, and will find it hard to justify
the staff that we know is needed to run an efficient lab.
For some states, there are restrictions in place as to who qualifies for
certain procedures to be done. Precertification is not a guarantee for
reimbursement.
It takes the cooperation of the patient, physicians and the END lab
to ensure that all benefit from insurance reimbursements. I cannot
think of one patient that would be happy to pay more for a procedure
than they have to. Our office has a notice posted in all of our exam
rooms stating the potential changes in Medicare reimbursements,
asking patients to write to their representatives. Getting the word out is
the best way to let those in charge what these changes can do to
everyone. Wishing upon a star and rubbing Aladdin’s lamp so far has
not worked!
I’m looking forward to seeing you in Orlando!!!
DEPARTMENT MANAGERS
By Sharyn Katz, R. EEG T.
Volunteerism: A Marketable Skill Set
I write this column, this quarter, wearing two hats. One, as writer for
the Management Section of the Interest Sections and the other as chair
of the Volunteer/Leadership Development Committee. Coincidentally,
the two in many ways, are related and pertinent to our professional
development.
When you update your résumé do you list your skill sets? Do you
add your experience as a volunteer in your profession, your community,
your religious organizations, and your children’s activities as a skill set?
If not, why not? Baking cookies, coaching little league, soliciting
contributions, helping with a fund raising event or stuffing envelopes
for a mailing are marketable skills.
You may snicker at this, but rethink the relevance of these “skills.” It
shows support, commitment, teamwork, and positive energy. I would
much prefer hiring someone who lists volunteering as one of his or her
“skills” than someone who doesn’t think it relevant. In an interview,
when you discuss your other interests and skills, volunteering, at any
level, shows that you have potential for leadership and/or that you have
demonstrated leadership ability.
So, my question and challenge to you is: Do you want to increase
your skills? If so, volunteer! What better way to build and improve your
skills, than to involve yourself in your professional organizations?
Whether it’s involvement in a local, state or regional END organization,
or involving yourself in ASET, make that commitment.
I invite and encourage you to demonstrate to the staff you manage,
your commitment to your profession. We are stronger as individuals
and as a profession when we volunteer and support the activities of our
national organization. ASET is the voice of all who practice
electroneurodiagnostic technology in this country and with your
support we can make greater strides in accomplishing our goals.
As ASET prepares to install a new executive committee and new
board members this summer, sign up now to become involved. There
are opportunities at all levels of commitment during the year for
volunteering, so put your name on our volunteer list. It is easy to do. You
can contact the Executive Office for a volunteer form, go online to the
ASET website, or contact me at: [email protected].
Please join us in Orlando and attend the Volunteer/Leadership
Development presentation on Thursday afternoon, July 19th.
Familiarize yourself with committee activities and opportunities and
learn how you can put Volunteering on your résumé!
END EDUCATION
By Mark Ryland, MA, R. EP T., RPSGT
One of the challenges of teaching first year END students is getting
them through the technical material and keeping them focused on the
fact that this new and strange material will soon have relevance. The
students entering my program have completed prerequisite coursework
(college math, biochemistry, anatomy and physiology) so some of the
science concepts are already in place. However, the strange new
technical information they are accosted with during their first semester
is truly daunting. The initial concepts are so important because they lay
the groundwork for all that follows. Until the students put the
information into practice, however, it remains rather nebulous, and not
at all artistic.
During laboratory sessions as the students measure, mark, and
apply electrodes to mannequin “SAM” heads, then classmate’s heads,
things begin to come into focus. As the students progress into running
EEGs, on classmates, friends, family, and whatever hapless individual
they can drag into the lab, the picture becomes a little clearer yet. Some
of the “artistic” side of the profession begins to emerge. However, I have
found it is not until they do their first clinical rotation (in the second
semester of my program) that they really see the relevance of all they
have learned. Taking histories from and running EEGs on actual
patients with real neurological disorders generally brings the message
home. Sharing their stories with their classmates, their fears, excitement,
mistakes, and successes is also another way the picture becomes clearer.
They also begin to see the field of END not so much as a job, but a
profession.
As the students move into a new semester, and a new modality, the
process begins again, but the learning curve is less steep. Moving into
evoked potentials, then nerve conduction studies, and then
polysomnography, the previously learned concepts return, and they see
the application of the same concepts in more than one area. They see the
diversity and the possibilities the field has to offer. They also see that
each modality has an “artistic” as well as a “scientific” side to it. During
clinical visits, I witness the pieces truly come together: the student who
initially struggles, then obtains a difficult nerve conduction response;
the shy, quiet student who talks to and empathizes with a nervous
patient and gets the patient through the EEG.
During one of my recent clinical visit I watched one of my second
year students applying electrodes to an 8-year-old child with collodion.
The hook-up truly was artistic as she confidently marked, measured,
and applied the electrodes. Watching the flow and rhythm, it was clear
that all the pieces had come together.
Continued on page 27 E
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Volume 31, Number 2
END Education. . . Continued from Page 26
EPILEPSY MONITORING
By Tony Bell, R. EEG/EP T., CNIM
One of questions posed for this month’s newsletter was: “Are there
circumstances when the technical aspects of long-term monitoring
come into conflict with or overshadow the ‘people’ part of the task?” The
short answer is that the two go hand in hand and the technologist must
have skills in both areas to be successful.
As a technologist involved with epilepsy monitoring, the technical
aspects of recording must be a top priority. Vigilance and diligence are
needed to successfully accomplish the job of diagnostic monitoring. The
LTM technologist takes the lead role in informing the patient and family
members about the purpose of monitoring and the means to obtain
good data to accurately diagnose their condition. As long as the patient
and family fully understand this purpose, there are rarely conflicts.
Vigilance is important in controlling the integrity of the data.
Technologists must watch for changes in the recording environment.
For example, when there is a sudden change is the recording quality, the
technologist must first notice that the change occurred and then
immediately find out what caused the change. Sequential
troubleshooting techniques are essential. The problem may be
something as simple as a high impedance electrode, to something more
complex such as grounding related to the bed control connection in the
patient room. Since seizures can occur any time and often without
warning, there should be no procrastination when troubleshooting any
recording problem.
Technologists must be diligent in their pursuit of recording
problems. Occasionally, the source may be linked to the patient such as
gum chewing or the use of personal electronics. Clearly defining the
technologists’ responsibility as the “gatekeeper” of accurate data is
usually acceptable to most patients as a good reason for compliance.
The technologist involved with LTM has the opportunity to forge
unique relationships with patients and their families. It is a privilege and
an occasional challenge to be both a technical professional, responsible
for data integrity, and to be a patient advocate.
Realistically, technologists can strive for 100% success but must
accept the occasional shortfall.
INTRAOPERATIVE MONITORING
By Paul Berry, R. EEG T., CNIM
Margaret suggested that for this interest section article, I discuss
how I would handle a patient’s expectations before surgery. She
indicated that when performing pre-operative studies on patients, many
times patients have this idea that we will keep them from being
paralyzed. We do not do pre-operative studies at my current hospital
due to several factors including the volume of cases and the types of
cases we do (we are a Level I trauma center). But I agree with her that
many times patients will get this idea that I will keep them from being
paralyzed.
When we started offering TCeMEP monitoring in 2005, it was
determined that for scheduled cases the surgeon or his representative
would go over the screening form with the patient prior to the surgery
and then the screening form would be reviewed by the technologist
prior to the case. In cases of trauma, the technologist would go over the
form with the patient or competent person prior to the case if possible.
That went well for a while, but eventually the surgeons mostly left it to
us to accomplish this task, including informing the patient of the
June 2007
potential risks of TCeMEP. Now it is the standard at our institution for
the technologist to go over the TCeMEP screening form and risks of the
procedure with the patient (or competent person) prior to the case. We
realized that this presented some problems for us: 1) we didn’t want to
scare the socks off the patient, 2) we were concerned about presenting
the patient with accurate information, 3) we wanted information
coming from our technologists to be consistent, and 4) we were
concerned about liability.
During planning meetings and in talking with our surgeons, we
decided that we would develop a script for our technologists to follow.
We didn’t want to hamstring our technologists with only being able to
follow, verbatim, what was on the scrip - but instead, presented a
standard with the main points of what should be said and a proper
manner in which to say them. To be truthful, initially, this was geared
more toward our less experienced technologists, but we feel it is a good
thing for all of our technologists.
In our discussions with the patient we never mention words like
paralysis, deficits, or outcomes – these are subjects in the realm of
physicians and should be referred to them. We merely let the patient
know that we are going to monitor the integrity of the spinal cord
during their surgery and will present information to the surgeon that
can help keep [the patient] safe during surgery. In laymen’s terms we
generally explain what we are doing and how we will do it. We also go
over the relevant risks with the patient and how we try to avoid patient
injury. For example, tongue or cheek lacerations are a potential risk of
TCeMEP stimulation. To reduce the potential for this occurring, we
place bite blocks to pad the mouth. When going over our TCeMEP
screening form we let the patient know that there are some conditions
that may require special consideration. We then ask the questions of the
screening form. We answer questions relevant to monitoring to the best
of our ability, but refer any questions about outcomes or problems to
the surgeon or anesthesiologist. We never make any promises. If you
would like a copy of our TCeMEP pre-operative screening script, e-mail
me at [email protected].
NERVE CONDUCTION STUDIES
By Jerry Morris, MS, R. NCS T.
Much attention has been given to the new developments and
technologies that have been utilized in EMG during the last few years.
As we look at a bright and exciting future, let’s step back a couple of
years (and centuries) and see how electromyography came to be from a
historical perspective.
As early as the 1600s, electricity was described and numerous
scientists were experimenting with electricity in animals. Then in the
mid 1700s, scientists such as Kratzenstern, Cotugno, and Jallabert
described purposeful muscle contractions with electricity. In 1791,
Galvani began his observations on frog muscle contractions and wrote
his “Commentary.” Other breakthroughs soon followed. In 1794,
Galvani proved that electricity could be generated by animal tissue. In
1799, Volta developed a dependable source of continuous electric
current. Then, as the 1800s began, more and more work continued to be
done in the field of electromyography.
In 1833, G.B. Duchenne became interested in electropuncture and
electrical stimulation. Due to his work, many consider him the father of
electrodiagnosis. Others, however, believe he provided the impetus for
others to expand the horizon of electrodiagnosis and electrophysiology.
Research and interest in the field continued through the late 1800s and
into the early 1900s. As the twentieth century began, several important
Continued on page 28 E
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I NTEREST S ECTION B RIEFINGS
continued
Nerve Conduction Studies. . . Continued from Page 27
events took place that would help define the field of electrodiagnosis.
In 1907, Piper recorded voluntary contractions in a man’s forearm.
Then during the time frame of World War I and subsequent years, E.B.
Adrian made three outstanding contributions to the field of
electrodiagnosis.
1. In 1916, Adrian reported strength duration curves for healthy and
diseased muscles.
2. In 1929, Adrian used coaxial needles to record potentials from
muscle fibers.
3. Adrian also introduced the loudspeaker as a tool in the EMG
apparatus, thus allowing us to “hear” the potentials, a major and vital
aspect of EMG.
Other major events were also happening during this period before
World War II. In 1918, Hoffman recorded the “H” reflex. Lindsley
recorded the first tracing of a patient with myasthenia in 1935. By 1939,
Denny-Brown and Pennebacker differentiated between fibrillation
potentials and fasiculations. Denny-Brown and Nevin documented
myotonic potentials in 1941. Also in 1941, Buchthal and Clemmesen
used EMG to document muscle atrophy. Moersch coined the term
“carpal tunnel syndrome” in 1938, although it was first described in
1863.
World War II came and brought with it a greater interest in EMG
studies due to the increasing amount of nerve injuries. Hodes, Larrabee,
and German calculated conduction velocities in nerves in 1948 and in
1950 Magladery and McDougal named “F” responses. The year 1956
saw Simpson document slowing of the ulnar nerve across the elbow.
Much work was done in the 1950s and 1960s as EMG and nerve
conduction studies became more common in physical medicine and
rehabilitation (PMR) and neurology labs.
Most of the contents of the above discussion came from two great
sources of EMG history.
1. “Electrodiagnosis and Electromyography, 2nd Edition” edited by Dr.
Sidney Licht, Waverly Press, 1961.
2. “Muscles Alive” by Dr. J.V. Basmajian, Williams and Wilkins
Company, 1962.
There are also numerous Internet sites that discuss the specific
history of certain aspects of EMG – instrumentation, action potentials,
motor units, waveform analysis, specific disease processes, etc. We have
a wealth of knowledge about our past at our fingertips. We’re only a
click away.
particular area that seems to hold them back generally.
One explanation may in fact lie in the realm of genetics. Partners
often marry someone with similar tendencies: Impulsivity may be a
shared trait and thrill-seeking behavior as well, particularly among
those who marry young. Parents may have had a shared interest, dare we
say it, in certain recreational drugs during their youth. In other words,
the styles of functioning of their brains may be similar. Now it will be
readily agreed that a certain degree of obsession can be helpful in
achieving one's goals. And hypomania comes close to defining the
successful corporate personality these days. When these tendencies
compound from both the maternal and paternal side to form the
genetic endowment of the child, it should not come as a surprise that
some children are pushed over the cusp of optimum performance into
dysfunction. This we call "the other side of genius."
If this possibly describes the situation in your own family, it may be
useful to try to understand your situation from the standpoint of
"shadow syndromes," the subclinical manifestation of established
clinical syndromes. The most common of these is of course ADHD, or
Attention Deficit Hyperactivity Disorder. This is the most commonly
diagnosed disorder of childhood. Yet it is also clear that many, if not
most CEO's of startup enterprises would probably have been diagnosed
with ADHD in their youth if the diagnosis had existed at that time.
Clearly there is a certain good side to the condition. The restlessness of
ADHD in the classroom pays off in entrepreneurship. There is a certain
tolerance for risk-taking and adventurism that is positive in the new
executive. The ADHD person has been described as a "hunter in a
farmer's world," geared to novelty on the one hand, and undone by
drudgery and routine on the other. (See the books on ADHD by Thom
Hartmann in this regard.) In this view, ADHD is not so much a disorder
as it is a style of brain-functioning that is optimal for some challenges
and not for others. In some skills tests calling for quick judgments, for
example, ADHD children have been shown to excel.
So when the call comes from the teacher that your son should be on
Ritalin, the temptation may be to say, "He's ok, I was just like that when
I was young." That may be true, but it could also be the case that your
child is more challenged by his brain than you were at his age. What
might have been a shadow syndrome in your own case could be a real
challenge for your child. For reasons not yet fully understood, our
children seem to be facing greater mental health challenges than was the
case for earlier generations.
Read more at http://www.eeginfo.com/research/articles/
general_9.htm
NEW TECHNOLOGIES & RESEARCH
PEDIATRICS
By Leah Hanson, R. EEG/EP T.
EEG Research (http://www.eeginfo.com/research/articles/) is a really
terrific website which posts all types of articles. Many of the articles are
on biofeedback and other analysis techniques.
Here is a short excerpt of an article “The Other Side of Genius” by
Siegfried Othmer, Ph.D., September 2001:
Many parents find themselves challenged by children who, if
genetics were indeed in charge, should be doing well. Both
parents see themselves as reasonably functional adults, perhaps
successful professionals, and they sometimes wonder just why it
is that their child is struggling in school. Or both parents reflect
on the fact that they were high flyers during their early schooling,
whereas their child is just keeping up. Yet other children show
promise in a variety of areas, but seem to be struggling in one
By Shelley Gregory, R. EEG T.
This month I will have worked at Seattle Children’s Hospital and
Regional Medical Center for 27 years. Most people would ask, “27 years,
how can you work with the pediatric world for that long?” To be quite
honest, time has flown by and I periodically reflect on some of the more
memorable patients; the patients that everyone comes across at
sometime who are unforgettable and continue to stay in the deep areas
of our temporal lobes.
We currently have two cases of pentobarb coma due to status
epilepticus. One patient just came off continuous EEG monitoring for 64
days and the other patient started on continuous EEG monitoring 7 days
ago. We are currently averaging 4 to 5 cases per year of pentobarb coma
with continuous EEG monitoring. Even with all of my supposed years of
knowledge and wisdom I still don’t completely “get” why some patients
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AND
NEONATOLOGY
Continued on page 29 E
Volume 31, Number 2
Pediatrics and Neonatology. . . Continued from Page 28
can be pharmacologically broken of their status epilepticus in the ER and
others are put in a drug coma for an undetermined length of time.
I first met WC nine years ago. The doctors requested an EEG for
alteration of mental status in this eight-year-old. Over the course of
three days WC started having generalized seizures with apnea. WC’s
seizure frequency increased to the point that the physicians placed him
in a pentobarb coma with continuous EEG monitoring. All initial
workup came back normal except for the lumbar puncture which was
consistent with viral encephalitis.
Over the course of three and a half weeks, WC was lightened and put
back into a pentobarb coma at least three times. As a technologist you
get to know the family members very well and learn what the patient
was like outside of the hospital. During one of the “returns” to
pentobarb coma I was struck by how involved the entire family became
with WC. WC’s twin sister would read fairy tales to him while holding
his hand and his mom would sit for hours talking to him about school
and his friends. WC had one moment in his acute phase that they were
actually giving last rites but he bounced back.
Medical miracle or divine intervention; you decide, but WC came
off of continuous EEG monitoring and out of his pentobarb coma after
three and a half weeks! WC had a long road ahead of him but he never
had any more bouts of status epilepticus. He did however have partial
and generalized seizures from time to time.
In the following years, WC’s and I would cross paths. Whenever he
had an EEG, long-term monitoring, WADA, or PET, I would “dibs” him
and perform the study. It was a chance to catch up on his life outside of
the hospital and his family’s lives for that matter.
WC is currently waiting to see if he is a candidate for a Phase 2
monitoring (invasive grid/strips). He recently celebrated his 19th
birthday, is getting ready to graduate from high school in two months,
going from a part time to full time job, and he has a new girlfriend.
What I have learned from WC and others in similar situations over
the years is that even though the odds appear against them, miracles
really do happen on all levels. I will always pull those patients out of
deep areas of my temporal lobes to keep an optimistic view for current
and future patients I may be involved with their care.
POLYSOMNOGRAPHY
By Kathy Johnson, R. EEG/EP T., RPSGT
With the upcoming annual meeting in the most magical place on
earth, our topic for this issue is the magical things that happen in our
profession. First of all, I think it is magical just to be an END tech. I
always tell people I would otherwise probably be the greeter at Wal-Mart
or flipping burgers. One of the most magical memories of my life is the
call I got from the neurosurgeon EEGer asking if I wanted the job!
Well, now back to the topic of polysomnography…Everyone in the
field of sleep medicine has experienced over and over the magic of
actually fixing someone’s problem. This was pretty unique to me when we
first added sleep studies to our department. Although I had many years in
the END field, the ability to be a major player in transforming someone’s
life was, and still is, very satisfying. While not all sleep disorders are
curable, having a patient say “you saved my life” after just one night of
CPAP is something sleep techs hear frequently. Of course, END techs have
always contributed to life-changing diagnoses and therapy but were
seldom recognized by the patient as being the one who “cured” them. This
designation was always reserved, and rightly so, for the physicians.
However, even though we don’t write the order for that sleep study, or
June 2007
sign the prescription for that CPAP machine, in the mind of the patients
the tech who was with them through the night is their hero.
Does all this just happen magically? Not really. Often there is a
struggle to convince the patients they need a sleep study in the first
place. They only came to the sleep lab because their spouse insisted.
Then you have to get the insurance pre-certification, and a convenient
date (often rescheduled more than once), and the instructions followed.
Once the diagnosis of sleep disordered breathing is established, you have
to explain what that is and convince them they really have it. Now comes
the discussion of treatment options. Why isn’t there a pill to fix this
problem? Do I have to wear this mask for the rest of my life? Can’t we
just snip out what is blocking my airway? Finally, there is the fitting of
numerous masks to find one they can tolerate and holding their hand
while they become acclimated and overcome their claustrophobia. Now
they are off to bed and to the best sleep they have had for years! Again,
while the physicians play a vital role, it is the sleep tech (and other staff
members) who takes care of all these details (and I say this without fear
of contradiction by the sleep docs—they know a good tech is gold).
So, is there magic in our profession? You bet there is…..mixed with
a lot of dedication, hard work, understanding, patience, and pride in
what we do…..just like all END techs!
TECHNOLOGISTS WORKING ALONE
By Sunday Dale, R. EEG/EP T., CNIM
The suggestion for this newsletter was to “get out those magic wands,
think about some event in your past that has made ‘it’ all worthwhile.”
I am currently working at two different facilities. One is a hospital
performing EEGs on adults. The other is a pediatric neurologist office
performing EEGs on infants and young children. Not only do I have the
contrast of ages between the two facilities, but also two different EEG
equipment manufacturers and two different modes of setting the
patient up.
Therefore, there are numerous events and experiences that have
occurred throughout my career that have made “it” all worthwhile. I
have over 14 years experience working in a major children’s hospital. So,
when I was approached to “help out” until a full time tech could be
found, I said sure! The lab has a lazy-boy type chair that is used for set
up and recording of the patient’s EEG. This type of chair works very well
for teenagers and parents who have to hold their babies. For them it is
very comfortable; however it can be murder on the tech’s back. While
working at the children’s hospital we found that placing the chair on a
raised platform, with casters for easy mobility, will bring the chair up a
good 5 to 7 inches. With the chair up higher, the tech does not have to
bend over so much for the patient set up, which in turn saves the tech
from backaches at the end of the day and everybody is happy. Tomorrow
this lab’s chair will be placed on a platform.
In contrast to the lazy-boy chair, the hospital facility has a
transport type cart for patient setups and recording. The cart
works out very well and does not cause much strain on the tech’s
back because of the adjustable head end of the cart. The tech can
raise and lower the head of the cart as need be for set up and
recording. For carts that do not have adjustable head ends,
pillows can be placed under the mattress to raise the patient’s
head up to a more reachable height for setup and then the
pillows removed for recording purposes. There is always a
remedy for any recording situation when techs know how to take
care of their own needs as well as the patients.
Continued on page 30 E
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29
T HE NATIONAL S CENE
Legislative Issues in Electroneurodiagnostics
By Carrie Ford, R. EP T., R. NCS T. and Dorothy Gaiter, R. EEG T., R. NCS T.
“Hey! That’s my turf!”
A
SET believes that members will
benefit from this new Interest
Section on Legislative Issues in
Electroneurodiagnostics. Licensure bills
from all allied health professions are
being passed in various parts of the
country. Furthermore, other legislation
indirectly and directly is affecting our
field of Electroneurodiagnostics. With
this in the forefront of Electroneurodiagnostics, a new interest section has
come to fruition to aid in keeping ASET
members up-to-date on Legislative Issues
in Electroneurodiagnostics.
The co-leaders of the new interest
section that will feature information on
legislation involving Electroneurodiagnostics (EEG, NCS, IONM, and PSG)
are: Carrie E. Ford, R. EP T., R. NCS T.
and Dorothy J. Gaiter, R. EEG T., R. NCS
T. We have been in the field for many
years and have worked together at the
same facility for about 9 years. There was
a time when Dorothy and Carrie knew
absolutely nothing about legislation or
licensure or the consequences of language
in bills that are being passed by state
legislators. We began as green as the new
grass of spring. It has been a learning
process, and the knowledge that we have
acquired has come from the experience
gained from working on licensure in
Alabama.
With regards to Legislative Issues in
Electroneurodiagnostics,
many
legislation initiatives have come to pass. It
all started in a place called Wyoming and
the loss of identity for the END tech. No
longer were the Wyoming techs able to
practice their profession in the same
manner unless they were under the
authority of Respiratory Therapy. The
Respiratory Therapists of Wyoming
passed a bill without the knowledge of
the END techs that included
Electroneurodiagnostics. Consequently, it
was time for END techs to take a stand.
We remembered that it only takes two
sticks to start a fire and with that we took
on the major task of writing legislation to
protect our field and convinced other
Alabama END techs to join the fight.
Other states have taken similar
initiatives with regards to legislation.
Louisiana, Maryland, and New Jersey
have been successful in passing licensure
for PSG. Michigan and New Jersey have
been successful for passing legislation to
insure that EMG is the practice of
medicine. Other states are taking on the
tremendous responsibility of attempting
to pass legislation in order to protect
various fields of END, including EMG,
EEG, PSG, and NCS. The END field out
of necessity has become proactive and
reactive. No matter if you are proactive or
reactive, END techs and physicians
certainly are involved in fighting to keep
the END field within Electroneurodiagnostics without it being taken over by
other allied health groups.
We would like this interest section to
be an open forum to aid in helping techs
to form their own educated opinions
about Legislative Issues in Electroneurodiagnostics. Whether you are “pro” or
“anti” licensure, each state must take a
stand to protect the END field. We hope
to help you evaluate the situation in your
state and to know how to handle
particular situations with legislative
language and advice. Whether you want
to pass legislation in your state, be a
watchdog for legislative issues, or simply
be an advocate for legislation, we hope to
help you. Remember it all starts with
you…..
Stay tuned as the chronicles of
Legislative Issues in Electroneurodiagnostics continues….. P\
Editor’s Note: : Visit www.aset.org for
the newly created Legislative Issues in
Electroneurodiagnostics online forum.
Interest Section Briefings. Continued
Technologists Working Alone. . . Continued from Page 29
The most important thing about EEG equipment, regardless
of the manufacturing company, is that they all must have specific
common parameters. They must have appropriate high, low, and
notch frequency filter settings, various time frames per
page/epoch/screen, a variety of input voltages for calibrations to
demonstrate high voltage waveform discharges recorded,
required signal to noise ratios, grounding that meets electrical
safety requirements, montages that are common in all
laboratories, also a device for the presentation of photic
stimulation, as well as a means of checking impedances. The
challenge that comes with using different manufacturers’
equipment from one to the other is remembering the icons that
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are used to represent the specific common parameters when
recording! I have overcome this challenge by creating “cheat
sheets.” I have placed on the different pieces of equipment,
laminated cards and notes that I review briefly at the beginning of
each recording period for that facility. This saves me a lot of head
scratching and time wasting when trying to remember, quickly
and off the cuff, which icon to select when I want to make a
change in parameters. These “cheat sheets” worked for me over 20
years ago when I was working with different analog equipments
and they work just as well today with digital equipment.
Yes, every bit of “it” has been more than worthwhile! P
Volume 31, Number 2
CREDENTIALING ORGANIZATIONS
The following organizations administer and
award the R. EEG. T., R. EP T., CNIM,
RPSGT and R. NCS T. credentials to technologists. For specific requirements, including
re-certification, refer to the individual
Websites for the most current updates.
Upcoming ASET Fall &
Winter Seminars
Continued from Page 13
American Association of
Electrodiagnostic Techs [AAET]
CREDENTIAL: R. NCS T.
FOR MORE INFORMATION
Corinne Atkins, R. NCS T., Executive Director
AAET
28 Sabins Lane • North Chatham, MA 02650
508.945.2781 phone/fax
[email protected]; www.aaet.info
American Board of Registration
of EEG & EP Technologists
CREDENTIALS: R. EEG T.®, R. EP T.®, CNIM® and
EEG Laboratory Accreditation
Written exam applications can be requested
by contacting:
Professional Testing Corporation
1350 Broadway, 17th Floor • New York, NY 10018
212.356.0660;
www.ptcny.com [download an application]
FOR MORE INFORMATION
For general information and to obtain oral exam
applications, contact:
Janice Walbert, R. EEG/EP T.
Executive Director
ABRET Executive Office
1904 Croydon Drive
Springfield, IL 62703
217.553.3758; 217.585.6663 fax
[email protected]; www.abret.org
Written exam applications can be requested by
contacting:
Professional Testing Corporation
1350 Broadway, 17th Floor
New York, NY 10018
212.356.0660 phone
www.ptcny.com [download an application]
Board of Registered
Polysomnographic
Technologists [BRPT]
CREDENTIAL: RPSGT™
[Accredited by the National Commission of
Certifying Agencies – NCCA]
FOR MORE INFORMATION
Bobby Stanley, Jr., Executive Director
The Board of Registered
Polysomnographic Technologists
8201 Greensboro Drive, Suite 300
McLean, VA 22102
703.610.9020 • 703.610.9005 fax
[email protected]
Creating a New Dynamic For Our Future
…2007 ASET Election Results
Continued from Front Page
Elected to the ASET Board of Trustees for three-year terms are
Brian Markley,
R. EEG/EP T., R. NCS T., Silver Spring, MD; Kristin Roberts, R.
EEG/EP T., Long Beach, CA; Mark Ryland, MA, R. EP T., RPSGT,
Parma, OH; and Lois Wall, R. EEG/EP T., Durham, NC. Since
Brian Markley was filling out an unexpired board term, he was
eligible to run for another full term. Congratulations to this new
class of board members!
All the new officers and trustees will be sworn in at the July
annual business meeting in Orlando.
June 2007
TRENDS IN ICU, LTM AND REMOTE
MONITORING
November 30 – December 1, 2007
? Sacramento, CA
EARLY BIRD REGISTRATION DEADLINE 10.31.07
This is an advanced practice seminar for
technologists who have extensive
experience in basic EEG and are now
planning to expand their scope of practice
to advanced procedures in ICU and LTM
continuous EEG monitoring. The content
of this seminar will address future trends
in equipment and utilization of
continuous EEG.
By attending this seminar you will:
• Learn about the latest options for
equipment and software to record
continuous neurophysiological
signals;
• Hear fascinating case studies and learn
about clinical applications in a variety
of disease states; and
• Gain the knowledge you need to
accept an expanded role as part of the
LTM/ICU neuro team.
Who should attend?
This seminar is designed for
technologists who are experienced and are
in
continuous
facing
challenges
monitoring of epilepsy and critical care
patients, and for those who are seeking an
educational opportunity for recertification
that will provide an interesting and
inspiring look into our future. P
It is important to also thank the other candidates for their
commitment and dedication to ASET and to this process –
Dorothy Gaiter, Nancy Adams, Kevin McCarthy and Mary
McKinley. We deeply appreciate their interest and support of the
Society.
Another group of individuals that cannot be ignored include
the retiring board members and to Gail Hayden who will serve
as immediate past president on the board for one year. These
individuals have spent considerable time and energy diligently
leading the Society through the years and include Scott
Thurston, retiring secretary/treasurer; Lary Breeding, Sheila
Shelton and Jie Zhang. They will be missed for their wisdom,
humor and keen observations. They will be honored at the
annual conference in July. P
ASETnews
31
READY REFERENCES
The following listings are numbers and
addresses frequently requested from the
ASET Executive Office. They are published
as a service to members.
Illinois Society of END
Technologists
Phyllis Skowron Videtich, President, 2907
Heritage Drive, Apt. 3, Joliet, IL 60435;
815.725.7133 ext. 3824; [email protected]
International & Foreign
END Societies
Indiana Society of END Technicians
& Technologists
Beverly Williams, R. EEG T., President, St.
Vincent’s Hospital, EEG Lab, 695
Moonlight Bay Cir., Cicero, IN 46034;
317.338.3004; 317.338.6816 fax;
[email protected]
Canadian Association of
Electroneurophysiology
Technologists
Kimberly Skanes, RET, RT [EMG], The
Moncton Hospital Electrodiagnostic
Services, 135 MacBeath Ave., Moncton,
NB E1C 6ZB; 506.857.5272;
506.857.5697 fax;
[email protected];
www.caet.org
International Organisation of
Societies for Electrophysiological
Technology [OSET]
Margaret R. Walcoff, M. Ed, R. EEG/EP T.,
CNIM, President; 11 Country Mountain
Road, Asheville, NC 28803; 828.485.2501
work; [email protected]
Regional, State & Local
END Societies
Alabama Society of END
Technologists
Lisa Hill, R. NCS T., President;
205.599.3401;
[email protected];
www.alaset.org
Central Society of END Techs
[CSET]
Patricia Trudeau, R. EEG T., President,
Marshfield Clinic, 1000 N. Oak,
Marshfield, WI 54449; 715.387.5397;
715.387.5727 fax;
[email protected]
Charles E. Henry Society of END
Techs
Steve Erickson, R. EEG T., President,
Epilepsy Monitoring Unit, Strong
Memorial Hospital, Rochester, NY 14642;
[email protected];
www.cehenrysociety.org
Greater New Orleans END Society
Lynn Causey, President, Children’s
Hospital, 200 Clay Ave., New Orleans, LA
70118; 504.896.9596;
[email protected]
32
ASETnews
Iowa Association of END
Technologists
Dawn Byrne, R. EEG T., President, Trinity
Regional Medical Center, 802 S. Kenyon
Rd., Ft. Dodge, IA 50501; 515.574.6189
phone; [email protected]
Michigan Society of END Techs
Connie Kubiak, R. EEG/EP T., CNIM,
President, Munson Hospital, 9239 Vans
Lane, Kingsley, MI 49649; 231.879.3121;
[email protected]
Minnesota END Technologists
Society [METS]
Cindy Nelson, R. EEG T., President, 61923
252 Ave, Mantorville, MN 55955;
507.635.5519; [email protected]
New England Society of END
Technologists
Jack Connolly, R. EEG T., President;
617.355.7847;
[email protected];
www.aset.org/dataview/show/yellow_
pages/12
Puget Sound END Society
Carol Riley, R. EEG/EP T., RPSGT, CNIM,
President, Puget Sound Health Care
System; 206.277.3301;
[email protected]
Southern Society of END
Technologists
Kyle Kalkowski, R. EEG T., President, 8102
Lair Court, Chapel Hill, NC 27516;
919.966.1686; [email protected];
www.sset.org
Western Society of
Electrodiagnostic Technologists
Kristin Roberts, R. EEG/EP T., President;
714.771.8000 ext. 7187; [email protected]; www.wset.org
Wisconsin Society of END Techs
Colleen Helling, R. EEG T., RPSGT,
President, 1413 Terrace Court, Two Rivers,
WI 54241; 920.288.4350 or
920.553.7075; [email protected]
Other Resources
Committee on Accreditation for
Education in Electroneurodiagnostic Technology[CoA-END]
Janet Ghigo, Chair, Rt. 1 Box 59C, Green
Bank, WV 24922; 304.456.3298; [email protected]
Epilepsy Foundation
8301 Professional Place, Landover, MD
20785-7223; 800.332.1000; www.epilepsyfoundation.org
North Carolina Society of END
Technologists
Doaty Flanigan, 170 N. Davidson Dr.,
Winston-Salem, NC 27107;
336.718.5569; [email protected]
Northeastern Society of END Techs
Kathy Curzi, R. EEG/EP T., President, 2028
Country Pl, Bethlehem, PA 18018;
610.867.7183; [email protected]
Ohio Society of END Technologists
Sheryl Nehamkin, R. EEG/EP T., CNIM,
President, 4075 Eastway Road, S. Euclid,
OH 44121; 216.844.2377;
[email protected]
Volume 31, Number 2
WORKSHOPS, COURSES AND SEMINARS
Knowledge Plus, Inc
EEG, EP, IOM, Polysomnography
Courses
P
remier END education company with quality driven and
board focused courses and on-site training for practitioners
seeking INTERACTIVE training experiences. Class size is
kept small to provide individualized attention to all levels of
technologists. Classes held near Chicago with access to all of the
excitement of the city!
Custom Training at YOUR FACILITY. Call for Quotes Today
I Intraoperative Monitoring: Basic & Transcranial Motors
August 16-18, 2007
December 6-9, 2007
I Evoked Potentials
October 11-13, 2007
I EEG Basics to Boards
August 20-24, 2007
November 5-9, 2007
I R. EEG T. Board Preparation
November 10-11, 2007
I R. EP T. Board Preparation
September 8-9, 2007
I CNIM Board Preparation
September 8-9, 2007
I Basic Polysomnography
August 6-10, 2007
I RPSGT Board Preparation
August 25-26, 2007
November 10-11, 2007
I Virtual Classroom: Comprehensive Intraoperaltive
Monitoring
TBD
For detailed training package, custom quotes, and additional
information contact:
Rebecca Clark-Bash, R. EEG\EP T., CNIM
Knowledge Plus, Inc., P.O. Box 356, Lincolnshire, Il 60069
Phone: 815.341.0791 • E-Mail: [email protected]
Larry Head Institute
Electroneurodiagnostic
Education
E
lectroneurodiagnostic technology training
courses in EEG, EEG Board Preparation, Evoked
Potentials and Intraoperative Monitoring are
offered to meet the needs of practicing technologists
seeking additional training or as preparation for registry
exams. Classroom-style format encourages instructorstudent interaction, creating a relaxed learning
atmosphere for all technologists, regardless of the level of
knowledge and experience. For course descriptions,
dates, costs and to even register on-line visit our WEB
SITE: www.larryheadinstitute.com or call/ write to
Larry Head Institute, LLC., 242 Bates Lane, Monroe, MI
48162; 734.240.3383; 734.240.3393 fax; or e-mail
[email protected].
I EEG Fundamentals
July 23 - 28
November 5 – 10
I EEG Board Preparation
August 16 – 18
I Evoked Potentials
October 1 – 5
I EP Board Preparation
September 20 – 22
I Nerve Conduction Studies
July 13 – 14
November 16 – 17
I Nerve Conduction Board Preparation
September 28-29
I Intraoperative Monitoring
Watch website for details and course dates.
I Polysomnography Fundamentals
June 22 - 29, 2007
October 19 - 26, 2007
I Polysomnography Scoring
August 24 - 25, 2007
November 30 - December 1, 2007
I Polysomnography Board Preparation
September 13 - 15, 2007
Announcement Policy - The appearance of meeting, course and workshop announcements in this newsletter does not constitute
endorsement or approval by ASET of the content or quality of the program. Announcements are accepted subject to publishers approval,
must be relevant and may be altered for clarity, style and length. Most events are paid advertising.
June 2007
ASETnews
33
ASET calendar of events
2007
SEPTEMBER
September 5
Conference Call Seminar - Pediatric Developmental Milestones in EEG
September 12
Conference Call Seminar - Digital EEG Concepts
September 19
Conference Call Seminar - The Difference between a Technical Description
and an Interpretation
September 21 & 22
Fundamentals of EEG
EEG Technology: A Comprehensive Review Course
ALASET Updates
The Annual Alabama Society of Electroneurodiagnostic Technologists (ALASET) was held
on Friday and Saturday March 9-10, 2007. Newly
elected officers are:
Allen Lee, R.EEGT . . . . . . . . . . . . . President
Mary Franklin, R.EEGT. . . . . President Elect
Mary Franklin, R.EEGT. . . . . . . . . Treasurer
Shaunda Hamm, R.EEGT. . . . . . . . Secretary
REGISTER TODAY!
September 26
Conference Call Seminar - The Cranial Nerves
OCTOBER
October 3
Conference Call Seminar - Long- Term Monitoring for Epilepsy
October 10
Conference Call Seminar - Evaluation of Patients in ICU with EEG and EP
NOVEMBER
November 7
Conference Call Seminar - The Sleep Apnea Evaluation
November 14
Conference Call Seminar - MSLT and Narcolepsy
November 28
Conference Call Seminar - Sleep Staging and Scoring: Old rules, new rules, no rules
ASET 2007 ANNUAL
CONFERENCE
July 18-21
Nov. 30 - Dec. 1
Trends in ICU, Long Term and Remote Monitoring
EEG Technology: A Comprehensive Review Course
Disney Coronado Springs Resort,
Florida
Please Note: Conference call seminars will take a break for the summer months
See page 15 for more information
about the conference and registration
information or visit www.aset.org
ASETnews
ISSN 0886-5620
ASET
6501 East Commerce Avenue, Suite 120
Kansas City, MO 64120