FREQUENTLY ASKED QUESTIONS ABOUT THE:
“NEUROLOGICAL DIAGNOSIS AND MONITORING
SPECIALIZATION AREA”
WHAT
IS INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING?
Intraoperative
neurophysiologic monitoring (IONM) is a technique that is directly aimed at
reducing the risk of neurological deficits after operations that involve the
nervous system. IONM is a technique that has evolved during the last two
decades; it makes use of recordings of electrical potentials from the nervous
system during surgical operations. The
use of IONM offers a possibility to detect injuries before they become so
severe they cause deficits after the operation. Introduction of IONM has
reduced the risk of debilitating deficits such as muscle weakness, paralysis,
hearing loss, and other loss of normal body functions. IONM is normally
performed by technologists supervised by a physiologist, or a neurologist.
Technologists are not permitted to make interpretations of recorded potentials
and give information to the surgeon; the supervising physiologist does that. It
is necessary to have certification to do IONM. Similar techniques as used in
IONM are now used in a few kinds of operations for guiding the surgeon in an
operation to help obtain the best results.
The
recommended Neurophysiological
Diagnosis and Monitoring Degree Plan in the Masters Program
in Applied Cognition and Neuroscience (ACN) will provide you with the
necessary coursework and background knowledge to pass the non-clinical component
of the IONM certification exam. Professor
Richard Golden is the ACN Program Head. One of the founders of IONM, Professor
Aage Moller teaches a two course sequence Intraoperative Neurophysiological
Monitoring I (Spring) and Intraoperative Neurophysiological Monitoring II
(Fall) which covers much of the material required to pass the certification
exam. IONM students should also take basic coursework in Systems Neuroscience
and Functional Human Neuroanatomy as well.
In order to take the
exam, however, you need to have a certain number of hours of clinical IONM
experience.
CERTIFICATION
PROGRAMS FOR INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING
The American Society for Electroneurodiagnostic
Technologists (ASET) provides certification for technologists and the American Board of Neurophysiologic Monitoring
(ABNM) provides certification for neurophysiologists regarding
interpretation of the recoded potentials. Technologists usually work for a
group that perform IONM to which hospitals contract IONM service. These groups
obtain the necessary privileges
to service the hospitals with which the group in question have a contact.
WHAT IS
REQUIRED TO BECOME CERTIFIED IN IONM?
The
coursework in the ACN program, especially IONM 1 and IONM 2, provides the
necessary theoretical background and relevant neurophysiologic and anatomical
background for the ASET certification. However, you must be the primary
technologist to perform IONM in 100 distinct surgical cases before you can take
the IONM certification (or registration) exams. The only way you can obtain
this experience is to work for a group who provide monitoring services. Only in
rare cases do hospitals employ technologists for IONM directly. The monitoring
group will provide information about record keeping for the purposes of
correctly documenting your surgical case experiences.
WHERE
MIGHT A STUDENT OBTAIN CLINICAL EXPERIENCES IN IONM?
Many hospitals and companies have facilities to support IONM
clinical experiences. However, such hospitals and companies are under no
obligation to provide such clinical experiences to students. Students must
actively obtain approval and support to pursue clinical experiences from
sponsoring monitoring groups. Presently UTD has a contract with Medical Center
of Plano that allows students to get Internship experience if the student can
get permission from a Technologist servicing the Hospital and a sponsoring
Physician. In Theory, if a student takes two semesters of Industry Internship
(3 Credits each semester) they will be able to obtain the hands on experience
that is required to for taking the CNIM Certification Exam to become a
Certified IONM Technologist. Exam information can be found at the website: www.aset.org (also see: www.ptcny.com).
Certification in interpreting results
of IONM that is provided by ABNM includes a written exam (250 multiple choice
questions) and an oral exam. To be eligible for taking the written exam, the
candidate must have a minimum of an earned master’s degree in a physical science,
life science or clinical allied health profession from an accredited
institution, been active in IONM for 3
years experience documented IONM in 300 operations, and two letters from
surgeons attesting to the candidate’s experience. Information can be obtained
at http://abnm.uchicago.edu/ or http://abnm.info,
or www.ptcny.com.
Individuals who have the ABNM cerification (diplomats) have the title of DABNM.
Some services
are:
·
Auditory
Brainstem Responses
·
Evoked
Potentials (EP):
1. SSEP (Somatosensory)
2. MEP (Motor)
3. TceMEP (Transcranial electric)
·
EMG
(Electromyography)
1. Free-run
2. Spontaneous (a.k.a.Triggered)
·
EEG
(Electroencephalography)
·
NCV
(Nerve Conduction Velocity)
Common specialties:
Neurosurgery
Orthopedic surgery
Neurosurgical Trauma
Microneurosurgery
Vascular surgery
MALPRACTICE INSURANCE
In some cases, an intern may be required to obtain
Malpractice Insurance ($29/year for one year as a Bio-Med Tech Student) which
includes
$1 million/$3 million limits of liability. Please viste
the website HPSO (Health care Providers Service Organization) or
call 1 (800)982-9491.
INTERNSHIPS
IN NEUROLOGICAL DIAGNOSIS AND MONITORING
Please contact Dr. Golden for a list of possible internships in the area of neurological diagnosis and monitoring.
WHAT ARE
THE SOME USEFUL WEBSITES TO PROVIDE ADDITIONAL
Resources
1) Dr. Møller’s book (used in ACN coursework)
entitled: Intraoperative
Neurophysiological Monitoring (Human Press). A copy of this book may be
found in the Dean’s Office. Dr. Golden also has a copy of this book in his
office.
2) There is an on-line education link on the ASET Website. Contact Dr. Møller for information regarding how to login
to the link.
4) Medline
Plus
7) Bone Tumor Information
Resource
8) Neuromonitoring
from Wikipedia
Societies
1) American Society of
Electroneurodiagnostic Technologists
2) American Society of
Neurophysiological Monitoring
3) International Organization of
Societies for Electrophysiological Technology
4) American Clinical Neurophysiology
Society
Board
Certification/Registration
Special thanks to Diana Chen and Dr. Møller for their contributions
in the collection and organization of information on this webpage!!