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)
2. Spontaneous (a.k.a.Triggered)
· EEG (Electroencephalography)
· NCV (Nerve Conduction Velocity)
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.
Please contact Dr. Golden for a list of possible internships in the area of neurological diagnosis and monitoring.
THE SOME USEFUL WEBSITES TO PROVIDE ADDITIONAL
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
Special thanks to Diana Chen and Dr. Møller for their contributions in the collection and organization of information on this webpage!!