FREQUENTLY ASKED QUESTIONS ABOUT INTRAOPERATIVE NEUROPHYSIOLOGICAL
MONITORING
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.
HOW
CAN THE MASTERS PROGRAM IN APPLIED COGNITION AND NEUROSCIENCE PREPARE ME FOR A
CAREER IN INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING?
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):
o
SSEP (Somatosensory)
o
MEP (Motor)
o
TceMEP (Transcranial
electric)
·
EMG
(Electromyography)
o
Free-run and Spontaneous
(a.k.a.Triggered)
·
EEG
(Electroencephalography)
·
NCV (Nerve Conduction
Velocity)
Common
specialties:
Neurosurgery
Orthopedic surgery
Neurosurgical Trauma
Microneurosurgery
Vascular surgery
WHAT ARE THE
PREREQUISITES FOR OBTAINING A CLINICAL IONM EXPERIENCE?
First: Students should
meet with Dr. Golden and/or Dr. Møller for Industry Internship guidance.
Second: Intern must obtain
Malpractice insurance $29.00 for one year as a Bio-Med Tech Student, the
plan includes $1million/$3million limits of liability, visit website HPSO (Health care Providers Service Organization)
or call 1 (800)982-9491.
Third: Must be familiar
with the following IONM presentation IONM Program powerpoint, HIPPA
Regulations and ASET
competencies.
Fourth: Student Obligation Checklist should be carefully reviewed and
all items checked off. Dr. Golden must
sign this checklist.
Fifth: Students are
responsible for contacting outside organizations to participate in
intraoperative monitoring experiences (“hands on” or “observing status”).
Presently, the only participating Hospital is Medical Center of Plano (interns
only) and
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!!