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Record Review

American Board of Registration of Electroencephalographic and Evoked Potential Technologists, Inc
Oral and Practical Examination for EEG Registration

RECORD REVIEW SECTION

Revised 01/2006

The expectations for safe and effective performance of this task are outlined in the EEG Practice Analysis, Domain I, T-1; Domain II, T-4, T-5, T-6; Domain IV, T-3.

The Record Review Section evaluates the candidate's 1) record quality and compliance with technical standards, 2) selection of recording techniques and parameters, and 3) discussion of electroencephalographic findings. During a one hour session, the candidate is expected to present, review, and discuss with the examiners, two abnormal EEG tracings that are representative of his or her best work.

Prior to the examination, the candidate selects two records that he/she has personally and independently set up and recorded, and brings those records to the examination. In order to pass the exam, the records must meet the following requirements.

Two records with distinctly different abnormalities, at least one having a clear focal abnormality.

The focal abnormality may occur in association with other findings but should be the predominant abnormality. Be prepared to discuss all aspects of the recording, including other abnormal components, normal variants and stages of sleep. An abnormality must be unequivocal. Patterns of questionable clinical significance are not permitted. Please remove patient identification. However, a history and the patient's age are necessary. Patient confidentiality must be respected, in compliance with HIPAA regulations. Please note that the candidate is expected to redact as much patient identification as possible; however, it is understood that in some instances, information cannot be removed, and so a Business Associate Agreement should be entered into with the hospital. A model Business Associate Agreement is available upon request.

Records may not have been used for a different Record Review examination.
Do not bring records which demonstrate cerebral death or status epilepticus, are neonatal, surgical, ambulatory, or long-term epilepsy monitoring.
Breach rhythm is not considered an acceptable focal abnormality.

The Examination Process

The examination begins as soon as the candidate enters the examination room. During the one hour session, the candidate reviews both records with the examiners for compliance with the mandatory requirements. In addition, and in order to pass the examination, the candidate must correctly 1) respond to questions regarding patient history and reasons for testing, 2) identify patterns and findings, 3) localize activity, 4) explain uses of recording parameters, montages, and activation procedures, and 5) be able to discuss the basic concepts of digital technology if a digital record is presented, and analog technology if an analog record is presented, including calibration and bio-calibration. Rulers will be provided. The candidate is expected to use appropriate terminology when describing and localizing activity.

Two examiners are in the room with the candidate through most of the examination, while the Section Director enters the room at random intervals to monitor examination progress. The records are kept by the examiners for up to 30 minutes after the candidate has completed the section. Candidates should retain the EEGs used in the Record Review section until the results of the examination are received and final.

EXPECTED TECHNICAL STANDARDS FOR RECORDS

The recordings must be interpretable.
Records must have been recorded within twelve months prior to the examination.
Each record must contain a minimum of sixteen channels of EEG.
Inter-electrode impedances (not greater than 5000 ohms) must be documented on record (either written or electronically).
Required documentation: Patient Age, Date, Tech Name or ID. Records should be labeled Record One and Record Two.
Required documentation: Time of Recording, Time and Date of Last Symptom or Event, Behavioral State of Patient, Medication, Summary of Relevant Medical History.
Records must not contain any patient information beyond the required documentation. If all other patient information cannot be removed, a Business Associate Agreement should be entered into with the hospital.
For Analog Recordings: Calibration must be performed. Square wave at beginning with standard settings, square wave at end and including all settings, bio-calibration at beginning. Calibration acceptable (signal variability +/- 5%): Amplitude, Input Voltage, Time Axis, Pen Damping, Electrical Baseline, Mechanical Baseline, Bio-calibration equal in all channels.

For Digital Recordings: Digital recordings may be printed out and bound or placed in a binder. Loose pages are not acceptable. Recording must display both voltage and time calibration marks. If meaningful calibration or bio- calibration is not available, ideally the first 30 seconds of recording should be observed by the technologist from the primary system reference montage.

Alternatively, candidates may bring a laptop computer to the examination and will be responsible for adequate operation of the equipment and display of their records. Identical guidelines apply. No technical support will be provided by ABRET or the examination site. Candidates may bring a hard copy backup.
A standard sensitivity 5-10 µv/mm and adjusted as needed.
A standard low frequency filter not greater than 1 Hz (time constant of .16 seconds) and adjusted as needed.
A standard high frequency filter 70 Hz, and adjusted as needed.
A standard paper speed 30mm/sec or a digital display of 10 seconds/page is required, and may be adjusted appropriately.
The 60 Hz filter should be used appropriately.
Any artifacts should be corrected or monitored, as necessary.
At least 120 pages or 20 minutes of EEG activity, not including instrument calibration or bio-calibration is required. Remontaged pages may not be used to lengthen a record that is less than 20 minutes in duration.
At least one bipolar and one referential montage should be recorded.
Montages must be complete and appropriate to demonstrate abnormality.
There should be at least one period of eye opening/eye closure.
Hyperventilation should be performed and acceptable with effort noted, or contraindicated.
Photic stimulation should be performed and acceptable, or contraindicated.
An adequate sleep recording should be attempted, obtained, or not needed.
Visual, auditory, or somatosensory stimulation used and documented, as appropriate.
The paper speed, sensitivity, filters, and montages clearly identified on the record and at times of change.
Patient's state and/or level of consciousness (awake, drowsy, sleep, comatose, etc.) and any changes, should be clearly noted on record.
Complete descriptions of patient events, movements, stimulation, and tech instructions should be clearly noted on the record at the time of occurrence. Examiners will not review video files on EEG recordings.
Clear documentation of patient's maximal level of alertness must take place at some time during recording.
Records (analog or digital) must be recorded continuously without deletion of pages or demonstrate a continuous time and montage sequence as recorded.
At the candidate's discretion, a few additional digitally reformatted pages may be included to better demonstrate the abnormality.