Nature of the Work:
Neurologists use electroencephalograms to help diagnose the extent of injury for patients suspected of having brain tumors, strokes, toxic/metabolic disorders, or epilepsy; to measure the effects of infectious diseases on the brain; and to determine whether individuals with mental or behavioral problems have an organic impairment such as Alzheimer's disease. Surgeons use them to monitor the patient's condition during major surgery. EEG's are standard in intensive care units as well, since absence of electrical activity in the brain is a basis for determining that a patient is clinically dead, or is used to assess the prospects for recovery of patients in a coma.
More sophisticated equipment is used for special EEG procedures, including ambulatory monitoring. Evoked potential studies, nerve conduction studies, sleep studies, and brain wave mapping are other neuro-diagnostic procedures often conducted by the EEG technologist. Tests such as these improve the physician's ability to detect the underlying reasons for a wide variety of troubling conditions.
Ambulatory monitoring is used to check the activity of the brain over a 24-hour period. Some-limes, in cases where patients experience dizzy spell or sudden blackouts, brain waves may appear perfectly normal until the onset of symptoms. By monitoring such patients for an extended period of time, there is a better chance of detecting abnormal brain wave patterns. Evoked potential studies aid in the evaluation of the visual, auditory, and other sensory systems of the body, and in the diagnosis of chronic diseases like multiple sclerosis. Nerve conduction studies are used to evaluate muscle and nerve problems such as carpal tunnel syndrome.
Sleep studies have proven valuable in the treatment of sleep disorders, impotence, and some cases of hypertension. Brain wave mapping involves the use of computer- generated images of brain function; it is simply an enhancement of the EEG, in which a color-coded picture or map shows the intensity of brain waves in different areas of the brain.
The people who operate electroencephalographs are called EEG technologists or technicians. The term technologist is generally used for workers who are registered or certified and technician for those who are not. With the introduction of additional tests and instruments that measure the electrical activity of the brain, new job titles are coming into use. Among the most common are electro-neurodiagnostic technologist and neurophysiologic technologist. In some places, these workers are simply known as diagnostic technicians. It may take years, however, before another term replaces EEG technologist in standard usage.
It is not just job titles that are changing with the development of new ways of monitoring and evaluating the functioning of the nervous system. Job duties and skill levels are changing as well. Proficiency in operating basic EEG equipment is becoming little more than the entry level skill for jobs in this field; additional training is necessary for personnel who perform special EEG procedures.
Before EEG technologists produce electroencephalograms, they take a short medical history and help the patient relax. Then they apply electrodes to designated spots on the patient's head and body and make sure that the instruments are working correctly. The technologist chooses the most appropriate combination of instrument controls and electrodes to produce the kind of record needed. Technologists must recognize and correct any artifacts that appear, an artifact is an electrical or mechanical event that comes from somewhere other than the brain, such as eye movement or interference from electrical sources. Mechanical problems with the electroencephalograph are reported to the supervisor, so that the instrument can be repaired promptly.
The first step in conducting a special procedures EEG is essentially the same as that for a resting EEG, attaching electrodes to the patient's body. However, electrodes for a resting EEG are secured at various places on the scalp, whereas a special procedures EEG may require that electrodes be secured on the chest, arm, leg, or spinal column as well, to record activity from both the central and peripheral nervous systems.
In the procedure known as ambulatory monitoring, activity of the heart as well as the brain may be monitored while the patient carries out normal activities over a 24-hour period. Once the monitoring time has elapsed, the technologist removes the small recorder fastened to the patient's side and feeds the recorded information into a special machine which transforms the digital recordings into hard copy EEG tapes. The technologist reviews the tapes, a process which can take several hours, selecting sections for the physician to examine.
In order to determine which sections merit attention from the physician, the technologist must be able to distinguish between normal and abnormal brain wave patterns.
Whereas ambulatory EEG's measure general brain wave activity, evoked potential testing uses a special machine to measure sensory and physical response to specific stimuli. After the electrodes have been attached properly, the technologist sets the instrument for the type and intensity of the stimulus. If there is no reaction, progressively stronger stimuli are applied until the patient reacts. Once there is a reaction, the sensation level is noted.
Additional stimuli are applied until the technologist decides an adequate reading has been taken. The technologist may spend anywhere from 1 to 4 hours with the patient when an evoked potential test is being run.
Increasingly, technologists are called upon to set up and monitor EEG's and evoked potential tests in the operating room. Surgical monitoring requires that technologists be well versed in anesthesia and its effect on brain waves, so that they can alert the surgical team when readings from the EEG instrument suggest a change in the patient's recording.
The procedure known as nerve conduction is used to diagnose muscle and nerve problems. The technologist prepares the patient for the 1-hour exam by placing electrodes on the skin above a nerve and on the skin above the muscle. Then the technologist operates a machine that stimulates the nerve with an electrical current and records how long it takes the nerve impulse to reach the muscle.
By comparing the patient's muscle reaction reading to normal and abnormal charts, the technologist provides the physician with information that may lead to a diagnosis. Nerve conduction studies are often performed in conjunction with electromyography's (EMG's); however, a physician performs the actual EMG since it involves needle insertion.
Sleep studies and brain wave mapping arc examples of other diagnostic procedures administered by specialized EEG personnel. Sleep studies require technologists to be competent in monitoring respiration and heart activity in addition to brain wave activity. Technologists must know the various stages of sleep, the average length of each stage, and the characteristic functioning of the neurologic and cardiopulmonary systems during each stage. When all the necessary readings have been taken, the technologist coordinates readings from the various organ systems, separating them according to the various stages of sleep, and relays them to the physician. Brain wave mapping requires the technologist to decide which sections of the EEG should be transformed into color-coded pictures of brain wave frequency and intensity, for examination by a physician.
Technologists must know how to recognize changes in the patient's neurologic, cardiac, and respiratory status. To react properly in an emergency, they must understand the kinds of medical emergencies that can occur while they are taking the EEG. For example, if a patient suffers an epileptic seizure in the EEG laboratory, the technologist must be prepared to take the proper action.
Besides conducting EEG's, technologists may have supervisory or administrative responsibilities. They may, for example, manage the EEG laboratory, arrange work schedules, keep records, schedule appointments, order supplies, and provide instruction in EEG techniques.
In some hospitals, job duties are not confined to electroencephalography. EEG technologists perform EEG's and other kinds of procedures as well. To acquire the requisite skills, technologists are cross-trained to handle several different machines.
Working Conditions:
EEG technologists usually work in clean, well-lighted surroundings, and spend about half of their time on their feet. A lot of bending is necessary, as they may work with patients who are unruly or very ill and require assistance.
A 5-day, 40-hour workweek with some overtime is normal, although some hospitals require EEG technologists to be on call after hours and on weekends and holidays. These employees generally work during the day, but those involved in sleep studies may work evenings and nights.
Employment:
Most Electroencephalographic technologists' jobs are in hospitals, but other health care settings are gaining in importance. EEG technologists work in neurology laboratories, offices of neurologists and neurosurgeons, group medical practices, health maintenance organizations, urgent care centers and clinics, and psychiatric facilities. Most technologists work full time.
Training, Other Qualifications, and Advancement:
EEG technologists generally learn their skills on the job, although some complete formal training programs. Applicants for trainee positions in hospitals need a high school diploma. Often, EEG trainees transfer to the neurology department from other jobs in the hospital, such as laboratory aide or licensed practical nurse.
Formal training is offered at the postsecondary level by hospitals, medical centers, community colleges, vocational-technical institutes, and colleges and universities. Programs usually last from 1 to 2 years and include laboratory experience as well as classroom instruction in neurology, anatomy, neuroanatomy, physiology, neurophysiology, clinical and internal medicine, psychiatry, and electronics and instrumentation. Graduates receive associate degrees or certificates.
Credentials for EEG personnel are available through the American Board of Registration of Electroencephalographic Technologists, which awards the title Registered EEG Technologist to qualified applicants. This board also accredits technologists in the subspecialty of evoked potential as Registered Evoked Potential Technologist. Although not generally required for entry level jobs, registration indicates professional competence, and usually is necessary for supervisory or teaching jobs.
Persons who want to enter this field should have manual dexterity, good vision, writing skills, an aptitude for working with electronic equipment, and the ability to work with patients as well as with other health personnel. High school students considering a career in this occupation should take courses in health, biology, human anatomy, and mathematics.
EEG personnel in large hospitals can advance to chief EEG technologist and take on increased responsibilities in laboratory management and in teaching basic techniques to new personnel or students from EEG training programs. Chief EEG technologists generally are supervised by a physician - an electroencephalographer, neurologist, or neurosurgeon.
Job Outlook:
Employment of EEG technologists is expected to grow much faster than the average for all occupations, reflecting greater use of the EEG and related neurodiagnostic tests and the willingness of health insurers and others to pay for them. Nonetheless, most job openings will result from the need to replace workers who transfer to other occupations or leave the labor force entirely.
Continued acceptance of the value of the EEG is expected to sustain demand for the workers who perform these tests. Moreover, further advances in clinical neurophysiology are a virtual certainty, and these are likely to spur demand by expanding the uses of neurodiagnostic testing.
The rate at which this field expands will also be governed by the willingness of third-party payers to pay for neurological testing. EEG laboratories, which offer outpatient as well as inpatient testing, have become revenue centers for hospitals inasmuch as outpatient services are fully reimbursed at present. Some hospitals have expanded their EEG laboratories, adding space and hiring additional personnel. Nonhospital providers have responded to incentives in the reimbursement system as well, expanding the range of EEG procedures they offer and creating more jobs for EEG technologists.
Since job growth through the year 2000 is expected to be very rapid in outpatient settings, including offices of neurologists, medical group practices, and health maintenance organizations, opportunities are likely to be especially favorable in those settings. Opportunities for individuals who have a background in EEG technology will be excellent Hospitals and other employers prefer to hire individuals with some formal preparation.
EEG technologists in hospitals receive the same benefits as other hospital personnel, including paid vacations, sick leave, health insurance, and pensions. Some institutions provide tuition assistance, uniforms, parking, child care, and other employee benefits.
Related Occupations:
Related occupations in supervised health care activities are audiometrist, electrocardiograph technician, clinical laboratory technician, occupational therapy assistant, surgical technician, physical therapy aide, and psychiatric aide.
