Dr. Richard T. Atkins Lecture Series
Mark Bromberg, M.D. “The Electrodiagnosis of Primary Demyelination” Ke vin N. Mor ley, R . NC S.T. Morle R. NCS.T ley S.T. “Venoms and Toxins and Their Effect on the PNS” Brett Netherton, MS, CNIM “Intraoperative Monitoring” Sasa Zivkovic, M.D. “Neuromuscular Junction Disorders” Carrie E. For d, R .EP.T., R .NC S.T.. For R.EP.T., R.NC S.T.. ord, .EP.T .NCS.T "Update on Alabama Licensure" Lois Nora, M. D. “ Informed Consent” Asa Wilbourn, M.D. “Lightening Strikes and Other Electrical Injuries” Lawrence R. Robinson, M.D. “traumatic Injuries R obert T. Leshner, M.D. T. Leshner, “Current and Future Treatments for Children with Duchenne Muscular Dystrophy” Kimber le y Butler, R .EP.T., CNIM, R .NC S.T. Kimberle Butler, R.EP.T., ley .EP.T R.NC S.T. .NCS.T “ Interpretation of Data” Other Speakers to be announced
GENERAL INFORMATION
Portola Plaza Hotel 2 Portola PLZ Monterey, CA 93940 (831) 649-4511 Rate: $199. + tax. Monterey Marriott Hotel 350 Calle Principal Monterey, CA 93940 (831) 649-4234 Rate: $189. + tax. Casa Munras Garden Hotel (831) 375-2411 700 Munras Ave Monterey, CA 93940) $149. + tax. Reservations must be made personally. One must say they are with AAET to get the rate. DEADLINE FOR HOTEL REGISTRATION: August August 23, 2005
The Newsletter of the American Association of Electrodiagnostic Technologists
News
June 2005
The AAET News
The AAET News is a newsletter for Electrodiagnostic Technologists, made possible by the professional commitment of the AAET to provide nerve conduction technology to Electrodiagnostic Technologists.
Next Newsletter Deadline
August 15, 2005 Advertising Cost: $200.00 (News & 1 Month Website listing)
SOCIAL EVENT
Thursday, September 22, 2005 5:00pm - 10:00pm Hawaiian Luau Live Band & Beach Party
Officers 2005
AMERICAN ASSOCIATION OF ELECTRODIAGNOSTIC TECHNOLOGISTS
30th Annual Meeting September 21-24, 2005 Monterey Convention Center Monterey, California
Deadline is August 29, 2005 Please check for which you are registering:
$250.00 (Members) $25.00 additional late fee. $300.00 (Non-Members) (Includes admission to all lectures, and AAEM Exhibits. (Includes meeting materials, breakfast, lunch and breaks)
Hands on NCS Workshop - September 21st.
Kimberly Bunch,R.NCS.T. President MaryEllen Burriss, R. EEG/EP T., R. NCS.T. Vice-President Mary M. Javurek, R. NCS.T. Secretary/Treasurer Carlene Murphy, R.NCS.T. Member at Large Deborah Stumpf-Crapse, R. NCS.T. Member at Large Maureen MacNeil,R EMG T.,R. NCS.T. Exam Chair Corinne C. Atkins, R. NCS.T., Newsletter Editor Corinne C. Atkins, R. NCS.T., Executive Director
REGISTRATION FORM
Please Print
Social Event Luau at Adventures by the Sea
$55.00
Monterey Convention Center Monterey, California
NAME: INSTITUTION/CLINIC: ADDRESS: CITY: TELEPHONE: FAX: STATE:
TITLE:
A.A.E.T. Executive Headquarters
28 Sabins Lane North Chatham, MA 02650 Voice & FAX: (508) 945-2781 Web site: AAET.info E-Mail: RTA1@aol.com
Future AAET Annual Meetings
October 11-14, 2006 Washington, D.C. October 17-20, 2007 Phoenix, Arizona
ZIP CODE: E-MAIL:
Mail Registration Form and Check to the AAET - 28 Sabins Lane • North Chatham, MA 02650
R. EDT. Credential changed to R. NCS.T.
Effective January 1, 2005 the R. EDT. has been changed, to “R.NCS.T.” (Registered Nerve Conduction Studies Technologist). This credential clearly states what field the registered technologist has mastered by examination, and this credential clears one of the major hurdles we faced in the accreditation process. All 2005 members of the A.A.E.T. will be sent a new certificate, along with a small wallet size laminated card for easy identification purposes. To optain your new certificate and card, attach a copy of your old certificate with your 2005 membership dues. Those individuals who are not members will be required to pay a $25.00 fee to obtain a new certificate. This notice will be posted on our web site. If there are any questions regarding this matter, do not hesitate to call the Executive Headquarters or email RTA1@aol.com, and we will attempt to answer any and all queries.
ECS “Electrocerebral Silence”
(ECS isn’t just about brain death anymore, or is it? The answer depends on who is defining the term) A look at Physical Therapists and EMG To electroneurodiagnostic/electrodiagnostic technologists, technicians, and neurologists, “ECS” is defined as “electrocerebral silence.” The test to determine brain-death or ECS is an ECS electroencephalograph (EEG) tracing. For years in the world of electroneurodiagnostics (END) and electrodiagnostic (EDX) medicine this term has been the only acronym that we have known—ECS—electrocerebral silence. In the field of END and EDX medicine, the acronym—ECS is also being used by the Physical Therapists (PTs). This acronym is used to define “Clinical Electrophysiology Specialist” or “ECS”, who is a Physical Therapist (PT) who is specially trained to perform the needle electromyography (EMG) study.(1) The American Board of Physical Therapy Specialists or ABPTS allows PTs to specialize seven individual fields of expertise, including Neurologic Certified Specialist (with the credentials of NCS) and Clinical Electrophysiologic Specialist (ECS-for the specialty of EMG).(2) One of the fields of expertise is — needle EMG or as the PT defines it—“electroneuromyography.”(3) Upon successful completion of the ABPTSEMG boards, the PT may use the credentials—ECS following their name. In addition, the PT has proven that they have passed the requirements to perform accurate and quality needle EMG studies. Regardless of who is performing the needle EMG test, the needle EMG has been determined by the American Medical Association, American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation, the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM), the Department of Veterans Affairs (Veterans Administration) and several state medical boards to be the “practice of medicine.”
(4) Why is this? The needle EMG is an extension of the neurological exam in which a fine needle is placed in the muscle and is studied by the electromyographer or EMGer (person performing the needle EMG study or test). EMG studies include but are not limited to the neck and back muscles, leg muscles, facial muscles, arm muscles, the tongue muscle, and even muscles close to the lungs—placing the needle too close to the lung, can ultimately collapse a lung by puncturing it. Only a trained physician has the capability to study these muscles, interpret the muscle’s signals, and accurately place the needle in the muscle without causing damage to the patient. The EMG is an ongoing clinical exam that is not only seen on a screen but is also “heard.” Basically, muscles make noises, in which the EMGer can assess disease processes within the muscles and/or nerve roots. Only a trained physician can accurately distinguish these fine noises and analyze the ongoing waveforms or signals on the screen. The EMG is unique because it is performed in “real time,” and it can only be interpreted and read while the test is being performed and not at a later time, like an X-Ray. During the EMG, the physician makes a diagnosis, which may include: neuromuscular diseases, neck pain, back pain, radiculopathies, neuropathies, myopathies, Guillain Barré syndrome, an entrapment syndrome (such as carpal tunnel syndrome), multiple sclerosis, or even amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s Disease. Depending on the disease process, these patients may need special treatment, bloodwork, surgery, and in some cases, immediate hospitalization. The nonphysician not only lacks the license to practice medicine, but also is deficient in the knowledge, training, skills, and background to be qualified to order the extensive workups needed for further diagnosis, medication, surgeries, treatment and follow-up that is required for the patient’s health. Unlike the needle EMG, the non-invasive END or EDX studies may be interpreted at a later time, such as EEG, evoked potentials or nerve conduction studies. A physician should be available if these results appear to be unusual or unexpected, so that there may be an opportunity to reassess the
Opportunities
Children’s Hospital Boston, ranked #1 pediatric hospital in the country has an excellent opportunity for Electroneurodiagnostic Technologists. We are interviewing for both per diem and full time positions. We offer high quality patient care, a rewarding academic and research work environment, competitive salary, and the opportunity to work closely with some of the finest pediatric specialists in the field. Our state-of-the-art Clinical Neurophysiology Laboratory includes a 4 bed outpatient testing Lab with suburban 1 bed satellite, qEEG(BEAM) center; and a 6-bed (LTME) inpatient Epilepsy Unit. We are currently seeking candidates who have completed EEG/EP training leading to board eligibility and have at least one year of experience administering EEGs/EPs. Strong customer service, commitment to professionalism and the ability to be a team player is essential.. Registration and pediatric background preferred. Experience with evoked potentials, ambulatory EEG, or invasive epilepsy monitoring is a plus. Full time and per diem positions include paid on-call, holiday schedule and occasional weekends. If you are interested in learning more about these position openings please contact Maria G. Gabriel, or send a copy your resume and references to: Children’s Hospital 300 Longwood Avenue Boston, MA 02115 Attn: Maria G. Gabriel Business: (617) 355-4863 Cell: (617) 686-0402 maria.gabriel@childrens.harvard.edu
Electrodiagnostic Technologist
A full time position as an electrodiagnostic technologist performing EEG and EP’s. Training in NCS is recommended, but not required. Excellent health benefits and vacation. Support is offered for education. Resume should be mailed or faxed to: Pamela Jones, Administrator 300 Carew Street Suite #2, Springfield, MA 01104 telephone # is: 413 781-5050 fax: 413 781-2510
Registered Nerve Conduction Studies Technologist
seeking full-time position in Portland, OR. Four years experience performing clinical outpatient evoked potentials and nerve conduction studies in high-volume EMG clinic.
Available early July. Salary negotiable. References upon request. If interested, please contact Greta Miracle @ gretamiracle@hotmail.com for a detailed resume and more information!
differential diagnosis and develop alternative testing strategies. However, if a non-physician performs the needle EMG or interprets any END or EDX tests results, inaccurate diagnosis or interpretations may be dangerous and misleading when returned to the referring physician. To place the patient’s tests results or interpretations in the care of a non-physician is substandard patient care. The differences in the training that the PTEMGer obtains and the MD/DO EMGer obtains are staggering. The following is a comparison between the recommended qualifications to perform the needle EMG of the PT-EMGer and the MD/DO-EMGer: PT-ECS (PT-EMG) minimum qualifications: * 2000 hours of direct patient care in the field of EMG within 10 years * 25% (500 hours) must have occurred within the last 3 years * evidence of “performing a minimum of 500 complete electroneuromygraphy examinations during those hours” * “Applicants must submit evidence of clinical education experience in electrophysiologic testing, preferably under the direct supervision of a clinical electrophysiologist who meets the requirements for specialist certification.” * “Applicants are required to submit actual patient reports that have been completed within the last three years including an entrapment of a peripheral nerve, a proximal lesion, such as a root or a plexus, and a polyneuropathy that demonstrate sampling of at least three extremities.”(5) MD/DO minimum qualifications: * Completion of medical school (4 years) * A neurology or physical medicine and rehabilitation residency accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the Royal college of Physicians and Surgeons of Canada (RCPSC) (usually 3 years) * Period of preceptorship under the supervision of an experienced EDX consultant (MD—American Board of Electrodiagnostic Medicine) which may be taken during and/or after an approved residency training program and must be at least 6 months full-time or equivalent. During the preceptorship, at least 200 complete Electrodiagnostic evaluations must
be performed on separate occasions; these studies must be documented and interpreted. The individual must have experience in neuromuscular disorders in children and adults. * The preceptorship in EDX training should include: anatomy, pathology of muscle and nerve, electrophysiology (instrumentation, quantification, statistical analysis,) and clinical aspects of neurological and musculoskeletal conditions with particular emphasis on diagnosis and treatment of diseases as they pertain to clinical EDX medicine.(6) AANEM states: Competency in EDX medicine can only be achieved with at least 1 year of experience following training during which they must perform an additional 200 complete EDX evaluations on separate occasions.(7) If the patient were given a choice as to whom they would want treat them or interpret their END or EDX test results based on the above criteria, I would bet that the patient would chose the physician to treat, diagnose, interpret test results, and care for them. Sample questions of the PT-EMG boards on nerve conduction studies and EMG may be seen on-line. The exam is “strictly written”; moreover, the 200 multiple choice question exam is converted to a standard score and is “scaled.”(8) It should be noted that no oral boards are mentioned in the outline in order to assess technical ability of the candidate. One may review these sample questions on the website by going to the www.apta.org and then going to the following website and choosing the “2005 information booklet for clinical electrophysiology”: http://www.apta.org/ Education/specialist/ABPTSCert Not one sample question regards the neuromuscular junction, myasthenia gravis, or other neurological syndrome. The Content Outline for the PT-EMG 200 multiple choice exam includes: Electrophysiologic Evaluation 58% Neuromusculoskeletal exam 5% Formulating plan for NCV/EMG 5% Conduct NCV/EMG exam 45% SSEP 2% Kinesiologic EMG 1%
Basic Sciences: 21% Including Anatomy, physiology, kinesiology, and histology Clinical Sciences: 15% Pathology, Pathophysiology, pathokinesiology, pharmacology, clarifying diagnostic procedures, and biomedical instrumentation Another 6% is given to consultation, administration, teaching and research. (9) ABPTS-ECS specialists (PT-EMGers) are well represented throughout the country. Currently in the USA, there are about 100 PTs with ECS credentials.(10)
Arkansas-1 Arizona-1 Alabama-1 Alaska-1 California-4 Colorado-2 Florida-2 Georgia-10 (Columbus 6) Indiana-1 Illinois-2 Iowa-2 Louisiana-1 Kentucky-11 Maryland-3 Michigan-2 Minnesota-1 Mississippi-1 Missouri-1 New Jersey-1 North Carolina-3 New York- 4 Pennsylvania-17 South Carolina-1 Tennessee-5 Texas-3 Virginia-6 West Virginia-1 Utah-1
Washington State -3
As a R.NCST. or Registered Nerve Conduction Study Technologist, I was surprised to learn that PTs have their own boards to perform and interpret the needle EMG and NCS study. These boards also cover SSEP, which was another surprise. It was an eye-opener to review some of their sample questions, and realize that the PTs have published their own books on NCS and EMG. Not only that, but Medicare reimburses PTs for these studies. The AAET NCS (nerve conduction study) boards, written and orals, are well-worded and the content is quite thorough. AAET NCS boards cover disease processes, anomalies, brachial plexus, lumbosacral plexus, waveform recognition, electrophysiology, neuroanatomy, instrumentation, and the list goes on and on. We (R.NCST.) are qualified to perform the non-invasive portion of the NCS, under the supervision of a physicianEMGer. All AAET members and boarded technologists have signed a code of ethics stating that the needle EMG will be performed only by a physician-EMGer. Furthermore, AAET has PTs and chiropractors who maintain R.NCST.
credentials. We trust our physician-EMGers, who interpret our nerve conduction studies, other END studies (EEG, EP etc) , and diagnose patients, and we are proud to work beside them. EMG IS THE PRACTICE OF MEDICINE! In reality, the words electroneurodiagnostic and electrodiagnostic carry a meaning of “diagnosis.” To quote the American Association of Neuromuscular and Electrodiagnostic Medicine “don’t remove diagnosis from Electrodiagnostic medicine. (11) Nationwide, physicians are fighting for patients’ rights and quality health care, which is the bottom line. Physicians should be the only ones legally able to perform the needle EMG study and interpret all END and EDX studies. That is our fight in Alabama. That is the fight in Michigan. State by state the END and EDX physicians will protect those patients and provide quality health care because they, unlike non-physicians, are qualified by nature of their profession as medical doctors to interpret studies and diagnose diseases. EMGs which are being performed and interpreted by non-physicians should be brought to a stop before patients are inaccurately diagnosed with disease processes that are not understood by those who did not go to medical school. PT has deemed EMG and NCS as a “scope of practice” in the rules and regulations of many states and is trying to make this into a law in many states. Patients need to be aware of the problem that is before them. Patients have had END tests repeated due to inaccurate tests results by non-physicians. This is not only uncomfortable for the patient, but it is also costly to the insurance carrier. These patients should understand that duplicate testing, unnecessary testing, and poor and inaccurate diagnosis is the epitome of substandard patient care. I have opened the door for you to look inside a new concept that we all need to be aware of and that is quite prevalent in the field of EDX medicine and END. The most important thing to remember is that no matter how many definitions one can find for “ECS”, the only definition of significance in the field of neuromuscular diseases, neurological disorders, electrodiagnostic medicine and clinical electroneurophysiology remains electrocerebral silence (ECS) or brain-death. Respectfully submitted, Carrie E.Ford, R.EP.T., R.NCST. References: (1-3) www.apta.org (4) www.aanem.org (5) www.apta.org (6-7) www.aanem.org (8-10) www.apta.org (11) AANEM CD/Brochure—“Don’t Remove Diagnosis from Electrodiagnostic Medicine”
American Association of Electrodiagnostic Techs (AAET)
Credential: R. NCS.T. Eligibility Requirements
Technologist must complete an application and enclose a letter of recommendation by supervising physician attesting that the technologist is not performing invasive (needle) examinations and he/she is responsible for interpreting the data. It is recommended that the technologist has successfully completed a two-year college program in END technology or an equivalent of two years of college level classes in math, basic biology, anatomy, physiology and English. Six months of practical training in Nerve Conduction Studies (NCS). It is recommended that this training involve both hands on and theory directly relating to performing NCS, under the direction of either an AAEM board physician or an R. NCS.T.
NCS Written Exams
Fees Appl. Deadline
August 15,2005 October 1, 2005
$275.00 Exam Date
A.A.E.T. Application for Membership
Name: Work Address: Home Address:
Locations :
Birmingham, AL Little Rock, AR San Francisco,CA Phoenix, AZ Los Angeles, CA Denver, CO Miami, FL Atlanta, GA Indianapolis, IN New Orleans, LA College Park, MD Minneapolis, MN New York City, NY Durham, NC Oklahoma City, OK Memphis, TN Houston, TX Seattle, WA Toronto, Ontario Tampa, FL Springfield, IL Iowa City, IA Boston, MA Detroit, MI Kansas City, MO Buffalo,NY Columbus, OH Philadelphia,PA Dallas, TX Norfolk, VA LaCrosse,WI Vancouver, BC
Work Telephone: ( ) Home Telephone: ( ) Correspondence sent to:
The Code of Ethics of the American Association of Electrodiagnostic Technologists adopted: June 27, 2004
Work Home As a Member of the American Association of Electrodiagnostic Technologists, I, by my signature below, subscribe to this Code of Ethics. 1. In my work I will act in a manner so as to merit the respect of the public, those providing medical care to the public, and my fellow Members. 2. I will not at any time perform independent needle EMG examinations. 3. I will not at any time provide a written clinical interpretation derived from the procedure, which I have carried out. 4. I will maintain the confidentiality of any information about any patient, including the results of any tests carried out on the patient. 5. I will treat all patients with the utmost respect and courtesy, regardless of their sex , race, creed, or the nature of their presenting disease. 6. I will strive to achieve excellence in my work, and to assist other technologists to do the same. I understand that in becoming a member of the American Association of Electrodiagnostic Technogists, I am bound by this Code of Ethics, and that I am required to follow rules and regulations established from time to time by the Board of Directors of the American Association of Electrodiagnostic Technologists. If I am found by the Board of Directors of the Association to have violated this Code of Ethics or any rules and regulations of the Association, the Board of Directors may revoke my membership and I may no longer represent myself as a member of the American Association of Electrodiagnostic Technologists. Signed Date
Training in Electrodiagnostic Procedures: Did you receive your training under the direction of a Physician who is an active member of the AAEM? If yes, NAME: Are you currently employed as an electrodiagnostic technologist performing non-invasive nerve conduction studies and/or electrodianostic procedures? How Long? List of Experience that applies to your employment: Date Place Employer
Written exam applications can be requested by contacting: Progessional Testing Corporation 1350 Broadway, 17th FI New York, NY 10018 (212) 356-0660 www.ptcny.com (download an application)
BE ADVISED: One MUST pass the Expiration of Certification/ Registration
There are no regulations in place to date concerning expiration.
WRITTEN examination PRIOR to sitting for the oral.
Total Years of employment as a tech: Approximate # of patients tested monthly Types of Procedures or duties you perform: Motor/sensory NCS’s Evoked Potentials EEG Reflex Studies Ordering Supplies/Scheduling Assisting MD in EMG MD Supervisor of Lab/Office: Signature of MD:
Preparing patient Staff Training Machine upkeep Paperwork Other (explain)
Oral Exams Fee $225.00
Date & Location
June 24-25 Cincinnati, OH Deadline: May 20, 2005 September 23-24 Monterey, CA Deadline: August 15, 2005 December 2-3 Lake Buena Vista, FL Deadline: November 7, 2005
Applications must be requested by calling Executive Headquarters 508-945-2781
Re-Certification
A technologist will be required to meet such requirements as are in effect at that time.
Return the completed application with $75.00 or $375.00 membership dues to:
How do you feel you will benefit by becoming a member of AAET?
How did you hear about our Organization? MEMBERSHIP: Applicants for ACTIVE MEMBERSHIP or ACTIVE MEMBERSHIP BY EXAMINATION shall have had training under the direction of an active member of the AAEM or have been actively employed in the capacity of an Electrodiagnostic Technologist performing non-invasive nerve conduction studies and/or electrodiagnostic procedures prior to application for membership. Applicants must sign the pledge agreeing to comply with AAET’s Code of Ethics. Applicant will be notified of approval. Membership Dues are $75.00 per year , on an individual basis and $375.00 for group of 10 payable to AAET.
For More Information
For general information contact: Corinne Atkins, R. EDT. Executive Director AAET 28 Sabins Lane North Chatham, MA 02650 508.945.2781 phone/fax rta1@aol.com www.aaet.info
A.A.E.T. Executive Headquarters 28 Sabins Lane North Chatham, MA 02650 508-945-2781 • Fax 508-945-2781 Email: RTA1@aol.com WWW.AAET.INFO
Hands on Nerve Conduction Studies Workshops
Cincinnati Hyatt Regency Cincinnati, Ohio June 24-26, 2005 Annual Meeting, Monterey Monterey California September 21st, 2005 Lake Buena Vista Holiday Inn Walt Disney World Lake Buena Vista, Florida December 2-3, 2005
Meeting fee for Workshops is $300. for A.A.E.T. Members Nonmembers $350. Workshops cover all hands-on techniques for studies involving upper and lower extremities, plus special studies, ie., Blink, “H” reflexes and “F” waves, etc. with lectures in theory and application. Certificates of attendance are presented. Hotel reservations must be made personally. Call (508) 945-2781 for further details. 13.5 Ace Credits will be provided for 2 1/2 day workshops; 7.75 for 1 day.
A.A.E.T.
CALL FOR POSTERS
ABSTRACT APPLICATION FORM
A. Name of Primary Author: Address: Name and Address of Secondary Authors:
We would like to share in what YOU are doing in Electrodiagnostics. This possibility is now yours by participation in the AAET Poster Session. Whether you have developed a new technique to record digital potentials, identified rare anomalies, developed methods to obtain artifact-free recordings, or summarized an interesting presentation or procedure, we would all benefit by sharing this with all of us in California. Now is the time to start planning your presentation. Enclosed you will find an application form. We would like to invite you to provide an abstract, a summary of your presentation in approximately 50-150 words. With this information we will assemble a booklet 2005 abstracts which will be included in your registration package. If approved meeting registratiion is free. The fee of the social is not included. Please submit your abstracts by July 31, 2005, to provide sufficient time for collation of the information to make it available for the program. Please send applications and abstracts to the: Executive Headquarters 28 Sabins Lane North Chatham, MA 02650 Voice & FAX: (508) 945-2781 E-Mail: RTA1@aol.com
Phone - Work
Home
B. Abstract
**Note: Abstract is to be typed; not less than 50 words, nor greater than 150 words. 1. Title: 2.Description:
C. Estimated space required for poster presentation: (wide) by high (specify inches or cm) Please submit original NO LATER THAN July 31, 2005 SIGNATURE: DATE: