National Competency Skill Standards For Performing Magnetoencephalography (MEG)

Magnetoencephalography (MEG) Specialists practice in accordance with the facility policy and procedure manual which details every aspect and type of recording.

ASET – The Neurodiagnostic Society presents this document to provide the national criteria for evaluating competencies for technologists performing a Magnetoencephalogram (MEG). The technical components include those defined in the American Clinical Magnetoencephalography Society Clinical Practice Guidelines 1–4 published in August 2011 published in the Journal of Clinical Neurophysiology, Volume 28, Number 4.

Section I: MEG Core Knowledge Statements

The neurodiagnostic technologist who performs MEG (referred to as MEG Specialist in this document) has the knowledge base to interact with the patient and obtain a quality, interpretable MEG recording that will yield information about the brain’s neuronal activity. The MEG Specialist possesses the appropriate knowledge level of diseases to correlate patient history and clinical symptoms to determine appropriate paradigms to be performed during the MEG.

Technical Skills and Other Abilities:

1.1 The MEG Specialist provides a safe recording environment by:

• Verifying identity of patient (using two patient identifiers).
• Disinfecting electrodes1 after each procedure or using disposable products.
• Following standard precautions for infection prevention1 according to facility policy and procedures.
• Attending to patient needs as established by facility policy and procedures.
• Recognizing/responding to life-threatening situations.
• Maintaining certification in Basic Life Support (BLS) and following facility policy and procedures for respiratory or cardiopulmonary crisis.
• Following HIPAA policy and facility procedures for cybersecurity and safety of electronic records.
• Following facility policy and procedures for sedation.
• Complying with facility policy and procedures for emergency and disaster situations.
• Complying with hazardous material handling procedures.
• Maintaining instrument/equipment in good working order.
• Taking appropriate precautions to ensure safety.
• Having patient change into gown, paper pants, etc.
• Ensuring all metal has been removed from the patient’s body.

1.2 The MEG Specialist establishes rapport with the patient and the patient’s family by:

• Using personal communication skills to achieve patient relaxation/cooperation.
• Explaining all test procedures including activation procedures.
• Explaining the electrode application method (paste, collodion, etc.).
• Interacting on a level appropriate to patient’s age and cognitive ability.
• Maintaining respect and patient confidentiality.

1.3 The MEG Specialist evaluates the patient to:

• Determine the patient’s mental age, mental state and comprehension level.
• Note the patient’s overall physical condition.
• Determine appropriate method of electrode application.
• Ascertain the patient’s capacity to cooperate with activation procedures.
• Accommodate for disabilities or special needs.
• Determine the need for additional physiological monitors.
• Document unusual or inappropriate behavior suggestive of seizure or psychogenic nonepileptic event.
• Determine the possible need for restraints or emergency intervention.

1.4 The MEG Specialist prepares patient demographics that include:

• Patient’s information (name, age, ID number, referring physician, etc.).
• Recording time, date and Specialist’s name or initials.
• Pertinent patient history and familial medical history.
• Previous EEG reports.
• Current medication/sedation and time of last dosage.
• Time of last meal.
• Time, date, aura and circumstances of last seizure or symptoms.
• Patient’s mental, behavioral and consciousness states.
• Diagram of skull defects or anomalies (if any).
• Diagram of any modifications in electrode placement.
• Note head size in relation to helmet.
• Note if head rest is removed.
• Diagram of head location if moved to each side, front or back of sensor helmet.
• Note if there is non-removable metal in the body.
• Note VNS settings prior to turning the system off.

The MEG Specialist’s electrode application follows a method that includes:

• Following American Clinical Neurophysiology Society (ACNS) guidelines for head measurement, utilizing the International 10–20 and 10–10 Systems for electrode application. Properly cleaning the electrode site to reduce skin impedance prior to scalp electrode application.^{2, 3}
• Applying surface electrodes with EEG conductive paste or with collodion and electrolyte.
• Verifying surface electrode impedances measure below 10 kΩ and are balanced.
• Verifying when sterile, disposable subdermal needle electrodes are used, impedances measure below 10 kΩ.
• Applying additional electrodes to record ECG and EOG.