Pruning EEG Waves
Analyzing EEG is both an art and a science. Each waveform has different shapes, patterns, and frequencies, making attention to detail of utmost importance. To the untrained eye, an EEG is just a bunch of lines on a paper, but to understand the elements of an EEG and analyze its waveforms requires years of training and experience. An EEG pruning technologist is one of the first people to study and analyze the EEG data and helps the neurologist or epileptologist to identify potential abnormalities.
The Value of a Pruning Technologist
Pruning technologists are experienced medical professionals who analyze EEG waveforms and condense, or “prune” long term video EEG studies into preliminary results for the ordering physician to review. Pruners play a critical role in assisting neurologists and epileptologists in the diagnosis of seizures and seizure-like disorders by reviewing hours of EEG and video footage and highlighting any potential abnormalities.
Pruning technologists typically have worked in the field of EEG for 5-10 years before obtaining their registry (R. EEG T.) through The American Board of Registration of Electroencephalographic and Evoked Potential Technologists, Inc. (ABRET). Many of Stratus’ pruners hold advanced certifications such as Certification of Neurophysiologic Long-Term Monitoring (CLTM) and NeuroAnalyst (NA-CLTM) as well. Technologists take part in EEG pattern review sessions, EEG conferences, and online EEG courses to stay up to date on the knowledge needed to analyze EEG waveforms. They must also work within the scope of ASET’s pruning guidelines and adhere to all HIPAA, company confidentiality, and codes of conduct.
There are several commercially available software products for spike and seizure detection that improve in quality every year, and these may significantly increase the efficiency of both technologist and physician review in terms of time. But as of today, none have reached the point of entirely replacing human review – and even if that standard were achieved, a technologist and physician review of the video in combination with the EEG would still be required for the most accurate identification of EEG findings. Artifacts, normal variants, and seizures may all benefit from simultaneous EEG and video review by the pruning technologist.
The Value of a Pruned Report
Pruners review the raw EEG data and corresponding video as well as any patient logs/notes. Then they abbreviate it so that physicians can focus strictly on the abnormal parts of each study. A pruned report may reduce the burden of reading long-term EEGs and allow the neurologist to focus on diagnosing the patient accurately and more efficiently. Furthermore, the likelihood of under reads and the corresponding inaccurate diagnoses may be reduced when you have a pruned report. Technologists are trained to highlight any questionable activity for review, and the physician reader can be confident in the pruned exam as multiple sets of experienced eyes have reviewed the exam. At Stratus, pruners provide the neurologist with a thoroughly pruned exam and a detailed report, typically within 3-5 business days. With every study, the physician always has the option to go back and review any or all of the raw EEG data.
It’s All in the Details
It is critical for an EEG pruning technologist to become well-versed with the identification of normal EEG variants before interpreting abnormal wave forms. This takes years of training and experience working alongside other well-trained techs and neurologists to spot the differences. However, even the smallest spike or sharp wave could help a neurologist determine what is happening with the patient. That is why paying attention to the details is vital for pruners. Misinterpretation of the EEG can lead to overdiagnosis of epilepsy and unnecessary prolonged treatments with anti-epileptic drugs. On the other hand, underdiagnosis due to the wave forms not being highlighted or interpreted as abnormal can cause years of suffering with no help for the patient.
Stratus is committed to ongoing training and offers free CEU credits for EEG Technicians and Pruning Technologists through our yearly EEG U program.