EEG reviewing/recording strategy

Accurate interpretation of EEGs requires the ability to detect, identify, and correctly characterize waveforms. Both technologists and reviewers can easily be lulled into a false sense of complacency when using digital recording. They may believe that rapidly optimizing the appearance of the EEG while it is being recorded or initially reviewed is not that important because an unlimited number of adjustments can be made later. Unfortunately, subtle EEG abnormalities may be missed entirely during initial review if such abnormalities occur infrequently and are masked by muscle artifact, low display gain, EKG contamination, or poor montage selection. No further review may be deemed necessary under these circumstances. Detection errors can be minimized if reviewers know how to optimize the appearance of each page and make the necessary adjustments quickly during the initial review of the EEG. EEG technologists can reduce detection errors by using optimal recording techniques to highlight any irregularities they encounter. The display parameters that can be quickly modified during review and acquisition are montage selection, filtering, sensitivity, and the number of seconds of EEG displayed on each page. The effect of these instrumentation changes upon the appearance of the EEG is discussed and examples are provided.