The technicians who perform intraoperative neuromonitoring are not there to diagnose an issue that occurs during surgery, but they must be quick at recognizing one that emerges.

What makes this difficult is how infrequently they occur — technicians can monitor hundreds of consecutive operations without witnessing something go wrong.

“I think that’s a major issue because, thankfully, it’s not very often that these major complications happen. But when they do, it’s so important for the technologist to be prepared and proactive and make quick, snap decisions,” said Christopher Halford, program director at the END Institute, a training program for neurodiagnostic technologists at University of Utah Health at the University of Utah Hospital in Salt Lake City.


Full audio of our interview with Christopher Halford below


Halford said technologists gain proficiency through on-the-job training. They may not see a critical, reportable change even once during intraoperative time with their preceptor, adding to the difficulty inexperienced techs face.

“For a seasoned tech, these extended periods without critical changes can be considered a perk of the job,” Halford explained. “A boring case is a good thing in IONM.”

Advancements in usage

The field has changed in recent years, but not in the same way many other areas of medicine have. The latest advances in intraoperative neuromonitoring (IONM) have less to do with the technology involved than the way it’s deployed.

“The technology itself really hasn’t changed a lot,” he said. “I think now people are realizing how much you can do with the technology to be preventative, to be proactive, and to really make significant improvements when it comes to neurological surgery.”

People have a better understanding of IONM, which Halford detailed in a presentation at the ASET Annual Conference in August 2021. It is used to map the nervous system, which has expanded the safety of different types of surgeries.

It’s become common practice, for example, to map cortical and subcortical structures during major brain surgeries, Halford said. That has increased the ability to resect major devastating tumors and have better, longer-lasting results.

Meeting growing needs

He called the lack of training options a big challenge for technicians looking to break into IONM. The field lacks what he calls “grassroots opportunity” — IONM used to be a “well-kept secret, which wasn’t a good thing,” he added.

But that’s changing rapidly.

“We get a lot of people who call and say, ‘Do you guys do intraoperative monitoring?’ It’s very in demand, it’s valuable,” he said. “As more neurosurgeons, more orthopedic spine surgeons, even shoulder and hip surgeons, vascular surgeons, cardio surgeons are understanding the value of IOM, they’re starting to use it.”

And as these services expand to meet these growing needs, “our field has to expand to meet the growing needs as well,” Halford said. “I feel like there’s a lot of opportunity for technologists to enter the field, but also a lot of opportunity to come up with a solution to these problems — turning technologists into well-trained, highly-functioning technologists.”

Click below to listen to Neurology Insight’s full interview with Halford from the ASET conference, and click here for another conversation with Halford, about two cases where IONM played a critical role in patient outcomes.