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Modified 10-20 Set Up for Sleep Recordings

Modified 10-20 Set Up for Sleep Recordings. Jon W. Atkinson, BS, RPSGT. Goals. Provide: Historical perspective into 10-20 measurement Detailed measuring/marking procedure Tips to aid in success Demonstration. Historical perspective.

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Modified 10-20 Set Up for Sleep Recordings

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  1. Modified 10-20 Set Upfor Sleep Recordings Jon W. Atkinson, BS, RPSGT

  2. Goals • Provide: • Historical perspective into 10-20 measurement • Detailed measuring/marking procedure • Tips to aid in success • Demonstration

  3. Historical perspective • Herbert Jasper, 1958. “Report of the committee on methods of clinical examination in electroencephalography: 1957” – described EEG placement based on anatomical landmarks • EEG was at the forefront of non-invasive neurodiagnosis • Provided consistent, replicable location of EEG electrodes and a standard nomenclature

  4. Historical perspective • Alan Rechtschaffen and Anthony Kales, 1968. “A Manual of Standardized Terminology, Techniques and Scoring System For Sleep Stages of Human Subjects” • Adopted C3,4 and O1,2 to contralateral ears in the scoring manual • A need for consistency and replication (largely for research purposed) … Sleep disorders per se was little considered at that time. • Based on “normal” subjects

  5. Historical perspective • Conrad Iber, et al,2007 The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications • Added F3, 4 to the standard electrode placements • Enhance the appearance of “qualifying” slow waves and K complexes • Problems • Many technicians/technologists were unfamiliar with the mechanics of F3,4 localization • Not well addressed in training programs or not followed through by students • Personal observation – proper localization of F3,4 was rare, even among RPSGT’s!!!

  6. Measuring and marking procedure

  7. Nasion 50% 50% Inion Anterior-Posterior Midsagittal Plane • Find landmarks nasion & inion; measure distance between the two being sure to keep the tape taut • Mark 50% of nasion-inion distance perpendicular to the tape

  8. Nasion 10% 20% 20% 10% Inion Completing the A-P measurement • Measure from nasion to inion • Mark 50% point (Cz) • Mark 20% forward from Cz (Fz) • Mark another 20% forward (Fpz). This leaves 10% to the nasion. • Mark 40% back from Cz (Oz). This leaves 10% to the inion. 40%

  9. A-P measurement Note position of ring finger and thumb as anchors for tape tautness 50% mark

  10. A-P measurement 20% forward from 50% mark Additional 20% forward, leaving 10% from nasion

  11. A-P measurement 40% back from 50% mark, 10% up from the inion indicated by the wax pencil

  12. Nasion L-PAN R-PAN 10% 10%% 20% 20% 20% 20% 50% 50% Inion Mid-coronal plane • Measure distance between L-PAN & R-PAN and mark 50% to complete CZ • Measure 20% down from Cz and mark for C3 and an additional 20% and mark T3 • Measure 20% down from Cz and mark for C4 and an additional 20% and mark T4

  13. Mid-coronal measurement Note again, anchoring of tape with thumb and ring finger or pinkie to pull the tape taut.

  14. Mid-coronal measurement 50% mark perpendicular to tape 20% down from 50% mark

  15. Mid-coronal measurement Additional 20% down, leaving 10% up from the R-PAN 50% mark (at the pencil) and 20% (C3) down and 20% down (T3)

  16. Nasion L-PAN R-PAN Inion Circumference • Eyeball the middle of the Fp plane by making a mark in the middle of the forehead sighting down to the nasal septum. (Fpz) • Measure the circumference from the Fpz through the T3 marking through the Oz plane through the T4 marking back to Fpz • Mark the base of the over the inferior frontal areas on each side.

  17. Circumference 10% • Measure and mark 50% of the circumference from Fpz to locate Oz • Mark 5% of the entire circumference on either side of Oz to locate O1 and O2 • Make a mark 5% on either side of FPz (FP1 & FP2) • Mark 10% of the circumference from FP1 and FP2 to localize F7 and F8 Nasion 10% 10% 5% 5% L-PAN R-PAN 5% 5% Inion 10%

  18. Circumference “Eyeballing” midline for the FPz mark Measuring the circumference through the 10% lines; I just mentioned the needle electrodes

  19. Circumference 50% of the circumference for Oz 5% marks on either side of Oz for O1 and O2

  20. Circumference 5% mark on either side of Fpz for Fp1 and Fp2 Additional 10% back from Fp2 on the 10% line for F8

  21. Marking Anterior Coronal Line • Measure from L Inferior Frontal (F7) line through Fz to R Inferior Frontal line (F8). • Mark 50% to finalize Fz • Mark 25% (half of the half) to create initial marks for F3 and F4 Nasion L-PAN R-PAN 25% 50% Inion

  22. Marking Anterior Coronal Line Measuring from F7 to F8 through FZ. Note anchoring and taut tape. 50% mark and then 25% (half of the half) for F3

  23. Nasion L-PAN R-PAN Inion Finalizing F3, F4, C3 and C4 • Measure from FP1 through F3 and C3 to O1 • Mark 50% to finalize C3 and 25% (half of the half) forward to finalize F3 • Measure from FP2 through F4 and C4 to O2 • Mark 50% to finalize C4 and 25% forward to finalize F4 25% 50%

  24. Finalizing F3, F4, C3 and C4 Measuring from Fp1to O1 through F3, C3. Note anchoring and taut tape. Marking 50% of the Fp1-O1 distance and then marking “half of the half” forward.

  25. Final product Antero-superior view. Note the mild bow from Fp’s to F’s to C’s .

  26. Localize M1 and M2. • Pull forward and outward on the pinna. • Most people have a little fold of skin about midway up on the ear where it attaches to the side of the head. • Locate the mastoid just superior to this fold. • Too high will produce higher amplitude EEG (alpha like) activity and contaminate your signal when used as a reference for the F’s, C’s and O’s • too low will produce muscle artifact from sterno-cleido-mastoideus

  27. Summary • A-P, mark Cz, Fz, Fp line and O line • Mid-coronal, mark Cz, C3 and C4, T3 and T4 • Circumference through the 10 percent line, mark Fp1 , Fp2, O1 and O2 • Anterior coronal, mark Fz, F3, F4 • Parasagittal, from Fp’s to O’s, mark C3 and C4, F3 and F4 • Localize mastoids for M1 and M2

  28. Tips • Keep the tape taut • Use ring finger or pinkie and thumb as anchors • Mark perpendicular to the tape • Remember to mark F7,8 when marking the circumference • Move the tape as few times as possible • Practice, Practice, Practice • Do it every time

  29. References • Jasper, H. "Report of the committee on methods of clinical examination in electroencephalography: 1957". Electroencephalography and Clinical Neurophysiology 10 (2): 370–375, Elsevier, 1958. • Iber, C; Ancoli-Israel, S; Chesson, A; Quan, SF. for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester: American Academy of Sleep Medicine; 2007. • Rechtschaffen, A; Kales, A. A Manual of Standardized Terminology, Techniques and Scoring System For Sleep Stages of Human Subjects. US Dept of Health, Education, and Welfare; National Institutes of Health, 1968

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