Difference between revisions of "Policies and Procedures"

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Policy: All non-disposable EEG caps and electrodes that come in contact with skin that has been abraded will be considered “contaminated”. Non-disposable electrodes and EEG caps will be sent to Central Hospital Supply (CHS) for disinfection / sterilization. *With the exception of the VSM Easycap which will be transported to the NINDS EEG Department for disinfection as per specific manufacturer’s instructions as outlined in P&P 9.45.
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<div style="margin-left:0.0626in;margin-right:0in;"><u>'''Policy</u>: In order to interrupt the spread of infection at the point of transmission between sources and host: 1) all non-disposable equipment will be properly cleaned, <br>disinfected and/or sterilized between uses and, 2) all single use equipment will be properly disposed.'''
  
 
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Revision as of 14:48, 31 May 2018

Policies and Procedures Manual

These documents comprise the official policies and procedures for the MEG lab.

  • MEG Core Facility
MISSION STATEMENT


The Magnetoencephalography (MEG) Core Facility is a multi-user facility dedicated to providing resources for use by NIH Institutes and the Clinical Center. The mission of the MEG Core Facility is to provide all necessary support for Principal Investigators (PI) conducting research to successfully design and implement an MEG based project. This will usually include detailed experimental design discussion, software and hardware design and testing, training in data collection and system instruction, signal processing and data analysis.


VISION STATEMENT


The MEG Core Facility is dedicated to offering and providing state-of-the-art services. We will maintain excellence in the performance of magnetoencephalography research and will be recognized as a preeminent center for the performance of biomedical imaging research.


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Operations(1.00)

Hours of Operation 1.00

National Institute of Mental Health

Subject:
MEG Core Facility
Hours of Operation
Policy No. 1.00

Date: 1/03
Revised 9/03; 6/06; 7/07; 10/08; 8/09; 1/12; 1/14; 1/15

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The MEG Core Facility hours of operation are from 9:00 a.m. to 5:00 p.m. Monday thru Friday.


1) Normal hours of operations 9:00-5:00 pm Monday - Friday. The MEG Core Facility staff will be available to assist users during normal hours of operation.
2) Users may schedule scans for after hours provided they have received training and are capable of operating MEG equipment in accordance with MEG policies and procedures.
After hours use authorization must be obtained from MEG Core staff.


_________________________________________________________________________________________________


Laboratory Access 1.05

National Institute of Mental Health

Subject:
MEG Core Facility
Laboratory Access
Policy No. 1.05

Date: 1/03
Revised 9/03; 6/06; 7/07; 10/08; 1/12; 1/14; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The MEG Lab keyless entry system will be utilized for MEG lab access before, during or after normal lab hours.


1) MEG Users will be given the MEG Lab keyless entry code during the MEG Orientation Training class.
2) During Normal Hours of Operations- the MEG Lab may or may not be locked, however, if locked access may be gained / the door can be unlocked by using the access code.
3) After Normal Hours of Operations and on the weekends- the MEG Lab will be locked, however, access can be gained by using the keyless entry system.
4) All equipment, except for all computers (acquisition and workstation), must be powered off upon departure.
5) It will be the responsibility of the user to make sure the lab is locked upon departure.


_________________________________________________________________________________________________


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Scheduling (2.00)

Scheduling 2.00

National Institute of Mental Health

Subject:
MEG Core Facility
Scheduling Procedures
Policy No. 2.00

Date: 1/03
Revised 9/03; 6/06; 7/07; 10/08; 1/12; 1/14; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: MEG scan time will be requested and scheduled electronically via the web-based calendar at: http://kurage.nimh.nih.gov/cal/. Scan time will be scheduled on a first-come -first served basis. All requests must be approved before going "live" on the public calendar. All unapproved time requests will appear in red. When a MEG schedule notification is received, an MEG administrator will be responsible for approving or denying the request. Users will auto matically receive an email message notifying them when their time has been approved.


Procedure:

I. Requesting Time -
1. Click on Login location near the bottom of the MEG Schedule/Calendar.
2. Enter “Username” and “Password”.
3. Click on Login.
4. On the calendar - Click on the  at the day and time desired.
5. Enter the “Add Entry” form information –
a. Investigator’s Name - enter the last name of the PI / last name of the person who is going to run the scan (acquisition computer). For example - BERMAN / J. Mitchell. In this case Dr. Berman is the PI and Judy Mitchell is running the scan.
b. Description of experiment – provide a simple description
c. Comments - Use this field to enter any private comments, subject name / phone number or MIS number. Information in this box will not appear on the published calendar. Important: ::::This box is for confidential information.
d. Sensor position – Sitting or Supine.
e. EEG electrodes – indicate whether EEG, EOG, EMG electrodes will be used.
f. Date
g. Time - military time.
h. Duration – indicate how much time needed to complete your study. Please allow enough time for any possible delays (set up / prep time, subject late, equipment malfunction, etc.).
i. Hold approval – only use holds if your subject needs to get back with you to confirm the appointment. Appointments can only be held for 2-3 days.
j. ParticipantsDO NOT ALTER THIS FIELD (should always be admin for MEG staff who are doing the scheduling).
k. Repeat Type – if a recurring appointment enter here; however, check with Staff Scientist before scheduling any repeats!
l. Repeat End Date – *for recurring appointments only.
m. Repeat Day (weekly) - *for recurring appointments only.
n. Frequency – for recurring appointments only.
6. Click on “Save”.


II. To Edit or Cancel an Appointment –
a. Click on the login.
b. Enter User Name and Password.
c. Click on the entry to be changed (at the point where it gives the little popup detail description).
d. Click on option: Edit entry, Delete entry, Add to My Calendar, etc.
*Please note: you must be the owner to be able to edit or delete an entry in the schedule.
III. To Refresh the Calendar –
1. Click on My Calendar.


_________________________________________________________________________________________________


Facility Access Requests 2.01

National Institute of Mental Health

Subject:
MEG Core Facility
Facility Access Requests
Policy No. 2.01

Date: 3/03
Revised 9/03; 6/06; 7/07; 10/08; 1/12; 1/14; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: Each MEG user who wants to schedule subjects for an MEG scan must filled out and electronically submit the MEG Facility Access Request Form (FAF). The Facility Access user account will allow the MEG user to: 1) schedule MEG scans via the MEG Lab scheduling calendar and, 2) access MEG data. The MEG Core Facility website administrator will be responsible for approving and maintaining all facility access requests.



Procedure:

1. A Facility Access Request (FAF) must be submitted electronically to become a MEG Lab user. The form may be accessed via the MEG Lab website at: http://kurage.nimh.nih.gov/meglab under User Information  Becoming a User.
2. All the requested information must be provided, such as the protocol #, PI’s last name and the name of the person who be in the MEG Lab running the study. In addition, we must have a cell phone number so that we can contact you in an "emergency".
3. The username will be the user’s last name as entered on the Facility Access Form (FAF).
4. When a Facility Access Request Form is received the accounts administrator will assign an account and issue a temporary password.
5. An email notification of the account name and temporary password will be sent to each applicant.
6. User accounts may not be shared.


______________________________________________________________________________________________________________________________
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User / Subject Guidelines (3.00)

User Guidelines 3.00

National Institute of Mental Health

Subject:
MEG Core Facility
User Guidelines
Policy No. 3.00

Date: 1/03
Reviewed: 6/03; 9/03; 6/06; 7/07; 10/08; 1/12; 1/14; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: All investigators interested in conducting MEG scans / research studies are required to meet all the requirements of the Institutional Review Board (IRB) and adhere to MEG Core Facility policies and procedures as outlined below.


Procedure:

I. Becoming a User
1. Protocol Approval
a. User groups are required to have an IRB approved protocol with a description of the intended MEG research before a user account ID or scanning time can be assigned.


2. User Accounts
a. A Facility Access Request must be filled out electronically (http://kurage.nimh.nih.gov/meglab ) to establish a user account. Filling out this request will initiate the process of establishing a user account ID and password.
b. The account ID and password will give users access to the scheduling calendar and provide access to the MEG Core Facility data storage system. All requests must be sent electronically.
d. The account ID information will be emailed to the email address provided in the Facility Access Request Form, generally within 24 hours, if not call the Staff Engineer at 301/402-2362.


3. MEG Orientation
a. Users must schedule / attend an informal MEG orientation to become familiar with the lab operations and equipment.
b. Established users with new protocols will be required to complete a “new” Facility Access Request for each new protocol indicating the new protocol number.


II. Initiating a MEG Study
1. Study Design Review
a. Users must provide the director and/or staff scientist with a description of the research study design including information regarding setup requirements, software and equipment needs.
2. System Testing / Task Setup
a. Users must schedule a time to test their task / paradigm, equipment, software, etc. When scheduling indicate in the scheduling module that the appointment is for a “system test”.
b. Indicate whether programming or scripting support will be needed for the stimulus program.
c. Also, indicate whether technical support is needed – i.e., training or assistance with EEG/EP electrode placement or setup. If you have a specific electrode setup or placement and require MEG Core staff assistance you must provide a detailed description of your setup.
3. Pilot Studies
a. Most protocols will require a pilot study to test equipment, paradigms / programs and refine procedures with a test subject. Users must provide their own volunteer subject; if this is an external volunteer, he/she must be consented according to IRB guidelines.
b. You must schedule time for the pilot study via the web calendar. Please indicate in the description that time is being requested for a “pilot study”.


4. User Training
a. There is a three-step training program specifically designed so that users can acquire practical experience. The user is expected to become competent in performing all aspects of MEGs on their own subjects. MEG Core staff is available to provide training and technical assistance.
1. Instruction – (without a subject) MEG setup instructions and equipment operation.
2. Observation – (with a subject) instructions and observation of MEG setup and scan.
3. Practicum – hands on training session running a subject during a MEG scan.
b. User training must be scheduled via the web-based calendar. You must indicate in the description that this is MEG Training – Instruction, MEG Training-Observation, or MEG Training-Practicum. MEG staff will assist users during all phases of this training.


5. Scheduling Scan Time
a. Scan time must be requested electronically via the web-based calendar at http://kurage.nimh.nih.gov/cal/. Currently scan time is scheduled on a first-come-first-served basis.
b. To Request Time – Enter User Name and Password; click on Login; enter form information; save.
c. Approvals - All requests must be approved before they will go “live” on the public calendar. You will receive an email message notifying you that your time has been approved. All unapproved requests will appear in red.
d. To Edit or Cancel an Appointment –
• Enter User Name and Password; click on Login;
• Click on the entry to be changed (at the point where it gives the little popup detail description);
• Select an option: Edit entry, Delete entry, Add to My Calendar, etc.
• *Please note: you must be the owner to be able to edit or delete an entry in the schedule.
e. To Update Calendar - click on My Calendar.
f. Certain times in the schedule will be reserved for maintenance / quality assurance.
g. Allow about 2 hrs per subject for MEG (depending upon the study) and about 3 hrs for a MEG with EEG.


III. User Log
Users MUST document any scan that they perform in the User Log Book. If a subject was set up for the MEG but the scan was not able to be performed – that scan must still be logged in the User Log Book with a comment explaining why the study was not performed.
Subject information and all other pertinent information must be filled out in the log book, i.e., date, PI name, operator’s initials, protocol #, subject’s initials, MIS -#, and the gantry position. Do not leave any blank entries.


IV. Lab Safety
1. Equipment Operation - When performing a MEG study there must be at least two persons assisting with a study; one person must be capable of operating the equipment.
2. Subject Safety – a subject must never be left in the MSR. The subject must be observed at all times and must never be left alone in the MSR for any reason. Two persons must be available for assistance if the subject were suddenly to take ill or if something unexpected were to happen.
3. Chair / Table Safety – Care should be taken when raising the chair / table when you have a subject sitting or supine in the gantry. In order to avoid injury, it is important to understand how to operate the chair and table. Operating instructions are in the MEG Policy & Procedures Manual and the CTF Users Manual. The chair has a 300 lbs. maximum weight limit and if using the bed the weight limit is around 250 lbs. maximum.
4. Gantry Safety – It is important to understand how to operate the gantry. Never adjust the gantry (tilt or angle) when a subject is seated in the chair or lying on the table. Instructions are available in the MEG Policy & Procedures Manual and the CTF User’s Manual.
5. If a medical emergency occurs call X111. For Fire or Police call 9111. For any other emergency contact the director or staff scientist for assistance at the phone numbers posted in the lab.


V. Process Improvement / Variance Reporting
1. Process Improvement / User Feedback – Users may make suggestions or give feedback to the MEG staff via the Variance Process Improvement Report. Feedback may also be provided via the MEG Discussion List at MEG_DISCUSSION@LIST.NIH.GOV.
2. Variance Reporting – Users are responsible for reporting complications, incidents, or problems that occur involving the facility via the Variance Process Improvement Report.
3. Equipment Failure -Users are also responsible for reporting any equipment failure or any equipment that may not be working properly via the Variance Process Improvement Report.
4. Broken Equipment - Any equipment that is inoperable or broken should be tagged with an Out of Service / Do Not Use sticker indicating the date and time taken out of service. Fill out the sticker including the name of the person making the report, phone number and a brief description of the problem.
5. All non-urgent communications will be reported using the Variance / Process Improvement Report.


VI. Magnetically Shielded Room (MSR) Guidelines
There are no known risks associated with MEG/EEG recordings. Although wearing metal objects while in the MSR (Magnetically Shielded Room) is not harmful to the individual, bringing metal objects in the MSR can result in a poor quality / uninterruptible recording. In addition, bringing magnetized objects into the MSR can cause trapped flux in the SQUIDS which can lead to long and expensive service to fix causing obvious interruptions and scheduling delays. Thus, we have established these guidelines:
1. Subjects should not bring any metal objects inside the MSR. Any subject entering the MSR must first “de-metal” (remove any metal objects; empty pockets; remove jewelry, hairclips, pens, clipboards etc.). These include belts, keys, watches, rings/earrings, necklaces, coins, eyeglasses and pieces of clothing with metal parts such as bras with under wires or bras with metal adjustment rings.
2. No one (not subjects / nor MEG Users) should bring electrical equipment inside the MSR. Objects such as cell phones, pagers, cameras, flashlights, or any other electrical equipment are strictly forbidden.
3. Magnets and anything magnetized is never allowed inside the MSR by anyone.
4. No one should wear shoes inside the MSR. To prevent any metal or magnetic dust from getting into the MSR shoes must be removed before entering the MSR.
5. Any “unapproved” equipment should not be brought into the MSR. Any “special” equipment must be approved by the director or staff scientist prior to its use.
6. Do not use small metal objects (i.e., staples, paper clips) around the MSR.
7. NO equipment will be left in the MSR other than the equipment that belongs in the MSR.


_________________________________________________________________________________________________


Subject Guidelines 3.20

National Institute of Mental Health

Subject:
MEG Core Facility
Subject Guidelines
Policy No. 3.20

Date: 1/03
Revised: 9/03; 6/06; 7/07; 10/08; 1/12; Reviewed: 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: MEG normal control / volunteer subject selection / screening will conform with MEG best practices criteria. In addition, MEG guidelines will be consistent with the policy and procedures established by the NIH and the IRB.


Procedure:

1. Subject Registration
a. All subjects participating in MEG studies are required to have a valid medical record number (Medical Information System /MIS #).
b. It will be the responsibility of the principal investigator (PI) to make sure that all outpatients and control subjects have gone through the appropriate registration process and have a valid MIS#.
c. A doctor’s order is not required for an MEG scan but a progress note must be placed in the subject’s chart indicating the nature of the scan performed, the date, time, and protocol number. The patient’s condition and general performance should also be noted. The progress must also be signed by the appropriate personnel.


2. Consent Forms
a. An IRB approved consent form must be signed by all subjects prior to participating in any MEG research study.
b. Investigators are required to satisfy all Clinical Center documentation requirements.
c. It will be the responsibility of the PI to assure that subjects have signed the appropriate consent form.


3. Subject Pre-Screening
a. Although MEG/EEG poses no known risk to subjects, certain physical conditions may make subjects ineligible to participate in scanning. Some subjects will be ruled out for participation in scanning due to factors involving metallic foreign bodies which may prevent obtaining artifact free data.
b. It will be the responsibility of the PI to pre-screen subjects for the below listed contraindications during the selection process.
Conditions That Will Rule Out a Subject:
• Cardiac pacemaker / Cardiac or neural defibrillators
• Metal fragments in the eyes
• Metal plates, pins or bolts in head
• Any magnetic implantation / implantations made from iron (ferrous products)
An Additional Consideration Which Will Rule Out a Subject:
• Head size greater than 60 cm: if a subject’s head is too large to fit in the helmet


4. Subject Screening
a. Investigators may use the MEG Screening Questionnaire and/or Handedness Form as a subject evaluation / screening tool.
b. All MEG subjects should be screened for the following items which may cause recording artifact.
Conditions That May Rule Out a Subject:
• Surgical aneurysm clips
• Shrapnel
• Intra-orbital metallic structures
• Neurostimulator
• Implanted pumps (i.e., Insulin pumps)
• Steel pins from root canals; a permanent retainer
• Ear implants (certain cochlear implants)
• Metal rods, plates or screws in the body or mouth
• Previous surgery (if metal was left in the body)
• Hearing aids (should be removed before scanning)
• Braces (causes severe artifact)
• Tattoos (may have metallic paint)
• Piercings (may have metallic ink)
Other Considerations Which May Rule Out a Subject:
• Head size: if a subject’s head is too fit in the helmet
• Movement disorders (i.e., ticks, restless legs, etc., any condition that may cause excessive movement)
• Vision / Hearing problems
• Problems using response devices


c. The confidentially of the MEG Subject Screening Questionnaires and Handedness Forms will be the primary responsibility of the study’s principal investigator.


5. Subject Instructions
a. Users/PI’s are responsible for giving subjects instructions prior to any scheduled procedure.
b. Subjects should be informed not to wear these items:
• Bras with underwires
• Makeup (mascara, eye liner, eye shadow)
• Clothing containing metallic (shiny) threads or glitter
• Metal on clothing (i.e., metal buttons, snaps or trimming)
c. Subjects should be informed that metallic/magnetic items should not be taken into the Magnetically Shielded Room (MSR). These include such items as:
• Belts
• Keys
• Watches
• Coins
• Eyeglasses
•Cell phones
• Pagers
• Credit Cards
• Small metal objects such as hair pins, paper clips, safety pins, etc.
• Shoes (may have metallic dust particles on them)
d. It is the responsibility of the PI to inform subjects that if they arrive unprepared i.e., have metallic/magnetic parts on their clothing that cannot be easily removed, they may be asked to change into non-magnetic clothing which will be provided by staff.
e. If there is any question about whether an object is magnetic, the object is not taken inside the MSR.



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MEG / EEG (4.00)

MEG / EEG Setup Procedures 4.00

National Institute of Mental Health

Subject:
MEG Core Facility
MEG / EEG
Policy No. 4.00

Date: 1/03
Revised: 9/03; 6/06; 8/07; 10/08; 1/12; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: All subjects/patients will be up set for MEG according to standardized procedures in accordance with manufacturer’s specifications.

Procedure:

1. Head Size / Fit Test
a. Determine head size by measuring the subject’s head. The Gantry head limits are:


Nasion-Inion Preauricular Point to
Preauricular Point
Circumference
< 40 cm < 40 cm < 59 cm


b. Determine fit by placing the MEG helmet along with a protective cap over the subject’s head.
2. Fiducial Points/Head Coil Placements
*If subject has had previous digital pictures of the fiducial points retrieve images and match placement.
a. Place a small black dot near the nasion (indentation between the forehead and the nose); between the eyebrows midline.
b. Place a small black dot at the left and right preauricular points centered (about 1.5Cm) in front of the tragus. This should be measured on a straight line from the tip of the tragus to the outer canthus for accuracy.
c. Take a digital picture of these locations, download and print Place in subject’s MEG file for future reference.
d. Attach a small (MEG) Adhesive Washers to each head localization coil.
e. Attach head localization coils at the fiducial marks. *Make sure the marks line up with the center of the head coils. Place the:
f. Place tape over the coil and the cable to secure.


MEG HEAD COIL PLACEMENTS
RIGHT
PRE-AURICULAR POINT
NASION LEFT
PRE-AURICULAR POINT
Red Yellow Blue


References:

1. NIMH MEG Core Facility Data Tutorial Manual
2. MEG/EEG Operation and Technical Reference Manuals, CTF Systems Inc.


______________________________________________________________________________________________________________________________


EEG Easy Cap Setup Procedures 4.20

National Institute of Mental Health

Subject:
MEG Core Facility
EEG Easy Cap Setup Procedures
Policy No. 4.20

Date: 1/03
Reviewed: 9/03; 6/06; 8/07; 10/08; 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The EEG Easy Cap will be used per manufacturer’s guidelines and recommendations.


Procedure:


A. Head Size / Fit Test
1. Determine head size by measuring the subject’s head.
2. Select cap size: Small (< 56 cm); Medium (< 58 cm); Large (< 60cm).
3. Determine MEG gantry fit by placing the MEG sizing helmet along with a protective cap over the subject’s head.


B. Measuring & Marking Head
1. Measure and mark FP1, FP2, FPz and Cz.


C. Mounting the Cap
1. Rotate the adaptors in cap so that the narrow opening is toward the back of the head.
2. Place anchoring adhesive washer on Fp1 & Fp2.
3. Press Fp1 & Fp2 onto adhesive washers. Have subject hold Fp1 & Fp2 in place while turning cap over the head. Gently pull cap over the head and ears into place.
4. Check and adjust cap so that the Cz electrode is at the Cz mark.
5. Check Fp1 & FP2 and O1 & O2 to assure that they are placed correctly, if not choose another cap size.
6. Anchor the cap either with the chest belt or the chin strap.
7. Snap electrodes into the adaptors in a systematic manner starting at the back of the head. Insert so that the lead wire points towards the narrow side of the adaptor.
8. Push electrode into the adaptor with the fingers or with the aid of an old ballpoint pen where the mine (point) has been removed. Pay attention not to bend or place excessive pressure on the lead wire where it attaches to the electrode.


______________________________________________________________________________________________________________________________


Electrode Specifications 4.30

National Institute of Mental Health

Subject:
MEG Core Facility
Electrode Specifications
Policy No. 4.30

Date: 1/03
Reviewed: 9/03; 6/06; Revised: 9/07; 10/08; 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Electrodes used for MEG and EEG will meet CTF's guidelines and recommendations.

For large electrode arrays the use of an electrode cap system is recommended, however, alternative methods of electrode application may be used. Additionally, electrodes can be glued or pasted to the scalp using various types of electrodes. But because of the different properties of the various metals used for electrodes careful attention should be given to the choice of electrode material. These and other factors need to be considered when choosing electrodes for any MEG/EEG application. Below are the recommendations for electrode selection:


1. Silver/Silver-Chloride (Ag/AgCl) electrodes are recommended to take advantage of the DC response of the EEG amplifiers.
2. Sintered electrodes are preferred to avoid chloriding the electrodes after every few uses.
3. It is recommended that the lead length be at least 1.4 meters (48 inches) to allow the amplifier to be reasonably far away from the MEG sensors.
4. The material in the electrodes and associated connectors should be non-magnetic.
5. The thickness of the EEG electrode should be minimal to avoid fitting problems in the MEG helmet.
6. Electrodes should have the DIN style connector.


Reference:

1. CTF MEG System Operation and Technical Reference Manual (P/N 900-0028), VSM MedTech Ltd.


______________________________________________________________________________________________________________________________


Polhemus Digitizatin System 4.40

National Institute of Mental Health

Subject:
MEG Core Facility
Polhemus Digitization System
Policy No. 4.40 CURRENTLY UNDER REVIEW

Date: 1/03
Revised: 9/03; Reviewed: 6/06; 9/07; 10/08; 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Polhemus Digitizer is used for the digitization of the EEG electrode positions and for the determination of head shape. EEG electrodes will be digitized using the Polhemus according to standardized procedures in accordance with manufacturer's specifications.


Procedure:

1. Mark the fiducial points (nasion, left & right preauricular points).
2. Take a digital picture of those points. Download to computer and print pictures.
3. Mount the Easy Cap on the subject. *Refer to the Easy Cap instructions.
4. Place the small Receiver Module at the top of the cap / head midline. Secure with tape.
5. Place the large transmitter on a non-metallic stand midline behind the subject. Tape the transmitter to the stand to secure.
6. Turn on the laptop computer:
a. Double click on Electrode Digitizer Program. The software should detect two (2) stations if not check the connections then restart the program.
b. In order to start - Define the Head Coordinate System.
• Press the button on the Stylus Pen to begin.
• To define the (head) coordinates (locate each head coil position) - Place the stylus pen tip at the center of the head coil location
(nasion, left preauricular, right preauricular) then
• Press the stylus button.
c. To begin Digitization – From the Laptop/Computer: Click on Digitizing Start/Stop.
• Digitize all electrode positions by placing the stylus pen at the center of each electrode location then pressing the stylus button.
—A single data point is collected each time the stylus button is depressed and a beep will alert the user to each acquired point.
—The program will assign a number to the electrode position in the sequence that the electrodes are selected, I.e., 1, 2, 3, 4, etc.
• Click on Digitizing Start / Stop when done.
• If a mistake is made:
i) Press the stylus pen until all head coordinates have been entered then,
ii) Press define Head Coordinates again. Do not save the previously acquired
locations simply, start over from the beginning.
d. Verify Digitization Accuracy. Review the diagram of the electrode placements which appears on the monitor. If the diagram is:
• Correct then click on continue.
• Not correct check to make sure that the receiver or transmitter did not move and repeat digitization.
7. Click on File / Save Menu.
8. Save the data to the Laptop hard drive and
9. Save the data to a floppy disk. The filename is the current date.
10. Exit the program. Eject disk. Turn off laptop.
11. Transfer Polhemus head coordinate file to computer at acquisition workstation / console.


Note: The operator and anyone within 10 feet of the transmitter and receiver should de-metal. The general rule of thumb is three times the separation distance between the transmitter and receiver from any metal in the room. For example, if the separation distance is one foot, metal within three feet of the transmitter or receiver may cause distortion and inaccurate measurements.



Transferring the Polhemus Digitization File to the Acquisition Computer
1. Insert the memory stick with the digitization file into input of the Acquisition Computer (Squid).
2. On the Acquisition Computer, open a new terminal window and cd to your user directory. This will be something like:
cd users/<username>
3. Copy the file using mcopy:
mcopy a:YYYYMMDD.pos
4. Refer to your montage file which should display the labels for the EEG electrodes
in the order in which they were digitized. This file looks something like this:
1. fp1
2. fp2
3. f7
4. f3
5. fz
6. f4
7. f8
and should be called: <something>.layout (e.g., “10-20.layout”).
5. Run the mkeeglayout.py program to create a .eeg file:
mkeeglayout.py -l <something>.layout YYYYMMDD.pos
6. This will create YYYYMMDD.eeg.
7. In Acq, click on the “Window / EEG Channel Parameters” menu.
8. Click on the “File / Open EEG File”, and enter the .eegfilename.
9. Highlight all the EEG channels by clicking and dragging.
10. Select “Accept New Attribute Values”.
11. Impedances may also be checked from this screen or Exit.
Rev 4/12/18


Reference:

1. Polhemus Fastrak System (http://www.polhemus.com/fastrak.htm).


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Fudicial Points Digital Images 4.60

National Institute of Mental Health

Subject:
MEG Core Facility
Fudicial Points Digital Images - Cannon A1400 Digital Camera
Policy No. 4.60

Date: 1/03
Reviewed: 9/03; 6/06; 9/07; 10/08; 1/12; 1/14; 1/15; Revised: 5/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: Digital images of the fudicial points will be taken in order to co-register MRI data. The digital camera will be utilized in accordance with manufacturer’s guidelines.

Three or four views will be taken: 1) Right tragus fiducial point position; Left tragus fiducial point position; Nasion position (on the forehead between the eyebrows); and 4) subject full view (this picture is optional).

Procedure:

1. TURN ON THE POWER
a. Press the power button.
2. FOCUSING AN IMAGE:
a. To FOCUS / FRAME images (especially when taking close-up-shots) use the SHUTTER BUTTON.
b. Frame the picture in the IMAGE DISPLAY (for a close up; with the camera about 12 inches away from the object).
c. Press the ZOOM IN BUTTON then
d. Press and hold the SHUTTER BUTTON (large round silver button) halfway down to allow the camera to adjust the focus and exposure, then


3. TAKING A PICTURE:
a. Press the SHUTTER BUTTON all the way down to take the picture.


4. VIEWING IMAGES:
a. Press the MENU / PLAY button to turn on the image display. The last picture you took or viewed appears on the image display.
b. Use the CONTROLLER (OK) to scroll through the images.
c. After reviewing the images, press the PREVIEW BUTTON to turn off the image display.


5. UPLOADING / PRINTING images:
a. Turn camera OFF.
b. Connect the camera via the USB cable to a computer running Windows with the HP camera software (Ebi).
c. Turn the camera on.
d. Open the HP Photo Imaging Software by double clicking on the icon on the desktop.
e. Right click then select "MOUNT VOLUME".
f. Open the DCIM folder.
g. Open the FOLDER labelled "152_(number for the current month); Jan=1, Feb=2...
h. Copy pictures and drag to the appropriate "USER" folder. If you don't have a user folder first create one.
i. Rename the pictures by date taken (Example, 20151201a, 20151201b, 20151201c, etc.
j. Deletes all pictures from the Camera - if you delete the pictures from the DCIM Folder this will delete your pictures from the camera.
k. Right click to UNMOUNT the volume.
l. Unplug the camera.
m. Turn off camera.
n. Log out of the computer.


6. PRINTING IMAGES:
a. Select pictures to be printed.
b. Right Click then sleect OPEN with --> PhotoPrint. Or Left Click on FILE then --> Select Open with PhotoPrint.
c. Click on FILE then --> /Select PRINT SETUP.
d. Select "COLOR" as the printer (the HP Laserjet Printer near the Stimulus Computer).


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EEG Impedance Check on the MEG System 4.70

National Institute of Mental Health

Subject:
MEG Core Facility
EEG Impedance Check on the MEG System
Policy No. 4.70

Date: 1/03
Reviewed: 9/03; Revised: 6/06; 9/07; 10/08; 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: When performing EEG, the electrode impedance will be checked using the MEG acquisition software to ensure that impedances are within acceptable levels.


After the electrodes are attached to the subject’s scalp / electrode cap placed, the electrode impedance(s) will be checked to ensure good contact. The impedances measured should only be used to judge scalp contact and should not be considered a precise measure of actual impedance. Ideal impedances for scalp electrodes typically range from 1-5kohms. Impedances for other non-cerebral electrodes ideally should be < 50kohms.


Procedure:

1. Attach electrodes to the scalp / place cap.
2. Touch the static discharge button before connecting electrodes or cap connector jig to the amplifier unit. Connect the electrodes or electrode cap to the amplifier unit.
3. Launch ACQ - Run the appropriate EEG program.
4. Select the EEG Setup Window menu.
5. Highlight desired channels.
6. Click on CHECK IMPEDANCE.
a. The results are displayed in the appropriate columns.
b. To check the impedance of all active EEG channels, press the CTRL key on the keyboard at the same time as clicking on the impedance check button.
c. Please note: The impedance check requires 3 electrodes: The electrode being measured and at least 2 other electrodes.
7. Click OK / EXIT.


Reference:

1. Data Acquisition Manual, p/n 900-0006, CTF Systems Inc. (www.ctf.com).


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EEG Impedance Check using the Grass Impedance Meter 4.75

National Institute of Mental Health

Subject:
MEG Core Facility
EEG Impedance Check using the Grass Impedance Meter
Policy No. 4.75

Date: 1/03
Reviewed: 9/03; 10/03; Revised: 6/06; 9/07; 10/08; 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: When performing EEG, the electrode impedance will be checked using the Grass Impedance Meter to ensure adequate electrode contact with the scalp.

An external impedance check should be performed on all electrodes used for EEG, EOG or EMG using the Grass S88 Impedance Meter. The Grass Impedance Meter measures AC impedance (resistance and capacitance). When two or more electrodes are plugged into the electrode switch positions, all electrodes except the one selected electrode being measured are connected and provide the reference for the one being measured.

To perform an Impedance Check, at least two electrodes are required to be plugged in to the impedance meter.

Procedure:

1. The Electrode Selector Switch should be at position 1 - 10.
2. Plug the ground electrode (Grd) into electrode jack 1 position.
3. Plug the other electrode(s) into the jack positions 2 - 10 in a systematic manner.
4. Press the Red ON Button to activate the impedance check. *The power will automatically shutoff after approximately 2 minutes. (There is no OFF button.)
5. If the impedance is too high:
a. Take a cotton tip swab dipped in Nuprep (Abralyt or other skin prep) and twirl against the skin.
b. Re-insert electrolyte.
c. Re-measure impedance.
d. Repeat this process until all impedances are within acceptable levels.
Impedance Recommendations
EEG Electrodes 5-10K ohms
EMG Electrodes (EOG, ECG, etc.) < 50K ohms
6. If the impedance exceeds 199.9K ohm, a “1” will appear in the left display window with all other digits blanked out indicating that the impedance is too high to be read:
a. Take a cotton tip swab dipped in Nuprep (Abralyt or other skin prep) and twirl against the skin.
b. Re-insert electrolyte.
c. Re-measure impedance.
d. Repeat this process until all impedances are within acceptable levels.


Reference: 1. Grass EZM Electrode Impedance Meter Instructions Manual, Grass Instrument Division, Astro-Med, Inc.


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Magnetically Shielded Room (MSR) & Subject Support (5.00)

Magnetically Shielded Room (MSR) 5.00

National Institute of Mental Health

Subject:
MEG Core Facility
Magnetically Shielded Room (MSR
Policy No. 5.00

Date: 1/03
Reviewed: 9/03; 10/03; Revised: 6/06; Reviewed: 9/07; 10/08; 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Magnetically Shielded Room (MSR) will be utilized in accordance with manufacturer's recommendations and MEG Core guidelines.


I. MSR Room Lighting

Turning on the lights in the MSR:
  • Depress the square green button on the VAC Power Supply Unit which is located on the bottom shelf of the equipment stand outside the MSR.
Dimming the lights in the MSR:
  • Use the Brightness (black) knob to dim the light.



II. MSR Door Operation

Closing the Door:
1. Push the door up to the door frame as far as possible.
2. Press the OPEN/CLOSE BUTTON (Black Button) until the air locks activate and the door begins to close then quickly release the button to seal the door.
Opening the Door:
1. Press the OPEN/CLOSE BUTTON (Black Button) until the air locks release and the door begins to open then quickly release the button.
2. Pull the door open.
Door Emergency Operation:
1. Emergency Door Open Button - If the door fails to open, press the EMERGENCY OFF BUTTON (red button) located on the wall outside of the MSR. There is also an EMERGENCY OFF BUTTON located on the inside of the MSR door.
2. Emergency Door Open Key - If the door fails to open when using the Emergency Off Button, then insert the EMERGENCY DOOR KEY in the upper and lower Emergency Unlock (yellow) keyholes and turn. This will manually release the door locks. Keys and keyholes are located on both sides of the MSR door.



III. MSR Monitors

A. Oxygen Monitor
The Safetnet Oxygen Monitor which is mounted in the MEG Lab on the wall just outside the MSR measures the percentage of oxygen in the MEG lab which may be an indication of the air exchange in the MSR and/or the general integrity of the Dewar and related equipment. Refer to Policy No. 10.15 Daily System Monitors / Quality Assurance.


B. He Gas Flow Meter
The Gilmont Gas Flow Meter is located inside the MSR mounted on the back left wall. It monitors the MEG Dewar helium level or rate of Helium boil off which gives an indication of the general integrity of the MEG Dewar and related equipment. Refer to Policy No. 10.15 Daily System Monitors / Quality Assurance.


C. Liquid Helium Level
The AMI Model 135 Liquid Helium Level Monitor which is located on the stand just outside the MSR measures the amount of helium inside the MEG Dewar. Refer to Policy No. 10.15 Daily System Monitors / Quality Assurance.



References:

1. VacuumSchmelze.
2. MEG/EEG Operation and Technical Reference Manuals, CTF Systems Inc. (www.ctf.com).


______________________________________________________________________________________________________________________________



Gantry Operation 5.20

National Institute of Mental Health

Subject:
MEG Core Facility
Gantry Operation
Policy No. 5.20

Date: 1/03
Reviewed: 9/03; 10/03; Reviewed: 6/06; 9/07; 10/08; 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The MEG Gantry will be used and maintained in accordance with manufacturer's specifications and MEG Core guidelines.


There are two Gantry controls which are located on the side of the Gantry base: 1) the Brake Lever and, 2) the Tilt Control Lever. The Gantry controls have been designed so that the operator is required to use two hands to operate.

Please note:
• The Brake Lever and the Tilt Control Lever must be engaged more-or-less at the same time.
• Pulling up on the Brake Lever turns on the power and releases the brake.
• Releasing the Brake Lever engages the lock and turns off the power.
• The Tilt Control Lever is OFF when in the center position.


Procedure:

To re-position / move the Gantry - lift the Brake Lever and hold it in the up position then:

1. If raising the gantry,
a. While still holding the Brake Lever in the release (up) position, lift the Tilt Control Lever handle until the brake is released. You might hear a click or feel the pressure release. Maintain this position until the desired angle of tilt is reached.
b. As the Tilt Control Lever handle is lifted further the gantry will begin to rise faster.
c. When the angle of tilt is reached first release the Tilt Control Lever and then release the Brake Lever.


2. If lowering the gantry,
a. While still holding the Brake Lever in the release (up) position, lift the Tilt Control Lever handle to raise the gantry up a few degrees until you hear the click or the Dewar begins to move in the upward direction. This action will release the brake then allow the gantry to lower.
b. Then push the Lever in the downward direction. Pushing the Tilt Control Lever handle down will cause the gantry to lower.


4. Returning the Tilt Control Lever to the center “OFF” position will cause the gantry motion to slow to a stop.


5. Release the brake lever allowing it to go back to the horizontal position to turn off the power and engage / lock the brake.



Gantry Recording Positions
Sitting Position 15 degrees
Supine Position 90 degrees
Reclined Position at various degrees of tilt




References:

1. MEG/EEG Operation and Technical Reference Manuals, CTF Systems Inc. (www.ctf.com).



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Chair Operation 5.40

National Institute of Mental Health

Subject:
MEG Core Facility
Chair Operation
Policy No. 5.40

Date: 1/03
Reviewed: 9/03; 10/03; Reviewed: 6/06; 10/08; 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The MEG chair will be adjusted per standardized procedures in accordance with manufacturer's specifications while optimizing recording standards and observing patient safety.


Please Note: Chair Weight Limit - The MEG chair can accommodate subjects who weight up to approximately 300 lbs.

The MEG Chair Height can be raised and lowered for optimal positioning of the subject in the gantry. The chair is a pneumatic-hydraulic unit and there may be a 2-3 second delay when turning controls from the unlocked to the locked position or when making chair adjustments.

  • Turn the hand wheel and valves slowly when making any adjustments to allow the air pressure to equalize.
  • The Chair Back Rest Tilt can be adjusted for various angles of reclined recording. And, the gantry angle can be adjusted for various angles of reclined recording, however, when the chair is in the upright position the gantry should be at 15 degrees.
  • The operator should be completely familiar with the operation of the controls before operating the chair with a subject or patient’s head inside the gantry.
  • There are two kinds of controls:
-The Hand Wheel which controls the directions and rate of movement and
-The Valve Lock controls which adjustment is selected or activated; it locks and unlocks the Back Rest and the Height controls.


Procedure:

1. CHAIR BACKREST ADJUSTMENT
The TILT Valve Lock - is located on the front panel of the armrest near the top, locks and unlocks the tilt function of the chair backrest.
a. Slowly turn the TILT Lock Valve to the unlocked position.
b. Start in the upright position then adjust of necessary or requested by the subject. Position the backrest to provide the optimal level of neck and back alignment and comfort.
c. With the TILT Lock Valve in the UNLOCKED position the hand wheel controls the movement of the backrest / the backrest angle. Turn the hand wheel:
• Clockwise to move the backrest forward.
• Counter-clockwise for backward motions.
d. The Lock Valve should always be left in the LOCKED position unless adjustments are being made.


2. CHAIR HEIGHT ADJUSTMENT
The ELEVATION Lock Valve – located on the front panel of the armrest near the bottom, locks and unlocks the height function of the chair.
a. Slowly turn the Elevation Lock Valve to the unlocked position. * If this valve is released too fast the chair will “jump” in the direction last activated.
b. Position the subject so that his/her head is at or near the top of the dewar. Care should always be exercised when adjusting the chair height while a subject is seated under the gentry. *When trying to determine how close to the top of the Dewar the subject is positioned periodically ask the subject to raise himself/herself up in the dewar to determine how much room is remaining. Do not raise the chair while the subject is rising up in the chair. Ask the subject to relax back to whatever is comfortable for them, then adjust the chair to the subject.
c. Turn the Hand Wheel:
• Clockwise to make the chair move upward.
• Counter-clockwise for downward motions.
d. Turn the Elevation Lock Valve to locked position unless adjustments are being made.
e. When lowering the chair leave at least 3 inches in the bellows.


3. CHAIR MOVEMENT
The BRAKE Lock Valve - is located on the side panel. It locks and unlock the brakes for the chair’s back and forward movement on the (plexiglass) track. The brake provides only a light braking effect.
a. Turn the valve to the UNLOCKED position. While it is possible to move the chair with the brake in the LOCKED position this should be avoided as it will cause premature wear to the brake pad.
b. Physically push the chair back so that the subject’s head is positioned directly under the gantry; the back of the head should at the back of the dewar. Two people are required to move the chair so that the chair glides evenly on the track and is not torqued to one side or the other which might damage or break the track. Move the chair into position with one person pushing from each side of the chair.
c. After adjusting the chair set the Brake Valve to the LOCKED position to prevent movement of the chair.
d. When done recording, unlock the Brake Valve to move the chair forward to allow the subject to exit the chair without bumping their head on the Dewar or the Dewar arm.
  • Always check to make sure that cables are not on the track before moving the chair.



References: 1. MEG/EEG Operation and Technical Reference Manuals, CTF Systems Inc. (www.ctf.com).


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Bed Operation 5.60

National Institute of Mental Health

Subject:
MEG Core Facility
Bed Operation
Policy No. 5.60

Date: 1/03
Reviewed: 9/03; 10/03; Revised: 6/06; 9/07; 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The MEG bed will be placed and adjusted per standardized procedures in accordance with manufacturer's specifications while optimizing recording standards and observing patient safety.


Please Note: Bed Weight Limit - The MEG bed can accommodate subjects who weight up to approximately 250 lbs. Before placing the bed, the chair must be at the lowest possible height. The arm rest must be removed and the chair back rest must be tilted to approximately 45-degrees. The gantry must be tilted to 90 degrees. Two people must manually lift the bed and place it onto the chair pedestal.

Procedure:

1. Lower the Gantry to 90o tilt (horizontal position). Gantry Controls are located on the right side of the base. The controls require the operator to use both hands to operate. If either handle is released the gantry motion will stop.
a. Raise the Brake Control Lever (lower / long handle).
b. Then raise the Direction Control Lever (upper / shorter handle). This will release the brake.
c. Then move the Direction Control Lever in the downward direction.
d. Using the Angle Indicator readout located on the gantry near the front pivot point position, lower the gantry to 90 degrees.
e. Release the Direction Control Lever to stop the motion. Release the Brake Control Lever.


2. Lower the chair and slide the chair forward.


3. Recline the chair backrest to approximately a 45 degree tilt.


4. Remove the arm rest from the chair.


5. The back cushion may be removed or left in place.


6. If the top portion of the bed will have its angle adjusted, place the Roller Wheel Assembly and follow the steps below; if not skip to section 7.
• If the chair back cushion has been left in place, first slide the backrest cushion to its lowest position.
• Mount the Roller Wheel Assembly to the exposed seat back support plate. *These steps are optional if the bed it is to be used in the flat/horizontal position.
• If the head end cushion will have its angle adjusted, the cushion lock bolts should be removed from their locked position and stored in the holes I the blocks to which they are tied.
• The head end cushion of the bed can be adjusted in angles from horizontal to approx. 30 degrees using a link to the adjustable chair backrest.


7. Using two people, lift the bed by the ends using the hand grips which are mounted to the under side of the bed. *Lift the bed above the optical cables and any other sensitive equipment.


8. Set the bed onto the unpadded armrests of the chair. Align the holes on the bed frame with the holes on the pedestal.


9. Insert the four mounting bolts, which are tied to the base of the bed, through the holes in the bed base / pedestal.
a. All four bolts should be screwed in a couple of turns and
b. Fully tightened when all four are engaged.


10. Raise the bed so that it is level with the Dewar.


11. Slide the bed back so that it rests against the Dewar.


  • Never operate the gantry while a subject’s head is in the helmet.
  • For subject safety one side rail must be in place before allowing a subject to get onto the bed; place the second rail after the subject has mounted the bed.


References: 1. MEG/EEG Operation and Technical Reference Manuals, CTF Systems Inc. (www.ctf.com.)


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Stimulus / Response / Monitoring Equipment (6.00)

DLP Projector 6.00

National Institute of Mental Health

Subject:
MEG Core Facility
Propixx DLP Projector
Policy No. 6.00

Date: 5/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Propixx DLP Projector will be utilized in accordance with manufacturer's specifications and MEG Core policies and procedures.


The ProPixx DLP Back Projector system consists of a projector and a screen mounted to the gantry. Images are projected through a hole in the shielded room wall into a set of mirrors which projects the image onto the screen.
Features:
-The image size is up to 40 degrees visual field for eye-screen distance of 37.2 to 52.5 cm.
-a native resolution of 1920 x 1080 and can be driven with refresh rates up to 500Hz (RGB mode) or 1440 Hz (Greyscale mode) with deterministic timing.
-Uses high brightness LEDs as a light source, giving a larger color gamut
-The LEDs support high bit depth and high frequency full color stimulation.
-TACHISTOSCOPC stimulation capability.
Equipped with:
-a complete digital I/O subsystem that synchronizes subject I/Os to video refresh with microsecond precision.
-High-contrast white screen for precision color operation.


I. Powering the Projector:
*The Projector has a 30-40 ms delay before it displays an image.
1. TO POWER ON - On the Propixx Projector, press the POWER BUTTON Power Button once. *The power switch on the Controller Box should always be in the ON position.
2. TO POWER OFF - press the POWER BUTTON Power Button and hold for 3 seconds. The projector will enter the thermal shutdown mode and after a short delay the power will turn off / enter the sleep mode. *In order to preserve the bulb life, turn the projector "OFF" after each use.
**CAUTION: Do NOT touch the POWER ON / OFF SWITCH**
If you switch to the "OFF" position the projector will lose all programmed settings!
Power Switch picture.jpg



II. Positioning the Projector:
The position of the projector does not need to be changed. For further information or help see MEG Staff.


III. Lens Adjustments:
Manual Adjustment
To Focus - Turn the knurled ring (the silver and black lens collar) at the outer end of the lens to adjust the focus until the image is sharp. Generally, the focus should not have to be adjusted.
To Zoom - Turn the smooth ring on the lens, closest to the case, to adjust the zoom so that the image fills the screen.
*The projector lens should be centered in the middle of the screen and should be perpendicular to the mirror; otherwise the image will be distorted, making viewing difficult.


IV. Program Adjustment:
All functions, like resolution, can be changed from the desktop of the stimulus computer. However, if changes are made, please change back to the default settings when done.


V. The Remote Controller:
The Remote control has a 40 degree reception angle. The Remote must be pointed at the projector's LED (which is located in the back left corner of the projector) within that 40 degree angle to be received.
  • Using The Remote To Power The Projector On - Press POWER ON on the Remote Control to switch the projector ON.
  • Using The Remote To Power The Projector Off - Press POWER OFF on the Remote Control to switch the projector to OFF / SLEEP mode.
Please note: The LED ON / OFF button on the remote functions as the shutter on / off button.


VI. Projector Status Indicators:
The Projector's LEDs supply info on the power status and the energy status of the projector.
AWAKE MODE:
Press the POWER button and release, the projector will power ON.
The LED will be a solid BLUE light.
SLEEP MODE:
Press the POWER button for 3 secs,
the LEDs will be a solid RED.

The projector will be in the sleep mode.

THERMAL SHUTDOWN:
Flashing RED LEDs indicates the lamp is shutting down.

When flashing stops, the projector is in the SLEEP Mode (OFF)
as indicated by the solid RED LEDs.


VII. Reversing The Projection Scheme For Supine Recording – To Be Determined
a. Press MENU.
b. Use OPTION2 menu
c. Select REAR projection- choose this option if pictures are projected from the rear of a reflective screen.
d. Select CEILING mount – choose this option if the projector is installed on the ceiling (or upside down).
VIII. Mirror Adjustments
Wall Mirror Adjustments for Seated Recording:
1. Project an image onto the mirror.
2. Adjust the wall mirrors:
a. Position the top mirror in front of the lens so that the image is reflected down to the bottom mirror.
b. Adjust the bottom mirror so that the image is projected centered onto the screen.
IX. Ceiling Mirror Adjustments for Supine Recording:
1. Place the ancillary wall mirror (smaller mirror) on the 2nd set of wall brackets.
2. Position the top mirror so that it projects onto the smaller mirror. Position the smaller mirror so that it projects onto the ceiling mirror.
3. Slide the ceiling mirror into position so that the image from the ceiling mirror is projected onto the screen.


X. Screen Adjustments – There are two screens:
a) the original screen with the original color pallet and,
b) a white screen for high-resolution color.
1. Position the screen so that the image is projected centered onto the screen. If possible, the screen should be perpendicular to the floor.
2. The screen distance can be increased or decreased by loosening the black knob located on the telescoping screen arm and adjusting the arm length.
3. If necessary, the screen can also be removed and flipped so that it is closer to the subject. Loosen the knob located on the telescoping screen arm. Pull the arm out, flip the screen and re-insert. Position the screen and tighten the knob.
4. Use the black knob located on the gantry mounting bar to raise and lower the screen.
*If you use the High-Resolution Screen please put the original screen back in place when done.


Reference: 1. Propixx DLP Projector User Manual.


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Nerve / Muscle Stimulator 6.10

National Institute of Mental Health

Subject:
MEG Core Facility
Nerve / Muscle Stimulator
Policy No. 6.10

Date: 1/03
Reviewed: 10/03; 8/06; 11/08; 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Grass S88 Stimulator will be utilized in accordance with manufacturer's specifications and MEG Core policies and procedures.

The Grass S88 Stimulator is a dual output general purpose stimulator intended for nerve and muscle stimulation procedures. The two output channels can be operated independently or synchronized to produce complex paradigms. The outputs are non-isolated constant voltage positive pulses. Features include computer compatibility and flexibility of synchronization circuits: the synchronous inputs and outputs are TTL, 5 volts, PC compatible. A rear DB25S connector permits external analog control of the timing circuits. The Stimulus Isolation Unit (SIU) allows for applications requiring isolation and/or constant current. Grass S88 Electrical Nerve/Muscle Stimulator - Stimulation is triggered via TTL outputs from the S88 to the MEG system electronics.

Procedure: 1. Power Switch a. The POWER toggle switch is flanked by the ON pilot lamp and the red overload lamp.

b. In the ON position, the pilot lamp will glow orange, indicating that line power is being supplied to the instrument.

c. The OVERLOAD lamp will glow red in the event of a short circuit at either output. The circuit overload shuts off the HIGH VOLTAGE power supply.

d. The red indicator lamp will remain ON until the POWER switch is turned OFF for a few seconds.


2. Stimulus ON-OFF-ON Lever Switch a. The STIMULUS ON-OFF-ON LEVER SWITCH is located at the right-hand corner of each channel.

b. The upper ON position is for continuous voltage at the output; the lever switch will remain depressed (in the on position) when released; power will remain ON until the lever is switched to the up or off position.

c. In the lower ON position the lever switch will remain ON only if it is depressed; it will return to the OFF position as soon as it is released.


-1-

MEG Core Facility Grass S88 Nerve/Muscle Stimulator Procedures Manual Policy No. 6.10 -2-

3. Stimulus Mode The S88 FUNCTION can be set to deliver: a. Single – the RED SINGLE pushbutton is for manual operation (single independent pulses); also, delivers single repetitive stimulus. b. Repeat – repetitive stimulus; continuous presentation of a selected stimulus pattern (recurring pulses). c. Trains – trains per seconds (TPS) covers a range of 0.01 to 100 TPS; delivers a select number of pulses in defined intervals/delays. d. Twin Pulses – pulse per seconds (PPS); delivers two pulses of identical voltage and duration; the time between the onset of the first and second twin pulse is determined by the DELAY Circuit; twin pulses can be obtained singly, repetitively on in trains of pulses (can be used to determine nerve and muscle refractory times. e. Trains of Twin Pulses – delivers two pulses together in a series in defined intervals/delays from its single output.


4. Controls All controls are equal to the setting on the dial multiplied by the setting indicated on the decade (multiplier) switch. a. Rate – determines the rate at which pulses are delivered in pulses per second (1/100 sec to 100 PPS).

b. Delay – length of time before the pulse starts; pre-pulse interval (10usec to 10 sec).

c. Duration – pulse length; determines the length of time (T) in milliseconds that a pulse of a given frequency and voltage is delivered [1 msec to 10,000 msec (10 sec)].

d. Volt Control - Controls the intensity / strength of the pulse; range at the output is from 0.01 to 150 volts. Always begin with the VOLTS dial set to minimum (1) and increase until the desired stimulus intensity is achieved.

e. Voltage Decade (multiplier) Switch- multiplier switch; the output impedance is also determined from the Volts Decade Switch.

• In the first four positions, the output impedance is 250 ohms and is constant at these four positions: i. X.01, ii. X.1, iii. X1 and iv. X10(SIU).

• At X10(25Ω) the output impedance is 25 ohms.

• For special applications requiring low impedance, high current output - set the multiplier to X10(25Ω). This position is provided for use with low impedance electrodes to obtain a relatively high current out. When using this mode, caution should be taken since very high stimulus currents can be delivered.

• When a Stimulus Isolation Unit (SIU) is connected in series with the output the:

i. X10(SIU) position is recommended for 15 to 150 volts out; *The SIU7

                       Isolation /Constant Current Unit should be operated at all times with the
                       stimulator VOLTS multiplier set to the X10(SIU). 

ii. X1 position is recommended for outputs of less than 15 volts.

MEG Core Facility Grass S88 Nerve/Muscle Stimulator Procedures Manual Policy No. 6.10 -3-


f. Train Rate – in the S2 TRAIN position, trains of stimulus patterns are presented at the output of S2 at the rate set by this control.

g. Train Duration - in the S2 TRAIN position, trains of stimulus patterns are presented at the output of S2 at the duration set by this control.

h. Train Mode – To obtain trains, this switch must be in the SINGLE or REPEAT position.

Grass S88 Stimulator Specifications Train Rate (S1 and S2) 1/100 sec to 100 TPS (4 decades) Train Duration 1msec to 10 secs (4 decades) Rate (S1 and S2) 1/100 sec to 1000 PPS (5 decades) Pulse Delay (S1 and S2) 10usec to 10 secs (6 decades) Pulse Duration (S1 and S2) 10usec to 10 secs (6 decades) Synchronous Outputs (TTL) S1, S2 S1 Delay, S2 Delay, Train; Front Panel: 10 usec, 50Ω Rear Panel: 1 or 10 msec and Train End Synchronous Inputs (TTL) Train Duration, S1 Delay, S2 Delay, Trigger from rising or falling edge Rear Connector (DB25S) All SYNC INPUTS and OUTPUTS; External Analog Timing Control Volts Out (S1 and S2) 10mV to 150V (4 decades) Peak Output Current 150mA with 1000Ω on highest range Output Impedance 250Ω nominal on all voltage ranges 25Ω and 100kΩ on highest range AC Power 115/230V, 50/60Hz, 125 watts peak, 20 watts standby

The maximum power output is 22 watts. Current out is 150 milliamperes with a 1000-ohm load. Output Impedance is determined by the position of the VOLTS multiplier switch. All parameters are accurate to +5%.

• The output is a positive (with respect to chassis ground) non-isolated constant voltage square pulse. • The S88 cannot deliver a true symmetrical biphasic pulse which is equal in positive and negative amplitudes. • However, if a Model Stimulus Isolation Unit (SIU)5 is used at either the S1 or S2 output, a biphasic waveform can be produced which, although not symmetrical, does have a negative and positive component which is equal in effective energy in terms of coulombs, if averaged over a sufficiently long period of time. • It is possible to obtain a true symmetrical biphasic pulse by mixing the output pulses from both S1 and S2 outputs through two Stimulus Isolation Units. Polarity can be changed only by connecting the S88 in series with an SIU and reversing polarity at the output of the SIU.







Reference: 1. Grass S88 Muscle / Nerve Stimulator Manual


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Auditory Stimulus System 6.20

National Institute of Mental Health

Subject:
MEG Core Facility
Auditory Stimulus System
Policy No. 6.20

Date: 1/03
Reviewed: 10/03; Revised: 8/06; 11/08; 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Auditory Stimulation System will be used to deliver bilateral or unilateral tones at various decibels, frequencies, pitches and patterns as programmed or
determined by the user or staff.


The auditory stimulus is produced using Presentation or SoundBlaster software. The interface includes: a Stereo amplifier, a pair of low-distortion silicone tubes which have
about a 10 msec delay (due to the length of the tubing) and a bandwidth of 5kHertz, foam ear inserts (in various sizes) to fit in the subject’s ear canal, and a sound level meter
to calibrate sound delivered to the subject.


Procedure:

1. Attach the Foam Ear Tip Insert into the short Auditory Tubing Inserts. A connector (tube nibble) is required to keep the insert from coming out.

2. Attach the short Auditory Tubing Inserts onto the end of the Low Distortion Silicone Auditory Tubes which are hanging on each side of the Gantry mounting bar.

Place Red on the right side and the Blue on the left.

3. Slowly roll (rather than squeeze) the Foam Ear Tip into so that they are as small as possible.

4. Quickly insert the compressed plug well into the ear canal.

5. Hold in the ear with finger tip until expansion is complete.

6. Repeat process for the remaining ear.

7. The tubing may be taped to the ear or on the subject’s cheek to assure that

the insert does not become dislodged during testing.

8. Click on Presentation or SoundBlaster software from the desktop on the Stimulus Computer located at the operator’s console.

9. Test to make sure that the equipment is working properly and to assure that the sounds

are being delivered to both left and right ears.

10. Adjust the sound intensity to the desired level (db).


How To Place Foam Ear Tip Inserts
For A Secure & Comfortable Fit
1. Roll the tube really tight (usually better if you use both hands).
2. Figure out how the tube should go in the ear canal first by determining
the angle of the ear canal. Generally, the ear canal goes up at an angle.
3. Pull the ear out and up to open up the canal.
4. Then gently push the tube in so that it is situated behind the tragus.
5. Hold the tube in place for several seconds to allow the tube to expand in the ear canal.
*If you do not hold the tube in place while it expands it is possible that it might be push out
of the ear canal while expanding.
Note: if the tube does not go or fit in the ear canal do not force it in; take the tube back out and re-roll;
if it still does not fit, use a smaller size.
*Insertion depth affects interaural attenuation. Be sure to select the correct size Foam Ear Tip to

obtain the best fit in the ear canal. Insert as far as possible into the ear canal.


Reference:

1. Auditory Tubing User Instructions.


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Eye Tracking System 6.30

National Institute of Mental Health

Subject:
MEG Core Facility
Eye Tracking System
Policy No. 6.30

Date: 1/03
Revised: 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Infrared Eye Position Tracking System will be used to track eye position or fixation when needed during MEG recording.


The Infrared Eye Position Tracking System – The infra-red eye tracking system captures a zoomed in video of the subject’s eye after calibration, and can estimate
gaze position onto a screen providing gaze coordinates and pupil dilation. Gaze position can then be broadcast to the stimulus and/or ACQ computer for
real-time or post-hoc analysis.


The Infrared Eye Position Tracking System includes the:

1. Infrared Camera (located in the MSR).
2. Infrared Light
3. Eye Tracking Computer
4. Eye Tracking Software


*See MEG Core staff for setup.


______________________________________________________________________________________________________________________________


Response Devices 6.40

National Institute of Mental Health

Subject:
MEG Core Facility
Response Devices
Policy No. 6.40

Date: 1/03
Reviewed: 10/03; Revised: 8/06; 11/08; 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The various response systems will provide for subject response monitoring via an electronics interface which will output to the acquisition computer to observe or examine response input and / or response time.


Procedure:

I. Lumitouch Response Pad
The Lumitouch is a fiber optic response keypad where there are five response buttons arranged in a row to correspond to the thumb and the fingers. The response keypads and cabling are fabricated from 100% plastic materials and therefore do not cause electromagnetic interference. The fiber-optic cables run from the pads through a wave guide to a controller box which is connected to the stimulus PC via a USB cable.
1. Place the response pad on the left or right arm rest.
2. Arrange fingers so that all or a subset of fingers can be used in natural
order and positioning when responding to visual and/or auditory stimuli.
3. Place the cables so that they are not on the MEG chair’s track when the chair is being moved.
4. Instruct the subject in the use of the Lumitouch Response Keypad for the research study task.


II. FORP Response Pad
The FORP is a Fiber-Optic Response Pad (FORP) where the 4 keys arranged in a diamond pattern. There are 4 colored buttons which are arranged in a diamond pattern: Blue=1, Yellow=2, Green=3, Red=4. The response keypads and cabling are fabricated from 10% plastic materials and therefore do not cause electromagnetic interference. The fiber-optic cables run from the pads through a wave guide to a controller box which is connected to the stimulus PC via a USB cable.
1. Instruct the subject to hold or cup the response pad in the dominant or non-dominant hand while using the thumb to respond to the appropriate color, position, number or pattern. ::::Position the pad so that the cable is in the superior orientation.
2. Place the cables so that they are not on the MEG chair’s track when the chair is being moved.
3. Instruct the subject in the use of the FORP Response Pad for the research study task.


III. Joy Stick Control
The Joy Stick is a manual input device with a moveable control lever that can be tilted in various directions to control pointing devices or on-screen objects used for graphic applications.
1. Instruct the subject to grasp the joystick control lever.
2. Place the cable so that they are not on the MEG chair’s track when the chair is being moved.
3. Instruct the subject in the use of the joystick for the research study task.


IV. Motion Detector
The laser Motion Detector is a device that contains a physical mechanism or electronic sensor that quantifies movement which is integrated with or connected to other devices that alert the user of the presence of a moving object within the field of view.


V. Optical Microphone
An Optical Microphone is an acoustic-to-electric transducer or sensor that converts sound into an electrical signal.


VI. Pneumatic Air Pressure Device
The Pneumatic Air Pressure Device is attached to the pressure response ball which the subject squeezes to indicate a response. The unit can be calibrated for a gradated response or the thresholds can be set to give an on / off response.



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Stimulation Devices 6.45

National Institute of Mental Health

Subject:
MEG Core Facility
Stimulation Devices
Policy No. 6.45

Date: 1/03
Reviewed: 10/03; Revised: 8/06; 11/08; 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The various stimulation devices provide for subject stimulation via an electronics interface which will output to the acquisition computer to observe or examine
response input, subject reaction and / or response time.

Procedure:

I. Air Puff Stimulator
The Air Puff Stimulator is a tactile sensory nerve stimulator. The Air-puff stimulator is applied to the fingertip. It produces a puff of air which provides tactile stimulation that
produces a measurable sensory response in the nerve.
II. LED Flasher
The LED Flasher is a light emitting diode which flashes a red strobe light for visual system stimulation.
III. PIEZO BUZZER
A buzzer device which has no moving parts which uses the electromechanical interaction between the mechanical and the electrical state in a crystalline material to measure
pressure, acceleration, strain or force and converts them to an electrical charge.


______________________________________________________________________________________________________________________________


Video Camera Operation 6.60

National Institute of Mental Health

Subject:
MEG Core Facility
Video Camera Operation
Policy No. 6.60

Date: 11/03
Reviewed: 8/06; 11/08; Revised: 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: Video cameras are used to view and monitor subject inside the MSR on the Video Display Monitor and, to record subjects to digital video media (VHS or DVD)
using the Video Cassette Recorder. The video camera system will be utilized in accordance with the manufacturer’s guidelines and MEG Core Facility policies and procedures.


There are two cameras located inside the MSR: 1) an infrared and 2) a color camera. The infrared camera is displayed on Channel 1; the color camera is displayed on Channel 2.

Procedure:


1. Position / Re-position cameras manually for optimal viewing / display.
2. Press the channel button located on the Video Display Monitor to change from Camera 1 to Camera 2 or vice versa.


______________________________________________________________________________________________________________________________


Voice Intercom System 6.70

National Institute of Mental Health

Subject:
MEG Core Facility
Voice Intercom System
Policy No. 6.70

Date: 11/03
Reviewed: 8/06; 11/08; Revised: 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Voice Intercom System will be used to facilitate communications with subjects while inside the Magnetically Shielded Room (MSR).


The Voice Intercom System consists of:

1. The Intercom Electronics Box - located at the acquisition workstation / operator’s console. The Intercom Electronics Box allows the MEG operator to adjust the volume level at the console and the volume level inside the MSR independently. When at the Acquisition Console, the MEG operator can communicate with the subject inside the MSR through this device. This system works like a Walkie-Talkie, that is, when the operator is talking (depressing the “talk” button he/she cannot hear the subject and when he/she releases the button he/she can hear the subject speaking).


2. Parabolic Microphone - located inside the MSR. It is used to pick up and amplify the subject’s voice so that it can be heard at the operator’s console in order to facilitate communication between the subject and the operator.


3. Flat Speaker - located inside the MSR. It is used to pick up and amplify the operator’s voice so that it can be heard by the subject inside the MSR.


*There are no intercom controls inside the MSR.


Procedure:

1. Press the Red power button to turn ON the Intercom Electronics Box.
2. Press the PUSH TO TALK button located on the front of the Intercom Electronics Box to speak to a subject inside the MSR.
3. Release the button to hear the subject speak.
4. Adjust the volume inside the MSR, so that the subject inside the MSR can hear the operator, using the knob labelled “MSR” located on the Intercom Electronics Box.
5. Adjust the volume at the Acquisition Workstation / Operator’s Console, so that the operator at the console can hear the subject, using the knob labelled “Console”
on the Intercom Electronics Box.



Reference:

1. MEG/EEG Operation and Technical Reference Manuals, CTF Systems Inc. (www.ctf.com).



______________________________________________________________________________________________________________________________


Video Display Monitor 6.80

National Institute of Mental Health

Subject:
MEG Core Facility
Video Display Monitor
Policy No. 6.80

Date: 11/03
Reviewed: 8/06; 11/08; Revised: 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Video Display Monitor will be used to monitor subjects inside the MSR.


The Video Display Monitor which is located at the acquisition workstation / operator’s console is used to monitor subjects inside the MSR. MEG users will observe the subject at all times while inside the MSR. There are currently two channels / two cameras in use for subject observation. Each camera is located or mounted at a different angle. Select the camera angle that is best for viewing the subject and any related equipment.


Procedure:

a. To turn the monitor on - press the ON/OFF switch located on the front panel of the Video Display Monitor.
b. Press the channel button once to access the next channel.
c. Continue to press the channel button to access the other channels.
Channel 1 Camera 1 (Infrared Camera)
Channel 2 Camera 2 (Color Camera)
Channel 3 VCR Play back

(connected to Color Camera)

Channel 4 (Blank)


*Always monitor subjects via the Video Display Monitor when running a study.
THE SUBJECT MUST BE OBSERVED AT ALL TIMES DURING TESTING.



______________________________________________________________________________________________________________________________


Infrared Lighting 6.90

National Institute of Mental Health

Subject:
MEG Core Facility
Infrared Lighting
Policy No. 6.90

Date: 11/03
Reviewed: 8/06; 11/08; Revised: 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Infrared Light will be utilized in accordance with the manufacturer’s guidelines
and MEG Core Facility policies and procedures.


The Infrared Light illuminates the inside of the MSR when recording in a dark environment so that the subject may be seen via the Video Display Monitor. The Infrared Light Control Box is located on the stand outside the MSR.


'Procedure:

1. Press the Red ON/OFF switch to turn the power on and off for the Infrared Light Power Supply (SEC 1212).



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Data Acquisition / Data Analysis (7.00)

Data Acquisition 7.00

National Institute of Mental Health

Subject:
MEG Core Facility
Data Acquisition
Policy No. 7.00

Date: 10/03
Revised: 6/06; 11/08; 1/12; 1/15; Reviewed: 2/18

CURRENTLY UNDER REVISION

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The Acquisition Computer will be utilized in accordance with manufacturer's recommendations and MEG Core guidelines.

The Acquisition Computer controls all aspects of electronics, tuning, aquisition and data storage. The Acquisition Computer is configured with CTF's Omega software.




______________________________________________________________________________________________________________________________


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Infection Prevention / Control (9.00)

Infection Control / Universal Precautions 9.00

National Institute of Mental Health

Subject:
MEG Core Facility
Infection Control / Universal Precautions
Policy No. 9.00

Date: 1/03
Reviewed: 11/03; Reviewed: 11/03; Revised: 8/06; 7/07; 11/08; 1/12; 1/15; Reviewed: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: Infection Control practices and procedures will be in place in order to interrrupt the spread of infection at the point of transmission between source and host.
Protective clothing, safety goggles and gloves will be used as needed. Proper hand hygiene practices will be observed.


Infection Control Training - All MEG staff are required to take the annual training /retraining regarding Standard / Universal Precautions and Transmission Based Precautions
through the hospital Epidemiology Office (HES). All documentation of training will be maintained by MEG staff as part of the MEG Quality Assurance / Risk Management
/ Compliance Program.


The NIH infection prevention / control methods and procedures incorporate Universal Precautions (OSHA) and Standard Precautions (CDC). Herein the NIH procedure
will be referred to as Standard / Universal Precautions.


Infection Control Procedures - MEG staff and MEG users are required to adhere to the Clinical Center’s infection prevention / infection control policy and procedures,
in addition to MEG Lab practices.


Universal Precautions - will be employed based upon the contact with blood, body secretions, excretions, non-intact skin, and mucous membranes. Anyone who has patient
contact and / or the potential for occupational exposure to human blood and body fluids are required to adhere to infection prevention / infection control practices.


Standard Precautions - consists of work practices which are employed as a mean of standard / basic level of infection control which will be followed for all subjects/patients
regardless of whether an infectious disease is identified whenever there is a potential for the transmission of pathogens. Standard precautions integrate and expand the
elements of universal precautions into a standard of care designed to prevent transmission by blood or any other body fluid, excretion, or secretions (except sweat),
regardless of whether they contain blood, or is from non-intact skin or mucous membranes.


Transmission Based Precautions - will also be utilized to interrupt the transmission of known infections.

I. Standard / Universal Precautions include these practices:
1. Hand Hygiene – using soap and water or alcohol hand gel must be performed in each of these situations:
• After reporting to work (at the beginning of your shift);
• At the beginning and end of each MEG scan;
• Before and after subject/patient contact;
• Before donning gloves
• After removing gloves and other personal protective equipment;
• After touching objects that are likely to be contaminated with microorganisms (e.g., equipment or other items,
keyboards, <be>telephones / cell phones, doorknobs, stair banister, etc.
• Whenever hands are visibly soiled
• After sneezing, coughing or blowing your nose;
• After contact with blood, or other potentially infectious material and equipment or articles;
2. Use of protective barriers / personal protective equipment (PPE), which will include:
• Gloves - (latex or latex-free non-sterile gloves)
o During EEG/ EMG / Evoked Fields set up and clean up;
o When abrading the skin;
o When applying, handling and processing electrodes;
o When hands are likely to be contaminated with blood, body fluids, secretions or excretions;
o When handling any equipment that comes in contact with subjects with a known infection.
Gowns / Plastic apron –
o Usually not indicated for routine MEG Scans;
o To be worn during activities that are likely to generate splashes.
Masks –
o Usually not indicated for routine MEG scans;
o To be worn wherever splashes, spray, spatter or droplets may be generated toward the eyes, nose or mouth
(in these situations wear a mask and eye protection or a chin length face shield).
Protective Eyewear (i.e., eye shields or goggles) –
o Usually not indicated routine MEG scans;
o To be worn wherever splashes, spray, spatter or droplets may be generated toward the eyes, nose or mouth
(in these situations wear a mask and eye protection or a chin length face shield).
3. Appropriate handling and disposal of sharps and other contaminated or infectious waste –
o All sharp items including needles and blunted needle tips will be disposed of in a Sharps Container.
o Sharps container will be disposed of when ¾ full; seal container closed and place in a Medical Pathological Waste (MPW) box.
o All disposable items contaminated with blood, body fluids, secretions or excretions will be disposed of in a MPW box.
4. Use of Aseptic techniques- to control microorganisms in the environment-
• Cleaning – removal of all foreign materials using isopropyl alcohol (i.e., soil, organic material) from objects.
Cleaning must precede disinfection and sterilization procedures.
• Decontamination – using Dispatch (1:10 solution of Sodium Hypochlorite) renders instrument surfaces safe
to handle by reducing microbial burden.
• Disinfection – items are sent to Central Sterile Supply where a chemical or physical agent is used to eliminate nearly
all recognized pathogenic organisms but not necessarily all microbial forms on inanimate objects.
5. Use of Sterilization – items are sent to Central Sterile Supply where:
• Gas is used to eliminate or destroy all forms of microbial life, especially microorganisms and spores.
II. Transmission Based Precautions – additional precautions which are designed to interrupt transmission of known infections which should be used in addition
to Standard / Universal Precautions when transmission of known infections might not be contained by using Universal Precautions alone. Transmission based
precautions are based upon and used for patients known or suspected to be infected or colonized with epidemiologically important or highly transmissible
pathogens that can cause infections:
1. Respiratory Precautions –
a. Airborne Transmission (i.e., tuberculosis, measles virus, chickenpox virus);
b. Acid Fast Bacilli (AFB) (i.e., tuberculosis) or
c. Droplet Transmission (i.e., mumps, rubella, pertussis, influenza);
2. Contact Precautions - Direct or Indirect Contact dry skin (i.e., colonization with Multi-Resistant Staphylococcus Aureus [MRSA], ringworm, head lice, scabies) or
3. Strict Precautions - Any combination of these routes. *See IC Flipchart.
4. CNS Precautions – contact with blood or body fluids especially cerebral spinal fluid (CSF).



References:

1. National Institute of Health, Clinical Center Hospital Epidemiology Service (HES); http://intranet.cc.nih.gov/hospitalepidemiology/ .
2. OSHA Infections Control Guidelines; www.osha.gov .
3. CDC Infections Control Guidelines; www.cdc.gov .


______________________________________________________________________________________________________________________________

Hand Hygiene, Cleaning & Washing Procedures 9.20

National Institute of Mental Health

Subject:
MEG Core Facility
Hand Hygiene, Cleaning & Washing Procedures
Policy No. 9.20

Date: 1/03
Reviewed: 11/03; Reviewed: 11/03; Revised: 8/06; 7/07; 11/08; 1/12; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: Hand hygiene/washing procedures will be instituted to prevent the transmission of infectious disease from subject to subject, patient to patient and to or from
subject /patient to staff.


Procedure:

I. Steps to Assure Effective Hand Hygiene:
a. Keep nails short and neat. Cracked or chipped nail polish provides crevices for organisms.
b. Limit wearing of hand and wrist jewelry. Jewelry provides crevices for organisms.
c. Dry, cracked, broken skin increases chance of harboring transient bacteria. Dry hands well. Do not over use antimicrobials. Use hand lotion.
d. Liquid soap from a dispenser is preferred, however, if bar soap is used, rinse soap after use and keep on racks that allow drainage of water.


II. What to Use for Hand Hygiene:
1. Antimicrobial Soap and Water
Hands must be washed using an antimicrobial soap (Bactifoam) and running water.
In the absence of a true emergency, personnel should always wash their hands with soap and water.
If hands are visibly soiled they must be washed using an antimicrobial soap and running water as soon as possible.
2. Alcohol Based Gels
If hand washing using soap and running water is not possible an alcohol gel such as Avagard D (61% alcohol) may be used.
Alcohol gel products do not require water.


III. How to Wash Hands:
a. Use continuously running water.
b. Wet hands thoroughly.
c. Dispense enough hand soap for a good lather.
d. Vigorously rub together all surfaces of lathered hands for at least 10 seconds.
Take care not to break or abrade your skin.
e. Keep hands down at all times so run off goes into sink and not down arms.
Avoid splashing.
f. Rinse thoroughly under a stream of water.
g. Dry hands well with paper towel.
h. After washing turn off hand operated faucets with clean dry paper towel and
dispose of properly.


IV. How to Clean Hands Using Alcohol Based Gels:
a. Apply to dry hands.
b. Apply enough to moisten all hand surfaces (front and back).
c. Rub hand together for 20 seconds; cover all surfaces of the hands,
fingers and nails.
d. Allow hands to dry.
e. Do not wipe off excess gel; rub on skin until dry.
f. After every 10 applications of hand gel, perform hand hygiene with soap and running water.
g. If hands are visibly soiled they must be washed using soap and water.


V. When to Clean Hands:
• At reporting to work (at the beginning of your shift);
• At the beginning and end of each MEG scan;
• Before and after subject/patient contact;
• Before and after touching high risk subjects or patients
(before taking care of a particularly susceptible patient – i.e., severely immuno-compromised).
• After contact with blood or other body fluids, secretions, or excretions.
• Before donning gloves;
• After removing gloves- gloves can become perforated during use;
bacteria can multiply rapidly on gloved hands.
• After touching objects that are likely to be contaminated with microorganisms
(e.g., equipment or other items, keyboards, telephones, doorknobs, stair banister, etc.
• After applying or adjusting electrodes.
• After removing electrodes and cleaning hair and scalp.
• After handling electrodes for cleaning or after disinfecting.
• Before and after eating.
• Whenever hands are soiled;
• After going to the bathroom.
• After blowing or wiping nose, coughing or sneezing.


References:

1. Refer to the CC Handwashing Policy.
2. National Institute of Health, Clinical Center Hospital Epidemiology Service (HES); http://intranet.cc.nih.gov/hospitalepidemiology/ .
3. OSHA Infection Control Guidelines; www.osha.gov
4. CDC Infection Control Guidelines: www.cdc.gov


______________________________________________________________________________________________________________________________



Cleaning, Disinfection & Sterilization of MEG Equipment 9.30

National Institute of Mental Health

Subject:
MEG Core Facility
Cleaning, Disinfection & Sterilization of MEG Equipment
Policy No. 9.30

Date: 1/03
Reviewed: 11/03; Reviewed: 12/03; Revised: 8/06; 7/07; 3/09; Reviewed: 4/10; 5/11; 6/12; 7/14; 1/15; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: In order to interrupt the spread of infection at the point of transmission between sources and host: 1) all non-disposable equipment will be properly cleaned,
disinfected and/or sterilized between uses and, 2) all single use equipment will be properly disposed.


The MEG Core Facility is in compliance with all categories of isolation and specifications as mandated by the Clinical Center. All MEG Users / Research Assistants are required
to take the CC annual Infection Control / Universal Precautions Training. Each User / Research Assistant will be responsible for compliance with all MEG lab Infection Control
policies and procedures. All MEG Users / Research Assistants using electrodes and / or cap applications will be trained by the MEG technologist regarding specific MEG Lab
Infection Control policies and procedures.


I. PERSONAL PROTECTIVE EQUIPMENT

Personal Protective Equipment (PPE) -gloves, gown, plastic apron, masks, protective goggles and impervious barrier will be used, if transfer, aerosolization
or splattering of particulate matter is likely to occur. *If items are visibly soiled dispose of in a Medical Pathological Waste (MPW) Box otherwise disposed in the trash.
• Gloves will be used when:
- Abrading skin,
- Cleaning, disinfecting or handling equipment used on abraded skin,
- Handling all soiled instruments and equipment,
- In contact with a patient/subject with a known infectious disease,
- In accordance with Universal / Standard Precautions, Transmission Based Precautions and CC Infection Control guidelines.


• Protective Impervious Barrier will be used when: -
-Abrading the skin the physical work area surface will be partially covered with a barrier which will be used to place “contaminated/used” equipment or supplies, i.e.
- To place any item considered contaminated if needed for additional use otherwise if disposable the item should be disposed of in the trashcan or if
non-disposable cleaned using a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol,
- To place all soiled instruments and equipment,
- To place items that have come in contact with a patient/subject with a known infectious disease,
- In accordance with Universal / Standard Precautions, Transmission Based Precautions and CC Infection Control guidelines.



II. NON-PORTABLE NON-DISPOSABLE / REUSABLE EQUIPMENT

A. ROUTINE CLEANING PROCEDURE
All Non-Disposable Immobile or Non-Immersable equipment that comes in contact with a subject/patient will be routinely cleaned by the person(s) conducting the MEG scan
(each User/Research Assistant) using a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl alcohol or isopropyl alcohol after each subject/patient use.
Materials Required: Gloves, a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant
Frequency: After each use.
*Dispose of gloves in the trash after use; if visibly soiled, dispose in an MPW box.


B. KNOWN INFECTIOUS DISEASE PROCEDURE
Most EEG/MEG equipment (other than electrodes and caps) usually pose no significant hazard of infection transmission, however, when used by a patient with a known
infectious disease the equipment will be disinfected in compliance with Transmission Based Precautions by each User/Research Assistant after each subject/patient use.


Materials Required: Gloves, Prepping (Blue) Pad, Disposable Wash Cloth, a hospital approved disinfectant
such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant
Frequency: After each use.
*Dispose of gloves and other PPE in an MPW box.



C. TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHIES (Prions)
Use Disposable Equipment and supplies only for transmissible spongiform encephalopathies (Creutzfeldt Jakob Disease, Variant Creutzfeldt Jakob Disease,
Fatal Familial Insomnia, Gerstmann-Straussler-Scheinker Syndrome, Kuru). Any Portable Disposable or Non-Disposable items used on a patient with Transmissible
Spongiform Encephalopathies will be double bagged and sent for gas sterilization and then discarded. *Contact the Department of Perioperative Medicine
and Laboratory of Pathology, and also Hospital Epidemiology Service for further instructions and to make arrangements in advance.


Usually Non-Disposable Immobile or Non-Immersable equipment (i.e., the MEG machine, chair or bed) would not come into direct contact with a patient who has
Creutzfeldt Jakob or other transmissible spongiform encephalopathies (prions). Any Immobile Non-Disposable Equipment used in the presence of Creutzfeldt Jakob
or other transmissible spongiform encephalopathies (prions) will be wiped down with a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl
or isopropyl alcohol. *Contact the Department of Perioperative Medicine and Laboratory of Pathology, and also Hospital Epidemiology Service for further instructions.


Materials Required: Gloves, Prepping (Blue) Pad, Disposable Wash Cloth, a hospital approved disinfectant
such as Hydrogen Peroxide, 70-90% ethyl or isopropyl alcohol.
Responsibility: Each User / Research Assistant
Frequency: After each use.
*Double bag all used items and place in an MPW box then contact the Department of Laboratory
Medicine to arrange gas sterilization and disposal.Dispose of gloves and other PPE in the MPW box.



III. PORTABLE NON-DISPOSABLE / RE-USABLE EQUIPMENT

A. ROUTINE PROCEDURE FOR EQUIPMENT USED ON ABRADED SKIN
All non-disposable electrodes, EEG Caps that comes in contact with skin that has been abraded will be considered “contaminated”. This equipment will be
handled / processed by the User/Research Assistant conducting the scan utilizing Standard/ Universal Precautions and placed in the appropriate Biohazard Transport Container.
MEG staff will transport the equipment to Central Hospital Supply (CHS) for disinfection / sterilization.



1. ELECTRODE PROCESSING - Easy Cap Silver/Silver Chloride Disc Electrodes, Gereonics Silver /Silver Chloride Electrodes, IVM Slim-Trode Silver /Silver Chloride Pellet Electrodes.


Materials Required: Gloves, Prepping (Blue) Pad, Disposable Wash Cloth, Biohazard Transport Container,
Zip Lock Specimen Bag, Steam /Gas Sterilization Request Form,
a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant
Frequency: After each use
Transport to CHS: MEG Staff


Procedure:
a. Wash hands.
b. Don gloves.
c. Place the disk end of the ELECTRODE in the zippered compartment of the double pocket plastic Specimen Bag.
Tuck the cable (pin) end of the electrode in the un-zippered compartment.
d. Place the plastic specimen bag containing the electrodes in the top tray of the three (3) piece amber OSHA approved BIOHAZARD CONTAINER.
e. Discard the used/” contaminated” gloves in the trash unless visibly contaminated.
f. Wash hands after removing gloves.
g. Place the lid on the BIOHAZARD CONTAINER.
h. Place the BIOHAZARD CONTAINER with the soiled used/” contaminated” electrodes on the top shelf of the CHS cart.
i. Fill out a STEAM / GAS STERILIZATION REQUEST FORM. Indicate item quantity and the date. The Requester is “MEG”.
The User/Research Assistant filling out the request should sign their name in the section entitled Requester’s Signature.
j. Place the Request Form on top of the lid of the closed BIOHAZARD CONTAINER.
k. Wipe the Prep Table with
l. MEG Core staff will be responsible for transporting the BIOHAZARD CONTAINER to Central Hospital Supply for disinfection/sterilization.



2. EASY CAP PROCESSING


Materials Required: Gloves, Prepping (Blue) Pad, Disposable Wash Cloth, Biohazard Transport Container,
Zip Lock Specimen Bag, Steam /Gas Sterilization Request Form,
a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Processing Responsibility: Each User / Research Assistant.
Transport to CHS: MEG Staff /
Frequency: After each use.



Procedure:
a. Wash hands.
b. Don gloves.
c. Place the CAP in the top tray of the three (3) piece amber OSHA approved BIOHAZARD CONTAINER.
d. Discard the used/ “contaminated” gloves in the trash unless visibly contaminated.
All disposable items that are visibly contaminated with blood or body fluids will be disposed of in an MPW Box.
e. Wash hands after removing gloves.
f. Place the lid on the Biohazard Container.
g. Place the Biohazard Container with the soiled used/” contaminated” cap on the top shelf of the CHS cart.
h. Fill out a STEAM / GAS STERILIZATION REQUEST FORM. Indicate item, quantity and the date.
The Requester is the “MEG Core Facility” and the User/Research Assistant filling out the request
should sign their name in the section entitled Requester’s Signature.
i. Place the Request Form on the top of the lid of the closed Biohazard Container.
j. MEG staff will be responsible for transporting Biohazard Container to Central Sterile Supply.



B. ROUTINE PROCEDURE FOR EQUIPMENT USED ON UN-ABRADED SKIN
All Portable Non-Disposable equipment, i.e., head localization coils, that comes in contact with un-abraded and otherwise intact skin (including sweat)
will be cleaned using a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl alcohol or isopropyl alcohol.


Materials Required: 70-90% Ethyl Alcohol, Isopropyl Alcohol, Alcohol Prep Pads, and gloves
Responsibility: Each User / Research Assistant
Frequency: After each use
Transport to CHS: MEG Staff


1. MEG HEAD LOCALIZATION COILS CLEANING
Procedure:
a. Wash hands.
b. Wipe the Head Localization Coils with alcohol.
c. Adhesive Remover may be used occasionally to remove any adhesive buildup or sticky residue.
d. Wash hands.


C. KNOWN INFECTIOUS DISEASE (Abraded Skin or Un-Abraded Skin)
All Portable Non-Disposable / Reusable Equipment used by a patient with a known infectious disease will be sent to CHS for disinfection /sterilization; the only exception is for
Transmissible Spongiform Encephalopathies (Creutzfeldt-jakob Disease, Variant Creutzfeldt-jakob Disease, Fatal Familial Insomnia, Gerstmann-Staussler-Scheinker
Syndrome, and Kuru). If possible, use only disposable equipment and supplies.


Materials Required: Gloves, Prepping (Blue Pad), Disposable Wash Cloth, Biohazard Transport Container,
Zip Lock Specimen Bag, Steam / Gas Sterilization Form,
a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant
Frequency: After each use
Transport to CHS: MEG Staff


Processing Procedure:
a. Wash hands.
b. Don gloves.
c. Place the disk end of the ELECTRODE in the zippered compartment of the double pocket plastic Specimen Bag.
Tuck the cable (pin) end of the electrode in the un-zippered compartment.
d. Place the plastic specimen bag containing the electrodes in the top tray of the three (3) piece amber OSHA approved BIOHAZARD CONTAINER.
e. Discard the used/” contaminated” gloves and other disposable used supplies in an MPW Box. Follow the specific guidelines for the Transmission Based Precautions.
All disposable items that are visibly contaminated with blood or body fluids will be disposed of in an MPW Box.
f. Wash hands after removing gloves.
g. Place the lid on the Biohazard Container.
h. Place the Biohazard Container with the soiled used/” contaminated” electrodes on the top shelf of the CHS cart.
i. Fill out a STEAM / GAS STERILIZATION REQUEST FORM. Indicate item quantity and the date. The Requester is “MEG”.
The User/Research Assistant filling out the request should sign their name in the section entitled Requester’s Signature.
j. Place the form on top of the lid of the closed Biohazard Container.
k. MEG Core staff will be responsible for transporting the Biohazard Container to Central Hospital Supply for disinfection / sterilization.



D. TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHIES (Prions)
Use only Disposable / Single Use equipment, if possible. Portable equipment that has been exposed to or used in the presence of Creutzfeldt Jakob or other transmissible spongiform
encephalopathies (prions) must be immediately placed in a sterilization bag (double bagged) and sent for gas sterilization and then discarded. The bag should be properly labeled
indicating the infectious agent, method of sterilization and final disposition of the contents. *Contact the Department of Perioperative Medicine and
Laboratory of Pathology and Hospital Epidemiology Service to make arrangements in advance.


Materials Required: Gloves, Prepping (Blue Pad), Disposable Wash Cloth, Biohazard Transport Container,
Zip Lock Specimen Bag (2), Steam / Gas Sterilization Form,
Contents/ Warning Label, Marker, MPW Box, and a hospital approved
disinfectant such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant
Frequency: After each use
Transport to CHS: MEG Staff


Procedure:
1. Wash hands;
2. Double glove;
3. Immediately place in a sterilization bag (double bagged); place bag in an MPW Box for transport;
4. Discard gloves in an MPW box;
5. Wash hands;
6. Label the bag indicating the:
a) Infectious Agent,
b) The department to which the items / bag is going;
c) Method of Sterilization - Gas, and
d) Method of Final Disposition - Contents to be immediately discarded;
7. Place the bag in an MPW Box and contact the appropriate department regarding instructions for transport;
8. Don gloves; clean all surface areas with Dispatch;
9. Wash hands.



IV. DISPOSABLE / SINGLE USE EQUIPMENT
Disposable only; single use equipment will not be re-used.
A. Routine Procedure for Single Use Equipment used on Abraded Skin
All Disposable / Single Use Equipment used abraded skin will be disposed of in the trash. Gloves will be used when abrading the skin.
Materials Required: Gloves.
Responsibility: Each User / Research Assistant.
Frequency: After each use.



B. Routine Procedure for Single Use Equipment used on Un-Abraded Skin
All Disposable / Single Use Equipment that is used on un-abraded skin will be disposed of in the trash by each user / Research Assistant after each use.



C. Known Infectious Disease (Single Use Equipment)
All Disposable / Single Use Equipment used by a patient with a known infectious disease must be disposed of in a Medical Pathological Waste (MPW) Box.
Materials Required: Gloves, Prepping (Blue) Pad, MPW Box, and a hospital approved disinfectant
such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant / MEG Technologist.
Frequency: After each use.



D. Transmissible Spongiform Encephalopathies (Prions)
Disposable / Single Use Equipment and other materials or equipment that has been exposed to or used in the presence of Creutzfeldt Jakob or other transmissible spongiform
encephalopathies (prions) must be immediately placed in a sterilization bag (double bagged) and sent for gas sterilization and then discarded. The bag should be properly
labeled indicating the infectious agent, method of sterilization and final disposition of the contents. *Contact the Department of Perioperative Medicine and Laboratory of Pathology and
Hospital Epidemiology Service to make arrangements in advance.


Materials Required: Gloves, Prepping (Blue) Pad, Disposable Wash Cloth, Sterilization Bag (2),
Contents / Warning Label, Marker, MPW Box, and a hospital approved
disinfectant such as Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant / MEG Technologist.
Frequency: After each use.



Procedure:

1. Wash hands; double glove;
2. Immediately place in a sterilization bag (double bagged);
3. Discard gloves in an MPW box; wash hands;
4. The bag should be properly labeled indicating the:
a) Infectious Agent,
b) Department to which the items / bag is going,
c) Method of Sterilization - Gas Sterilization and
d) Method of Final Disposition - Contents to be immediately discarded;
5. Send sterilization bag with contaminated equipment for gas sterilization and final disposition of the contents as instructed;
6. Don gloves;
7. Clean all surface areas with Dispatch;
8. Wash hands.


Adverse Occurrences:

1. Exposure to an infectious agent.

Course of Action for Adverse Occurrence:

1. Follow the Clinical Center Infection Control Guidelines in accordance with the specific kind of exposure.
2. Report to Occupational Medical Service (OMS).
3. Fill out a MEG Variance Report.




References:

1. National Institute of Health, Clinical Center Hospital Epidemiology Service: http://intranet.cc.nih.gov/hospitalepidemiology/ .
2. OSHA Infection Control Guidelines: www.osha.gov .
3. CDC Infection Control Guidelines; www.cdc.gov /



______________________________________________________________________________________________________________________________

Infection Control - EEG Caps & Electrodes 9.40

National Institute of Mental Health

Subject:
MEG Core Facility
Infection Control - EEG Caps & Electrodes
Policy No. 9.40

Date: 1/03
Reviewed: 2/18; Revised: 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: In order to interrupt the spread of infection at the point of transmission between sources and host: 1) all non-disposable equipment will be properly cleaned,
disinfected and/or sterilized between uses and, 2) all single use equipment will be properly disposed.


Materials Required: Gloves, Prepping (Blue Pad), Disposable Wash Cloth, Biohazard Transport Container,
Zip Lock Specimen Bag (2), Steam / Gas Sterilization Request Form,
Contents/ Warning Label, Marker, MPW Box, and a hospital approved disinfectant such as
Hydrogen Peroxide, 70-90% ethyl or,/isopropyl alcohol.
Responsibility: Each User / Research Assistant
Frequency: After each use
Transport to CHS: MEG Staff


Procedure: I. NON-DISPOSABLE ELECTRODE(S) – e.g., Silver/Silver Chloride Disc Electrodes, Gereonics Silver /Silver Chloride Electrodes, Grass Gold Electrodes Procedure: 1. Latex rubber gloves must be use whenever handling and/or processing electrodes used on abraded skin. For individuals sensitive to latex, nitrile rubber gloves may be used.

2. Place the disk end of the electrode in the zippered section of the 2-pocket zip lock plastic bag.

3. Place the wire end in the un-zippered pocket of the zip lock plastic bag.

4. Place the plastic bag containing the “contaminated” electrode(s) in the top tray of the three (3) piece amber OSHA approved Biohazard Container.

5. Place the lid on the Biohazard Container.

6. Place the Biohazard Container on the top shelf of the Environmental Services Department (ESD) Processing Cart.

7. Fill out a “Steam/Gas Sterilization Request Form” for each container and place the form on the top of the appropriate closed Biohazard Container.

8. MEG staff will transport the Biohazard Container to ESD for disinfection/sterilization.

9. Biohazard Containers with “contaminated” equipment will be logged in and out per ESD procedures.

II. NON-DISPOSABLE EEG CAP – i.e., Easy Cap Procedure: 1. Latex rubber gloves must be used whenever handling and/or processing an EEG Cap that has been used on abraded skin. For individuals sensitive to latex, nitrile rubber gloves may be used.

2. Removed all electrodes from the cap. *The EEG Cap and electrodes will be processed separately.

3. Place the cap in the top tray of the three (3) piece amber OSHA approved Biohazard Container.

4. Place the lid on the Biohazard Container.

5. Place the Biohazard Container on the top shelf of the ESD processing cart.

6. Fill out the Gas Sterilization Request form and place on top of the appropriate closed container.

7. MEG staff will transport the Biohazard Container to ESD for disinfection / sterilization.













References: 1. National Institute of Health, Clinical Center Hospital Epidemiology Service (HES); http://intranet.cc.nih.gov/hospitalepidemiology/ . 2. OSHA Infections Control Guidelines; www.osha.gov . 3. CDC Infections Control Guidelines; www.cdc.gov .





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Quality Assurance / Risk Management (10.00)

QA /QI Risk Management Plan

National Institute of Mental Health

Subject:
MEG Core Facility
QA /QI Risk Management Plan
Policy No. 10.00

Date: 1/03
Revised: 8/06; 11/08; Reviewed: 1/12; 1/15; 2/18

Recommended By:
MEG Core Facility Staff

Distribution: MEG Core Facility

Policy: The MEG Core Facility Quality Improvement Plan/ Risk Management Program will objectively and systematically monitor and evaluate the quality of services provided in order
to pursue opportunities for improvement. The quality of services provided will be identified by predetermined, validated and/or approved criteria, indicators, standards, practice
guidelines, and/or parameters which are objective, measurable, based on current knowledge, research practice and/or experience and defined within institutional, departmental
and laboratory policies and procedures.


Procedure:

STEP I. ASSIGN RESPONSIBILITY

Identify the principle person responsible for administering the program and others team members’ responsibilities.


STEP II. DEFINE THE TYPES OF SERVICES PROVIDED –

Identify the types of services.


STEP III. DELINEATED SCOPE OF SERVICES -

Identify groups / clientele serviced and staff responsibilities / duties in providing services.


STEP IV. DETERMINE IMPORTANT ASPECTS OF CARE -

Identify broad categories of areas of interest, opportunities for improvement, problems or areas of concerns.


STEP V. IDENTIFY INDICATORS –

Identify specific components of care (problems or concerns) to be studied based upon written criteria, standards, guidelines,
and parameters of care or services, relevant to the essential or critical aspects of care or services.
Indicators - are problems or concerns.
Criteria - are predetermined measurable elements used as a basis for establishing standards.
Standards - are professionally developed expressions of the measure of acceptable variation from a given norm or criteria.
Indicators can be:
- used to review staff performance, systems processes, practices, supplies, equipment, facility conditions, etc.
- drawn from standards of professional practice, significant changes in occurrence, size, or scope in the results of care or services
provided and facility standards; institute policies and procedures; standards developed by professional organizations; standards
established by accreditation organizations.



STEP VI. DETERMINE THRESHOLD LEVELS FOR INDICATORS -

Threshold is the beginning or starting point of an evaluation of care and/or service triggered by exceeding pre-established indicators, criteria.


STEP VII. COLLECT AND IDENTIFY DATA -

Tabulate, summarize and where appropriate statistical analysis will be performed on the select aspects of service for a specified period of time. Once tabulated, data will be considered as “fact” for the purposes of the study.


STEP VII. EVALUATE AND ANALYZE DATA / IDENTIFY DEFICIENCIES -

A. Determine Appropriateness - The study should answer questions such as: Are studies being conducted appropriately? To answer questions relating to the study proper benchmarks must be constructed which correctly identify efficacious procedures, optimal outcomes or ideal organization.


B. Evaluate and Revise Criteria - Criteria are used to measure the extent to which the actual delivery of service conforms to the optimal delivery of service. The criteria used in evaluation studies should attempt to establish the parameters of legitimate medical or clinical conduct in relation to a particular problem, population, modality or program.


C. Evaluate Data - Appraise and assess data.


D. Identify Deficiencies - Recognize opportunities for improvement and categorize deficiencies.


STEP VIII. INSTITUTE CORRECTIVE ACTION / INTERVENTIONS / PLAN OF ACTION -

A. Personnel deficiency problem:
1. Lack of knowledge → education.
2. Lack of skill → training.
3. Attitudes in relation to task → education / training / discipline.
4. Lack of adequate staffing → hiring / re-allocation of manpower or duties.


B. Program deficiency problem:
1. Structure.
2. Policy.
3. Procedure.


C. Organizational deficiency problems:
1. Structure.
2. Policy.
3. Procedure.


STEP IX. OUTCOME OF CORRECTIVE ACTION TAKEN / ASSESS OR MONITOR THE IMPACT -

The impact of the corrective action will be observed via the Variance process. At a reasonable time after corrective action is completed, indicators/deficiencies will be:
A. Reviewed - to determine that appropriate changes have occurred.
B. Re-audited - whenever there is an overall average of less than 85% compliance.



______________________________________________________________________________________________________________________________
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Training & Education (11.00)

______________________________________________________________________________________________________________________________


Compliance (12.00)

______________________________________________________________________________________________________________________________


Quality Assurance Manual

This manual contains information on the MEG Core Facility Quality Assurance - Quality Improvement / Risk Management Program. These programs monitor and evaluate the quality of services provided in order to pursue opportunities for improvement. This manual is currently under development.

Tutorials

Here is some tutorial documentation that has been compiled as a complement to the information available on the website. Some of the topics are covered in more depth in these manuals, although the information on the website may be more current.

  Word.png  MEG Data Acquisition Tutorial (last updated 8/22/03), update coming soon)
  Pdf.png  MEG Data Acquisition Tutorial (last updated 8/22/03), update coming soon)

  Word.png  MEG Data Analysis Tutorial (last updated 8/13/03, update coming soon)
  Pdf.png  MEG Data Analysis Tutorial (last updated 8/13/03, update coming soon)

How To Instructions

These are instructions or handouts which cover various different topics pertinent to the performance of MEG scans and/or data analysis.

* Word.png  MEG Fiducial Placement Instructions
* Pdf.png  MEG Fiducial Placement Instructions

Octave Class

Tom gave a short tutorial on switching from Matlab to Octave. Here are the class notes: Msppt.png Octave class (MS PowerPoint Presentation) This reflects versions 2.9.10 of Octave. Also, here are two sample scripts:

* Octave-logo.png  anything.m
* Octave-logo.png  mkmesh.m

Miscellaneous Documentation

  • Adobe-ps.png SensLayout-275 — a color picture showing the sensor names and relative locations (ps).
  • Pdf.png SensLayout-275 - a color picture showing the sensor names and relative locations (pdf).