The procedure setup file is the stored template for the settings used to perform testing. Users will typically create several procedure setup files – one or more procedure setup files for a particular type of surgery. A procedure setup file is required before you begin a monitoring session. You can change or modify existing ‘factory’ setup procedures and permanently save the changes or you can create your own procedure setups.
In the setup file, you specify what amplifier inputs will be used and assign them to amplifier channels, add acquisition modes, and assign amplifier channels to each mode, and create views of window configurations.
The best way to learn how to modify or make new setups is by creating a very simple new procedure. To create a Left and Right Median SEP procedure follow these steps.
Steps to Create a New Procedure Setup File
- Start Cascade Classic. From the home page, click the File menu and then select Create New Procedure Setup. The Procedure Setup window will open.
- Click on Channel Setup. In the Pod A, B, C, D section define your amplifier inputs. Label the input jacks that will be used (i.e. type in C3’, C4’, Fpz, C5s (for the 5th cervical spinous process), LEP (for left Erb’s point), and REP (for right Erb’s point). Use the pull down arrow to use commonly used electrode labels.
- Design the montage channels required for every required modality (ABR, SSEP, MEP, EMG) For Cascade Pro and Elite systems, Pod A and B are used in Channels 1-16 and Pod C and D are used in Channels 17-32. For Cascade 16 units, A-B-C-D are all used for channels 1-16. To program montage derivations, click on the active box for channel 1, then click on the electrode pod number you would like in channel 1 active. Repeat for Channel 2 reference. Repeat for additional channels.
- For multi-modality procedures, it is often necessary to create separate tests to program more than 16 or more than 32 montage derivations. For example, you may want to place MEP recording channels into a second test. Use the link box only if you intend to duplicate channels from one test to another.
- Name, Gain, Hi Cut and Lo Cut fields are automatically generated and can be edited. For evoked potentials, set the Amplifier Gain to 10 or 20. Right-click on a channel row to delete the channel.
- Specify Notch Filter and Audio settings. A checked Audio box means the channel’s signal will output to the computer speakers, and is most commonly used in EMG channels. A checked Notch Filter box means that a 60 Hz digital filter will be applied to that channel. Notch filters on EP modes may induce ringing into the average signal, and should be used sparingly as it can reduce the overall capability of the program to run multiple modes simultaneously. Filter settings are determined by clinical protocols. Recommended filter settings can be found at ACNS.org.
- Click OK to proceed to Mode programming.
- Click on Add Mode to program the first mode. A separate mode is required for each stimulator attached to the patient. Example modes are L SSEP upper, R SSEP upper, L MEP, R MEP, EEG, ABR, Train of Four, T-EMG, S-EMG, F-EMG.
- Enter a name for the mode, select the mode type from the drop-down list, and click OK. To monitor Live EMG or EEG, create a mode in the same manner but do not assign a stimulator to the mode. For Stimulated or Triggered EMG, you will need to assign an electrical stimulator to the mode.
- Select stimulus. Click the drop-down arrow and select a Stim Type. You may edit the default stim parameters by clicking the Setup Stim button. Choose a Repetition Rate (RR), and then select the Stim Number as it corresponds with the numbered output on the electrical stimulus splitter box (1 – 4 for high current, or Low 1 for low current). Click OK.
- Assign amplifier channels to each mode in the Channel Settings box. Click the channel button in the test table to input settings. Check the Invert box if needed. (Cp3-Cp4 vs Cp4-Cp3).
- Set up the cursor table. Refer to Setting Up Cursor Table in the Cascade Help File.
- Verify that you are in the correct Test, then Click on Add Mode to program your next mode. Repeat steps above to create additional acquisition modes. You can Copy Mode Setup and Copy Cursor Table from the Create New Mode window to copy and paste settings.
- Add View to program views to program different recording screens. Check windows that you would like in the view. Example views are “SEP EMG live”, “MEP”, and “Print Summary”. See View Setup in the Cascade Help file for more information. Program default settings. Click the Window Setup button and edit as needed.
- Click File and Save As to name your procedure file prior to clicking OK to close it.
- Click OK to exit the Procedure Setup window.
- Practice recording with your new procedure file prior to using it in the OR!