Tech Tips: A Checklist for Troubleshooting Artifacts:  


Artifacts in Neurodiagnostic testing are ubiquitous and found in every recording, and therefore, as the eyes and ears of the physician, it is every technologist’s responsibility to minimize the effect(s) of artifacts on the recording and improve the overall interpretability of the recording. There are many common artifacts that technologists troubleshoot daily, however, an astute technologist approaches artifact troubleshooting in a systematic and meticulous way to ensure an efficient and effective resolution. Furthermore, and most importantly, an astute technologist will document, document, document, not just the source(s) of artifact, but the steps taken to determine, isolate and reduce or eliminate the artifact.   

In an effort to provide technologists with a convenient source of documentation, below is a general checklist, which is by no means a comprehensive list, but it provides a general guide to walk through the systematic process of troubleshooting artifacts  


Check input cables  


  Electrode connections into headbox amplifier  


  Headbox connection to the computer 


  Computer connection to the monitor 




Check electrodes 


  Electrode placement into appropriate headbox designation (tap test) 


  Electrodes are securely attached to patient 


  Electrode wires securely bundled together (can help reduce 60 Hz) 


  Individual electrode integrity, change/replace for isolated activity 




Check electrode placement  


 Distance between electrodes is consistent and equal 


 Ensure no salt bridge is present and any sweat from the patient is minimized 




Check impedances 


  10 Ω 




  Ground and system reference electrode integrity 




Check montage (ANCS Guideline 3: 




 Longitudinal Bipolar 


 Transverse Bipolar 


 Ensure the selected montage is appropriate for the test 


 Change/test montage setting which may help localize the artifact 




Check chart speed/timescale (ACNS Guideline 1: 10–20 seconds/page, depending on display size [should correspond to chart speed of 30 mm/second) 




Check filter settings (ACNS Guideline 1: 


 HFF (ACNS Guideline 1: 70 Hz [–3Db]) 


 LFF (ACNS Guideline 1:  1 Hz [23 dB], i.e., time constant of at least 0.16 second) 


 Notch (ACNS Guideline 1: Only used when other measures to reduce 60 Hz fail) 




Check sensitivity (per Guideline 1, range of 5–10 µV/mm; commonly set to 7 µV/mm) 




Check the patient for physiologic sources of artifact and patient surroundings for non-physiologic sources 






 Glossokinetic, mouth movement 


 Review medical record for implantable devices: cochlear implant, pacemaker, DBS, etc. 


 Proximity of cell phone or other mobile device 


 Proximity of headbox or equipment cables to patient bed monitors and/or cable 


 Proximity of headbox or equipment cables to ancillary monitors in the patient room 




Check software settings 


 Camera and/or audio settings 


 Common mode rejection ratio (CMRR) 


 Ensure filter and sensitivity settings are consistent for all channels 

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