AAEM minimonograph #16: instrumentation and measurement in electrodiagnostic medicine--Part II.

A review of instrumentation and measurement in electrodiagnostic medicine is continued in this Part II which focuses on digital instrumentation principles, gain and sweep effects, noise, nerve stimulation, and conduction measurement limitations. With the adoption of microprocessor-based equipment, the neurophysiologic signal must undergo analog-to-digital conversion (ADC) before analysis and display on a video monitor. ADC resolution and sampling rates affect accuracy and measurement precision. Following waveform display, the visual assessment of latency and duration may be influenced by sweep and gain settings, often overlooked sources of error. Undesired signal or noise typically originates from power-line interference, electronic amplifier noise, background muscle activity, or nerve stimulation artifact. Noise often interferes with clinical studies but techniques exist to reduce noise to acceptable levels in virtually all situations. An awareness and understanding of these technical issues will lead to an appreciation of the limitations of electrodiagnostic testing and improve interpretation and clinical decision-making.