Vietnam National Universities –
HCMC
International University
School of Biomedical Engineering
Internship Report
At
Military Hospital 175
Student: Đinh Vương Bá Nhân
ID: BEBEIU18225
Academic Advisor: Trịnh Như Thùy, PhD
Internship Instructor: Dr. Hoàng Tiến Trọng Nghĩa
Ho Chi Minh city, Vietnam
8-2023
Internship Organization’s name
School of Biomedical Engineering
APPROVAL
This report has been submitted for examination with the approval of the supervisor.
Internship supervisor/instructor: < Dr. Hoàng Tiến Trọng Nghĩa >
Signature: ....................................................................
Date: .............................................................................
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ACKNOWLEDGEMENT
I would like to express my sincere gratitude and appreciation to all individuals and
organizations who have contributed to the completion of this internship. Their support, guidance,
and assistance have been invaluable throughout this journey.
First and foremost, I am deeply indebted to my internship supervisor, Dr. Hoànng Tiến Trọng
Nghĩa, for Dr. Nghĩa's unwavering support, expertise, and invaluable guidance. Dr. Nghĩa's
dedication, encouragement, and insightful feedback have been instrumental in shaping the direction
and quality of this work. I am truly grateful for Dr. Nghĩa's mentorship and the opportunities they
have provided me.
I would like to extend my heartfelt thanks to the members of the technician team and doctors
at the neurology department for their valuable input, constructive criticism, and scholarly advice.
Their expertise and diverse perspectives have significantly enriched this study.
I am grateful to the military hospital 175 and the neurology department for providing the
necessary resources, facilities, and funding that facilitated the successful completion of this project.
The neurology department has created an intellectually stimulating environment that nurtured my
academic growth.
I would also like to acknowledge the contributions of my fellow colleagues who have provided
invaluable assistance and insightful discussions. Their support and camaraderie have been a source
of inspiration and motivation.
Furthermore, I appreciate all the participants who generously volunteered their time and
actively contributed to this study. Without their involvement, this research would not have been
possible.
Finally, I would like to express my deepest gratitude to my family, friends, and loved ones for
their unwavering encouragement, understanding, and patience throughout this endeavor. Their
constant support and belief in my abilities have been a constant source of strength.
In conclusion, this work results from collective efforts and support from numerous individuals
and organizations. While I have attempted to acknowledge everyone, there may be others whose
contributions have inadvertently been overlooked. I extend my sincere apologies to them and
express my gratitude for their assistance.
Thank you all for your invaluable contributions and for being an integral part of this journey
of an internship.
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Table of Contents
I.
Introduction ..................................................................................................................... 1
1. Military hospital 175 ................................................................................................... 1
1. Introduction to the Military hospital 175 .................................................................. 1
2. Main departments of the Military hospital 175 ........................................................ 2
Department of Internal Medicine ..................................................................................... 2
Department of Surgery ...................................................................................................... 3
Clinical Diagnostic Block ................................................................................................... 3
Institutes .............................................................................................................................. 4
2. Neurology Department ............................................................................................... 4
1. General information about the Neurology department ........................................... 4
2. Examinations, diagnoses, and treatments included in the Neurology
department: ............................................................................................................................ 5
3. Machines used in the Neurology department ....................................................... 5
3. Electroencephalogram (EEG) .................................................................................... 7
1. Introduction to EEG ................................................................................................... 7
2. Placement of scalp electrodes (electrode array) ....................................................... 8
3. Types of electrode ........................................................................................................ 9
II.
The Internship activities ........................................................................................... 14
Working on an EEG machine ......................................................................................... 15
Routine EEG ................................................................................................................. 15
III. Contributions and gaining ........................................................................................ 16
1. Knowledge/experience gained .................................................................................. 16
Two types of artifacts ....................................................................................................... 16
2. Contributions ............................................................................................................. 17
REFERENCES ..................................................................................................................... 20
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List of Figures
Figure 1. The Institute of Orthopedic Trauma of the military hospital 175 (source: bedental.vn
(left); vtv.vn (right)) ........................................................................................................................ 1
Figure 2. The military hospital 175 viewed from Nguyễn Thái Sơn overpass (source: vtv.vn)
......................................................................................................................................................... 1
Figure 3. Members of the Neurology Department ................................................................... 4
Figure 4 & 5. Doctor and technician working on a patient using the VNG ............................. 5
Figure 6 & 7: RTMS Machine without a patient (left) and with a patient (right) .................... 6
Figure 8 & 9. EMG maachine by Natus (source: ebay.com)(right) ......................................... 6
Figure 10 & 11: Nihon Kohden EEG machine (left) and Natus EEG machine (right) ............ 7
Figure 12. 10-10 array (source: commons.wikimedia.org ....................................................... 8
Figure 13. 10-20 array .............................................................................................................. 9
Figure 14. 10 -20 + 6 array ....................................................................................................... 9
Figure 15. Routine EEG procedure ........................................................................................ 15
Figure 16. First lesson with Dr. Ý .......................................................................................... 18
Figure 17. Second lesson with Dr. Ý ...................................................................................... 18
Figure 18. First picture with the "team" ................................................................................. 19
Figure 19. End of internship celebration ................................................................................ 19
List of Table
Table 1. Internship schedule ................................................................................................... 14
Table 2. Daily activities .......................................................................................................... 14
Table 3. Goals for the internship ............................................................................................ 14
Table 4. Responsibilities of an intern ..................................................................................... 14
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I. Introduction
1. Military hospital 175
Figure 1. The Institute of Orthopedic Trauma of the military hospital 175
(source: bedental.vn (left); vtv.vn (right))
1. Introduction to the Military hospital 175
Military Hospital 175, also known as Bệnh viện Quân y 175 in Vietnamese, holds a significant
position in the healthcare landscape of Vietnam. Established in 1955, it has emerged as a premier
military medical facility, serving the healthcare needs of military personnel, veterans, and the
broader civilian population. Situated in Ho Chi Minh City, Military Hospital 175 has a
distinguished history and a reputation for providing comprehensive and specialized medical care.
With a commitment to excellence, Military Hospital 175 offers a wide range of medical
services across various specialties. These include internal medicine, surgery, pediatrics, obstetrics
and gynecology, orthopedics, neurology, cardiology, and more. The hospital is known for its
expertise in trauma and emergency care, rehabilitation, and the treatment of war-related injuries,
making it a pivotal institution in addressing the healthcare needs of military personnel.
Equipped with state-of-the-art facilities and advanced medical technologies, Military Hospital
175 ensures that patients receive the
highest standard of care. Its modern
operating rooms, intensive care units,
diagnostic imaging facilities, and
laboratories
enable
accurate
diagnosis, effective treatment, and
comprehensive medical support. The
hospital boasts a dedicated team of
highly
skilled
healthcare
professionals, including doctors,
nurses, technicians, and support staff,
who work tirelessly to provide
compassionate and efficient care to
patients.
Figure 2. The military hospital 175 viewed from Nguyễn Thái Sơn overpass
(source: vtv.vn)
In addition to its medical services, Military Hospital 175 actively engages in research and
training endeavors. The hospital collaborates with other medical institutions, participates in
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research projects, and contributes to advancing medical knowledge, improving treatment
outcomes, and developing innovative techniques. Furthermore, it plays a vital role in medical
education, offering training programs for medical students, residents, and military personnel,
thereby nurturing the next generation of healthcare professionals in Vietnam.
Military Hospital 175 also embraces its responsibility towards the community through various
engagement initiatives and humanitarian efforts. It may extend medical assistance during times of
natural disasters, organize health campaigns, and provide medical outreach programs to
underserved areas, embodying the values of compassion and service.
With its rich history, comprehensive medical services, state-of-the-art facilities, and
commitment to research and training, Military Hospital 175 stands as a pillar of healthcare
excellence in Vietnam. Its unwavering dedication to providing exceptional medical care to military
personnel and the wider community solidifies its position as a respected institution within the
healthcare landscape.
Main departments of the Military hospital 175
Department of Internal Medicine
2.
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Department of High-ranking Military Officer Treatment (A1): Specializes in providing
medical care to high-ranking military personnel.
Department of Cardiovascular and Endocrine Rheumatology (A2.1): Focuses on the
diagnosis and treatment of cardiovascular diseases and endocrine disorders.
Department of Cardiovascular Intervention (A2.2): Specializes in interventional
procedures for cardiovascular conditions.
Department of Gastroenterology (A3): Deals with the diagnosis and treatment of
digestive system disorders.
Department of Infectious Diseases (A4): Focuses on the diagnosis, treatment, and
prevention of infectious diseases.
Department of Tuberculosis and Pulmonology (A5): Specializes in the diagnosis and
treatment of tuberculosis and respiratory diseases.
Department of Psychiatry (A6): Deals with the diagnosis and treatment of mental
health disorders.
Department of Neurology (A7): Specializes in the diagnosis and treatment of
neurological disorders.
Department of Dermatology and Allergy (A8): Focuses on the diagnosis and treatment
of skin diseases and allergies.
Department of Pediatrics (A9): Specializes in the medical care of infants, children, and
adolescents.
Department of Central Health Protection and Care for Central Officials (A11):
Provides healthcare services and support for central government officials.
Department of Intensive Care (A12): Focuses on providing intensive care and life
support for critically ill patients.
Department of Blood Transfusion (A14): Deals with the collection and administration
of blood and blood products.
Department of Occupational and Clinical Hematology (A25): Deals with occupational
diseases and clinical hematology conditions.
Department of Functional Restoration (A26): Specializes in restoring and improving
the functional abilities of patients.
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Department of Surgery
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Department of Urology (B2): Specializes in the diagnosis and treatment of urinary tract
disorders.
Department of Abdominal Surgery or General Surgery (B3): Deals with surgical
procedures involving the abdominal region.
Department of Thoracic Surgery or Chest Surgery (B4): Specializes in surgical
procedures related to the chest cavity.
Department of Anesthesiology and Intensive Care (B5): Provides anesthesia services
for surgeries and critical care management.
Department of Neurosurgery (B6): Specializes in surgical procedures involving the
brain, spinal cord, and peripheral nerves.
Department of Ophthalmology (B7): Deals with the diagnosis and treatment of eyerelated conditions.
Department of Maxillofacial Surgery (B8): Focuses on surgical procedures involving
the face and jaw.
Department of Ear, Nose, and Throat (ENT) or Otorhinolaryngology (B9): Deals with
conditions related to the ear, nose, and throat.
Department of Dentistry or Dental Department (B10): Specializes in oral health and
dental care.
Department of Obstetrics and Gynecology (B11): Focuses on women's reproductive
health and childbirth.
International Department (A16): Provides healthcare services for international patients.
Clinical Diagnostic Block
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Emergency Department (C1-3): Handles emergency medical cases and provides
immediate care.
Department of Hematology (C2): Specializes in the diagnosis and treatment of blood
disorders.
Department of Biochemistry (C3): Deals with the analysis of biochemical components
in bodily fluids for diagnostic purposes.
Department of Microbiology (C4): Focuses on the study and identification of
microorganisms that cause diseases.
Department of Pathology (C5): Examines tissues and organs to diagnose diseases and
understand their underlying causes.
Department of Functional Diagnosis (C7): Conducts tests and assessments to evaluate
the functioning of various bodily systems.
Department of Diagnostic Imaging (C8): Utilizes medical imaging techniques such as
X-rays, CT scans, and MRIs to diagnose and monitor medical conditions.
Department of Nutrition (C11): Provides dietary assessments, consultations, and
specialized nutritional plans for patients.
Department of Infection Control (C12): Focuses on preventing and managing
healthcare-associated infections within the hospital.
Department of Transfusion Medicine (C16): Deals with blood transfusion procedures
and management of blood products.
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Institutes
Institute of Orthopedic Trauma:
 Department of Upper Extremity Surgery (B1.A): Specializes in surgical procedures
related to the upper limbs, such as arms and shoulders.
 Department of Lower Extremity Surgery (B1.B): Focuses on surgical procedures
involving the lower limbs, such as legs and hips.
 Department of Sports Medicine (B1.C): Deals with the medical care and treatment of
sports-related injuries and conditions.
 Department of Burn and Reconstructive Surgery (B1.H): Specializes in the treatment
of burn injuries and reconstructive procedures.
 Department of Intensive Care for Trauma (A12.2): Provides specialized intensive care
services for critically injured patients.
Institute of Oncology and Nuclear Medicine:
 Department of Outpatient Examination and Treatment (A20.1): Conducts outpatient
examinations and provides non-emergency medical care.
 Department of Radiation Therapy (A20.2): Focuses on using radiation for the treatment
of cancer.
 Department of Chemotherapy (A20.3): Specializes in administering chemotherapy
treatments for cancer patients.
 Department of Palliative Care (A20.4): Provides supportive care and pain management
for patients with serious illnesses, including cancer.
 Department of Nuclear Medicine (A20.5): Deals with the use of radioactive substances
for diagnostic imaging and treatment.
2. Neurology Department
1. General information about the Neurology department
The Neurology Department at Military Hospital 175 specializes in the diagnosis, treatment,
and management of neurological disorders and conditions. Neurology is a medical specialty that
focuses on the nervous system, which includes the brain, spinal cord, and peripheral nerves. The
department has full inpatient and outpatient treatment areas, as well as a neurofunctional diagnostic
unit.
In
addition,
the
Neurology Department closely
collaborates
with
other
departments,
units,
and
divisions in all patient care
activities,
such
as
the
Department of Neurosurgery,
Interventional Neurology Unit,
and Intensive Care Unit.
Experienced doctors with
comprehensive training both
domestically
and
internationally
directly
examine and treat patients.
Figure 3. Members of the Neurology Department
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2. Examinations, diagnoses, and treatments included in the Neurology department:
 Common neurological disorders such as headaches, dizziness, and nerve pain.
 Movement disorders such as Parkinson's disease, tremors, and spasticity.
 Neuro-muscular disorders such as nerve inflammation, muscle weakness, and myositis.
 Cognitive decline such as Alzheimer's disease, post-stroke cognitive impairment.
 Epilepsy and seizures.
 Acute stroke (cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage),
stroke prevention methods such as medication and endovascular interventions.
 Botulinum neurotoxin treatment for movement disorders (facial spasms, eyelid spasms,
cervical dystonia, writer's cramp), muscle stiffness, excessive sweating, drooling, and
treatment-resistant chronic pain.
 The neurofunctional diagnostic unit performs around 8,000 electromyography cases,
10,000 electroencephalography cases, and 3,500 transcranial ultrasound cases per year.
Additionally, they are equipped with new techniques such as the vestibulo-ocular reflex
measurement system and vHIT glasses, as well as transcranial magnetic stimulation.
 Organizing patient club activities to provide knowledge to patients and their families.
 Conducting scientific research projects, many of which have been successfully
implemented and applied in diagnosis and treatment.

3. Machines used in the Neurology department
 Videonystagmography machine by VisualEyes™
Videonystagmography (VNG) is a series of tests used to evaluate and analyze eye
movements in order to assess the function of the vestibular system, which is responsible for
maintaining balance and coordinating eye movements. It helps identify vestibular system
impairments, aiding in the diagnosis and treatment of dizziness disorders. The Neurology
Department at Military Hospital 175 takes pride in being the first unit in the South of
Vietnam to effectively implement this new technique, bringing an end to the discomfort
experienced by patients with dizziness.
Figure 4 & 5. Doctor and technician working on a patient using the VNG
Figure 5
 Repetitive Transcranial Magnetic Stimulation
Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive medical procedure
used to treat various disorders, including chronic pain. It is a brain stimulation technique that
involves generating a magnetic field using a stimulation device placed on the patient's scalp. This
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magnetic field has the same nature and intensity as the magnetic field used in magnetic resonance
imaging machines. The magnetic pulses create a weak electrical current in the brain, thereby
rapidly activating neural circuits at the stimulation site. rTMS is a procedure that can be used to
treat patients with chronic pain who have a poor response to medication-based treatments.
Figure 6 & 7: RTMS Machine without a patient (left) and with a patient (right)
(source: en.wikipedia.org)
Figure 7
 Electromyography Machine
An electromyography (EMG) machine is a medical device used to measure and record
electrical activity in muscles. EMG is a diagnostic procedure used to evaluate the health and
function of muscles and the nerves that control them. It involves measuring and recording the
electrical activity generated by muscles during rest and contraction. EMG can detect muscle
disorders, nerve damage, neuromuscular diseases, and abnormalities in muscle and nerve function.
It provides valuable information about muscle activity, and nerve conduction, and helps diagnose
conditions such as muscular dystrophy, neuropathies, myopathies, and nerve compression
syndromes.
Figure 8 & 9. EMG maachine by Natus (source: ebay.com)(right)
Figure 9
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 Electroencephalography Machine
An electroencephalography (EEG) machine is a medical device used to measure and record
the electrical activity of the brain. It detects and records the brain's electrical signals, known as
brainwaves, using electrodes placed on the scalp. The EEG machine provides valuable
information about brain function and is primarily used in diagnosing and monitoring conditions
such as epilepsy, sleep disorders, brain injuries, and certain neurological disorders. It helps
healthcare professionals analyze brainwave patterns and identify abnormalities or changes in
brain activity.
This is also the machine that I have been exposed to and trained on during the recent
internship period. There are a total of three EEG machines in the department, of which two are
from Natus NeuroWorks while the other one is from Nihon Kohden. One of the Natus EEG
machine is being used for sleep EEG while the Nihon Kohden EEG machine is used for routine
EEG. A fun fact is that the Nihon Kohden EEG machine has been used for over the period of 18
years, as it’s first usage was back in 2005.
Figure 10 & 11: Nihon Kohden EEG machine (left) and Natus EEG machine (right)
Figure 11
3. Electroencephalogram (EEG)
1. Introduction to EEG
Rlectroencephalography was discovered in the early 20th century. The first recording of
human brainwaves using EEG was achieved by Hans Berger, a German psychiatrist and
neurologist, in 1924. Berger's discovery laid the foundation for the development and advancement
of EEG as a valuable tool in studying brain activity and diagnosing various neurological conditions.
EEG is a technique to record brainwave activity by placing electrodes on the scalp or directly on
the brain. It measures the electrical impulses generated by neurons in the brain, helping to diagnose
and identify conditions such as epilepsy. EEG provides valuable insights into brain function and is
a commonly used method in neurology. EEG is mainly used for diagnosing and monitoring
conditions related to brain function and activity. It is particularly valuable in the diagnosis and
management of epilepsy, as it helps to detect and characterize abnormal brainwave patterns
associated with seizures. EEG is also used in the evaluation of sleep disorders, brain injuries,
neurological disorders, and research studies related to brain activity and cognitive processes.
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Additionally, it can provide valuable information during brain surgery by mapping functional areas
of the brain and monitoring brain activity in real-time.
2. Placement of scalp electrodes (electrode array)
There are 3 main placement for electrode in EEG:
 10 – 10 array
 10 – 20 array
 10 – 20 array + 6 additional subtemporal electrodes
The letters in the EEG system represent the anatomical regions of the scalp where the
electrodes are placed. These letters are used in various electrode systems, including the 10-20 and
10-10 systems, to label specific electrode positions:
 F: Frontal (frontal cortex, located at the front of the head)
 C: Central (central cortex, located in the middle of the head)
 P: Parietal (parietal cortex, located on the top and back of the head)
 O: Occipital (occipital cortex, located at the back of the head)
 T: Temporal (temporal cortex, located on the sides of the head)
10 – 10 array
In the 10-10 array system, the scalp is divided into regions based on anatomical landmarks.
The electrodes are then positioned at specific sites within these regions, resulting in a grid-like
pattern. The name "10-10" indicates that the electrodes are placed at intervals of 10% of the total
front-back and right-left distances of the skull. This array provides a higher electrode density
compared to the previous 10-20 system. It includes a total of 94 electrode sites, with 19 electrodes
placed along the midline (Fz, Cz, Pz, etc.) and 75 electrodes placed symmetrically on each
hemisphere.
The 10-10 array is widely used in EEG research and clinical practice, as it allows for more
precise spatial sampling of brain activity. The increased electrode density enables better
localization of neural signals and improves the ability to capture subtle changes in brain dynamics.
Figure 12. 10-10 array (source: commons.wikimedia.org
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10 – 20 array
The 10-20 electrode system is named after the distances
between electrode placements, which are positioned at
specific locations on the scalp, that are either 10% or 20% of
the total front-back or right-left distance of the skull. The
system provides a standardized way to ensure consistent
electrode placement across different individuals and
facilitates accurate comparison of EEG data between different
studies and laboratories.
In the 10-20 system, a standard configuration includes a
total of 21 electrodes. These electrodes are positioned based
on anatomical landmarks such as the nasion, inion, and
preauricular points. The first electrode in each direction is
Figure 13. 10-20 array
placed at 10% of the total distance from the landmarks, and
(source: en.wikipedia.org)
subsequent electrodes are placed at intervals of 20% of the
total distance. For example, Fp1 is positioned at a point that is 10% of the total distance from the
nasion, and Fz is situated at a location that is 20% of the total distance from Fp1. This standardized
electrode configuration allows for consistent and accurate placement of electrodes for EEG
recordings.
10 – 20 + 6 array
The 10-20 array with 6 additional subtemporal electrodes is
a new and extended electrode configuration used in
electroencephalography (EEG) recordings. It combines the
standard 10-20 system with an additional set of electrodes placed
in the subtemporal region. When the 10-20 array is extended with
6 subtemporal electrodes, additional electrode positions are
added in the subtemporal region. The subtemporal region is
located on the sides of the head, near the temples, and
encompasses the temporal lobes. These lobes are involved in
various cognitive processes such as auditory perception,
memory, and language.
By incorporating these subtemporal electrodes, the extended
Figure 14. 10 -20 + 6 array
10-20 array allows for more comprehensive coverage of the scalp,
including the temporal regions. This enhanced coverage can be particularly useful for capturing
and analyzing brain activity in the temporal lobes. However, further research and evaluation are
necessary to determine the benefits and potential applications of this extended configuration in
comparison to the established 10-20 system.
3. Types of electrode
There are three types of electrodes that I have been able to work with while on the internship,
and they are also the main types of electrode commonly used for EEG screenings, which are: Disc
electrodes, cap electrodes, and bridge electrodes.
Disc electrodes:
Disc electrodes are small, flat metal discs that are typically placed directly on the scalp. They
have a conductive surface that makes contact with the scalp to measure the electrical activity of the
brain. Disc electrodes are commonly used in traditional EEG setups and are attached to the scalp
using adhesive or conductive gel. They are the most accurate way to get a clear brainwave
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recording, so they are used in sleep EEG, as it is particularly helpful in evaluating and diagnosing
epilepsy, a neurological disorder characterized by recurrent seizures.
A disc electrode
Tools used for sleep EEG: tape and marker to
measuring the patient’s head for accurate
placement of the disc electrodes, cotton swab
to get abrasive gel and clear an area of skin on
the patient head so the adhesive gel can stick
better, reducing the skin impedance
Abrasive gel
Adhesive gel
Preparation on the patient for a sleep EEG
using disc electrodes
Cap electrodes:
The cap electrode utilizes a spandex-type fabric with recessed, pure tin electrodes. These
electrodes are positioned according to the International 10-20 system for electrode placement. The
cap electrode comes in various sizes, with the medium size fitting approximately 65% of patients
over the age of 5. The small and extra small sizes are designed for children aged 2 to 5 years and 9
months to 2 years, respectively. This cap electrode provides a comfortable and standardized
solution for EEG electrode placement, ensuring accurate and reliable recordings for patients of
different age groups. After the cap is worn onto the patient’s head, conductive gel is pumped into
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electrodes on the cap to lessen the impedence of the skin. The gel consists of 80-85% ultrasonic
gel with the other 15-20% being sodium chloride water.
Cap electrode
Ultrasonic gel
Sodium chloride water
Sodium chloride-ultrasonic gel mixture and a
pair of pumps
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Gel mixture is being pumped into one of the
electrode
Bridge electrodes:
The bridge electrode is a specialized electrode used in EEG examinations. It features a sintered
Ag/AgCl composition for reliable electrical conductivity. Its threaded body ensures easy insertion
and positioning, while the fabric-covered surface provides comfort. Prior to use, it is recommended
to immerse the electrode in saline solution or apply electrode paste. The bridge electrode offers a
convenient and effective solution for accurate EEG recordings, facilitating comprehensive analysis
of brain activity. It is less effective than the disc electrode but more than the cap electrode. In order
to attach the bridge electrodes onto the patient’s head, a silicone cap is used to hold the electrodes
in place.
A bridge electrode
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A bridge electrode without the fabric
Patient with the silicone cap and electrodes
fully attached
A long metal tool is used to separate hair in
order to get the electrode in contact with the
skin
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II. The Internship activities
Internship period: from July 17th → August 17th (31 days)
Monday Tuesday Wednesday Thursday Friday Saturday
Morning (8:00 – 11:30)
Work
Afternoon (13:30-16:30)
Work
Work
Work
Work
Work
Work
Work
Work
Table 1. Internship schedule
Daily activities
1
Work on the EEG machines (attaching cap/bridge electrode, handling
EEG machine. Give patient instructions)
2
Hand EEG print outs to doctors
3
Return EEG results to patients
4
Call patients in for their scheduled appointment
5
Assist technicians and doctors
Table 2. Daily activities
Goals
1
Learn to operate EEG machines
2
Learn about different brainwaves
3
Basic readings of an EEG graph
Table 3. Goals for the internship
Responsibilities
1
Wear appropriate clothing (sleeved shirt, long-legged pants, straight and
smooth lab coat)
2
Approach and communicate to the patients in a calm, respectful fashion
3
Be quick and agile
4
Be professional and serious to colleagues in work hour
5
Be on time
Table 4. Responsibilities of an intern
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Working on an EEG machine
Routine EEG
 Prepare the necessary equipment for the routine EEG, including the electrode (cap or
bridge electrode), gel, and ultrasound gel wipe.
 Engage with the patient by accurately identifying them, exchanging greetings,
introducing oneself, and explaining the tasks involved.
 Prepare the patient by instructing them on proper posture, disinfecting their hands,
cleaning the skin, and ensuring both the technician and patient wear masks if in a closed
space. Obtain relevant medical history and information from the patient.
 Provide a detailed explanation and consultation to the patient, including the purpose of
the procedure, the process involved, duration, patient cooperation requirements, and
addressing any questions or concerns the patient may have.
 Perform the EEG measurement procedure as follows:
o Sanitize hands and wear gloves.
o Open the EEG software and enter patient information.
o Begin the recording.
o Apply gel to the electrode cap.
o Instruct the patient to breathe normally with their eyes closed and remain
relaxed.
o Conduct an eye-opening phase with normal breathing, ensuring the patient
keeps their eyes moderately open without moving or blinking.
o Perform the Berger maneuver (repeatedly open and close the eyes for 5-10
seconds) three times.
o Administer intermittent photic stimulation (IPS) test.
o Conduct a hyperventilation test, where the patient breathes deeply and quickly
for 3-5 minutes at a frequency of 20-30 times per minute.
o Allow the patient to rest for 30-45 seconds.
o End the recording.
 Conclude the procedure:
o Inform the patient that the EEG recording is complete and remove the electrode
cap.
o Provide the patient with an ultrasound gel wipe to clean their head.
o Finalize the recording and print out the results.
o Present the results to the doctor for review.
Figure 15. Routine EEG procedure
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III. Contributions and gaining
1. Knowledge/experience gained
Two types of artifacts
EEG artifacts refer to unwanted or extraneous signals that can be present in an
electroencephalogram recording, which may distort or interfere with the accurate interpretation of
brain activity.
There are two primary classifications of artifacts: physiological/biological artifacts and nonphysiological artifacts. Physiological artifacts encompass various sources such as cardiac activity,
pulse, respiration, sweat, glossokinetic (related to tongue movement), eye movements (including
blinks and spikes from lateral eye movement), as well as muscle and movement artifacts. Nonphysiological artifacts can arise from electrical phenomena or devices present in the recording
environment.
Physiological artifacts
Cardiac Artifacts: Electrical activity generated by the heart can interfere with the EEG signal,
leading to rhythmic patterns or spikes in the recording.
 Solution: Placing electrodes away from the chest area can help reduce the impact of
cardiac artifacts.
Eye Blink Artifacts: Eye blinks can introduce large amplitude, slow-wave artifacts in the
EEG signal, particularly in frontal electrode channels.
 Solution: Insrtuct the patient to blink less or tell them to blink in algorithms to minimize
the artifacts
Muscle Artifacts: Muscle contractions or movements, such as jaw clenching or facial
twitches, can introduce unwanted high-frequency noise or large amplitude spikes in the EEG.
 Solution: Instructing the patient to relax and minimize muscle movements during the
recording can help reduce muscle artifacts.
Non-physiological artifacts
Mains Interference: Mains interference, also known as electrical line noise, is caused by the
presence of power sources or electrical equipment, resulting in rhythmic patterns or fluctuations in
the EEG signal.
 Solution: Implementing proper grounding and shielding techniques, utilizing notch
filters to remove power line frequencies (e.g., 50 or 60 Hz), and ensuring the recording
equipment is properly isolated from electrical sources can help reduce mains
interference artifacts.
Electrode Pop: Electrode pop artifacts occur when there are sudden movements or
disturbances at the electrode sites, leading to brief, high-amplitude spikes or transients in the EEG
signal.
 Solution: Ensuring electrodes are securely attached and properly prepared can help
minimize electrode pop artifacts.
Cable Movement: Cable movement can introduce artifacts characterized by irregular
waveforms or fluctuations in the EEG signal when the cables connecting the electrodes are
disturbed or displaced.
 Solution: Ensuring cables are properly secured and minimizing patient movement
during the recording can help reduce cable movement artifacts. Using cable clips,
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adhesive tapes, or other means to prevent cable dislodgment can be effective in
minimizing this type of artifact.
Bad Channel Connection: A bad channel connection occurs when there is a faulty or unstable
connection between the electrode and the recording system, resulting in intermittent or distorted
signals from that channel.
 Solution: Regularly checking the electrode connections and ensuring proper impedance
can help identify and resolve bad channel connections. Adjusting or reattaching the
electrode, cleaning the electrode site, or replacing faulty equipment or cables can help
restore a reliable channel connection.
2. Contributions
 Re-configure the photic protocol, add easy-accessed buttons to the user interface of
the Natus EEG program.
 Adjust settings, software fixes of EEG, EMG machine
 Contacts and figure out problem with Natus machine engineer
 Records and hands EEG to doctors
 Assist technicians and doctors in multiple machines (rTMS, VNG)
 Help with miscellaneous tasks (bringing EMG machine back to the VNG room,
bringing back autoclaved tools)
 Work on a small essay for doctors
A few noteworthy moments
Figure 16. First day as interns
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Figure 17. First lesson with Dr. Ý
Figure 18. Second lesson with Dr. Ý
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Figure 19. First picture with the "team"
Figure 20. End of internship celebration
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REFERENCES
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Britton JW, Frey LC, Hopp JLet al., authors; St. Louis EK, Frey LC, editors.
Electroencephalography (EEG): An Introductory Text and Atlas of Normal and
Abnormal Findings in Adults, Children, and Infants [Internet]. Chicago: American
Epilepsy Society; 2016. Appendix 4. Common Artifacts During EEG
Recording. Available from: https://www.ncbi.nlm.nih.gov/books/NBK390358/
Gebodh N, Esmaeilpour Z, Adair D, Chelette K, Dmochowski J, Woods AJ,
Kappenman ES, Parra LC, Bikson M. Inherent physiological artifacts in EEG during
tDCS. Neuroimage. 2019 Jan 15;185:408-424. doi: 10.1016/j.neuroimage.2018.10.025.
Epub 2018 Oct 12. PMID: 30321643; PMCID: PMC6289749.
https://www.learningeeg.com/artifacts
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