Gastrointestinal (GI) function investigations have become an important tool in the diagnosis of digestive diseases. For over 30 years GI Physiology testing has played a role in assisting surgeons and physicians in the diagnosis and management of patients with GI disorders.
Oesophageal disorders are extremely common with most patients presenting with symptoms of gastro-oesophageal reflux such as heartburn, epigastric and retrosternal discomfort, bloating and nausea. Many patients also present with dysphagia (difficulty swallowing), which may be indicative of a mechanical disorder of the lower oesophageal sphincter or a disorder of oesophageal peristalsis. In some cases dysphagia may be indicative of something more sinister such as oesophageal carcinoma.
Patients with angina-like chest pain, respiratory symptoms such a wheezing and cough, laryngeal and voice disorders and patients with unexplained dental erosion are also commonly referred for GI physiology investigations to help ascertain whether the primary cause of their symptoms is gastro – oesophageal reflux disease. The GI physiology unit also carries out lower GI investigations to help colorectal surgeons and physicians in the diagnosis of Ano rectal disorders.
Today there are five GI Physiology Units. These are located in St James’s Hospital, Dublin, The Mater Private, Dublin, Tallaght (AMNCH) Hospital, Dublin, Cork University Hospital and Galway University Hospital.
There are currently seven full time Clinical Measurement scientists working in the area of GI Physiological testing.seven
Ms Patricia Lawlor (Chairperson)
Ms Tracey Moran (Communications officer)
Ms Lillian Barry (Education Officer)
Ms Julie O’Neill (IICMS Executive Representative)
Cardiac Physiologists are involved in and responsible for the recording and analysis of various physiological data on suspected or known cardiac disease required to assist in the diagnosis and treatment. Cardiac physiologists are professionals that operate in a highly scientific environment, which primarily include interfaces linking technological equipment and the patient. Most cardiac physiologists work in outpatient cardiology department performing and reporting variety of cardiac examinations, some work in cardiac catheterisation laboratory or cardiac electrophysiology study laboratory as part of
multidisciplinary medical team. These provide valuable clinical and functional information to doctors, surgeons and the medical team.
Cardiac physiologists perform multiple examinations such as ECG, stress tests, holter monitors, blood pressure monitors, echocardiograms to diagnose and often follow up numerous conditions. Conditions such as cardiac arrhythmias, bradycardia, heart blocks, achyarrhythmias, coronary artery disease, angina/ischaemia, cardiac aneurysms, cardiomyopathies and various other conditions are commonly diagnosed and followed up.
Furthermore, cardiac physiologist aid in implanting, checking and following up multiple implantable devices such as loop recorders, pacemakers, ICDs and CRTs. Currently, there are numerous amount of cardiac units in both private and public sectors in Ireland, and there are number of units still developing and increasing in capacity.
Sharon Donohue (Chairperson IICMS Executive)
Robbie Ryan (IICMS Executive, Treasurer, Acute Coronary Syndrome, Representatives, Vocation Group_
Gintaras Michalauskas (Secretary & Public Relations)
Karen Cunningham (Kevin St Tutor, Student Liaison)
Lorna Doran ( Echocardiography)
Aine Cooney (Paediatrics)
Anne Tierney (Arrthymia –Pacing, EP)
Andrea Ballantyne (Education Committee, Vocational Group)
- Clinical neurophysiology is an area of medical practice that primarily focuses on measuring the function of the central and peripheral nervous systems, including the autonomic nervous system and muscles. Physiologists who work in the discipline of Neurophysiology carry out tests that identify and characterise diseases of these areas. This field relies on these measurements of the ongoing function whether it is spontaneous or in response to a defined stimulus (EEG, EP). Each of these tests measure function by recording alterations in physiology as manifested by changes in electrical waveforms, force or electromagnetic fields. These measurements are then obtained by measuring a waveform that changes over time. An important factor of being a physiologist is the knowledge of the generation, recording, measurement and analysis of such waveforms.
The range of tests carried out in this field include:
Long Term Monitoring (LTM)
Evoked Potentials (EP)
Nerve Conduction Studies (NCS)
Intraoperative Neuromonitoring (IONM)
An Electroencephalogram (EEG) is one of the principle tools in clinical neurophysiology that records the ongoing electrical activity of the brain. It is used to assist in the diagnosis of many illnesses including seizure disorders such as epilepsy, infections affecting the brain known as encephalopathies and a variety of other neurological symptoms.
The Physiologist applies the EEG by using a specific measurement system, the most common being the International 10-20 System or the Modified Maudsley. It is a non-invasive and painless test that is obtained by placing electrodes on the scalp with a conductive paste. A video is recorded alongside the ongoing EEG to further assist in diagnosis in relation to clinical features.
A routine EEG generally lasts for 20-30minutes whereas as a sleep EEG can last for 60-90minutes. Overnight and prolonged recordings have a longer duration and are typically known as Long Term monitoring (LTM)
Long Term Monitoring
Long Term Monitoring uses the same principles as a routine EEG recording only it is recorded over a longer period of time, sometimes up to 2 weeks. This test is used as a more thorough evaluation of the person’s illness. It can be requested in the context of pre-surgical workup for epilepsy or to characterise a person’s events. It may also be used in the intensive care setting to continuously monitor a patient over time.
Invasive monitoring is a specialized and detailed way of confirming the exact area of the brain that is causing seizures and the exact areas of the brain being used for important tasks such as speech or movement. Invasive monitoring involves an operation to place electroencephalogram (EEG) electrodes, directly over the surface of the brain (grids or strips), or into the brain itself (depth electrodes). These electrodes are then connected to an EEG monitor so that the Physiologist can record the brain activity over several days.
Evoked Potentials (EPs) are recordings of electrical activity from the brain, spinal nerves, or sensory receptors in response to specific external stimulation. The range of routine evoked potential tests carried out are known as; Somatosensory Evoked Potentials (SSEPs), Visual Evoked Potentials (VEPs) and Brainstem Auditory Evoked Potentials (BAEPs).
SSEP: The Physiologist places electrodes over specific areas of the body on the upper or lower limbs. A small generator (electrode/probe) is used to create tiny electrical impulses that stimulate nerves in the limb such as the wrist or ankle. Impulses are usually not painful but may cause corresponding twitches (thumb) which is normal.
VEP: The Physiologist places electrodes on the scalp to obtain a recording in response to a stimulus such a checkerboard pattern on a computer screen or a flash light. These responses originate from the occipital cortex which is the area of the brain involved in receiving and interpreting visual signals. An adjunct to the VEP test is an electroretinogram (ERG). The ERG is a measurement of the physiology of the retina. ERG’s are used to evaluate potential causes of night/colour blindness.
BAEP: The Physiologist places electrodes on the head to obtain a recording in response to an aural stimulus. This is usually in the form of head phones that plays a series of ‘clicks’. The responses originate from relay structures within the brainstem.
These tests are helpful in evaluating a number of different neurological problems, including spinal cord injuries, visual disturbances and hearing loss. These test are carried out in the lab, on the ward or in the ICU setting.
Nerve conduction Studies (NCS)
Nerve Conduction Studies evaluate electrical potentials from peripheral nerves. Neurophysiologists use a small generator to stimulate the nerve with an electrical current and then record how long it takes the nerve impulse to reach the muscle. The patient may feel a mild and brief electrical shock from the stimulator. This test is generally carried out on patient’s that suffer from nerve conditions with symptoms such as numbness, tingling, muscle pain, muscle weakness, muscle cramping, or pain/loss of sensation. The areas usually studied are the face and the upper and lower limbs.
Intraoperative Neuromonitoring (IONM) involves the use of neurophysiological recordings for detecting changes in the function of the nervous system during orthopaedic and neurosurgical procedures. It is an effective method that provides real time monitoring of function that can reduce the risk of postoperative deficits in procedures where the nervous tissue is being manipulated, which can be of great value to the surgeon.
Two of the main types of testing carried out by the Neuro-physiologists are somatosensory evoked potentials and motor evoked potentials. One of the differences between clinical EPs and intraoperative EPs is the use of needle electrodes.
Examples of the neurosurgical and orthopaedic procedures that may use IONM are scoliosis corrective surgeries, tumour resections and treatment for aneurysms.
Maura Connell, Mater Misericordiae University Hospital, Dublin 1 (Chair)
Aoife Lavin Temple Street Hospital, Dublin (Vice Chair)
Elaine Dolan, Our Lady’s Children’s Hospital, Crumlin, Dublin 12 (Website)
Ciara Mc Grane, St James Hospital, Dublin 8 (Education Committee)
Ciara Gorman , Tallaght University Hospital, Dublin 24 (Ordinary Member)
Vascular physiologists are primarily involved in the diagnosis of disease of the veins and arteries. Most vascular physiologists work within vascular laboratories as part of a multidisciplinary surgical team. These physiologist lead services perform and report on a wide variety of ultrasound examinations and functional studies which provide valuable information to the surgeons or other referring doctors.
Conditions which are commonly diagnosed and followed up by vascular physiologists include; cerebrovascular disease that can lead to stroke, aneurysmal disease of the arteries that can lead to rupture if undetected, peripheral arterial disease which can cause difficulty walking and eventually lead to limb amputation if untreated, or venous disease which causes varicose veins and can lead to ulceration if untreated.
At present there are a number of vascular laboratories in Ireland in both public and private hospitals. There are several in Dublin but there are also labs in Galway, Limerick, Tullamore, and Waterford.
Tanya Byrne, Chair & IICMS Chair
Avril Kenny, IICMS Executive
Gráinne Buicke, Education Committee
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