Real Time Neuromonitoring Associates - RTNA

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Real Time Neuromonitoring Associates - RTNA

Real Time Neuromonitoring Associates (RTNA) is the country’s leading professional oversight practi

03/31/2026

Fix CMAP clipping by increasing the amplifier gain of recording muscle. In this image you will see baseline clipping in the TOF (blue trace). This is resolved with increase of amplifier gain.

Want to double-check your technical setup and make sure clipping is avoided? Check out the parameter setup RTNA recommends for TOF.

03/25/2026

What’s the big deal with waveform clipping?

Accurate waveforms = reliable waveforms.
Reliable waveforms = IONM team can trust the data.
Trusted data = Surgeons get high-quality information.

And most importantly… our patients get the high-quality care they deserve. Here’s a case example. During a thoracic spine correction, baseline MEPs include hands that are clipped while the feet are not. How could this create problems later?

Imagine the foot responses attenuate as the case progresses. You and your supervising clinician now need to decide: is this a global change or something isolated to the lower extremities?

If the hand baselines were clipped from the start, you lose a clean comparison point. Without an accurate upper extremity reference, it becomes much harder to determine whether the attenuation is systemic or focal. Signals may appear present but aren’t fully interpretable, and that uncertainty can impact real-time clinical decision making.

All of this can often be avoided with a quick adjustment to the amplifier gain for the clipped channel at baseline.

03/18/2026

Huge news! 🎉 We’re pleased to announce that RTNA has achieved accreditation from Joint Commission!

The Joint Commission’s accreditation process validates our dedication to top-tier quality and safety standards, highlighting our culture of continuous improvement and commitment to excellent patient care.

Huge shout out to our incredible team who helped make this possible! 👏

03/17/2026

🎉 Exciting news! 🎉 We’re pleased to announce that George “Trey” Lee, III, MD, founder of both Real Time Neuromonitoring Associates and Real Time Tele-Epilepsy Consultants, is the President-Elect of the Tennessee Medical Association (TMA).

Dr. Lee will serve one year as President-Elect, one year as President, and one year as Immediate Past President. His primary role is to serve as the face of the organization and spokesman for TMA with its membership, the media, government officials, and the citizens of Tennessee. Read More: https://members.tnmed.org/news/Details/dr-george-r-trey-lee-iii-voted-tma-president-elect-new-board-and-judicial-council-members-elected-315910

Please help us congratulate Dr. Lee on this well-deserved achievement in the comments below 👇

03/12/2026

Reliable baseline results are critical. Waveforms that show clipping, or “squaring off” at baseline, do not capture the full amplitude of a CMAP. Clipped waveforms are less reliable and make it difficult, sometimes impossible, to detect meaningful changes later in the case.

So what is actually happening? The amplifier gain setting tells your system the maximum signal size it will allow in. If the signal exceeds that maximum, the top of the waveform is cut off. That is clipping. Instead of a smooth peak, you see a flat, squared appearance because the true amplitude is not being displayed.

Why does this matter clinically? Consider TOF monitoring:

• If all TOF CMAPs are clipped, the system may display NO FADE, TOF ratio 100%, even if fade is actually present.
• If only the first CMAP is clipped, the system may underestimate the degree of fade, producing a falsely elevated TOF ratio.

In both scenarios, the data can look reassuring while masking real physiologic changes.

Take a moment at baseline to confirm your amplitudes are fully captured. A small gain adjustment early can protect the integrity of your monitoring for the entire case.

Swipe below for classic examples of waveform clipping. 👇

02/18/2026

Our team combines innovative technology, superior service, and dedication to help technical services providers, physician practices, hospitals and health care systems deliver the highest level of neurological patient care.

02/11/2026

Utilizing a Facial Nerve Monitoring checklist like the one below will serve as a reminder to perform all the recommended steps, help during documentation, and allow you to focus on providing the best possible monitoring for the neural structures at risk. Download this and other excellent resources at https://www.americanotologicalsociety.org/educational-resources.

02/04/2026

Don’t let stim artifact fool you! This response spans across all four channels, including bilateral trap, classifying it as artifact and not physiological response.

01/29/2026

Our drive is based on three simple principles: offer clients sustainable surgery coverage that helps deliver positive patient outcomes, build a team of experts to implement services and technologies to support IONM physician oversight, and deliver on our promises to practice partners. Get to know the team of people delivering our professional IONM oversight services: https://rtnassociates.com/our-team/

01/21/2026

Why choose RTNA? We are nationally recognized as the leading physician practice in remote neurophysiological monitoring and neurodiagnostics. Our team ensures our clients' IONM services are backed by professional oversight through people, processes, and technology. Learn more: https://rtnassociates.com/

01/08/2026

In the new year, take proactive steps to manage your CNIM recertification process!

✅ Be strategic: 50 CEUs over 5 Years
✅ Start the recertification process early
✅ Review CNIM Recertification Requirements here: https://abret.org/recertification
✅ Follow your favorite IONM groups online to keep an eye out for upcoming CEU opportunities

Recertifying your CNIM doesn’t have to be a complicated or confusing. Stay organized and absorb the significant knowledge you'll obtain in the process.

01/01/2026

Wishing you a 2026 filled with peace, prosperity, and exciting opportunities!

Address

Nashville, TN
37203

Telephone

+16153468182

Website

http://rtnassociates.com/

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