The CBRET Exam Process
Important Dates
Registration
Register as an exam candidate by Nov 1, 2024 for any exams planned in 2025
Spring Written Exam
Register and pay by December 15, 2024
Exam: March 16-30, 2025 - Prometric Testing Centers
Refund deadline: Feb 1
Spring Oral/Record Review Exam
Register and pay by Jan 15, 2025
April 2025 - BC Children's Hospital
April 2025 - Toronto Sick Kids Hospital
Refund deadline: Mar 1
Fall Written Exam
Register and pay by May 15, 2025
Exam: Aug 16-30, 2025 - Prometric Testing Centers
Refund deadline: July 1
Late fee of $100 will apply for any section. Late registration is subject to approval based on availability.
International Candidate Requirements
The following information is intended for applicants who have been educated and trained outside Canada as certified Electroencephalograph Technologists.
- C.B.R.E.T., Inc. does not have reciprocal arrangements with any country outside of Canada at this time. Formal EEG training received outside Canada may be accepted towards eligibility into the C.B.R.E.T., Inc. examination process.
- Once ALL required documents and information, as listed in the Registration Requirements section, have been received, the C.B.R.E.T., Inc. Registrar and Chairman will determine whether your education, training, and work experience are considered equivalent to the C.B.R.E.T., Inc. standards.
- If you do not meet current registration requirements you will be informed of the reasons for this decision.
- The Registrar and Chairman may require you to complete further testing, assessment, or training.
- You will be required to submit all necessary documents listed in the Registration Requirements section.
- Submit a completed candidacy application form and pay the candidacy application fee & international document assessment fee prior to gathering and submitting all the necessary documents.
- Your file will be assessed when all documents have been received.
In order to receive your R.E.T. status in Canada, you may be required to undergo the examination, testing, assessment, training, or education program as recommended by the Registrar and Chairperson of C.B.R.E.T., Inc. Once you have met all requirements as outlined by the Registrar and Chairperson, you are deemed eligible to sit the CBRET written and clinical examinations.
Please note that the international application and assessment process can take from 6 months to 2 years to complete, depending on specific testing or education that may be required.
Complete all sections of the Application for Assessment – Internationally Educated Electrophysiology Technologist. This can be found in the International Eligibility Application Forms Section.
Include:
- the Candidacy fee of $70.00 Canadian dollars (CAD).
- applicable non-refundable documentation assessment fee of $150.00 Canadian dollars (CAD).
A)Applicants with a minimum of 4000 hours (2 years full-time) clinical experience as an independent EEG technologist in their country of origin. Time spent in a student or trainee role DOES NOT COUNT towards the required minimum time.
Applicants must include:
- Documentation of education/training in EEG in the form of copies of college diploma, training, or registration certificates.
- Letters from employers documenting years of experience, including reference to the number of hours worked. The 4000-hour requirement must be met within 5 years of the date of application.
- Work placement in Canada and completion of a three-month apprenticeship in EEG in addition to a recommendation from an R.E.T. to support eligibility for the C.B.R.E.T., Inc. examinations. Applicants must be registered with C.B.R.E.T. as a candidate and notify the C.B.R.E.T., Inc. Registrar of the location and dates of the apprenticeship prior to the start of the three-month apprenticeship. Work placement is the sole responsibility of the applicant.
B)Applicants with less than 4000 hours of clinical experience in EEG in their country of origin:
In addition to the education and training requirements listed above, candidates with fewer than 4000 clinical hours must complete the following:
Personal recordings of 500 EEGs under the direct supervision of an R.E.T. in Canada as follows:
(a) 400 adults plus 100 children 12 years of age or younger, with at least 20 of those children being under the age of two (2) years
OR
(b) 400 children plus 100 adults 21 years of age or older, with at least 20 of those adults being over the age of 60 years
Documentation of all these recordings must be contained in a logbook and must be individually signed off by the supervising R.E.T. This logbook must be presented at the practical examination.
If you have achieved registration in EEG technology with a professional association, society, or regulatory body from your country of origin, you will need to submit evidence of that registration. You should include a copy of your professional organization’s Code of Ethics, Standards of Practice, and Scope of Practice documents. If there is no established professional organization in your country, please contact the C.B.R.E.T. Registrar.
A letter of reference, attesting to your “good character” is required for candidacy. The reference letter should bear the printed and signed name of the referee, as well as their contact information.
Evidence of oral and written language proficiency in English is required.
CBRET English Language Proficiency Policy
Internationally trained electrophysiology technologists whose natural/native language IS NOT English are required to contact CBRET for assessment of their language proficiency.
Electrophysiology technologists who have received their education/training/work experience outside of Canada or in a primary language other than English must have their language equivalency assessed by one of the following criteria:
TOEFL = Test of English as a International Language : Overall score of 74 with a minimum score of 21 in speaking.
IELTS = International English Language Testing System : A minimum of 6.0 in each section. Must be from the academic needs testing.
CLBA = Canadian Language Benchmark Assessments : A minimum of 7 in each section.
MELA = Michener English Language Assessment : A minimum of 8 in reading, listening, and speaking and 7 in writing.
CBRET Approved Hospital Based Training Programs in Canada
Hospital Based Training Programs for EEG Technologist training must be approved by CBRET, Inc.
Programs seeking approval by CBRET must fulfill the following requirements and Curriculum Content expectations:
- Minimum of one full time >50% Electroencephalographer, MD, CSCN Diplomate (EEG)” .
- Minimum of one CBRET Registered Technologist
- Train candidates for a minimum of 2 years
- Be registered as an approved training program for at least one year prior to the candidate’s eligibility for writing the part I exam
- Pay a one time fee (if updated every 4 years) of $500.00
- Update curriculum every 4 years to remain current with CBRET
- Without an update every 4 years, the facility will be required to pay the $500 fee again
Must have written confirmation from CBRET Inc. that they have been approved. This approval is subject to review at the discretion of the CBRET Inc. Board.
Current Hospital Programs:
- London Health Sciences Centre, Ontario: recruitment@lhsc.on.ca
- Hamilton Health Sciences, Ontario: mogridge@hhsc.ca
- Halifax Infirmary at QEII, Nova Scotia: mike.whitehead@nshealth.ca
- Toronto Sick Kids: roy.sharma@sickkids.ca
- Kingston Health Sciences Centre: helen.driver@kingstonhsc.ca
Curriculum content:
- Course outline in segments that could be either semesters, terms, or year one/year two, etc
- Each course segment should have a schedule of course topics and content requirements
- The content of the curriculum must be representative of the Competency Profile as well as the exam content both of which can be found under the EXAM INFORMATION tab under Competency Profile, or under References
- A minimum of 10 hours of structured learning per week must be included, initialed by a supervising R.E.T. in a log book, and should include the following:
- Lectures: Classroom chalkboard style, PowerPoint or other visual aids, etc.
- Reading sessions: with Electroencephalographers and RETs
- Quizzes/Assignments: Oral and Written
- CBRET will require an update by letter from the training programs at year 1 and at 12 weeks prior to the end of the program
- This letter is to provide CBRET with an assurance that the students in the program are on track with learning goals and obtaining the required number of EEG tests (total 500) in the required age categories.
Written Exam Eligibility
Successful completion of a 2-year CBRET, Inc. certified college or hospital-based Electroneurophysiology program.
Practical/Clinical Examination Eligibility
Hospital-Based Programs:
Evidence of all of the following:
1. Training in an EEG department approved by CBRET, Inc. for a period of twenty-four months, with the exception of holidays permitted under the various collective agreements. The candidate must have trained for the entire twenty-four months under the direct supervision of a CBRET, Inc. R.E.T. and CSCN Electroencephalographer.
2. Personal recordings under the direct supervision of an R.E.T. of a minimum of 500 EEGs by the practical exam date consisting of the following:
100 pediatric (12 years and under) recordings with 20 of those children being under the age of 2 years (24 months) plus, 100 adult (18 years and over) recordings with 20 of those being patients older than 60 years.
The remaining 300 recordings do not have any age requirements.
Logbooks:
- Must be presented at the practical examination
- Must be highlighted by age group to easily identify the specific age group requirements
- Must contain the following information on each recording:
- Patient procedure number
- Age
- Date of recording
- Referring diagnosis
- Signature of the supervising R.E.T. for each recording
3. A letter of support from the supervisory technologist and/or the chief Electroencephalographer.
The candidate must have documentation from a registered EEG technologist(s) confirming that the required numbers of EEGs have been performed under their supervision.
Diploma Programs:
Evidence of all of the following:
1. Proof of training from a two year CBRET, Inc. certified diploma program.
2. Personal recordings under the direct supervision of an R.E.T. of a minimum of 500 EEGs by the practical exam date consisting of the following:
100 pediatric (12 years and under) recordings with 20 of those children being under the age of 2 years (24 months) plus, 100 adult (18 years and over) recordings with 20 of those being patients older than 60 years.
The remaining 300 recordings do not have any age requirements.
Logbooks:
- Must be presented at the practical examination
- Must be highlighted by age group to easily identify the specific age group requirements
- Must contain the following information on each recording:
- Patient procedure number
- Age
- Date of recording
- Referring diagnosis
- Signature of the supervising R.E.T. for each recording
3. A letter of support from the supervisory technologist and/or the chief Electroencephalographer.
The candidate must have documentation from a registered EEG technologist(s) confirming that the required numbers of EEGs have been performed under their supervision.
Complete and submit the practical/clinical examination application form along with applicable fees to the C.B.R.E.T., Inc. Registrar via cheque or PayPal.
Provide documentation of completion of the above requirements.
The clinical examination is offered once in the Spring at two sites in Canada.
The practical section of the clinical exam will be held at the candidate's place of employment. The Registrar will make arrangements with your lab supervisor to arrange a time for this section of the exam to be scheduled. Once this section is completed, final exam results will be available within 6 weeks of exam completion.
Practical Section
The candidate is given 90 minutes to take a patient history, measure and apply electrodes and run a complete 30-minute routine EEG with activation procedures performed in their place of employment. Your examiner will evaluate your competence in accurate and secure electrode application, patient preparation and rapport, patient safety, and your clinical EEG recording abilities.
Electrodes may be applied with either paste or collodion. Electrodes are to be applied using the 10/20 head measurement system. Needle electrodes and electrode placement caps may not be used for this section of the examination.
Record Review Section
The candidate will be given 90 minutes for this section. Each candidate will be required to read two (2) abnormal EEG recordings. These EEG recordings will have been obtained according to CAET Technical standards by an independent R.E.T. The candidate will be given one (1) paediatric EEG recording (12 years or younger) and one (1) adult EEG recording (21 years or older). The candidate will be given 45 minutes to generate two technical reports on a provided EEG report template. The candidate will be required to describe the following:
- Normal background features/rhythms
- Sleep features, if present
- Activation procedures and their EEG features
- Abnormal EEG patterns
- Provide a technical impression.
After the 45-minute period, the candidate will review their technical reports and the corresponding EEG recordings, with two (2) examiners: a R.E.T. and a C.S.C.N. electroencephalographer during an additional 45 minutes.
The EEG recordings provided will be in digital format that can be reviewed on either a laptop computer or desktop computer supplied by the CBRET Registrar at the exam site.
Oral Section
The Oral Exam will last approximately 60 minutes during which time the candidate will be shown EEG samples and diagrams pertaining to the areas listed in the Competency Profile. Questions are asked by two (2) examiners: a R.E.T. and a C.S.C.N. electroencephalographer.
Candidates will receive the results by of the exam by email, as either a pass or fail, after all sections are completed. At a later date, successful candidates will receive a C.B.R.E.T., Inc. Registration Certificate and an official letter of notification. The decision of the examiners is final.
The oral, record review and practical portions of the exam are marked separately. A candidate can successfully complete one (1) part of the exam and then repeat the remaining portion(s) within two (2) years. A candidate who is unsuccessful in three (3) attempts or a candidate who waits longer than two (2) years to repeat the exam will be required to reinitiate the entire examination process which will involve re-application following documentation of additional training and repeating the written examination.
References and Exam Content
1. Abou-Khalil, B., Misulis, K.E., Atlas of EEG and Seizure Semiology. Butterworth-
Heinemann, 2005.
2. Aminoff, M.J. (ed.) Electrodiagnosis in Clinical Neurology, 5th ed. Churchill Livingstone,
2005.
3. Altman, C. “Infection Control: 2000 Review and Update for Electroneurodiagnostic
Technologists.” American Journal of Electroneurodiagnostic Technology. 40(2) pp 73 –97, 2000.
4. Blume, WT., Kalibara., M., Young.,GB. Atlas of Adult Electroencephalography, 2nd
Edition. Lippincott, Williams & Wilkins, 2002.
5. Canadian Association of Electroneurophysiology Technologists Inc. Code of Ethics.CAET, 1994.
6. Canadian Association of Electroneurophysiology Technologists Minimal Technical Standards. CAET, 2016.
7. Canada’s National Occupations health and Safety Website. www.canoshweb.org
8. Canadian Centre for Occupational Health and Safety. www.ccohs.ca
9. Ebersole, J.S. and Pedley, T.A. (eds.) Current Practice of Clinical Electroencephalography,
3rd Edition. Lippincott Williams & Wilkins. 2003.
10. Fisch, B.J. Fisch & Spehlmann’s EEG Primer: Basic Principles of Digital and Analog
EEG, 3rd Revised and Enlarged Edition. Elsevier. 1999.
11. Goldensohn E.S. (ed) et al Goldensohn’s EEG Interpretation: Problems of Overreading
and Underreading, 2nd Edition. Futura. 1999.
12. Health Canada Infection Control Guidelines (July 1999, Volume 25 S4). Routine Practices
and Additional Precautions for Preventing the Transmission of Infection in health Care.
13. Krass, G.L. and Fisher. R.S. The Johns Hopkins Atlas of Digital EEG: An Interactive
Guide. Johns Hopkins Press, 2007.
14. Misulis, K.E., Essentials of Clinical Neurophysiology, 2nd Edition. Butterworth-
Heinemann. 1997.
15. Mizrahi, E.M., Hrachovy, R.A., Kellaway, P. Atlas of Neonatal Electronencephalography,
5th ed. Urban and Schwarzenberg, 2004.
16. Donald L. Schomer and Fernando H. Lopes Da Silva,. Neidermeyer’s Electroencephalography: Basic Principles, Clinical Applications and Related Fields, 6th edition. Lippincott, Williams & Wilkins. 2011.
17. Noachtar, S., Wyllie, E. Electroencephalographic Atlas of Epileptiform Abnormalities in the
Treatment of Epilepsy: Practice & Principles. 4th Edition., 2006: 183-214.
18. Office of the Privacy Commission of Canada www.privcom.ca
19. Purtilo, Ruth. Ethical Dimensions in the Health Professions. 3rd edition. 1999.
20. Purtilo, R., and Haddad, A. Health Professional and Patient Interaction. 5th edition. 1996.
21. Stern, JM., Engel, J. Jr. Atlas of EEG Patterns. Lippincott, Williams & Wilkins, 2004
22. Tatum, W.O., Husain, A.M. Benbadis, S.R., Kaplan, P.W., Handbook of EEG
Interpretation. Demos, 2007.
23. Wyllie, E., Gupta, A., Lachhwani, D.K. (eds.) The Treatment of Epilepsy: Principles and Practice, 4th Ed. Lippincott Williams & Wilkins, 2006.
24. Guidelines for Visual-Sensitive EEG Testing Prepared by a Task Force* of the Canadian Society of Clinical Neurophysiologists Can. J. Neurol. Sci. 2008; 35: 133-135
25. American Clinical Neurophysiology Society Guidelines in Electroencephalography,
Evoked Potentials, and Polysomnography. www.acns.org. 2006.
TECHNOLOGY
Electrode application:
- 10-20 measuring system technique and theoretical basis
- extra electrode positions (10-10 and auxiliary electrodes)
- measuring technique for asymmetrical heads and surgical scars
- properties of electrodes, polarized and non-polarized metals
- measuring electrode impedance
- desirable electrode impedance values
EEG Machine:
- functions of the preamplifier
- differential amplifier
- effects of input impedance
Digital EEG concepts and instrumentation, including:
- Analog-to-Digital Converter (ADC)
- sample rate
- Nyquist’s theorem
- sample skew
- ADC precision (vertical resolution)
- aliasing
- system reference electrode
- digital filters
- reformatting montages and screen display.
- basic computer components (i.e. CPU, RAM, networking etc.) and their function(s)
- archiving, retrieval and printing
- understanding of common mode rejection and factors that affect it
- high and Low frequency filters and their response curves
- calculation of sensitivity values
- Indication for varied time scales
Polarity:
- EEG convention
- cancellation
- localization on referential and bipolar montages
- advantages and disadvantages of bipolar and referential montages
Artifacts:
- environmental, mechanical, and physiological causes
- recognition, localization and elimination of artifacts
- placement of electrodes and indications for monitoring of respiration, eye movements, and muscle jerks or twitches
Electronics:
- Ohm’s Law
- calculation of resistance, voltage and current in series or parallel circuits
- properties of individual electronic components (e.g. Resistor, capacitor, voltage sources, transistors) Capacitance, electromagnetism, and induction. Properties of a good conductor
Electrical Safety:
- understanding of the ground electrode
- ground loops
- leakage current
- CSA acceptable levels of leakage current
- recognition of electrically susceptible patients, and prevention of electrocution
The Normal EEG:
- descriptive features and identification of waveforms in the normal, waking, and sleep EEG of adults and children
- normal variants
- basic Neonatal EEG.
- maturation of the EEG from infancy to old age
Hyperventilation:
- method and mechanism
- metabolic changes
- normal and abnormal responses at all ages
- Indications and contraindications
Photic Stimulation:
- normal and abnormal responses
- photoparoxysmal and photomyogenic response
- indications/contraindications
- type of disease process activated by photic stimulation
Sleep:
- sleep stages
- the use of sleep as an activator
- the normal sleep cycle
- narcolepsy, cataplexy, sleep apnea, and night terrors
- neonatal sleep stages
Clinical EEG:
The use of and EEG findings in the investigation of:
- epilepsy
- tumors, infections
- head injuries
- coma
- encephalopathy’s
- cerebrovascular disease
- psychiatry
- dementia
- anoxia
- metabolic and toxic conditions
Specific Patterns:
- Alpha coma
- burst suppression
- triphasic waves
- Periodic Epileptiform Discharges (PEDs)
Electrocerebral Silence:
- Definition
- minimum technical requirements
- identification and elimination of artifacts
- Causes of transient ECS
EKG
- basic morphology of the ECG/EKG complex
- Tachycardia/bradycardia/arrhythmia
- Asystole
- “R” wave artifact in the EEG caused by EKG
Seizures:
- knowledge of the International Classification of Seizures
- clinical expression/seizure semiology of all generalized, focal and secondarily generalized seizures
- anatomical localization of seizure symptoms
- activation procedures indicated for common seizure types
- care of the patient during a seizure
- aura
- Todd’s paralysis
- psychogenic non-epileptic seizures
- Epilepsia Partialis Continua
- Status Epilepticus
BASIC NEUROLOGY:
Clinical and EEG features of the following conditions:
- migraine headaches
- vascular disease such as stroke, and transient ischemic attacks
- degenerative diseases including Alzheimers, Jacob Creutzfeldt, white and grey matter degeneration
- coma
- drug overdose
- syncope
- hydrocephalus
- tumors
- metastatic disease
- brain abscess
- encephalitis
- meningitis
- Multiple Sclerosis
- Reye’s Syndrome
- S.S.P.E.
- Tuberous Sclerosis.
- upper motor neuron vs lower motor neuron signs
Neuroanatomy:
- Gross anatomy of the head and neck
- Lobes and main fissures of the cerebral hemispheres and their relation to the skull and scalp
- Anatomical correlates with the 10-20 system routine and extra electrode positions
- The main subcortical structures including the cerebellum, brain stem and spinal cord
- Cortical areas concerned with motor, sensory and speech functions
- Arterial and venous supply of the brain
- Knowledge of the location and function of the cranial nerves
- The formation and circulation route of cerebro-spinal fluid
- The meninges.
- Basic knowledge of the structure of the neuron, action potentials, synaptic potentials, inhibitory and excitatory potentials
- Properties of the neuromuscular junction
Medications:
The indication, toxicity and effect on the EEG of:
- anti-seizure medications
- barbiturates
- tranquilizers
- sedatives
- contraindications to sedation
Included in the Competency Profile:
- Legislation, Standards, Ethics
- Collaborative Practice
- Professionalism, Professional Accountability and Responsibility
- Workplace Health and Safety (WHIMS) including Material Safety Data Sheets (MSDS), Infection Control
- Patient Care Fundamentals
- Patient Assessment
- Equipment
- Standard Recordings
- Customization and Adaptation of recordings
- Analysis and reporting
TECHNOLOGY
1.What is the voltage of a spike that measures 15mm peak to peak at sensitivity 10uV/mm?
a) 1.5 uV
b) 5 uV
c) 15 uV
d) 50 uV
e) 150 uV
2. Using the 10 – 20 International Measuring system, the distance transversely between
F7 and F8 is 22 cm. What will be the distance between F4 and F3?
a) 2.2 cm
b) 4.4 cm
c) 5.5 cm
d) 11 cm
e) 16.5 cm
3. Constant use of a High Frequency filter setting of 15 Hz during a normal wake and
sleep record other than reducing muscle artifact, would
a) Decrease the frequency of beta.
b) Decrease the frequency of alpha.
c) Cause no change in any activity of brain origin.
d) Decrease the amplitude of beta and sleep spindles.
e) Decrease the amplitude of drowsy theta and hyperventilation build-up.
CLINICAL EEG AND ACTIVATION PROCEDURES
4. The degree of EEG response to hyperventilation will NOT be influenced by
a) age
b) gender
c) posture
d) blood sugar
e) degree of gas exchange
5. A patient has seizures beginning with numbness of the left hand. The electrode positions
most likely to record its origin are
a) C4 and F4
b) C4 and T4
c) C4 and P4
d) Cz and P4
e) Cz and C4
6. Cerebral infarction can produce all of the following EEG abnormalities EXCEPT
a) LPEDs
b) Focal theta
c) Small sharp spikes
d) Depression of sleep spindles unilaterally
e) Focal diminution of voltage of cerebral activity
7 . The technologist arrives in ICU to record the EEG. He has been told Mr. D is in room 15. The patient does not respond when his name is called. To confirm the patient’s identity, the technologist should:
a) Ensure names on patient chart and requisition match.
b) Ensure names on patient wristband and requisition match.
c) Ask the attending nurse to confirm patient’s name.
d) Ensure the names on patient room and requisition match.
CLINICAL EPILEPSY, NEUROLOGY, ANATOMY, MEDICATIONS
8. A lesion in the right optic tract will result in a loss of vision in
a) the left eye
b) the right eye
c) both nasal fields
d) the left visual field
e) the right visual field
*The examination content and sample multiple choice questions are offered as reference material
RECIPROCITY
CBRET, Inc. does not have reciprocal training arrangements with any other country or any Internet-based training sites or distance education programs. Only approved Canadian training sites are acceptable. EEG training received outside Canada may be accepted towards eligibility into the CBRET, Inc. Please refer to the International Candidates Assessment section for details.
WRITTEN EXAMINATION APPLICATION PROCEDURE
You must be registered as a CBRET, Inc. candidate prior to the exam. Please see the Candidate Eligibility page.
Complete a written exam application form available in the Written Exam Application section.
Provide proof of educational and training requirements.
Forward the completed written examination application form, proof of education and training requirements, and the exam fee.
REFUNDS
Refunds may be issued to candidates who notify the Registrar.
Requests to withdraw must be received by August 15 for the fall exam and March 15 for the spring exam.
REGISTRATION DEADLINES and FEES
Persons who have received training in Canada must register as a candidate by November 15 for the following years exams.
CAET, Inc.
Applicants must be current members of the Canadian Association of Electroneurophysiology Technologists (CAET Inc). Please see CAET.org for more information.
WRITTEN EXAM FORMAT
The CBRET, Inc. Written Examination is a three hour, 170 question multiple-choice exam. Each question has only one correct answer.
The exam incorporates the 2016 CAET Competency profile (see references).
The Passing Grade is 70%.
REPORT OF RESULTS
All candidates are notified of a pass/fail within six (6) weeks of the exam date. Absolute marks are not disclosed but candidates are informed of their strengths and weaknesses in the competencies.