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  • What We Screen For In Ontario
    • Trisomy 21 (Down Syndrome)
    • Trisomy 18 (Edwards Syndrome)
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  • Prenatal Screening Options
    • Is Prenatal Screening Right For Me?
    • Less than 14 Weeks' Pregnant
    • 14-21 Weeks' Pregnant
    • More than 21 Weeks' Pregnant
    • Twins and More Than Two Babies
    • Vanishing Twins
  • Results and Next Steps
    • Enhanced First Trimester Screening Results
    • Second Trimester Screening Results
    • Screening for Vanishing Twins Results
    • Non-invasive Prenatal Testing (NIPT) Results
    • 11-14 Week (Nuchal Translucency) Ultrasound Results
    • 18-22 Week Ultrasound Results
    • Diagnostic Testing
  • For Providers-How to Order
    • enhanced First Trimester Screening (eFTS) Guide
    • Second Trimester Screening (STS) Guide
    • Non-Invasive Prenatal Testing (NIPT) Guide
    • Screening for Vanishing Twins Guide
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    • Log in to the BIS
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    • NT Quality Assurance
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HomeFor Sonographers
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For Sonographers

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Nuchal Translucency Registration

Visit PSO's NT Registration pages for information on how to register with PSO at BORN Ontario and how to get your Ontario NT ID number (issued by the Ontario Multiple Marker Screening labs).

scatter plot of crown-rump lengths and nuchal translucencies
Log In to the BORN Information System

Log in to the BIS if you have already registered with PSO at BORN Ontario (i.e., you have a PSO/BORN username and password), and you would like do the following:

  • Update your personal contact details in the BIS.
  • View your personalized NT performance distribution
open book with a plant in the background
About NT Quality Assurance

Visit PSO's NT Quality Assurance pages for information on Ontario's NTQA program including current and future requirements for maintaining your NT certification (e.g., personalized NT performance distribution audits and NT image audits).

BORN has extended its password expiry duration to one year

This change means that you will be prompted to reset your password on an annual basis, instead of every 90 days.  This password expiration duration change will take effect for each user after their next password change.

Having trouble logging in to the BIS?

  • Please log in to the BIS using a computer and not a mobile device (e.g., do not use an iPhone, iPad)
  • Please turn off your popup blocker
  • If you have previously logged in to your BIS account, and you are having trouble logging back in, your password may have expired, please call the BORN Helpdesk at 1-855-881-2676 (BORN).
  • If this is your first time logging in to your BIS account, and you are having trouble logging in, please email PSO at BORN Ontario or call 1-833-351-6490.

Facilities that offer Nuchal Translucency ultrasound

Visit our interactive map to find facilities offering NT ultrasound in Ontario. Click to zoom in on your area of interest to locate a NT ultrasound facility near you!

Additional information about PSO and NTQA

Prenatal Screening Ontario (PSO), a program housed within BORN Ontario, has been given the mandate to coordinate prenatal screening in the province including the quality assurance of nuchal translucency ultrasound and first trimester screening.

Guided by BORN Ontario data and a panel of experts in diagnostic imaging and prenatal screening, PSO is implementing a nuchal translucency quality assurance (NTQA) program for the province.

Since the incorporation of the NT measurement into the prenatal screening process, sonographers have played a huge role in providing the majority of pregnant persons with excellent quality risk prediction for Trisomy 21 (Down syndrome) and Trisomy 18 (Edwards syndrome). Professional bodies recommend that sonographers participate in a formal NTQA program if taking NT measurements.  Without participation in such a program, measurement quality and screening quality deteriorates over time. 

The goal of PSO's NTQA program is to support sonographers in their practice by assessing their NT measurement performance and providing them with actionable feedback to help them improve and/or maintain their skills.

All sonographers who provide, or who wish to provide NT measurements to the Ontario MMS labs for first trimester screening must register with PSO at BORN Ontario to get their Ontario NT ID numbers, gain access to the BORN Information System (BIS), and receive information on Ontario's NTQA program.

This information also applies to physicians who perform, or who wish to perform NT measurements and submit these to the Ontario MMS labs. 

Physicians who report NT measurements acquired by sonographers should ensure that sonographers are complying with the guidance above and the expectations of Ontario's NTQA program.

Physicians who report, but do not scan, NT ultrasounds do not require an Ontario NT ID number.  PSO recommends that these physicians complete the Fetal Medicine Foundation (FMF UK) 11-13 weeks scan course to refresh their knowledge on proper NT measurement protocol.

Resources and Point of Care Tools

These resources and point of care tools will support sonographers in performing high quality nuchal translucency (NT) and crown-rump length (CRL) measurements, assist sonographers in properly completing patients' first trimester screening requisitions, and answer other frequently asked questions about NT ultrasound and PSO's NTQA program.

Please email PSO at BORN Ontario if you have suggestions for information that you would like to see included on this webpage.

Video Resources

The short video below provide step-by-step instructions and useful information to support sonographers in understanding, and interpreting their NT performance data. 

Screenshot of video
Interpreting Your NT Curve

NT Ultrasound 

Fetal Medicine Foundation (FMF UK)

  • How to register with the FMF UK and/or log in to your FMF UK personal profile page
    • FMF UK registration application form 
    • FMF UK personal profile login page 
  • How to earn and/or access your FMF UK NT certificate of competence  
    • Information on the FMF UK NT certificate of competence
  • How to participate in the FMF UK annual NT image audit and access your image audit report 

Obtaining diagnostic NT and CRL measurements

  • Review the FMF UK 11-13 weeks scan course
  • FMF USA first trimester ultrasound ultimate survival guide video

For Ultrasound Practitioners: Helpful Hints for Completing the Multiple Marker Screening (MMS) Requisition

These are general guidelines to assist you in completing the requisition and should not take precedence over the informed clinical decisions that you and your physician make to best benefit your patient. 

 

ACRONYMS

  • eFTS – enhanced first trimester screening            
  • STS – second trimester screening
  • NT + STS – nuchal translucency plus second trimester screening
  • NIPT – non-invasive prenatal testing
  • MMS – multiple marker screening
  • FMF UK – Fetal Medicine Foundation (UK)
  • NT – nuchal translucency

 

ONTARIO’S MULTIPLE MARKER SCREENING LABORATORIES

  • MSH – Mount Sinai Hospital
  • THP-CVH – Trillium Health Partners-Credit Valley Hospital
  • NYGH – North York General Hospital

 

NOTES ON YOUR ONTARIO NT ID NUMBER:

If you do not have an Ontario NT ID number, you cannot perform NT ultrasound and fill out this requisition without the supervision of an Ontario NT certified ultrasound practitioner. The Ontario MMS labs cannot process an eFTS or NT + STS screen without the NT ID number, name, and signature of an Ontario NT certified ultrasound practitioner.

 

GOLD STANDARD
An Ontario NT certified ultrasound practitioner scans the patient to obtain NT and CRL measurements that are then recorded on the patient’s requisition under the NT ID number of the Ontario NT certified ultrasound practitioner.

Outside of assisting your colleagues in obtaining the measurements they need for NT certification, sharing your Ontario NT ID number is strictly prohibited. Your NT ID number is for your use alone. You must protect it and you must not share it.

NT certified practitioners can supervise individuals working to obtain their Ontario NT ID numbers, and assist them in obtaining the NT and CRL measurements they need for certification in the following two ways:

1. The Ontario NT certified ultrasound practitioner scans the patient to obtain the NT and CRL measurements that are recorded on the patient’s requisition under the NT ID number of the Ontario NT certified ultrasound practitioner. The practitioner in training then scans the patient to obtain the NT and CRL measurements they need for certification.

2. The practitioner in training obtains the NT and CRL measurements they need for certification. The Ontario NT certified ultrasound practitioner reviews these images to make sure that they (a) meet the Fetal Medicine Foundation (FMF UK) criteria, and (b) represent images they would take when scanning. These NT and CRL measurements are then recorded on the patient’s requisition under the NT ID number of the Ontario NT certified ultrasound practitioner.

It is important that your patient consent to two ultrasound practitioners performing the NT ultrasound. Your patient should be informed that one practitioner is in training.    

 

ULTRASOUND PRACTITIONERS - HOW TO COMPLETE THE REQUISITION

Below are the steps required to complete the Ultrasound (U/S) Information section on the Multiple Marker Screening (MMS) requisition. This is the section that you, as ultrasound practitioners, are responsible for completing when patients request enhanced first trimester screening (eFTS) or Nuchal Translucency and Second Trimester Screening (NT + STS). It is important that you fill out ALL the information below carefully, accurately, and completely. Incorrect or missing information can negatively affect how quickly a patient receives a risk assessment and/or how this risk assessment is calculated. 

1. Please record the day that you performed the NT ultrasound.

2. Please record the crown-rump length (CRL) measurement and the nuchal translucency (NT) measurement obtained on the day that you performed the NT ultrasound. Please pay close attention to the unit of measurement that you select (mm/cm).

3. Please record the bi-parietal diameter (BPD) if the CRL measurement is >84mm. Please pay close attention to the unit of measurement that you select (mm/cm).

4. Please record your Ontario NT ID number.

5. Please record the name of the hospital/clinic where you performed the NT ultrasound. Please record a contact number including the direct extension of your department.

6. Please print your name and sign the form.

7. Scan a copy of the completed requisition into the patient file for your records. This provides back up should the requisition be misplaced.

 

NOTES ON NUCHAL TRANSLUCENCY (NT) MEASUREMENTS:

Please include the widest NT measurement that meets the FMF UK criteria on the requisition.

If you cannot obtain an NT measurement and…

a)…the CRL is <84mm, please review the case with your physician and rebook the patient according to the guidelines of your place of practice. To avoid delay in screening, if you are unable to review the case with a physician and rebook your patient, please perform a dating ultrasound, record all required information on the requisition (i.e., CRL, U/S date, all practitioner information) except for the NT measurement (write “N/A, cannot obtain NT, needs rebook”), and send the patient for bloodwork.

b)…the CRL is >84mm, please perform a dating ultrasound, record all required information on the requisition (i.e., CRL, BPD, U/S date, all practitioner information) except for the NT measurement (write “N/A, cannot obtain NT”), and send the patient for bloodwork.

 

NOTES ON CROWN-RUMP LENGTH (CRL) MEASUREMENTS:

The best CRL measurement, or the average of several satisfactory CRL measurements, should be written on the requisition.

 

IF THE CRL <45mm:

Please review the case with your physician and rebook the patient according to the guidelines of your place of practice. 

To avoid delay in screening, if you are unable to review the case with a physician and rebook your patient, please perform a dating ultrasound, record all required information on the requisition (i.e., CRL, U/S date, all practitioner information) except for the NT measurement (write “N/A, patient too early for eFTS”), and send the patient for bloodwork.

 

IF THE CRL >84mm:

If the CRL is >84mm, please perform a dating ultrasound, record all required information on the requisition (i.e., CRL, BPD, U/S date, all practitioner information) except for the NT measurement (write “N/A, patient too late for eFTS”), and send the patient for bloodwork.

 

NOTES ON BI-PARITEAL DIAMETER (BPD) MEASUREMENTS:

Please record the BPD measurement if the CRL measurement is >84mm.

 

NOTES ON CUTOFFS:

Please use the CRL cut-offs (between 45mm and 84mm) when determining if a patient is eligible for eFTS or NT + STS. Do not use gestational age cut-offs.

 

NOTES ON MULTIPLE PREGNANCIES:

Non-Invasive Prenatal Testing (NIPT) is funded by the Ministry of Health (MOH) for all twin pregnancies, regardless of gestational age, maternal age or other factors. Concurrently, First Trimester Screening (FTS) for twin pregnancies has been discontinued in Ontario.

 

A stand-alone nuchal translucency (NT) ultrasound is still recommended for twin pregnancies, where available.

 

What to do in the following scenarios:

  • Twin pregnancy identified prior to the NT ultrasound and the pregnant individual appropriately does not present with an MMS requisition
    • Proceed with stand-alone NT ultrasound
    • Sonographers do not need to record the NT measurement on any requisitions; no risk calculations will be performed by the MMS labs for twin pregnancies.

 

  • Twin pregnancy identified prior to the NT ultrasound, but the pregnant individual inappropriately presents with an MMS Requisition for eFTS
    • Proceed with NT ultrasound
    • Sonographer to check the “Viable twin pregnancy identified on this U/S” check box in the Ultrasound (U/S) Information section. Checking this box will signify to the MMS lab that this is a twin pregnancy, therefore, FTS cannot be performed.
    • The pregnant individual is to proceed with blood draw, and upon receipt of the blood sample the MMS lab will notify the ordering professional that FTS for twins has been discontinued and OHIP-funded NIPT is available.

 

  • A pregnant individual presents with an MMS Requisition with a presumed singleton pregnancy, but a viable twin pregnancy is identified on the NT ultrasound
    • Proceed with NT ultrasound
    • Sonographer to check the “Viable twin pregnancy identified on this U/S” check box in the Ultrasound (U/S) Information section. Checking this box will signify to the MMS lab that this is a twin pregnancy, therefore, FTS cannot be performed.
    • The pregnant individual is to proceed with blood draw, and upon receipt of the blood sample the MMS lab will notify the ordering professional that FTS for twins has been discontinued and OHIP-funded NIPT is available.

 

SUSPECTED OR CONFIRMED VANISHING TWIN/CO-TWIN DEMISE

To improve the screening process for pregnancies with a suspected or confirmed vanishing twin/co-twin demise, a new test menu option, “NT + Second Trimester Screening (NT + STS) for suspected or confirmed vanishing twins/co-twin demise only,” has been added. NT + STS includes a NT ultrasound (11w2d – 13w3d) and second trimester blood sample (14w0d-20w6d). The blood draw can be done 8 weeks after demise.  The ordering professional is to calculate the date after which the pregnant individual can have their blood drawn and record this on the requisition within the NT + STS section, where indicated.

 

What to do in the following scenarios:

  • A pregnant individual presents with an MMS Requisition for NT + Second Trimester Screening (NT + STS)
    • Proceed with NT ultrasound
    • Sonographer to complete Ultrasound Information section of the MMS Requisition
    • Patient to proceed with blood draw after the date written on their MMS Requisition

 

  • A pregnant individual presents with an MMS Requisition with a presumed singleton pregnancy, but a suspected or confirmed vanishing twin/co-twin demise is identified on the NT ultrasound
    • Proceed with NT ultrasound
    • Sonographer to record ultrasound information for the viable fetus in the Ultrasound Information section of the MMS Requisition
    • Sonographer to check the “Confirmed or suspected vanishing twin/co-twin demise” check box in the Ultrasound (U/S) Information section. Checking this box will signify to the MMS lab that STS + NT needs to be performed.
    • The pregnant individual is to proceed with blood draw after their NT ultrasound, and upon receipt of the blood sample the MMS lab will notify the ordering provider of the next steps, which would be to arrange an STS blood draw between 14w0d-20w6d, and 8 weeks after the estimated date of demise.

 

NT Quality Assurance

Information on your personalized NT performance distribution

  • Guide on how to interpret your personalized NT performance distribution

NT ID number and NT data table resources

  • NT ultrasound professional conduct: why we do not share our NT ID numbers and our NT data tables!
  • How to train your colleagues working toward obtaining their FMF UK and Ontario certifications in NT ultrasound 

NTQA Email Communications Archive

2019

September 9, 2019

October 9, 2019

2020

January 17, 2020

March 13, 2020

NTQA Update Newsletter Archive

2020

January

May

  • For Sonographers
    • Log in to the BIS
    • NT Registration
      Toggle Section NT Registration Menu
      • I do not have an Ontario NT ID number
      • I have an Ontario NT ID number
      • I am a Quality Advisor or Medical Director
    • NT Quality Assurance
      Toggle Section NT Quality Assurance Menu
      • NTQA Requirements

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