Nuchal Translucency (NT) Ultrasound 

The fetal nuchal translucency (NT) is a collection of fluid that is present at the back of the fetal neck in the first trimester of pregnancy.

Increased NT thickness can be associated with chromosomal differences, cardiac defects, and/or other genetic syndromes.

A NT certified sonographer performs an ultrasound on a pregnant individual to measure the thickness of the fetal NT when the fetal crown rump length (CRL) is between 45mm and 84mm (approximately 11 ̶ 14 weeks gestation). If the pregnant individual has requested first trimester screening, this NT measurement is submitted to one of the three Ontario Multiple Marker Screening (MMS) laboratories along with a blood sample. The Ontario labs use this measurement along with biographical information and biochemical markers from the maternal serum to calculate individual risk for a pregnancy affected with a chromosomal abnormality (e.g., Down syndrome, Trisomy 18).

The NT measurement is the most heavily weighted factor is this equation.

Visit the Fetal Medicine Foundation (FMF UK) website for more information about the fetal NT, the relationship between the NT measurement and prenatal screening, and the diagnostic requirements of NT ultrasound.

History of Nuchal Translucency Quality Assurance (NTQA) in Ontario

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 Down syndrome and Trisomy 18.

Both international and national 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.

Historically, many Ontario sonographers have not been a part of any recognized NTQA program after obtaining their initial certification.

The Better Outcomes Registry and Network (BORN) Ontario and sonographers' personalized NT performance distributions 

Since 2012, BORN Ontario has collected NT ultrasound measurement data as recorded on pregnant individuals' first trimester screening (FTS) requisitions.

They have correlated this data with individual NT ID numbers belonging to certified sonographers and have created personalized NT performance distributions for each scanner. Personalized performance distributions reflect sonographers' NT measurement performance when compared against the expected normal population distribution established by the FMF UK.

You can gain access to your personalized NT performance distribution, housed in the BORN Information System (BIS), by registering with PSO at BORN Ontario.

Although BORN Ontario has been able to collect and assess this data, they have not had the capacity to provide NT certified sonographers with feedback concerning provincial, and individual, scanning performance.

Prenatal Screening Ontario's NTQA Program 

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 NTQA program for Ontario that is:

• Re-defining the requirements for obtaining and maintaining NT certification in Ontario
• Establishing a framework for communicating with the imaging community concerning NT measurement performance

There are two vital tools used to assess NT measurement performance:

• personalized NT performance distribution audits
• NT images audits

As PSO implements the NTQA program, we are working to support sonographers in their practice by using these tools to assess their NT measurement performance and provide them with actionable feedback to help them improve and/or maintain their skills. 

How to stay up-to-date on the changes coming to NTQA in Ontario 

There are several ways that you can stay up-to-date on the changes coming to NTQA in Ontario.

Please note that missing important communications concerning the developments in Ontario's NTQA program could result in NT ID number loss or suspension.

Register with PSO at BORN Ontario

PSO has created an internal database of all NT certified sonographers in Ontario in the BORN Information System (BIS). As the NTQA program develops, PSO will use this database to communicate with the imaging community concerning the changes made to NT certification and NT quality assurance in the province.

Please register with PSO at BORN Ontario. This will give you access to the BIS and to your personalized NT performance distribution. You are not a part of our internal database of sonographers if you have not registered with our organization and; therefore, will not receive the communications that we send out concerning the upcoming developments in Ontario's NTQA program.

Update your contact details in the BORN Information System (BIS)

Please update your personal contact details in the BIS if you have already registered with PSO at BORN Ontario. Failure to provide up-to-date contact information (a current email address and a phone number with a direct extension) may result in you missing communications sent out by PSO concerning the upcoming developments in Ontario's NTQA program.

Regularly check the NTQA Requirements page and the NTQA Updates page on the PSO website

The NTQA Requirements page lists the current and future requirements for keeping your Ontario NT certification current and your NT ID number active. The NTQA Updates newsfeed (coming soon!) will highlight all developments in Ontario's NTQA program. We will continually update the information on these webpages as the NTQA program develops and the NT certification requirements for Ontario sonographers change.

Contact us

If you have any questions about the accreditation process, the registration process, the quality assurance process, or Ontario's NTQA program, please email PSO at BORN Ontario or call 1-833-351-6490.