Current NTQA requirements for Ontario

PSO is currently implementing a Nuchal Translucency Quality Assurance (NTQA) program in Ontario. This will involve changes to how a sonographer maintains their NT certification with the province. PSO will communicate these changes to sonographers via the email address provided in their BORN profiles and will update the list of quality assurance requirements on the PSO website as the program unfolds. Sonographers are required to do the following to maintain their NT certification at this time:

How to maintain your NT certification in Ontario

• Register with PSO at BORN Ontario and log in to the BORN Information System (BIS)
• Update your contact details in the BIS
• View your personalized NT performance distribution in the BIS
• Review proper NT image protocol established by the Fetal Medicine Foundation (FMF UK)
• Do not share your NT ID number

PSO also recommends that all sonographers participate in the FMF UK annual image audit by submitting three images a year to the FMF UK for review and feedback.  

Future NTQA requirements for Ontario 

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

• personalized NT performance distribution audits
• NT image audits

As PSO develops 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.

We are currently building systems to support these quality assurance requirements; therefore, no action involving these tools is required of sonographers at this time.

Please do not send NT/CRL measurement data to PSO at BORN Ontario. We collect all of this data from the first trimester screening requisitions and record it under your personal NT ID number.

Please do not send NT images to PSO at BORN Ontario at this time.

Personalized NT performance distributions 

The Better Outcomes Registry and Network (BORN) Ontario has been collecting prenatal screening information from pregnant individuals' first trimester screening (FTS) requisitions since 2012.  BORN has then mapped individualized curves of NT measurements over the 11 to 14 week gestational period for each sonographer according to their NT ID number.  Personalized NT performance distributions map each individuals' cumulative NT data against the FMF standardized population curve.  You can gain access to your personalized NT performance distribution, housed in the BORN information system (BIS), by registering with PSO at BORN Ontario.

Logging in to the BIS to view your personalized performance distribution

Please see these step-by-step instructions for how to log into the BIS to view your personalized NT performance distribution.

• How to view your personalized NT performance distribution

How to interpret your personalized NT performance distribution

Please see the following resources for more detailed information on how your performance distribution is calculated, how to interpret your distribution, and how it represents your NT scanning practise.

• Interpret your personalized NT performance distribution
• Nuchal Translucency Measurements and Quality Assurance Report 

NT image protocol 

The FMF UK has established protocol for how to obtain high quality NT images.

• FMF UK NT Image Protocol

Common mistakes that sonographers make when taking NT images and recording NT measurements on first trimester screening requisitions

• not measuring the NT measurement with the fetus in the midsagittal plane
• not zooming in so that the fetal head and thorax occupy the 75% of the NT image
• not measuring the NT with the fetus in a neutral position
• not measuring the widest portion of the NT or recording the widest measurement obtained that meets the FMF UK criteria on pregnant individuals' first trimester screening requisitions
• improper caliper placement

Crown rump length (CRL) images

It is important to take high quality crown rump length measurements when performing NT ultrasound because the calculation of an individual's risk for chromosomal abnormalities (e.g., Down syndrome and Trisomy 18) for a given pregnancy is based on the NT measurement for the size (CRL) of the fetus.

Common mistakes that sonographers make when taking CRL images and recording CRL measurements on first trimester screening requisitions

• not taking the CRL measurement with the fetus in the midsagittal plane (e.g., similar criteria to the NT measurement image)
• not measuring the CRL with the fetus in a neutral position
• improper caliper placement
• not recording the best or an average of the best CRL measurements on pregnant individuals' first trimester screening requisitions