NUCHAL TRANSLUCENCY
Nuchal Translucency
The 11-13 weeks scan:
To obtain a certificate of competence you need to attend the online course on the 11-13 weeks scan and submit images for nuchal translucency on the FMF website.
Visit:
Requirements for certification
The requirements for obtaining the FMF certificate of competence in the nuchal translucency (NT) scan are:
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Attendance of the internet based course on the 11-13 weeks scan.
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Submission of a logbook of 3 images demonstrating the measurement of NT.
Protocol for measurement
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The gestational period must be 11 to 13 weeks and six days.
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The fetal crown-rump length should be between 45 and 84mm.
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The magnification of the image should be such that the fetal head and thorax occupy the whole screen.
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A mid-sagittal view of the face should be obtained. This is defined by the presence of the echogenic tip of the nose and rectangular shape of the palate anteriorly, the translucent diencephalon in the centre and the nuchal membrane posteriorly. Minor deviations from the exact midline plane would cause non-visualization of the tip of the nose and visibility of the maxilla.
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The fetus should be in a neutral position, with the head in line with the spine. When the fetal neck is hyperextended the measurement can be falsely increased and when the neck is flexed, the measurement can be falsely decreased.
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Care must be taken to distinguish between fetal skin and amnion.
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The widest part of translucency must always be measured.
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Measurements should be taken with the inner border of the horizontal line of the callipers placed ON the line that defines the nuchal translucency thickness - the crossbar of the calliper should be such that it is hardly visible as it merges with the white line of the border, not in the nuchal fluid.
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In magnifying the image (pre or post freeze zoom) it is important to turn the gain down. This avoids the mistake of placing the calliper on the fuzzy edge of the line which causes an underestimate of the nuchal measurement.
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During the scan more than one measurement must be taken and the maximum one that meets all the above criteria should be recorded in the database.
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The umbilical cord may be round the fetal neck in about 5% of cases and this finding may produce a falsely increased NT. In such cases, the measurements of NT above and below the cord are different and, in the calculation of risk, it is more appropriate to use the average of the two measurements
In Ontario, Canada after certification, registration is required for BORN.
Registration process for the NTQA program
Registration with PSO at BORN Ontario will allow you, as a sonographer or physician, to perform nuchal translucency (NT) measurements for Multiple Marker Screening tests, such as enhanced First Trimester Screening (eFTS). It will also allow you compare your NT measurement performance against international standards and obtain support to improve or maintain the quality of your scanning.
https://www.prenatalscreeningontario.ca/en/pso/forsonographers/nt-registration.aspx
Step 1:
Register with the Fetal Medicine Foundation (FMF UK) and get a certificate of competence in nuchal translucency scanning. This certificate requires you to complete the FMF UK online 11 ̶ 13 weeks scan course and to send three images to the FMF UK that demonstrate proper NT measurement protocol. The FMF UK will email you a certificate and an ID number once you have completed these requirements. You can also access the certificate on their website.
Step 2:
Fill out the new Sonographer form on BORN
https://forms.bornontario.ca/PSO/New-Sonographer-Registration-Form
You will receive an email confirmation after you submit the registration form. There will be a link to an application within this email with instructions on how to obtain NT measurement accreditation with the Ontario MMS labs.
Step 3:
Record 15 NT/CRL data points on the application form
Scan NT patients and collect 15 nuchal translucency (NT) and 15 crown-rump length (CRL) measurements to complete the NT data table found on the application form. Take these measurements over the CRL range as specified by the data table.
Ask for help from an Ontario registered sonographer
You must get these measurements yourself; however, do not record these measurements on the pregnant individual's Multiple Marker Screening (MMS) requisition. You will need to ask for help from an Ontario NT certified sonographer. Only Ontario NT certified sonographers are able to record NT and CRL measurements on the pregnant individuals' Multiple Marker Screening requisitions and send them to the labs.
Step 4:
Email application form and FMF UK NT certificate of competence to one of the three Ontario MMS labs
Email the following documents to the lab that you selected on your PSO/BORN registration form:
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Your accreditation application form which your 15 NT and CRL measurements.
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Your FMF UK NT certificate of competence (see step 1).
The email addresses for all of the Ontario MMS labs are at the bottom of the accreditation application form.
Please do not email this form to multiple labs (acceptance by one lab equals acceptance by all labs) or to Prenatal Screening Ontario.