All you need to know about the NT program

Locum Sonographer Brisbane sonogirl

Hello Sono Buddies,

Many of you have been scanning for a long time and sometimes things slide by without notice. Did you know how much the NT audit has been simplified since 2013/2104? There are only 6 criteria we need to comply with.  We no longer need to show the amnion but must show a “representative length of the NT”, meaning a good length of it. Having a horizontal image is not assessed, but it is implied.  And though you only need to get 4 out of the 6 criteria to pass each image, if all 3 submitted images fail the same criteria the operator will need to submit a further 3 images.

All the information below has been sourced directly from the Nuchal Translucency Program website (RANZCOG), https://www.nuchaltrans.edu.au, and was current as at March 2018

On this page you will find:

  • NEW Recommendation for reporting NT risk assessment AFTER a patient has had NIPT
  • Link to all the courses associated with NT (NTOLP, DV, UAP)
  • Basic info on the NTOLP course
  • Link to the Nicolaides article
  • How to get Nasal Bone Certification
  • Link to forms to add a user to your site and/or set up a new site
  • Info on assessment criteria, NB assessment criteria, and image audit submission requirement.

Risk assessment following cfDNA testing / NIPT

There is now an official recommendation from the International Society of Ultrasound in O&G  https://www.isuog.org/uploads/assets/uploaded/5b7d5b52-e1b3-4dab-8a585f2e070bd73e.pdf  Stating that when a 11-14 weeks scan is performed after cfDNA  / non-invasive prenatal testing results are available,  risk calculation for trisomies 21, 18 and 13 should not be issued.

All components of the ultrasound risk assessment (NT / NB / DV) should be recorded as per routine practice in your centre. These markers should be clearly reported as per usual practice in the final ultrasound report.

 

Want to enroll?

Nuchal Translucency Program (NTOLP), Ductus Venosus Screening Course, or Uterine Artery Pulsatility Index Course? Click following the link.

Link to Nuchal Courses

About the NTOLP:

  • It is an online self-paced learning and assessment course
  • 8 to 9 topics in total
  • Can be completed in a single day or over a year
  • Once completed, the student can apply for CPD points
  • Logbook of 3 images must for submitted within 1 year of completion of the course. See below for criteria. If the course takes 2 years to complete, it will need to be repeated before images can be submitted.

 

The NTOLP Bible: Professor Kypros H Nicolaides article – The Diagnosis of Fatal Abnormalities 2004. See the following link for the document. Gestational age 11 to 13 weeks 6 days (CRL 45-84mm)

The 11-13(+6) Weeks Scan PDF

Nasal Bone Certification

  • Can only be applied for after an operator has been certified through the NTOLP
  • The operator must have passed at least one audit
  • There is no theory course to complete associated with this certification
  • To apply you simply need to submit 3 images (different foetuses) with a present Nasal Bone, complying with NB evaluation criteria (see below) AND Pay $A103 Link to payment form
  • Once certified, the operator must submit a nasal bone image with their routine annual audit, and indicate if nasthe al bone is present/absent

Nucal Translucency NB Certification

 

Add a User to your site

Need to add a user to your site and/or set up a new site? Here are the links to the 2 required forms:

NT Notice of Intention to Practice

NT Terms and Conditions MUST SIGN

 

Image Assessment

Logbook / Audit Images Scoring Method

  1. Three images (3) are to be submitted for Logbooks and Audits. Plus a fourth image for Nasal Bone Assessment marked present/or absent.
  2. Each image will be assessed individually on the following six criteria –
  • Image size (head & thorax occupy the whole of the image)
  • Mid Sagittal section
  • Caliper placement – Click here for the protocol for measuring the NT
  • Measure NT a site of Maximum Lucency
  • Neutral Head position
  • Representative length of the nuchal membrane
  • To pass an image 4 of the assessment criteria must be met. However, if the same assessment criteria are not met in any of the three images, a further three images will be requested by the assessor. In this situation, the logbook will not pass overall, even though a score of 4 has been obtained for each image. for e.g. If all three images fail on the criteria of caliper placement, the logbook will not pass and another logbook of three images will be requested.
  • All images must be passed.

Demonstration of Scoring Method:

Six criteria     Image 1   Image 2    Image 3

Image size (head & thorax)
 ✓ X    X

Mid Sagittal section
 ✓
   X
 Caliper placement      X
 Maximum lucency  ✓
 Neutral Head position  ✓
 Representative length of the nuchal membrane  
Note: Image 3 is a fail.

Audit Image Submission Requirements

These requirements are in addition to those mentioned in the regulations for the measuring of Nuchal Translucency, the 11-14 week scan.

  • De-identify all hard copy images. Using scissors, cut out the patient’s name and site of scan (blocking out details with text is not appropriate).
  • Date and time scan were performed to remain on the image.
  • Each image is to be from a different patient.
  • All images must be collected within the audit period.
  • Please follow the instructions for your images as specified below depending on the medium you are using for your submission.
  • If these requirements are not met, further images will be requested.

FOR SUBMISSION VIA EMAIL (preferred method):

JPEG Format imported to a PowerPoint file.

  • The images need to be de-identified following the guidelines.
  • You can use any Photoshop program or Microsoft Paint to black out / erase the name of the patient and the center where the scan was performed. In the interests of unbiased assessment, it is preferable that the assessor does not have access to patient information and the location of the scan.
  • Save de-identified images as <ID#>Image1.jpg, <ID#>Image2.jpg and <ID#>Image3.jpg. If you do not know your ID, use your name. We will rename these files before sending to the assessor to ensure anonymity.
  • Import images to a PowerPoint file.

Save the document as <Your ID #>.ppt Email it to nuchaltr@ranzcog.edu.au

FOR HARDCOPY SUBMISSION:

  • Paste hardcopy images on to a plain (not letterhead) A4 sheet of paper and number them.  Please put your operator ID on each page. If you do not know your ID number, place your name at the top of the sheet in pencil.

Disclaimer

This information is intended to provide general advice for sonographers. It is Sonogirl’s personal review of the official RANZCOG NT Program website due to frustration in needing to find this information quickly.

Whilst Sonogirl endeavors to ensure that information is accurate and current at the time of preparation, she takes no responsibility for matters arising from changed recommendations or information or material that may have become subsequently available.