NUCHAL TRANSLUCENCY

Regulations

Regulations for Certification and Audit in the 11-14 Week Scan

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) under the auspices of the Fetal Medicine Foundation (FMF) in the United Kingdom, administers a process for certification in the 11-14 Week Scan to ensure that all those performing this ultrasound examination have been adequately trained to do so and that high standards of performance are maintained by continuous education and audit.

Once the certificate of training in the 11-14 week scan has been obtained candidates will be entitled to receive the FMF software for the calculation of risk for Down syndrome using maternal age, Nuchal Translucency (NT) measurement and serum biochemistry.

The conditions for the use of this software and ongoing certification are that candidates provide their measurements and images for the purpose of audit annually and at other times at the request of RANZCOG.

The Certification Process

The Theoretical Course

The Logbook

Ongoing Certification and Audit

The Certification Process

Requirements

1. Successful completion of the Australian NT Online Theoretical Course, or attending a Theoretical Course conducted by the Australian Nuchal Translucency - Ultrasound, Education and Monitoring Program or its equivalent and completing MCQ’s associated with the courses.

2. Submission of 5 Nuchal Translucency images demonstrating the practitioner’s ability to comprehensively measure the Nuchal Translucency.  For details of submission see The Logbook and image submission requirements.

Once this process has been successfully completed, then the practitioner is offered the use of the Fetal Medicine Foundation's software after declaring their intention to practice.

The Theoretical Course

All practitioners involved in antenatal care and first trimester ultrasound are invited to participate in the NT – Ultrasound Education and Monitoring Programs Online Theoretical Course due to commence in June 2009, or attend a FMF / RANZCOG courses on the 11-14 week scan.  All Australian ultrasound providers will be required to complete the online course or other Theoretical courses that may be conducted in Australia. 

Delegates completing the Australian Theoretical Courses (online or face to face) will complete multiple-choice questionnaires as part of the course; this is designed to ensure that candidates have understood the concepts of the course the source book can be used for reference.  

The course content is supported by a monograph 11-14 Week Scan - The Diagnosis of Fetal Abnormalities edited by Professor Kypros H Nicolaides and published by The Fetal Medicine Foundation London 2004.  A CD of this book will be distributed to delegates registered for the Online Theoretical Course.

Candidates who are participating in Practice Improvement projects / MOSSIP Programs etc: will be able to gain points after completing the course and the MCQ’s.  It’s necessary to contact your particular organisation to determine how points are allocated.  RANZCOG Fellows see RANZCOG CPD for further information

The courses will cover the following topics:

• Principles of Screening

• Practicalities of NT measurement
• NT and chromosomal defects
• Biochemistry screening
• Diagnosis of fetal abnormalities at the 11-14 week scan
• Screening test results and informed choice
• Increased NT with normal karyotype
• Determination of chorionicity, diagnosis and management of multiple pregnancy at the 11-14 week scan

The FMF runs regular courses in London and supports a number of other recognised Training Centres throughout the World to run similar courses.  An online course is also available on the FMF website www.fetalmedicine.com as an additional resource for operators in Australia.  Courses held in Australia and the Online Theoretical Course follow a similar format as courses run in the UK.

The Logbook

The aim of the logbook is to demonstrate an understanding of the FMF / RANZCOG guidelines for the measurement of the NT.  

See below and the Protocols:   http://www.nuchaltrans.edu.au/guidelines.shtml
Five (5) thermal / photo images pasted chronologically into a small exercise book, (one image per double page) are required to demonstrate the candidate's evolving experience in performing the 11-14 Week Scan.  Image files (.jpg or .jpeg format) can also be submitted on a CD, with the images named as “Image 1.jpg”, “Image 2.jpg” etc.  Images can also be submitted by email.  See logbook submission requirements for more details regarding image submission.

Images are to be collected on an ultrasound machine whose specifications include:

• Zoom facility
• Cineloop function
• Focal zone adjustment
• Is able to measure in 0.1 mm increments

The candidate's images should demonstrate their skill at:

• obtaining sagittal section of fetus
• determining appropriate image magnification
• positioning the calipers on the borders of the translucency
• placing the calipers on the area of maximal translucency thickness

Once completed, the logbook should be sent to:

Nuchal Translucency Program Officer
RANZCOG
254-260 Albert Street
East Melbourne VIC 3002

A score of 10 or higher for each image is required to pass the image and a total score of 80% or more (at least 4 images out of 5) for a successful completion of the logbook assessment. See Image assessment for more details. 

The Practical Assessment / Exam has been discontinued

Quality review and ongoing Certification in nuchal translucency

• Each sonographer using the FMF 11-13 weeks scan risk calculation software is required to submit NT data for audit 3 months after obtaining the FMF Certificate of competence in NT measurement and the FMF 11-13 weeks scan software.
  
  In addition to the FMF audit, all sonographers are encouraged to perform their own internal quality assurance on a monthly basis by examining their NT distribution using the automated audit module incorporated within the FMF risk calculation software.

• The major annual audit involves assessment of the distribution of NT measurements of the centre and of each sonographer and examination of their images. Sonographers passing their audit will be re-audited and re-licensed on an annual basis thereafter. The NT distribution cannot be assessed if fewer than 30 scans have been performed; in this situation an individual can still pass their audit if their images are satisfactory.
  
• If an individuals NT distribution falls outside the satisfactory range advice will be given on how to improve the technique for measuring the NT, based on the review of images. The name of the sonographer will be removed from the Programs website list of holders of the Certificate of competence in NT. A new audit will be carried out in 6 months and the sonographer will only be reinstated on the FMF website list once the audit is considered satisfactory.
  
  However, if in the repeated audit the standard of the sonographer has not improved then their FMF software license will be revoked. In this case the sonographer will need to be retrained and apply for recertification by attending the FMF internet based course on the 11-13 weeks scan and submitting the appropriate logbook of images.

© RANZCOG