Screening for Down syndrome with nuchal translucency is becoming more widespread. Training and credentialing sonographers is currently being provided by experts in fetal ultrasound, such as those administering the Society for Maternal Fetal Medicine’s Nuchal Translucency Quality Review (NTQR) program or the Fetal Medicine Foundation/USA (FMF/USA) program. The laboratory has the important role of establishing and maintaining appropriate reference values to interpret these NT measurements and to provide a patient risk that combines both the ultrasound and biochemical results. The laboratory also has a responsibility to monitor and evaluate NT measurements (e.g., epidemiological monitoring) to help assure quality prenatal screening. When many sonographers submit NT measurements, the task of interpreting and monitoring them can be overwhelming for the laboratory. Laboratories may not have the time, resources or expertise to perform these tasks at meaningful intervals. Unfortunately, laboratories may be held partially responsible if a poorly performing sonographer contributes to ‘missing’ a Down syndrome pregnancy.

With this as background, our First Trimester Interlaboratory Comparison Program (ICP) is now introducing a new service - NTMonitor. Prenatal screening laboratories can utilize NTMonitor as an adjunct to existing NT quality review. NTMonitor provides a quality assessment of the NT measurements that your laboratory receives, regardless of an individual sonographer’s source of accreditation. The assessment includes:

• A comprehensive review of your data every 6 months, starting in the quarter of your choice (January, April, July, or October).

• Sonographer-specific and center-specific medians appropriate for implementation, with selected options tailored for each laboratory (for example, some laboratories may want the sonographer’s name on each report, while others might prefer the credential number or code).

• A full page report for each sonographer who has provided sufficient data over the last 6 months (or last year). These reports include graphics, epidemiologic parameters (with reference ranges), and interpretive statements in a format suitable for transmission to the sonographer.

• A listing of sonographers reporting too few data for reliable interpretations.

• The charge will range from $2,000 to $10,000 per year per site, depending both on profit/non-profit status and the number of sonographers submitting data to your laboratory.

• Protected health information (PHI) is not requested or received, so HIPAA issues are not a concern.

• A sample NTMonitor report is available (click on link above).

• Additional individualized services are available – contact us for further details.

The operating principal of NTMonitor is collegial in which questions regarding NT interpretation and performance are encouraged and suggestions for improvement of NTMonitor are welcome.

To enroll your laboratory in NTMonitor:

• Fill out the enrollment form (link above) and return with payment.

• Consult with our staff about data fields and report formatting.

• Submit an Excel file (pre-determined format) with your data covering a six month time period.

• Upon receipt of your first report, consult with our staff to ensure that your laboratory fully understands the findings.

George J. Knight, Ph.D. Glenn E. Palomaki, Ph.D.,
(207) 894-6610

Jacob A. Canick, Ph.D. Geralyn M. Messerlian, Ph.D.,
(401) 453-7650

Department of Pathology and Laboratory Medicine

Women & Infants Hospital, Providence , Rhode Island