Registered sonographers

As a registered sonographer, you can submit NT / CRL measurements on Multiple Markers Screening requisitions under your own Ontario NT ID number. It is important to be aware of how to complete the requisition accurately and thus have a positive impact on the care of pregnant individuals.

How to complete the MMS requisition

Benefits to being part of the NTQA program

Here are some of the benefits to being registered in the NTQA program:

Gain awareness of your NT measurement performance

BORN Ontario collects NT/CRL data as recorded on pregnant individuals' MMS requisitions.

The MMS labs can correlate this data with your Ontario NT ID number and create your personalized NT performance distributions. The distribution will reflect your NT measurement performance when compared against the expected normal population distribution established by the FMF UK.

We encourage you to gain access to your personalized NT performance distribution by logging into the BIS and learn about your scanning habits.

"How to" tips:

Instructions for logging into the BIS and resetting your password.
Guides on how to access your personalized NT performance distribution and how to interpret it.
Video guide to support sonographers in understanding and interpreting their personalized NT performance data.

example of a personalized sonographer NT performance distribution

Above image shows an example of a personalized NT performance distribution. The NT is on the vertical axis and the CRL is on the horizontal axis. The resulting distribution (grey dots) is compared against the expected NT for gestation as represented by the blue FMF UK curve.

Get support from Prenatal Screening Ontario

We encourage you to frequently check, interpret your NT performance distribution and make changes to your practice. A proactive approach will help keep your Ontario NT ID number active.

Contact our clinical content specialist in sonography, Susan Burnett-Roy, at PSO@BORNOntario.ca, for questions or guidance on how to improve your scanning habits. The Ontario Multiple Marker Screening (MMS) labs may identify you as requiring assistance. This means that you will take part in a formal mentorship program to maintain your NT registration in Ontario. PSO will assess your NT measurement performance by auditing your personalized NT performance distribution data and your NT images. Our goal is to support you through this process and to provide you with actionable feedback that will help you to improve your NT measurement performance. Most of the time, you will maintain an active Ontario NT ID number during this process which means you will continue to be able to perform NT scans.

Sometimes, the Ontario MMS labs will suspend a sonographers' Ontario NT ID number, which means you will not be able to perform NT scans or submit NT data to the labs for Multiple Marker Screening until you have completed the PSO NT mentorship program.

“The moment a sonographer thinks ‘I don't have anything else to learn’ or ‘What's this person going to teach me?’, it’s time to hang up your probes, because that's a part of our careers. We’re always going to be learning”.
Katie Virgin, sonographer
(read about her experience in the mentorship program in the BORN 2021-2022 annual report)

Contribute to a high-quality prenatal screening system

Obtaining high-quality NT measurements is important for an accurate risk assessment through multiple marker screening. Currently, the MMS labs use a coefficient for each sonographer based on their performance to adjust pregnant individuals' prenatal screening results and thus maintain a high prenatal screening performance:

Accessible version of above visual (text only)

Your distribution is assessed - there is a discrepancy between each sonographers' distribution and the standard FMF UK curve
A coefficient is applied - MMS labs apply a coefficient to your measurement to correct for this discrepancy.
High-quality system is maintained - this practice supports a high detection rate for trisomy 21 and 18 in Ontario

The performance distribution is reviewed annually by the MMS labs. If you have shown consistency in your scanning practice, your coefficient will remain the same. Otherwise, the coefficient will be changed based on your current scanning habits and/or you will identified as requiring further assistance to support your practice.

The goal of the NTQA program is to support and improve sonographers' NT scanning practice so that the labs no longer need to rely on this coefficient to maintain a high-quality prenatal screening system.

It's working! Each year since 2017 we have seen an increasing proportion of sonographers who have performance distributions that align with FMF standards, and therefore do not require an adjustment coefficient by the Ontario MMS labs.

Get proof of registration for employment

Many employers now request that sonographers are registered in the NTQA program. The statement "As of today’s date, dd-mmm-yyyy, Sonographer code XXXXX is currently registered as an active Nuchal Translucency Sonographer by the Ontario Multiple Marker Screening (MMS) Laboratories." has been added to the individual NT curve of active sonographers. Log into BIS, review your personalized NT performance distribution curve and take a screenshot to provide proof of registration to employers.

Guidelines for maintaining your registration

There are several guidelines that we encourage you to follow to maintain your registration and improve your NT scanning practice:

Curve audit: view your personalized NT performance distribution bi-annually

Take a proactive approach in monitoring your personalized NT performance distribution by logging into the BIS at least biannually, and contact us with any questions or if you require support.

FMF UK image audit

Participate in the FMF UK NT image audit by submitting three images a year to the FMF UK for review and feedback. These image audits are an assessment of ultrasound images for alignment with the FMF protocols. Having this audit can help explain finding for your NT performance distribution. We encourage you to implement slight changes in your practice based on what you have learned from the audit and NT performance curve.

Do not share your NT/CRL data table or Ontario ID number (unless the purpose is for training)

NT/CRL data table and NT ID number sharing reduce the accuracy of patients' prenatal screening tests. Please protect your patients by safeguarding your Ontario NT ID number and personalized NT performance distribution.The NT/CRL distribution from the data table is personal to you and is representative of your individual NT practice; therefore, it is imperative that the measurements collected to create this data table are obtained by you.

Similarly, the NT/CRL data is collected under your Ontario NT ID number and are added to your baseline personalized performance distribution to assess your ongoing NT measurement accuracy. The Ontario MMS labs use a coefficient to adjust for any discrepancies between your data and the standardized curve established by FMF. This coefficient is used to adjust pregnant individuals' multiple marker screening results. Therefore, screening results generated using someone else's Ontario NT ID number will be skewed.

It is a privilege to perform NT scans and your personalized NT performance distribution reflects the quality of your work. Maintain the integrity of your distribution by making sure that you are the only one contributing to it.

Stay up to date with prenatal genetic screening information

It is your responsibility to keep abreast of prenatal genetic screening landscape in Ontario, such as requisition updates, changes in NIPT funding criteria. PSO sends out email communications that are relevant to your practice.

Update your contact details in the BORN Information System (BIS)

As a registered sonographer, you are required to update your personal contact details in the BIS. Failure to provide up-to-date contact information (a current email address and a phone number with a direct extension) will result in missing important communications sent out by PSO concerning the upcoming developments in Ontario's NTQA program such as new requirements to maintain your registration.

Assisting other sonographers in obtaining NTQA registration

Sharing your Ontario NT ID number is strictly prohibited outside of assisting your colleagues in obtaining the measurements they need for NT certification.

NT certified practitioners can supervise individuals working to obtain their Ontario NT ID numbers, and assist them in obtaining their NT and CRL measurements. The pregnant individual should consent to two ultrasound practitioners performing the NT ultrasound and should be informed that one practitioner is in training.

There are two ways for assisting other sonographers:

First method (gold standard)

The gold start is for the Ontario NT registered ultrasound practitioner to scan the pregnant individual and obtain the NT and CRL measurements. The measurements are then recorded on the pregnant individual's MMS requisition under the registered practitioner's Ontario NT ID number. The practitioner in training then scans the pregnant individual to obtain the NT and CRL measurements they need for the registration application.

Second method

The practitioner in training obtains the NT and CRL measurements they need for registration. While the pregnant individual is still on site, the Ontario NT registered ultrasound practitioner reviews these images to make sure that they (a) meet the Fetal Medicine Foundation (FMF UK) criteria, and (b) represent their standard of work, as the measurements will be represented on their personal NT performance curve. These NT and CRL measurements are then recorded on the pregnant individual's MMS requisition under the NT ID number of the registered ultrasound practitioner.