Quality Review and Ongoing Certification for the first trimester scan

How performance is measured – Standards used for assessment of performance

1. For operators scanning a normal population and taking measurements according to the Australian Nuchal Translucency Program and the Fetal Medicine Foundation (FMF) guidelines, the overall Bias of paired NT and CRL measurements is estimated relative to the FMF reference curve and is the primary focus of audit feedback. Ideally, half the measurements should lie above the curve and half below.
2. The NT Bias relative to the FMF reference curve should be 0.10mm or less. A deviation from this could indicate systematic under-estimation or over-estimation of the measurements. However, if an operator has scanned less than 30 patients, it is not possible to draw any meaningful conclusions from the data submitted.
3. Please refer to this document on the NT website for further information on Bias, Spread and Trend and interpreting your audit report – Audit Assessment Guide

Annual Audit

All licensed Operators are required to submit data and 1 Nuchal Translucency image for their annual audit. For Operators who are licensed to perform Nasal Bone, Uterine Artery Pulsatility Index (UAPI) and Ductus Venosus (DV) Screening, 1 image is also required to be submitted annually for audit.

The annual audit involves assessment of the distribution of NT measurements of each operator and assessment of their images. Operators passing their audit will be re-audited and re-licensed on an annual basis.

If operators are working at multiple centres, their image should be submitted for the first audit they participate in for each calendar year. Only one image submission is required annually, and images can be submitted from the operator’s preferred workplace.

1. If the operator meets the required standard their FMF Software license will be renewed for 12 months.
2. If the operator has not met the required standard following the annual audit the license will be renewed for 6 months.

Less than 30 scans

The distribution of NT measurements cannot be meaningfully assessed if fewer than 30 scans have been performed.

As of June 2022, scans will no longer be amalgamated to reach the minimum 30 required.

If an operator is unable to secure a case load of 30 plus cases annually for 2 consecutive years, they will be asked to submit 3 images for their annual audit the following year.

2/3 images must pass to be re-licensed for a year, if only 1 or none of the images pass then the operator will be placed on a 6 month license and be required to submit the number of images they did not pass (2 or 3) at their short audit.

If an operator does not pass their major or short audit images for two consecutive audit years, they will be required to attend a Teleconference Tutorial.

If an operator does not pass their major or short audit images in the third year, their license may not be renewed.

An operator will continue to submit 3 images for audit if they continue to perform less than 30 scans yearly.

NT Audit Images

Important Message
If you are able to submit your images electronically we strongly recommend you do this. If you still need to post your images to us, we suggest using a tracking number so they can be easily followed up. ​

Only 1 NT image will be required for audit from January 2020.

Compliance

• If an operator’s audit result generates a Red Bias and they fail their audit image assessment, they must supply one more image at their short audit in 6 months’ time. This image needs to be collected prospectively.
• If an operator has low numbers (<30 for the year) and their audit image does not pass, they will be placed on a 6-month license and be asked to submit another image for assessment within those 6 months.  This image needs to be collected prospectively. Please see the ‘Less than 30 scans’ section above for when an operator will be required to submit 3 images for audit.
• Operators who submit, but do not pass, the 6-month audit image will receive a warning to indicate that their license will be removed at the next major annual audit if they do not submit and pass their audit image.
• Operators who do not submit a further image at 6 months will have their license removed.

Non-compliance

• If an operator does not submit an image for audit, they will be placed on a 6-month license and be asked to submit another image for assessment within those 6 months. This image needs to be collected prospectively. If the operator again fails to submit an image at the 6-month audit, their license will be removed.

Marker Images (NB, UAPI & DV)

• Only 1 image for each marker an operator is certified for is required for audit from January 2020.
• If an operator fails a marker image, they will be placed on a 6-month license and be asked to submit another image for assessment within those 6 months. This image needs to be collected prospectively.
• If an operator does not re-submit another marker image for assessment within the 6-month timeframe, they will receive a warning to indicate that they will be switched off for that marker in the software at the next major annual audit if they do not submit and pass an audit image for that marker.
• Operators who submit, but do not pass, another marker image for assessment within the 6 month timeframe will receive a warning to indicate that they will be switched off for that marker in the software at the next major annual audit if they do not submit and pass an audit image for that marker.

Appeals

This document is the policy and guidelines for the RANZCOG Appeals Committee (a Standing Committee of the Board), which hears appeals in relation to decisions made by or on behalf of the RANZCOG. It took effect on 27 March 2004, when it was approved by the RANZCOG Council, and includes subsequent amendments. Selecting this link will take you to the document.

Document Created December 2014

Document Reviewed April 2017

Document Reviewed December 2019

Document Reviewed June 2022