1) Nuchal translucency screening uses ultrasound to measure the thickness of fluid behind the fetal neck to calculate the risk of Down syndrome and other chromosomal abnormalities. 2) To obtain an accurate measurement, the ultrasound image must be positioned in the sagittal plane and show at least two-thirds of the fetal head and neck, with the maximum fluid thickness measured perpendicular to the long axis. 3) While special training is required to perform nuchal translucency screening, radiologists are well-suited for it since they are trained to examine areas surrounding the uterus in addition to what is inside.

1. Courtesy Deborah Levine
To obtain a high-quality nuchal translucency image, measure the maximum lucency perpendicular to the long axis of the fetal nuchal region.
ment. You’re looking at structures that are Although special training is needed
extremely small, and calipers have to be to perform NT screening, “it’s becoming
positioned precisely.” more in demand, and not enough facili-
TO THE POINT
ties o er this,” says Kleiner. “Very few • Nuchal translucency (NT)
A Valuable Education people are exposed to this unless they’re screening, an obstetrical
Levine describes several criteria going into perinatology practice. I think ultrasound test that can help
for a high-quality NT image. An NT most [programs] aren’t giving residents calculate risk for Down syn-
measurement should be obtained from training in ultrasound.” drome and other chromosomal
an image magni ed to contain the fetal Levine and other members of the ACR abnormalities, is an opportunity
head and neck region, which should Commission on Ultrasound are working for radiologists to recapture
represent at least two-thirds of the image. with the Fetal Medicine Foundation and obstetric ultrasound volume.
Additionally, the image should be in the the Nuchal Translucency Quality Review • Radiologists and sonographers
true sagittal plane (i.e., pro le of a fetus’s Program to ensure that radiologists are uniquely suited to perform
face without an orbit in the image), with and the technologists they work with NT screening because they
the fetus’s head in the neutral position. continue to have access to the education tend to look not just at the
Calipers should be “on-to-on” with and quality-assurance programs o ered by fetus but also at areas
respect to the ultrasound echoes sur- these organizations. surrounding the uterus.
rounding the NT. e maximum lucency Although more education and training • Currently, two organizations
should be measured perpendicular to the are necessary for such a specialized test, radi- can certify individuals to
long axis of the fetal nuchal region. ologists may be able to o er more compre- perform NT screening, The
A er the image is acquired, an algorithm hensive screening for patients because “we Fetal Medicine Foundation
is used to calculate the individualized tend not to look only in the uterus, so we can (www.fetalmedicineusa.com)
risk of trisomy 21, 18, or 13 from the pick up other abnormalities,” says Kleiner. and the Nuchal Translucency
NT measurement, biochemical markers “If you’re going to o er to do obstetrical Quality Review Program
(pregnancy-associated Plasma Protein A imaging, it’s important to be able to o er the (www.ntqr.org).
and free beta-HCG), and patient age. entire spectrum of services.” //
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 9