Maintaining quality assurance for sonographic nuchal translucency measurement: Lessons from the FASTER trial

M. E. D'Alton, J. Cleary-Goldman, G. Lambert-Messerlian, R. H. Ball, D. A. Nyberg, C. H. Comstock, R. Bukowski, R. L. Berkowitz, P. Dar, L. Dugoff, S. D. Craigo, I. E. Timor, S. R. Carr, H. M. Wolfe, K. Dukes, J. A. Canick, F. D. Malone

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Objective To evaluate nuchal translucency measurement quality assurance techniques in a large-scale study. Methods From 1999 to 2001, unselected patients with singleton gestations between 10 + 3 weeks and 13 + 6 weeks were recruited from 15 centers. Sonographic nuchal translucency measurement was performed by trained technicians. Four levels of quality assurance were employed: (1) a standardized protocol utilized by each sonographer; (2) local-image review by a second sonographer; (3) central-image scoring by a single physician; and (4) epidemiological monitoring of all accepted nuchal translucency measurements cross-sectionally and over time. Results Detailed quality assessment was available for 37018 patients. Nuchal translucency measurement was successful in 96.3% of women. Local reviewers rejected 0.8% of images, and the single central physician reviewer rejected a further 2.9%. Multivariate analysis indicated that higher body mass index, earlier gestational age and transvaginal probe use were predictors offailure ofnuchal translucency measurement and central image rejection (P = 0.001). Epidemiological monitoring identified a drift in measurements over time. Conclusion Despite initial training and continuous image review, changes in nuchal translucency measurements occur over time. To maintain screening accuracy, ongoing quality assessment is needed.

Original languageEnglish (US)
Pages (from-to)142-146
Number of pages5
JournalUltrasound in Obstetrics and Gynecology
Issue number2
StatePublished - Feb 2009
Externally publishedYes


  • Down syndrome screening
  • Nuchal translucency
  • Quality assessment
  • Quality assurance
  • Ultrasound

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology


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