Teleconference tutorials are a convenient, accessible and effective way to obtain immediate and sustained improvement in operator performance.

The number of operators certified to perform the NT scan has increased since 2002, although availability in some states remains low. An initial improvement in performance of operators appears to have reached a plateau. It is time to become more proactive in engaging operators in the audit cycle.

Introduction: Standardization of first-trimester nuchal translucency (NT) image acquisition is crucial to the success of screening for Down syndrome. Rigorous audit of operator performance and constructive feedback from assessors maintain standards. This process relies on good inter-rater agreement on image assessment. We describe the Australian approach to NT image assessment and evaluate the impact of a targeted intervention on inter-rater agreement. Methods: Between 2002 and 2008 a group of experienced practitioners met nine times to compare their assessment of a series of NT images. Each assessor had previously scored the images according to a system described in 2002. Inter-rater agreement was evaluated before and after an intervention where the assessors were required to refer to a detailed resource manual designed to reduce the subjectivity inherent in image assessment. Results: There was a statistical improvement in inter-rater agreement for all elements of image assessment (original scores and individual component scores) after the intervention, apart from horizontal fetal position. However, even after the intervention, inter-rater agreement levels generally remained moderate (kappa range: 0.14–0.58). Conclusions: This study has shown that provision of detailed resource documentation to experienced assessors can significantly improve inter-rater agreement in all facets of NT image assessment. It also highlights areas of image assessment that require critical review. It is recommended that all audit bodies regularly review their inter-rater agreement to ensure consistent feedback to operators who submit images for expert peer review.

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Objectives:To estimate the risk of miscarriage and stillbirth following first trimester risk assessment among women pregnant after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) or intrauterine insemination (IUI) compared to spontaneously conceived pregnancies (SCP) Objectives: To develop an intervention to assist operators to improve their NT (nuchal translucency) technique with the aim of having a NT distribution within the appropriate range. Methods: All Australian operators who are accredited to measure NT undergo annual review of their clinical practice. Their NT data is assessed to check that an acceptable proportion of measurements (40-60%) lie above the gestation-related median. Operators with NT distributions falling outside of the acceptable range undertook a teleconference tutorial.Tutorials were offered on a fortnightly basis and involved two tutors, a sonographer experienced in NT education and the quality program manager. The tutorial lasted 60 minutes. By using desktop sharing software the operators and the tutors were able to review a series of images together and establish a mechanism for improving operator technique. The quality program manager reinforced the concepts of audit, how performance is measured and how the first trimester screening software program calculates the risks for Down syndrome and other chromosome abnormalities. Discussion was encouraged in an attempt to dispel some common misconceptions. Results: In 2011 there were 1254 operators performing NT scans in Australia. After the annual audit in 2011, 106 operators were found to have a NT distribution falling outside the acceptable range, 98 operators were under-measuring and 8 were over-measuring (range: 8.43% -83.33% above the median), these operators undertook a teleconference tutorial.In the 2012 audit of results 103 of these106 operators remained active, 69/103 (71.07%) had improved their distributions to the acceptable range. Conclusions: Teleconference Tutorials are an effective way of improving operator distributions for NT measurement.

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