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   The Society for Maternal-Fetal Medicine

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Background Participation Fee
Course Image Submission
Credentialing Process Practice Administrator Accounts
CME Credits Media
Exam General/Troubleshooting
Quality Monitoring

BACKGROUND

Q: What is NTQR?

A: The Nuchal Translucency Quality Review Program was developed to facilitate the effective use of the nuchal translucency (NT) measurement in the U.S. and to provide a mechanism for ongoing quality review. The program is web-based and consists of three critical components: education & training, proficiency testing and quality review.

Q: I was credentialed by MFMF. Is NTQR the same program or a different program?

A: MFMF changed its name to NTQR on 2/1/2006. No action is required on the part of the provider.

Q: Why did MFMF change its name to NTQR?

A: Our program is consensus-based, with leaders in fields other than Maternal-Fetal Medicine. We felt that the program name should be representative of who we are and what we were created to do. The name Nuchal Translucency Quality Review program does this.

Q: Who developed the program?

A: In 2002, the Society for Maternal Fetal Medicine (SMFM) established an NT oversight committee with members from both the BUN study and FaSTER trial. This oversight committee was challenged to first develop the specifics of the quality review process and the education content and then to create an independent entity, the Nuchal Translucency Quality Review (NTQR), to handle the program going forward.

Q: Who should participate?

A: Participation in the NTQR program is open to any ultrasound practice after basic educational and imaging criteria are met. Numerous US and European studies have found that ongoing monitoring of results is necessary to maintain quality. The Nuchal Translucency Quality Review offers the only epidemiologic quality monitoring program based in the US.

Q: Do I need to keep my FMF credentials?

A: The decision to maintain your FMF credentials is strictly a personal one. NTQR accepts all FMF credentialed providers and will provide ongoing quality monitoring through a wide variety of laboratories.

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CREDENTIALING PROCESS

Q: How do I become credentialed?

A: To become credentialed in the program, all providers must first register online at www.ntqr.org. The credentialing process takes into account the experience of the provider and establishes three different tracks for persons with different levels of experience in NT assessment.

  1. The first track is for providers with little or no formal background in NT screening. These individuals must complete an educational training course, pass an online exam and submit at least 5 satisfactory images from 5 different fetuses in order to be credentialed. The fee for the first track is $350 for doctors, $275 for sonographers.
  2. The second track is for providers with some NT experience who have not had their images externally reviewed and do not participate in an ongoing quality review program. This group will not have access to the online course materials, but will be required to pass an online exam and submit at least 5 satisfactory images in order to be credentialed. The fee for the second track is $200.
  3. The third track is for providers who have been previously credentialed through FMF, FASTER, BUN or Lenetix. This group is only required to register. The fee for the third track is $50.

Q: What is required to maintain my NTQR credentials?

A: The following actions are required to maintain your NTQR credentials:

  • Pay participation fee
  • Submit NT data via requisition form to participating laboratories
  • View reports and charts containing NT quality review information provided by the Nuchal Translucency Quality Review (NTQR)
  • Participate in on-going quality review exercises

Click here for further information

Q: What labs will recognize my NT submissions?

A: Please reference the Participating Labs section of our website.

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COURSE

Q: I attended a land-based course. How do I register?

A: To register online with NTQR after taking a land-based course, go to www.ntqr.org and click on “Register Now”. You will be prompted through several pages where you enter personal information as well as information about your practice. When prompted to select any in-person NT training courses you have attended, scroll through the list and choose the course you attended. At the Confirmation page, enter the promotional code that you were given at your course. This code will apply the discounted rate. If you were not given a code or do not remember it, email NTQRSupport@ntqr.org for assistance. After registering, you may log on and take the exam.

Q: I can no longer access the course materials from my Provider Summary page. How do I get access to them?

A: You can view them again at any point by clicking on Education --> Course from the menu when logged into your account. You may view the courses as many times as you wish throughout the credentialing process and also after you have received your NTQR Credentials.

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CME CREDITS

Q: Will the NTQR course count for CME credits?

A: Yes, those who view the NTQR course material may claim up to 3.0 CMEs. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of The American College on Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). The American College of Obstetricians and Gynecologists (ACOG) designates this educational activity for a maximum of 3 AMA PRA Category 1 credits or up to a maximum of 3 Category 1 ACOG Cognate Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. A certificate will be emailed to the provider within a month of taking the course.

Q: Will the CMEs be accepted by ARDMS?

A: Yes.

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EXAM

Q: How do I take the exam?

A: The exam is available online at www.ntqr.org. Once the provider is registered, he or she may log on, click the “Education” tab at the top of the page, and then select “Exam.” Those who are registered under Track A (Standard) must view the course materials before taking the exam. Those who are registered under Track C (Currently Credentialed) are not required to take the exam.

Q: Do you offer paper exams?

A: No, NTQR does not offer paper exams. All exams must be taken online at www.ntqr.org.

Q: Who developed the exam?

A: The exam was developed by the Nuchal Translucency Oversight Committee, which includes physicians who had participated in the NICHD sponsored BUN and FaSTER trials as well as individuals with related experience in this field.

Q: What do I do if I failed the exam three times?

A: Individuals who fail the exam three times must review the course material before taking the exam again. Once the course material has been reviewed providers will have three more opportunities to pass the exam.

  • Doctors who have not already paid for access to course materials will be required to pay an additional $150 in order to obtain access.
  • Sonographers who have not already paid for access to course materials will be required to pay an additional $75 in order to obtain access.

Q: How do I find out what my exam results are?

A: Exam results are posted immediately upon completion of the exam. A provider may also access his or her exam results at any point by logging onto www.ntqr.org and clicking on the "My Home" tab at the top of the page and selecting “Summary.”

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QUALITY MONITORING

Q: What kind of quality monitoring does NTQR perform?

A: Performance will be assessed using both image review and epidemiologic monitoring. NT measurement data submitted to your laboratory will be electronically transmitted to the NTQR website and analyzed for performance of the key quality review indicators. Quality monitoring reports will be available for providers and the provider’s Medical Director of Site / Supervisor on a regular basis. These reports will identify outliers and those in need of remediation.

Q: Who will receive my reports besides me?

A: Quality monitoring reports will be provided to both the provider and to Chair of the provider's department on a periodic basis. Laboratories will only have access to the reports of the providers that submit to them.

Q: Your literature states that the correct CRL range for first trimester NT measurement is 38-84 mm. However, my laboratory will not accept CRLs below 45mm. What should I do?

A: NTQR suggests a CRL range of 38 - 84 mm based on the current literature. NTQR is working with the national laboratories to get their CRL ranges adjusted to the NTQR range. Some laboratories are using currently a different CRL range for first trimester risk estimation. Please check with your local laboratory and adjust your first trimester risk assessment to the laboratory CRL range at this time.

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PARTICIPATION FEE

Q: What is the Participation Fee?

A: Credentialed Physicians will be required to pay a flat yearly participation fee of $150.
Credentialed Sonographers will be required to pay the same yearly fee of $35.00.

Q: What happened to the Data Monitoring Fee?

A: The Participation Fee is replacing the Data Monitoring Fee. In surveying our members, it became clear there was a general dislike of the "click fee". Previously, NTQR debited a Provider's Practice Administrator Account (PAA) $1.00 per NT record. When the program was implemented, NTQR believed it to be the fairest way to distribute the cost associated with the maintenance of the NTQR Program. In the feedback NTQR has received, the "click fee" was considered cumbersome and confusing. In addition, physicians with significant volume asked NTQR to consider a volume discount. In order to address both concerns, NTQR has instituted a three category annual participation fee that decreases progressively with volume. In addition, we have also implemented a nominal $35.00 fee for credentialed sonographers to help defray the costs.

Q: How do I pay the Participation Fee?

A: To pay the yearly participation fee you only have to log in to your account. If the fee is due you will be presented with a screen to pay the fee. If you move away from the screen to view other information you can select "Products" under "Home" from the main menu. This will return you to a screen giving the ability to pay the fee.

Q: How is the Participation Fee assessed?

A: For the first year or two, the physician fee will be based on the honor system. Physicians should estimate how many scans he/she will perform and read over the following year and choose the level that applies. Thereafter, the fee will be based on actual data submitted by the physician's laboratory. The sonographer fee is a flat rate, not based on volume.

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IMAGE SUBMISSION

Q: Can I submit more than one image per fetus?

A: No, each image must be from a different fetus. No fetus may have more than one image submitted.

Q: If I took several NT images of a fetus and do not "pass" quality review on the first try, can I use the fetus in a subsequent batch?

A: No, each image must be of a different fetus. You may not submit more than one image of a fetus across batches.

Q: One of my patients has a multiple pregnancy. Can I submit an image from each fetus?

A: Yes, for multiple pregnancies you may submit more than one image per patient as long as it is not of the same fetus.

Q: How long will it take for images to be reviewed?

A: Images will be reviewed within four weeks of the submission date. Images submitted via mail will be reviewed within four weeks of the day we receive and scan your images. You will receive an email confirmation when you submit your batch for review, which will list the date by which your review will be complete. You will receive another email notification when your review is complete.

Q: How do I submit NT images for review?

A: Images may be submitted in two ways:

  • Electronic Submission (Preferred Method): Upload .JPG or .GIF images and enter corresponding NT data into the website.
  • Mail Submission to NTQR: (a $20 fee will be assessed during registration): Enter NT data into the website and then mail images to NTQR. All thermal images mailed to NTQR must be stapled to the corresponding NT data form (printed from the website) after data entry has been completed. NTQR will scan the images and upload them to the website for Quality Review. Images will not be mailed back to the provider. Review will be completed within four weeks of the date we receive and scan your images. NTQR’s mailing address will be displayed after all NT data has been successfully entered into the website.

Q: Can I mail images?

A: Yes, for an extra $20 you may mail your images. However, you must still enter your NT data into the website. All thermal images mailed to NTQR must be stapled to the corresponding NT data form (printed from the website) after data entry has been completed. Images submitted via mail will be reviewed within four weeks of the date we receive and scan your images. The mailing address will be displayed after all NT data has been successfully entered into the website.

Q: Can I mail a CD-ROM of images?

A: Currently, we are only accepting images that are uploaded via the website or submitted by mail. If images exist in CD-ROM format, you should be able to save them as either .JPEG or .GIF files and upload them to the NTQR website. If images are not in .JPEG or .GIF format, files can be easily converted using photo editing software.

Q: My electronic images are not in the required .JPEG or .GIF format. Now what do I do?

A: Files that are in a format other than .JPEG or .GIF (such as .BMP) can easily be converted using photo editing software.

Q: Can I submit a PowerPoint file containing my images?

A: Currently, we are only accepting images that are uploaded via the website or submitted by mail. If images exist in PowerPoint format, you should be able to convert them to .JPEG or .GIF files and upload them to the NTQR website. If images are not in .JPEG or .GIF format, files can be easily converted using photo editing software.

Q: How will I know whether or not I passed the image review?

A: You will receive an email notification when the image review is complete which will also tell you whether you passed the image review. After receiving the email, you may log into your account on the NTQR website to view your individual results. If it has been 4 weeks since you submitted your images and you have not received an email, please log on to www.ntqr.org and check your status on the Provider Summary page as it is possible that our auto-email was filtered into your junk mail folder.

Q: What are the image review scoring criteria?

A: Each batch must meet all three of the following criteria:

  • Total score must be 80% or greater
  • All images must satisfy at least 7 out of 9 criteria and pass criteria (g)scoring criteria
  • No individual criteria can fail on all images

Q: I submitted my images for review but did not receive an email confirmation. What went wrong?

A: It is possible that our auto-email was filtered into your junk mail folder or that you did not complete the image submission process. Log on to www.ntqr.org and check the status on your Summary page. If you successfully submitted your images, the status will indicate this along with the date your review will be completed. If you did not complete the last step to officially submit your images, the Summary page will indicate this and provide a link to the page where you may complete the last step.

Q: If I accidentally submitted incorrect NT data on the website, how do I go about changing it?

A: During the image submission process, you have the option to edit or delete submitted images until you officially submit your batch by clicking the final “Submit Batch for Quality Review” button. While submitting the individual images, you have the option to delete images altogether or to easily edit your data by clicking the data icon on the right-hand side of the “Batch Manager” page. However, after you have uploaded all your images and clicked the “Submit Batch for Quality Review” button, you will no longer have the option to edit your data. In the event that you recognize an error after clicking “Submit Batch for Quality Review”, you may contact us at NTQRSupport@ntqr.org.

Q: Does NTQR and FMF use the same protocol for measuring the NT space?

A: Yes. Both programs use “On-to-On” measurements.

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PRACTICE ADMINISTRATOR ACCOUNTS

Q: What is a Practice Administrator Account?

A: The Nuchal Translucency Quality Review offers a Practice Administrator Account to assist with payment of registration and training fees. The Practice Administrator Account gives practice administrators the ability to manage payments for their providers who register for the Nuchal Translucency Quality Review Program.

Q: How do I create an account?

A: Click “Create an Account” and follow the on-screen instructions. You will be asked to provide information regarding the practice location(s) you manage and the credit card to be used for payment.

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MEDIA

Q: I'm running Netscape and the presentation is not playing properly.

A: The only browsers supported by this application are Internet Explorer 5.5x and higher.

Q: I'm using a Macintosh computer and the presentation does not play properly.

A: The operating systems supported by this application are Microsoft Windows 98, Me, NT, 2000 and XP. Other operating systems are not supported.

Q: I downloaded the media player installation file, but the media still won't play.

A: Make sure you have actually run the installation file you downloaded. Downloading alone will not install the player.

Q: I see the player in the browser, but no media is playing.

A: Try pressing the play button. The media is supposed to start playing automatically, but sometimes it may need a little help. Also, check the status of the media at the very bottom of the player in green letters. If the word ‘buffering' appears there, the media is on its way. Just give it a moment.

Q: The media is playing, but I can't hear it.

A: Check your volume controls. It's a simple solution, but one that is often overlooked. Also check that your speakers or headphones are plugged in properly.

Q: The media keeps starting and stopping. Why is it being interrupted?

A: If you are using a slower connection, or internet traffic is very heavy, the media may be having trouble playing over the network to your computer. Sometimes these breaks happen once or twice within a long file. If they happen every few seconds, you may consider stopping and trying the media at another time.

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GENERAL/TROUBLESHOOTING

Q: I have forgotten my password.

A: From the home page, click on the "Forgot your password?" link and follow the directions given.

Q: I am running Netscape and the sign-in screen isn't working properly.

A: The NTQR website currently only supports Internet Explorer version 5.5x and higher.

Q: I tried to register on your web site as a Currently Credentialed Provider but got a message saying that my name does not match your list.

A: This could be because the list of provider names that we have on file is not 100% up to date, your name has been misspelled or your name has changed (e.g. after being married).

  • FMF: Please fax your certificate of competence to the attention of NTQR support at 1-405-752-2928 or email your FMF ID to NTQRSupport@ntqr.org. Please allow 2 business days before trying to log back on to the site.
  • FASTER/BUN: Please email NTQRSupport@ntqr.org your name and the institution where you participated in the trial. Please allow 2 business days before trying to log back on to the site.
  • Lenetix: Please email your name to NTQRSupport@ntqr.org. We will contact you when your information has been verified.

Q: How do I find my NTQR Provider ID number?

A: Once you have become credentialed you may print your Certificate of Completion. A link to the certificate is also available on the “Provider Summary” page, which is the first page that appears after logging onto www.ntqr.org. The number appears on the certificate.

Q: How do I find my Site/Practice ID?

A: Log on to www.ntqr.org and click on "My Home" and then "Practice Locations". Your Site/Practice ID is located within the displayed grid. If you entered more than one Site/Practice, each location will have its own ID.

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