Written Feedback on Thermal Index During the First-Trimester Nuchal Translucency Examination Does Not Improve Compliance With the “as Low as Reasonably Achievable” Principle

Objective: The null hypothesis was that there would be no change in as low as reasonably achievable (ALARA) behavior based on feedback from comments on the nuchal translucency quality review (NTQR) image submissions. Methods: A review of the Perinatal Quality Foundation Database found 206 practitioners who failed their first credential attempt and received ALARA comments as feedback. The second submissions of the same subjects were reviewed to determine if compliance with ALARA improved following written feedback. Results: Seventeen percent of all second submissions addressed ALARA. Sixty-one percent of second submissions passed, however only 18.4 % of those addressed ALARA. Among those who submitted thermal index at bone values on both first and second submissions, the mean values on the second submission were 0.20 lower compared to the first submission ( P = .0288). Second submission mean thermal index at bone values were 0.68 lower among those submissions with ALARA concerns addressed compared to those not addressing these concerns ( P < .001). Conclusions: Written feedback without consequences on the ALARA principle did not improve compliance.