First trimester nuchal translucency ultrasound has evolved from an ultrasound measurement used only in a research setting to a screening tool which is being offered to the general obstetric population. Studies of nuchal translucency suggest great variation in Down syndrome detection rates which may be secondary to significant differences in sonographic training and nuchal translucency image quality. Inaccurate screening has the potential to adversely impact patients. This paper will explore: (1) why quality review in nuchal translucency ultrasound is important, (2) methods of nuchal translucency quality assessment, (3) experience with quality review in the research setting, and (4) current strategies for quality assessment in patient care.