1263 AJR 1996;166:1263-1264 0361-803X196/1 666-1 263 © American Roentgen Ray Society Computers in Radiology Using the World-Wide Web to Train and Certify Physicians in the Safe Use of Fluoroscopy Wayne L. Thompson1, Jonathan P. Dyke, Edward Buonocore OBJECTIVE. We sought to create a computer-generated cer- tification examination that concurrently tests and educates flu- oroscopy users. MATERIALS AND METHODS. A trial examination was placed on the Internet for area physicians who requested fluoroscopic privileges at our institution.The name and address of each mdi- vidual who achieves a passing score is automatically sent by e- mail to the examination administrator. RESULTS. Physicians expressed widespread satisfaction with this certification process. The difference in number of attempts and score of the first attempt between groups of radi- ologists and nonradiologists favored the radiologists (p .03 in both cases) when analyzed using an unpaired t test. CONCLUSION. This examination ensures understanding of the procedural parameters that contribute to skin injury in patients and affords an easy approach to self-education. Physicians who perform lengthy fluoroscopically guided procedures may not be aware of or appreciate the potential for serious radiation-induced skin injury [1]. Such injuries often are not immediately apparent and may not be expressed until weeks later, after the physician has lost contact with the patient [2]. Occasionally, these injuries are an unavoidable consequence of the time required to perform complex proce- dures. The risks, however, can be minimized through better understanding of or reminders about how the equipment works and how operational procedures affect total skin dose. We sought to provide a means of instructing physicians on the safe use of fluoroscopy and certifying a minimum level of understanding. For most institutions, reaching large numbers of physicians in various specialties can be a daunting task, especially when physicians have practices outside the institu- tion but have hospital privileges. A requirement that each phy- sician joining the medical staff be certified competent before using fluoroscopic equipment can also challenge an institu- tion because such training must be offered repeatedly. Because fluoroscopic equipment in most institutions is super- vised by highly trained technologists or nurses, the focus of our examination is to teach physicians to recognize undesir- able operating parameters and to predict the likelihood of skin injury. The purpose of this report is to describe a practical, user-friendly, computer-driven method to achieve these goals. Materials and Methods A hospital medical-staff committee decided that a self-education and examination procedure would be required of all physicians using fluoroscopy at our institution to demonstrate ability to safely use fluoroscopic equipment. In response, a certifying examination that we placed on the World-Wide Web was unanimously endorsed by the hospital’s physician-governing body. It is accessible, using a personal computer and any popular browser software, to all physi- cians who use fluoroscopy at our institution (Fig. 1). Introductory material is displayed before the examination is taken, but most of the material to be mastered is presented in the examination. For each examination attempt, 20 questions are randomly drawn from a larger pool. The question pool is kept small (n = 30) so that physi- cians will not become frustrated by too many new questions, yet they cover the information needed to avoid fluoroscopic complica- tions. Correct answers are posted at the end of each examination for review of questions missed. Examination questions are then ran- domly rearranged, and the operator can try again. Physicians are educated because they are forced to learn correct answers for missed questions to improve. They must answer 85% of questions correctly to pass. When they achieve this score, their names, social security numbers, and mailing addresses are sent automatically by e-mail to the examination administrator. Signed certificates (valid for 5 years) are mailed to physicians for their files, and their names are added to the hospital list of certified fluoroscopy users. Like many other teaching institutions that have discovered the mer- its of advertising on the World-Wide Web, our center has established a home page (http://www.mc.utk.edu) that contains general and department-specific information. From this page, users at our institu- tion can access our fluoroscopic examination through hypertext links. Received November 2, 1995; accepted after revision January 10, 1996. authors: Department of Radiology, University of Tennessee Medical Center at Knoxville, 1924 Alcoa Hwy., Knoxville, TN 37920. Address correspondence to W. L. Thompson.