Advanced imaging systems, such as C-Arm machines, greatly improve physicians' diagnostic abilities and provide greater precision. Yet, these benefits come with a price of ionizing radiation exposure to medical teams and patients. Supplying proper training and skill improvement to operators on how to use this technology safely can help minimize risk of exposure. Previous studies on radiation knowledge among physicians and radiologists presented disturbing results of underestimated risk of exposure. The following research is based on an innovation in simulation-based training (SBT), a simulator using the Wizard of Oz (WOZ) concept that incorporates an online human trainer and was used for training emergency room (ER) physicians and ultrasound medical personnel. This research integrated WOZ technology with a radiation exposure formula for training to minimize unnecessary radiation exposure. The exposure formula presents real-time and overall exposure levels to operators based on their technique. The simulator also incorporates 3D animation graphics, enabling trainees to simulate the control of various factors. Image quality and the operator's radiation exposure levels are also animated, assisting trainees to focus on their exposure based on their device settings. Contrary to most previous studies, we measured radiation dose to the operator and quantified image quality accordingly. Validation was done on different C-Arm machines. Validation of learning outcomes was done using knowledge exams. Results from our knowledge exams presented significant improvement. The average result of knowledge exams given prior to training was 54%, whereas the average result after training was 94% (p < 0.001). Additionally, after a gap of 2–3 months, high retention was also found.

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