How I finish my California fluoroscopy credits every two years

PubMed provides an open-access window to earning credits by reviewing the latest literature on fluoroscopy and radiation safety

6 min readMay 6, 2019

Do you know which component is the x-ray tube and which component is the flat panel detector? “Fluoroscopy” chapter illustration from the radiology board review book *Radiology Simplified (Apple Books) by Ram Srinivasan MD PhD and Jonathan Park MD. Illustration by Rachel Demers (Los Angeles).*

Be sure to read at least 8 articles/abstracts (4 credits) on radiation safety in fluoroscopy, and 12 articles (6 credits) that relate more broadly to fluoroscopy in clinical practice, i.e. “the application of x-ray to the human body”.

Need help? Email support@orbitcme.com

Fluoroscopy is an integral part of my scope of practice as a radiologist in Berkeley. When I need to earn fluoroscopy credits to renew my California fluoroscopy license, I like to keep the process simple, credible, and well-documented. If you’re a physician or PA in California looking for fluoro credits to renew your fluoro license, here’s how I do it.

**Excerpt from my fluoro license renewal application.** I’ve designated Orbit CME as the course title, Tufts University OCE as my provider of fluoroscopy credits, and “online” as my location. The Group “b” designation (Medical Board of California) confirms to the RHB that the medical board accepts these credits, which they do because they’re *AMA PRA Category 1 Credits™*.

0. Select the right fluoroscopy course — don’t inflict burnout on yourself

I use Orbit Fluoroscopy, certified by Tufts University School of Medicine, and specifically designed for the recurring fluoroscopy requirement here in California. Decide what works best for you, but when you’re choosing your fluoroscopy course, ask yourself these three questions:

Will this course reduce my administrative burnout? Finish fluoroscopy credits that also count towards credit for your state board license, i.e. AMA PRA Category 1 Credits™.
Can I do this credit from my computer? Save your travel money and vacation time for other stuff.
Will I learn something useful related to my practice? Study so that you can give your patients the most informed care.

Most existing fluoro courses aren’t much better than online traffic school, which isn’t surprising — very few of us need fluoro credits, so there isn’t massive demand for this service.

1. Sign into Orbit Fluoroscopy

If you don’t already have an account in Orbit Fluoroscopy, get one here now. This is what I use. It takes care of both your California state license CME and your fluoro CME, so you’ll be happy you started using it. Select the Basic plan — your card won’t be charged in the first 7 days. You can upgrade to Pro anytime to get cheaper pricing based on 2 year renewals.

Hint: Charge your Orbit subscription to your educational allowance or ask your accountant about writing this off as a business expense.

2. Install the Orbit plugin on your browser

Orbit will guide you to install the Orbit plugin, which tracks which peer-reviewed sites you visit. You’ll also install the ad blocking plugin, which is required because you’re not allowed to view ads while engaging in continuing medical education.

Hint: The plugins work on the Chrome browser for laptop or desktop

Here’s a screenshot from Chrome where I’m searching PubMed for open-access abstracts and articles related to fluoroscopy. My Chrome plugin tray is in the top right, including ad blocker and Orbit plugins (red rectangle).

3. Set your specialty and fluoroscopy state in the Profile view

Once you’re finished with the initial 20 second tutorial exercise that Orbit takes you through to earn your first credit, you can access your Profile view. Go there and :

Select your specialty (Anesthesiology, Internal Medicine, Orthopedic Surgery, Neurosurgery, PMNR, Radiology, Urology, etc.). Enter “California” for states where you hold fluoroscopy licenses

Configure your Profile view by indicating that you hold a fluoroscopy license in California.

This tells Orbit to optimize your system to earn California fluoroscopy credits.

4. Navigate to PubMed and read abstracts and full-text articles related to fluoroscopy

Now that you’re logged into Orbit, any peer-reviewed abstracts or articles you visit will count for credit. Beginning your exploration from PubMed is the most efficient way to explore reputable, peer-reviewed, current, and open-access articles.

Either this PubMed abstract on radiation safety or the full-text version of the article (red circle) counts for 0.5 AMA PRA Category 1 Credits™. *An ocean of abstracts and articles are now freely available through PubMed, partly because the NIH and other agencies require it, and all of this counts for fluoro credit through Orbit.*

The Department of Health and Human Services runs PubMed, and now’s your chance to make the most of it for your fluoro credits using Orbit. When you’re on an eligible page, you can click on your Orbit plugin icon to check if you’re detecting and submitting the article or abstract for credit.

Be sure to read at least 8 articles (4 credits) on radiation safety in fluoroscopy. One of the best articles on this topic is an open-access tutorial by Edward Nickoloff. Dr. Nickoloff passed away March 11, 2019 and this paper is part of his legacy to radiology physics education. You’ll find others through PubMed.

An additional 12 articles (6 credits) should relate more broadly to fluoroscopy in clinical practice, i.e. “the application of x-ray to the human body”. Feel free to include abstracts or articles that use fluoroscopy as it relates to your scope of practice.

5. Redeem your articles using the Fluoroscopy and Radiation Safety tags

Twenty seconds later, your activity on the page is sent for processing, and every 10 minutes, any new articles you’ve read are batch delivered to your feed on Orbit. You don’t have to check the feed constantly, but once you’re ready to convert all of your article and abstract visits into Fluoroscopy credit, login to the feed and click “Redeem”

Screenshot of my feed in Orbit. The fluoroscopy abstract I read in PubMed appears about 10 minutes later on the feed. I click “Redeem” to convert the learning I did with this abstract into 0.5 fluoroscopy credits. The “8 articles available” means that there are a total of 8 articles that I haven’t redeemed — the rest of the articles are stacked underneath this one. If I don’t want to redeem an article, I can remove it by hitting the “X” icon.

The “Redeem” process for each article includes a mandated self-assessment process defined by the AMA, which allows you to document and reflect on your learning with the specific abstract or article. At the bottom of the redeem section, you’ll see the option to tag your article with the fluoroscopy or radiation safety tag. Only select this tag if you want this article to count towards your fluoroscopy or radiation safety credit. The process is fully auditable, including which articles you claimed for credit and when those articles were accessed. So be sure your articles match the required scope and content of the fluoroscopy and radiation safety credit requirement as we’ve described above.

6. Print your Fluoroscopy & Radiation Safety Certificate

If you’re just renewing your fluoro license, you don’t actually need to print your certificate — the RHB just requires that you attest to having completed your credits.

If you’re being audited by the RHB, you’ll need to print out your fluoroscopy and radiation safety certificates. Switch to the “Submit” tab, select your fluoroscopy license deadline, and going back 2 years. Scroll down to print a specialty certificate, select the fluoroscopy or radiations safety tag, and click “Generate”. You’ll be able to print your certificate, or share the URL since it’s hosted in the cloud.

Bottom Line

Fluoroscopy is a powerful, life-saving x-ray based modality with the power to also cause serious injury. Use the fluoroscopy CME requirement as an opportunity to browse PubMed for the latest articles on radiation safety and fluoroscopy in your scope of practice, while simultaneously earning the required fluoroscopy credit through Orbit Fluoroscopy.