A hospital performance improvement project to improve the quality of x-ray interpretations in the emergency department is described. To amplify the benefits of this project, a multimedia computer pro gram containing this information was created and dis tributed via the mail and over the internet. Users are encouraged to copy the program disks and distribute them to others (no fees or royalties). The advantages of this method over conventional journals in print are described. Successful distribution of this program, known as Radiology Cases in Pediatric Emergency Medicine (RCPEM), and positive feedback from users, stimulated the continuation of this project, which has now released its fifth volume with two more volumes planned. RCPEM (a hospital performance improvement project) now continues to expand as the knowledge gained is disseminated over the internet to improve the quality of care rendered to children all over the world. Amplifying the benefits of other performance improve ment projects can be done in a similar manner.