Artificial neural network (ANN) is a flexible and powerful machine learning technique. However, it is under utilized in clinical medicine because of its technical challenges. The article introduces some basic ideas behind ANN and shows how to build ANN using R in a step-by-step framework. In topology and function, ANN is in analogue to the human brain. There are input and output signals transmitting from input to output nodes. Input signals are weighted before reaching output nodes according to their respective importance. Then the combined signal is processed by activation function. I simulated a simple example to illustrate how to build a simple ANN model using nnet() function. This function allows for one hidden layer with varying number of units in that layer. The basic structure of ANN can be visualized with plug-in plot.nnet() function. The plot function is powerful that it allows for varieties of adjustment to the appearance of the neural networks. Prediction with ANN can be performed with predict() function, similar to that of conventional generalized linear models. Finally, the prediction power of ANN is examined using confusion matrix and average accuracy. It appears that ANN is slightly better than conventional linear model.