Edward Weinberger

Seattle Children's Hospital, Seattle, Washington, United States

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Publications (34)63.71 Total impact

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    ABSTRACT: The purpose of this article is to illustrate types of diagnostic errors and feedback given to radiologists, using cases to support and clarify these categories. A comment-enhanced peer review system may be leveraged to generate a comprehensive feedback categorization scheme. These include errors of observation, errors of interpretation, inadequate patient data gathering, errors of communication, interobserver variability, informational feedback, and compliments. Much of this feedback is captured through comments associated with interpretative agreements.
    No preview · Article · Sep 2015 · Current problems in diagnostic radiology

  • No preview · Poster · May 2015
  • Ramesh S Iyer · Andrew Munsell · Edward Weinberger
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    ABSTRACT: Peer review is a requisite for a comprehensive quality assurance program. Although RADPEER implementations have been well documented, the feedback process has been underemphasized. Our radiology department developed feedback scorecards to address this gap. In this article, we describe our scorecard components, the software applications we independently created and utilize, and how they align missions of quality improvement and radiologist education. The result is a web-based, comment-enhanced, monthly feedback scorecard that to our knowledge is the first of its kind described in the literature.
    No preview · Article · Jul 2014 · Current Problems in Diagnostic Radiology
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    ABSTRACT: LEARNING OBJECTIVES As healthcare costs become a primary area of emphasis, the "premium" that was allowed for academic medical centers is no longer in place. However, optimal care at acceptable cost is readily attainable in an academic center when the missions of the academic department and the hospital are aligned. In this presentation, the learner will recognize approaches to educating the next generation of radiologists while improving access, decreasing overutilization, enhancing safety and decreasing cost.
    No preview · Conference Paper · Dec 2013

  • No preview · Article · Aug 2013 · Journal of the American College of Radiology
  • Ramesh S Iyer · Jeffrey P Otjen · Edward Weinberger

    No preview · Article · Mar 2013 · Journal of the American College of Radiology: JACR
  • Shawn E Parnell · Corey Wall · Edward Weinberger
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    ABSTRACT: Background Skeletal dysplasias are conditions of abnormal bone and cartilage growth resulting in short stature. Developing expertise in the radiographic evaluation of dysplasias can be difficult because more than 250 skeletal dysplasias have been described. Exhaustive description of individual dysplasias can be found in hard copy textbooks, without the ability to compare dysplasias side by side. Objective To provide radiographic images of several common skeletal dysplasias with comparative normal skeletal surveys, thus facilitating understanding of the terminology and differences in imaging appearances commonly encountered in interpreting dysplasias. Materials and methods Images from skeletal surveys obtained at our institution from 2006 to 2010 were compiled and reviewed for best quality images. Selected surveys were divided into body parts. The software program used for viewing the atlas permits linked scrolling, resizing of images, and simultaneous comparison of cases. Results Radiographic images for 13 common skeletal dysplasias and 3 comparative normal skeletons (neonate, infant and child) are provided as an interactive digital atlas. Conclusion The placement of images of several common skeletal dysplasias with descriptive text in an interactive and comparative format facilitates understanding of basic radiographic terminology and appearances. We describe the atlas and discuss skeletal survey interpretation.
    No preview · Article · Mar 2013 · Pediatric Radiology
  • Ramesh S Iyer · Jonathan O Swanson · Randolph K Otto · Edward Weinberger
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    ABSTRACT: The objective of our study was to categorize radiologist peer review comments and evaluate their functions within the context of a comprehensive quality assurance (QA) program. All randomly entered radiology peer review comments at our institution were compiled over a 1-year period (January 1, 2011, through December 31, 2011). A Web-based commercially available software package was used to query the comments, which were then exported into a spreadsheet. Each comment was then placed into a single most appropriate category based on consensus decision of two board-certified pediatric radiologists. QA scores associated with each comment were recorded. A total of 427 peer review comments were evaluated. The majority of comments (85.9%) were entered voluntarily with QA scores of 1. A classification system was devised that augments traditional error classification. Seven broad comment categories were identified: errors of observation (25.5%), errors of interpretation (5.6%), inadequate patient data gathering (3.7%), errors of communication (9.6%), interobserver variability (21.3%), informational and educational feedback (23.0%), and complimentary (11.2%). Comment-enhanced peer review expands traditional diagnostic error classification, may identify errors that were underscored, provides continuous educational feedback for participants, and promotes a collegial environment.
    No preview · Article · Jan 2013 · American Journal of Roentgenology
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    ABSTRACT: PURPOSE/AIM 1. Radiology online resources are ubiquitous and include teaching files, case collections, lectures, training modules, journals with online content, and more recently podcasts. 2. It is time consuming for trainees and practitioners to know which online resources have trustworthy information, and to organize them for learning and quick reference. 3. We present an application to access these resources on smartphones and portable devices. CONTENT ORGANIZATION 1. 348 free radiology online resources have been organized into the following categories: radiologic anatomy, radiology physics, radiology teaching file collections, open access lectures, MSK radiology, nuclear medicine, neuroradiology, breast imaging, chest imaging, cardiac imaging, gastrointestinal and genitourinary radiology, pediatric radiology, ultrasound, emergency imaging, miscellaneous, radiology journals, radiology societies, medical education, radiology freeware, and productivity tools. 2. To the best of our knowledge a mobile application to organize radiology education online content allowing trainees to supplement their learning has not been developed. SUMMARY 1. Our application is accessible from any smartphone or portable device such as iphone, ipad, android platform among others, providing a valuable tool for organized access to the high-quality online radiology resources.
    No preview · Conference Paper · Dec 2012
  • Jason N Nixon · Luana A Stanescu · Edward Weinberger
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    ABSTRACT: Spinal cord signal abnormality resulting from alterations in cerebrospinal fluid flow at the craniocervical junction has been termed a presyrinx state. This condition has been described in the adult literature in association with a variety of conditions that cause obstruction to normal cerebrospinal fluid flow. We present a case of presyrinx in a child in the setting of acquired Chiari I malformation caused by lumboperitoneal overshunting. Awareness of the potentially reversible nature of this condition might allow for intervention before irreversible neurological damage has occurred.
    No preview · Article · Aug 2012 · Pediatric Radiology

  • No preview · Article · Jul 2012 · Journal of the American Academy of Dermatology
  • Ramesh S Iyer · Douglas P Hanel · Brianna K Enriquez · Edward Weinberger
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    ABSTRACT: A 5-month-old previously healthy girl presented to the emergency department with a large palpable nontender mass in the hypothenar soft tissues of her left hand. US revealed a well-demarcated nonvascular soft tissue mass. Subsequent MR imaging showed a rim-enhancing mass with heterogeneous intrinsic signal characteristics. Abscess and necrotic tumor were the primary considerations. Surgery demonstrated a thrombosed aneurysm continuous with the ulnar artery system. The aneurysm was resected and the ulnar artery was ligated at the wrist.
    No preview · Article · Jun 2012 · Pediatric Radiology
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    ABSTRACT: Peer review has become an essential component of a comprehensive radiology department quality assurance program. Multiple commercial programs, such as RADPEER, are available to fill this need but may be limited by low radiologist compliance and delayed or limited feedback. Consequently, these peer review programs may not achieve the greater goal of improving diagnostic quality. This article presents data from a peer review system implemented in an academic radiology group at a large urban multidisciplinary children's hospital. The peer review system offered instantaneous feedback with an enhanced comment feature for peer radiologists. Peer review data were collected on 5278 radiologic studies over a 12-month period including 15 radiologists. The data were analyzed for compliance rate, discrepancy rate, and comment usage. The compliance rate for peer review averaged 52% for the 12-month period. The compliance rate trended upward over the course of the year, with a final month's compliance rate of 76%. The discrepancy rate between original interpretation and peer review was 3.6%. Comments were voluntarily included in 7.3% of nondiscrepant peer review scores. Our peer review process was enhanced by real-time comment-enriched feedback on both discrepant and nondiscrepant peer reviews. We show improved radiologist compliance over the course of a year in a peer review program with no incentives or penalties for performing reviews. To our knowledge, no compliance rates exist in current literature for comparison.
    No preview · Article · May 2012 · American Journal of Roentgenology
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    ABSTRACT: The authors created a computer-based, interactive atlas of pediatric chest radiographs to facilitate (1) understanding of normal variants and (2) interpretation of pediatric chest radiographs in the acute setting. Seventy-three normal pediatric chest radiographs were selected for inclusion in the atlas by consensus after review by 3 pediatric radiologists. Sixteen abnormal pediatric chest radiographs showing a variety of abnormalities (infection, malignancy, congenital abnormalities, foreign body, and acquired disease), as well as 4 normal adult chest radiographs, were also included in the atlas. Images for the atlas were derived from Digital Imaging and Communications in Medicine-compliant data. The atlas software was written in C# and offers features of a picture archiving and communication system viewer. In addition, the atlas offers annotated series that describe particular radiographic features of normal variants and disease. The digital, interactive pediatric chest atlas displays normal chest radiographs of children aged 7 days to 17.8 years, as well as 4 normal adult chest radiographs and 16 abnormal pediatric chest radiographs. The digital interactive format of the atlas allows for (1) easy manipulation of atlas cases and (2) direct comparison between normal atlas cases and provided abnormal cases, as well as (3) the potential for direct comparison with images displayed on an institution's picture archiving and communication system. The atlas is available for free download at http://www.seattlechildrens.org/radiologyeducation/pediatric-chest. Improved interpretation of pediatric chest radiographs in the acute setting may be facilitated by a comprehensive, computer-based, pediatric chest atlas.
    No preview · Article · Feb 2012 · Pediatric emergency care
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    Grace S. Phillips · Edward Weinberger

    Preview · Article · Jul 2011 · Radiology Case Reports
  • Paritosh C Khanna · Mahesh M Thapa · David de Regt · Edward Weinberger
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    ABSTRACT: OBJECTIVE: Our objective was to develop a way to enhance scientific and educational PowerPoint presentations containing stack-based, multiple-image techniques such as CT and MRI. CONCLUSION: We developed a PowerPoint add-in that facilitates the creation of stackable image sets in a simple and intuitive manner, permitting real-time scrolling, editing, and manipulation of imbedded image stacks. Contrast and brightness adjustments, cropping, and linking are supported. Once created, the PowerPoint presentation can be viewed without hardware or venue limitations on any computer, without reinstallation of the add-in.
    No preview · Article · Mar 2009 · American Journal of Roentgenology
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    ABSTRACT: PURPOSE/AIM 1.To review normal CT/MR anatomy of the nasal cavity and paranasal sinuses using an online large-data-set, interactive format that allows scroll feature in axial, coronal, and sagittal planes. 2.To review CT/MR examples of normal variants and pathology of the nasal cavity and paranasal sinuses in children using format described in Aim 1. CONTENT ORGANIZATION 1. Normal CT/MR anatomy of the nasal cavity and paranasal sinuses with emphasis on changes seen throughout childhood. 2. Normal variants 3. Pathological conditions: a)Congenital b)Infectious/Inflammatory c)Neoplastic d)Traumatic e)Iatrogenic/Surgical SUMMARY The major goals of this exhibit are: 1. To provide an online, easy-to-use, interactive method to learn imaging anatomy and variants of the pediatric nasal cavity and paranasal sinuses. 2. To provide an online, interactive, digital CT/MR teaching file of pathological conditions of the pediatric nasal cavity and paranasal sinuses that a) contains scroll feature in three planes for each case b)allows for side-by-side comparison with normal subject c)includes option to "take cases" as unknowns.
    No preview · Conference Paper · Jan 2009
  • John F McLaughlin · Roberta A Pagon · Edward Weinberger · Joel E Haas
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    ABSTRACT: The authors describe clinical and MRI features of a girl and two boys, aged 9, 17 and 19 years, respectively, with Marinesco-Sjogren syndrome. The clinical findings included the major features of the syndrome, including growth deficiency, ataxia, cataracts, hypogonadism (in two) and seizures (in two). Truncal hypotonia (in three), microcephaly (in two) and leg spasticity (in two) were also present. MRI showed a very small cerebellar vermis in all three patients, various supratentorial abnormalities, an apparently small anterior pituitary gland in two and the absence of a posterior pituitary gland in all three. The MRI features are similar to the few reported pathologic Findings for persons with Marinesco-Sjogren syndrome. MRI may be helpful in the early diagnosis of the disorder. Syndrome de Marinesco-Sjögren: caractéristiques cliniques el ď imagerie de résonance mugnétique (IRM) chez trois enfants. Les auteurs décrivent les caractéristiques cliniques et IRM ď une fille et de deux garçons, âgés respectivement de 9, 17 et 19 ans, présentant un syndrome de Marinesco-Sjögren. Les dpnnées cliniques intégraient les caractéristiques principales du syndrome, incluant un deTaut de croissance, une ataxic, une cataracte, un hypogonadisme dans deux cas, une comitialité dans deux cas. Une hypotonic du tronc (trois cas), une microcéphalic (deux cas) et une spasticité des membres inférieurs (deux cas) étaient également présentes. Ľ IRM montrait un tirés petit vermis cerebelleux dans les trois cas, des anomalies supratentorielles varices, une ante-hypophyse apparemment petite dans deux cas et ľ absence de post-hypophyse dans les trois cas. Les caracteristiques IRM correspondent aux quelques donnecs anatomo-pathologiques rapportées chez les sujets présentant un syndrome de Marinesco-Sjogren. ľ IRM peut être utile au diagnostic précoce du trouble. Marinesco-Sjögren Syndrom: klinische und MRT Befunde bet drei Kindern Die Autoren beschreiben die klinischen und die MRT Befunde von einem Mädchen und zwei Jungen im Alter von 9, bzw. 17. bzw. 19 Jahren mit Marinescu-Sjögren Syndrom. Die klinischen Symptome beinhalteten die Hauptmerkmale des Syndroms eirischließlich Wachstumsmangel, Ataxie, Katarakte, Hypogonadismus (bei zwei Kindern) und Anfalle (bei zwei). Außerdem wurden Rumpfhypotonie (in drei Fällen), Mikrozephalie (in zwei) und Spastik der Beine (in zwei) nachgewiesen. Das MRT zeigte einen sehr kleinen Vermix cerebellaris bei alien drei Patienten, verschiedene supratentorielle Anomalien, einen offenbar kleinen Hypophysenvorderlappen bei zwei Palienten und das Fehlen des Hypophysenhinterlappens bei alien drei. Die MRT Befunde entsprechen den wenigen bisher beschriebenen pathologischen Befunden von Patienten mit Marinesco-Sjögren Syndrom. Das MRT kann für die Früherkennung dieses Krankheitsbildes hilfreich sein. Sindrome de Marimesco-Sjögren: characterísticas clínicas y de la imagen por resonancia magnética (IRM) en ires niños Los autores describen las characterísticas clinicas y de IRM de una nifia y dos muchachos de 9, 17 y 19 años respectivamente con síndrome de Marinesco-Sjögren. Los hallazgos clínicos fueron las caractenstícas mayores del síndrome, incluyendo déficit de crecimiento, ataxia, catarata, hipogonadismo (en dos) y convulsiones (en dos). Tambien existía hipotonia de tronco (en tres), microcefalia (en dos) y espasticidad de piernas (en dos). La IRM mostró un vermis cerebeloso muy pequeño en los tres casos, diversas anomalias supratentoriales, una pituitaria anterior aparentemente pequeña en dos y ausencia de una pituitaria posterior en tres. Las caractenstícas IRM son similares a los pocos hallazgos patológicos visto en personas con síndrome de Marinesco-Sjögren. La IRM puede ayudar en el diagnóstico precoz de la altcración.
    No preview · Article · Apr 2008 · Developmental Medicine & Child Neurology
  • Dave DeRegt · Edward Weinberger
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    ABSTRACT: PURPOSE/AIM DICOM based external studies can pose difficulty in interpretation for the radiologist as he or she may not be familiar with the built in viewer. We believed this problem could be solved with a lightweight application capable of both viewing and uploading external studies into any PACS system. CONTENT ORGANIZATION To solve these problems we created DICOMManager, a Windows application written in C#, which imports DICOM CDs and other DICOM filesets with very little user interaction required. The user selects the CD to load or drags files to be transferred onto the application, selects a send destination, and the images are transferred using DICOM. The user also has the ability to automatically anonymize or uncompress the images before sending, as well as viewing the study in a built-in viewer. SUMMARY The application fills the need for a simple application for viewing outside exams and general DICOM image transfer needs demanded by a computer-based workflow. The application can import a vast collection of DICOM image types from different modalities, and will correct any deviations in the DICOM format of the image from the official specifications. The images can then be quickly viewed, merged into a PACS system, or anonymized images can be viewed on an external research system.
    No preview · Conference Paper · Nov 2007
  • Mahesh Thapa · Jenny McBroom · Joel A. Gross · Edward Weinberger
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    ABSTRACT: PURPOSE In pediatrics, we wanted to evaluate the diagnostic accuracy of using a ≥ 6 mm diameter measurement of the appendix to identify appendiits. METHOD AND MATERIALS In this pilot study, right lower quadrant ultrasounds for suspected appendicitis performed on 78 consecutive patients referred to the radiology department during on-call hours from September 2003 to April 2004 were retrospectively evaluated. There were a total of 29 boys and 49 girls, with ages ranging between 1.5 and 16 years. RESULTS Of the 78 patients in our study, the presumed appendix was found and measured in 57 cases. In 2 additional cases where the appendix was not visualized, a diagnosis of abscess secondary to perforated appendicitis was made. None of the 20 patients with maximum appendix diameter (MAD) of 6 mm or less had appendicitis with one exception where an appendix measuring 5.1 mm was correctly identified as perforated with abscess formation. With the exception of 2 cases, all 28 patients with MAD measurement greater than 7.5 mm had appendicitis. Of the 8 patients with MAD measurement between 0.60 and 0.75 cm, 4 had appendicitis, 1 had a Meckel’s diverticulum, and 3 had no appendicitis. None of the 3 cases with a normal appendix at surgery had strong secondary signs of inflammation. CONCLUSION Based on our initial pilot results, we suggest the following for diagnosing appendix in the pediatric population: If appendix ≤ 0.60 cm, negative for appendicitis with the caveat that incomplete visualization of the appendix and/or presence of secondary signs of appendicitis may reflect perforated appendicitis. A normal appendix may not be visualized by ultrasound If appendix ≥ 0.75 cm, appendicitis is likely present, although rare exceptions will occur. If 0.61 cm ≤ Appendix ≤ 0.74 cm, indeterminate zone. The ultrasound report can be further colored by the presence or absence of secondary inflammatory signs. (i.e. Indeterminate but likely negative in the absence of secondary signs) Now, we will evaluate > 2000 patients to verify our conclusions. CLINICAL RELEVANCE/APPLICATION Close attention to secondary signs and size of the appendix, will significantly improve diagnostic accuracy of appendicitis.
    No preview · Conference Paper · Nov 2007

Publication Stats

249 Citations
63.71 Total Impact Points


  • 1997-2015
    • Seattle Children's Hospital
      • • Department of Radiology
      • • Children's Hospital and Medical Center
      Seattle, Washington, United States
  • 1995-2013
    • University of Washington Seattle
      • • Department of Radiology
      • • Department of Medicine
      • • Department of Neurology
      Seattle, Washington, United States
  • 2006
    • Riley Hospital for Children
      Indianapolis, Indiana, United States