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1...Does this mean the analyst is aware of the recommendation in the
2...Accordingly, the analyst should be asked to expressly contrast results
CONTACTS
SUBJECTS
CT Test 060505 Report Received Findings No Evidence of Disease NED L
1003 -
1003 - ..
1004 - Summary/Objective
1005 -
100501 - Follow up ref SDS 81 0000. ref SDS 79 0000.
100502 -
100503 -
100504 -
100505 -
100506 -
100507 -
100509 - ..
1006 -
1007 -
1008 - Progress
1009 -
100901 - CT Contrast Study 060505 Compare with PET Scan Test on 060414
100902 -
100903 - Follow up ref SDS 81 II4L, ref SDS 79 II4L.
100904 -
100905 - Millie had a CT test on 060505, ref SDS 80 II4L, planned during the
100906 - meeting with the doctor on 060428 to follow up PET test findings of
100907 - possible relapse, ref SDS 76 K64X Yesterday, Arlette called
100908 - responding to Mil's letter, ref DIP 2 0001 asking Arlette to assist
100909 - the doctor in distributing the report for the CT test on 060505.
100910 - ref SDS 81 4S5T Arlette said the test has been received.
100912 - ..
100913 - Millie submitted ref DIT 1 0001 a follow up letter to the doctor
100914 - saying...
100915 -
100916 - 1. Thanks for your letter on May 20th saying the CT test on May 5
100917 - was not lost. ref DIT 1 0001
100919 - ..
100920 - 2. Arlette called yesterday and said it is now available.
100921 - ref DIT 1 W35M
100923 - ..
100924 - 3. I am at work today, and tomorrow will be rushing around getting
100925 - ready to go on a vacation cruise to Alaska. If the report
100926 - can be submitted electronically, as was done for the prior PET
100927 - test on 060414, received on 060428, ref SDS 76 YU3H, email
100928 - transmission would save a lot of time. I need the whole thing,
100929 - including the log ID data. ref DIT 1 S36G
100931 - ..
100932 - 4. If there is not enough time to send it, then please print a
100933 - copy, and I will work in a trip to the hospital tomorrow and
100934 - pick it up at the front counter. Arlette may have already done
100935 - this. We played phone tag yesterday and I am not sure.
100936 - ref DIT 1 846O
100938 - ..
100939 - 5. Please let me know. ref DIT 1 A47L
100941 - ..
100942 - 6. Thanks for extra help on this. ref DIT 1 J47O
100943 -
100944 -
100945 -
100947 - ..
1010 -
1011 -
1012 - 2104
1013 -
101301 - Received ref DRT 1 0001 from the doctor submitting the report, as
101302 - follows...
101304 - ..
101305 - Test History No Evidence Distant Metastasis
101306 - Distant Metastasis No Evidence 5 Years Imaging Tests
101307 -
101308 -
101309 - Type Date Received Source
101310 - CT 060505 reported on 060523........... ref SDS 0 WJ6G
101311 - PET 060414 reported on 060428........... ref SDS 76 WJ6G
101312 - PET 060120 reported on 060126........... ref SDS 66 WJ6G
101313 - PET 051005 reported on 051007........... ref SDS 58 WJ6G
101314 - CT 050530 reported on 050610........... ref SDS 53 G75L
101315 - CT 050325 reported on 050422........... ref SDS 49 G75L
101316 - CT 041217 reported on 041230........... ref SDS 42 G75L
101317 - CT 041103 reported on 041104........... ref SDS 39 NL4N
101318 - CT 040921 reported on 041005........... ref SDS 38 NL4N
101319 - CT 040710 reported on 040811........... ref SDS 35 DU9I
101320 - CT 040410 reported on 040416........... ref SDS 30 HX4K
101321 - CT 040307 reported on 040318........... ref SDS 29 LK5L
101322 - CT 031031 reported on 031205........... ref SDS 25 IG9K
101323 - CT 030626 reported on 030710........... ref SDS 23 AL6N
101324 - CT 030428 reported on 030508........... ref SDS 21 LK5L
101325 - PET 021218 reported on 030109........... ref SDS 19 LK5L
101326 - PET 020529 reported on 020603........... ref SDS 8 0001
101328 - ..
101329 - CT test on 060505 finds no evidence of cancer in the left
101330 - supraclavicular (neck), ref SDS 0 4R82, nor in the left axillary,
101331 - ref SDS 0 Q95L, and findings in the right axillary are reported too
101332 - small to assess. ref SDS 0 WT6M There are no findings of distant
101333 - metastasis.
101335 - ..
101336 - This test aligns with patient history for the past 5 years that has
101337 - not found distant metastasis, although the test reported on 040318
101338 - made findings in the left supraclavicular which have since been
101339 - treated with systemic chemotherapy, and have not occurred again until
101340 - the PET scan test on 060120, and the follow on test performed 060414.
101341 - Since this contrast CT test study makes no findings in the same
101342 - region, at this time it is NED. ref SDS 0 4R82
101343 -
101345 - ..
101346 - CT NECK, CHEST AND ABDOMEN (Digital)
101349 -
101350 - ------ R E P O R T N O T A U T H E N T I C A T E D -------
101351 -
101352 -
101353 -
101354 -
1014 -
SUBJECTS
Comparison CT Test 060505 with PET Test 060414 Not Evident CT Test 0
1703 -
170401 - ..
170402 - CT Comparison Test 060505 with PET Test 060414 Not Evident
170403 - CA 15-3 49 Steady Rise Conflicts with CT Test Findings
170404 -
170405 - Follow up ref SDS 76 DH4O.
170406 -
170407 - ** HISTORY **:
170408 -
170409 - This is an add-on.
170411 - ..
170412 - Does this mean the analyst is aware of the recommendation in the
170413 - report for the PET scan test on 060414 for a contrast CT study,
170414 - reviewed on 060428, ref SDS 76 MU5M, and so "add-on" indicates this is
170415 - the "contrast study"?
170417 - ..
170418 - CT Test 060505 report continues...
170419 -
170420 - TECHNIQUE:
170421 -
170422 - Following administration of oral and intravenous contrast, 5 mm
170423 - images were obtained through the chest, abdomen and pelvis.
170424 - Following this, 5 mm images were obtained from the skull base
170425 - to the vertex. Delayed imaging through the kidneys was
170426 - obtained as well.
170428 - ..
170429 - COMPARISON:
170430 -
170431 - Compared to the prior exam of 5/30/05.
170433 - ..
170434 - Comparison with the prior CT test is helpful, per above. ref SDS 0
170435 - 009L There was an express request in the report for the PET scan test
170436 - on 060414 for a CT comparison study, discussed with the doctor on
170437 - 060428. ref SDS 76 MU5M Thus, the purpose of ordering the CT test on
170438 - 060428 was not to compare with a CT test on 050530, but with the PET
170439 - scan test on 060414. ref SDS 76 K64X
170440 -
170441 - [On 061024 case study medical practice computer access limited
170442 - even with everything on the computer, people can't find details
170443 - stored in parts of the computer (software modules) that are not
170444 - frequently used. ref SDS 91 JD9L
170446 - ..
170447 - Finding that the right axillary is not enlarged by CT standards is
170448 - very good news, ref SDS 0 4O8P, and finding no lymphadenopathy in the
170449 - neck is the best possible news, ref SDS 0 IM9M, however, numbers alone
170450 - can sometimes be misleading without knowledge of context from
170451 - connecting cause and effect, reviewed on 040312. ref SDS 28 YH4G
170452 -
170453 - [...below, misleading findings of "stable" condition compared to 1
170454 - year ago, overlook dramatic change from test 3 weeks ago.
170455 - ref SDS 0 4O8P
170457 - ..
170458 - Rising node size would explain rising CA 15-3 over the past five (5)
170459 - months from 28 to 44, discussed with the doctor on 060428, ref SDS 76
170460 - 0001, and continuing with the doctor's recent report of further rise
170461 - to 49, 10 points above the cancer signal.
170462 -
170463 - [On 060605 CA 15-3 test on 060522 shows another big rise to 59.
170464 - ref SDS 86 DB3J
170466 - ..
170467 - Accordingly, the analyst should be asked to expressly contrast results
170468 - for the CT test on 060505 with the PET scan test on 060414, as
170469 - recommended in the PET scan report, received on 060428. ref SDS 76
170470 - MU5M
170471 -
170472 - [On 060524 Millie's letter to the doctor asks for comparing CT
170473 - test on 060505 with PET scan test on 060414. ref SDS 83 KG4W
170475 - ..
170476 - [On 060526 the doctor asks for clarification of the date format.
170477 - ref SDS 85 6T8L Millie responds with clarification, and explains
170478 - advantage of comparing recent tests to supplement comparing tests 1
170479 - year apart. ref SDS 85 JD5K
170481 - ..
170482 - [On 060623 meeting with doctor does not address correcting error in
170483 - CT test study. ref SDS 88 U86U
170484 -
170485 -
170486 -
170487 -
170488 -
170489 -
170490 -
1705 -
SUBJECTS
Lymphadenopathy Not Found Left Supraclavicular NED Findings CT Test
2303 -
230401 - ..
230402 - Neck NED Lymphadenopathy Not Found Left Supraclavicular
230403 - Lymphadenopathy Not Found Left Supraclavicular Neck NED
230404 - Left Supraclavicular NED Lymphadenopathy No Findings in Neck
230405 -
230406 -
230407 - CT Test 060505 report continues...
230409 - ..
230410 - ** FINDINGS **:
230412 - ..
230413 - The parotid and the submandibular glands are within normal limits.
230414 - No lymphadenopathy on the CT scan of the neck. No aggressive
230415 - osseous lesions.
230417 - ..
230418 - CT test on 060505 reporting no findings in the neck assume the same as
230419 - finding no cancer in left supraclavicular, seems both encouraging and
230420 - stunning compared to the PET test on 060414 that reported growth of
230421 - swelled nodes in this region indicating possible cancer, as shown by
230422 - review on 060428. ref SDS 76 MU5M
230424 - ..
230425 - Does this mean the analyst examined data from the CT test for the area
230426 - where the PET scan test on 060414 made findings of FDG uptake SUV 4.5
230427 - in the left supraclavicular, as reported on 060428? ref SDS 76 MU5M
230428 -
230429 - [On 060524 Millie's letter to the doctor asks for comparing CT
230430 - test on 060505 with PET scan test on 060414. ref SDS 84 KG4W
230432 - ..
230433 - [On 060929 Doctor Benz 2nd opinion notes that failure of CT
230434 - test to report findings in left supraclavicular where PET test
230435 - finds nodes progressing in size raises concerns. ref SDS 89
230436 - WI4I
230438 - ..
230439 - [On 061020 CT scan test for pulmonary embolism also examined
230440 - axillary and other regions; reported finding no evidence of
230441 - lymphadenopathy. ref SDS 90 LP5G
230443 - ..
230444 - Does this align with research on 060428 indicating that FDG uptake can
230445 - occur without metastatic disease, if for example the patient was tense
230446 - during the PET scan test. ref SDS 76 NN5O
230448 - ..
230449 - There is still the issue of reconciling CA 15-3 rising to 49, now 10
230450 - points above the cancer signal, and 21 points above the low of 28 this
230451 - past December, per above. ref SDS 0 MC4G
230452 -
230453 -
230454 -
230455 -
230456 -
2305 -
SUBJECTS
Esophagitis Right Paratracheal Region CT Test 060505 Findings Less t
3003 -
300401 - ..
300402 - Right Paratracheal Region Less 1 CM Nodes Esogophagitis???
300403 - Paratracheal Right Region Esogophagitis Less 1 CM Nodes???
300404 - Esogophagitis Right Paratracheal Region Less 1 CM Nodes???
300405 -
300406 -
300407 - CT Test 060505 report continues...
300409 - ..
300410 - CT CHEST:
300411 -
300412 - There is an area of decreased attenuation within the right lobe
300413 - of the thyroid gland not significantly changed from the prior
300414 - exam. No lymphadenopathy in the mediastinum although, less
300415 - than 1 cm lymph nodes within the right paratracheal region are
300416 - identified. Right axillary lymph node is noted which is not
300417 - enlarged by CT criteria. The patient appears to be status post
300418 - left mastectomy. No pericardial fluid or thickening. No
300419 - pleural effusions.
300421 - ..
300422 - CT test findings less than 1 cm lymph nodes within the "right
300423 - paratracheal region" may relate to the report in the PET scan test on
300424 - 060116 that diagnosed esophagitis, reviewed on 060126. ref SDS 66 DH4O
300426 - ..
300427 - Disparity in terminology with PET test citing "esophagitis" and CT
300428 - test describing nodes in right "paratracheal region" may cause busy
300429 - doctors and staff to overlook alignment in testing that confirms issue
300430 - for investigation and possible treatment, in this case esophagitis.
300432 - ..
300433 - Terminology differences causing errors in analysis was previously
300434 - reviewed on 040416 as part of medical testing reliability study.
300435 - ref SDS 30 GN7J
300437 - ..
300438 - On 060428 read medical test findings - case study doctors limited time
300439 - prevents reading findings to correlate clinically for discovering
300440 - symptomatic trends that enable proactive case management; there is
300441 - only enough time to read summaries that present the gist of findings.
300442 - ref SDS 77 VG5L
300444 - ..
300445 - [On 060607 Millie admitted to emergency room for
300446 - temperature of 104.2; xray shows pneumonia, ref SDS 87
300447 - PT7S, doctor reports Kaiser's computer says Millie has been
300448 - diagnosed with esophagitis, and asks how esophagitis is
300449 - being treated. ref SDS 87 LO3H Research indicates possible
300450 - correlation between esophagitis and pneumonia. ref SDS 87
300451 - I24L
300453 - ..
300454 - [On 060623 doctor unable to access computer to review test
300455 - findings on esophagitis. ref SDS 88 463H
300457 - ..
300458 - [On 060623 medical chart says esophagitis not symptomatic,
300459 - ref SDS 88 7M5H; there is no record of receiving the letter
300460 - submitted on 060320 and listing symptoms. ref SDS 70 X94Q
300461 -
300462 -
300463 -
300464 -
3005 -
SUBJECTS
Left Axillary CT Test 060505 No Findings Lymphadenopathy Silent Not
3603 -
360401 - ..
360402 - Left Axillary No Findings Indicates No Cancer or Overlooked Region
360403 -
360404 - No report finding cancer (lymphadenapathy, swelled lymph nodes) in the
360405 - left axillary is very encouraging, extending case study on 040517,
360406 - ref SDS 31 TD8J, provided this does not represent failure of the CT
360407 - test analyst to examine the location. ref SDS 0 WL6M
360409 - ..
360410 - The fact that the right axillary was examined, per below, ref SDS 0
360411 - WT6M, and general "impression" statements in the report suggest a
360412 - review was made, per below. ref SDS 0 014T
360414 - ..
360415 - [On 061020 CT scan test for pulmonary embolism also examined
360416 - the right axillary and reported finding no evidence of
360417 - lymphadenopathy in the axilla. ref SDS 90 6Q6H
360418 -
360419 -
360420 -
360421 -
360422 -
360423 -
3605 -
SUBJECTS
Right Axillary CT Test 060505 No Findings Lymphadenopathy Lymph Node
4303 -
430401 - ..
430402 - Right Axillary Lymph Node Same Size as Test on 050530
430403 - Misleading Comparing Test 1 Year Ago Instead of 2 Weeks Ago
430404 -
430405 - Follow up ref SDS 76 CZ8L.
430406 -
430407 - Finding the right axillary below standards for suspecting
430408 - lymphadenopathy is very favorable. ref SDS 0 4O8P
430410 - ..
430411 - Finding this region unchanged from the CT test on 050530, reported on
430412 - 050610, ref SDS 53 TH9N, and finding nodes below standards by size
430413 - criteria for recognizing lymphadenopathy, ref SDS 0 WL6M, may be
430414 - misleading because the test on 050530 reported declining node size
430415 - following treatment, and subsequent PET scan test on 051005 reported
430416 - on 051007 further decline in size after continuing treatments.
430417 - ref SDS 58 GJ4S Since it appears that PET scan and CT test analyses
430418 - do not expressly address prior findings between these test methods,
430419 - per above, ref SDS 0 006P, there is a possibility that conditions of
430420 - falling node size on 050530 are now reversed and so are actually
430421 - rising during the current "treatment holiday," since 050916,
430422 - ref SDS 57 407N, based on comparison with the PET scan test on 060414
430423 - that reported increased activity in the right axillary, as reported on
430424 - 060428, rather than stable, as suggested in the CT test per above.
430425 - ref SDS 0 4O8P
430426 -
430427 - [On 061020 CT scan test for pulmonary embolism also examined the
430428 - right axillary and reported finding no evidence of lymphadenopathy
430429 - in the axilla. ref SDS 90 8T4S
430430 -
430431 -
430432 -
430433 -
430434 -
430435 -
4305 -
SUBJECTS
CT Test 060505 Other Results Stable and Unremarkable
4403 -
440401 - ..
440402 - CT Test Other Results Stable and Unremarkable
440403 -
440404 -
440405 - CT Test 060505 report continues...
440406 -
440407 - Minimal reticular opacities within the left apex not
440408 - significantly changed from the prior exam. 3 mm nodule within
440409 - the right upper lobe (image 21) unchanged from the prior exam
440410 - as well. 4 mm nodule within the right middle lobe adjacent to
440411 - the major fissure (image 37) unchanged from the prior exam. No
440412 - definite lung nodules noted on the left.
440414 - ..
440415 - CT ABDOMEN:
440416 -
440417 - There is an area of decreased attenuation within the dome of
440418 - the liver with Hounsfield unit measurement similar to that of
440419 - fluid unchanged from the prior exam statistically representing
440420 - a cyst. The remainder of the liver is unremarkable. There are
440421 - calcifications identified within the spleen which may represent
440422 - prior granulomatous process. The pancreas is within normal
440423 - limits. Calcification of the splenic artery with tortuosity in
440424 - appearance unchanged from the prior exam. The gallbladder,
440425 - adrenal glands and the kidneys are within normal limits. No
440426 - lymphadenopathy within the abdomen. No free fluid. No
440427 - aggressive osseous lesions.
440429 - ..
440430 - ** IMPRESSION **:
440431 -
440432 - Less than 1 cm right axillary lymph node. No significant
440433 - change since the prior exam of 5/30/05.
440435 - ..
440436 - See review of findings, ref SDS 0 4O8P, and action item to verify this
440437 - CT test analysis against the PET scan test performed on 060414.
440438 - ref SDS 0 MC4F
440440 - ..
440441 - Findings received today do not reconcile CA 15-3 rising to 49, 10
440442 - points above the cancer signal, reported recently, per above.
440443 - ref SDS 0 MC4G
440445 - ..
440446 - Pathology for the CT test on 060505 reporting no evidence of cancer
440447 - anywhere, including axilla, and supraclavicular regions, per above,
440448 - ref SDS 0 4O8P, generally align with the earlier PET scan test on
440449 - 060414, as reviewed with the doctor on 060428. ref SDS 76 A544
440450 -
440451 - [On 060623 examination shows rising left breast inflammation
440452 - indicating IBC relapse; reconciles rising CA 15-3 cancer marker
440453 - with no evidence of disease reported in image tests, because IBC
440454 - occurs in the skin (dermal lymphatics), which is hard to recognize
440455 - in image testing. ref SDS 88 025H
440456 -
440457 -
490430 -
490431 -
4905 -
SUBJECTS
Default Null Subject Account for Blank Record
7503 -
750401 - ..
750402 - Vacation Notice Planning Treatment Schedule
750403 - Treatment Planning Schedule Accomodate Planned Holiday Travel
750404 -
750405 - Follow up ref SDS 81 576N, ref SDS 76 AW5G.
750407 - ..
750408 - Millie's letter on 060512 asked about scheduling resumption of
750409 - treatment around her vacation schedule. ref SDS 81 576N
750411 - ..
750412 - Favorable CT test today, per above, ref SDS 0 4R82, suggests any
750413 - resumption of treatment will not be required until after the next
750414 - meeting with the doctor in June.
750415 -
750416 -
750418 - ..
750419 - Radiation Treatment Left Neck Tumor Board Recommendations
750420 -
750421 - Follow up ref SDS 81 4T3S.
750422 -
750423 - As a result of favorable CT test findings of NED reported
750424 - today, per above, ref SDS 0 4R82, consideration of radiation
750425 - treatment, cited in Millie's letter on 060512, ref SDS 81 4T3S,
750426 - can as well be deferred until the meeting with the doctor in
750427 - June.
750428 -
750429 -
750430 -
750431 -
7505 -
SUBJECTS
Status Test for Change More Urgent with Signs of Relapse ER PR HER2/
7803 -
780401 - ..
780402 - Status Change Retest Biopsy 040419 Treatment Options
780403 - Treatment Options Status Change Retest Biopsy 040419
780404 -
780405 - Follow up ref SDS 81 X54M, ref SDS 76 ZR6J.
780406 -
780407 - As a result of favorable CT test findings of NED reported today, per
780408 - above, ref SDS 0 4R82, consideration of radiation treatment, cited in
780409 - Millie's letter on 060512, ref SDS 81 X54M, can as well be deferred
780410 - until the meeting with the doctor in June, and following up
780411 - discussions during the meeting on 060428. ref SDS 76 ZR6J
780412 -
780413 -
780414 -
780415 -
780416 -
780417 -
780418 -
780419 -
780420 -
780421 -
7805 -