CONTACTS 

SUBJECTS
CT Test 080718 Report Received Condition  Sable Right Axilla Possibl

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 73 0000. ref SDS 63 0000.
110502 -
110503 -
110504 -
110505 -
110506 -
110507 -
110509 -  ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - CT Test on 081107 Report Received from Kaiser
110902 -
110903 - Follow up ref SDS 73 6V5I, ref SDS 63 R45G.
110904 -
110905 - Millie received ref DRT 1 0001 a letter dated today 081112 1410 from
110906 - the primary care physician at Kaiser in Walnut Creek transmitting the
110907 - CT test on 081107, ref SDS 82 3G5I, which was ordered by Doctor
110908 - Johnson during the meeting at Kaiser on 081024, ref SDS 79 454L, and
110909 - arranged by the CT Department also on 081024. ref SDS 81 QJ88
110910 - Millie's prior test was on 080911 at Kaiser in Oakland, ref SDS 72
110911 - 358L, and the report was received from Kaiser on 080912. ref SDS 73
110912 - 6V5I
110914 -  ..
110915 - The doctor's letter was received in the late afternoon.  Millie
110916 - submitted a reply asking about failure to compare the test on 081107
110917 - with results for the most recent prior test at Kaiser in Oakland on
110918 - 080911, and also asking the anlayst to check the scans to verify
110919 - findings in the "right" supraclavicular presented in the report for
110920 - the test on 081107, when there is no prior history of lymph adenopathy
110921 - in this location, and the test report makes no findings of swelling in
110922 - the left supraclavicular when a biopsy was performed no 081022 that
110923 - reported swelled lymph nodes are positive for cancer, reported on
110924 - 081023. ref SDS 78 W15N
110925 -
110926 -            [On 081113 Millie received another letter from the doctor
110927 -            transmitting a second report for the CT test performed on
110928 -            081107, and covering only the neck area, ref SDS 89 6V5I;
110929 -            complements the report today on area below the neck.
110931 -  ..
110932 - This evening entered the pathology report into the record...
110934 -  ..
110935 - The doctor's letter says or reasonably implies...
110936 -
110937 -    1.  [Here is the report on the CT test performed at Kaiser on
110938 -        November 7, 2008, ref DRT 1 0001
110940 -  ..
110941 - The primary care physician at Kaiser responds to the letter Millie
110942 - submitted to Kaiser on 081111 requesting submission of test reports in
110943 - time for review, to be prepared for a productive meeting with the
110944 - medical team at UCSF on 081113. ref SDS 83 2E5P  Earlier today, Millie
110945 - sent a follow up letter reminding Kaiser to submit test reports.
110946 - ref SDS 84 SM7K
110947 -
110948 -            [On 081113 Millie received another letter from the doctor
110949 -            transmitting a second report for the CT test performed on
110950 -            081107, and covering only the neck area, ref SDS 89 6V5I;
110951 -            complements the report today on area below the neck.
110953 -             ..
110954 -            [On 081113 case study patient history shows Millie has had
110955 -            11 previousl CT and PET scan tests covering the same scope
110956 -            for the neck, chest, abdomen, and pelvis, and all results
110957 -            were consolidated into a single report. ref SDS 89 HV4H
110959 -             ..
110960 -            [On 081230 Jennifer, CT Technologist at Kaiser CT
110961 -            Department in Walnut Creek CA added comments to the work
110962 -            order for the CT test to consolidate findings in a single
110963 -            report, ref SDS 98 FF8M, and to correct the test last month
110964 -            on 081107 by comparing with the previous test on 080911,
110965 -            rather than with the test on 080718. ref SDS 98 F34K
110966 -
110968 -         ..
110969 -        Test History No Evidence Distant Metastasis
110970 -        Distant Metastasis No Evidence 7 Years Imaging Tests
110971 -
110972 -        Follow up ref SDS 73 GM3N, ref SDS 63 GM3N.
110973 -
110974 -        Type    Date           Received          Source
110975 -         CT     081107 reported on 081112........... ref SDS 0 DA6Q
110976 -         CT     080911 reported on 080912........... ref SDS 73 DA6Q
110977 -         CT     080718 reported on 080723........... ref SDS 63 DA6Q
110978 -         CT     080425 reported on 080428........... ref SDS 53 DA6Q
110979 -         CT     080212 reported on 080215........... ref SDS 48 DA6Q
110980 -         CT     071210 reported on 071213........... ref SDS 39 UG4L
110981 -         CT     070930 reported on 071018........... ref SDS 36 VK8L
110982 -         CT     070723 reported on 070802........... ref SDS 33 IM6M
110983 -         CT     070520 reported on 070524........... ref SDS 32 DA6Q
110984 -         CT     070326 reported on 070329........... ref SDS 31 DA6Q
110985 -         CT     070131 reported on 070202........... ref SDS 29 1Y8G
110986 -         PET/CT 061227 reported on 070102........... ref SDS 25 1Y8G
110987 -         CT     060930 reported on 061012........... ref SDS 23 284J
110988 -         MRI    060708 reported on 060711........... ref SDS 21 PT4K
110989 -         Xray   060623 reported on 060711........... ref SDS 21 WJ6G
110990 -         CT     060505 reported on 060523........... ref SDS 20 E355
110991 -         PET    060414 reported on 060428........... ref SDS 19 WJ6G
110992 -         PET    060120 reported on 060126........... ref SDS 18 WJ6G
110993 -         PET/CT 051005 reported on 051007........... ref SDS 16 WJ6G
110994 -         CT     050530 reported on 050610........... ref SDS 15 G75L
110995 -         CT     050325 reported on 050422........... ref SDS 14 G75L
110996 -         CT     041217 reported on 041230........... ref SDS 13 G75L
110997 -         CT     041103 reported on 041104........... ref SDS 12 WV7H
110998 -         CT     040921 reported on 041005........... ref SDS 10 NL4N
110999 -         CT     040710 reported on 040811........... ref SDS 9 H85S
111000 -         CT     040410 reported on 040416........... ref SDS 7 LK5L
111001 -         CT     040307 reported on 040318........... ref SDS 6 LK5L
111002 -         CT     031031 reported on 031205........... ref SDS 5 IG9K
111003 -         CT     030626 reported on 030710........... ref SDS 4 AL6N
111004 -         CT     030428 reported on 030508........... ref SDS 3 LK5L
111005 -         PET    021218 reported on 030109........... ref SDS 2 LK5L
111006 -         PET    020529 reported on 020603........... ref SDS 1 0001
111008 -         ..
111009 -    1.  Patient
111017 -         ..
111018 -    2.  CT OF CHEST, ABDOMEN AND PELVIS
111019 -        ref DRT 1 HC8K
111020 -
111021 -            [On 081113 Millie received second report for the CT test
111022 -            performed on 081107, and covering only the neck area,
111023 -            ref SDS 89 6V5I; complements the report today for the
111024 -            chest, abdomen and pelvis.
111026 -             ..
111027 -            [On 081113 case study patient history shows Millie has had
111028 -            11 previousl CT and PET scan tests covering the same scope
111029 -            for the neck, chest, abdomen, and pelvis, and all results
111030 -            were consolidated into a single report. ref SDS 89 HV4H
111032 -             ..
111033 -            [On 081113 Millie's letter to medical team cited confusion
111034 -            in the record caused by getting a report for the neck that
111035 -            was separate from the primary report on the CT test at
111036 -            Kaiser, on 081107; Doctor Rugo requested correction to the
111037 -            report by adding comparison with the test on 080911.
111038 -            ref SDS 90 8Q8V
111040 -             ..
111041 -            [On 081217 Millie's letter to the medical team cited
111042 -            confusion caused by getting multiple reports for the CT
111043 -            test on 081107. ref SDS 94 YJ5Q
111045 -             ..
111046 -            [On 081230 CT Technologist adds comments to CT test work
111047 -            order for analyst to compare test on 081230 with the prior
111048 -            test on 081107, and to correct the report for 081107 by
111049 -            comparing with previous test on 080911, rather than with
111050 -            the test on 080718. ref SDS 98 F34K
111052 -             ..
111053 -            [On 090409 2018 Doctor Davidson, Director fo Radiology of
111054 -            Kaiser Mt Diablo Service Area, advised that Kaiser CT
111055 -            Department Walnut Creek made a mistake issuing multiple
111056 -            reports for the CT test on 090413, ref SDS A1 WB6G, and
111057 -            advised that findings for future CT tests will consolidate
111058 -            findings into a single report for each test. ref SDS A1
111059 -            XZ6U
111061 -         ..
111065 -         ..
111066 -        Date:  081107 1322
111068 -         ..
111069 -        Performed in:  WCR Outpatient in Walnut Creek
111070 -
111074 -
111075 -
111076 -
1111 -

SUBJECTS
CT Test 080212 Report Errors Omissions Comparisons Patient History T

3703 -
370401 -  ..
370402 - Errors Omissions Comparisons Patient History Trend Analysis
370403 - Patient History Comparison PE Cor Pulmonale Esophigitis Enlarged Heart
370404 -
370405 - Follow up ref SDS 73 IX4F, ref SDS 63 IX4F.
370406 -
370407 - CT test 081107 report continues...
370409 -         ..
370410 -    3.  HISTORY
370411 -
370412 -        72-year-old female with history of IVC of left breast who was
370413 -        initially diagnosed 03/04/02.  She had recurrent disease noted
370414 -        initially in the cervical lymph nodes 03/03/04.  On E2100 study
370415 -        with avastin but she had a PE noted on CT 11/03/04.  Then
370416 -        because of progression of disease, the patient was started on
370417 -        taxotere and Xeloda 04/15/05.  She had a total of 8 cycles
370418 -        ending 09/16/05.  She had a palliative left mastectomy
370419 -        performed 10/21/05.  Then her left chest lesions began
370420 -        expanding again.  The patient started on taxotere and Xeloda
370421 -        again 07/21/06 for 7 cycles.  She was started on a clinical
370422 -        trial of 02/01/07 at UCSF and was randomized to the Erbitux
370423 -        only (no carboplatin) arm.  She had weekly carboplatin added
370424 -        03/13/08 because of progression of disease.  Her disease has
370425 -        progressed again and she is being considered for phase 1/2
370426 -        study of Sunitinib (SU112408) at UCSF). ref DRT 1 QB8M
370428 -  ..
370429 - Problems with history on prior tests failing to provide context for
370430 - reviewing CT test scans reported for the test on 080911, reviewed
370431 - 080912, ref SDS 73 9W8F, are partially corrected today, with the
370432 - analyst for the test on 081107 extracting the summary of patient
370433 - history in the medical chart for Millie's meeting with the primary
370434 - care physician at Kaiser on 081024.
370435 -
370436 -            [On 081113 report for the CT test on the neck presents
370437 -            substantially identical patient history. ref SDS 89 WQ5M
370439 -  ..
370440 - Tracking patient history enables the analyst to investigate changes on
370441 - critical issues, cited previously as problematic. ref SDS 73 MB6F
370443 -  ..
370444 - This statement cites patient history of pulmonary embolism, which
370445 - alerts the analyst to check for progression.  The test report today
370446 - continues to omit patient history on...
370447 -
370448 -        1.  Likely esophigitis test on 060120
370449 -            reported.......................... 060126, ref SDS 18 DH4O
370451 -             ..
370452 -        2.  Pulmonary embolism found in test
370453 -            on 060930 reported................ 061012, ref SDS 23 294Q
370455 -             ..
370456 -        3.  Cor pulmonali (enlarged right
370457 -            ventricle) test on 061012,
370458 -            and reviewed on................... 061012, ref SDS 23 7E5L
370460 -             ..
370461 -        4.  Slightly enlarged heart test
370462 -            on 071210, received at
370463 -            UCSF.............................. 071213. ref SDS 39 SR5I
370465 -             ..
370466 -        5.  Interstitional lung disease test
370467 -            on 080718 reported................ 080723, ref SDS 63 TS4J
370469 -  ..
370470 - There is an error in the medical chart citing "history of IVC," which
370471 - is therefore carried forward into the CT test report today, per above.
370472 - ref SDS 0 WQ5M  Millie has a history of IBC.
370474 -  ..
370475 - The report today repeats errors and omissions listed in the report for
370476 - the prior test listed on 080215. ref SDS 48 IX4L
370478 -  ..
370479 - CT test 081107 report continues...
370480 -
370481 -    4.  TECHNIQUE:
370482 -
370483 -        Routine CT of chest, abdomen and pelvis performed with IV and
370484 -        oral contrast. 150 ml IV Omnipaque 300 were administered.
370485 -        ref DRT 1 VD4N
370487 -         ..
370488 -        Port-a-Cath is again seen in the right chest wall.  The patient
370489 -        appears unchanged from prior exam. ref DRT 1 WQ5L
370491 -  ..
370492 - This report aligns with the record of work at Kaiser on 081107
370493 - describing Barium Sulfate suspension, ref SDS 82 BG4J,
370494 -
370495 -            [On 081113 report for the CT test on the neck presents
370496 -            substantially similar explanation of test technique.
370497 -            ref SDS 89 EO5N
370499 -  ..
370500 - CT test 081107 report continues...
370501 -
370502 -    5.  COMPARISON:
370503 -
370504 -        This study is compared with prior exacerbate dated 07/18/08.
370505 -        ref DRT 1 FT5I
370507 -  ..
370508 - Test on 080718 was received from Kaiser and reviewed on 080723.
370509 - ref SDS 63 IX4F
370511 -  ..
370512 - There is no explanation for not comparing the current test on 081107
370513 - with the most recent test on 080911, ref SDS 72 2U6L, received on
370514 - 080912, ref SDS 73 RV49, excpet that the test was done at Kaiser in
370515 - Oakland, and so possibly the records got mixed up.  Since Kaiser's
370516 - records on the computer, and since Doctor Daamen saw the record of the
370517 - CT test at Oakland during a meeting at Kaiser in Walnut Creek on
370518 - 081022, ref SDS 77 516F, it is not clear why the CT analyst at Kaiser
370519 - in Walnut Creek would not also see the test at Oakland on 080911.
370521 -  ..
370522 - Errors and omissions performing test comparisons reported in case
370523 - study on 061012. ref SDS 23 A55J
370525 -  ..
370526 - Case study on medical mistakes reported on 040416. ref SDS 7 GN7J
370527 -
370528 -            [On 081112 earlier today, Millie sent a letter to the
370529 -            primary care physician asking the analyst to compare the
370530 -            test on 081107 with the test on 080911. ref SDS 85 WJ4Q
370531 -
370532 -            [On 081113 Doctor Johnson deferred correcting mistakes in
370533 -            the CT test on 081107 on the grounds that Doctor Rugo's
370534 -            "view" of necessity for making corrections is important.
370535 -            ref SDS 88 ML8N
370537 -             ..
370538 -            [On 081113 Doctor Rugo requested correction to the report
370539 -            for the CT test on 081107 by adding comparison with the
370540 -            test on 080911. ref SDS 90 8Q8V
370542 -             ..
370543 -            [On 081113 Millie's letter to medical team cited confusion
370544 -            in the record caused by getting a report for the neck that
370545 -            was separate from the primary report on the CT test at
370546 -            Kaiser, on 081107; Doctor Rugo requested correction to the
370547 -            report by adding comparison with the test on 080911.
370548 -            ref SDS 90 8Q8V
370550 -             ..
370551 -            [On 081217 Millie's letter to the medical team cited
370552 -            confusion caused by getting multiple reports for the CT
370553 -            test on 081107. ref SDS 94 YJ5Q
370555 -             ..
370556 -            [On 081230 Jennifer, CT Technologist at Kaiser CT
370557 -            Department in Walnut Creek CA added comments to the work
370558 -            order for the CT test to consolidate findings in a single
370559 -            report, ref SDS 98 FF8M, and to correct the test last month
370560 -            on 081107 by comparing with the previous test on 080911,
370561 -            rather than with the test on 080718. ref SDS 98 F34K
370562 -
370563 -
370564 -
370565 -
3706 -

SUBJECTS
Right Axillary Lymph Node Minimally Enlarged CT Test 080212 Findings

6603 -
660401 -  ..
660402 - CT test 081107 report continues...
660403 -
660404 -    6.  FINDINGS
660406 -  ..
660407 - Thyroid Gland Findings Described Unchanged Not Presented in Prior Test
660408 -
660409 - Follow up ref SDS 73 NB3L, ref SDS 63 NB3L.
660410 -
660411 - CT test 081107 report continues...
660412 -
660413 -        1.  Thyroid gland...
660414 -
660415 -            As seen on prior study, a 5-mm hypodensity as seen on the
660416 -            right lobe of the thyroid.  This is stable. ref DRT 1 M26G
660418 -  ..
660419 - Since the test compared with the CT test report on 080723, ref SDS 63
660420 - NB3L, per above, ref SDS 0 RV49, it further seems stable since the
660421 - most recent prior test on 080911, reviewed on 080912. ref SDS 73 NB3L
660422 -
660423 -
660424 -
6605 -

SUBJECTS
Default Null Subject Account for Blank Record

6703 -
670401 -  ..
670402 - Left Supraclavicular No Findings Nodes Conflicts Patient History
670403 - Right Supraclavicular Several Nodes Found Conflicts Patient History
670404 -
670405 - Follow up ref SDS 73 5O6N.
670406 -
670407 - CT test 081107 report continues...
670408 -
670409 -        2.  Several enlarged right supraclavicular lymph nodes are
670410 -            seen.  These measure 1 to 1.1 cm in longest axis.  They do
670411 -            appear slightly larger than on the prior study when they
670412 -            measured 9 mm.  The 4-mm node is seen lateral to the left
670413 -            lobe of the thyroid (image #4).  This appears larger than
670414 -            on the prior exam. ref DRT 1 CR6J
670416 -  ..
670417 - Note -- turns out there is a second test report on only the neck which
670418 - corrects errors and omissions in this report, received the next day on
670419 - 081113. ref SDS 89 OO6M
670421 -  ..
670422 - Findings seems conflicting with patient history showing no record of
670423 - swelled lymph nodes in the right supraclavicular.  Comparison with
670424 - test on 080718 shows no report of nodes in the right supraclavicular,
670425 - reviewed on 080723. ref SDS 63 EO8F  Comparison with test on 080911
670426 - shows no report of nodes in the right supraclavicular, reviewed on
670427 - 080912. ref SDS 73 OO6M
670428 -
670429 -                [...in another record today on 081112 Millie wrote a
670430 -                letter to Kaiser requesting clarification of possible
670431 -                conflict in the report failing to report findings on
670432 -                adenopathy in left supraclavicular. ref SDS 85 WJ4W
670434 -                 ..
670435 -                [On 081113 Doctor Johnson deferred correcting mistakes
670436 -                in the CT test on 081107 on the grounds that Doctor
670437 -                Rugo's "view" of necessity for making corrections is
670438 -                important. ref SDS 88 ML8N
670440 -                 ..
670441 -                [On 081113 Doctor Rugo requested corrections to
670442 -                Kaiser's CT test. ref SDS 87 DP8J
670444 -                 ..
670445 -                [On 081113 primary care physician submitted to the
670446 -                medical team a report on a 2nd CT test covering only
670447 -                the neck, ref SDS 89 YO7M, and it describes the node in
670448 -                the left supraclavicular. ref SDS 89 OO6M
670450 -                 ..
670451 -                [On 081218 Tara advised that Kaiser did not submit to
670452 -                UCSF the 2nd report on the neck for the CT test on
670453 -                081107, and asked Millie to submit the report to UCSF.
670454 -                ref SDS 95 LM4I
670456 -                 ..
670457 -                [On 081218 Millie submitted to UCSF the 2nd report on
670458 -                the neck for the CT test on 081107, which was requested
670459 -                during the meeting today on 081118. ref SDS 96 4B7N
670461 -                 ..
670462 -                [On 081218 Millie's letter to Kaiser requests
670463 -                consolidated report for the CT test on 081230 in order
670464 -                to avoid confusion caused by Kaiser publishing multiple
670465 -                reports for the CT test on 081107. ref SDS 96 UY3T
670467 -                 ..
670468 -                [On 081219 Millie met with primary care physician at
670469 -                Kaiser and requested clarifications of work order to
670470 -                consolidate findings into a single report for the CT
670471 -                test on 081230. ref SDS 97 PI5M
670473 -                 ..
670474 -                [On 081230 Jennifer, CT Technologist at Kaiser CT
670475 -                Department in Walnut Creek CA added comments to the
670476 -                work order for the CT test to consolidate findings in a
670477 -                single report, ref SDS 98 FF8M, and to correct the test
670478 -                last month on 081107 by comparing with the previous
670479 -                test on 080911, rather than with the test on 080718.
670480 -                ref SDS 98 F34K
670482 -  ..
670483 - Failure to find swelled lymph node in left supraclavicular conflicts
670484 - with patient history...
670485 -
670486 -            1.  Examination at UCSF found swelled
670487 -                lymph node........................ 080821, ref SDS 67 4C6O
670488 -
670489 -            2.  Primary care physician at Kaiser
670490 -                palpates lump left supraclavicular,
670491 -                reported in letter to medical
670492 -                team.............................. 080829, ref SDS 71 RP8T
670494 -                 ..
670495 -            3.  CT test on 080911 report shows no
670496 -                findings swelled lymph nodes in
670497 -                left supraclavicular
670498 -                area.............................. 080912, ref SDS 73 5O6N
670500 -                 ..
670501 -            4.  Examination at UCSF could not find
670502 -                swelling in left supraclavicular,
670503 -                which may align with the CT test
670504 -                not reporting findings in this
670505 -                area.............................. 080918, ref SDS 74 366L
670507 -                 ..
670508 -            5.  Medical team examination at UCSF
670509 -                confirms previous
670510 -                findings.......................... 081016, ref SDS 75 J34X
670512 -                 ..
670513 -            6.  Biopsy pathology swelled lymph node
670514 -                in left supraclavicular was postive
670515 -                for breast cancer reported by
670516 -                Kaiser............................ 081023, ref SDS 78 4Q9Q
670517 -
670518 -
670519 -
670520 -
670521 -
6706 -

SUBJECTS
Right Axillary Lymph Node Minimally Enlarged CT Test 080212 Findings

9603 -
960401 -  ..
960402 - Findings Stable No Progression Lymphadenophathy Since February
960403 - Right Axillary 3 Lymph Node Stable No Evidence Progression Disease
960404 - Stable Lymphadenophathy No Progression of Cancer CT Test 080911
960405 - Distant Metastasis No Evidence Disease NED Stable No Progression
960406 -
960407 - Follow up ref SDS 73 4K5H, ref SDS 63 4K5H.
960408 -
960409 - CT test 081107 report continues...
960410 -
960411 -        3.  Numerous enlarged lymph nodes are seen in the right axilla.
960412 -            These appear to have enlarged and progressed since the
960413 -            prior study.  The two largest nodes now measure 1.6 x 1.4
960414 -            cm and 1.6 x 1.6 cm respectively.  These measured 1.6 x 1.3
960415 -            cm and 1.3 x 1.3 cm respectively on the prior exam.  Other
960416 -            enlarging nodes are seen.  These nodes all measure less
960417 -            than 1 cm in size but have progressed from the prior exam.
960418 -            The most prominent node which has enlarged is seen on image
960419 -            #16 deep towards the chest wall.  This node now measures
960420 -            1.0 x 0.7 cm.  Diffuse ill-defined hazy opacity is seen
960421 -            throughout the right axilla. ref DRT 1 513G
960423 -  ..
960424 - Evidently, there are still only 3 nodes visible in the CT scan for the
960425 - right axillary.
960427 -  ..
960428 - On 080918 Brigid could not feel any swelling in the right axillary.
960429 - ref SDS 74 4C6K
960430 -
960431 -               [On 081113 these findings from the CT test below the
960432 -               neck align with additional findings from a second test
960433 -               for the neck only that made notational findings of the
960434 -               right axillary. ref SDS 89 HW45
960436 -  ..
960437 - This is helpful work comparing node for node with prior test reported
960438 - on 080718. ref SDS 63 4K5H
960440 -  ..
960441 - Comparing with the report for the most recent test on 080911 shows...
960442 -
960443 -                Current Test        Prior Test           Prior Test        Prior Test           Prior Test
960444 -                   081107             080911              080718              080425              080212
960445 -
960446 -             1.  1.60 x 1.40 cm ... 2.00 x 1.50 cm .... 1.70 x 1.50 cm .... 1.90 x 1.10 cm .... 1.90 x 0.90
960447 -             2.  1.60 x 1.60 cm ... 1.50 x 1.80 cm .... 1.30 x 1.30 cm .... 1.30 x 1.20 cm .... 1.27 x 1.13
960448 -             3.  1.00 x 0.70 cm ... 1.00 x 1.00 cm .... 1.10 x 0.80 cm .... 1.00 x 1.00 cm .... 1.00 x 1.00
960450 -  ..
960451 - Similar problems occur with reporting for the recent test on 081107
960452 - that occurred for the prior test on 080911, as set out in the record
960453 - on 080912. ref SDS 73 5P4K
960455 -  ..
960456 - At that time on 080912, review showed the analyst for the test on
960457 - 080911 comparing with the prior test on 080718 presented nodes
960458 - slightly differently (1.8 x 1.5 rather than 1.70 x 1.50).
960460 -  ..
960461 - Similarly review today shows the analyst for the recent test on 081107
960462 - again comparing with the prior test on 080718 (rather than the most
960463 - recent CT test on 080911, noted above, ref SDS 0 RV49, used
960464 - numbers for the CT test on 080718...
960465 -
960466 -                    1.6 x 1.3 cm ..... ref SDS 0 4K5H
960468 -  ..
960469 - The report for the test on 080718 was received on 080723 and shows...
960470 -
960471 -                    1.7 x 1.5 cm ..... ref SDS 63 4K5H
960473 -  ..
960474 - The report for the test on 080911 was received on 080912 and list the
960475 - same node numbers for the test on 080718...
960476 -
960477 -                    1.8 x 1.5 cm ..... ref SDS 73 4K5H
960479 -  ..
960480 - If numbers for node size are changed this should be noted and
960481 - reconciled as "technique" issues so that people do not get confused.
960482 - Evidently, the comparison was made between scans, rather than between
960483 - the current scan and the report for the prior scan.  Three different
960484 - people looking at the same scan at different times came to slightly
960485 - different conclusions measuring very small elements, previously noted
960486 - on 080912. ref SDS 73 5P4K
960488 -  ..
960489 - Analysis today comparing the past 5 tests seems to indicate at least a
960490 - stable condition, i.e., without significant change), over the past 10
960491 - months, and that differences are attributible to test methods (see
960492 - "Impression," below, ref SDS 73 DC5G), which equally suggests there
960493 - could have been actual decline, i.e., improvement in the condition.
960494 -
960495 -            [On 090226 1342 radiation treatment plan does not list
960496 -            right axillary, perhaps suggesting belief that stable
960497 -            condition of right axillary nodes indicates these nodes are
960498 -            not cancer. ref SDS A0 D452
960500 -  ..
960501 - Problems with image test reporting were previously reviewed on 040416,
960502 - and reflect continuing quality issues, ref SDS 7 PTSX, though
960503 - recently significant improvement in some areas.
960504 -
960505 -
960506 -
9606 -

SUBJECTS
Default Null Subject Account for Blank Record

9703 -
970401 -  ..
970402 - Left Axilla Stable No Evidence Disease NED Unchanged Prior Test
970403 -
970404 - Follow up ref SDS 73 WM9L, ref SDS 63 WM9L.
970405 -
970406 - CT test 081107 report continues...
970407 -
970408 -        4.  No significant left axillary adenopathy is noted.
970409 -            ref DRT 1 FN4I
970410 -  ..
970411 - Continues prior findings from beginning of year and before, shown from
970412 - prior test on 080911, and reported on 080912. ref SDS 63 WM9L
970413 -
970414 -
970415 -
9705 -

SUBJECTS
Default Null Subject Account for Blank Record

9803 -
980401 -  ..
980402 - AP Window Node Appears Enlarged
980403 - Pretracheal 1 CM Node Node Identified Similar Paratrachael??
980404 - Paratracheal Adenopathy Unchanged Prior Study 3 Nodes Identified
980405 -
980406 - Follow up ref SDS 73 RV70, ref SDS 63 RV70.
980408 -  ..
980409 - CT test 081107 report continues...
980410 -
980411 -        5.  Pretrachael, paratracheal and prevascular
980412 -
980413 -            Few, shotty, nonenlarged pretracheal and prevascular lymph
980414 -            nodes are seen.  On image #20, there is suggestion of a 1.2
980415 -            cm AP window node which appears enlarged compared with the
980416 -            prior examination.  Some of this appearance, however, may
980417 -            be volume averaging with the overlying pulmonary artery.  A
980418 -            1-cm pretracheal lymph node is also identified. ref DRT 1
980419 -            YE5G
980421 -  ..
980422 - How does this report relate to findings of small right paratracheal
980423 - and prevascular lymph nodes cited in the test on 080425, and reported
980424 - on 080428, ref SDS 53 RV70, but which were not mentioned in the report
980425 - for the CT test on 080718, ref SDS 63 RV70, nor mentioned in the
980426 - report for the test on 080911. ref SDS 73 RV70
980427 -
980428 -
980429 -
980430 -
9805 -

SUBJECTS
Default Null Subject Account for Blank Record

9903 -
990401 -  ..
990402 - Hilar Left Side Lymph Node 5 MM Stable No Right Hilar Adenopathy
990403 -
990404 - Follow up ref SDS 73 TY6H.
990405 -
990406 - CT test 080911 report continues...
990408 -             ..
990409 -        6.  Stable 5-mm left hilar lymph node is noted.  No significant
990410 -            right hilar adenopathy is identified. ref DRT 1 YE54
990412 -  ..
990413 - This seems to align with finding for the test on 080911 reported on
990414 - 080912 as....
990415 -
990416 -                "There are small mediastinal lymph nodes, which are
990417 -                stable.  No new hilar adenopathy is seen.  There is no
990418 -                pericardial or pleural effusion." ref SDS 73 TY6H
990419 -
990421 -  ..
990422 - Findings for the test on 081107 further seem to align with prior test
990423 - on 080718, reviewed on 080723...
990424 -
990425 -                "A few minimally enlarged lymph nodes in the
990426 -                mediastinum and no significant adenopathy in the
990427 -                mediastinum nor in the hila." ref SDS 63 TY6H
990428 -
990429 -
990430 -
9905 -

SUBJECTS
Default Null Subject Account for Blank Record

A003 -
A00401 -  ..
A00402 - Heart Normal Change from 071210
A00403 -
A00404 - Follow up ref SDS 73 UR4S, ref SDS 63 UR4S.
A00405 -
A00406 - There is no mention of the heart in the current test on 081107,
A00407 - repeating the practice for the test on 080911, reported on 080912.
A00408 - ref SDS 73 UR4S
A00410 -  ..
A00411 - The CT test on 080718 shown in the record on 080723, ref SDS 63 UR4S,
A00412 - described possible improvement from the test on 071210 reporting the
A00413 - heart appeared slightly enlarged, shown in the record on 071213.
A00414 - ref SDS 39 SR5I
A00415 -
A00416 -
A00417 -
A005 -

SUBJECTS
Default Null Subject Account for Blank Record

A103 -
A10401 -  ..
A10402 - Lungs 4 Nodes Appear Little Changed from Prior Studies
A10403 - Pulmonary Embolism Findings CT Test 080718 Similar 080425
A10404 -
A10405 - Follow up ref SDS 73 RV78, ref SDS 63 RV78.
A10407 -  ..
A10408 - CT test 081107 report continues...
A10409 -
A10410 -        7.  Lung windows show stable scarring in the left lung apex.
A10411 -            Small 2-mm nodule is again seen in the right upper lobe and
A10412 -            in the region of the minor fissure.  Stable 4 mm nodular
A10413 -            density is seen along the pleura anteriorly in the right
A10414 -            middle lobe (image #37).  Stable nodular density is seen
A10415 -            laterally along the pleura of the right lower lobe (image
A10416 -            #45).  Stable scarring is seen anteriorly in the lingula,
A10417 -            likely related to prior radiation. ref DRT 1 IJ6I
A10418 -
A10419 -               [On 090107 0423 report for CT test on 081230 finds
A10420 -               additional scarring from linugla. ref SDS 99 RV78
A10422 -  ..
A10423 - The CT test on 081107 seems to align with case study on patient
A10424 - history listed in the record on 070117 that finds no support for
A10425 - Kaiser's medical chart notation of "lung cancer." ref SDS 27 6T5I
A10427 -  ..
A10428 - Pulmonary embolism was found in a CT test on 060930, reviewed on
A10429 - 061012.  Findings in the CT test on 080425 seem similar to language in
A10430 - the report finding PE on 061012. ref SDS 23 294Q  Language in the CT
A10431 - test yesterday, shown above, does not seem related to PE findings.
A10432 - ref SDS 73 RV78
A10434 -  ..
A10435 - On 080226 letter to Kaiser with copy to UCSF requests comment from
A10436 - medical team, including notice to coagulation control case management.
A10437 - ref SDS 51 S14Y
A10438 -
A10439 -
A105 -

SUBJECTS
Default Null Subject Account for Blank Record

A203 -
A20401 -  ..
A20402 - Cetuximab Side Effects Interstitial Disease CT Test Finding
A20403 - Interstitial Disease Lungs No Findings Reported CT Test 080911
A20404 -
A20405 - Follow up ref SDS 73 TS4J, ref SDS 63 TS4J.
A20406 -
A20407 - CT test 081107 report continues...
A20408 -
A20409 -        8.  What appears to be interstitial disease is seen in the
A20410 -            right lower lobe.  This does appear to have progressed from
A20411 -            the prior exam in July of 2008 and it appears more similar
A20412 -            to those studies of February of 2008.  No new parenchymal
A20413 -            nodules are seen.  No pleural effusions are noted.
A20414 -            ref DRT 1 9M7H
A20416 -  ..
A20417 - Interstitional lung disease found in the CT test on 081107, and
A20418 - reported today aligns with prior findings from the CT test on 080718
A20419 - and reviewed on 080723. ref SDS 63 TS4J
A20420 -
A20421 -            [On 081209 Millie very tired; feels badly, and does not
A20422 -            look well after 26 treatments and total of 976.0 mg of
A20423 -            sunitinib, 12 treatments that total 600 mg of
A20424 -            cyclophosphamide, and 4 totaling 20 mg of methotrexate.
A20425 -            ref SDS 92 KM5F
A20427 -             ..
A20428 -            [On 090107 1058 CT test on 081230 reported findings that
A20429 -            ground glass in the right lung base is slightly more
A20430 -            prominent. ref SDS 99 9R5F
A20432 -  ..
A20433 - Case study on 080723 shows Millie's patient history on prior reports
A20434 - of Interstitional Lung disease. ref SDS 63 7W6F  There were 6
A20435 - questions presented by prior findings listed on 080723. ref SDS 63
A20436 - 6A4J
A20437 -
A20438 -            [On 090107 1058 CT test 081230 reports pleural normal, and
A20439 -            no report fo interstitional lung disease. ref SDS 99 TS4J
A20441 -  ..
A20442 - On 080804 Millie's letter to Doctor Rugo with copy to primary care
A20443 - physician at Kaiser notifying of plans on returning to work, cites CT
A20444 - test findings of Interstitioal lung disease. ref SDS 65 GU6P  On
A20445 - 080821 meeting with medical team, there was no discssion of CT test
A20446 - performed 080718 finding Interstitial lung disease. ref SDS 67 056G
A20448 -  ..
A20449 - On 080829 during a meeting at Kaiser the primary care physician used
A20450 - the computer in the Examination room to open files for the CT test on
A20451 - 080718; the doctor commented that Interstitional lung disease reported
A20452 - on 080723, ref SDS 63 TS4J, appears very mild in the CT scan files,
A20453 - and so not a significant side effect of cetuximab treatment for
A20454 - Millie's cancer. ref SDS 71 RP4X
A20456 -  ..
A20457 - Interstitional disease was not mentioned in the report for the prior
A20458 - CT test on 080911, reviewed on 080912. ref SDS 73 TS4J
A20460 -  ..
A20461 - Millie started the current treatment with sunitinib on 081114, a week
A20462 - after the CT test on 081107, reviewed today. ref SDS 0 TS4J  Treatment
A20463 - consent documents for sunitinib protocol list Interstitial pneumonitis
A20464 - as a rare, serious side effect of cyclophosmphamide, reviewed on
A20465 - 081017, ref SDS 76 AR3W, which is part of daily treatments in the
A20466 - sunitinib protocol. ref SDS 76 Q14K
A20467 -
A20468 -            [On 081210 the doctor seemed to indicate in a call to
A20469 -            Kaiser that Interstitional Lung Disease would not typically
A20470 -            relate to Millie's symptoms of fatigue and not looking
A20471 -            well.  The doctor further indicated that the rate of
A20472 -            progression reported by the CT test on 081107 in relation
A20473 -            to prior tests suggests very slow progression that would
A20474 -            take 10 - 20 years to become a serious health issue for
A20475 -            Millie. ref SDS 93 H46H
A20476 -
A20477 -
A20478 -
A20479 -
A20480 -
A20481 -
A205 -

SUBJECTS
Default Null Subject Account for Blank Record

A303 -
A30401 -  ..
A30402 - Hepatic Dome Liver Lesions Continue Stable
A30403 -
A30404 - Follow up ref SDS 73 653N.
A30405 -
A30406 - CT test 081107 report continues...
A30407 -
A30408 -        9.  As noted on prior studies, a well-circumscribed hypodense
A30409 -            cystic-appearing lesion is seen in the liver at the hepatic
A30410 -            dome.  This measures 1.9 x 1.5 cm on the current exam.
A30411 -            When comparing in similar plane, I do not believe this has
A30412 -            changed from the prior studies.  No new hepatic masses are
A30413 -            seen.  No biliary ductal dilatation is noted. ref DRT 1
A30414 -            H47O
A30416 -  ..
A30417 - Seems to align with the test on 080911 reviewed on 080912. ref SDS 73
A30418 - 653N  This shows stable condition with the CT test on 080718 reviewed
A30419 - on 080723, ref SDS 63 653N, and extends favorable findings for the
A30420 - prior test on 080425 reviewed on 080428. ref SDS 53 RV91
A30421 -
A30422 -
A305 -

SUBJECTS
Default Null Subject Account for Blank Record

A403 -
A40401 -  ..
A40402 - Spleen Calcifications Granulamatous Disease
A40403 - Granulamatous Disease Spleen Calcifications
A40404 -
A40405 - Follow up ref SDS 73 N96N, ref SDS 63 N96N.
A40407 -  ..
A40408 - CT test 080911 report continues...
A40409 -
A40410 -       10.  Numerous coarse calcifications are again see in the spleen
A40411 -            consistent with prior granulomatous infection.
A40412 -            Calcifications are in the splenic artery are again
A40413 -            identified and appear unchanged. ref DRT 1 D78M
A40415 -  ..
A40416 - Seems unchanged from report for prior test on 080911 reported on
A40417 - 080912. ref SDS 73 N96N  This shows stable condition from the CT test
A40418 - on 080718 reported in the record on 080723. ref SDS 63 N96N
A40419 -
A40420 -
A405 -

SUBJECTS
Default Null Subject Account for Blank Record

A503 -
A50401 -  ..
A50402 - Kidneys Gallbladder Adrenal Appear Unchanged
A50403 -
A50404 - Follow up ref SDS 73 PH6I, ref SDS 63 PH6I.
A50405 -
A50406 - CT test 080911 report continues...
A50407 -
A50408 -       11.  The gallbladder, pancreas and adrenals appear unchanged.
A50409 -            On the left 1 cm hypodensities are seen in the kidneys as
A50410 -            before.  This is most prominent in the lower pole of the
A50411 -            left kidney.  These are stable and likely represent small
A50412 -            cysts.  No hydronephrosis or renal masses are noted.
A50413 -            ref DRT 1 Y49H
A50415 -  ..
A50416 - Seems unchanged from report for prior test on 080911 reported on
A50417 - 080912. ref SDS 73 PH6I  This shows stable condition from the CT test
A50418 - on 080718 reported in the record on 080723. ref SDS 63 PH6I
A50419 -
A50420 -
A505 -

SUBJECTS
Default Null Subject Account for Blank Record

A603 -
A60401 -  ..
A60402 - Colon Bowel Hiatal Hernia Diverticulitis No evidence
A60403 - Bowel Colon Hiatal Hernia Diverticulitis No evidence
A60404 - Diverticulitis No evidence Colon Bowel Hiatal Hernia
A60405 - Hiatal Hernia Diverticulitis No evidence Colon Bowel
A60406 -
A60407 - Follow up ref SDS 73 EQ5J, ref SDS 63 EQ5J.
A60408 -
A60409 - CT test 080718 report continues...
A60411 -             ..
A60412 -       12.  The small bowel and colon appear unchanged and normal.
A60413 -            ref DRT 1 GG9O
A60415 -  ..
A60416 - Seems to align with prior test on 080911 reported on 080912.
A60417 - ref SDS 73 EQ5J  This shows stable condition from the CT test on
A60418 - 080718 reported on 080723, ref SDS 63 EQ5J; except the prior test
A60419 - reported hiatal hernia and diverticulosis, which is cited in prior
A60420 - studies shown by case study on patient history on 080723. ref SDS 63
A60421 - GZ3J
A60422 -
A60424 -  ..
A60425 - Abdominal Aorta No Aneurysm No Adenopathy
A60426 - Pelvic Splenic Artery Calcification Aneurysms
A60427 -
A60428 - Follow up ref SDS 73 NC8N, ref SDS 63 NC8N.
A60430 -  ..
A60431 - CT test 080718 report continues...
A60432 -
A60433 -       13.  No significant adenopathy as seen within the abdomen or
A60434 -            pelvis.  No free fluid or focal fluid collections are
A60435 -            identified. ref DRT 1 8K4H
A60437 -  ..
A60438 - Seems to align with prior test on 080911 reported on 080912.
A60439 - ref SDS 73 NC8N, and so indicates stable condition with no evidence of
A60440 - cancer; however, since the analyst expressly compared the test on
A60441 - 081107, with the test on 080718, per above, ref SDS 0 RV49, there is
A60442 - less certainty about comparison with the test on 080912.  In any case,
A60443 - findings for the current test on 081107 seem favorable and unchanged
A60444 - from report for prior test on 080718 reported in the record on 080723.
A60445 - ref SDS 63 NC8N
A60446 -
A60448 -  ..
A60449 - Spine Lower Lumbar Degenertive Changes in Disks Facet Joints
A60450 -
A60451 - Follow up ref SDS 73 NC4L, ref SDS 63 NC4L.
A60453 -  ..
A60454 - CT test 080718 report continues...
A60455 -
A60456 -       14.  The bone windows show degenerative changes in the lumbar
A60457 -            spine.  No lytic or blastic lesions are seen. ref DRT 1
A60458 -            IN4L
A60460 -  ..
A60461 - Seems to align with prior test on 080911 reported on 080912.
A60462 - ref SDS 73 NC4L  Since the analyst expressly compared the test on
A60463 - 080718 reported on 080723, ref SDS 63 NC4L
A60465 -  ..
A60466 - CT test 080718 report concludes...
A60468 -  ..
A60469 - May be Increased Lymph Nodes Right Axilla Interstitial Disease
A60470 -
A60471 - Follow up ref SDS 73 FY5O, ref SDS 63 FY5O.
A60472 -
A60473 -    7.  IMPRESSION
A60474 -
A60475 -        Interval progression of metastatic adenopathy particularly
A60476 -        within the right axilla, ref SDS 0 4K5H, and right
A60477 -        supraclavicular region. ref SDS 0 5O6N  There is possible
A60478 -        progression of adenopathy within the mediastinum with an
A60479 -        apparent enlarged node within the AP window.  This, however,
A60480 -        may merely be volume averaging with the overlying vessel.  Some
A60481 -        interval worsening of the interstitial lung disease seen at the
A60482 -        right lower lobe.  This, however, does appear to somewhat wax
A60483 -        and wane as it was improved on the prior exam and appears now
A60484 -        more similar to the study of February of 2008.  No other
A60485 -        significant interval changes. ref DRT 1 SP5F
A60487 -  ..
A60488 - Impression of stable condition shows no significant evidence that
A60489 - cancer is expanding, which aligns with visible observations of IBC
A60490 - rash areas stable to subsiding, cited in examination at UCSF on
A60491 - 080821. ref SDS 67 YW6M  Comparison of measured nodes today, per
A60492 - above, shows 6 months stable condition since February. ref SDS 73 4K5H
A60494 -  ..
A60495 - Stable findings seem conflicting with rising CA 15-3 reported on
A60496 - 080821. ref SDS 67 GP3M
A60498 -  ..
A60499 - Failure to comment on left supraclavicular where palpation on 080821
A60500 - identified swelling, ref SDS 67 4C6O, and which was noticed a week
A60501 - later on 080829 by the primary care physician at Kaiser, reported in a
A60502 - letter to the medical team, may reflect improvement, or failure to
A60503 - perform comprehensive review of scans, per above. ref SDS 73 5O6N
A60505 -  ..
A60506 - Failure to comment on "interstitional lung disease" may reflect
A60507 - improvement. ref SDS 73 TS4J
A60508 -
A60509 -        Chu, E, MD
A60510 -
A60511 -
A60512 -
A60513 -
A60514 -
A60515 -
A60516 -
A60517 -
A60518 -
A60519 -
A60520 -
A60521 -
A60522 -
A606 -