CONTACTS 

SUBJECTS
CT Test 080718 Report Received Condition  Sable Right Axilla Possibl

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 81 0000. ref SDS 73 0000.
110502 -
110503 -
110504 -
110505 -
110506 -
110507 -
110509 -  ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - CT Test on 081107 Second Report Neck Only Received from Kaiser
110902 -
110903 - Follow up ref SDS 81 6V5I, ref SDS 73 6V5I.
110904 -
110905 - Yesterday on 081112, Millie received ref DRP 10 0001 a letter dated
110906 - 081112 1410 from the primary care physician, ref SDS 81 6V5I, at
110907 - Kaiser in Walnut Creek transmitting the CT test on 081107. ref SDS 77
110908 - 3G5I  Review at that time on 081112 indicated mistakes failing to
110909 - report findings on left supraclavicular, ref SDS 81 5O6N, which are
110910 - prominent in patient history, and presenting findings on the right
110911 - supraclavicualr which has no patient history. ref SDS 81 5O6N
110913 -  ..
110914 - Millie sent a letter yesterday requesting clarification to resolve
110915 - evident mistakes in the report. ref SDS 80 WJ4W
110917 -  ..
110918 - Millie met with the medical team at UCSF this morning at 0830.  The
110919 - doctor asked about evident errors in the report for the CT test on
110920 - 081107 that cites adenopathy in the right supraclavicular and makes no
110921 - fingings for the left supraclavicular, which has a long patient
110922 - history of cancer, ref SDS 82 DP8J, including most recently biopsy on
110923 - 081023 finding relapse of cancer. ref SDS 76 4Q9Q  This glaring
110924 - conflict caused concern about errors in the CT test, causing the
110925 - doctor to request clarification from Kaiser CT Department. ref SDS 82
110926 - 9C9M
110928 -             ..
110929 -            [On 090409 2018 Doctor Davidson letter advises Kaiser made
110930 -            a mistake publishing multiple reports for each CT test that
110931 -            causes confusion and error presenting patient medical
110932 -            condition, ref SDS 90 L14I; advises future tests will
110933 -            consolidate findings into single report for each test that
110934 -            maintains a well ordered record for efficient case
110935 -            management essential to save lives, time, and money.
110936 -            ref SDS 90 XZ6U
110938 -  ..
110939 - After meeting with the UCSF, medical team at 0830, this afternoon at
110940 - 1247 Millie received ref DRT 1 0001 a letter dated today 081113 0852
110941 - from the primary care physician at Kaiser in Walnut Creek transmitting
110942 - a report on the 2nd part of the CT test for only the neck and
110943 - performed on 081107. ref SDS 77 FW6L  This supplements the report on
110944 - the CT test from below the neck, received yesterday on 081112.
110945 - ref SDS 81 RU6R
110947 -  ..
110948 - The 2nd report today on the CT test performed 081107 clarifies in part
110949 - questions on the 1st report received yesterday, which cited swelled
110950 - lymph nodes in the right supraclavicular and reported no adenopathy in
110951 - the left side. ref SDS 81 YO77
110952 -
110953 -            [On 090409 2018 Doctor Davidson, Director fo Radiology of
110954 -            Kaiser Mt Diablo Service Area, advised that Kaiser CT
110955 -            Department Walnut Creek made a mistake issuing multiple
110956 -            reports for the CT test on 090413, ref SDS 90 WB6G, and
110957 -            advised that findings for future CT tests will consolidate
110958 -            findings into a single report for each test. ref SDS 90
110959 -            XZ6U
110961 -  ..
110962 - The doctor's letter says...
110963 -
110964 -    1.  [Here is the report for the second CT test performed on
110965 -        November 7, 2008 at Kaiser in Walnut Creek, and for the neck
110966 -        only. ref SDS 0 DA6Q  This supplements the report for the CT
110967 -        test the same day on November 7, 2008 which tested below the
110968 -        neck]. ref DRT 1 0001
110970 -  ..
110971 - The primary care physician at Kaiser responds again to the letter
110972 - Millie submitted to Kaiser on 081111 requesting submission of test
110973 - reports in time for review, to be prepared for a productive meeting
110974 - with the medical team at UCSF on 081113. ref SDS 78 2E5P  Yesterday,
110975 - Millie sent a follow up letter reminding Kaiser to submit test
110976 - reports. ref SDS 79 SM7K
110977 -
110978 -               [On 081218 Tara advised that Kaiser did not submit to
110979 -               UCSF the 2nd report on the neck for the CT test on
110980 -               081107, and asked Millie to submit the report to UCSF.
110981 -               ref SDS 83 LM4I
110983 -                ..
110984 -               [On 081218 Millie submitted to UCSF the 2nd report on
110985 -               the neck for the CT test on 081107, which was requested
110986 -               during the meeting today on 081118. ref SDS 84 4B7N
110988 -                ..
110989 -               [On 081218 Millie's letter to Kaiser requests
110990 -               consolidated report for the CT test on 081230 in order
110991 -               to avoid confusion caused by Kaiser publishing multiple
110992 -               reports for the CT test on 081107. ref SDS 84 UY3T
110994 -                ..
110995 -               [On 081219 Millie met with primary care physician at
110996 -               Kaiser and requested clarifications of work order to
110997 -               consolidate findings into a single report for the CT
110998 -               test on 081230. ref SDS 85 PI5M
111000 -                ..
111001 -               [On 081230 Jennifer, CT Technologist at Kaiser CT
111002 -               Department in Walnut Creek CA added comments to the work
111003 -               order for the CT test to consolidate findings in a
111004 -               single report, ref SDS 86 FF8M, and to correct the test
111005 -               last month on 081107 by comparing with the previous test
111006 -               on 080911, rather than with the test on 080718.
111007 -               ref SDS 86 F34K
111008 -
111010 -        ..
111011 -       Test History No Evidence Distant Metastasis
111012 -       Distant Metastasis No Evidence 7 Years Imaging Tests
111013 -
111014 -       Follow up ref SDS 81 GM3N, ref SDS 73 GM3N.
111015 -
111016 -       Type    Date           Received          Source
111017 -    1.  CT     081107 reported on 081113 (neck).... ref SDS 0 DA6Q
111018 -        CT     081107 reported on 081112 (1st part) ref SDS 81 DA6Q
111019 -    2.  CT     080911 reported on 080912........... ref SDS 73 DA6Q
111020 -    3.  CT     080718 reported on 080723........... ref SDS 63 DA6Q
111021 -    4.  CT     080425 reported on 080428........... ref SDS 53 DA6Q
111022 -    5.  CT     080212 reported on 080215........... ref SDS 48 DA6Q
111023 -    6.  CT     071210 reported on 071213........... ref SDS 39 UG4L
111024 -    7.  CT     070930 reported on 071018........... ref SDS 36 VK8L
111025 -    8.  CT     070723 reported on 070802........... ref SDS 33 IM6M
111026 -    9.  CT     070520 reported on 070524........... ref SDS 32 DA6Q
111027 -   10.  CT     070326 reported on 070329........... ref SDS 31 DA6Q
111028 -   11.  CT     070131 reported on 070202........... ref SDS 29 1Y8G
111029 -   12.  PET/CT 061227 reported on 070102........... ref SDS 25 1Y8G
111030 -   13.  CT     060930 reported on 061012........... ref SDS 23 284J
111031 -   14.  MRI    060708 reported on 060711........... ref SDS 21 PT4K
111032 -   15.  Xray   060623 reported on 060711........... ref SDS 21 WJ6G
111033 -   16.  CT     060505 reported on 060523........... ref SDS 20 E355
111034 -   17.  PET    060414 reported on 060428........... ref SDS 19 WJ6G
111035 -   18.  PET    060120 reported on 060126........... ref SDS 18 WJ6G
111036 -   19.  PET/CT 051005 reported on 051007........... ref SDS 16 WJ6G
111037 -   20.  CT     050530 reported on 050610........... ref SDS 15 G75L
111038 -   21.  CT     050325 reported on 050422........... ref SDS 14 G75L
111039 -   22.  CT     041217 reported on 041230........... ref SDS 13 G75L
111040 -   23.  CT     041103 reported on 041104........... ref SDS 12 WV7H
111041 -   24.  CT     040921 reported on 041005........... ref SDS 10 NL4N
111042 -   25.  CT     040710 reported on 040811........... ref SDS 9 H85S
111043 -   26.  CT     040410 reported on 040416........... ref SDS 7 LK5L
111044 -   27.  CT     040307 reported on 040318........... ref SDS 6 LK5L
111045 -   28.  CT     031031 reported on 031205........... ref SDS 5 IG9K
111046 -   29.  CT     030626 reported on 030710........... ref SDS 4 AL6N
111047 -   30.  CT     030428 reported on 030508........... ref SDS 3 LK5L
111048 -   31.  PET    021218 reported on 030109........... ref SDS 2 LK5L
111049 -   32.  PET    020529 reported on 020603........... ref SDS 1 0001
111050 -
111052 -         ..
111053 -    1.  Patient
111061 -         ..
111062 -    2.  CT NECK (second report)
111063 -        ref DRT 1 6PUP
111065 -  ..
111066 - This is a second report that supplements the report received yesterday
111067 - on 081112 for the same CT scan test on 081107 and covering the chest,
111068 - abdomen, and pelvis. ref SDS 81 RU6R
111070 -  ..
111071 - Case study of patient history today shows Millie has had a total of 32
111072 - CT and PET scan tests beginning in 2002. ref SDS 0 GM3N  Of these, 11
111073 - have included both the neck, chest, abdomen, and pelvis. ref SDS 0
111074 - HV4H  At least one included the head.  There has never been a separate
111075 - report for the neck, until the report today for the test on 081107.
111076 -
111077 -            [On 090409 2018 Doctor Davidson, Director fo Radiology of
111078 -            Kaiser Mt Diablo Service Area, advised that Kaiser CT
111079 -            Department Walnut Creek made a mistake issuing multiple
111080 -            reports for the CT test on 090413, ref SDS 90 WB6G, and
111081 -            advised that findings for future CT tests will consolidate
111082 -            findings into a single report for each test. ref SDS 90
111083 -            XZ6U
111085 -  ..
111086 - Errors and omissions in health care are reported on 040416.
111087 - ref SDS 7 GN7J
111088 -
111089 -            [On 090109 1537 multiple reports issues separately again;
111090 -            Millie received from the primary care physician using
111091 -            Kaiser's Knowledge Management system an electronic
111092 -            submission of the report for Millie's the CT test on
111093 -            081230; the doctor submitted only 1 of the 2 reports
111094 -            prepared by the CT Department, ref SDS 88 V53J; mistakes
111095 -            performing case management reflect confusion that increased
111096 -            cost and delayed work, reported on 081219, ref SDS 85 T59G,
111097 -            and caused by failing to consolidate findings into a single
111098 -            report for the CT test, which was ordered by the doctor on
111099 -            081219. ref SDS 85 WP30
111100 -
111102 -  ..
111103 - CT test on 081107 2nd report of neck only continues...
111108 -         ..
111109 -        Date:  081107 1322
111111 -         ..
111112 -        Performed in:  WCR Outpatient in Walnut Creek
111113 -
111117 -
111118 -
111119 -
1112 -

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 81 IX4F, ref SDS 73 IX4F.
370406 -
370407 - CT test on 081107 2nd report of neck only continues...
370409 -         ..
370410 -    3.  HISTORY
370411 -
370412 -        72-year old female with history of invasive breast ca of the
370413 -        left breast who was initially diagnosed 3/4/02.  She had
370414 -        recurrent disease noted initially in the cervical lymph nodes
370415 -        3/3/04.  On E2100 study with Avastin she had a PE noted on CT
370416 -        11/3/04.  Then, because of progression of disease, the patient
370417 -        was started on Taxotere and Xeloda 4/15/05.  She had a total of
370418 -        8 cycles ending 9/16/05.  She had a palliative left mastectomy
370419 -        performed 10/21/05.  Then her left chest lesions began
370420 -        expanding again.  The patient started Taxotere and Xeloda again
370421 -        7/21/06 for 7 cycles.  She was started on a clinical trial
370422 -        2/1/07 at UCSF and was randomized to the Erbitux only (no
370423 -        carbo) arm.  She had weekly carboplatin added 3/13/08 because
370424 -        of progression of disease.  Her disease has progressed again
370425 -        and she is seen considered for Phase I/II study of Sunitinib
370426 -        (SU11248) at UCSF. ref DRT 1 XT8I
370428 -  ..
370429 - For some reason the doctor presented a slightly different patient
370430 - history for the 2nd part of the CT test on 081107 from the 1st part
370431 - reported yesterday on 081112. ref SDS 81 WQ5M
370433 -  ..
370434 - See comments for 1st part of the test. ref SDS 81 9W8F
370435 -
370437 -  ..
370438 - CT test on 081107 2nd report of neck only continues...
370439 -
370440 -    4.  TECHNIQUE:
370441 -
370442 -        Routine CT of the neck protocol utilized with IV contrast.  The
370443 -        study was performed in conjunction with the study of the CT of
370444 -        the chest, abdomen and pelvis. 150 ml IV Omnipaque 300 were
370445 -        administered in total for both exams. ref DRT 1 G84H
370447 -  ..
370448 - The doctor's clarification that this report supplements the report for
370449 - the chest, abdomen, and pelvis is very helpful; this is a day late,
370450 - because separate submission caused confusion and error applying the
370451 - first report earlier this morning at UCSF, because nobody was aware
370452 - there were multiple reports.
370454 -  ..
370455 - This explanation similar to technique for 1st part of CT test reported
370456 - yesterday on 081112. ref SDS 81 EO5N
370458 -  ..
370459 - CT test on 081107 2nd report of neck only continues...
370460 -
370461 -    5.  COMPARISON:
370462 -
370463 -        No prior neck CT is available for direct comparison.
370464 -        Comparison is made with images of chest CT 7/18/08. ref DRT 1
370465 -        KC4L
370467 -  ..
370468 - Test on 080718 was received from Kaiser and reviewed on 080723.
370469 - ref SDS 63 IX4F
370471 -  ..
370472 - See comments for the 1st part of the CT test reported in the record
370473 - yesterday on 081112. ref SDS 81 WU3F
370474 -
370476 -  ..
370477 - Case Study CT Tests Consolidated Report Neck Chest Abdomen Pelvis
370478 -
370479 - Patient history shows 11 CT and PET studies are available at Kaiser
370480 - for comparison of neck CT scan results on 081107, and further shows
370481 - all previous CT and PET scans were consolidated into a single report
370482 - for each test, rather than publish separate reports for a single test
370483 - as occurred for the CT test on 081107. ref SDS 0 RU6R
370484 -
370485 -    1.  CT test on 081107 for neck, chest, abdomen
370486 -        and pelvis, ref SDS 77 MX6K, reported
370487 -        separately for chest, abdomen and
370488 -        pelvis only............................ 081112, ref SDS 81 RU6R
370489 -        separate report for only the
370490 -        neck................................... 081113, ref SDS 0 RU6R
370492 -         ..
370493 -    2.  Doctor Daamen reviewed CT scans for Millie's
370494 -        CT tests on 080425 and the next test on
370495 -        080718 both performed at Kaiser in Walnut
370496 -        Creek and show enough of the neck to evaluate
370497 -        adenopathy in the left supraclavicular; the
370498 -        doctor further noted that the most recent
370499 -        CT test at Kaiser in Oakland on 080911 did
370500 -        not include enough of the neck to
370501 -        evaluate the node in the left
370502 -        supraclavicular........................ 081022, ref SDS 75 516F
370504 -         ..
370505 -    3.  PET/CT test on 061227 describe scope
370506 -        from the head and neck................. 070102, ref SDS 25 9X9Y
370507 -        and makes findings in left
370508 -        supraclavicular........................ 070102, ref SDS 25 9X4S
370510 -         ..
370511 -    4.  CT test on 060505 makes affirmative
370512 -        findings of no adenopathy in
370513 -        the neck............................... 060523, ref SDS 20 4R82
370515 -         ..
370516 -    5.  PET scan test on 060614 reports findings
370517 -        of cancer in left supraclavicular and
370518 -        recommends contrast CT study to
370519 -        correlate findings..................... 060428, ref SDS 19 MU5M
370520 -        pressaged relapse for patient
370521 -        and medical team to plan for treating
370522 -        cancer disgnosed....................... 060711, ref SDS 21 025H
370524 -         ..
370525 -    6.  CT test on 050530 was reported in the record
370526 -        meeting with the doctor in Oncology, and
370527 -        expressly includeded the neck, chest,
370528 -        and abdomen like the current
370529 -        test on 081107......................... 050610, ref SDS 15 QRTQ
370530 -        findings were consolidated into a
370531 -        single report.......................... 050610, ref SDS 15 WA8N
370532 -        unlike reporting received today for
370533 -        the test on 081107 which reported
370534 -        findings separately for
370535 -        the neck............................... 081107, ref SDS 0 RU6R
370537 -         ..
370538 -    7.  CT test on 050325 reported in the record
370539 -        meeting with the doctor in Oncology, and
370540 -        expressly includeded the neck, chest,
370541 -        and abdomen like the current
370542 -        test on 081107......................... 050422, ref SDS 14 QRTQ
370543 -        findings were consolidated into a
370544 -        single report.......................... 050422, ref SDS 14 WJ8J
370545 -        unlike reporting received today for
370546 -        the test on 081107 which reported
370547 -        findings separately for
370548 -        the neck............................... 081107, ref SDS 0 RU6R
370550 -         ..
370551 -    8.  CT test on 041103 reported in the record
370552 -        meeting with the doctor in Oncology, and
370553 -        expressly includeded the neck, chest,
370554 -        and abdomen like the current
370555 -        test on 081107......................... 041104, ref SDS 12 QRTQ
370556 -        findings were consolidated into a
370557 -        single report.......................... 041104, ref SDS 12 5F3R
370558 -        unlike reporting received today for
370559 -        the test on 081107 which reported
370560 -        findings separately for
370561 -        the neck............................... 081107, ref SDS 0 RU6R
370563 -         ..
370564 -    9.  CT test on 040921 reported in the record
370565 -        meeting with the doctor in Oncology, and
370566 -        expressly includeded the neck, chest,
370567 -        and abdomen like the current
370568 -        test on 081107......................... 041005, ref SDS 10 EG50
370569 -        findings were consolidated into a
370570 -        single report.......................... 041005, ref SDS 10 WV5W
370571 -        unlike reporting received today for
370572 -        the test on 081107 which reported
370573 -        findings separately for
370574 -        the neck............................... 081107, ref SDS 0 RU6R
370576 -         ..
370577 -   10.  CT test on 040710 reported in the record
370578 -        meeting with the doctor in Oncology, and
370579 -        expressly includeded the neck, chest,
370580 -        and abdomen like the current
370581 -        test on 081107......................... 040811, ref SDS 9 EG50
370582 -        findings were consolidated into a
370583 -        single report.......................... 040811, ref SDS 9 WV66
370584 -        unlike reporting received today for
370585 -        the test on 081107 which reported
370586 -        findings separately for
370587 -        the neck............................... 081107, ref SDS 0 RU6R
370589 -         ..
370590 -   11.  CT test on 040410 reported in the record
370591 -        meeting with the doctor in Oncology, and
370592 -        expressly includeded the head, neck, chest,
370593 -        and abdomen similar to the current
370594 -        test on 081107......................... 040416, ref SDS 7 EG50
370595 -        findings were consolidated into a
370596 -        single report.......................... 040416, ref SDS 7 039U
370597 -        unlike reporting received today for
370598 -        the test on 081107 which reported
370599 -        findings separately for
370600 -        the neck............................... 081107, ref SDS 0 RU6R
370602 -         ..
370603 -   12.  PET test on 021218 reported in the record
370604 -        meeting with the doctor in Oncology, and
370605 -        expressly includeded the head, neck, chest,
370606 -        and abdomen similar to the current
370607 -        test on 081107; findings were
370608 -        consolidated into a
370609 -        single report.......................... 030109, ref SDS 2 GJ4S
370610 -        unlike reporting received today for
370611 -        the test on 081107 which reported
370612 -        findings separately for
370613 -        the neck............................... 081107, ref SDS 0 RU6R
370614 -
370615 -
370616 -
370617 -
370618 -
3707 -

SUBJECTS
Right Axillary Lymph Node Minimally Enlarged CT Test 080212 Findings

6603 -
660401 -  ..
660402 - CT test on 081107 2nd report of neck only continues...
660403 -
660404 -   13.  FINDINGS
660406 -  ..
660407 - Findings Progression Lymphadenophathy Right Supraclavicular
660408 - Right Supraclavicular Adenopathy New Findings Progression Cancer
660409 - Lymphadenophathy Progression of Cancer CT Test 081107 Right Side Neck
660410 -
660411 - Follow up ref SDS 81 4K5H, ref SDS 73 4K5H.
660412 -
660413 -        a.  Tubing from right sided central venous line is noted.
660414 -            ref DRT 1 YL5F
660416 -             ..
660417 -        b.  Numerous enlarged supraclavicular lymph nodes are seen
660418 -            bilaterally.  These are much more prominent on the right
660419 -            than the left.  Size of the supraclavicular nodes have
660420 -            increased from the prior exam.  The largest node on the
660421 -            right now measures 1 cm in diameter (image 36).  This
660422 -            previously measured 9 mm on the exam 7/18/08. ref DRT 1
660423 -            GP5K
660425 -  ..
660426 - These are entirely new findings.  Reporting "nodes have increased" is
660427 - startling and misleading.  The report on 080912 for the test on 080911
660428 - makes no mention of adenopathy in supraclavicular regions. ref SDS 73
660429 - 5O6N  The report on 080723 for the test 0n 080718 also does not
660430 - present findings for the right nor left supraclavicular. ref SDS 63
660431 - EO8F
660433 -  ..
660434 - This 2nd report helps clarify misleading findings in the 1st report by
660435 - presenting evidence that aligns with results of biopsy on 081022 that
660436 - found cancer in the left supraclavicular, reported on 081023.
660437 - ref SDS 76 4Q9Q; the 2nd report too late to prevent complexity,
660438 - confusion, and error applying CT test data in the meeting at UCSF
660439 - earlier this morning in San Francisco. ref SDS 82 DP8J
660441 -  ..
660442 - Correlating this second report with the first report takes time and
660443 - causes mistakes due to rising complexity that prevents a well ordered
660444 - record essential for effective case management, explained in POIMS.
660445 - ref OF 7 1113  Issuing multiple reports for the same test days apart
660446 - increases potential for medical mistakes.
660448 -                ..
660449 -               [On 081218 Tara advised that Kaiser did not submit to
660450 -               UCSF the 2nd report on the neck for the CT test on
660451 -               081107, and asked Millie to submit the report to UCSF.
660452 -               ref SDS 83 LM4I
660454 -                ..
660455 -               [On 081218 Millie submitted to UCSF the 2nd report on
660456 -               the neck for the CT test on 081107, which was requested
660457 -               during the meeting today on 081118. ref SDS 84 4B7N
660459 -                ..
660460 -               [On 081218 Millie's letter to Kaiser requests
660461 -               consolidated report for the CT test on 081230 in order
660462 -               to avoid confusion caused by Kaiser publishing multiple
660463 -               reports for the CT test on 081107. ref SDS 84 UY3T
660465 -                ..
660466 -               [On 081219 Millie met with primary care physician at
660467 -               Kaiser and requested clarifications of work order to
660468 -               consolidate findings into a single report for the CT
660469 -               test on 081230. ref SDS 85 PI5M
660471 -                ..
660472 -               [On 081230 Jennifer, CT Technologist at Kaiser CT
660473 -               Department in Walnut Creek CA added comments to the work
660474 -               order for the CT test to consolidate findings in a
660475 -               single report, ref SDS 86 FF8M, and to correct the test
660476 -               last month on 081107 by comparing with the previous test
660477 -               on 080911, rather than with the test on 080718.
660478 -               ref SDS 86 F34K
660480 -                ..
660481 -               [On 090109 1537 Millie received from the primary care
660482 -               physician using Kaiser's Knowledge Management system an
660483 -               electronic submission of the report for Millie's the CT
660484 -               test on 081230; the doctor submitted only 1 of the 2
660485 -               reports prepared by the CT Department, ref SDS 88 V53J;
660486 -               mistakes performing case management reflect confusion
660487 -               that increased cost and delayed work, reported on
660488 -               081219, ref SDS 85 T59G, and caused by failing to
660489 -               consolidate findings into a single report for the CT
660490 -               test, which was ordered by the doctor on 081219.
660491 -               ref SDS 85 WP30
660493 -                ..
660494 -               [On 090226 1342 radiation treatment plan does not list
660495 -               right axillary, perhaps suggesting belief that stable
660496 -               condition of right axillary nodes indicates these nodes
660497 -               are not cancer. ref SDS 89 D452
660499 -  ..
660500 - Findings of numerous lymph nodes infected with cancer in the report
660501 - for the CT test of the neck on 081107 conflict with the record on
660502 - 080912 that omission of finding on testing indicates no change or
660503 - negligible findings, ref SDS 71 HI8N, which was requested for
660504 - clarification in a follow up letter to Kaiser on 080912. ref SDS 72
660505 - O664
660507 -  ..
660508 - Findings CT test on 081107 2nd report of neck only continues...
660509 -
660510 -        c.  Note is also made of multiple enlarged irregularly shaped
660511 -            right axillary lymph nodes.  These are better evaluated on
660512 -            the chest CT. ref DRT 1 YQ3I
660514 -  ..
660515 - Findings of enlarged lymph nodes in the right axillary are reported
660516 - yesterday on 080912 for the primary CT test on 081107 that scanned
660517 - below the neck. ref SDS 81 4K5H
660518 -
660519 -
660521 -  ..
660522 - Left Supraclavicular Findings Align with Examinations UCSF and Kaiser
660523 -
660524 - Follow up ref SDS 81 5O6N, ref SDS 73 5O6N.
660525 -
660526 - Findings CT test on 081107 2nd report of neck only continues...
660528 -             ..
660529 -        d.  A 5 mm supraclavicular node is seen on the left as well.
660530 -            In addition, there is enhancing irregularly shaped mass
660531 -            seen in the left supraclavicular region near the tail of
660532 -            the sternocleidomastoid muscle.  This is seen best on image
660533 -            33.  It measures 1.2 x 1.3 cm in transverse diameter.  I do
660534 -            not appreciate this on the prior exam but it may have been
660535 -            excluded.  This may represent a direct tumor implant or an
660536 -            enlarged irregularly shaped node. ref DRT 1 6Q6I
660537 -
660538 -               [On 090107 1058 CT test on 081230 reports the large
660539 -               lymph node mass in image #33 is no longer visible.
660540 -               ref SDS 87 QS7G
660542 -  ..
660543 - This finding for the 2nd report on the CT scan test on 081107 corrects
660544 - errors and omissions in the 1st report received in the record
660545 - yesterday on 081112. ref SDS 81 5O6N
660547 -  ..
660548 - On 080821 palpation during examination at UCSF reported feeling a
660549 - slight lump in left supraclavicular region. ref SDS 67 4C6O  This was
660550 - noted again by primary care physician during follow up examination at
660551 - Kaiser on 080829, noted in letter to medical team. ref SDS 69 RP8T
660553 -  ..
660554 - On 080918 Brigid could not find swelling in the left supraclavicular,
660555 - which may align with the CT test not reporting findings in this area.
660556 - ref SDS 74 N65G
660558 -  ..
660559 - On 081022 Doctor Daamen takes biopsy of swelled lymph node in left
660560 - supraclavicular, and reviews CT test on 080911, and says the scans did
660561 - not include enough of the neck to evaluate the node in the left
660562 - supraclavicular. ref SDS 75 516F
660564 -  ..
660565 - On 081023 report on biopsy performed 081022 shows lymph node in left
660566 - supraclavicular positive for cancer. ref SDS 76 4Q9Q
660568 -  ..
660569 - Findings CT test on 081107 2nd report of neck only continues...
660570 -
660571 -        e.  Within the neck itself, few shotty, nonenlarged lymph nodes
660572 -            are seen in the right jugulodigastric region and right
660573 -            posterior triangle.  The largest of these nodes measures 7
660574 -            mm. ref DRT 1 WS3N
660576 -             ..
660577 -        f.  The nasopharynx and oropharynx appear unremarkable.  The
660578 -            parotid glands and submandibular glands appear symmetric
660579 -            and normal. ref DRT 1 QS4I
660581 -             ..
660582 -        g.  Visualized portions of the brain appear unremarkable.
660583 -            ref DRT 1 NF5F
660584 -
660586 -  ..
660587 - Thyroid Gland Findings Describe Unchanged
660588 -
660589 - Follow up ref SDS 81 NB3L, ref SDS 73 NB3L.
660590 -
660591 - Findings CT test on 081107 2nd report of neck only continues...
660592 -
660593 -        h.  Thyroid gland...
660594 -
660595 -            5 mm hypodensity is seen in the right lobe of the thyroid
660596 -            (image 33).  This is unchanged from previous studies.
660597 -            Focal scarring is again seen in the left lung apex.
660598 -            ref DRT 1 FT4N
660600 -  ..
660601 - Seems to align with 1st part of CT test on 081107 from the neck down,
660602 - reported on 081112, ref SDS 81 NB3L, and further reflecting the CT
660603 - test on 080718, reported in the record on 080723. ref SDS 63 NB3L
660605 -  ..
660606 - There is no evident description of "thyroid" in the CT test report
660607 - received from Kaiser on 080428. ref SDS 53 RV70
660608 -
660610 -  ..
660611 - Worsening Cancer Supraclavicular Bilaterally
660612 -
660613 - Follow up ref SDS 81 FY5O, ref SDS 73 FY5O.
660614 -
660615 - CT test on 081107 2nd report of neck only continues...
660617 -         ..
660618 -   14.  IMPRESSION
660619 -
660620 -        Worsening supraclavicular adenopathy bilaterally.  The
660621 -        adenopathy is greater on the right than the left.  However,
660622 -        there is a prominent irregular shaped enhancing mass seen in
660623 -        the superior left neck/supraclavicular region near the tail of
660624 -        the left sternocleidomastoid muscle.  This measures 1.2 x 1.3
660625 -        cm and may represent an enlarged node or focal metastatic
660626 -        implant.  Adenopathy in the right axillae appreciated.  This is
660627 -        better evaluated on chest CT however.  No significant
660628 -        adenopathy within the neck itself. ref DRT 1 OU5I
660630 -  ..
660631 - See analysis of findings in right supraclavicular conflict with
660632 - patient history. ref SDS 0 HW8M
660633 -
660634 -
660635 -
660636 -
660637 -
660638 -
6607 -