THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: April 15, 2009 04:42 PM Wednesday;
CT test Apr 13th for Millie received from Kaiser no distant metastasis.
2...CT Test on 090413 Report Received from Kaiser
........Test History No Evidence Distant Metastasis
........Distant Metastasis No Evidence 7 Years Imaging Tests
....2...CT NECK, CHEST, ABDOMEN AND PELVIS
3...Errors Omissions Comparisons Patient History Trend Analysis
4...Patient History Comparison PE Cor Pulmonale Esophigitis Enlarged Heart
5...Thyroid Gland Findings Described Unchanged Not Presented in Prior Test
6...Findings Stable No Progression Lymphadenophathy Since February
7...Right Axillary 3 Lymph Node Stable No Evidence Progression Disease
8...Stable Lymphadenophathy No Progression of Cancer CT Test 080911
9...Distant Metastasis No Evidence Disease NED Stable No Progression
10...Left Axilla Stable No Evidence Disease NED Unchanged Prior Test
11...Hilar Left Side Lymph Node 5 MM Stable No Right Hilar Adenopathy
12...CT Tests Find Ground Glass Opacities Early Signs Cancer
13...Lungs 4 Nodes Appear More Conspicuous than on Prior Studies
14...Ground Glass Opacities Nodular Densities Appear More Prominent
15...Cancer Early Signs Ground Glass Opacities Identified by CT Tests
............Ground-glass opacity is a non-specific term that refers to
............Limited Excision Found Successful for Ground Glass Lung
............Lesions: Presented at STS
............Ground Glass Opacities Early Lung Cancers
............Radiation Ground Glass Opacities Lung Injuries
............Radiation Side Effects Ground Glass Opacities Lung Injuries
............Ground Glass Opacities Radiation Side Effects Lung Damage
............Radiation injury: imaging findings in the chest, abdomen
............and pelvis after therapeutic radiation
16...Cetuximab Side Effects Interstitial Disease CT Test Finding
17...Interstitial Disease Lungs No Findings Reported CT Test 080911
18...Hepatic Dome Liver Lesions Continue Stable
19...Spleen Calcifications Granulamatous Disease
20...Granulamatous Disease Spleen Calcifications
21...Kidneys Gallbladder Adrenal Appear Unchanged
22...Colon Bowel Hiatal Hernia Diverticulitis No evidence
23...Bowel Colon Hiatal Hernia Diverticulitis No evidence
24...Diverticulitis No evidence Colon Bowel Hiatal Hernia
25...Hiatal Hernia Diverticulitis No evidence Colon Bowel
26...Abdominal Aorta No Aneurysm No Adenopathy
27...Pelvis Splenic Artery Calcification Aneurysms
28...Spine Lower Lumbar Degenertive Changes in Disks Facet Joints
29...May be Increased Lymph Nodes Right Axilla Interstitial Disease
Click here to comment!
CT Test 090413 Report Received Condition Iproved Right Axilla and L
1603 - ..
1604 - Summary/Objective
160501 - Follow up ref SDS A0 0000. ref SDS 84 0000.
160508 - ..
1608 - Progress
160901 - CT Test on 090413 Report Received from Kaiser
160903 - Follow up ref SDS A0 6V5I, ref SDS 84 6V5I.
160905 - Millie had a CT test at Kaiser in Walnut Creek CA on 090413 1500.
160906 - ref SDS A8 SO3G This morning, Millie sent a letter to the medical
160907 - team coordinating getting results of the test from Kaiser for
160908 - distribution at UCSF. ref SDS B0 KG9X
160910 - ..
160911 - This afternoon Millie notified the medical team about new resperatory
160912 - symptoms of cough and heavy chest that began to gradually occur from a
160913 - week earlier, shown in Millie's letter on 090415 1424. ref SDS B1 GU8X
160915 - ..
160916 - After sending the letter on 090415 1424, Arlette advised in a
160917 - telephone call at 1454 from Kaiser that the CT test on 090413 shows
160918 - progression of nodules in the lungs; she advised this often indicates
160919 - lung cancer, shown in the record on 090415 0911. ref SDS A9 RW9K
160920 - Millie was worred that the CT test report reflects new symptoms of
160921 - cough and heavy chest, that began a week earlier; Arlette planned to
160922 - notify the doctor immediately to take timely action, ref SDS A9 CX6N,
160923 - responding to Millie report of new symptoms on 090415 1424.
160924 - ref SDS B1 GU8X
160926 - ..
160927 - Doctor Johnson called today on 090415 1519 after talking to Arlette
160928 - about CT test reporting progression of nodules in the lungs, and
160929 - responding to Millie's letter also on 090415 1424 asking about
160930 - symptoms of heavy chest. ref SDS B2 GT4M The doctor said he reviwed
160931 - the CT scans and found evidence showing only minimal increase of
160932 - nodules in the lungs, and this would not cause resperatory problems.
160933 - ref SDS B2 E09J
160935 - ..
160936 - Asked the doctor to submit a letter confirming his findings.
160937 - ref SDS B2 E049
160939 - ..
160940 - Millie received ref DRT 1 0001 from Doctor Johnson at Kaiser in Walnut
160941 - Creek, CA, transmitting the report for the CT test a few days ago on
160942 - 090413. ref SDS A8 0E4I
160944 - ..
160945 - This report consolidates findings for the CT test, as ordered by
160946 - Doctor Davidson in a letter on 090409 2018. ref SDS A7 XZ6U
160948 - ..
160949 - Case study on 081113 shows Millie's CT tests that include the neck
160950 - have always been consolidated into a single report for consideration
160951 - by the doctor performing examinations and prescribing treatment.
160952 - ref SDS 87 HV4H
160954 - ..
160955 - The doctor's letter says...
160957 - 1. [I am submitting findings from your CT test at Kaiser on April
160958 - 13, 2009], ref DRT 1 0001
160960 - ..
160961 - 2. Spoke with [you the] patient and Rod regarding the most current
160962 - CT findings [for the test on April 13, 2009 reporting
160963 - progression of nodules with "ground glass" opacities in the
160964 - lungs, per below. ref SDS 0 RV78]. The changes are are minimal
160965 - and certainly should not be causing and respiratory
160966 - compromise:, ref DRT 1 885L
160968 - [On 090416 0010 Millie's letter to medical team confirms
160969 - understandings from Doctor Johnson's call today, and
160970 - transmits his letter this afternoon confirming
160971 - understandings from his call, including transmitting the
160972 - report on findings from the CT test on 090413. ref SDS B4
160973 - 835R
160975 - ..
160976 - [On 090514 0830 Doctor Rugo seemed to clarify a month later
160977 - during a meeting at UCSF that slight increase in "ground
160978 - glass opacities" listed in Millie's CT test on 090413, and
160979 - reviewed on 090415, see below, ref SDS 0 RV78, were likely
160980 - progressing and therefore cause breathing problems due to
160981 - radiation injury. ref SDS B6 U85I
160984 - ..
160985 - Test History No Evidence Distant Metastasis
160986 - Distant Metastasis No Evidence 7 Years Imaging Tests
160988 - Follow up ref SDS A0 GM3N, ref SDS 84 GM3N.
160990 - Type Date Received Source
160991 - 1. CT 090413 reported on 090415........... ref SDS 0 DA6Q
160992 - 2. CT 081230 reported on 090107.(neck).... ref SDS A0 DA6Q
160993 - CT 081230 reported on 090107.(1st part) ref SDS A0 5O6N
160994 - 3. CT 081107 reported on 081113 (neck).... ref SDS 87 DA6Q
160995 - CT 081107 reported on 081112 (1st part) ref SDS 84 DA6Q
160996 - 4. CT 081107 reported on 081112........... ref SDS 84 DA6Q
160997 - 5. CT 080911 reported on 080912........... ref SDS 73 DA6Q
160998 - 6. CT 080718 reported on 080723........... ref SDS 63 DA6Q
160999 - 7. CT 080425 reported on 080428........... ref SDS 53 DA6Q
161000 - 8. CT 080212 reported on 080215........... ref SDS 48 DA6Q
161001 - 9. CT 071210 reported on 071213........... ref SDS 39 UG4L
161002 - 10. CT 070930 reported on 071018........... ref SDS 36 VK8L
161003 - 11. CT 070723 reported on 070802........... ref SDS 33 IM6M
161004 - 12. CT 070520 reported on 070524........... ref SDS 32 DA6Q
161005 - 13. CT 070326 reported on 070329........... ref SDS 31 DA6Q
161006 - 14. CT 070131 reported on 070202........... ref SDS 29 1Y8G
161007 - 15. PET/CT 061227 reported on 070102........... ref SDS 25 1Y8G
161008 - 16. CT 060930 reported on 061012........... ref SDS 23 284J
161009 - 17. MRI 060708 reported on 060711........... ref SDS 21 PT4K
161010 - 18. Xray 060623 reported on 060711........... ref SDS 21 WJ6G
161011 - 19. CT 060505 reported on 060523........... ref SDS 20 E355
161012 - 20. PET 060414 reported on 060428........... ref SDS 19 WJ6G
161013 - 21. PET 060120 reported on 060126........... ref SDS 18 WJ6G
161014 - 22. PET/CT 051005 reported on 051007........... ref SDS 16 WJ6G
161015 - 23. CT 050530 reported on 050610........... ref SDS 15 G75L
161016 - 24. CT 050325 reported on 050422........... ref SDS 14 G75L
161017 - 25. CT 041217 reported on 041230........... ref SDS 13 G75L
161018 - 26. CT 041103 reported on 041104........... ref SDS 12 WV7H
161019 - 27. CT 040921 reported on 041005........... ref SDS 10 NL4N
161020 - 28. CT 040710 reported on 040811........... ref SDS 9 H85S
161021 - 29. CT 040410 reported on 040416........... ref SDS 7 LK5L
161022 - 30. CT 040307 reported on 040318........... ref SDS 6 LK5L
161023 - 31. CT 031031 reported on 031205........... ref SDS 5 IG9K
161024 - 32. CT 030626 reported on 030710........... ref SDS 4 AL6N
161025 - 33. CT 030428 reported on 030508........... ref SDS 3 LK5L
161026 - 34. PET 021218 reported on 030109........... ref SDS 2 LK5L
161027 - 35. PET 020529 reported on 020603........... ref SDS 1 0001
161029 - ..
161030 - 1. Patient
161038 - ..
161039 - 2. CT NECK, CHEST, ABDOMEN AND PELVIS
161041 - Kaiser issued 1 report, recieved from Doctor Johnson today,
161042 - ref DRT 1 0001, per above, ref SDS 0 YO7M, and as ordered by
161043 - Doctor Davidson in his letter on 090409. ref SDS A7 XZ6U
161045 - ..
161046 - This report corrects problems reporting findings on prior CT tests
161047 - that issued separate reports on the neck and for below the neck, shown
161048 - in the record on 090107, ref SDS A0 RU6R, for the test on 081230,
161049 - ref SDS 96 JR4L, and which repeated mistakes on the prior test on
161050 - 081107, and reported on 081113. ref SDS 87 YO7M and ref SDS 87 RU5N
161052 - ..
161053 - Kaiser's consolidated report received today for the CT test on 090413
161054 - implements the doctor's referral order issued on 080325 requesting a
161055 - consolidated report. ref SDS A5 LX5J
161057 - [On 090617 0842 radiology report on Millie's CT test on
161058 - 090612 was again issued in multiple, separate, and
161059 - overlapping reports, ref SDS B0 6V4S, contrary to Doctor
161060 - Davidson's instructions today, per above, ref SDS A7 XZ6U;
161061 - Al Hutchins, Manager of Reporting for Radiology, apologized
161062 - for continuing difficulty implementing policy to use good
161063 - management that avoids mistakes. ref SDS B0 6V5I
161065 - ..
161066 - Consolidating findings for the CT test on 090413 into a single report
161067 - further implements instructions on 090409 2018 set out by Doctor
161068 - Davidson, Chief of Radiology for the Diablo Service Area, in a letter
161069 - disclosing that Kaiser made mistakes publishing multiple reports for
161070 - each CT test, because expanding the record increases complexity which
161071 - causes confusion and error presenting patient medical condition.
161072 - ref SDS A7 L14I At that time on 090409 Doctor Davidson advised that
161073 - future tests will consolidate findings into a single report for each
161074 - test, and for the purpose of providing a well ordered record essential
161075 - for efficient case management required to save lives, time, and money.
161076 - ref SDS A7 XZ6U
161079 - ..
161080 - CT test 090413 report continues...
161082 - Performed in: WCR Outpatient in Walnut Creek
CT Test 080212 Report Errors Omissions Comparisons Patient History T
420401 - ..
420402 - Errors Omissions Comparisons Patient History Trend Analysis
420403 - Patient History Comparison PE Cor Pulmonale Esophigitis Enlarged Heart
420405 - Follow up ref SDS A0 IX4F, ref SDS 84 IX4F.
420407 - ..
420408 - CT test 090413 report continues...
420410 - 3. HISTORY
420412 - Metastatic IBC s/p chest wall hyperthermia and XRT. ref DRT 1
420413 - EI8J
420415 - ..
420416 - Problems with history on prior tests failing to provide context for
420417 - reporting on CT test scans reported for the test on 080911, reviewed
420418 - 080912, ref SDS 73 9W8F, are repeated today, rather than continue with
420419 - scope applied by the analyst for the most recent prior test on 081107
420420 - extracting the summary of patient history in the medical chart for
420421 - Millie's meeting with the primary care physician at Kaiser on 081024.
420423 - ..
420424 - Tracking patient history enables the analyst to investigate changes on
420425 - critical issues, cited previously as problematic on 080912.
420426 - ref SDS 73 MB6F
420428 - ..
420429 - The report today repeats errors and omissions listed in the report for
420430 - the prior test listed on 080215. ref SDS 48 IX4L
420432 - ..
420433 - CT test 090413 report continues...
420435 - 4. TECHNIQUE:
420437 - Routine CT scan of the neck, chest, abdomen and pelvis with
420438 - oral and IV contrast. ref DRT 1 BM9G
420440 - ..
420441 - CT test 090413 report continues...
420443 - 5. COMPARISON:
420445 - CT test 12/30/08....................... ref DRT 1 BJ9K
420447 - ..
420448 - This is a mistake, repeating past error.
420450 - ..
420451 - There were 2 tests on 081230, assume the test on 090413 for the neck,
420452 - chest, abdomen, and pelvis, compared with the test on 081230 on the
420453 - neck which was received on 090107. ref SDS A0 RU6R
420455 - ..
420456 - Assume comparison for the test today on the chest, abdomen, and pelvis
420457 - compares with the same scope for the 2nd report on 090107. ref SDS A0
420458 - RU6R
420460 - ..
420461 - Errors and omissions performing test comparisons reported in case
420462 - study on 061012. ref SDS 23 A55J
420464 - ..
420465 - Case study on medical mistakes reported on 040416. ref SDS 7 GN7J
Right Axillary Lymph Node Minimally Enlarged CT Test 080212 Findings
710401 - ..
710402 - CT test 090413 report continues...
710404 - 6. FINDINGS
710406 - ..
710407 - Neck Supraclavicular
710409 - Follow up ref SDS A0 5O6N.
710411 - 1. There are stable supraclavicular lymph nodes. ref DRT 1
710412 - XB9M
710414 - ..
710415 - Does this mean conditions in the right side previously described as
710416 - "decreased" with 1 node 9 mm is still the same? ref SDS A0 5O6N
710418 - ..
710419 - Does this mean conditions on the left supraclavicular found for the CT
710420 - test on 081107, and reported on 081113, ref SDS 87 5O6N, that
710421 - supported diagnosis of cancer relapse, i.e., progression, on 081016,
710422 - and were reported no longer visualized in the test on 081230, reported
710423 - in the record on 090107, ref SDS A0 QS7G, have remained "resolved,"
710425 - ..
710426 - There is still no evident correlation to previous test on 081107
710427 - reported on 081113 for right supraclavicular, ref SDS 87 OO6M, nor for
710428 - the left supraclavicular. ref SDS 87 5O6N
710431 - ..
710432 - Thyroid Gland Findings Described Unchanged Not Presented in Prior Test
710434 - Follow up ref SDS A0 NB3L, ref SDS 84 NB3L.
710436 - CT test 090413 report continues...
710438 - 2. Thyroid gland...
710440 - Redemonstration of nonspecific small thyroid lesions.
710441 - ref DRT 1 JC4F
710443 - ..
710444 - Aligns with test on 081107, reported on 081113, ref SDS 87 NB3L, and
710445 - with the prior test on 081230, reported on 090107. ref SDS A0 NB3L
Right Axillary Lymph Node Minimally Enlarged CT Test 080212 Findings
A00401 - ..
A00402 - Findings Stable No Progression Lymphadenophathy Since February
A00403 - Right Axillary 3 Lymph Node Stable No Evidence Progression Disease
A00404 - Stable Lymphadenophathy No Progression of Cancer CT Test 080911
A00405 - Distant Metastasis No Evidence Disease NED Stable No Progression
A00407 - Follow up ref SDS A0 4K5H, ref SDS 84 4K5H.
A00409 - CT test 090413 report continues...
A00411 - ..
A00412 - 3. There is decrease in size in the previously identified
A00413 - prominent right axillary lymph node. There are multiple
A00414 - small nodular soft tissue densities involving the right
A00415 - axillae with associated stranding of fat. The degree of
A00416 - stranding of fat has increased since the previous
A00417 - examination. There is also an increase in the number of
A00418 - small soft tissue nodular opacities. ref DRT 1 PX4I
A00420 - ..
A00421 - Decrease in previous prominent right axillary lymph node, since the
A00422 - prior test on 081230, reported on 090107, ref SDS A0 4K5H, sounds very
A00423 - helpful, suggesting continued recovery since ending radiation and
A00424 - hyperthermia on 090317.
A00426 - ..
A00427 - Analyst repeats new practice of failing to present specific details
A00428 - reported the past year, and cited as missing in the report for the
A00429 - pior test on 081230, shown in the record 090107. ref SDS A0 YH54
A00431 - ..
A00432 - Problems with image test reporting were previously reviewed on 040416,
A00433 - and reflect continuing quality care problems, ref SDS 7 PTSX, though
A00434 - recently significant improvement seemed to occur in some areas; yet,
A00435 - today there was reduced support. ref SDS A0 YH54 Variability in
A00436 - quality of radiology reporting places patients and Kaiser at risk.
Default Null Subject Account for Blank Record
A10401 - ..
A10402 - Left Axilla Stable No Evidence Disease NED Unchanged Prior Test
A10404 - Follow up ref SDS A0 WM9L, ref SDS 84 WM9L.
A10406 - ..
A10407 - CT test 090413 report continues...
A10409 - ..
A10410 - There is no report on the left axillary, perhaps reflecting long
A10411 - standing prior findings from beginning of year and before, shown from
A10412 - prior test on 081107, and reported on 081112. ref SDS 83 WM9L
Default Null Subject Account for Blank Record
A20401 - ..
A20402 - Hilar Left Side Lymph Node 5 MM Stable No Right Hilar Adenopathy
A20404 - Follow up ref SDS A0 5H6F, ref SDS 84 5H6F.
A20406 - CT test 090413 report continues...
A20408 - 4. The hilar and mediastinal regions are stable, ref DRT 1
A20409 - YY5G,
A20411 - ..
A20412 - Aligns wtih the test on 081230 reported on 090107, ref SDS A0 5H6F,
A20413 - and continues alignment with favorable finding for the test on 081117
A20414 - reported on 081112. ref SDS 83 5H6F
Default Null Subject Account for Blank Record
A30401 - ..
A30402 - CT Tests Find Ground Glass Opacities Early Signs Cancer
A30403 - Lungs 4 Nodes Appear More Conspicuous than on Prior Studies
A30404 - Ground Glass Opacities Nodular Densities Appear More Prominent
A30405 - Cancer Early Signs Ground Glass Opacities Identified by CT Tests
A30407 - Follow up ref SDS A0 RV78, ref SDS 84 RV78.
A30409 - ..
A30410 - CT test 090413 report continues...
A30412 - 5. Reticular nodular densities are seen involving the lingula
A30413 - which demonstrate progression since the previous
A30414 - examination. There are patchy reticular nodular densities
A30415 - as well as ground glass opacities involving bilateral lung
A30416 - zones which appear more conspicuous since the previous
A30417 - examination. This is partly related to difference in
A30418 - technique between the two studies. ref DRT 1 TJ5J
A30420 - [...earlier today on 090415 1642 Doctor Johnson's letter
A30421 - confirms telecon that findings in CT test on 090413 does
A30422 - not show any concern for loss of respiratory function,
A30423 - per above. ref SDS 0 YO7M
A30425 - ..
A30426 - [On 090416 0010 Millie's letter to medical team confirms
A30427 - understandings from Doctor Johnson's call today, and
A30428 - transmits his letter this afternoon confirming
A30429 - understandings from his call, including transmitting the
A30430 - report on findings from the CT test on 090413.
A30431 - ref SDS B4 835R
A30433 - ..
A30434 - [On 090510 1953 Millie notifies medical team breathing
A30435 - problems worsening shown by persistant cough and
A30436 - clearing throat. ref SDS B5 LJ6T
A30438 - ..
A30439 - [On 090514 0830 Doctor Rugo seemed to clarify a month
A30440 - later during a meeting at UCSF that slight increase in
A30441 - ground glass opacities listed in Millie's CT test on
A30442 - 090413, and reviewed today on 090415, per above,
A30443 - ref SDS B3 RV78, were likely progressing and therefore
A30444 - cause breathing problems due to radiation injury, rather
A30445 - than spread of cancer. ref SDS B6 U85I
A30447 - ..
A30448 - [On 090608 0900 Doctor Hsu diagnosed Millie suffering
A30449 - painful breathing from radiation injury caused by
A30450 - medical mistakes getting radiation services at UCSF on
A30451 - referral from Kaiser. ref SDS B8 QG8F
A30453 - ..
A30454 - [On 090616 1245 Doctor Rugo requested Kaiser's radiology
A30455 - report for Millie's CT test on 090612 in order to check
A30456 - for progression of ground glass opacities in the lungs
A30457 - which contributes to evaluating Doctor Hsu's concern on
A30458 - 090609 that medical mistakes performing radiation in
A30459 - Feb-Mar failing to treat IBC in the breastbone area
A30460 - could be causing problems in Millie's lungs that explain
A30461 - recent loss of breathing capacity, and excessive
A30462 - coughing. ref SDS B9 D644
A30464 - ..
A30465 - [On 090617 1737 nodules of ground glass opacities,
A30466 - atelectasis and bronchiectasis, and biapical scarring in
A30467 - lungs reported new findings from CT test on 090612,
A30468 - align with Doctor Hsu's report today that radiation has
A30469 - continued effects for months after ending treatment.
A30470 - ref SDS C1 RV78
A30472 - ..
A30473 - [On 100302 0830 CT test on 100218 shows recovery from
A30474 - radiation injury because ground glass opacity nodules
A30475 - are reduced in Millie's lungs, aligns with improved
A30476 - breathing shown by resuming hiking. ref SDS C3 FB85
A30478 - ..
A30479 - Research shows....
A30481 - Lingual (latin = "tonge") seems to be a small protruding
A30482 - section at the bottom of lungs on only the left lobe, and
A30483 - is said to be equivalent to the middle lobe of the right
A30484 - lung.
A30486 - ..
A30487 - Middle lobe the portion of the right lung supplied by the
A30488 - middle lobar bronchus is found in the right lung only; it
A30489 - possesses 2 bronchopulmonary segments: medial and lateral;
A30490 - lingula of the inferior lobe of the left lung is equivalent
A30491 - to the middle lobe of the right lung
A30493 - ..
A30494 - Ground-glass opacity is a non-specific term that refers to
A30495 - the presence of increased hazy opacity within the lungs
A30496 - that is not associated with obscured underlying vessels
A30497 - (obscrued underlying vessels is known as consolidation).
A30498 - It can reflect minimal thickening of the septal or
A30499 - alveolar interstitium, thickening of alveolar walls, or
A30500 - the presense of cells or fluid filling the alveolar
A30501 - spaces. In an acute setting, it can represent active
A30502 - disease such as pulmonary edema, pneumonia, or diffuse
A30503 - alveolar damage.
A30505 - [...below, ground ground lass opacities is described as
A30506 - precursor to lung cancer. ref SDS 0 XM5F
A30508 - ..
A30509 - http://www.healthsystem.virginia.edu/internet/radiology/educ/groundglass.cfm
A30511 - ..
A30512 - An article dated 030205...
A30514 - Limited Excision Found Successful for Ground Glass Lung
A30515 - Lesions: Presented at STS
A30517 - http://www.docguide.com/news/content.nsf/news/8525697700573E1885256CC40076C5BE
A30519 - ..
A30520 - SAN DIEGO, CA -- February 5, 2003 -- So-called ground
A30521 - glass opacity lung lesions detected by computed tomography
A30522 - (CT) scans can be safely excised without lobectomy, a
A30523 - surgeon reported here on February 2nd at the 39th Annual
A30524 - Meeting of the Society of Thoracic Surgery.
A30527 - ..
A30528 - Ground Glass Opacities Early Lung Cancers
A30530 - "Ground glass" -- or subcentimeter -- tumours are being
A30531 - detected more frequently thanks to the development of new
A30532 - imaging technologies, according to Hisao Asamura, MD, a
A30533 - researcher at the National Cancer Center Hospital, in
A30534 - Tokyo. "These ground glass opacity lesions are true early
A30535 - cancers," Dr. Asamura said during a moderated poster
A30536 - session.
Ground Glass Opacities Nodules Lungs Early Cncers Can Be Caused by
AF0401 - ..
AF0402 - Radiation Ground Glass Opacities Lung Injuries
AF0403 - Radiation Side Effects Ground Glass Opacities Lung Injuries
AF0404 - Ground Glass Opacities Radiation Side Effects Lung Damage
AF0407 - Nodules in the lungs evidently can be caused by radiation, reported by
AF0408 - Doctor Johnson in a call earlier today on 090415 1519. ref SDS B2 E09J
AF0410 - ..
AF0411 - Research today found...
AF0413 - Cancer Imaging
AF0415 - Radiation injury: imaging findings in the chest, abdomen
AF0416 - and pelvis after therapeutic radiation
AF0418 - October 31, 2006
AF0420 - ..
AF0421 - Revathy Iyer, MD............ 713 792 5043
AF0422 - Department of Radiation Oncology
AF0423 - University of Texas,
AF0424 - MD Anderson Cancer Center,
AF0425 - Houston, TX 77030, USA........... ref OF 1 0001
AF0427 - ..
AF0428 - This is a comprehensive review of radiation side effects. The paper
AF0429 - says the following about side effects to the lungs resulting from
AF0430 - radiation...
AF0432 - [On 090630 1824 letter to Doctor Iyer at MD Anderson
AF0433 - asks for review of CT scans on 090413 and 090612 to
AF0434 - evaluate radiation injury to lungs, possible lung
AF0435 - cancer. ref SDS C2 HP7F
AF0437 - ..
AF0438 - Lungs
AF0440 - ..
AF0441 - Radiation pneumonitis and fibrosis are expected changes in
AF0442 - the chest. Other more serious complications such as
AF0443 - myocardial infarction, pericardial effusion, brachial
AF0444 - plexus neuropathy, bone and soft tissue necrosis, fractures
AF0445 - and radiation-induced malignancy may also occur .
AF0446 - ref OF 1 PT58
AF0448 - ..
AF0449 - Radiation induced pneumonitis typically develops
AF0450 - approximately 6-8 weeks after treatment with doses of 30-40
AF0451 - Gy and is a well known early expected effect of therapy
AF0452 - that is related to total dose and fractionation .
AF0453 - Radiation pneumonitis is most extensive 3-4 months
AF0454 - following the end of therapy and eventually becomes
AF0455 - radiation fibrosis (Fig. 1). ref OF 1 5F5N
AF0457 - ..
AF0458 - On 090403 Doctor Hsu asked Millie to get examination at Kaiser for
AF0459 - pneumonia, based on symptoms of cough and shortness of breath.
AF0460 - ref SDS A6 Z66M
AF0462 - [On 090616 1245 Doctor Rugo requested Kaiser's radiology
AF0463 - report for Millie's CT test on 090612 in order to check
AF0464 - for progression of ground glass opacities in the lungs
AF0465 - which contributes to evaluating Doctor Hsu's concern on
AF0466 - 090609 that medical mistakes performing radiation in
AF0467 - Feb-Mar failing to treat IBC in the breastbone area
AF0468 - could be causing problems in Millie's lungs that explain
AF0469 - recent loss of breathing capacity, and excessive
AF0470 - coughing. ref SDS B9 D644
AF0472 - ..
AF0473 - MD Anderson article on radiation injury continues...
AF0475 - Fibrosis becomes a stable finding approximately 9-12 months
AF0476 - after therapy . If changes occur after that time
AF0477 - period, superimposed infection or recurrent tumor should be
AF0478 - considered . Concomitant chemotherapy especially with
AF0479 - drugs that have known direct pulmonary toxicity such as
AF0480 - bleomycin further potentiates the effects of radiotherapy.
AF0481 - Other radiation enhancing drugs include actinomycin D,
AF0482 - adriamycin, cyclophosphamide, mitomycin C and vincristine
AF0483 - . ref OF 1 0A4O
AF0485 - ..
AF0486 - Millie was treated with cyclophosphamide as part of the sunitinib
AF0487 - metronomic clinical trial at UCSF, during November - December 2008,
AF0488 - and was discontinued in January 2009, because blood counts could not
AF0489 - be maintained.
AF0491 - [On 090605 Kaiser prescribed treating Millie with
AF0492 - Gemzar to recover from 8th relapse of IBC; Kaiser's
AF0493 - guidance says use Gemzar with extreme caution after
AF0494 - radiation treatment. ref SDS B7 V34K
AF0496 - ..
AF0497 - MD Anderson article on radiation injury continues...
AF0499 - Radiation injury to the lungs does not follow anatomic
AF0500 - boundaries. It has sharp, well defined areas of air space
AF0501 - consolidation with borders that conform to the radiation
AF0502 - portals. Less extensive radiation pneumonitis may present
AF0503 - as patchy consolidation in the irradiated field and when
AF0504 - the damage is very early or minimal in extent, manifests as
AF0505 - indistinctness of the pulmonary vasculature. Radiation
AF0506 - fibrosis is generally seen in all patients who received
AF0507 - therapeutic doses of radiation. Volume loss is typical.
AF0508 - ref OF 1 0258
AF0510 - "Volume loss" may relate to heavy chest and shortness of breath from
AF0511 - the lungs having less volume.
AF0513 - [On 090510 1953 Millie notifies medical team beginning
AF0514 - to have breathing problems shown by persistant cough and
AF0515 - clearing throat. ref SDS B5 LJ6T
AF0517 - ..
AF0518 - [On 090616 1245 Doctor Rugo requested Kaiser's radiology
AF0519 - report for Millie's CT test on 090612 in order to check
AF0520 - for progression of ground glass opacities in the lungs
AF0521 - which contributes to evaluating Doctor Hsu's concern on
AF0522 - 090609 that medical mistakes performing radiation in
AF0523 - Feb-Mar failing to treat IBC in the breastbone area
AF0524 - could be causing problems in Millie's lungs that explain
AF0525 - recent loss of breathing capacity, and excessive
AF0526 - coughing. ref SDS B9 D644
AF0528 - ..
AF0529 - MD Anderson article on radiation injury continues...
AF0531 - Bronchiectatic changes may also be seen. Less obvious
AF0532 - changes include minimal pleural thickening, slight
AF0533 - elevation of the hila or minor fissure, slight medial
AF0534 - retraction of pulmonary vessels, minimal tenting of
AF0535 - elevation of a hemidiaphragm and minor blunting of
AF0536 - cardiophrenic angles. ref OF 1 9N8J
AF0538 - ..
AF0539 - Computed tomography (CT) demonstrates radiation injury
AF0540 - earlier than conventional radiographs because of its
AF0541 - greater sensitivity to minimal differences in radiographic
AF0542 - density [5, 6]. On CT, radiation change can appear as
AF0543 - homogeneous consolidation, patchy consolidation, discrete
AF0544 - consolidation or solid consolidation . Homogeneous
AF0545 - consolidation appears as ground glass opacity on thin
AF0546 - section CT and occurs within 2-3 weeks of therapy. Patchy
AF0547 - consolidation is analogous to the findings on conventional
AF0548 - radiographs. ref OF 1 UN9I
AF0550 - ..
AF0551 - On 090317 Millie completed 4 weeks of instense radiation. ref SDS A4
AF0552 - 9L7K The scope of radiation is listed on 090226. ref SDS A3 D452
AF0553 - Doctor Hsu recommended review by Doctor Johnson at Kaiser to get a CRX
AF0554 - to evaluate for pneuomia, when Millie reported cough on 090403.
AF0555 - ref SDS A6 Z66M
AF0557 - [On 090415 1642 report today for CT test on 090413 shows
AF0558 - possible increased ground glass opacities in the lungs,
AF0559 - ref SDS 0 RV78, which research indicates can be early
AF0560 - cancer in the lungs. ref SDS 0 XM5F
AF0562 - ..
AF0563 - [On 090510 1953 Millie notifies medical team beginning
AF0564 - to have breathing problems shown by persistant cough and
AF0565 - clearing throat. ref SDS B5 LJ6T
AF0567 - ..
AF0568 - [On 090514 0830 Doctor Rugo was concerned that ground
AF0569 - glass opacities were caused by Millie's radiation in
AF0570 - February and March. ref SDS B6 DE8M
AF0572 - ..
AF0573 - [On 090616 1245 Doctor Rugo requested Kaiser's radiology
AF0574 - report for Millie's CT test on 090612 in order to check
AF0575 - for progression of ground glass opacities in the lungs
AF0576 - which contributes to evaluating Doctor Hsu's concern on
AF0577 - 090609 that medical mistakes performing radiation in
AF0578 - Feb-Mar failing to treat IBC in the breastbone area
AF0579 - could be causing problems in Millie's lungs that explain
AF0580 - recent loss of breathing capacity, and excessive
AF0581 - coughing. ref SDS B9 D644
AF0583 - ..
AF0584 - [On 090630 1824 letter to Doctor Iyer at MD Anderson
AF0585 - asks for review of CT scans on 090413 and 090612 to
AF0586 - evaluate radiation injury to lungs, possible lung
AF0587 - cancer. ref SDS C2 9W8W
AF0590 - ..
AF0591 - MD Anderson article on radiation injury continues...
AF0593 - Discrete consolidation is well demarcated but non-uniform
AF0594 - with traction changes that likely represent fibrosis.
AF0595 - Solid consolidation is seen at doses higher than 50 Gy and
AF0596 - is more uniform with volume loss and bronchiectatic change.
AF0597 - Conventional radiotherapy delivers higher doses to the
AF0598 - surrounding tissues because of radiation attenuation.
AF0599 - Three-dimensional conformal therapy is used to limit the
AF0600 - amount of injury to the lung and surrounding tissues by
AF0601 - using multiple smaller beams aimed at the tumor. This type
AF0602 - of therapy results in injury that has different patterns:
AF0603 - mass-like, modified conventional and scar-like .
AF0604 - ref OF 1 RP4H
AF0606 - ..
AF0607 - Recurrent disease should be suspected in irradiated lung if
AF0608 - there is alteration in the stable contours of radiation
AF0609 - fibrosis, failure of contracture of an area of radiation
AF0610 - pneumonitis or filling in of ectactic bronchi .
AF0611 - ref OF 1 9Q5J
Default Null Subject Account for Blank Record
AG0401 - ..
AG0402 - Cetuximab Side Effects Interstitial Disease CT Test Finding
AG0403 - Interstitial Disease Lungs No Findings Reported CT Test 080911
AG0405 - Follow up ref SDS A0 TS4J, ref SDS 84 TS4J.
AG0407 - ..
AG0408 - CT test 090413 report continues...
AG0410 - Pleura: Normal for CT test on 081230 reported in the
AG0411 - record on 090107. ref SDS A0 TS4J
AG0413 - ..
AG0414 - There is no report on "pleura" for the current CT test on 090413,
AG0415 - received today.
AG0417 - ..
AG0418 - CT test on 081230, reviewed on 090107 reported "Impression" finding
AG0419 - progression of right base interstitial process; drug reaction seems
AG0420 - likely etiology, ref SDS A0 AQ6U, and based on findings in the left
AG0421 - lobe of the lungs. ref SDS A0 MR7F The CT test on 081230 seems to say
AG0422 - this condition is slightly more prominent in the right lobe.
AG0423 - ref SDS A0 02AS
AG0425 - ..
AG0426 - This presents a confusing picture, particularly with no findings for
AG0427 - the current test on 090413.
AG0429 - ..
AG0430 - The CT test on 081107 reported findings of apparent "interstitial
AG0431 - disease" in the right lower lobe of the lungs, reviewed on 081112.
AG0432 - ref SDS 83 TS4J
AG0434 - ..
AG0435 - CT test on 081230 seemed to align with case study on patient history
AG0436 - listed in the record on 070117 that finds no support for Kaiser's
AG0437 - medical chart notation of "lung cancer," ref SDS 27 6T5I, because the
AG0438 - report does not specifically find "cancer." ref SDS A0 RV78 The
AG0439 - report today finding "progression" of ground glass opacities for the
AG0440 - CT test on 090413, per above, ref SDS 0 RV78, makes the 3rd test in a
AG0441 - row indicating possible progression (see again report of increased
AG0442 - scarring of lingula, for test on 081230 listed on 090107, ref SDS A0
AG0443 - MR7F, and possible increased ground glass opacities, ref SDS A0 02AS),
AG0444 - which may suggest lung cancer, based further on research associating
AG0445 - ground glass opacities with early signs of cancer, also, per above.
AG0446 - ref SDS 0 XM5F
AG0448 - [On 090510 1953 Millie notifies medical team beginning
AG0449 - to have breathing problems shown by persistant cough and
AG0450 - clearing throat. ref SDS B5 LJ6T
AG0452 - ..
AG0453 - [On 090616 1245 Doctor Rugo requested Kaiser's radiology
AG0454 - report for Millie's CT test on 090612 in order to check
AG0455 - for progression of ground glass opacities in the lungs
AG0456 - which contributes to evaluating Doctor Hsu's concern on
AG0457 - 090609 that medical mistakes performing radiation in
AG0458 - Feb-Mar failing to treat IBC in the breastbone area
AG0459 - could be causing problems in Millie's lungs that explain
AG0460 - recent loss of breathing capacity, and excessive
AG0461 - coughing. ref SDS B9 D644
AG0463 - ..
AG0464 - [On 090630 1824 letter to Doctor Iyer at MD Anderson
AG0465 - asks for review of CT scans on 090413 and 090612 to
AG0466 - evaluate radiation injury to lungs, possible lung
AG0467 - cancer. ref SDS C2 9W8W
AG0469 - ..
AG0470 - Pulmonary embolism was found in a CT test on 060930, reviewed on
AG0471 - 061012. Findings in the CT test on 080425 seem similar to language in
AG0472 - the report finding PE on 061012. ref SDS 23 294Q Language in the CT
AG0473 - test on 081230, reported on 090107 does not seem related to PE
AG0474 - findings. ref SDS 73 RV78 Notice of "ground glass opacities"
AG0475 - "progression" in the test on 090413 and reported today on 090415, per
AG0476 - above. ref SDS 0 RV78
AG0478 - ..
AG0479 - On 080226 letter to Kaiser with copy to UCSF requests comment from
AG0480 - medical team, including notice to coagulation control case management.
AG0481 - ref SDS 51 MS3H
AG0483 - ..
AG0484 - Interstitional lung disease is not reported for the test on 081230,
AG0485 - which was found in the CT test on 081107, and reported today,
AG0486 - ref SDS 83 TS4J, align with prior findings from the CT test on 080718
AG0487 - and reviewed on 080723. ref SDS 63 TS4J
AG0489 - ..
AG0490 - Case study on 080723 shows Millie's patient history on prior reports
AG0491 - of Interstitional Lung disease. ref SDS 63 7W6F There were 6
AG0492 - questions presented by prior findings listed on 080723. ref SDS 63
AG0493 - 6A4J
AG0495 - ..
AG0496 - Additional background reported on 081112. ref SDS 83 5V9J
Default Null Subject Account for Blank Record
AH0401 - ..
AH0402 - Hepatic Dome Liver Lesions Continue Stable
AH0404 - Follow up ref SDS A0 653N, ref SDS 84 653N.
AH0406 - CT test 090413 report continues...
AH0408 - 6. There is a stable lesion involving the dome of the liver.
AH0409 - ref DRT 1 EM6H
AH0411 - ..
AH0412 - Seems to align with the test on 081230, reported on 090107,
AH0413 - ref SDS A0 653N, continuing stable conditions found in the test on
AH0414 - 081107 reviewed on 081122, ref SDS 83 653N, and with the test on
AH0415 - 080911 reviewed on 080912. ref SDS 73 653N This shows stable
AH0416 - condition with the CT test on 080718 reviewed on 080723, ref SDS 63
AH0417 - 653N, and extends favorable findings for the prior test on 080425
AH0418 - reviewed on 080428. ref SDS 53 RV91
Default Null Subject Account for Blank Record
AI0401 - ..
AI0402 - Spleen Calcifications Granulamatous Disease
AI0403 - Granulamatous Disease Spleen Calcifications
AI0405 - Follow up ref SDS A0 N96N, ref SDS 84 N96N.
AI0407 - ..
AI0408 - CT test 090413 report continues...
AI0410 - 7. Evaluation of the spleen, pancreas, adrenal glands, kidneys
AI0411 - and bladder demonstrate no significant changes since the
AI0412 - previous examination. ref DRT 1 L46K
AI0413 - ..
AI0414 - Seems unchanged from report for prior test on 081230, reported in the
AI0415 - record on 090107, ref SDS A0 N96N, and continuing findings from
AI0416 - previous tests on 081107 reported on 081112, ref SDS 83 N96N, and from
AI0417 - report for prior test on 080911 reported on 080912. ref SDS 73 N96N
AI0418 - This shows stable condition from the CT test on 080718 reported in the
AI0419 - record on 080723. ref SDS 63 N96N
Default Null Subject Account for Blank Record
AJ0401 - ..
AJ0402 - Kidneys Gallbladder Adrenal Appear Unchanged
AJ0404 - Follow up ref SDS A0 PH6I, ref SDS 84 PH6I.
AJ0406 - CT test 090413 report continues...
AJ0408 - 8. Gallbladder: Normal. ref DRT 1 L46K
AJ0410 - ..
AJ0411 - 9. Pancreas: Normal. ref DRT 1 L46K
AJ0413 - ..
AJ0414 - 10. Adrenal glands: no express report. ref DRT 1 L46K
AJ0416 - ..
AJ0417 - 11. Kidney: No change, ref DRT 1 L46K
AJ0419 - ..
AJ0420 - Seems unchanged from report for prior test on 081230, reviewed on
AJ0421 - 090107, ref SDS A0 PH6I, 081107, and continuing findings from prior
AJ0422 - tests reported on 081112, ref SDS 83 PH6I, and also from report for
AJ0423 - prior test on 080911 reported on 080912. ref SDS 73 PH6I This shows
AJ0424 - stable condition from the CT test on 080718 reported in the record on
AJ0425 - 080723. ref SDS 63 PH6I
Default Null Subject Account for Blank Record
AK0401 - ..
AK0402 - Colon Bowel Hiatal Hernia Diverticulitis No evidence
AK0403 - Bowel Colon Hiatal Hernia Diverticulitis No evidence
AK0404 - Diverticulitis No evidence Colon Bowel Hiatal Hernia
AK0405 - Hiatal Hernia Diverticulitis No evidence Colon Bowel
AK0407 - Follow up ref SDS A0 EQ5J, ref SDS 84 EQ5J.
AK0409 - ..
AK0410 - CT test 090413 report continues...
AK0412 - 12. Bowel loops -- no express report.
AK0414 - Diverticulosis, ref DRT 1 UK3F
AK0416 - ..
AK0417 - Seems unchanged from report for prior test on 081107 reported on
AK0418 - 081112, ref SDS 83 EQ5J, and also from report for prior test on 080911
AK0419 - reported on 080912. ref SDS 73 EQ5J This shows stable condition from
AK0420 - the CT test on 080718 reported on 080723, ref SDS 63 EQ5J; except the
AK0421 - prior test reported hiatal hernia and diverticulosis, which is cited
AK0422 - in prior studies shown by case study on patient history on 080723.
AK0423 - ref SDS 63 GZ3J
AK0426 - ..
AK0427 - Abdominal Aorta No Aneurysm No Adenopathy
AK0428 - Pelvis Splenic Artery Calcification Aneurysms
AK0430 - Follow up ref SDS A0 NC8N, ref SDS 84 NC8N.
AK0432 - ..
AK0433 - CT test 090413 report continues...
AK0435 - 13. Vascular calcifications are seen involving the left upper
AK0436 - quadrant. A splenic artery aneurysm cannot be excluded.
AK0437 - ref DRT 1 UK3F
AK0439 - ..
AK0440 - Free fluid: no express report for this test.
AK0442 - ..
AK0443 - Pelvic structures: s/p hysterectomy: no express report for
AK0444 - this test.
AK0446 - ..
AK0447 - Urinary bladder: Normal. no express report for this test.
AK0449 - ..
AK0450 - Splenic artery aneurysm cannot be excluded may align with the prior
AK0451 - findings of "significant splenic artery calcifications," from the CT
AK0452 - test on 081230, reviewed on 090107. ref SDS A0 QU87
AK0454 - ..
AK0455 - Generally, seems unchanged from prior test on 081230 reviewed on
AK0456 - 090107, ref SDS A0 NC8N, and continuing findings for CT tests 081107
AK0457 - reported in the record for 081112, ref SDS 83 NC8N, and which at that
AK0458 - time on 081112 seemed to align with prior test on 080911 reported on
AK0459 - 080912. ref SDS 73 NC8N, and so indicates stable condition with no
AK0460 - evidence of cancer; however, since the analyst expressly compared the
AK0461 - test on 081107, with the test on 080718, ref SDS 84 RV49, there is
AK0462 - less certainty about comparison with the test on 080912. In any case,
AK0463 - findings for the current test on 081230 seem favorable and unchanged
AK0464 - from report prior tests extending back to 080718 reported in the
AK0465 - record on 080723. ref SDS 63 NC8N
AK0468 - ..
AK0469 - Spine Lower Lumbar Degenertive Changes in Disks Facet Joints
AK0471 - Follow up ref SDS A0 NC4L, ref SDS 84 NC4L.
AK0473 - ..
AK0474 - CT test 090413 report continues...
AK0476 - 14. Evaluation of the bony structures demonstrates no
AK0477 - significant change since the previous examination.
AK0478 - ref DRT 1 VX3L
AK0480 - ..
AK0481 - Seems to align with prior test on 081230, reviewed on 090107,
AK0482 - ref SDS A0 NC4L, and continues findings from testing on 080911
AK0483 - reported on 080912. ref SDS 73 NC4L Since the analyst expressly
AK0484 - compared the test on 080718 reported on 080723, ref SDS 63 NC4L
AK0486 - ..
AK0487 - CT test 090413 report continues...
AK0489 - ..
AK0490 - May be Increased Lymph Nodes Right Axilla Interstitial Disease
AK0492 - Follow up ref SDS A0 FY5O, ref SDS 84 FY5O.
AK0494 - 7. IMPRESSION
AK0496 - 1. There is decrease in size of the previously identified
AK0497 - large right axillary lymph nodes. There is however
AK0498 - increase in the degree of small nodular densities as well
AK0499 - as from the fat involving the right axillae which is
AK0500 - nonspecific. ref DRT 1 G54F
AK0502 - ..
AK0503 - Impression of improvement on right axillary reflects analyst's finding
AK0504 - that previously prominent lymphadenopathy significantly decreased to
AK0505 - zero visibility, per above, ref SDS 0 4K5H; implications of increase
AK0506 - in small nodular densities is not clear at this time.
AK0508 - ..
AK0509 - CT test 081230 report continues...
AK0511 - 2. Reticular nodular as well as ground glass opacities are
AK0512 - seen involving bilateral lung zones which demonstrate
AK0513 - progression since the previous examination. This is
AK0514 - [partly due to differences in technique] between the two
AK0515 - studies.
AK0517 - ..
AK0518 - Oveall impression of increased ground glass opacities aligns with
AK0519 - findings that cite differences in technique with the prior study, per
AK0520 - above. ref SDS 0 RV78
AK0522 - [On 090608 0900 Doctor Hsu diagnosed Millie suffering
AK0523 - painful breathing from radiation injury caused by
AK0524 - medical mistakes getting radiation services at UCSF on
AK0525 - referral from Kaiser. ref SDS B8 QG8F