CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 9 0000, ref SDS 5 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Met Haine in Radiology Department on 2nd floor this morning. He said
040902 - VA performed calcium scoring for CCTA on 151019 0930. ref SDS 6 TT6L
040904 - ..
040905 - This was news, because the report issued by the VA says calcium
040906 - scoring was not performed. ref SDS 6 8Q6I
040908 - ..
040909 - Asked to speak with a radiologist. Haine said he would ask one of
040910 - the doctors on staff today, to come out for an ad hoc meeting.
040912 - ..
040913 - Met later with...
040914 -
040915 - Brett Elicker, MD
040916 - Associate Professor
040917 - UCSF School of Medicine
040918 - Radiology
040919 - 505 Parnassus Ave, Moffitt
040920 - San Francisco, CA 94143
040921 - 415 353 1958
040922 - Brett.Elicker@ucsf.edu
040923 -
040924 - http://profiles.ucsf.edu/brett.elicker
040926 - ..
040927 - Brett M Elicker, MD is an Associate Professor of Clinical
040928 - Radiology and Chief of the Cardiac and Pulmonary Imaging
040929 - Section at the University of California, San Francisco. As
040930 - the Chair of the Postgraduate Education Committee in the
040931 - Department of Radiology, he is committed to maintaining the
040932 - high quality of UCSF's educational offerings to practicing
040933 - radiologists. Dr Elicker earned his medical degree in 2000
040934 - from New York Medical College, and completed a residency in
040935 - Diagnostic Radiology at Yale New Haven Hospital,
040936 - Connecticut in 2005, followed by a fellowship in Thoracic
040937 - Imaging from UCSF in 2006. He came to UCSF in 2005 as a
040938 - Clinical Fellow in Cardiac and Pulmonary Imaging and joined
040939 - the faculty of Radiology and Biomedical Imaging in July
040940 - 2006
040942 - ..
040943 - The doctor advised the calcium score for bypassed coronary arteries
040944 - determined from the CCTA performed at the VAMCSF on 151019, is 1360.
040945 - This finding was omitted in the CCTA test report on 151019 0930.
040946 - ref SDS 6 8Q6I
040948 - ..
040949 - The radiology team did report on 151019, there is more calcium in the
040950 - bypassed vessels than are evident from the prior CT scan, ref SDS 6
040951 - 074J, performed on 091102, ref SDS 2 4R8H, a few weeks after CABG +4
040952 - surgery on 091022.
040954 - ..
040955 - Asked Doctor Elicker what health risk occurs for calcium sore in
040956 - bypassed arteries?
040958 - ..
040959 - Doctor Elicker seemed to say that calcium plaque in bypassed blood
040960 - vessels presents no risk of any kind to patient longevity nor to
040961 - quality of life because all of the calcium and plaque found in the
040962 - CCTA test on 151019, occur in the 4 bypassed blood vessels that are no
040963 - longer in the active circulatory system, i.e., they are inactive
040964 - having been bypassed with CABG procedure on 091022.
040965 -
040966 - [On 160104 0855 Doctor Jha, attending physician for this
040967 - CCTA imaging study on 151019, advised that bypassed blood
040968 - vessels for CABG surgery on 091022, now have substantial
040969 - plaque, and this presents no health risk to the patient.
040970 - ref SDS 14 054G
040972 - ..
040973 - Requested clarification that CCTA on 151019, yielded findings that
040974 - bypass grafts are patent. 151019 0930, ref SDS 6 JW8O
040976 - ..
040977 - Doctor Elicker agreed the radiology report for the CCTA scan on
040978 - 151019, presents vague (sparse) findings and impressions.
040980 - ..
040981 - We reviewed patient history of CABG +4 on 091022. 091022 0700,
040982 - ref SDS 1 PQWU At that time, Progress Notes on the operation reported
040983 - 4 bypass grafts were performed, reported in the record a year later on
040984 - 100928 0706, ref SDS 3 HT9G, and they were all of "good quality,"
040985 - ref SDS 3 YI7K,
040987 - ..
040988 - Doctor Elicker noted that grafts using the saphenous vein from the leg
040989 - are most at risk, because it is less able to withstand high pressures
040990 - that occur closer to the heart, e.g., LIMA.
040992 - ..
040993 - He said there are no apparent lesions in the bypass grafts, which
040994 - establishes that the calcium score in the active cardiac circulatory
040995 - system is 0.
040997 - ..
040998 - We discussed research indicating coronary conditions of calcified
040999 - plaques present less risk of cardiac events requiring interventions,
041000 - e.g., CABG surgery, than do non-calcified and mixed plaques, and
041001 - further that calcified plaques take longer to form, reported in review
041002 - on 151119 2141. ref SDS 8 D45X
041004 - ..
041005 - Doctor Elicker seemed to indicate today, that the VA Radiology
041006 - Department did not analyse plaque characteristics. The CCTA scan file
041007 - produced by the VA on 151019, does not have sufficient detail to
041008 - distinguish and quantify plaque characteristics.
041010 - ..
041011 - He went on to say, that even though the scan technology cannot
041012 - distinguish plaque characteristics, when he read the scan file, there
041013 - was no evidence of blockages of any kind in any amount anywhere in the
041014 - active circulatory system which was covered by the scan.
041015 -
041016 - [On 151217 2052 letter to Doctor Elicker requests the
041017 - Radiology team file an addendum clarifying findings for
041018 - CCTA on 151019, stating the test shows no evidence of
041019 - blockages of any amount in the active circulatory system
041020 - covered by the scan. ref SDS 11 Y56G
041022 - ..
041023 - [On 151223 0921 called Doctor Elicker; he recommended
041024 - asking the attending physician, Doctor Jha, to file an
041025 - addendum clarifying the radiology report on 151019.
041026 - ref SDS 13 PE34
041028 - ..
041029 - [On 160104 0855 Doctor Jha, attending physician for this
041030 - CCTA imaging study, advised that standard of practice for
041031 - radiology reporting is to present any and all blockages of
041032 - any kind observable in CCTA scan imaging; so, in this case,
041033 - since none are reported, the CCTA test on 151019, can
041034 - correctely be interpretted to mean there are no blockages,
041035 - plaques, stenosis of any kind evident from the scan file
041036 - record. ref SDS 14 054G
041038 - ..
041039 - [On 160114 0022 letter commends Doctor Jha and faculty
041040 - colleagues at UCSF for good faith review to clarify CCTA on
041041 - 151019, that demonstrates CCTA evaluating response to
041042 - treatment (hiking 10K miles raising HDL 30 to 70) for
041043 - regressing atherosclerosis to 0. ref SDS 16 N760
041045 - ..
041046 - [On 170428 1205 notified Doctors Jha and Elicker that on
041047 - 170414, Doctor Simpson discussed CCTA performed on 151019,
041048 - with "Radiology" and wrote addendum to Progress Notes
041049 - saying unnamed people said "...the technique cannot rule
041050 - out atherosclerosis, but can detect significant stenoses of
041051 - = or > 50% vessel diameter". ref SDS 17 8H5G Research
041052 - found CT "technique" is limited, as noted in Doctor
041053 - Simpson's addendum, ref SDS 17 Z89 This has no evident
041054 - climical relevance to Doctor Jha's addendum reporting CCTA
041055 - on 151019 found no significant plaque, since that finding
041056 - was not based on CCTA automatic calculating technique,
041057 - which is limited, but on direct examination of CT scans,
041058 - reported by Doctor Elicker on 151203 1014, ref SDS 10 SZ5F,
041059 - and by Doctor Jha on 160104 0855. ref SDS 15 SU3M
041061 - ..
041062 - This seems a significantly more important finding than a mere calcium
041063 - score. It appears that on the date of the CCTA scan test, 151019, the
041064 - patient was clear of any arterosclerosis thoroughout the coronary
041065 - area, at least to the extent that can be identified with CCTA testing.
041067 - ..
041068 - During the meeting with Doctor Simpson in Cardiology on 151028, the
041069 - doctor explained that limitations of CCTA testing augurs for caution
041070 - relying on test results for guiding line of care for atherosclerosis.
041071 - ref SDS 7 J69I
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