Thinking About Cryoablation?
Submit Your Case Online to Find Out if You Are A Candidate
Many of our cryoablation patients come to us from places as far as Australia, the United Kingdom, South Africa, Eastern Europe and many cities across the U.S. To eliminate the expense and inconvenience of traveling to Los Angeles for an initial consultation, we utilize mymedicalimages.com to provide a fast and secure way for you to upload your medical images for their review by simply selecting the blue "Upload mymedicalimages" button below. Dr. Holmes’s office will not charge you for the preliminary review of your case.
Mymedicalimages.com in an independent, secure, HIPAA-compliant medical record file storage and file-sharing website that allows you to store your medical files for your own use and/or to share with another person of your choice even if they don't have a mymedicalimages.com account. The cost of a mymedicalimages.com subscription is $29.95, which permits unlimited use of the account for 1 year. You can obtain a $10.00 discount by entering the discount code: CRYO. The subscription may be cancelled or renewed at the end of the 1-year term.
The best thing about mymedicalimages.com is that medical images can be uploaded and shared in just minutes; the original files never leave your computer; you'll never have to worry about records getting delayed or lost in the mail; and there is no need for us to return medical files to you---just delete them on our end. You can also use your mymedicalimages.com subscription to share follow-up imaging studies performed after your cryoablation procedure.
Visit My Medical Images to find out more about the website.
Preparing for Your Case Submission
Make sure you have a complete set of imaging studies. Dr. Holmes performs cryoablation under ultrasound guidance. However, he relies of the combination of ultrasound, mammography, and contrast-enhanced breast MRI to obtain the best assessment of breast anatomy and cancer extent. The reason for combining this trio of imaging studies is that ultrasound does not always reveal the full extent of the the cancer.
Mammograms might reveal features of the cancer not seen by ultrasound (for example, calcifications) but might miss other cancer features especially if the breasts are dense. Contrast-enhanced breast MRI does not detect calcifications but often reveals suspicious area of blood flow that are not seen by mammograms or ultrasound, including additional areas of cancer. Some patients also choose to have thermography.
Make sure your studies are up to date. Ultimately, the best possible short-term and long-term results from cryoablation are achieved when Dr. Holmes has the most complete understanding of normal breast anatomy and the cancer extent. Having recently performed breast imaging studies is important to making sure that your cancer features do not change significantly between the date of your cancer diagnosis and the date you would be scheduled to undergo cryoablation. By “recent,” we mean:
Mammograms of the affected breast – performed or repeated less than 3 months before cryoablation
Ultrasound of the affected breast – performed or repeated less than 2 months before cryoablation
Contrast-enhanced Breast MRI of the breasts – performed less than 2 months before cryoablation
Submitting Your Case
In the following explanation, we will refer to each of the items you upload as a “file.” For example, an uploaded CD containing 25 images is a “file.” A scan of a single page is a “file.” A scan of a 15-page report is a “file.” A digital photograph is a “file.”
Step 1: Contact our office at 1-818-539-1985 or email@example.com to let us know that you will be submitting your case for review. You can also use discount code "CRYO" for a $10 discount for the first year of your mymedicalimages.com subscription. You will need the code when signing up for mymedicalimages.com for the first time.
Step 2: Download and complete our 2-page "Case Review Questionnaire" and upload it with your case.
Step 3: Review the “Step-By-Step Guide to Uploading Your Case".
Step 4: Collect Your files. To prepare your case for upload, collect and organize any recent reports, documents and CDs related to your case. This should include your most recent mammograms, ultrasound, and breast MRI, and any needle biopsies performed in the affected breast. You will need to scan any paper documents and convert or save them as “PDF” files. Some healthcare or radiology facilities allow you to request or download electronic or PDF files directly from your patient portal.
Step 5: Email a copy of your imaging (mammogram, US, and MRI) and core biopsy pathology reports to us at firstname.lastname@example.org.
CD images can be submitted online through mymedicalimages.com. The corresponding imaging and pathology reports can be faxed to 1-844-878-7438 or emailed to email@example.com. You may also mail these files (imaging CDs and corresponding imaging and pathology reports) to the following address using a secure method like FEDEX or USPS that allows you to obtain a tracking number:
Dennis R. Holmes, MD
Sam and Grace Carvajal Comprehensive Breast Center
1505 Wilson Terrace, Suite 370
Glendale, California 91206
Phone: 1-818-630-8680 (Select the option for “ No Signature Required”)
Step 6: Find a strong wifi or internet connection. Before uploading your case, it is best to complete the final steps in a place with a strong internet connection because some of the files will be quite large and will likely take some time to upload if your internet connection is slow. Even with a strong internet connection, it still might take 5 minutes or more to upload a CD that contains hundreds of images. You will need a computer with a CD or DVD drive to upload images from a CD.
Step 7: Use the blue upload button at the top of this webpage to connect directly to mymedicalimages.com to begin your case upload. After you upload each file, we recommend that you select the “View” button next to each uploaded file to confirm that it has been fully uploaded. It you have any difficulties, there is a “chat box” in the right lower corner of the web page to contact mymedicalimages.com for “support.”
a. Enter the email address and phone number associated with your account,
b. Type the name of the recipient (“Dennis R. Holmes, MD”),
c. Add any additional comments in the space below, and
d. Select “send” to transmit the case.
Step 8: Within seconds of hitting “send,” we will receive an email from mymedicalimages.com indicating that you have uploaded files for review. Within 48 hours, you will also receive an email directly from our office confirming receipt of your case. If you have not received a confirmation from us by 48 hours, please contact our office at 1-818-539-1985 or firstname.lastname@example.org to confirm that your case has been received.
IMPORTANT: If you ultimately come in for an appointment after submitting your imaging studies online, we will still want you to bring the ORIGINAL CD's with you when you come to see us.
Step 9: If Dr. Holmes determines that you are eligible for cryoablation, his staff will contact you to schedule an initial appointment by telehealth, by phone, or in person if you desire to move forward with the appointment.
Obtaining Your Case Review
The purpose of Dr. Holmes’ “case impression” is to specifically evaluate your eligibility for cryoablation. It is NOT intended to provide general medical advice about your cancer diagnosis nor does it eliminate the need for a breast examination.
You will be notified if additional medical files (for example, reports, radiology images) or procedures (for example, an additional breast biopsy) are needed before determining if you are eligible for cryoablation.
You will also be notified if updated studies are needed before making a determination of eligibility for cryoablation. In general, imaging studies should be no more than 2-3 months old.
If a phone discussion or video chat is requested by either you or Dr. Holmes, we will work with you to schedule a mutually convenient time. You will be charged for this consultation.
DISCLAIMER: There is a possibility that a face-to-face interview, physical examination, and/or repeat ultrasound performed by Dr. Holmes could reveal additional findings that affect your eligibility for cryoablation or influence the approach that would be taken at the time of cryoablation. For example, if Dr. Holmes detects a new, previously unreported growth in the breast or lymph node area, you might be advised to undergo an additional needle biopsy and/or an additional cryoablation procedure to treat the new area. It is also possible that a face-to-face visit could determine that you are not a candidate for cryoablation, necessitating a new treatment plan. To minimize the chance of such “surprises” on the day of your consultation, it's important that you submit a complete and recent set of imaging studies for consideration of cryoablation.
The Case Impression --- 3 possible Scenarios:
Scenario #1: You could be informed that you are eligible for cryoablation within an open clinical trial. You will NOT be billed for cryoablation within a clinical trial. However, participation in a clinical trial requires that you commit to ALL of the trial’s requirements. If you are unwilling to follow ALL of the trial’s requirements, you might be offered cryoablation outside of the trial or "off-protocol" (see Scenario #2).
Scenario #2: You could be informed that you are NOT eligible for cryoablation within a clinical trial but that you ARE a candidate for cryoablation outside of a clinical trial or “off-protocol.” The cost of cryoablation “off-protocol” is charged to the patient and not billed to insurance or Medicare. The actual cost is based on the number of cryoablations that are needed to completely cryoablate the cancer in addition to a surrounding margin of normal tissue. You will be given a quote ($) for the cost of cryoablation prior to having the procedure performed. Off-protocol treatment also applies to women who qualify for an open clinical trial but are unwilling to adhere to all of the trial’s requirements.
Scenario #3: You could be informed that you are NOT eligible for cryoablation under any circumstances, but Dr. Holmes will discuss other treatment options that might be available to you. Sometimes surgery is required. Some patients opt to have Dr. Holmes perform their surgery.
Obtaining A Face-To-Face Consultation
If you ultimately decide to travel to Los Angeles for cryoablation, we will work with you to coordinate your visit as well as a formal, face-to-face consultation with Dr. Holmes. The office consultation will include a detailed review of your case files. A physical examination will be performed. Breast and lymph ultrasound will repeated as part of your breast examination. You will also be provided the informed consent documents that must be completed and signed before the procedure. REMINDER: If you previously submitted your imaging studies online, we will still want you to bring the actual CD's with you when you come to see us.
Visit “Guide for Out-of-Town Patients” to find out what you should know about traveling to see Dr. Holmes for cancer treatment.