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. The eliminate the expense and inconvenience of traveling to Los Angeles for an initial consultation, we have partnered with 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 contact our office at 1-818-539-1985 or firstname.lastname@example.org for a $10 discount code that you may use when signing up. The subscription may be cancelled or renewed at the end of the 1-year term.
The best thing about mymedicalimages.com is that medical documents and CDs 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 or reports 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 ultrasoundguidance. 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-enhances 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
Thermography of the breast – less that 4 months before cryoablation, if performed.
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 to let us know that you will be submitting your case for review. We will also provide you a discount code 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, collected 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: Organize paper files by study type and date they were performed (for example, “Mammograms from 3-26-2019” or “Needle Biopsy from 4-2-2019”) and then scan and upload each study as a single file. You will likely find it helpful to save all of your scanned or electronic files in a folder on your computer desktop so you can find them easily when you need them. Give the folder a name that is easy to find (for example: “Files uploaded to mymedicalimages”). If all of this is too complicated for you, seek help from a more tech savvy friend or relative. If none is available, simply organize all of the paper documents in chronological order (oldest on the top and most recent on the bottom) scan them together so that they may be uploaded as a single file.
If all of this is too complicated for you, seek help from a more tech savvy friend or relative. If none is available, simply organize all of the paper documents in chronological order (oldest on the top and most recent on the bottom) scan them together so that they may be uploaded as a single file.
We STRONGLY prefer that you submit your entire case (report files and CD images) through mymedicalimages.com. If that is simply not possible, you may fax or email your reports to 1-800-203-5515 or email@example.com. (If after reviewing the reports Dr. Holmes requests CDs of our imaging studies, you will be asked to upload your CD at mymedicalimages.com (strongly preferred) or send them by express mail (FEDEX or UPS) with a tracking number. Mailed files should be sent to the following address:
Dennis R. Holmes, MD
1505 Wilson Terrace, Suite 150
Glendale, California 91206
Phone: 1-818-539-1985 (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 or go 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.
Step 9: Within 4 days of acknowledging receipt of your case or email, Dr. Holmes will review your files and send you a follow-up email with his “case impression.” If you do not hear from Dr. Holmes by the 5th day, please call or email the office to inquire about the delay.
Obtaining Your Case Review
The purpose of Dr. Holmes’s “case impression” is to specifically evaluate your eligibility for cryoablation. It is NOT intended to provide general medical advice about your cancer diagnosis or 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 making a determination of eligibility.
You will also be notified if your imaging studies are out-of-date and if updated studies are needed before making a determination of eligibility. In general, imaging studies should be no more than 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.
The case review will be complete when Dr. Holmes has reviewed your complete set of uploaded files and offered his initial “case impression.”
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 a new, previously unreported growth could be detected in the breast or lymph node area by Dr. Holmes on the day of your consultation, which might necessitate another 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 (for example, whole breast radiation if younger than 70 years of age). 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 you might to offered participation in a non-cryoablation clinical trial appropriate for your cancer extent or stage.
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.
Visit “Guide for Out-of-Town Patients” to find out what you should know about traveling to see Dr. Holmes for cancer treatment.