h Cardiovascular Imaging Center oa Mount 1428 Madison Avenue * New York, NY * 10024 Sinai Phone: 212-241-3000 * Fax: 646-537-9693 Name: Epstein, Jeffrey Scan Date: 04/10/2018 MRN: 7206913 Acc Number: 3578773 DOB: 01/20/1953 ReferringMD: Rony Shimony, MD Age/Gender: 65/M AttendingMD: Adam Jacobi, MD Summary CTA with contrast was performed for coronary artery evaluation in a patient with chest pain, Reconstructions were transferred to a workstation for further analysis. Post-processing techniques (volume rendering, maximum intensity projections and multi-planar reformations) were employed for analysis of images. 1. Coronary atherosclerosis without significant stenosis. 2. The calcium score Is 55, representing the 46th percentile adjusted for age, gender, and ethnicity. 3. No significant extracardiac findings. Scan Info General Contrast Agent Medication Administered During Scan Type: lsovue-370 Type: Metoprolol lV, NTG SLO.4mg Dose: 55 mi Metoprolol IV, Dose: 10 mg Rate (m/s): 4.0ml/s Bolus Technique: Biphasic Vitals Height: 72in Height: 182.9cm Body Weight: 190 /bs Body Weight: 86.2 kg Systolic BP: 160 mmHg Diastolic BP: 88 mmHg Heart Rate: 62 8PM Heart Rhythm: Sinus Rhythm BSA; 2.1m°*2 Setup Type: Clinical Location: Outpatient ECG Gating Technique: Prospective Study Quality: Good Referring Provider: Rony Shimony, MD Attending Radiologist: Adam Jacobi, MO Attending Cardiologist: Javier Sanz, MD Billing Finalized and signed by Adam Jacobi on 04/10/2018 15:37:51 (uid:180) Page 1 of 3 EFTA00304934

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Nh Mount Sinai Heart CPT Code(s) 75574 CTA Heart & Bypass Grafts (when present) w Contrast Coronary Arteries Q9967 ISOVUE 370 ICD-10 Code(s) General Indicators RO7.9 Chest pain unspecified Cardiac Coronaries Coronary Arteries Cardiovascular Imaging Center 1428 Madison Avenue « New York, NY « 10024 Phone: 212-241-3000 + Fax: 646-537-9693 Coronary Arterial Dominance: Right ARTERIES Proximal RCA Mil RCA Distal RCA PDA LM Proximal LAD Mid LAD Distal LAD DI be Proximal LCX OM Mub LOX OMe? Distal Lex Posterolateral Other DIAMETER STENOSIS; 0; < 25%; 25%; 25-49%; < 504%; 5046, 50-6940: 70-99%; 75%; 190%, UE = UNEVALUABLE | = NONCALC.: PNC = PREDOMIN, NG: PC = PREDOMIN. C; C = CALCIFIED STENT: NORMAL; <5096; >S0%; O = OCCLUDED: ? = CANNOT EXCLUDE PLAQUE: M | DIAMETER STENOSIS ococo.¢ ° <25% <25% oc oc9o.o' oc 0 Coronary Caicium Scoring | Score ' Percentile Agatston Volume Finalized and signed by Adam Jacobi on 04/10/2018 15:37:51 (uid:180) ‘ a6 } i ' ' t ' PLAQUE "STENT Page 2 of 3 EFTA00304935

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S, Cardiovascular Imaging Center Mount 1428 Madison Avenue « New York, NY « 10024 fea! Phone: 212-241-3000 + Fax: 646-537-9693 Vascular Upper Vascular EVALUATION OF THE THORACIC AORTA COMMENTS (no comments) ; . | , Evaluation Details [ASCENDING AORTA | Oimension A: 3.7 cm | Dimension B: 3.7.cm ISTHMUS OF THE AORTA | Dimension A: 2.7 cm i | Dimension B; 2.7 cm Other Findings Lung Nodules Lung Nodules?: No Finalized and signed by Adam Jacobi on 04/10/2018 15:37:51 (uid:180) Page 3 of 3 EFTA00304936