https://www.selleckchem.com/ALK.html Despite palliative chemotherapy and trastuzumab, the patient died 2 months after the diagnosis of metastasis to the parotid gland. CONCLUSIONS We report a rare case of metastasis from breast cancer to the parotid gland, with imaging findings including neck ultrasonography and contrast-enhanced neck computed tomography. Breast cancer rarely metastasizes to the parotid gland, but radiologists should be aware of this possibility, especially in patients with a prior history of breast cancer. Incorporation of Lean into health care requires consideration of the patient and other customer experience of care as well as final health outcomes. We incorporate experience-based design (EBD) into our Lean management method to assess the experience of care, guide redesign of care processes, and assess the effectiveness of quality improvement on the care experience. Foundational to EBD is identification of "touch points," moments in the health care delivery process where a patient has a strong positive or negative emotional response that has the potential to alter the way patients feel about their overall care experience. EBD proceeds sequentially from qualitative assessment of customer experience and touch points (through observations and interviews); semiquantitatively assessing the experience across many patients (through EBD questionnaires); engaging in codesign with patients (through improvement teams and events); and reassessing the care experience after improvement (through follow-up EBD questionning change. The American Society for Gastrointestinal Endoscopy and Society of American Gastrointestinal and Endoscopic Surgeons provide guidelines for managing suspected common bile duct (CBD) stones. We sought to evaluate adherence to the guidelines among patients with choledocholithiasis and/or acute biliary pancreatitis (ABP) and to evaluate the ability of these guidelines to predict choledocholithiasis. We prospectively identified patients u