Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate ETT placement History: s/p arrest ET tube tip within 1 cm of the carina.Cardiomegaly and bilateral nonspecific pulmonary opacities, not significantly changed allowing for marked rotation and underinflation.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: evaluate SG positioning History: see above Cardiomegaly status post sternotomy.Right jugular Swan-Ganz catheter tip in proximal right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter slightly advanced, otherwise no change.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: cough with hx of PNA, COPD, and CHF History: increasing cough x 2 weeks Cardiomegaly, slightly increased in size when compared to prior. Diffuse pulmonary opacities increased from previous, most compatible with pulmonary edema. Trace right pleural effusion. No pneumothorax.

Output: Cardiomegaly slightly increased from prior exam. Diffuse opacities favoring edema.


Instruction: Generate impression based on medical findings.

Input: Reason: compare to prior - development of PNA vs pulm edema History: new bibasilar crackles Normal heart size with evidence of previous median sternotomy.Basilar opacities compatible with pleural effusions and atelectasis, generally unchanged.No specific evidence of pulmonary edema or pneumonia.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: Evaluate central line placement History: As above Right IJ line terminates likely within the IVC. This has been subsequently retracted. Bibasilar opacities and pleural effusions, unchanged. Moderate cardiomegaly again noted. No pneumothorax.

Output: Right IJ line terminates likely within the IVC. This has been subsequently retracted. Unchanged basilar opacities and pleural effusions with moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: History of multiple myeloma History: New lung nodule noted on skeletal survey Left-sided Port-A-Cath with its tip at the SVC/RA junction.The cardiomediastinal silhouette is unremarkable.Small right upper lobe peripheral nodule identified.Mild left basilar scarring/discoid atelectasis.No pleural effusions.

Output: Small right upper lobe nodule not well seen on prior portable chest radiographs. CT of the chest is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Follow-up pleural effusion drainage, assess for pneumothorax. No significant pneumothorax. Moderate to large loculated right pleural fluid collection similar in volume. Right subpulmonic Pleurx catheter similar in position. Basal atelectasis bilaterally, increased on the left.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Non-Hodgkin lymphoma. 73-year-old male CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the lingula on image number 42/89. Scarring and traction bronchiectasis in the left lower lobe, unchanged.MEDIASTINUM AND HILA: Multiple nonenlarged mediastinal lymph nodes. There efferents lymph nodes in the right paratracheal region measures 13 x 9 mm on image number 24/225.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver are unchanged. Some of the lesions are too small to accurate characterize large ones are likely cysts. Lack of IV contrast precludes optimal evaluation. Cholelithiasis unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval left nephrectomy. No evidence of enlarged lymph nodes in the abdomen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hepatic lesions are unchanged.Interval left nephrectomy. No evidence of recurrence or residual mass.Small nonenlarged mediastinal lymph nodes. Subcentimeter lingular pulmonary nodule.Scarring in the left lower lobe is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: et tube History: intubated Endotracheal tube terminates approximately 5 cm from carina. Low lung volumes. Question of mild pulmonary edema. No large pleural effusion or pneumothorax. Cardiomegaly again noted.

Output: Low lung volumes. Question of mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: FemaleReason for Study: Reason: cardiac surg History: - Right IJ Swan-Ganz has been removed.Chest/mediastinal tubes unchanged.No evidence of a pneumothorax. Stable cardiac enlargement with basilar atelectasis and small effusions similar to the prior exam.

Output: Interval removal of a right IJ Swan-Ganz. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Heart failure and Swan-Ganz placement Unchanged Swan-Ganz with tip projected in the main pulmonary artery at the bifurcation. Of particular importance is the redundant catheter within the right heart.Underlying cardiopulmonary appearance is otherwise similar

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: Are there infiltrates? History: Cough, CP Cardiomegaly. Osseous changes of sickle cell disease.Cardiomegaly unchanged. Venous catheter tip in high right atrium.Diffuse nonspecific airspace and interstitial opacity grossly stable versus prior.

Output: Diffuse nonspecific airspace and interstitial opacity grossly stable versus prior.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Prominent central pulmonary vessels suggest early mild hypertension. Otherwise borderline cardiomegaly. Lungs are clear.Spine demonstrates mildly increased diffuse density involving the endplates, possible renal osteodystrophy. Venous stenting is also observed across the left axilla and subclavian

Output: No acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: cardiopulm eval, preop History: as above Cardiac silhouette is borderline enlarged and unchanged.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax. Question mild right upper lung bronchiectatic changes.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old with history of shortness of breath, COPD Low lung volumes. Diffuse interstitial fibrotic appearance of the lung periphery with upper lobe cysts. Retrocardiac consolidation, which in the setting of interstitial lung disease raises question of a neoplastic process. Bibasilar atelectasis, consolidation and nodular opacities. Cardiac enlargement with left pleural effusion/thickening.

Output: Chest radiographic findings highly suspicious for interstitial fibrosis. Nonspecific focal retrocardiac consolidation. Recommend further evaluation with CT chest (ILD protocol) when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: ett tube History: ett tube Left humeral prosthesis partially visualized. Endotracheal tube terminates 4 cm above the carina.Remaining support devices are unchanged.Persistent right lower lobe opacity unchanged. Retrocardiac subsegmental atelectasis slightly improved. No significant pneumothorax.

Output: Persistent right pleural effusion and lower lobe opacities suspicious for aspiration. Nasogastric tube side hole remains at the GE junction.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: patient febrile, neutropenic, look for infection History: neutropenic, febrile Left-sided PICC tip overlies the distal SVC.Stable cardiomediastinal silhouette with calcified aortic arch.Slight increase in interstitial prominence and particularly peribronchial cuffing. No focal consolidation or sizable pleural effusion.

Output: Interval increase in interstitial prominence and particularly peribronchial cuffing probably relates to worsening interstitial edema or atypical infection. Correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: interval eval History: empyema s/p thoracotomy/debridement Right-sided chest tubes remain in place. Diffuse right-sided pleural parenchymal opacities again noted. No new focal pleural parenchymal opacity in the left hemithorax. Unchanged heart size. No significant pneumothorax. Right-sided subcutaneous emphysema, as before.

Output: Diffuse right-sided pleural parenchymal opacities again noted. No new focal pleural parenchymal opacity in the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Low-grade lymphoma/CLL. There is a well-circumscribed 9 mm nodule within the right upper lobe, which appears to have been present on prior PET/CT from 2013. Low lung volumes without pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.

Output: No significant change in a right upper lobe nodule compared to prior PET/CT from 2013; this may be post-infectious and is favored to be benign given stability, however, if there are additional risk factors for malignancy, follow up with CT should be considered.


Instruction: Generate impression based on medical findings.

Input: Reason: Organ donation History: organ donation ET tube tip approximately 4 cm above the carina.Basilar interstitial opacity and subsegmental atelectasis, likely related to aspirated secretions.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with leukocytosis. Evaluate for pulmonary source. No focal airspace opacities, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with history of colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large hepatic metastatic lesion has decreased in size and now measures 8 by 5.5 cm on image number 87, series number 3. No other focal lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right perisigmoid soft tissue density measures 16 by 15-mm image number 172, series number 3, not significantly changed from previous study.BOWEL, MESENTERY: Focal wall thickening involving the distal rectosigmoid colon is again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the hepatic metastatic lesion. No significant change in the rectosigmoid wall thickening and right perisigmoid soft tissue density lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: swan in place History: swan in place Interval extubation. Stable line position.Moderate right effusion is unchanged. No other interval change.

Output: Interval extubation with no other interval change.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with clincher carcinoma and liver abscess. Please reevaluate liver abscess and drainage from drain. Cannot get IV dye secondary to increased creatinine. Generalized pain. CHEST:LUNGS AND PLEURA: Atelectasis right base. Elevation right hemidiaphragm. No effusions.MEDIASTINUM AND HILA: Postsurgical changes.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast.LIVER, BILIARY TRACT: Liver enlarged 21.3 cm cephalocaudad coronal image 44/96.Biliary stents in place; at least two is seen one entering via a ventral percutaneous route. Percutaneous pigtail catheter drain in place. Previously seen loculated fluid along the dorsal margin of the liver contains a pigtail catheter and is no longer measurable. Small branching collection process extending from the subcapsular portion of the lateral aspect of the liver series 10 image 95 and centrally towards the porta hepatis. This collection is best appreciated on coronal images 27-30 4/96. On coronal image 28 measures 4.1 x 0.9-cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scattered small areas of high attenuation, some probably vascular in nature and some may be consistent with nephrolithiasis in both kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic changes. No evidence of aneurysm.

Output: Marked decrease in size of perinephric fluid collection. Intrahepatic collection persists the small. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with metastatic colon cancer. CT for restaging. Abdominal pain. CHEST:LUNGS AND PLEURA: Scarring and bulla right apex. No lung nodules. No effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left-sided central line with tip in the SVC.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made. AnLIVER, BILIARY TRACT: Cholecystectomy clips. No obvious liver lesions.SPLEEN: Atherosclerotic changes splenic artery. No evidence of aneurysm. Normal size spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right hemicolectomy. Surgical clips. Stranding with no evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: Midline surgical cough scar. Mild anasarca. Hemangioma left aspect L2 vertebral body.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Prominent uterine fundus a possibly related to fibroids. No calcified lesions.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis. No ascites.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted.

Output: Given limitations no IV contrast, no definite metastases. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old. New catheter from the right extending to the SVC. Left jugular catheter unchanged.Basilar opacities compatible with atelectasis and small effusions.Radiolucency adjacent to the left heart border is compatible with pleural fluid outlining the superior segment of the left lower lobe.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 28 year-old male with Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Mild bibasilar scarring is again identified. 5 x 8 reference pleural-based right lower lobe nodule remains (series 4, image 53).MEDIASTINUM AND HILA: The cystic lesion in the anterior mediastinum is unchanged, measuring 28 x 25 mm, consistent with a thymic cyst (given known relationship with Hodgkin's disease post treatment).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable subcentimeter right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral spondylolysis of L5, unchanged.OTHER: No significant abnormality noted

Output: Stable examination. Cystic anterior mediastinal lesion compatible with a thymic cyst.


Instruction: Generate impression based on medical findings.

Input: Chest tube to water sealVIEW: Chest AP 1/30/15 Left chest tube in place. There is a small left apical pneumothorax minimally increased in size. Cardiothymic silhouette normal. Left lung opacity increased in the interval. There is a small left pleural effusion increased in the interval. Minimal subcutaneous emphysema in the left lateral chest wall. Patchy opacities in the right lower lobe.

Output: Left apical pneumothorax minimally increased in the interval.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: SOB, cough Cardiomegaly and mild basilar interstitial opacity, not significantly changed from previous.The differential diagnosis includes atelectasis and aspiration. A more recent radiograph has been interpreted.

Output: Cardiomegaly and mild nonspecific basilar opacity, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Shortness of breath question pneumonia Moderate cardiomegaly with enlargement of the central pulmonary vasculature unchanged. Tortuous thoracic aorta. Left subclavian ICD unchanged in position; a portion of the pulse generator obscures a small area of the left upper lobe which cannot be assessed. The remainder of the left lung is clear.There is some faint hazy opacity at the right base. Elevation of the right hemidiaphragm with adjacent atelectasis.Atherosclerotic calcification in the carotid vascular distribution bilaterally.

Output: Hazy opacity in the right lower lobe new from previous, suspicious for acute aspirate or developing infection. Acute unilateral edema in this location is considered much less likely.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Feeding tube. Feeding tube terminates within the proximal aspect of the stomach. Other lines and tubes, unchanged. Large mass again noted in the left hilar region. Patchy left greater than right basilar opacities again noted. No new focal pleural parenchymal opacity. Small left pleural effusion. No pneumothorax.

Output: Lines and tubes, as above. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Neutropenic fever. Resolution of acute edema component, but the diffuse interstitial opacities are overall worse. Small bilateral pleural effusions. Stable cardiomediastinal silhouette.

Output: Diffuse basilar predominant interstitial opacities are consistent with worsening atypical infection. Improved superimposed pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: eval for PNA, hypoxic respiratory failure, ILD History: as above There are decreased lung volumes with borderline cardiac enlargement.Diffuse predominant peripheral interstitial opacities in both lungs significantly increased from the remote CT exam.No focal areas of consolidation.No pleural effusions.Surgical clips in the right upper abdomen compatible with prior cholecystectomy.

Output: -Interval increase in predominantly peripheral interstitial opacities. This may represent acute exacerbation of ILD versus pulmonary edema superimposed on underlying ILD. Recommend CT of the chest with an ILD protocol.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Weakness and AMS with history of OHT A right upper extremity PICC joints and the right subclavian vein. Median sternotomy wires and mediastinal surgical clips are noted.Right pleural thickening and basilar scarring is unchanged. A calcified right upper lobe granulomas noted, unchanged. No pneumothorax or large pleural effusion. The cardiomediastinal silhouette is stable.

Output: Chronic appearing pleural and parenchymal abnormalities without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: 68 yo M with cml blast phase on dasatinib with increasing sob; r/o edema/effusions History: see above There are now bilateral pleural effusions with underlying compressive atelectasis.Cardiac size cannot be assessed.No focal areas of consolidation noted within the visualized lungs.

Output: Development of moderate sized bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: reassess left pleural effusion History: pleural effusion seen on previous CXR and chest CT Iatrogenic devices are unchanged. Basilar Unchanged cardiomegaly. No pneumothorax. No new focal pleural parenchymal opacity.

Output: Unchanged left greater than right pleural effusions and bibasilar atelectasis. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: lvad, swan Left-sided ICD leads and generator in place. Both components unchanged. Patient is status post sternotomy. Right Swan-Ganz catheter tip in the right pulmonary artery.Marked cardiomegaly and faint interstitial opacities unchanged. Left lung base atelectasis/scarring.

Output: Support devices unchanged. Stable cardiomegaly and faint interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess placement of swan History: as above, new swan inserted Moderate to severe cardiomegaly without edema.Right jugular Swan-Ganz catheter far peripherally in the right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.IABP catheter proximal marker projects over the aortic arch.

Output: Right jugular Swan-Ganz catheter, tip peripherally in the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for pneumothorax s/p thoracentesis History: none Bilateral effusions and atelectasis, left greater than right. Left effusion is improved from the prior exam.No pneumothorax.Stable cardiomediastinal silhouette.Midline upper abdominal skin staples, left upper quadrant surgical clips and surgical drain are noted.

Output: 1.No evidence of pneumothorax.2.Effusions and atelectasis, improved on the left.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval for PNA History: fever of unknown origin Basilar subsegmental atelectasis left greater than right with chronic appearing elevation left hemidiaphragm.Heart size normal.No specific evidence of infection or edema.

Output: Basilar subsegmental atelectasis, over an elevated left hemidiaphragm, otherwise unremarkable. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Dysphagia LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Acute chest History: chest pain Focal opacity and volume loss at left lung base.

Output: Focal opacity and volume loss at left lung base may be due to pneumonia, atelectasis, or related to acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with renal cell cancer status post 8 cycles of therapy. CHEST:LUNGS AND PLEURA: Index right upper lobe nodule series 5 image 13 measures 11.9 x 11.2 mm previously 10.5 x 10 mm.Reference left lower lobe nodule series 5 image 71 measures 28.9 x 26.2 mm. Previously 20.7 x 24.1 mm.Visually, numerous other nodules are grossly unchanged no new nodules are seen.Increase in size of right pleural effusion.MEDIASTINUM AND HILA: Index right paratracheal node series 4 image 11 measures 29.2 x 21.7 mm. Previously 25.1 x 22 mm.Index prevascular node series 4 image 19 measures 26.6 x 15.7 mm. Previously 26.2 x 17.9 mm. other nodes are grossly unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule series 4 image 91, 48.8 x 3.6 mm. Left adrenal gland normal.KIDNEYS, URETERS: Heterogeneous right renal mass redemonstrated unchanged. Hypoattenuation within the enlarged right renal vein. This likely extends into the inferior vena cava as seen on coronal image 70/128.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue mass left lower abdominal posterior wall musculature series 4 image 109. Probably unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered colonic diverticulosis.BONES, SOFT TISSUES: No definite lytic or blastic disease. Surgical appliance left hip. OTHER: No significant abnormality noted

Output: Increase in size of several lesions as above. Increase in right pleural effusion. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: assess ETT History: as above ET tube and left central venous catheter unchanged.Stable cardiac mediastinal silhouette.Perihilar opacity similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: r/o acute process History: chest pain Stable cardiomediastinal silhouette.Increased lung volumes compatible COPD.No new pulmonary opacities noted.No pleural effusions.Expansile lesion involving the anterior aspect left seventh rib similar to the prior exam.

Output: No acute cardiopulmonary abnormalities identified without interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p ETT insertion History: s/p ETT insertion ET tube 8 cm above the carina and NG tube tip in the stomach.Diffuse bilateral interstitial and airspace opacity without significant change.

Output: Slightly high position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: intubated, interval change History: intubated, interval change Endotracheal tube terminates 2 cm from the carina. Nasogastric tube extends inferiorly off the field-of-view. Diffuse pulmonary opacity, right greater than left, again noted. Worsening left basilar opacity. Probable small pleural effusions. Dense retrocardiac opacity is again noted. Unchanged heart size. No pneumothorax.

Output: Increasing left basilar opacity, likely atelectasis. Otherwise, no substantial change compared to last study.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: OG, intubated History: OG, intubated Support devices unchanged.Stable cardiac mediastinal silhouette.Pleural effusions and basilar atelectasis/edema similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pleural effusions and basilar edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: 37 F s/p central PICC placement for TPN History: please eval for position of PICC Interval placement of a left PICC that terminates within the right atrium.Persistent opacification which secures the left hemidiaphragm, possibly from aspiration. The remaining lungs are unremarkable. The heart size is normal.

Output: No pneumothorax following left PICC placement which terminates in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: pna? History: cough Changes of a prior median sternotomy are noted. Surgical clips project over the descending.The cardiomediastinal silhouette is normal. Right basilar opacity likely atelectasis or scarring. No pneumothorax or large pleural effusion.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years Reason: evaluate for medistinal air History: injury w/air noted in C-spine The cardiomediastinal silhouette is normal. Lungs are clear of air space and interstitial opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Concern for fluid overload. History of COPD. Stable myocardium equally. Intact median sternotomy wires, status post CABG.Increased lung volumes and signs of severe emphysema with right upper lobe predominance again noted.The known solid spiculated pulmonary nodule in the right midlung is unchanged from priors, although poorly characterized on plain radiographs.No abnormal focal lung parenchymal opacities suggesting pneumonia or pulmonary edema.No pleural effusion or pneumothorax.

Output: No radiographic findings to suggest pneumonia or pulmonary edema, as clinically questioned.Signs of severe emphysema and right upper lobe bullous disease again noted.Known right upper lobe spiculated solid pulmonary nodule previously noted is obscured, although characterized on chest CT dated 2/18/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Neutropenic fever Mild cardiomegaly with clear lungs. Right jugular has been placed tip over the SVC without pneumothorax.

Output: Clear lungs. No pneumothorax post right jugular catheter tip over SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Chest pain, ACS work up History: See above Evidence of healed granulomatous disease. The heart size remains normal. The lungs and pleural spaces are clear. There is evidence of calcification of the right subclavian artery and descending thoracic aorta.

Output: Heart size is normal. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: evaluate for pneumonia History: altered mental status Bilateral loculated pleural effusions or thickening again noted. Mild diffuse pulmonary edema, again noted. Moderate cardiomegaly, unchanged. Right IJ line again terminates at the cavoatrial junction. No definite pneumothorax. Bullet again noted overlying the lower thoracic spine.

Output: No substantial difference in pulmonary edema and bilateral loculated pleural effusions and/or pleural thickening. Moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Three day old 31 week gestational age patient with pneumothorax and adjustment of lines.VIEWS: Chest and abdomen AP (two views) 01/25/15, 1412 Endotracheal tube tip is just above thoracic inlet. Feeding tube tip is in gastric body. Umbilical venous line tip is at level of foramen ovale. A right chest tube has been placed.Right pneumothorax is much smaller. Anteromedial component persists. Hazy opacities are seen bilaterally. Mediastinum is no longer shifted. Cardiothymic silhouette is normal.Bowel gas pattern is disorganized. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is seen.

Output: Decrease in size of right pneumothorax after chest tube placement. Disorganized bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Cough rule out pneumonia Normal heart size. No focal air space opacities, pleural fluid or pneumothorax. Scarring along the left hemidiaphragm. Calcified lymph nodes suggestive of old, healed granulomatous infection.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt with lost tooth, please eval for location in respiratory tract History: ARDS Tracheostomy tube and a left chest tube unchanged.Interval removal of right jugular catheter with a new left jugular catheter extending to the SVC.Pulmonary interstitial opacity compatible with ARDS with a large perihilar cyst.No sign of an aspirated tooth.

Output: No sign of an aspirated tooth.New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: chest pain, hx pneumonia History: chest pain, SOB, palp Cardiomediastinal silhouette is normal in size and configuration.Lungs are clear. No pneumothorax.No acute osseous abnormality.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Renal mass No cardiopulmonary abnormality within limitations of the ICD generator obscuring the right upper lung

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 84 yearsGender: MaleReason for Study: Reason: r/o acute process History: shortness of breath Moderate size right-sided pleural effusion is now noted.Cardiac size cannot be adequately assessed.Mild left basilar atelectasis.

Output: Moderate/large right-sided pleural effusion .


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: assess Swan position History: cardiogenic shock Cardiomegaly with unchanged lower lung zone edema.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter, tip peripherally in the right descending pulmonary artery, more so than on the prior study.Left jugular catheter, tip in SVC.Left PICC, tip in axillary region.

Output: Unchanged lower lung zone edema. Right jugular Swan-Ganz catheter tip peripherally in the right descending pulmonary artery, slightly more so than on the prior study.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: h/o sarcoidosis History: see above The cardiomediastinal silhouette is unremarkable.Minimal scarring/discoid atelectasis at the left lung base.Calcified granuloma left midlung.No focal airspace opacities.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No radiographic evidence of sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Asbestosis. Kidney transplant. Cardinale again noted. Mild interstitial abnormality suggesting edema is present and similar to prior. No pneumothorax.

Output: Mild interstitial edema pattern. No pneumothorax or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: r/o infectious etiology History: chest discomfort The right hemithorax volume loss with loculated effusion is unchanged. The prior CT study of 7/3/2015 revealed air-fluid levels and bronchi and cavities. Associated hyperexpansion of left lung is also unchanged. No new evidence of additional infection.

Output: There is no significant interval radiographic change. CT would be necessary for direct comparison to the study of 7/3/2015.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval lung fields History: eval lung fields Cardiomegaly.Chronic elevation left hemidiaphragm with overlying atelectasis.No specific evidence of infection or edema.Unchanged support devices.

Output: Cardiomegaly without acute edema or pneumonia. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: r/o PNA History: cough, fatigue Moderate cardiomegaly, with small lung volumes.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: r/o PNA History: fever POD-3 Status post clam shell sternotomy for bilateral lung transplant.Scattered linear scarring but no sign of infection or edema.

Output: Status post lung transplant. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female; 42 years old. Reason: rule out pneumonia History: short of breath, fever Stable cardiomegaly.No overt edema or consolidation, with the examination again difficult for evaluation of mild edema due to body habitus and low lung volumes.No pneumothorax.

Output: No evidence of overt edema or infection.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with fever, tachycardia, hypoxia. Stable cardiomediastinal silhouette.New area of patchy opacification in the left mid to lower lung zone may represent aspiration or infection. Stable interstitial pulmonary edema. No pleural effusion or pneumothorax.Unchanged lines and tubes.

Output: New area of patchy opacification in the left mid to lower lung zone may represent aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval ETT placement History: ETT The endotracheal tube tip is approximately 3 cm above the carina.Right chest wall Port-A-Cath tip terminates at the cavoatrial junction.Nasogastric tube tip projects out of the field of view inferiorly, with the side-port at the level of the GE junction.No focal consolidation, pleural effusion or pneumothorax is seen.Pulmonary vascular redistribution similar to prior.Calcified hilar lymph nodes again seen.The cardiac and mediastinal contours are normal in size.

Output: Lines stable. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Shortness of breath. Low lung volumes. Posterior costophrenic angle blunting consistent with small pleural effusions. Hazy opacities suggesting aspirated secretions bilaterally. Right jugular catheter tip at the SVC.

Output: Small pleural effusions. Hazy opacities bilaterally are most consistent with acute aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: assess lung fields History: assess lung fields Right central venous catheter has been removed.NG tube with its side-port in the stomach.Stable cardiac enlargement.Increasing basilar opacities compatible with pleural effusions, edema, and atelectasis.

Output: Interval increase in pleural effusions, pulmonary edema, basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for interval change History: hypoxia Extensive bilateral nonspecific air space and interstitial opacity, consistent with known metastatic disease with possible superimposed infection or hemorrhage, not significantly changed.Loculated pleural effusion at the right base, confirmed on a previous CT scan. No new findings.

Output: Extensive bilateral opacity compatible with known metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Shortness of breath. Cardiomediastinal silhouette is within normal limits. No focal airspace opacity, pleural effusion, or pneumothorax. Previously identified left paraesophageal nodular opacity is obscured on the current examination.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: swan placement History: swan placement Left PICC line unchanged.IABP marker in the aortic arch.Stable cardiac enlargement.Right pleural effusion and basilar atelectasis similar to the prior exam.No new bony opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval for infiltrate/edema History: chest pain Small lung volumes.Bronchial wall thickening suggestive of asthma or chronic bronchitis.No reliable evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Nonspecific bronchial wall thickening suggestive of asthma or chronic bronchitis, but no sign of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Hypoxemia Bilateral multifocal opacities are stable and may reflect aspiration/infection. No pneumothorax. Tracheostomy tube again noted. Multiple surgical clips over the left neck and subclavian region.

Output: Stable multifocal bilateral pulmonary opacities may reflect aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval ETT, lung fields History: s/p LVAD Endotracheal tube is about 4 cm above the carina. Small left pleural effusion. Bibasilar subsegmental atelectasis. No focal pulmonary opacity. Interval placement of LVAD with new sternotomy hardware intact. Swan-Ganz catheter terminates in the main pulmonary artery.

Output: Endotracheal tube is about 4 cm above the carina. Bibasilar subsegmental atelectasis. Postoperative chest without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: right chest wall biopsy. History: none Right apical scarlike opacity unchanged.No pneumothorax following biopsy.Left subclavian catheter tip at the RA level.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube to water seal, please eval resolution progression of ptx History: ptx Left chest tube unchanged with no significant pneumothorax.Mild diffuse chronic interstitial opacity, unchanged.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 3 cm above the carina.Venous catheter unchanged.Cardiomegaly and nonspecific basilar opacity compatible with atelectasis and effusions.No significant change in line for position and projection.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: Eval for pulm edema History: SOB Left-sided ICD and LVAD unchanged.Stable cardiac enlargement and prominence of the pulmonary arteries.Increasing airspace and interstitial opacities compatible with worsening edema.Increasing pleural effusions.

Output: Increase in pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Check for fibrosis. Thorascopic lung biopsy Persistent decreased lung volumes with nonspecific interstitial abnormalities presumed chronic. No effusions or other findings to support definite edema and failure.The cardiac and mediastinal contours are within limits given technique

Output: Chronic interstitial disease and pattern again suggesting NSIP or chronic HSP


Instruction: Generate impression based on medical findings.

Input: 80 years, Male. Reason: NGT placement. Lower pelvis excluded from field-of-view. Feeding tube coiled in the gastric fundus with tip in mid gastric body. Generalized ileus pattern. Postoperative changes in the lumbar spine. Bilateral pleural effusions; please see same day chest radiograph for further details.

Output: Feeding tube coiled in the gastric fundus with tip in mid gastric body. Generalized ileus.


Instruction: Generate impression based on medical findings.

Input: Reason: acute hypoxia History: hypoxia Very mild basilar atelectasis in the posterior basal segments of lower lobes.Free intraperitoneal air, as shown on a recent CT scan likely related to recent surgery but more than expected.

Output: Persistent free intraperitoneal air and mild basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Intubated and unresponsive. Hypoxemia. Endotracheal tube 5.5 cm above the level of the carina. Peripheral venous catheter from the right and and enteric tube are unchanged in position.Pleural effusions with significant overlying atelectatic and consolidated lung, about the same. Dependent opacities most consistent with aspiration, about the same.

Output: No acute change in cardiopulmonary appearance suggestive of extensive aspiration with probable pneumonia in the lung bases. Pleural fluid volumes similar to previous.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Concern for pulmonary edema or pleural effusion Stable mild enlargement of the cardiac silhouette. Widening of the superior mediastinum secondary to mediastinal lipomatosis and known lymphadenopathy, as seen on prior chest CT dated 4/11/2016.Signs of chronic pulmonary venous hypertension. Bilateral vascular indistinctness and basilar predominant septal lines consistent with interstitial pulmonary edema.No pleural effusions or pneumothorax.

Output: Cardiomegaly, signs of pulmonary venous hypertension and interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: mediastinum History: back pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Low cervical spine stabilization hardware.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 44 year old female with renal insufficiency and renal transplant, new ascites. CHEST:LUNGS AND PLEURA: Mild central bronchial wall thickening. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with note made of a small pericardial effusion.Abnormally low attenuation of the blood pool when compared to the cardiac musculature suggests anemia.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate to large ascites.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Transplant kidney in the right hemipelvis is enlarged and diffusely heterogeneous. Note is also made of edema in the wall of the collecting system. No evidence of hydronephrosis.Moderate to large ascites.

Output: 1. Enlarged transplant kidney in right hemipelvis is diffusely heterogeneous with edema noted in the wall of the collecting system. Differential considerations on this noncontrast CT scan include rejection, infection, and ischemia. Correlation with ultrasound with Dopplers is recommended.2. Moderate to large ascites.3. Small pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: intubation History: intubated. Support devices not significantly changed.Low lung volumes with continued increase in diffuse multifocal opacities. Air bronchograms demonstrated in the right upper, right mid and right lower lobes consistent with more dense consolidation throughout the right lung. Additional development of air bronchograms in the left upper lobes consistent with progression of consolidations.Unchanged blunting of bilateral costophrenic angles.Nonspecific diffuse calcifications throughout the upper abdomen redemonstrated.

Output: Findings compatible with worsening cardiogenic edema.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: eval for effusion vs COPD History: SOB Left subclavian pacemaker unchanged.Interval increase in basilar edema bilaterally. Small bilateral pleural effusions.Large lung volumes compatible with COPD.Heart size upper limits of normal.

Output: Interval increase in basilar edema.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: SOB History: SOB Small lung volumes with diffuse interstitial opacities suggestive of edema although there are no pleural effusions and the heart size is normal.Nonspecific bronchial wall thickening has developed.No specific evidence of infection.

Output: Interstitial markings suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: right lower lobe lung cancer History: none Right-sided postsurgical volume loss with blunting of the right costophrenic angle from small pleural effusion. Lucency at the right peripheral mid zone may suspicious for small pneumothorax. Subsegmental atelectasis at the right lower zone is unchanged. Left lung remains clear.

Output: Stable right pleural effusion with postsurgical volume loss. Lucency at the peripheral right lung may represent a small pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: assess ETT placement, bilateral opacities History: respiratory failure New probable esophageal probe appears to terminate within the superior aspect of esophagus/hypopharynx. This could be repositioned as clinically indicated. Lines and tubes are otherwise unchanged. Diffuse left greater the right pleural parenchymal opacities, unchanged. Likely unchanged heart size. No definite pneumothorax though careful attention to the left apex is suggested on follow-up imaging.

Output: New probable esophageal probe appears to terminate within the superior aspect of esophagus/hypopharynx. This could be repositioned as clinically indicated. Diffuse left greater the right pleural parenchymal opacities, unchanged. No definite pneumothorax though careful attention to the left apex is suggested on follow-up imaging.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: heart transplant patient, eval for pneumonia History: fever Median sternotomy, heart size normal.Mild subsegmental atelectasis overlies an elevated right hemidiaphragm but there is no reliable evidence of infection.

Output: Right basilar subsegmental atelectasis, but otherwise no reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Altered (mental status), acute onset hypoxia and tachypnea. Concern for aspiration. Interval removal of right jugular catheter without pneumothorax. New left jugular catheter terminates in the projection of the left brachiocephalic vein to the right of midline. No pneumothorax.Unchanged cardiomediastinal silhouette.Paramediastinal basal opacity bilaterally suspicious for aspiration.

Output: Paramediastinal opacities in the lung bases suspicious for aspiration.


Instruction: Generate impression based on medical findings.

Input: 49 years old Male. Reason: pneumonia History: fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Reason: ? chest pain History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Infiltrates History: fever Unchanged heart and mediastinal silhouette.Persistent low lung volumes without focal consolidation pleural effusion or pneumothorax. Bilateral cervical ribs again seen.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: History of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Bilateral large pleural effusions, significantly enlarged compared to previous study. Postsurgical changes in the left upper lobe. Linear atelectasis in the left lower lobe. Index nodule in the right lower lobe is obscured by the large pleural effusion and subsegmental atelectasis in the right lower lobe, therefore cannot be measured. Other scatters subcentimeter nodules are unchanged.MEDIASTINUM AND HILA: Interval increase in the amount of pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 3 x 2.6 cm right adrenal mass on image number 104, series number 3, not significantly changed from previous study.KIDNEYS, URETERS: Status post left nephrectomy. Subcentimeter there for a lesions in the right kidney which are isodense to the kidney and closed contour lobulations are unchanged and remain concerning for malignancy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: Bladder wall is diffusely thickened.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes involving the thoracolumbar spine, unchanged fracture deformity of the Left greater trochanter are stable.OTHER: No significant abnormality noted

Output: Interval development of large bilateral pleural effusions and interval increase in the pericardial effusion.Right adrenal lesion and subcentimeter kidney lesions are unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: IABP, infiltrate History: heart failure Dextrocardia with situs inversus.IABP marker the proximal right sided descending aorta.Stable cardiac enlargement.No new pulmonary opacities noted.Swan-Ganz catheter has been removed.

Output: Stable cardiopulmonary appearance without specific evidence of acute infection. IABP marker in the proximal right-sided descending aorta in this patient with situs inversus.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: swan placement History: SOB Support devices are unchanged with a Swan Ganz catheter tip in the mid right interlobar pulmonary artery. Left axillary surgical clips and drain unchanged.The cardiac silhouette is enlarged but stable.Small bilateral pleural effusions persist and bilateral interstitial opacities appear stable.

Output: 1.Swan-Ganz catheter tip in the mid right interlobar pulmonary artery.2.Otherwise unchanged examination with pulmonary edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: evaluate lung fields History: R heart failure, L chest tube insertion, L pleural effusion Lines and tubes are unchanged. Lower lung volumes. Left pleural effusion and left lower lobe opacity, unchanged. Patchy right basilar opacity again noted. Unchanged heart size. No pneumothorax.

Output: Likely no substantial difference compared to previous study given lower lung volumes. Persistent left-sided pleural effusion and left lower lobe atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with history of shortness of breath. Evaluate for pneumonia versus volume overload. Bilateral axillary venous stents are present.Cardiac size appears similar to prior. Low lung volumes. Streaky bibasilar atelectasis. No focal airspace opacities, pleural effusions, or pneumothorax.

Output: Stable cardiopulmonary appearance with no specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Eval for pneumo or effusion History: S/P Chest tube removal Interval removal of left chest tube. Trace left apex pneumothorax. Other findings stable.

Output: Trace left apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Cough Stable cardiomediastinal silhouette, with mild cardiomegaly.Low lung volumes.Streaky bibasilar opacities likely represent subsegmental atelectasis.No specific evidence of infection or interstitial edema.No large pleural effusions.Enteric tube tip looped in the gastric body.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old. Small lung volumes with basilar streaky opacities compatible with subsegmental atelectasis.No sign of a venous catheter in the thorax.

Output: Basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: chf History: chf Cardiomegaly with mild perihilar edema.No specific evidence of infection.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly with mild perihilar edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: ETT, ICH History: as above Nonspecific basilar opacities suggestive of aspiration and/or edema.ET tube tip approximately 5 cm above the carina.NG tube, tip at the hemidiaphragm level.

Output: Basilar opacities suggestive of edema or aspiration. High NG tube.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Eval for cardiopulmonary disease. History: Weakness The mediastinum is widened. When correlated to the scout image on the recent CT and previous radiograph, an opacity extends left lateral to calcification in the distal transverse arch. There is atherosclerotic disease in this location on previous cross-sectional imaging; suggest CTA thorax for further evaluation of the aorta to evaluate for aneurysm or dissection.The lungs and pleural spaces are clear. The heart size is normal. No pneumothorax. This was discussed with Dr. Sorgeloos at 0900 hours who is caring for the patient.

Output: No evidence of pneumonia or edema. Mediastinal widening for which a CTA thorax is recommended to exclude progressive aneurysmal dilatation or possible dissection.


Instruction: Generate impression based on medical findings.

Input: Status post central ECMO decannulationVIEW: Chest AP (one view) 2/9/2016, 1907 Endotracheal tube tip is above thoracic inlet. The left neck ECMO catheters, right and left atrial lines, bilateral chest tubes, mediastinal surgical clips, and mediastinal drain are unchanged. There is improved aeration of the lungs with persistent opacities in the right lung. The cardiac silhouette is better assessed and appears normal in size.Soft tissue edema persists. Calcifications are noted in the right upper quadrant. Osseous changes from trichothiodystrophy are again noted.

Output: Improving aeration of the lungs.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with new diagnosis of AML presenting with shortness of breath and neutropenia. CHEST:LUNGS AND PLEURA: Patchy, peripheral, peribronchial alveolar infiltrates are seen in both lungs, greatest in the lower lobes.Mild bronchiectasis is identified in the lung bases.Small right pleural effusion.MEDIASTINUM AND HILA: Mediastinal and bilateral hilar adenopathy is seen. The largest lymph node measures 2.2 x 1.9 cm in the right hilum. A reference paratracheal node measures 1.6 x 1.5 cm (series 4; image 28).Small hiatal hernia.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensity in the upper pole of the right kidney is compatible with a cyst. Renal sinus cysts are seen bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Haziness of the mesentery in the left upper quadrant can be related to panniculitis.No bowel wall thickening is seen. Specifically, the ascending colon and cecum are unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Surgical clips are seen in the inguinal regions bilaterally.BONES, SOFT TISSUES: Patchy bone density affects the pelvic bones.OTHER: No significant abnormality noted

Output: Patchy, peripheral, peribronchial alveolar infiltrates bilaterally with mediastinal and bilateral hilar adenopathy. Findings can be seen with atypical infection, organizing pneumonia, or drug reaction.Patchy bone density within the pelvis may be due to leukemic involvement.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male. Mesothelioma patient with new hernia, please do pelvis scan along chest and abdomen and evaluate for disease. Dictate per mso protocol. CHEST:LUNGS AND PLEURA: Continued increase in multifocal pleural based masses are associated septal and interstitial thickening consistent lymphangitic tumor spread. Bilateral micronodules and multiple new nodules in the left lung. Volume loss particularly on the right. Increased bilateral pleural effusions particularly moderate and new on the left.Baseline measurement along the medial pleural surface at the level of the aortic arch 3 o'clock position series 4 image 34 measures 2.4 cm in thickness. On the same image the anterior pleural thickening is approximately 2.3 mm at the 12 o'clock position. There is complete opacification of the right base.MEDIASTINUM AND HILA: Increased diffuse mediastinal adenopathy involving all lymph node chains. There is involvement of the base of the right neck as well. Small pericardial effusion.CHEST WALL: Increased soft tissue tumor extends into the lower right chest wall subcutaneous tissues muscle and intercostal spaces. Soft tissue masses are also seen so seen in the right in anterior lower chest wall.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Adenopathy seen in the gastrohepatic ligament porta hepatis celiac areas approximately unchanged.BOWEL, MESENTERY: New moderate ascites. Soft tissue in the distribution of the omentum on the right consistent with carcinomatosis. This is a new finding.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Ascites and carcinomatosis on the right beneath the rectus muscle.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Progression of disease. New abdominal disease.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p right sided thoracentesis History: right pleural effusion Right pleural effusion appears decreased in comparison to prior examination. No pneumothorax status post thoracentesis. Interval increase in left pleural effusion and adjacent atelectasis. Cardiomegaly is unchanged. Tracheostomy in place.

Output: Interval decrease in right pleural effusion without pneumothorax. Interval increase in left pleural effusion and left atelectasis. These findings are compatible with ongoing CHF and edema.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: eval for chest pain History: pleuritic pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: r/o fluid overload, pneumonia History: 70F ESRD, CHF p/w n/v/d + pedal edema, also with URI sx Median sternotomy, heart size normal.No significant pulmonary or pleural abnormality.

Output: No significant abnormality. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 82 years old Male. Reason: Patient s/p ET tube advancement; please evaluate tube position History: As above. There is a new patchy opacity in the right lower lobe. Stable left small pleural effusion. There is no evidence of pneumothorax. The ET tube and NG tube are stable in position.

Output: New patchy opacity in the right lower lobe, which can be due to edema or infection. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Shortness of breath. Assess for pneumonia or pleural effusion. Study is limited by leftward patient rotation, nonvisualization of the left lateral costophrenic angle, and low lung volumes. Dense left lower lobe retrocardiac opacity again noted with some degree of volume loss. No convincing evidence of new focal lung consolidation. Unchanged heart size. No acute bony abnormality. No definite pleural effusion or pneumothorax.

Output: Study limitations, as above.Dense left lower lobe retrocardiac opacity, unchanged, consistent with atelectasis and/or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: r/o mediastinal changes History: emeis,s chest pain, heparin gtt Lungs are markedly hypoinflated with no new acute findings. Cardiomediastinal silhouette is unchanged.

Output: Lungs are markedly hypoinflated with no new acute findings. Cardiomediastinal silhouette is unchanged.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male. Metastatic GCT testicular cancer with a large left-sided abdominal mass. Status post chemotherapy. Evaluate interval change. This examination is limited by the absence of intravenous contrast.CHEST:LUNGS AND PLEURA: Multiple faint ground glass opacities in the upper lobe are present at axial images 17, 22 and 29/103 of series 6 are new. May be resolving infiltrates. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LUNG BASES: Bilateral gynecomastia. No acute infiltrates or effusions.LIVER, BILIARY TRACT: The metastatic mass in the right lobe of the liver is much smaller and now measures 2.8 x 3.4 cm on image number 87/213, series number 3.Additional ill-defined hypodense lesion adjacent to the gallbladder is not defined on this non-contrast exam. SPLEEN: No significant abnormality PANCREAS: No significant abnormality ADRENAL GLANDS: No significant abnormality KIDNEYS, URETERS: Left hydronephrosis has resolved with left double-J stent in place. Unchanged since the prior exam.RETROPERITONEUM, LYMPH NODES: There is a retroperitoneal mass that is significantly smaller measuring 8 x 10 cm on coronal image number 37. The mass encases the renal vessels and previously caused left-sided hydronephrosis. Left double J stent in the left renal collecting system.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Interval resolution of free fluid within the pelvis.

Output: Interval decrease in the size of the large retroperitoneal mass with resolution of the left hydronephrosis.Pelvic ascites has resolved since the prior exam. Hepatic metastatic lesions have decreased. Right hepatic lobe lesion is much smaller compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Check for TB. Nonspecific lab test No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: s/p thoracentesis, eval for pneumothorax History: s/p thoracentesis Stable position of the left subclavian catheter.Interval decreased size of the large right pleural effusion following thoracentesis. Interval small right hydropneumothorax. Stable size of large left pleural effusion which secures the cardiac silhouette.

Output: Small right apical hydropneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: 82F with point tenderness of chest after a fall. History: s/p fall, rule out anterior rib fracture, chest pain Patient is severely kyphotic with mild diffuse loss of height of several thoracic vertebral bodies and dextroscoliosis of the thoracolumbar spine.The bones are demineralized. No displaced rib fracture is identified. Streaky apical opacities may represent chronic scarring. No evidence of edema or infection. The pleural spaces are clear. The heart size is within limits of normal.

Output: No evidence of displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.LVAD/trach Cardiomegaly with diffuse interstitial edema pattern slightly progressed. LVAD incompletely visualized. Right subclavian line tip over the SVC/RA junction. Tracheostomy tube and ICD again noted, intact. Dobbhoff tube at least in the stomach.

Output: Mild to moderate interstitial edema pattern with cardiomegaly, slightly worse. Tubes and devices are stable.


Instruction: Generate impression based on medical findings.

Input: 77 year old female with syncope. Evaluate pacemaker position. Left sided pacemaker laterally positioned no overlying the left lateral chest wall with leads unchanged.No focal airspace opacities. Biapical calcifications unchanged. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: Left-sided pacemaker more laterally displaced compared to prior exam, leads unchanged however. Otherwise no interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for change given increased acidosis History: as above Unremarkable cardiac and mediastinal silhouette. Bilateral lower zone coarse interstitial and airspace opacities, not significantly changed.No new findings.

Output: Interstitial and airspace opacities, previously characterized by CT scan, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: sp MVR History: - There is now complete opacification left hemithorax compatible with large left pleural effusion and probable accompanying atelectasis.Left-sided chest tube in left sided pacemaker unchanged.Cardiac size cannot be assessed.Mitral valve replacement unchanged.The right lung is clear.

Output: New complete opacification of the left hemithorax compatible with a large pleural effusion as well as accompanying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusions History: none Cardiopulmonary monitoring and support devices, unchanged.Small lung volumes with nonspecific perihilar opacities compatible with subsegmental atelectasis and aspirated secretions.No specific evidence of pleural effusions.

Output: Perihilar opacities compatible with atelectasis and consolidation without significant change.


Instruction: Generate impression based on medical findings.

Input: Evaluate for gastroesophageal reflux disease. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. During the exam, provoked gastroesophageal reflux was observed within the distal esophagus, with rapid clearance. There was no hiatal hernia. Upon swallowing a barium pill, the pill readily passed from the esophagus into the stomach.TOTAL FLUOROSCOPY TIME: 3.27 minutes

Output: Mild provoked gastroesophageal reflux. Otherwise unremarkable esophagram.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old; Reason: Abnormal foci of uptake? History: Thyroid cancer s/pg I131 There is a faint focus of activity in the left upper neck. There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. Probe uptake of the neck is 0.105%.

Output: Faint focus of activity in the left upper neck is concerning for residual functioning thyroid tissue.


Instruction: Generate impression based on medical findings.

Input: Reason: Category P History: productive cough. Normal heart size with a tortuous aorta, accentuated by under inflation and rotation.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with locally advanced breast cancer. Restaging. CHEST:LUNGS AND PLEURA: Stable micronodules in the right lung. No pleural effusion.Scattered ground glass opacities located peripherally in the right lung are new and may be related to prior irradiation but not specific.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Patient is status post bilateral mastectomies. Interval resolution of previously noted postoperative fluid collection in the left chest wall.Stable degenerative changes of the spine.ABDOMEN:LIVER, BILIARY TRACT: Hypodensities in the liver too small to characterize; unchanged.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple bilateral cysts, unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative changes of lower lumbar vertebral facet joints.

Output: No conclusive evidence of metastatic disease. Groundglass nodules in the right lung and may represent early radiation pneumonitis in the appropriate clinical context; may be followed on subsequent exams. Stable pulmonary micronodules, likely postinflammatory


Instruction: Generate impression based on medical findings.

Input: Progressive dysphagia. Scout radiograph of the chest demonstrates mediastinal surgical clips and chronic appearing changes in the right lung base. The left costophrenic angle is excluded from the film. No abnormal mediastinal widening.Double contrast evaluation of the esophagus demonstrated no morphologic abnormalities of the mucosal surfaces. There was a diverticulum of the left mid esophagus that measures approximately 0.8 cm. Fluoroscopic evaluation of esophageal peristalsis demonstrated escape and a tertiary peristaltic wave, consistent with moderate esophageal dysmotility. Additionally, evaluation of swallow on the lateral view demonstrated deep tracheal penetration without evidence of aspiration. The patient had spontaneous gastroesophageal reflux that did not clear rapidly. No esophagitis. The barium tablet passed freely. No hiatal hernia.No specific evidence for an esophageal web, cricopharyngeal bar, or Zenker's diverticulum.Limited views of the stomach and duodenum are unremarkable.Fluoro capture recordings are labeled as series numbers: 18, 23.

Output: 1.Moderate esophageal dysmotility.2.Spontaneous gastroesophageal reflux did not clear rapidly. No esophagitis.3.Deep tracheal penetration on swallowing evaluation. No aspiration.4.Small esophageal diverticulum.


Instruction: Generate impression based on medical findings.

Input: Cough No interval significant change, specifically no evidence of pneumothorax or acute new abnormality. Diffuse interstitial opacity compatible with moderate fibrosis. Mild cardiomegaly with tortuous aorta, atherosclerotic disease and suspected pulmonary hypertensionOld previously described multiple vertebroplasty.

Output: Diffuse pulmonary fibrosis without evidence of superimposed new acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: swan, check placement and interval changes History: see above Lines and tubes are unchanged. Right-sided PICC again terminates in the subclavian vein. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: CHF, effusion, edema History: pleuritic chest pain worse with inspiration, hx of LVAD, AICD, CHF Cardiomegaly with lower lung zone edema and a right pleural effusion, or right lower lobe pneumonia, unchanged.No significant pneumothorax.Stable support devices.

Output: Stable support devices, cardiomegaly and pulmonary opacities. No findings to account for new pleuritic pain.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with metastatic renal cancer status post left nephrectomy. Status post right partial nephrectomy. CHEST:LUNGS AND PLEURA: 16 x 14 mm left lower lobe pulmonary nodule (series 4; image 57), previously measuring 9 x 8 mm is identified. It invades the lateral basal segmental bronchus of the left lower lobe, causing minimal postobstructive inflammatory changes. Subcentimeter pulmonary nodules are also seen bilaterally, some which have minimally increased in size.MEDIASTINUM AND HILA: Surgical clips are seen in the thyroid bed.Hazy tissue in the anterior mediastinum is likely residual thymus.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Hypodense lesion in the body of the pancreas measuring 11mm is unchanged (series 4; image 96). Additional subcentimeter hypodensities are seen in the pancreatic tail (series 4; images 98 and 101), stable. A punctate calculus is noted in the pancreatic tail.ADRENAL GLANDS: The adrenal glands are not visualized.KIDNEYS, URETERS: Status post left nephrectomy.Status post resection of the lesion in the midpole of the right kidney without evidence of abnormality in the postsurgical bed. An 11 x 11 mm lesion which enhances on portal venous phase and washes out on delayed images in the midpole the right kidney (series 4; image 109 and series 7; image 52) is noted, not significantly changed in size. Unchanged subcentimeter hypodense lesion in the lower pole of the right kidney, best seen on series 7, image 65.Patent right renal vein.Tiny simple cyst in the upper pole of the right kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post partial right nephrectomy and total left nephrectomy.Increase in size of the dominant pulmonary nodule, with bronchial invasion, described above.Enhancing 11-mm lesion in the midpole of the right kidney, unchanged in size, but worrisome for renal cell carcinoma. Indeterminate subcentimeter right renal hypodensity, unchanged.Unchanged hypodense pancreatic lesions, which may represent sidebranch IPMN's.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess for infiltrates History: acute new hypoxia, SOB Interval placement of external defibrillator pads.Progressive bilateral interstitial and airspace opacities of progressive edema with small pleural effusions. Cardiac enlargement with left ventricular chamber dilatation. Eventration of the diaphragm at midline with mild superior migration of a loop of colon. No pneumothorax.

Output: Progressive pulmonary edema with interval placement of external defibrillator pads. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Aortic valve replacement ETT has been removed. Swan-Ganz remains within the pulmonary outflow tract. Mediastinal chest tubes and underlying cardiopulmonary appearance is otherwise essentially unchanged given differences in technique.

Output: ETT removed


Instruction: Generate impression based on medical findings.

Input: Hypoxemic respiratory failure. Evaluate tube placement. Elective intubation for possible ARDS. Large layering right pleural fluid collection. Endotracheal tube tip 4.5 cm above the level of the carina. Mild dependent atelectasis on the left. Significant atelectasis and airspace opacity in the dependent right lung field; underlying infection or ARDS cannot be excluded.

Output: ETT tip 4.5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: r/o infection? bronchitis? History: cough x 2 weeks Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval for improvement in opacity History: hypoxemia Progression of right basilar opacity which can represent atelectasis and effusion. Heart size remains normal. Remaining lungs are clear. Consider right lateral decubitus for further evaluation.

Output: Progression of right basilar opacity which may be progressing atelectasis and/or consolidation and effusion. Consider right lateral decubitus for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: assess for changes in pulm edema, ett position History: sp intubation, ards Support devices are stable.No change in bilateral lung opacities. No pneumothorax.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: lung eval History: lung eval A new tracheostomy tube has been placed. Other lines and tubes, unchanged. Mild pulmonary edema pattern again noted. Left greater the right basilar opacities with small pleural effusions, as before. Unchanged cardiomegaly. No pneumothorax.

Output: A new tracheostomy tube has been placed. Mild pulmonary edema pattern again noted. Left greater the right basilar opacities with small pleural effusions, as before.


Instruction: Generate impression based on medical findings.

Input: Cough and afebrile. Elevated white count No acute cardiopulmonary abnormality other than the previously observed mild diminished lung volumes

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: pls assess IABP plcmt History: s/p IABP Balloon catheter marker in the descending aorta projected 6 cm below the top of the aortic arch. Swan-Ganz catheter tip in the main pulmonary artery.ICD lead unchanged.Cardiomegaly with no evidence of pulmonary edema or infection.

Output: Balloon catheter and Swan-Ganz catheter unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p trach, on vent History: asx Tracheostomy tube and feeding tube unchanged.No significant cardiopulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: fever, cough Normal heart size with a moderate scoliosis and degenerative disease in the spine.Calcified granulomas compatible with previous infection.No sign of pneumonia or other acute disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: febrile, need for o2 therapy History: infxn concern Interval extubation.Small lung volumes with bilateral basilar predominant opacity, suggestive of edema, with probable small bilateral pleural effusions.Venous catheters extending to the SVC though visualization is impaired by motion artifact.No specific evidence of pneumonia.

Output: Findings suggestive of edema and pleural effusions. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female preop series to check wire. Follow wire from dbs to chest wall SHUNT DEVICE: There are deep brain stimulation wires which are situated intracranially above the sella in the left and right paramidline. The wires exit the calvarium through their respective burr hole in the left and right frontal bones and coarse through the right scalp, soft tissues of the right neck and soft tissues of the anterior chest wall connecting to an internal pulse generator. There is no evidence of kinking or discontinuity within the radiopaque portions of the device.SKULL: The visualized paranasal sinuses are clear with no significant abnormality noted.CERVICAL SPINE: Alignment is anatomic with preservation of the disc spaces and vertebral body heights.CHEST: Lungs are clear and cardiomediastinal silhouette is within normal limits.

Output: Deep brain stimulation device as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval for ptx, rib fx History: chest pain after kick in chest Median sternotomy, heart size normal.No significant pulmonary or pleural abnormality, except for healed granulomatous disease.No displaced rib fracture or pneumothorax.Left subclavian pacemaker, leads unchanged in position.

Output: No pneumothorax or displaced rib fracture, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: febrile, trach, concern for pna History: febrile Tracheostomy tube and right Port-A-Cath unchanged.Stable cardiomediastinal silhouette.Interstitial and patchy airspace opacities similar to the prior exam.No new pulmonary opacities identifiedLoculated pleural effusion similar to the prior exam.

Output: Stable cardiopulmonary appearance of extensive pulmonary opacities and loculated pleural effusions. No new focal areas of consolidation .


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: s/p AVR and MVR History: s/p AVR and MVR Pleural effusions noted.Heart size normal status post aortic valve replacement.Left subclavian pacemaker, leads unchanged in position.

Output: Small pleural effusions. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: metastatic breast cancer, chronic pleural effusion History: fatigue No change in moderate right pleural effusion with associated atelectasis. ICD unchanged. No new opacity.

Output: Stable moderate right pleural effusion with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Shortness of breath evaluate for pneumonia. Cough. Large lung volumes with basilar scarring. Subtle focal opacity in the left upper lobe superimposed over the scapula indeterminate and could reflect active infection or other process. Severe enlargement of the central pulmonary vasculature consistent with pulmonary hypertension.

Output: Faint left upper lobe opacity which may reflect evolving scarring, active infection or other process, nonspecific. Follow-up PA and lateral chest radiographs suggested when feasible to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with ADHF, fever. Evaluate for infection. Left IJ Swan-Ganz catheter tip in the right pulmonary artery. Partially imaged left chest wall AICD with single lead in the right ventricular apex.Right basilar hazy opacity unchanged. New mild hazy retrocardiac opacity. Probable small right pleural effusion. No pneumothorax. Mild cardiomegaly.

Output: Unchanged right basilar hazy opacity with new hazy retrocardiac opacity may represent aspiration or edema.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: hx of colonic distension, History: nausea Small bowel gas pattern is nonobstructive. Previously administered oral contrast now resides within the colon. Enteric tube terminates over the left mid abdomen likely in the region of the jejunum.Postsurgical changes in the right lung and rib. No definite free intraperitoneal air.

Output: Nonobstructive bowel gas pattern


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with history of metastatic gist tumor. CHEST:LUNGS AND PLEURA: Scarring in bilateral upper lobes.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Expansile lytic lesion involving the transverse process, body and posterior elements of the C7 vertebral body. This lesion is slightly enlarged compared to CT dated 7/25/05.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previous described left-sided hypodense lesion is less well-defined but unchanged likely representing residual mass. However mostly right sided ill-defined perirectal mass appears to be increased in size. It cannot be distinguished from the rectum since rectum is not opacified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the ill-defined pelvic mass around the rectum. The mass cannot be differentiated from the unopacified rectum, therefore, accurate measurements cannot be obtained on CT. Pelvic MR is recommended for better characterization of the extent of disease.Expansile lytic lesion involving the C7 vertebral body. Differential diagnosis includes aneurysmal bone cyst, giant cell tumor or less likely metastases. Further evaluation with dedicated C-spine MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval clearance of the mid right lung focal opacity. Mild basilar scarring without evidence of new superimposed acute findings.

Output: Resolution of right midlung focal opacity


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: intubated patient History: mech vent Endotracheal tube unchanged in position. No change in position of the right central catheter, tip directed towards the right axilla the projection of the subclavian vein.Lungs clear of airspace opacities.Increased lung volumes compatible with COPD.No pleural effusions

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Aspiration pneumonia Endotracheal tube terminates approximately 2 cm from the carina. Central venous catheter, unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. New patchy bibasilar opacities. No large pleural effusion or pneumothorax. Unchanged heart size. Severe distention of the stomach.

Output: Endotracheal tube terminates approximately 2 cm from the carina. Severe distention of the stomach.New patchy bibasilar opacities certainly consistent with aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: pna Tracheostomy tube and venous catheters unchanged.Nonspecific basilar airspace opacity compatible with pneumonia, and small pleural effusions.No new findings.

Output: Nonspecific findings compatible with the clinical diagnosis of pneumonia with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 37 yearsGender: FemaleReason for Study: Reason: patient with fever, rule out infection History: fever ET tube and NG tube have been removed.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 55 years old Male. Reason: mechanical intubation History: mechanical intubation, aspiration. Cardiomegaly and left pleural effusion, unchanged as compared with prior study. Minimal interstitial changes are noted in both lungs. There is interval resolution of the patchy groundglass opacity in the right lower lung field. The ET tube, NG tube and ICD electrode are stable in position. There is no evidence of pneumothorax.

Output: Findings are consistent with mild CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: cough, fever History: cough, fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. Stable cardiomediastinal silhouette. Left Pleurx catheter unchanged.Decreased lung volumes with stable appearing interstitial opacities.Small left pleural effusion similar to the prior exam.No new pulmonary opacities identified.No evidence of a pneumothorax.

Output: Stable cardiopulmonary appearance with small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: line placement? History: as above No significant cardiopulmonary abnormality.Right PICC, tip in right subclavian.

Output: No significant abnormality. Right PICC, tip in right subclavian.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Chest pain, evaluate for acute cardiopulmonary abnormalities History: Chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Healed right rib fractures.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p CABG History: SOB Slight increase in patchy right basilar opacity. Stable left basilar opacity and left pleural effusion. Unchanged heart size. No pneumothorax.

Output: Slight increase in right basilar opacity, presumably atelectasis. Unchanged patchy left basilar atelectasis and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval pleural effusions History: SOB, on 3L NC postop. Interval extubation and removal of nasogastric tube. Right port remains present. Multiple skin staples occupy the abdominal midline.Mid to lower zone opacities have increased, along with small right pleural effusion. No pneumothorax.

Output: Right greater left pleural effusions with basilar atelectasis suggestive of hypervolemia.