Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: IABP placement History: concern for malfunction and malpositioning Cardiomegaly with a mild edema pattern and decreased inflation.IABP catheter proximal marker is projected over the aortic arch. Right jugular Swan-Ganz catheter tip in main pulmonary artery directed towards the right.Left subclavian ICD, leads unchanged in position.

Output: IABP catheter, appropriately positioned. Mild edema.


Instruction: Generate impression based on medical findings.

Input: 65 years old Female. Reason: Evaluate for aspiration or pneumonia. History: sob. There is interval improvement of the retrocardiac opacity. The feeding tube has been removed. The tip of the NG tube projects over the fundus of stomach. Stable small left pleural effusion. No evidence of pneumothorax.

Output: Interval improvement of the retrocardiac left lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p line placement History: as above Endotracheal tube terminates approximately 5.5 cm from the carina. Left IJ line terminates at the cavoatrial junction. Enteric tube extends inferiorly off the field-of-view. Diffuse pulmonary opacities again noted. Loculated left lateral pneumothorax, slightly increased from previous study. Unchanged heart size.

Output: Lines and tubes as above. Diffuse pulmonary opacities again noted consistent with diffuse alveolar damage. Increase in size of small loculated left lateral pneumothorax, likely related to differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Reason: Shortness of breath Study limited by large patient body habitus. Right basilar pleural-parenchymal scarring again noted. No new focal pleural parenchymal opacity. Marked cardiomegaly again noted. No large pleural effusion or pneumothorax.

Output: Study limited by large patient body habitus. Right basilar pleural-parenchymal scarring again noted. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Left upper lobe or bronchus neoplasm Improved vascular distribution and currently no cardiopulmonary acute abnormalities. Postsurgical left upper lobectomy changes. Cardiac and mediastinal contours are within limitsIncompletely visualized left shoulder arthroplasty

Output: Postsurgical scarring without acute abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: SOB Diffuse bilateral airspace and interstitial opacity, nonspecific, possibly related to aspiration or infection, less likely edema based on the appearance of the previous radiograph.No new findings.

Output: Diffuse nonspecific airspace and interstitial opacity, slightly less nodular than on the previous radiograph.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: eval for cause of fever History: fever Skin staples and surgical clips are again noted.The enteric tube tip is at the level of the diaphragm.Stable cardiomediastinal silhouette status post esophagectomy.Low lung volumes with streaky left greater than right basal patchy and persistent left lower lobe atelectasis/consolidation. Unchanged small left pleural effusion. No pneumothorax.

Output: Stable cardiopulmonary appearance. Left lower lobe atelectasis/consolidation may be a source of the patient's fever.


Instruction: Generate impression based on medical findings.

Input: Reason: infection, possible pneumonia History: leukocytosis Mild cardiomegaly with no sign of pneumonia or other acute findings.Tracheal deviation to the right in the neck consistent with a goiter, unchanged.

Output: Mild cardiomegaly and no acute findings.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p CABG ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.The lung catheter tip at the level of T6 and the descending aorta.Small lung volumes with basilar consolidation and atelectasis.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Hypoxia, question obvious pneumothorax Endotracheal tube tip is approximately 9 cm above the carina, at the level of the thoracic inlet.Enteric tube tip extends beyond the lower margin of the radiograph.Stable position of bilateral chest tubes.Exam is markedly limited due to the diffuse subcutaneous emphysema.Stable appearance of diffuse bilateral reticular opacities, compatible with patient's history of interstitial lung disease.Small left pneumothorax, unchanged. No large right-sided pneumothorax is identified.

Output: 1. Endotracheal tube tip is approximately 9 cm above the carina, at the level of the thoracic inlet.2. Otherwise, stable exam including small left-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: s/p pleurex in R lung History: s/p pleurex in R lung New right subpulmonic catheter placed, draining the majority of a right pleural effusion but there is now a right subpulmonic pneumothorax.Right upper lung zone emphysema unchanged.Slight increase in left-sided interstitial edema like opacities and left pleural effusion.

Output: New right subpulmonic pneumothorax following Pleurx catheter placement.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: why in svt? History: new svt Low lung volumes with right basilar opacity compatible with atelectasis. No large pleural effusion or pneumothorax. Prominence of the cardiac silhouette and superior mediastinum may be projection and related to prominent vasculature.

Output: 1. Low lung volumes with basilar atelectasis.2. Prominent superior mediastinum may be due to overlying vasculature and projectional.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: evaluate ETT History: ETT assessment Stable position of support devices. Interval decreased lung volumes. Coarse interstitial and airspace opacities not significantly changed. Basilar atelectasis and likely small left pleural effusion.

Output: No significant change in coarse interstitial opacities suggestive of ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Evaluate pneumothorax Tortuous aorta is noted. Right lung base streaky opacity compatible with atelectasis. No pneumothorax. Left hemidiaphragm elevation noted. Fracture of the left 10th rib, better evaluated on rib radiographs. Mild atelectasis and small pleural effusion noted.

Output: No evidence of pneumothorax as clinically questioned. Left rib fracture again seen. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male history of AML, pre-L. a stem cell transplant. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Simple bilateral cysts.RETROPERITONEUM, LYMPH NODES: IVC filter is in place.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: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: tachypnea coarse breath sounds History: tachypnea coarse breath sounds Mild right hemidiaphragmatic elevation again noted. No new focal lung consolidation. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pna in pt with WBC and productive cough History: productive cough s/p cystectomy, +WBC Postsurgical volume loss in the left hemithorax with residual scarring.Normal heart size and mediastinal contours.Air-filled hepatic flexure beneath the right hemidiaphragm.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: eval for interval change History: hypoxia Interstitial and airspace opacities left mid and lower lung zone predominant have worsened particularly in the left lung base.Heart size normal.

Output: Worsening left side predominant pulmonary opacities consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: assess LLL lesion, history of smoking There continues to be motion artifact at the lung bases, limiting assessment of image detail. Stable cardiomediastinal silhouette, with mild tortuosity of the thoracic aorta. Focal smoothly marginated nodular opacity at the left lung base appears grossly unchanged, measuring up to 1.3 cm and may contain internal calcification. Upon reviewing the patient's prior imaging, the nodule may have been partially imaged on the prior lateral lumbar spine radiograph from 10/28/2015 and the partially imaged caudal aspect of the nodule appears similar in size. No new focal pulmonary opacities, pleural effusion, or pneumothorax. Cervical spinal fusion hardware partially visualized. Degenerative changes of the acromioclavicular joints are noted.

Output: 1.3 cm nodule at the left lung base which may have been partially imaged on the prior lumbar spine radiograph from 10/28/2015. Overall, the characteristics favor a benign etiology. 4-6-month follow-up radiograph is recommended to ensure stability in the absence of prior exams for comparison unless there is a high level of clinical suspicion for nonbenign etiology. Optimally, comparison with remote outside prior chest radiographs would help determine stability if they can be obtained and submitted by the referring clinical service.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: Aspiration? Pneumonia? History: fever, s/p emesis and hematemesis Small lung volumes.Right lower lobe subsegmental atelectasisSurgical clips in the liver.No focal opacities.

Output: No evidence of pneumonia; right lower subsegmental atelectasis which could be from aspiration or mucous plugging.


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, 41 years old.Reason: r/o pna History: neutropenic fever No significant cardiopulmonary abnormality.Bilateral jugular catheters terminate in the SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: is there an infiltrate History: right chest wall and ruq pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: s/p esophagectomy History: s/p esophagectomy NG tube has been removed.Decreased lung volumes with stable cardiac mediastinal silhouette.Pleural effusions and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Interval removal of an NG tube. Stable cardiopulmonary appearance of pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: pulm edema History: SOB Defibrillator leads are unchanged in position.Calcified mediastinal and hilar lymph nodes are unchanged. The cardiac silhouette is stable. Bilateral, basilar predominant interstitial and airspace opacities have increased compared to the prior examination. There is subsegmental atelectasis at the right lung base. Background of emphysema noted. No large pleural effusions.

Output: Pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: 74 y/o M s/p lft nephroureterostomy now with increased O2 requirement, suspect aspiration vs PNA History: as above Stable basilar opacities suggestive of atelectasis. Large right diaphragmatic hernia unchanged. Small right pleural effusion/pleural thickening unchanged. Cardiomediastinal contours are stable.The imaged skeleton of the abdomen unremarkable.

Output: Stable bibasilar atelectasis and possible right pleural effusion/thickening.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: assess ett position and for infiltrate History: hypoxia Worsening left lower lobe consolidation, likely atelectasis given volume loss.Cardiomegaly.ET tube tip approximately 1 cm above the carina.Two enteric tubes extend below the lower margin of the image.

Output: Low ET tube with left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: pulmonary edema? History: hx amyloidosis p/w diffuse edema Extensive lower lung zone bronchiectasis, better seen on the prior CT, without evidence of new pneumonia or edema.No pleural effusions identified.Heart size normal.Tracheostomy tube tip approximately 5 cm above the carina.

Output: Extensive bronchiectasis better seen on CT, but no evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: infiltrate, edema History: advanced heart failure, on inotrope Cardiomegaly with a slight reduction in pulmonary edema and pleural effusions.Right subclavian Swan-Ganz catheter tip in right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Slight improvement in pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 1 cm above the carina.Bilateral perihilar and lower zone opacity, suggestive of aspiration.A more recent radiograph has been interpreted.

Output: Slightly low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: desat ICD lead unchanged. Cardiomediastinal silhouette is unchanged given differences in technique. No pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Leukocytosis, altered mental status. Assault by nonspecified means. Cannabinosis. No focal airspace opacities, pleural fluid or pneumothorax. Mild basal atelectasis.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Chest pain Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: evaluate pacemaker leads History: SSS No significant cardiopulmonary abnormality.Left subclavian pacemaker, leads projected over the right atrial appendage and directed towards the right ventricular outflow tract.

Output: No significant abnormality. Pacemaker leads discussed above.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: eval for pneumonia History: new cough Right upper lobe opacity with volume loss consistent with infection or mucus plugging.Right infrahilar opacity projected behind the right heart border may reflect pneumonia.Left upper lobe scarring and volume loss are present.Heart size normal.

Output: Multifocal opacities consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Desaturation during EGD while under sedation evaluate for etiology of hypoxia. ETT tip 5 cm above the level of the carina. There is a teardrop shaped density projecting over the midesophagus at the level of the left mainstem bronchus, new from prior. This appears to have passed into the stomach on a subsequent abdominal radiograph.Right jugular catheter tip in the right atrium.Pleural fluid, bronchial wall thickening and basal/dependent atelectasis about the same. Left costophrenic angle opacity present previously and unchanged.

Output: Teardrop shaped high density foreign object projecting over the midesophagus at the level of the left mainstem bronchus appears to pass to the stomach on a subsequent abdominal radiograph. This is of unclear etiology but most likely a tooth; recommend correlation with physical examination of the oral cavity to assess for possibility of missing teeth. SHAMAA, OBADA at 1956 notified of possible foreign body ingestion at 8:49 AM on 8/26/2016 via Web exchange text page (PNR). VOLERMAN BEASER, ANNA (1517) also notified via Web exchange text page at 11:04 AM on 8/26/2016 and was subsequently verbally notified; she will notify the ICU team.Extensive basal opacities suggestive of CHF and possible aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o aspiration History: r/o aspiration Moderate cardiomegaly with pacemaker leads in place, unchanged.Bilateral lower zone patchy airspace opacity, highly compatible with aspiration, new from previous.

Output: Bilateral airspace opacities compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male. History renal cancer. Assess for progressive disease. CHEST:LUNGS AND PLEURA: Index nodule right lower lobe seen on series 4 image 83 to measure 0.6 x 0.5 cm. Previously 1 x 1 cm. There is scarring in the right lower lobe be identified. Questionable micronodules elsewhere unchanged. No new nodules. No effusions.MEDIASTINUM AND HILA: Index precarinal node or cluster of nodes is measured on series 2 image 48, 1.2 x 0.7 cm previously 1.5 x .8 cm. Index anterior mediastinal nodes series image 56 measures 0.7 x 0.5 cm. Previously 0.6 x 0.4 cm. Other small mediastinal nodes are stable. No new nodes. Minimal atherosclerotic calcifications aortic arch.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: Small hypodense lesions likely cysts, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy with no evidence of recurrence in right renal fossa.Multifocal nephrolithiasis left kidney and large cysts. These findings are unchanged. No hydronephrosis or hydroureter.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: Scattered colonic diverticulosis. A focal soft tissue connecting the sigmoid colon and distal ileum suggestive of prior inflammatory process and possible fistulous connection. Please see coronal image 79/163 corresponding to axial image 176/233. In retrospect, unchanged from 9/7/11 series 3 image 170 No evidence of ascites. No evidence of mesenteric adenopathy or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No new sites of disease. Roughly stable measurements as provided.Evidence of prior inflammation and possible fistulous communication between sigmoid colon and distal ileum. Correlate for signs and symptoms in the past of diverticulitis. Discussed with Dr. Stadler.


Instruction: Generate impression based on medical findings.

Input: VATS procedure, right upper lobe Interval removal of 2 right chest tubes without postprocedural complication. Right-sided volume loss and postsurgical changes persist without new abnormality. Shifting and decreasing atelectasis in the left lung base.

Output: Chest tubes removed


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: ain Unremarkable cardiac and mediastinal silhouette. Mild blunting of the posterior costophrenic angle suggestive of scarring.No acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: Pneumonia? History: chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size at the upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Status post robotic ablation, chest tube clamp. Interval enlargement of left pneumothorax, now measuring approximate 4 cm. Left basilar atelectasis.Unchanged mild cardiomegaly.Left atrial clamp unchanged. Single left chest tube directed towards apex.

Output: Interval enlargement of left pneumothorax, now measuring approximate 4 cm. Left basilar atelectasis.Findings discussed with primary service/APN Patel on 9/23/2016 at 2:30 PM.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of melanoma worsening with fever of unknown origin and upper abdominal/lower chest pain that is worse with deep inspiration. Please evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the level of the segmental pulmonary arteries.LUNGS AND PLEURA: Minimal increased prominence of pleural nodularity in the left lobe with new nodularity seen in the right lower lobe as well. Minimal basilar scarring. No suspicious masses or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Right chest Port-A-Cath with tip in right atrium. UPPER ABDOMEN: Previously seen left adrenal mass is partially visualized on this study (series 5, image 29), measuring 8.4 x 6.4 cm in the axial plane.

Output: 1. No pulmonary embolus. Study is diagnostic to the level of the segmental pulmonary arteries.2. Nonspecific scattered pleural nodularity as above.3. Partial visualization of left adrenal mass.


Instruction: Generate impression based on medical findings.

Input: Reason: new intubation History: eval for tube placement ET tube 8 cm above the carina.New left jugular catheter sheath in the area of the jugular vein.Right jugular catheter and ICD lead unchanged.Mild atelectasis at the right base.

Output: Slightly high position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: FemaleReason for Study: Reason: eval mediastinum History: rollover mvc. The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No obvious fractures identified.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax? History: right sided chest pain, sob. Unremarkable cardiac and mediastinal silhouette.Mild scoliosis and mild pectus deformity.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: evaluate for recurrent effusion History: none Right pleural effusion decreased from the prior exam.Right mediastinal and suprahilar mass again noted.Right basilar subsegmental atelectasis.No new areas of consolidation.

Output: Interval decrease in right pleural effusion and redemonstration of a right suprahilar/mediastinal mass. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: CP History: CP Large lung volumes consistent with COPD.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: acute lung process? pneumonia? History: SOB, cough Bilateral upper lobe airspace opacities with extensive capitation, confirmed by CT scan, markedly increased since the previous radiograph.Findings are highly suspicious for necrotizing infection, and the differential diagnosis includes TB.Although pulmonary infarcts were previously suspected, that is unlikely given the appearance on the current CT scan.This was discussed with Dr. Tripp at the time of reporting.Normal heart size with extensive coronary artery calcification and a tortuous aortaICD leads unchanged.

Output: Progression of bilateral upper lobe airspace opacities with extensive cavitation consistent with necrotizing infection, including TB.


Instruction: Generate impression based on medical findings.

Input: Mitral valve replacement Right jugular sheath, and right chest tubes are otherwise unchanged. Small significant pneumothorax again observed with overlying mild to moderate chest wall and neck emphysema.Mild cardiomegaly with patchy basilar opacities, nonspecific

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: Is Swan in place? History: Swan in place Swan-Ganz catheter tip in the right descending pulmonary artery.Right jugular catheter is extending to the SVC.Cardiomegaly with pulmonary hypertension and nonspecific nodular and interstitial opacities in the left upper lobe, unchanged.

Output: Swan-Ganz catheter in the right descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: r/o cardiopulm abnormality History: dyspnea No pleural effusion or pneumothorax. Large lung volumes with mild blunting of the diaphragms. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: S/P right internal jugular line insertion, evaluate. Right jugular central venous catheter tip is in the right jugular vein.Cardiomegaly and pulmonary vascular distribution, unchanged. Pulmonary arteries are enlarged. Slight increase in retrocardiac opacity. No large pleural effusion or pneumothorax. Right hilar surgical clips are unchanged.

Output: 1.Right jugular central venous catheter tip is in the right jugular vein. No pneumothorax.2.Slight increase in retrocardiac opacity, presumably atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60 yo w heart failure, please evaluate lung fields History: heart failure The Swan Gantz catheter has been removed. Left subclavian ICD leads and sternotomy wires are unchanged.Stable cardiomegaly. The left pleural effusion has decreased in size, there is a probable small right pleural effusion. Interval improvement in basilar predominant pulmonary opacities. No pneumothorax.

Output: Interval improvement in pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Chest pain, SOB, VOC. Evaluate for edema/infection. Right jugular catheter tip in the right atrium. No pneumothorax.Moderate multichamber cardiomegaly and enlargement of the central pulmonary vasculature compatible with pulmonary hypertension.Basilar scarring. No focal airspace opacity to suggest acute chest syndrome.Skeletal stigmata of sickle cell disease.

Output: No radiographic signs of acute chest syndrome. Cardiomegaly and signs of pulmonary hypertension. Low position of right jugular catheter, with tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Intubated. Hypertension. Tubes and lines unchanged in position. Low lung volumes with basal retrocardiac atelectasis. Patchy airspace opacities in the dependent lung fields suggestive of atelectasis and aspirate. Moderate pleural effusions.

Output: No acute change in pleural fluid or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: chest pressure, cough History: 45968 Nonspecific airspace opacity adjacent to the left heart border could be infection or aspiration.Elsewhere, the lungs are unremarkable. Heart size normal.

Output: Possible left basilar infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: neutopenic fever History: neutopenic fever Cardiomediastinal silhouette is unchanged. Lungs clear.No pneumothorax. No pleural effusion. Stable position of PICC line.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Recurrent stage IIIc ovarian cancer. Status post chemotherapy. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the apical segment of the left lower lobe measures 7 x 6 mm on image number 36/228, and grossly stable. No new nodules.MEDIASTINUM AND HILA: Previously measured small right hilar lymph node is unchanged on image number 51/228 measuring 8mm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Peritoneal implant near the dome of the liver is unchanged measuring 2.8 x 9 mm image number 99. Evaluation of visceral organs is limited due to lack of IV contrast.SPLEEN: Parasplenic collection or implant is unchanged measuring 17 by 8mm image number 110.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right ureteral stent with distal lending to the bladder is unchanged. Hydronephrosis of the right kidney has slightly progressed. Small ill-defined hyperdensity within the right lower pole collecting system may represent a stone however due to lack of IV contrast, a small neoplasm cannot be excluded.RETROPERITONEUM, LYMPH NODES: Multiple stable retroperitoneal lymph nodes are noted. Reference mesenteric lymph node measures 11 x 10 mm image number 160. Stable in comparison with prior study. Reference left para-aortic lymph node is also unchanged measuring 12 x 6 mm image number 143.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy and oophorectomy.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: Previous described pelvic soft tissue density abutting the sigmoid colon measuring 5 x 2.8 cm unchanged.

Output: Limited study due to lack of IV contrast. No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: r/o hemothorax History: same No acute abnormality.Right jugular catheter, tip in SVC.A Dobbhoff tube extends below the lower margin of the image.

Output: No acute abnormality. No pleural fluid collection identified or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Chest pain rule out acute process. Normal heart size. Asymmetric enlargement of the right hilum and globular configuration of the right heart border, more than expected from pulmonary hypertension and asymmetric in appearance..

Output: Abnormal cardiomediastinal silhouette, correlation with thoracic CT recommended when feasible for further evaluation to delineate anatomy and exclude a mass lesion/lymphadenopathy


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-op clearance, known small cell lung cancer History: Pre-op clearance, known SCLC Extensive atelectasis and consolidation in the left lung with shift of the mediastinum to the left side and elevation of the left hemidiaphragm. Cystic lucent areas in the left upper lung, consistent with bronchiectasis and emphysema. Unremarkable right lung.

Output: Extensive left lung atelectasis and consolidation, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Two right chest tubes appear similar with persistent decreased lung volumes and superimposed changes largely the lower lungs again suggesting atelectasis and edema with cardiomegaly. Increased irregularity and pleural changes in the right hemithorax again compatible with patient's known history and grossly unchanged

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: cough with chest pain and dyspnea, eval for pneumonia History: as above No significant abnormality, and no sign of infection or edema.Azygos pseudolobe, normal variant.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Re-evaluate PICC line placement History: picc line pulled back Left-sided PICC terminates over the upper aspect the left hemithorax. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Left-sided PICC terminates over the upper aspect the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: PNA? History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with shortness of breath. Evaluate for pneumonia. Heart size upper normal. Mild aortic calcifications with dense mitral annulus calcifications. Left basilar opacity consistent with scarring/atelectasis.No focal lung opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Progression of prostate cancer status post week 97. Compared to previous scan. CHEST:LUNGS AND PLEURA: Stable calcification and pleural thickening in the posterior left lung. A few scattered micronodules appear stable.MEDIASTINUM AND HILA: Coronary arterial calcifications. Stable subcentimeter mediastinal and right hilar lymph nodes. These are not enlarged by CT size criteria.CHEST WALL: Unchanged sclerotic lesions at the posterior sixth rib. Bilateral gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Unchanged medial right lobe hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodensities too small to characterize likely representing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged sclerotic lesions of the T12 and L1 vertebral bodies. Degenerative disease of the thoracolumbar spine.PELVIS:PROSTATE, SEMINAL VESICLES: Unchanged prostatic calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged sclerotic lesions of the T12 and L1 vertebral bodies. Degenerative disease of the thoracolumbar spine.

Output: Unchanged osseous metastases as described above. Suggest correlation with today's bone scan.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: cp History: above Large lung volumes consistent with COPD. No evidence of pneumothorax or pneumonia.

Output: Large lung volumes consistent with COPD. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: r/o pneumonia History: chest pain, elevated wbc Very small pleural effusions. No focal lung consolidation though there is patchy left basilar opacity which could represent aspiration or developing pneumonia. Normal heart size. No pneumothorax. Postsurgical changes of the spine again noted.

Output: Very small pleural effusions. No focal lung consolidation though there is patchy left basilar opacity which could represent aspiration or developing pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: Hypoxia Right-sided chest port with tip at the cavoatrial junction. Right upper quadrant surgical clips reflect prior cholecystectomy.The cardiac mediastinal silhouette is unremarkable. Right basilar patchy consolidation nonspecific and better characterized on subsequent CT. Left-sided multiple foci consistent with cavitary lesions better characterized on subsequent CT chest. Small right pleural effusion.

Output: Right basilar opacity and multiple left sided opacities better characterized on subsequent CT.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: ACS rule out and hypoxia History: chest pain Status post median sternotomy and CABG surgery.Grossly stable cardiomediastinal silhouette with right cardiophrenic angle opacity likely related to hiatal hernia as seen on MRI chest 3/28/2014.Limited evaluation due to hypoinflation with bibasilar atelectasis and likely trace pleural effusions.

Output: Limited evaluation due to hypoinflation with bibasilar atelectasis and likely trace pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old. ET tube tip approximately 1.5 cm above the carina.Other devices unchanged.Cardiomegaly with small lung volumes and basilar opacity compatible with atelectasis.

Output: Interval adjustment of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab A single-lead left ICD in expected location.Stable severe cardiomegaly.No focal consolidation, significant pleural effusion, or pneumothorax.Mild pleural thickening at the left apex.

Output: Severe cardiomegaly, without significant interval change. No pneumothorax as clinically queried.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: f/u pleural eff History: SOB Left basilar pleural catheter unchanged.Interval reduction of left-sided pleural effusion.Persistent left basilar compressive atelectasis.Small right pleural effusion unchanged.Stable cardiomediastinal silhouette.Left paramediastinal opacity most likely representing partial atelectasis of the left upper lobe, however mass in this location cannot be excluded..

Output: Interval improvement in left pleural effusion. Left paramediastinal mass/atelectasis redemonstrated. Recommend CT of the chest with IV contrast if possible.


Instruction: Generate impression based on medical findings.

Input: Status post multiple gunshot woundsVIEW: Chest AP (one view) 12/27/2016 at 1358 hours. Left axillary vascular clips and bullet fragments overlying the left upper chest again noted. Stable position of left sided chest tube and ET tube. NG tube tip is at the stomach.Cardiac size is normal. Minimal left apical pneumothorax with no focal opacities or effusions.

Output: Minimal residual apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for fluid overload, rule out pneumonia History: exertional shortness of breath, productive cough Mild cardiomegaly.No significant pulmonary or pleural abnormality.No specific evidence of infection or edema.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.SOB and pericardial effusion rule out flash pulmonary edema. Weakness. Globular multichamber cardiomegaly/pericardial fluid, about the same.Linear opacity in the left upper paramediastinal region, probably due to adjacent emphysema or less likely pneumomediastinum or pneumopericardium in the absence of pericardiocentesis, correlate with history. No pneumothorax. Lung volumes remain low with mild left basal atelectasis which is improving.Thoracic kyphosis.

Output: Globular cardiomegaly/pericardial fluid. No signs of pulmonary edema. Linear opacity projecting over the left upper mediastinum is probably visible as a result of paramediastinal emphysema and rotation. If the patient has had a recent pericardiocentesis this can be monitored by plain film.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: history of bladder cancer eval for mets History: history of bladder cancer eval for mets Stable cardiac mediastinal silhouette.Small focal area of atelectasis at the left lung base unchanged.No new pulmonary opacities identified.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: pna History: cp Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No significant change.


Instruction: Generate impression based on medical findings.

Input: Bronchiolitis from human metapneumovirus. Fever and increased work of breathing. Crackles in right lower lung.VIEWS: Chest AP/lateral (two views) 03/15/16 Moderate peribronchial thickening continues. Lung volumes are increased with flattening of the hemidiaphragm and increased AP diameter of the chest. No focal airspace disease is seen. Cardiothymic silhouette is normal.

Output: Unchanged airway hyperreactivity/bronchiolitis pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate for pneumothorax post left sided ICD implantation History: left sided ICD palcement Unremarkable cardiac and mediastinal silhouette. New ICD device with leads projected in the area of the right atrium appendage and right ventricular apex.A previously described small nodular opacity is not visible but may be obscured by the ICD generator, but it is unlikely to be a lung cancer as it was not present on a recent CT scan of the chest. Mild subsegmental atelectasis or scarring at the left base, unchanged.

Output: New ICD device with no pneumothorax or other complications.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Left-sided ICD, LVAD, and right IJ venous catheter unchanged.New left IJ Swan-Ganz catheter with its tip in the right pulmonary artery.No evidence of pneumothorax.Stable marked cardiac enlargement.Minimal basilar atelectasis.

Output: Interval placement of a left IJ Swan-Ganz without complication. Stable cardiomegaly without evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: FemaleReason for Study: Reason: hx + TB skin test or + QFT History: eval for active TB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.History of lung cancer with pleural effusion now with increasing shortness of breath. Assess effusion and for pneumonia. Mitral valve prosthesis and sternal hardware in place. Left axillary vein graft is noted. The cardiomediastinal silhouette is stable.There is been an interval increase in the loculated right pleural effusion. There are stable postsurgical findings and volume loss in the right hemithorax. There is no consolidation. The left lung is unremarkable.

Output: Interval increase in loculated right pleural effusion. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: FemaleReason for Study: Reason: r/o focal infectious process new afib History: cough and malaise Stable cardiomediastinal silhouette.Interval improvement in the pleural effusions and interstitial opacities.No focal areas of consolidation.Median sternotomy is intact with stable aortic valve prosthesis.

Output: Interval improvement in and pleural effusions and interstitial opacities. No acute abnormality identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Positive TB test, check for abnormality No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: hit in chest with a cane; chest pain History: chest pain Cardiomediastinal silhouette is within normal limits. Chronic interstitial lung abnormality which may correlate to bronchial wall thickening is seen on the prior CT. No pneumothorax.Irregular contour of the superior aspect of the posterior sixth rib is noted. The appearance is slightly different when compared to the previous radiograph, which may be accounted for by differences in patient positioning. There is no visible overlying soft tissue swelling or cortical discontinuity.

Output: Irregular contour of the superior aspect of the posterior sixth rib is noted. The appearance is slightly different when compared to the previous radiograph, which may be due to differences in patient positioning. If this correlates with the site of the patient's pain, dedicated rib radiographs could be considered.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with PE, DVT, COPD, now with increased SOB. Evaluate for pleural effusion. LUNGS AND PLEURA: Interval development of bilateral small pleural effusions with compressive atelectasis of the adjacent lung. Scattered micronodules, a few of which are calcified, most likely postinflammatory. No focal consolidation.MEDIASTINUM AND HILA: Cardiac size is normal. Small pericardial effusion. Borderline enlarged pretracheal lymph nodes. Atherosclerotic calcifications noted.CHEST WALL: Kyphosis and near complete compression fractures of two upper thoracic vertebral bodies are unchanged.UPPER ABDOMEN: Hiatal and bilateral Bochdalek hernias unchanged.

Output: Interval development of small bilateral pleural effusions. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: eval swan History: swan Increased basilar markings with a right pleural effusion suggestive of worsening basilar pulmonary edema. Status post sternotomy, with mild cardiomegaly.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.

Output: Worsening CHF. New right jugular Swan-Ganz catheter placement.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT remains 5 cm above the carina. NG under advanced the side-port seen port or 5 cm above the GE junction.Cardiopulmonary appearance is also similar with large lung volumes and emphysematous changes with a retrocardiac opacity representing partial consolidation with small layered pleural effusions.

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: assess for pulmonary infiltrate History: shortness of breath, hypoxic to 70s, new-oxygen requirement, positive cough, known CHF Increasing basilar opacities suggestive of edema, and new consolidation in the left mid to upper lung zone.Small pleural effusions.Heart size upper normal.

Output: Increasing edema and new left mid to upper lung opacity suggestive of infection or aspiration. Infarction is in the differential diagnosis as well.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.SOB, fever, tachycardia. No focal airspace opacities, pleural fluid or pneumothorax. Patchy opacity in the left lower lobe may reflect atelectasis.

Output: No specific signs of pneumonia. Probable retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Evaluate infiltrate History: shortness of breath Increase in right upper lobe consolidation now nearly completely involving the right upper lobe. New diffuse opacity within the left lung. Moderate cardiomegaly, as before. Right IJ line terminates in the mid RA. No pneumothorax.

Output: Worsening right upper lobe consolidation consistent with pneumonia with new diffuse left lung opacities worrisome for multifocal pneumonia or early diffuse alveolar damage. Close imaging surveillance is suggested.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with malignant neoplasm of the head, face and neck. History of GI malignancy LUNGS AND PLEURA: Demonstration of a small 6 mm subpleural nodule posteriorly in the superior segment left lower lobe (image 63, series 5).MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Extensive coronary artery calcification. Cardiac size is normal without evidence of a pericardial effusion. Status post CABGCHEST WALL: Median sternotomy.UPPER ABDOMEN: No significant abnormality noted.

Output: Solitary 6-mm nodule in the left lower lobe. Follow up examination is recommended.


Instruction: Generate impression based on medical findings.

Input: Adenocarcinoma of unknown primary stage IV. Please evaluate right supraclavicular lymph node, subcarinal and superior mediastinal and paratracheal adenopathy, right adrenal mass and a new metastatic lesion. Status post 6 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right supraclavicular mass has decreased in size and is currently not measurable as it is indistinguishable from adjacent muscle. Subcarinal , superior mediastinal and paratracheal adenopathy has also regressed. Reference subcarinal lymph node measures 1.8 x 1.1 (image 41; series 4).CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Probable gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal mass measuring 2.2 x 1.5 cm (image 74; series 4) has decreased in size. Left adrenal gland is unremarkable.KIDNEYS, URETERS: Bilateral renal cysts. Multiple cysts on the left side.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Atypical position of the hepatic flexure is probably a normal variant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.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: Marked regression of supraclavicular and mediastinal adenopathy. Decrease in size of right adrenal metastasis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.History of hematemesis. The patient has been intubated with ET tube tip approximately 4 cm above the carina. The enteric tube tip is beyond the field of view.The cardiomediastinal silhouette is stable.There is subsegmental left basilar atelectasis without additional focal pulmonary opacity or large pleural effusions.

Output: Patient intubated with ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: stroke workup History: above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Sclerosing mesenteritis. 3.4 x 2.4 cm opacity in the left lung base abutting the pleura. Please assess for changes. CHEST:LUNGS AND PLEURA: Previously described 3.4 x 2.4 cm masslike lesion abutting the pleura in the left lung base associated with linear atelectasis is unchanged from previous CT. Pleural-based lingular nodular density is also unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described mesenteric mass is are again identified. More superior and lateral mass is slightly smaller now measures 6.6 x 3.7 cm in image number 126/214. The second more inferior mass is also slightly smaller and measures 4.2 x 1.9 cm on image number 134/214.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: No change in the previously described left lower lobe soft tissue density which represent atelectasis. Further follow-up is recommended to ensure stability.Slight interval decrease in the size of the previously described mesenteric masses.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: coughs after she eats anything History: she has coughing after eating=- rule out achalasia or esophageal issue Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Radiation dose was reduced utilizing fluoroscopy spot image captures and fluoroscopy video loops. Fluoroscopy loops are stored as series one and two.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces contours. There is a small hiatal hernia measuring approximately 2.7 x 3.1 cm, although this may be a slight underestimation. Spontaneous gastroesophageal reflux was noted to the level of the aortic arch. Fluoroscopic evaluation of esophageal peristalsis demonstrated abruption of the primary peristaltic wave in the lower thoracic esophagus, with proximal escape. An esophageal web is noted within the lower cervical esophagus, measuring approximately 11 mm in the transverse dimension. No aspiration was evident.TOTAL FLUOROSCOPY TIME: 2:33 minutes; entrance dose: 71.9 mGy.

Output: 1.Spontaneous gastroesophageal reflux to the level of the aortic arch.2.Small hiatal hernia.3.Lower cervical esophageal web.4.Minor motor abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: S/P OHT History: Patient has lines and CT placement Lines and tubes are unchanged. Slight improvement in left basilar opacities. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No significant pneumothorax.

Output: Improvement in left basilar opacity. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O unfiltrate History: persistant cough, slight weeze Unremarkable cardiac and mediastinal silhouette. Mild biapical scarring, not appreciably changed.Mild linear scarring at the left base.No sign of pneumonia or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: 76 y/o with ILD, recent cough/fever History: cough Moderate cardiomegaly.Mild interstitial opacities previously seen on CT which are likely chronic.No specific evidence of infection.

Output: Cardiomegaly and chronic appearing interstitial lung disease. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for infection vs other as cause of SOB History: SOB, concern for PNA vs volume overload Cardiomediastinal silhouette is unchanged.Left greater than right basilar airspace opacities, new from prior. No pleural effusion or pneumothorax.

Output: Bibasilar airspace opacities suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 99 years old.Reason: Evaluate for pneumonia History: found down x4 days Evaluation limited by rotation. The cardiomediastinal silhouette is unremarkable. No focal pulmonary opacity suggestive of pneumonia. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Evidence of metastatic disease History: None When compared to the prior study there appear to be multiple bilateral nonspecific subcentimeter nodules. There is no focal pulmonary opacities, effusion or pneumothorax. In view of the clinical question, CT scan of the chest is recommended for complete evaluation.

Output: Interval development of multiple bilateral nonspecific subcentimeter nodules. Recommend CT for complete evaluation.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with rheumatoid arthritis and right lower lobe nodule being followed by serial scans. Former smoker. LUNGS AND PLEURA: Severe, diffuse paraseptal and centrilobular emphysema.Multiple scattered pulmonary nodules are stable. A reference right lower lobe nodule measures 12 x 11 mm on axial image 43/70, unchanged. No new nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Hypodense lesions in both lobes of the thyroid, unchanged.The cardiac size is normal. No pericardial fluid. Aortic and coronary atherosclerotic calcifications are noted. Mild enlargement of the main pulmonary trunk at 3.4 cm (axial image 34/70) is unchanged and suggestive of pulmonary artery hypertension.CHEST WALL: Deformity of multiple posterior right ribs compatible with old healed fracture, unchanged.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable pulmonary nodules. One year follow-up is suggested. If no change is evident at that point, no further follow-up is required.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: monitor swan placement, pulmonary edema History: acute decomp heart failure The Swan-Ganz catheter is in the proximal right interlobar artery. Support devices unchanged. No pleural effusion. Unchanged cardiomegaly. No new focal pulmonary opacities, unchanged interstitial opacities suggestive of edema. Unchanged sternotomy wires are intact.

Output: No significant change from prior examination including cardiomegaly and edema. Swan-Ganz catheter tip is in the proximal right interlobar artery.


Instruction: Generate impression based on medical findings.

Input: Adrenal cancer, new cough Improving overall volumes, however lung volumes remain decreased with an elevated right hemidiaphragm. Mild basilar atelectasis with a more questionable focal opacity in the mid right lung, artifact from superimposed structures must be considered given inability to find a correlating abnormality in the lateral projection and the absence of a correlating abnormality on the recent CT 2/27/2016.

Output: No discrete new acute abnormalities, CT detail and description above


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: monitor ETT placement History: intubated Endotracheal tube terminates 3 cm above the carina. The remaining support devices are unchanged in position.Left greater than right layering effusions with associated atelectasis. No interval pneumothorax. The heart size is magnified secondary to portable technique; reassessment with upright PA and lateral radiograph can be obtained to exclude evolving pericardial effusion, when clinically appropriate.

Output: Left greater than right layering pleural effusions not significantly changed. Although magnified secondary to technique, heart size appears enlarged which may be due to accumulation of pericardial fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: change in IABP placement? History: balloon pump Unchanged basilar opacities and pleural effusions suggestive of CHF.Heart size relatively normal.IABP catheter tip 3 cm below the top of the aorta.A Dobbhoff tube terminates in the stomach.

Output: Unchanged basilar opacities and pleural effusions. IABP catheter tip unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Hypovolemia. Shock. Lungs are hyperlucent suggesting significant emphysema but clear without consolidation, effusion, or edema. Heart size within normal limits. Significant degenerative changes and likely rotator cuff tears of both shoulders. Extensive atherosclerotic calcifications of the aorta noted.

Output: Emphysema without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: check OGT placement History: OGT placement Enteric tube tip and proximal sidehole in the region of the gastric fundus. Endotracheal tube tip approximately 3 cm above the carina. Left central catheter with tip at the cavoatrial junction.Cardiomediastinal silhouette is normal. No large pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: Interval placement of enteric tube with tip and proximal sidehole in the region of the gastric fundus.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Status post thoracentesis and ET tube adjustment. Extensive tumor burden is not significantly changed compared to prior examination. ET tube is approximately 10 cm above the carina near the level of the thoracic inlet. The right-sided pleural effusion is not significantly changed compared to prior examination. No pneumothorax. Enteric feeding tube tip is at the level of the GE junction.

Output: No significant interval change in right-sided pleural effusion and extensive tumor burden. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old. Left-sided ICD and right central venous catheter unchanged.IBP marker in the distal aortic arch.Stable cardiac enlargement.The lungs are clear.No pleural effusions.Surgical clips identified in right axillary region.

Output: Support devices unchanged with IABP marker in the distal aortic arch. Stable cardiopulmonary appearance with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: Infiltrates History: fever Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p intubation History: above ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.NG tube tip in the area of the GE junction.Streaky opacity with volume loss in the right upper lobe and adjacent pleural thickening previously characterize by CT. Small pleural effusions and basilar atelectasis, unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Evaluate left-sided pleural effusion status post thoracentesis. There has been significant resolution of the left pleural effusion with improved aeration throughout the left lung. There is an insignificant pneumothorax at the left lung base. There is right lower lobe atelectasis.The stomach is distended.The right internal jugular terminates in the SVC and the left subclavian central venous catheter terminates at the cavoatrial junction, unchanged. The right pigtail catheter is unchanged in the pleural space. The endotracheal tube is approximately 6 cm from the carina. Skin staples seen over the chest and abdomen, multiple surgical clips are seen within the abdomen. A gastrostomy tube is in place.

Output: 1. Interval resolution of the left pleural effusion with improved aeration throughout the left lung.2. Trace pneumothorax seen at the left lung base.3. New right lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old. ET tube tip approximately 4 cm above the carina.Small lung volumes with a left Bochdalek hernia as previously described.No acute pulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with newly diagnosed melanoma, staging exam. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple, well-defined hypodensities are seen throughout the liver and are too small to characterize. No evidence of intra- or extrahepatic biliary ductal dilatation. The portal and hepatic vasculature are patent.SPLEEN: A 9-mm, hypoattenuating lesion is also seen in the spleen (series 3, image 88) and is a nonspecific finding.PANCREAS: Focal fatty atrophy of the pancreatic head and body.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts are seen bilaterally. A subcentimeter nonobstructing right renal stone is also identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: soft tissue mass is seen non-dependently along the internal aspect of the right bladder wall (series 3, image 179), measuring 2.7 x 1.7 cm in the axial plane. This finding is suspicious for malignancy.LYMPH NODES: Small pelvic nodes along the external and internal iliac chains.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked asymmetric degenerative changes of the right hip.

Output: 1. soft tissue mass is seen within the bladder, suspicious for malignancy. Correlation with endoscopy is recommended.2. Nonspecific, subcentimeter hypodense focus in the spleen.3. Marked asymmetric degenerative changes of the right hip.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with infected pancreatic pseudocyst. Status post drainage. Left chest diffusion. Please evaluate abdomen and pelvis for fluid. CHEST:LUNGS AND PLEURA: Minimal left-sided pleural effusion. Air within the left pleural cavity may be secondary to recent tap. Bilateral dependent atelectasis. Left-sided pleural effusion has decreased in size.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The mild intra-and extrahepatic biliary dilatation which has slightly increased compared to previous CT. No focal hepatic lesions. Small perihepatic collection is unchanged.SPLEEN: No change in the splenic infarct or parasplenic loculated gas fluid collection. Percutaneous drains unchanged in position.PANCREAS: Stable cyst gastrostomy. No change in the small collection adjacent to the pancreatic tail. Enhancement of the pancreas is unremarkable except for a small segment in the proximal body.ADRENAL 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: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the amount of the left-sided pleural effusion.Minimal increase in the amount of biliary dilatation. Otherwise no significant change in the abdomen findings.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old with chest pain and a history of a type B aortic dissection. Evaluate for widened mediastinum. The cardiomediastinal silhouette is not significantly changed when allowing for differences in technique and lung inflation.No new pulmonary opacity. No pleural effusion or pneumothorax.

Output: Stable cardiomegaly. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: evaluation for pleurex drain History: SOB, increased work of breathing Left Pleurx catheter with a loculated left pleural effusion compressing the left lung.Unchanged right-sided opacities consistent with metastases.

Output: Unchanged pleural effusions and pulmonary opacities. Pleurx catheter stable in position.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval L sided consolidation interval change after therapeutic bronchoscopy for mucus plugging History: hypoxemia, LUL consolidation Left basilar atelectasis and pleural effusion improved. Support hardware largely stable though the right chest tube is directed more inferiorly. No evidence of pneumothorax.

Output: Left basilar atelectasis and pleural effusion improved.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: assess for PNA History: dyspnea Loculated fluid in right-sided fissure is again noted. Persistent patchy right basilar opacity. Left lung remains clear. Enteric tube extends inferiorly off the field-of-view. Unchanged heart size.

Output: No substantial change compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Male 39 years old Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. No focal airspace opacity.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

Output: No evidence of cardiomegaly. No specific evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: et tube position History: ET tube ET tube tip approximately 2 cm above the carina.Moderate cardiomegaly with bilateral streaky pulmonary opacities compatible with atelectasis and aspirated secretions.NG tube coiled in the stomach.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: Hypotension evaluate for pneumothorax. The endotracheal tube is unchanged in position. Stable cardiomediastinal silhouette.No significant change in bibasilar opacities consistent with atelectasis and pleural effusions. There is no pneumothorax.

Output: No significant interval changes. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval volume overload History: SOB Cardiomegaly without edema.Median sternotomy for valve replacement.Left subclavian ICD, leads unchanged in position.Coronary stents or calcifications.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Cough, concern for chronic microaspiration. Low normal lung volumes with patchy basilar and dependent bronchial wall thickening and mild atelectasis, nonspecific but consistent with clinical suspicion of chronic aspiration. No specific signs of pneumonia. Small pleural effusions.7 mm nodular opacity left upper lobe incompletely evaluated.

Output: 1. 7 mm nonspecific left upper lobe nodule. Follow-up PA and lateral chest radiographs recommended as initial step in further characterization when feasible. 2. Small pleural effusions.3. Bronchial wall thickening and atelectasis consistent with clinical suspicion of chronic aspiration. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old. PICC line from the right extending to the area of the right axillary vein.ICD lead in aortic balloon catheter, unchanged.Moderate cardiomegaly and probable mild basilar interstitial edema.

Output: PICC line tip in the right axillary vein.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: dyspnea History: see above Stable size of left hydropneumothorax. Retrocardiac consolidation is unchanged. Diffuse airspace and interstitial opacities of edema with multifocal subsegmental atelectasis, progressive over the last 24 hours.

Output: Stable small to moderate left hydropneumothorax with progressive opacities favoring edema over the last 24 hours.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Cough, SOB, possible pneumonia. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: ptx History: ptx Small right apical pneumothorax, and extensive volume loss and atelectasis in the right lower hemithorax.Interval removal of a tracheostomy tube.Subcutaneous emphysema in in the right side of the neck.

Output: Small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval for pna History: cough Chronic appearing left hemidiaphragm elevation.Small lung volumes.Heart size upper normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.+PPD. The cardiac and mediastinal contours are within normal limits in this single AP projection.Lungs and pleural spaces are normal.No osseous lesions are present.

Output: No radiographic findings to suggest acute infectious process or sequela of prior infection.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female with history of sickle cell disease who presents with chest pain. Cardiomediastinal silhouette is unchanged.No consolidation, pneumothorax, or pleural effusion.Osseous changes compatible with sickle cell disease. Surgical clips overlie the mid abdomen, just to the right of midline.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: rising leukocytosis History: see above Moderate to severe cardiomegaly with a diffuse edema pattern that has progressed since the prior study.

Output: Moderate to severe cardiomegaly, with a worsening edema pattern, alternatively atypical infection.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: s/p failed central line History: s/p failed central line ETT 4 cm above the carina.Right internal jugular catheter has been removed.Stable low lung volumes with mild subsegmental basilar atelectasis/scarring.No pneumothorax. No new focal pulmonary opacities.

Output: Interval removal of left internal jugular catheter. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: post op History: post op Lines and tubes are unchanged. Low lung volumes with mild pulmonary edema. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: pna? History: cough, myalgias PICC terminates just above the cavoatrial junction. Loop recorder device overlies the left hemithorax. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged heart size. Status post cholecystectomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: hypoxia assess for pna History: hypoxia Enteric tube with its tip in the margin of the image.Cardiomediastinal silhouette is unremarkable.Basilar opacities are compatible with atelectasis and possible small effusions new compared to the recent CT.

Output: New basilar opacities compatible with atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: swan catheter placement History: see above Moderate cardiomegaly with a mild edema pattern unchanged.Right jugular Swan-Ganz catheter tip in right main or interlobar pulmonary artery.Left subclavian biventricular ICD unchanged.Possible ICD placement, the proximal marker 7 cm below the top of the aortic arch, versus a clip.

Output: Cardiomegaly with a mild edema pattern. Swan-Ganz catheter tip directed towards the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: Line placement History: line placement Tracheostomy tube is in place. Right internal jugular central venous catheter tip is at the superior cavoatrial junction.Small pleural effusions. No pneumothorax.Dense mass in the left upper lobe is unchanged.Increased right upper lobe opacity. Bibasilar opacities.

Output: Right upper lobe opacity may be due to infection or aspiration. Bibasilar opacities and small pleural effusions are not significantly unchanged.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female recently discharged from hospital after being found to have a terminal ileum mass on CT scan done on 11/2007. Patient has history mesentery ischemia and status post bypass in 2002. Please evaluate extent of mass in ileum and for any evidence of metastatic disease. CHEST:LUNGS AND PLEURA: Previously described scattered calcified granulomas and tiny nonspecific pulmonary nodules or opacities are unchanged.MEDIASTINUM AND HILA: Thoracic aortic aneurysm distal to the left subclavian artery and measures 4.6 x 4 . 7 cm, increased in size compared to previous CT. lack of contrast precludes further evaluation. No pathologic hilar or mediastinal adenopathy is seen.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Lack of IV contrast we limits evaluation of the liver. Previously described hypodense lesions in the liver are too small to characterize but unchanged. Cholelithiasis is present without evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Marked atrophy of the right kidney with punctate stones. Bilateral stents in both renal arteries are unchanged.RETROPERITONEUM, 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, ADNEXAE: Small fibroids unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described irregular wall thickening involving the terminal ileum and distal ileum are again noted.BONES, SOFT TISSUES: Multiple lucent lesions in the pelvis are unchanged.OTHER: No significant abnormality noted.

Output: Irregular wall thickening involving the distal ileum. Further evaluation with colonoscopy or enteroclyisis may be helpful.Interval increase in the size of the thoracic artery aneurysm.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Sickle cell crisis. Low normal lung volumes with mild chronic elevation of the right hemidiaphragm.Normal heart size.Parenchymal scarring, but no new opacities to suggest acute chest.Osseous to moderate sickle cell disease.Prominent central pulmonary vasculature, unable to exclude pulmonary hypertension, unchanged.

Output: Chronic abnormalities related to sickle cell disease, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: latent tb History: same Large lung volumes suggest COPD.Healed granulomatous disease, a pattern suggestive of histoplasmosis.No active TB, or other acute abnormality.

Output: No sign of active TB. Prior granulomatous disease likely histoplasmosis.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: pna? History: course breath sounds, rising wbc Unchanged interstitial opacities.Small pleural effusions noted.Mild cardiomegaly.No new findings.

Output: Unchanged interstitial opacities, possibly edema or aspiration, but no reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: 22 month old with hemophilia A receiving factor prophylaxis; difficulty accessing port - assess for line patency/thrombus History: difficulty accessing portVIEWS: limited chest port view AP 4/16/15 14:11Technique: 1cc of Omnipaque 300 was injected into the right chest port under fluoroscopy. No evidence of contrast leakage around the catheter. Contrast flows freely out of the catheter tip in linear manner.

Output: Intact patent right chest port.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: r/o acute process History: chest pain, cough Mild cardiomegaly.Mild interstitial opacities could be edema or aspirated secretions.No reliable evidence of infection.

Output: Cardiomegaly with interstitial opacities suggestive of mild edema.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: 47 y/o ICM, eval for edema History: sob Single ventricular left-sided ICD identified.Decreased lung volumes with mild cardiac enlargement.Right pleural thickening and evidence of old multiple right-sided rib fractures.No focal areas of consolidation.No large pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: patient with swan in place. eval placement History: swan in place No significant cardiopulmonary abnormality.Right jugular Swan-Ganz catheter, tip in the right interlobar pulmonary artery.Right subclavian ICD leads unchanged in appearance.

Output: Swan-Ganz catheter tip in right interlobar pulmonary artery. No significant pulmonary or pleural abnormality.


Instruction: Generate impression based on medical findings.

Input: Right upper chest pain, clavicle fracture Postsurgical excision of the medial right clavicle appears similar without evidence of change. Underlying vascular stenting is also observed and similar to prior. Left PICC line removedDecreased pulmonary volumes with an elevated right hemidiaphragm with scattered bilateral pulmonary nodules grossly similar. Marked interval improvement in aeration of the right upper lobe, presumably interval clearance of postobstructive changes previously described and observed on chest CT

Output: Bilateral pulmonary nodules with improved overall aeration of the right upper lobe. Left PICC line removed


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: asp pna History: cough sob ET tube tip 4 cm above carina. NG tube tip in stomach.Nonspecific basilar opacities as on prior and may be due to atelectasis or aspiration.

Output: Nonspecific basilar opacities as on prior and may be due to atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluate lung fields in patient s/p lung transplant, tracheostomy and desaturation History: desaturation on trach collar Unchanged pulmonary opacities and pleural effusions. Line position stable.

Output: Unchanged pulmonary opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: et tube History: intubated Improvement in left lower lobe opacity with no new findings.Moderate cardiomegaly.An NG tube terminates in the stomach.ET tube tip 8 cm above the carina.

Output: High ET tube. Improvement in left lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: FemaleReason for Study: Reason: pna? History: diminished BS RLL The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: pna? Edema History: chest pain, SOB The heart size is normal. Unremarkable cardiomediastinal silhouette. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: 48M with HCC, 75-pack-year tobacco history, new SOB and increasing abdominal pain History: REVIEW OF SYSTEMS The cardiomediastinal silhouette is unremarkable.Decreased lung volumes with mild basilar subsegmental atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Mild basilar atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: tachypnea, on CVVH and 2 inotropes History: as above Cardiomegaly with mild to moderate edema, consistent with CHF, unchanged.Stable support devices.

Output: Unchanged edema consistent with CHF. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: chest tubes in place History: asymptomatic Interval removal of enteric tube. Remaining support devices are unchanged.Small left hydropneumothorax. Persistent left lower lobe consolidation and atelectasis.

Output: Small left hydropneumothorax in the setting of 2 chest tubes.


Instruction: Generate impression based on medical findings.

Input: 50 year old male with metastatic GIST tumor CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Right hilar lymphoid tissue is stable measuring 12 x 11 mm image number 49, series number 3 slightly more prominent compared to previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the left lobe of the liver is stable.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: Reference lesion in the left hemiabdomen is now closer to midline and measures 5.1 x 3.9 cm on image number 148, not significantly changed from previous study. Reference lesion along the anterior aspect of distal transverse colon measures 1.7 x 1 .4 cm, image number 144. Reference lesion along the descending colon is also stable measuring 16 x 9 mm on image number 146. All of these reference lesions and peritoneal lesions are stable.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: Midline pelvic lesion is stable, measuring 2.5 x 1 .6 cm, image number 175.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable study without evidence of significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with recent diagnosis rectal cancer CHEST:LUNGS AND PLEURA: Nonspecific 3-mm nodule image number 72, series number 5 in the left lower lobe.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in both lobes of the liver suspicious for metastatic disease. An index lesion measures 19 x 21 mm image number 87, series number 3.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: No significant abnormality notedBOWEL, MESENTERY: Large mass arising from the rectum and extending into the perirectal fat. Numerous perirectal adenopathy. An index lymph node in the pelvis measures 15 by 13 mm on image number 156, series number 3.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large rectal mass extending beyond the mesorectal fascia and metastatic adenopathy.Metastatic liver lesions in both lobes of the liver.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Chest pain, SOB and cough. Normal heart size. Lung volumes are low normal. No focal airspace opacities, pleural fluid or pneumothorax.Severe spinal osteophyte formation in the thoracic spine.

Output: No acute pulmonary abnormality. Previously seen pneumonia has cleared.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: MaleReason for Study: Reason: New oxygen requirement. Please eval for acute processes History: As above Single lead left-sided pacemaker with the lead wire in right ventricle.Mild cardiac enlargement with atherosclerotic changes of the aorta.Lungs are clear.Mild elevation right hemidiaphragm.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Evaluate left internal jugular TLC position. Left internal jugular central venous catheter is malpositioned with tip directed superiorly toward the right brachiocephalic vein and pointing cranially. Endotracheal tube tip approximately 4 cm above the carina. Enteric tube with tip distal to the field of imaging. Stable right-sided opacities suggestive of edema with a small right pleural effusion. Extensive interstitial disease is stable involving the left native lung. No pneumothorax. Tracheomegaly.

Output: Malpositioned left internal jugular central venous catheter as above.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: hemoptysis, assess for worsening infiltrate History: see above Right Port-A-Cath unchanged.Left perihilar opacity compatible with known cancer post radiation changes.Increasing interstitial opacities and patchy airspace opacities in both lungs, left greater than right, compatible with edema. However, infection and aspiration cannot be excluded.Probable small pleural effusions .

Output: Increasing interstitial and patchy airspace opacities suggestive of edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: abnormality History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: eval widened mediastinum History: chest pain Cardiomediastinal silhouette is within normal limits. Lungs are clear of airspace and interstitial opacities. There is no pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 19 yearsGender: FemaleReason for Study: Reason: productive cough with yellow sputum +fever History: cough/fever The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o pna History: cough Low lung volumes. Mid and upper lung zones are clear of airspace and interstitial opacities. The cardiomediastinal silhouette are within normal limits.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Metastatic kidney cancer. CHEST:LUNGS AND PLEURA: Interstitial thickening predominantly on the left has slightly improved. Scattered micronodules are unchanged. No evidence of new larger nodules bilaterally. AMEDIASTINUM AND HILA: Bihilar adenopathy. Subcarinal reference adenopathy measures 19 x 18 mm on image number 49/230. This is slightly decreased from previous study. Other smaller mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Mass in the pancreatic head measures 3.2 by 2.7-cm, slightly decreased in size. Pancreatic duct is normal. This likely represents metastatic disease.ADRENAL GLANDS: Left adrenal mass is smaller measuring 2 x 1.7 cm. multiple right adrenal masses are also smaller.KIDNEYS, URETERS: Right nephrectomy site is clear. Left upper pole mass measures 4.1 x 2.8 cm smaller from previous study. There are additional smaller heterogeneous lesions more inferiorly. Punctate left renal stones.RETROPERITONEUM, LYMPH NODES: Reference retroperitoneal mass anterior to the right psoas muscle measures 2.4 x 1.7 cm, smaller compared to previous study. Portacaval, periceliac adenopathy is unchanged.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: Large left posterior acetabular mass is also slightly smaller.OTHER: No significant abnormality noted

Output: Interval decrease in the left pulmonary interstitial thickening, bihilar adenopathy, pancreatic bilateral adrenal and left renal masses and right retroperitoneal mass as well as the pelvic metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Cordis introducer, sedated and intubated. New right jugular Swan-Ganz catheter tip near the main pulmonary artery level. Other tubes and lines unchanged. Asymmetric interstitial and airspace opacities in the right lung, slightly worse, with clearance of abnormalities on the left. Probable small pleural effusions.Filling defect in the left lower lobe airway may reflect aspirated secretions.

Output: New right jugular Swan-Ganz catheter with tip near the main pulmonary artery level, no pneumothorax. Persistent asymmetric pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60 yo male with weakness, assess for PNA History: weakness Tortuous and dilated thoracic aortic arch and descending aorta consistent with a known chronic dissection.Heart size normal.No specific evidence of infection or edema.Right jugular catheter, tip at right atrial level.

Output: Known chronic aortic dissection. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: fluid vs pnemonia History: hypoxia Cardiac size is normal.Marked tortuosity of the aorta.Mild elevation of the right hemidiaphragm.No focal airspace opacities.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.AML, cough for 3 to 4 months. Not a smoker. Normal heart size. Unfolding of the thoracic aorta unchanged compared to 2007. No focal air space opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: is there any acute changes? History: Hypoxia Interval removal of nasogastric tube. Right IJ central catheter remains in stable position, terminating at the right atrium.New right apical and left mid zone subsegmental atelectasis. Lower zone bronchiectasis and bronchial wall thickening suggestive of chronic aspiration. A skinfold projects over the thoracic inlet; no pneumothorax is present. Heart size remains stable, normal in size.

Output: New foci of subsegmental atelectasis with infrahilar bronchiectasis suspicious for acute on chronic aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: shortness of breath History: shortness of breath Interval removal right chest tube with a trace right apex pneumothorax. Otherwise stable radiograph demonstrating bibasilar aspirate or atelectasis.

Output: Interval removal right chest tube with a trace right apex pneumothorax. Otherwise stable radiograph demonstrating bibasilar aspirate or atelectasis.