Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: abnormality History: chest pain No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.Right subclavian single chamber pacemaker unchanged.

Output: No significant abnormality. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ET tube History: intubated ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Moderate cardiomegaly with small lung volumes.Focal retrocardiac opacity compatible with subsegmental atelectasis and aspirated secretions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 63 years old Male. Reason: eval for signs of aspiration History: pt just vomited after brief apneic period. Hypoinflated lungs with the mild cardiomegaly. Streaky opacities are seen in the lower lungs, which are consistent with atelectasis. The IV access catheter tip project over the right atrium.

Output: Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: LLL resection. Cavitary infection. Rule out CA. CHEST:LUNGS AND PLEURA: Postoperative change status post left lower lobectomy. Cavitary left upper lobe lesion with internal fluid level is reidentified. The irregular, thickened wall of this lesion is thinner and more fibrotic in appearance on the current exam measuring approximately 4.4 x 1.2 cm (image 27), previously 5.5 x 1.8 cm. Previously seen areas of dense consolidation in the left base are improved, consistent with postinfectious or postinflammatory abnormality. Perihilar fibrosis is redemonstrated on the right. Few scattered nodules and micronodules are re-identified in the right lung and show no significant interval change.MEDIASTINUM AND HILA: Moderate pericardial effusion is larger. Small cardiophrenic lymph nodes are unchanged. Calcified hilar and subcarinal lymph nodes also unchanged. Low-density soft tissue in the region of the azygoesophageal recess is also unchanged (image 32) over greater than two year..CHEST WALL: Postoperative bony deformity in the left hemithorax. The posterior aspect of the fourth through seventh ribs on the left remain sclerotic.ABDOMEN: Limited images. Hypoattenuating lesion within the left lobe of the liver is smaller, measuring approximately 1.6 x 1.2 cm, previously 2.3 x 1.7 cm on axial image 111/140. Area of ill-defined hypoattenuation near the portal hilum on image 99 is unchanged. Cyst upper pole left kidney unchanged.

Output: Stable to improved findings as above with the exception of the pericardial fluid collection which is slightly larger, moderate in size.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p heart transplant evaluate lung fields History: O2 requirement Interval extubation and IABP removal. Left IJ Swan-Ganz catheter and mediastinal chest tubes remain unchanged. Left upper chest ICD generator and leads fragments remain stable.Unchanged cardiomediastinal silhouette.Mild streaky bibasilar atelectasis. No sizable pleural effusion or pneumothorax.

Output: 1.Interval extubation and IABP removal.2.Mild bibasilar streaky atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: r/o infiltrates, pt with hemoptysis last evening History: Hemoptysis Cardiomediastinal silhouette is unchanged.Slight increase in bibasilar opacities and blunting of the costophrenic angles likely reflects atelectasis. No pneumothorax.

Output: Slight increase in bibasilar opacities and blunting of the costophrenic angles likely reflects atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: CTICU History: Daily CXR Iatrogenic devices are unchanged. Dense left lower lobe opacification, slightly increased. Question small left pleural effusion. Unchanged cardiomegaly. No pneumothorax.

Output: Slight increase in dense left lower lobe opacification likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Worsening pneumonia? Worsening respiratory distress. Shortness of breath. Technologist notes that the patient was shaking and unable to stay quiet for examination. Best image possible obtained. Limited exam; image is degraded by motion artifact, low lung volumes and suboptimal technique.Interval extubation. Right jugular catheter unchanged in position. Dobbhoff tube has been retracted with tip now in the gastric body. Embolization coils project over the upper abdomen.Low lung volumes, further decreased since the prior study. Diffuse interstitial and airspace opacities bilaterally not appreciably changed.

Output: Interval extubation with further decrease in lung volumes. Within the limitations of the study, no acute change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Cough in HIV-positive Normal heart size. Crowding of hilar perivascular anatomy makes it difficult to assess for lymphadenopathy, but the appearance is similar to prior radiographs. No focal airspace opacities or pleural fluid.

Output: No visible signs of infection. If there is a high level of clinical suspicion for opportunistic pneumonia, a reduced dose thoracic CT may be obtained if required.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Evidence of pneumonia? History: Asthma exacerbation in setting or URI/pneumonic symptoms No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Heart disease, check Swan-Ganz Left chest tube and mediastinal chest tubes are otherwise similar with an unaltered cardiopulmonary appearance significant for decreased lung volumes, mild cardiac mainly in a retrocardiac opacity likely compression atelectasis.Swan-Ganz remains in the right pulmonary outflow tract right jugular dialysis catheter terminates in the proximal SVCIABP marker currently is not visualized, possible secondary to motion or interval removal

Output: Chest tubes unchanged and IABP marker currently not visualized. See above


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: r/o pulm edema or focal infiltrate History: SOB, chest and abdominal tightness, rhonchi No significant cardiopulmonary abnormality, except for subtle bronchial wall thickening..

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of intubation. ET tube 4 cm above the carina. Central venous catheter tip in SVC. NG tube tip outside the field-of-view.Stable cardiomegaly. Increasing basilar opacities and bibasilar pleural effusions.

Output: Worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.History of intubation. ET tube 2-3 cm above the carina. Interval removal of one of the prior right central venous catheters. The other right IJ catheter is unchanged with its tip in the SVC. Enteric tube courses distal to the field of view.Retrocardiac atelectasis unchanged. No new air space opacities or pneumothorax.Cardiac silhouette unchanged in size.

Output: Interval removal of one of the right central venous catheters without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: assess placement of central line, left IJ History: cardiogenic shock with Impella Cardiomegaly with a new Impella device.No specific evidence of infection or edema.Left jugular catheter tip at the RA level.

Output: New Cardiac Assist device. Left jugular catheter tip at the RA level.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: pre-V/Q scan History: pre-V/Q scan Univentricular right ventricular ICD electrode is unchanged in position.Persistent right pleural effusion with associated nodular opacity at the right inferolateral pleural surface. Further evaluation a CT thorax is recommended. Right hilar opacity can be evaluated at the same time to exclude lymphadenopathy. There is evidence of healed granulomatous disease.

Output: Moderate right pleural effusion. Associated nodular opacity right infralateral pleural surface. Further evaluation with a CT thorax is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: 53 y/o pt with recurrent fallopian tube cancer, rectovaginal fistula, DVT and new fevers History: Fevers, chills Heart size but appear normal with no sign of CHF or active pulmonary disease.Port catheter with its tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: assess atelectasis History: hypoxia Moderate cardiomegaly with large central pulmonary arteries.No specific evidence of infection or edema, the left lung base improved.Residual contrast material is seen in the colon.

Output: Cardiomegaly and possible pulmonary arterial hypertension, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 19 year-old female with left lower quadrant pain, rectal bleeding, and diarrhea. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The tip of the appendix is minimally dilated and fluid-filled while the remainder appears normal proximally and is opacified by contrast. No adjacent fat stranding or fluid collections are identified.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Arcuate uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No specific findings to account for the patient's symptoms. The tip of the appendix is minimally dilated while the remainder is normal in caliber. This is a nonspecific finding and correlation with patient's physical exam is recommended.Findings communicated to and after knowledge to by Gail Deluca of the Student Care Center at the time of dictation.Upon discussion with the ordering service, clinical suspicion for appendiceal pathology is very low. Therefore, the aforementioned finding is likely of little clinical significance.


Instruction: Generate impression based on medical findings.

Input: Chest pain Calcified right hilar lymph node without additional acute cardiopulmonary abnormality. Old granulomatous disease unchanged from prior exam.The cardiac and mediastinal contours are otherwise within normal limits

Output: Old granulomatous disease exposure without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: R/o infection History: SOB The lungs are slightly hyperexpanded with associated flattening of the diaphragms suggestive of COPD. No new focal air space opacity.Calcification of the aortic knob, and otherwise normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality. Evidence of COPD.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: shortness of breath History: shortness of breath Cardiomediastinal silhouette is unremarkable. No focal pulmonary opacities. No pleural effusion. No pneumothorax.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: cough, fever, eval for pneumonia History: above Normal heart size with ICD leads in place, unchanged.Vascular stent projected over the anterior left ventricle.No sign of CHF or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Chronic cough, asthma, wheezing Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.Cholecystomy clips in the right upper quadrant.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: evaluate for PNA History: see above No change in pulmonary opacities.No change in right effusion.Postoperative changes stable.Heart size stable.No pneumothorax.

Output: Stable pulmonary opacities and right effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surgery History: s/p cardiac surgery Swan-Ganz catheter and aortic balloon catheter unchanged. Small lung volumes with streaky basilar opacities consistent with atelectasis, not significantly changed from previous. No new findings.

Output: Basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: 51M with Swan in CCU, ? location History: 51M with Swan in CCU, ? location Swan-Ganz catheter looped in the area of the right atrium with its tip likely in the right ventricle directed superiorly towards the outflow tract.Cardiomegaly with interstitial opacity compatible with edema, and small pleural effusions.

Output: Swan-Ganz catheter looped in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Hypoxia in a lung transplant patient History: As above ETT 4 cm above the carina. Enteric tube tip in the stomach, extending beyond the field-of-view.Stable cardiomediastinal silhouette.Mild interval improvement in aeration of the left and right lung bases, with persistence left lower lobe subsegmental atelectasis.Interval increase in left upper lobe perihilar perihilar opacities, consistent with asymmetric edema or pneumonia. Interstitial septal thickening, consistent with interstitial pulmonary edema.Interval decrease in size of small bilateral pleural effusions with a loculated component on the right.No pneumothorax.

Output: 1. Interval decrease in size of small bilateral pleural effusions.2. Interval increase in left upper lobe perihilar opacities, consistent with asymmetric edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.History: Marfan Syndrome Moderate thoracic scoliosis.Severe osteopenia.Unremarkable cardiomediastinal silhouette with no evidence of mediastinal widening.Large lung volumes.No focal pulmonary opacity. No pleural effusions or pneumothorax.

Output: Severe osteopenia and moderate thoracic scoliosis. No evidence of mediastinal widening.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: Female, 63 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#1 Chest tubes with no pneumothorax.Mild to moderate edema pattern slightly worse, with persistent left basilar atelectasis.ET tube tip approximately 4 cm above the carina.Left subclavian Swan-Ganz catheter tip in main pulmonary artery.

Output: Slight increase in edema pattern but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: post op hypoxia History: oxygen requirement, HFpEF The patient is rotated to the right.Support devices are unchanged.Cardiomegaly is unchanged. No specific evidence of infection, edema, or large pleural effusions.

Output: Cardiomegaly without evidence of a acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: SOB, assess for edema History: see above Stable cardiomediastinal silhouette.Bilateral pleural effusion similar to the prior exam.No new pulmonary opacities identified.

Output: Bilateral pleural effusions unchanged from the prior exam.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of tachypnea. Left-sided pacemaker with leads stable in position. Stable cardiomediastinal silhouette. Diffuse bilateral patchy air space opacities appear similar to prior. Probable small bilateral pleural effusions.

Output: Diffuse bilateral airspace opacities and pleural effusions appear similar to prior.


Instruction: Generate impression based on medical findings.

Input: 63 years old Female. Reason: 63yo F w/ resp distress, s/p intubation assess ET placemen History: assess for. Endotracheal tube tip terminates within the right mainstem bronchus, however this has been retracted on the subsequent study but tip is obscured by overlying hardware. Overlying hardware also obscures portions of the lungs and mediastinum. Enteric tube tip in the gastric fundus. Small lung volumes with probable left pleural effusion with adjacent atelectasis/consolidation although this is incompletely evaluated due to overlying hardware. Cardiomegaly with interstitial changes.

Output: Findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 18-year-old female who is intubated.VIEW: Chest AP (one view) 5/24/2016 at 0446 hours Endotracheal tube tip at the thoracic inlet. Right internal jugular venous catheter with tip in the SVC. Two enteric tubes with tips beyond the field of imaging. Left chest wall vagal nerve stimulator with leads extending into the left neck.Cardiothymic silhouette is normal. Improving bilateral basilar pulmonary opacities. No large pleural effusions or pneumothorax.

Output: Improving bilateral basilar pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: PNA? History: Intubated Endotracheal tube has been advanced slightly now terminating approximately 6 cm from the carina. Again, the endotracheal tube balloon appears to be slightly hyperinflated. Enteric tube extends inferiorly off the field-of-view. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Endotracheal tube has been advanced slightly now terminating approximately 6 cm from the carina. Again, the endotracheal tube balloon appears to be slightly hyperinflated. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size. No large pleural effusion or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with left hemithorax opacification on chest x-ray and recent DVT. Evaluate for pulmonary embolus. CHEST:PULMONARY ARTERIES: Large filling defect is identified in the right descending pulmonary artery with extension into several basilar segmental arteries consistent with pulmonary embolus. Eccentricity of clot suggests a chronic component however expansion of the pulmonary artery is consistent with an acute embolus. Pulmonary artery measures 32 mm suggesting a component of pulmonary arterial hypertension.LUNGS AND PLEURA: Interval development of large left pleural effusion and associated compressive atelectasis in the left lower lobe. Additional consolidation is seen in the left upper lobe may be secondary to aspiration, hemorrhage, or infection. Patchy areas of consolidation in the left lung. MEDIASTINUM AND HILA: Postoperative changes in the prevascular space again noted. Heart size is normal with trace pericardial effusion.Unchanged elevation of left hemidiaphragm likely from postsurgical phrenic nerve paralysis.CHEST WALL: Median sternotomy wires. Lipoma in the left chest wall musculature.UPPER ABDOMEN: Note is made of vicarious excretion of contrast in the gallbladder. Infrarenal IVC filter in place

Output: 1.Pulmonary embolus in the right descending pulmonary artery. Though the appearance of the embolus has some chronic features, the differentiation of acute versus chronic emboli can be unreliable on CT.2.Consolidation in the left upper lobe is nonspecific and may be secondary to aspiration, hemorrhage, or infection.3.Interval development of large left pleural effusion with associated compressive atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: AM CXR with chest tube History: AM CXR with chest tube Right chest tube with no pneumothorax but persistent right supraclavicular and neck soft tissue emphysema.Diffuse edema pattern unchanged with a small right pleural effusion.The chest tube is kinked at the side port where it exits from the thorax.

Output: No pneumothorax. Right chest tube kinked at side port where it exits from the pleural space.


Instruction: Generate impression based on medical findings.

Input: Male 33 years old Reason: patient with acute psychosis, rising CRP, concern for aspiration pneumonia History: follow up from yesterday for atelectasis and concern for developing pneumonia Cardiomediastinal silhouette is unremarkable. Low lung volumes, with basilar atelectasis. No focal airspace opacity, pleural effusion or pneumothorax.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: Thoracoabdominal Aneurysm; Intubated History: Thoracoabdominal Aneurysm; Intubated ET tube and venous catheters unchanged.Cardiomegaly with opacity adjacent to the proximal descending aorta, better defined on recent CT scan.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with appendiceal carcinoma CHEST: Right thyroid nodule is unchanged.LUNGS AND PLEURA: Mild emphysematous changes.MEDIASTINUM AND HILA: No adenopathy. The pulmonary artery remains dilated, consistent with pulmonary arterial hypertension.Dense coronary artery calcifications. Calcifications affecting the aortic arch.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged without focal lesion. Borderline peritoneal thickening around the liver remains. The bile ducts are at the upper limit of normal status post cholecystectomy.SPLEEN: A few small splenic hypodensities are stable.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst, stable. Scattered scarring affects both kidneys, left greater than right.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 17 x 12 mm (series 3, image 96), not significantly changed when remeasured (previously 16 x 12 mm). Reference intra-aortic caval lymph node measures 15 x 10 mm (series 3, image 105), previously 15 x 12 mm.Few scattered mesenteric nodes remain.BOWEL, MESENTERY: Evidence of prior bowel resection.Focal, concentric narrowing of the mid transverse colon (series 3, image 108) is noted. No evidence of obstruction is seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evidence of prior bowel resection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of new disease.Focal, concentric narrowing in the mid transverse colon. Colonoscopy may be beneficial for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.CHF, CAD status post CABG presenting with chest pain S.O.B. Normal heart size. Multiple oval mediastinal surgical clips. Sternotomy wires.No focal pulmonary opacities or pleural fluid. No pneumothorax. No signs of pulmonary edema

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: CABG and aortic valve replacement Mediastinal and bilateral basilar chest tubes appear similar. ETT has been removed, however Swan-Ganz again projects into the right pulmonary outflow tract. Dobbhoff extends into the cardiaPersistent decreased lung volumes with small to moderate effusions, mildly larger on the right. Mild cardiomegaly unchanged

Output: ETT removed


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: assess edema History: hypoxemia Line position stable.Low lung volumes. Bilateral pleural effusions as well as perihilar and lower lobe consolidation. Findings unchanged.

Output: No change in line position or bilateral pleural effusions with consolidations.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: r/o infiltrate History: chest pain The heart size is normal. The lungs are clear. No pleural effusion or pneumothorax. Surgical clips overlie the right axilla.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Swan in place. Swan-Ganz catheter from an IVC approach terminates in the distal right main pulmonary artery.Low normal lung volumes, decreased from previous, with mild basal and dependent atelectasis.

Output: Swan-Ganz catheter terminates in the position of the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.History: Atrial fibrillation, CAD, hypertrophic cardiomyopathy, CHF. Status post biatrial ablation and removal of calcific plaque from left adrenal appendage. Redemonstrated cardiomegaly with patchy airspace opacities and a moderate right pleural effusion, with no significant interval change.ET tube with tip 4 cm above the carina.Two right central catheters with tips at the confluence of the right internal jugular vein and right brachiocephalic vein.Midline mediastinal drain.Interval placement of enteric tube with distal tip projecting inferiorly beyond the visualized field.No pneumothorax.

Output: No significant interval change in patchy airspace opacities and moderate right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: eval for pna History: leukocytosis, asp risk Right PICC line with its tip in the axilla.Decreased lung volumes with stable cardiomediastinal silhouette.Scattered areas of scarring/subsegmental atelectasis noted.No focal areas of consolidation.Possible small right pleural effusion.Barium is identified in the stomach.

Output: No significant interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: f/u pleural effusion History: SOB Large left pleural effusion occupying nearly 2/3 of the left hemithorax volume despite a subpulmonic drain.Stable left basilar consolidation.Minimal right pleural effusion.

Output: Unchanged large left pleural effusion, pleural drain in place.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o pneumothorax History: Removal of chest tube No significant pneumothorax following chest tube removal.Status post sternotomy with mild to moderate cardiomegaly.Slight improvement in basilar atelectasis with persistent effusions.

Output: No pneumothorax following chest tube removal. Improving basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Follow-up aspiration pneumonia. Diffuse bilaterally interstitial right-sided pulmonary opacities and more focal left retrocardiac opacities are stable. Small bilateral pleural effusions also stable. Cardiomegaly slightly progressed. These findings may reflect CHF or possibly infection.

Output: Cardiomegaly with stable bilateral opacities and effusions may reflect CHF or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: post-bronch cxr History: as above Interval intubation with ET tube tip in appropriate position.Left greater than right pleural effusions with adjacent atelectasis/consolidation with improvement in aeration at the left lung base.Diffusely scattered pulmonary nodules compatible with known metastatic disease. Metastatic involvement of the left scapula.No pneumothorax.

Output: Left greater than right pleural effusions with adjacent atelectasis/consolidation with improvement in aeration at the left lung base.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Worsening chest pain/SOB. Decreased lung volumes.Moderate cardiomegaly.Interval worsening of bilateral lower lobe airspace opacities and consolidation. Small to moderate right pleural fluid collection also increased in volume. Small volume of pleural fluid on the left about the same. Patchy opacities throughout the dependent aspect of the right lung suggestive of aspirate.

Output: Worsening lower lobe opacities, most consistent with aspiration/infection and atelectasis. Increased right pleural fluid volume.


Instruction: Generate impression based on medical findings.

Input: Reason: catheter in place? History: central catheter infusing tpa No sign of a central venous catheter in the chest. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No visible central venous catheter.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: h/o hepatic hydrothrorax. underwent tips yesterday History: hypoxia ET tube has been removed.Right central venous catheter with its tip in the RA.Stable cardiomediastinal silhouette.Pulmonary opacities and pleural effusions similar to the prior exam.

Output: Interval extubation. Pulmonary opacities and pleural effusions similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Shortness of breath, evaluate for infection. Normal heart size.Mildly prominent pulmonary arteries suggestive of pulmonary hypertension.Mild basilar scarring, similar to prior.No focal pulmonary opacities, pneumothorax, or pleural effusions.Subcentimeter high density focus within the left neck suggestive of carotid calcifications.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pacemaker r/o pneumothorax History: s/p pacemaker r/o pneumothorax New pacemaker with leads extending to the area of the right atrial appendage and right ventricular apex.No pneumothorax or other visible complications.Small lung volumes and small bilateral pleural effusions, not significantly changed.

Output: New pacemaker with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Status post chest tube removal, evaluate for pneumothorax. Interval removal of left apical chest tube leaving a small linear left lucency representing a tract of removed chest tube. Chest tube at left base unchanged in position. Persistent extensive opacity left hemithorax consistent with atelectasis and effusion as well as right-sided edema and pleural effusion.Left PICC tip in axillary region. Median sternotomy hardware, aortic graft and mitral valve prosthesis unchanged.

Output: Left chest tube removed.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: /p OHT c/b Nocardia PNA + CMV viremia, EF 18%, following for new opacities +/- History: as above Cardiomegaly with left sided opacity suggestive of infection or aspiration, unchanged.Right jugular catheter, tip in SVC.

Output: No change in left-sided opacities and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Device placement Single-lead right subclavian ICD is unchanged without postprocedural additional new complications observed. Left PICC line again terminates in the mid SVC unchanged.Underlying cardiopulmonary appearance is otherwise similar with diffuse four-quadrant nonspecific interstitial changes and left basilar scarring and/or atelectasis

Output: Right subclavian ICD unchanged


Instruction: Generate impression based on medical findings.

Input: Oxygen desaturation. Hypoxemia. Hilar enlargement and architectural distortion in the upper lobes with volume loss compatible with sarcoidosis. No specific evidence of aspiration or infection. No signs of edema.

Output: Chronic abnormalities consistent with sarcoidosis. No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: MaleReason for Study: Reason: evl pulm edema History: see above ET tube and NG tube have been removed.Right central venous catheter with its tip in the SVC.Stable cardiac mediastinal silhouette.Interval improvement in pleural effusions, pulmonary edema, and basilar atelectasis.

Output: Interval extubation. Improvement in pleural effusions, edema, basilar atelectasis compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.COPD, rheumatoid arthritis, mildly. Shortness of breath, cough, sputum, chills on CellCept Extensive chronic interstitial and airspace opacities consistent with known interstitial lung disease.Cardiomediastinal silhouette is unchanged. No pneumothorax. No large pleural effusion. No focal superimposed opacity to suggest infection.

Output: No focal superimposed opacity to suggest infection.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: chest pain History: chest pain Lungs and pleural spaces are clear. Heart size is normal.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old. Reason: Infiltrates History: fever Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: effusion vs pna History: SOB and CP Severe cardiomegaly status post sternotomy.Unchanged mild interstitial edema, the lungs better expanded.LVAD and ICD are unchanged. Right jugular catheter, tip in SVC.

Output: Increased lung volume, stable edema and no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Increased aeration of the left upper lobe. Large left pleural effusion again noted. Cardiomegaly again noted. Patchy right basilar opacity, unchanged. No pneumothorax.

Output: No pneumothorax. Improved aeration of the left upper lobe. Persistent large left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: lung cancer History: 11 months after LUL lobectomy for typical carcinoid tumor Postsurgical changes again noted in the left hemithorax. Mild left-sided pleural thickening, as before. Right lung remains clear. Unchanged heart size. No pneumothorax. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with history of metastatic rectal cancer CHEST:LUNGS AND PLEURA: Interval surgical changes to both lung apices with surgical sutures and scarring. There is a left upper lobe nodule which is slightly increased in size compared to previous study. Now it measures 1.7 x 1.3 image number 16, series number 5. It measured 1.1 x 0 .9-cm in image number 21, series number 4 in the previous study. No other significant change from previous study.MEDIASTINUM AND HILA: Calcified mediastinal nodes are stable.CHEST WALL: No significant abnormality noted.ABDOMEN:Limited study due to lack of IV contrast.LIVER, BILIARY TRACT: Lack of IV contrast and diffuse fatty infiltration significantly limits the ability of this study to detect focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Stable infrarenal abdominal aortic aneurysm. Index aortocaval node is stable measuring 1.4 x 1.3 cm image number 117, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable presacral soft tissue thickening and postsurgical changes. Small amount of air within the presacral soft tissue is unchanged. Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal interval increase in the size of the left upper lobe nodule. Otherwise no significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.SOB, wheezing and febrile. Pneumonia versus bronchitis. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Mild bronchial wall thickening.

Output: Mild bronchial wall thickening but no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: interval change. Right sided effusion/pneumonitis Left upper extremity PICC tip unchanged in position. Loculated moderate size right pleural effusion with right basilar atelectasis and edema, similar to prior examination. Visualized cardiomediastinal silhouette is unchanged.

Output: Right pleural effusion and compressive atelectasis, similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: PNA? edema? History: hypoxia Minimal right basilar nonspecific opacities, likely atelectasis. Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality or significant interval change


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o fluid overload History: esrd ,volume overload . Mild interstitial pulmonary edema again noted. Moderate cardiomegaly, as before. Question of small pleural effusions. No acute bony abnormality.

Output: Mild interstitial pulmonary edema and moderate cardiomegaly, as before.


Instruction: Generate impression based on medical findings.

Input: Cough Motion degrades sensitivity. Within this limitation no cardiopulmonary abnormality observed

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: postop History: postop ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.A more recent radiograph has been interpreted.

Output: Postoperative findings with basilar consolidation and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Chest tube in place, currently undergoing clamp trial. 40 pack years smoking history, tension pneumothorax status post CT insertion. Left chest tube directed towards the apex unchanged in position. No significant sized pneumothorax. Severe emphysema. Basilar opacities unchanged, continued follow-up suggested. Calcific scarring at the lung apices.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Cough awakening patient at night for one month assess for hypersensitivity pneumonitis or infiltrates. Normal cardiomediastinal silhouette. The lungs are well inflated. No pleural fluid or pneumothorax.Within the right lower lobe infrahilar region, there is crowding of vasculature and the suggestion of a small focus of atelectasis or consolidation.

Output: Possible small focus of atelectasis or consolidation in the right lower lobe infrahilar region of unclear etiology. Differential considerations include focal aspiration or infection given the patient's age. The appearance is not consistent with hypersensitivity pneumonitis. If the patient remains symptomatic, follow-up PA and lateral chest radiographs are suggested in 6 weeks to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o acute process History: sob Presternal ICD again seen.Unchanged cardiomegaly.Streaky basilar opacity suggestive of atelectasis. No focal consolidation or significant pleural effusions.

Output: No acute cardiopulmonary process is identified, and no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Decreased lung volumes with peripheral coarse interstitial opacities compatible with fibrosis .No focal areas of consolidation.No suspicious pulmonary nodules or masses.Mild cardiac enlargement.

Output: Pulmonary fibrosis without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Patient with breast cancer, invasive ductal, status post left mastectomy with sharp pleuritic pain at the second costochondral junction. PULMONARY ARTERIES: There are no filling defects in the pulmonary arteries to suggest pulmonary embolism.LUNGS AND PLEURA: There are innumerable bilateral round nodules, the largest of which measure about 12 mm in the right lower lobe and 18 mm in the left lower lobe, highly suspicious for metastatic disease. There is a developing area of consolidation in the left upper lobe measuring approximately 3.5 x 3.4 cm which is new since the prior study. This finding could reflect post radiation therapy change/fibrosis if the patient received radiation therapy and this area was included in the radiation field of the left breast. Conversely, this could reflect an area of developing pneumonia, though given its linear appearance on the sagittal view, postradiation change is favored.MEDIASTINUM AND HILA: There is an enlarged 19 x 12 mm carinal lymph node with enlarged bilateral hilar lymph nodes, the largest on the right measuring 16 x 20 mm. Clips are present in the left axilla.CHEST WALL: The patient is status post left mastectomy. The midsternum has a mottled appearance with cortical break in its lateral margin on the right. A pathologic fracture fracture- at this location is possible. Correlation with nuclear medicine bone scan is recommended. There is a small seroma in the left axilla measuring 2.0 x 1 .3 cm, likely prior secondary to prior resection.UPPER ABDOMEN: There is mild splenomegaly of uncertain etiology. Sutures around the stomach may reflect sequelae of prior gastric bypass.

Output: 1.No evidence of pulmonary embolism.2.Multiple bilateral lung nodules with hilar and mediastinal lymphadenopathy as described above are highly suspicious for metastatic disease given the patient's known breast cancer.3.Developing opacity in the left upper lobe is nonspecific but favored to reflect postradiation fibrosis if the patient has undergone radiation therapy for left breast cancer. Otherwise, this finding could reflect developing pneumonia.4.Mottled appearance of the sternum with discontinuity of the lateral cortex on the right side, near site of patient symptomatology. This could reflect metastatic disease to the sternum with a pathologic fracture, though this is equivocal. If clinically desired, further evaluation with bone scan can be obtained. There are no other osseous lesions identified.These findings were discussed with the clinical team at time of interpretation


Instruction: Generate impression based on medical findings.

Input: Endometrial cancer.. Assess disease process. CHEST:LUNGS AND PLEURA: A few scattered calcified and noncalcified micronodules are unchanged. No new suspicious nodules consolidation or effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Segment 6 low attenuation lesion is unchanged measuring 11 x 9 mm on image number 107, series number 4.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple punctate nonobstructing stones in the right kidney unchanged.RETROPERITONEUM, LYMPH NODES: Reference left upper quadrant peritoneal deposit measures 4-mm image number 124, series number 4. Other scattered mesenteric deposits are also smaller.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing ventral abdominal hernia is unchanged. Left lower quadrant bowel-containing hernia is also unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged bilateral inguinal lymph nodes, more prominent on the left are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable study.


Instruction: Generate impression based on medical findings.

Input: Female; 21 years old. Reason: sob, hx pneumonia History: sob Moderate right pleural effusion with underlying atelectasis/consolidation, compatible with infarct and hemorrhage as seen on subsequent CT chest.Moderate nonspecific left basilar atelectasis/consolidation.Normal cardiac and mediastinal silhouettes, aside from prominence of the main pulmonary artery.

Output: Right basilar infarct and hemorrhage as seen on subsequent CT chest. Nonspecific left basilar atelectasis/consolidation. See report from subsequent CT chest.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: tracheostomy History: tracheostomy Low lung volumes makes detailed cardiopulmonary assessment difficult. Tracheostomy in place. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Mild cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old. Interval eval for SOB Stable cardiomediastinal silhouette.Diffuse bilateral interstitial opacities suggestive of edema possibly with underlying fibrosis. Patchy left lower lobe opacity has increased. Persistent small left pleural effusion.

Output: Increase in patchy left lower lobe opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Intubated, MICU ARDS. ETT tip 3 cm above the level of the carina.Enteric tube tip off the caudal margin of the film.Proximal ECMO cannula tip at the level of the SVC.Distal ECMO cannula tip projects over the IVC with tip at the inferior right atrium.Diffuse upper zone predominant airspace opacities bilaterally with minimally improved areas of focally aerated lung in the bases. Probable apical pleural fluid bilaterally.

Output: Extensive airspace opacities bilaterally with fluid and pain over the lung apices.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Crackles at left base, history of PE. Rule out infection. Upper normal heart size.No pleural fluid or pneumothorax.Hazy focal opacity anterior left mid lung. Mild basal atelectasis.

Output: Hazy left midlung opacity, suspicious for pneumonia. Follow-up to complete radiographic resolution, PA and lateral chest radiographs suggested in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: tachypnea, tachycardia Lower zone opacity compatible with moderately large pleural effusions and underlying atelectasis.Port catheter extending to the SVC.Drainage catheter in the right upper quadrant of the abdomen and a second catheter projected over the right lower lung which may be internal or external to the patient.

Output: Pleural effusions and lower zone atelectasis with no significant change allowing for differences in position and projection.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p thoracotomy, diaphragm resection History: htx, ptx Right apical chest tube remains in place. Right IJ line, unchanged terminating in the RA. Curvilinear lucency again noted at the right lung base. Diffuse pulmonary opacities with more confluent basilar opacities, unchanged. Small pleural effusions, as before. Unchanged cardiomegaly. Increase in prominence of loops of bowel, correlation with recent abdominal radiograph is suggested.

Output: Lines and tubes, as above. No significant pneumothorax. Probable pulmonary edema. Increase in prominence of loops of bowel, correlation with recent abdominal radiograph is suggested.


Instruction: Generate impression based on medical findings.

Input: 36 years old Male. Reason: assess ETT placement, for infection History: ETT in place, hypercarbic respiratory failure, concern for infection. ET tube tip approximately 5 cm above the carina. An NG tube tip in the below the field of the view.Bilateral lower zone nonspecific opacity compatible with aspiration, infection and layeredout effusion slightly decreased in the left lower lung. Large lung volumes with extensive abnormalities as previously described consistent withemphysema and scarring, unchanged.

Output: Slightly decreased left lower lobe opacity compatible with improvement of the aspiration,atelectasis and layered effusion.


Instruction: Generate impression based on medical findings.

Input: Recent diagnosis of retromolar cancer. Rule out metastases. LUNGS AND PLEURA: 2-mm micronodule in the right lower lobe, probably calcified, and no other significant pulmonary abnormalities.MEDIASTINUM AND HILA: No significant lymphadenopathy.Extensive coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No sign of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval for pneumonia, septic emboli History: IV drug user, shortness of breath Low lung volumes. Questionable mild nodularity throughout the lungs. No focal lung consolidation. No pleural effusion or pneumothorax. Central venous catheter terminates in the RA. No acute bony abnormality.

Output: No focal lung consolidation.Questionable mild nodularity throughout the lungs, increased from previous study. If the patient has recently injected talc or methylcellulose containing oral medications intravenously, this may represent granulomatous inflammation within the lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: pneumonia, cardiomegaly, mass, effusion. History: tia/stroke workup b/l ext numbness and tingling Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia History: hypoxia Persistent opacity at the left base consistent with pleural effusion and underlying atelectasis.Small effusion on the right.Catheter tip in the SVC.Marked dextroscoliosis.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: sob Unremarkable cardiac and mediastinal silhouette. Blunting of the posterior costophrenic angles compatible with atelectasis and very small effusions, confirmed on an abdominal CT scan of the same day.No sign of pneumonia.

Output: Very small effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Dyspnea with cough and wheezing. Tobacco use Unchanged exam with a mildly yet nonspecific enlarged cardiac silhouette and extensive calcified mediastinal hilar lymph nodes. Old healed granulomatous disease exposure.No specific pulmonary abnormalities, specifically no findings to suggest infection or malignancy

Output: Old granulomatous disease exposure superimposed upon cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: On ECMO. CXR for catheter position. ARDS monitoring. Pneumomediastinum monitoring History: see above Diffuse pulmonary opacities again noted. Endotracheal tube terminates 2.5 cm from the carina. ECMO catheter overlies the right hemithorax and upper abdomen. Enteric tube extends inferiorly off the field-of-view. Improvement in pneumomediastinum.

Output: Diffuse pulmonary opacity consistent with diffuse alveolar damage, as above.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.PICC placed. Left upper extremity PICC tip projects over the superior cavoatrial junction. Elevation of the left hemidiaphragm with adjacent atelectasis or scarring unchanged. IABP marker projects over the level of T7/T8. IVC catheter extends into the right atrium.

Output: Left PICC tip projects over the superior cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: evaluate for edema, pneumonia History: shortness of breath Persistent severe cardiomegaly, unchanged.Increased interstitial opacities and right pleural effusion. No pneumothorax.Central venous catheter tip is in the right atrium. Surgical clips project over the axillae.

Output: Increased interstitial opacities and right pleural effusion consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assess ET tube History: sob, chest pain Endotracheal tube tip is 3 cm above the carina. Swan-Ganz catheter tip is seen distal to right main pulmonary artery. AICD leads are unchanged. The proximal marker of the IABP is 8 cm beneath the superior margin of the aortic arch.Stable cardiomegaly. Right lower lobe airspace opacity has progressed and a dense retrocardiac opacity is new. The vascular pedicle appears more prominent, with progressive perivascular haziness, indicating worsening pulmonary edema.

Output: 1. ETT tube 3 cm above the carina.2. Worsening pulmonary edema, cannot rule out new infection.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old. Patient had EGD. History of esophageal cancer. Assess post-procedure for any perforation. Large lung volumes consistent with known COPD.No evidence of infection or edema.Stable cardiomediastinal silhouette. Calcifications of the aortic arch. No pneumoperitoneum is identified.

Output: No pneumoperitoneum identified.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: ventilated patient, curious about interval change History: on ventilator Lines and tubes are unchanged. No substantial change in diffuse pulmonary opacities given differences in inspiration. Unchanged heart size. Small pleural effusions. No pneumothorax.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: pneumothorax? History: s/p left lung mass biopsy Right central catheter is unchanged in position.Low lung volumes with streaky left lower lobe opacities cough subsegmental atelectasis. Multiple pulmonary nodules better visualized on the recent cross-sectional imaging. No pneumothorax following biopsy.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: fluid retention History: desaturatino Mild bibasilar subsegmental atelectasis or scarring. Unchanged mild cardiomegaly. Aortic atherosclerosis again noted. No large pleural effusion or pneumothorax. Nasogastric tube side port again the gastroesophageal junction.

Output: Mild bibasilar subsegmental atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.PICC line placement. Interval insertion of right upper extremity PICC, tip directed superiorly into the right internal jugular vein.Stable moderate cardiomegaly with unchanged ICD.Focal opacity in the left mid zone suspicious for pneumonia and/or aspiration, unchanged accounting for differences in projection.

Output: Right PICC tip is in the right internal jugular vein. Left upper lobe pneumonia, recommend 6 week follow-up to confirm resolution.


Instruction: Generate impression based on medical findings.

Input: 30 year-old male with metastatic nonseminomatous tumor CHEST:LUNGS AND PLEURA: Linear atelectasis in the right upper lobe is 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: Collateral vessels in the left retroperitoneum around the left kidney are unchanged. Adjacent retroperitoneal soft tissue likely representing residual lymph nodes are stable and difficult to measure due to their ill-defined appearance. Reference left aortic lymph node measures 11 x 9 mm image number 119, series number 3. Mild left caliectasis is unchanged.RETROPERITONEUM, LYMPH NODES: Please see discussion aboveBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing periumbilical hernia.OTHER: 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: Stable study.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath, chest tube removed Interval removal of the right jugular sheath and 2 right chest tubes. Small residual apical pneumothorax with interval increasing chest wall and neck emphysema. Small bilateral effusions.Lungs otherwise clear other than minimal atelectasis. Cardiac and mediastinal contours are within limits.

Output: Right chest tube removed with residual small pneumothorax and chest wall emphysema.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: brain mass Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assess for PNA, left sided chest pain x 5 days History: chest pain High left paratracheal soft tissue opacity may be tortuous brachiocephalic vessels but a mass in this region is possible and a thoracic CT recommended.No significant pulmonary or pleural abnormality. Heart size normal.

Output: High left paratracheal opacity possible tortuous brachiocephalic vessels although a mass is possible and a thoracic CT recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Evaluate for RLL PNA History: RUQ abd pain, pleuritic chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: hemoptysis in pt w mital regurg History: coughing blood The cardiomediastinal silhouette is normal in size.Hyperexpanded lungs with flattened diaphragms suggestive of COPD. Nodular right upper lobe opacity, new from prior. No pleural effusion or pneumothorax.Loop recorder device in place.

Output: Nodular right upper lobe opacity is nonspecific with differential considerations including infection and neoplasm. A CT of the chest has been performed and provides a more detailed evaluation.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with persistent cough for two months and basilar crackles. Evaluate for pneumonia Cardiomediastinal silhouette is unremarkable.No focal lung opacity or pleural effusion.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiomegaly, effsusion, pna History: syncope Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Acute hypoxia evaluate for new pneumothorax. Small to moderate left pneumothorax stable in size and about 1 cm in size laterally and around 2 cm anteromedially abutting the mediastinum (not reliably measurable). Left chest tube is directed inferiorly; consider chest tube repositioning.Diffuse groundglass opacities and cysts bilaterally not significantly changed.Tracheostomy tube and bilateral jugular catheter similar in position. Subcutaneous emphysema left chest wall.

Output: Overall no significant change in small to moderate left pneumothorax or in diffuse pulmonary opacities. Consider repositioning left chest tube; please refer to recent CT report.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval for pna History: chest pain, sob, fever Cardiomediastinal silhouette is normal. Lungs clear of airspace and interstitial opacities. No pleural effusion. No pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: edema/infection History: SOB Cardiomegaly and diffuse airspace and interstitial pulmonary opacity suggestive of edema.Pleural effusions have decreased.

Output: Pulmonary edema with decreased pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: ptx History: s/p lul mesothelioma biopsy No pneumothorax. Nodular circumferential pleural thickening in the left hemithorax consistent with given history of mesothelioma. Right lung is clear. Heart size difficult to assess.

Output: No convincing evidence of pneumothorax. Mesothelioma in the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: assess for cause of fever, immunosuppressed History: as above, bone marrow transplant pt with fever Venous catheter tip in SVC. No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: daily chest tube film History: chest tube, empyema Unchanged pleural effusions and basilar consolidation left greater than right.Right chest tube is no pneumothorax.Tracheostomy tube tip approximately 4 cm above the carina.

Output: No significant pneumothorax. Stable basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain/distention Enteric tube seen coiled at gastroesophageal junction, repositioning recommended. Nonobstructive bowel gas pattern. Multiple skin staples and surgical clips, bilateral groin clips. Please see same day chest radiography for additional findings.

Output: Repositioning of enteric tube recommended.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: pneumonia History: shortness of breath Increased basilar interstitial markings and possible small bilateral pleural effusions. Mild cardiomegaly unchanged. The imaged skeleton of the abdomen are unremarkable.

Output: Mild cardiomegaly, increased basilar interstitial markings and possible small bilateral pleural effusions suggest mild pulmonary edema secondary to CHF.


Instruction: Generate impression based on medical findings.

Input: Cough and thoracic aortic aneurysm Interval clearance of previously described bronchial wall thickening and concern for possible aspiration. Mild COPD changes with mild volume loss on the right and likely postsurgical, all unchanged. No superimposed acute cardiopulmonary abnormalityCardiac and mediastinal contours remain within limits given mediastinal shift described above

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: eval for interval change History: sc iabp Aortic balloon catheter in the descending aorta and ICD leads in the expected position, unchanged from previous.No sign of CHF or other acute change.

Output: Aortic balloon catheter and ICD leads in place with no significant change.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Right basilar scarring without interval acute change. Appearance remains similar to 2015 and specifically no findings to suggest pulmonary metastatic disease. Mild COPDCardiac and mediastinal contours remain unchanged with mild tortuosity of the aorta and atherosclerotic diseaseLeft axillary surgical clips and soft tissue deformities suggesting partial lobectomy on the left, all unchanged

Output: Unchanged right basilar scarring


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: occult rib fx History: fall yesterday in PM Right apical volume loss and scarring with rightward mediastinal shift unchanged. Interstitial opacities and large lung volumes consistent with emphysema. Calcified nodules in left upper lobe unchanged. No new pulmonary opacities, effusion, or pneumothorax.No evidence of rib fractures; however, chest radiographs are not sensitive in this respect.

Output: Extensive scarring and emphysema, stable from prior exam. No evidence of rib fractures; however, chest radiographs are not sensitive in this respect.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Intubated with aspiration pneumonia and persistent hypoxia. ET tube 6-cm above the level of the carina. Low lung volumes. Layering pleural effusions increased in volume. Extensive airspace opacities, right greater than left, with retrocardiac opacity unchanged. Nasogastric tube tip off the caudal margin of the film.

Output: Interval placement of nasogastric tube with tip off the caudal margin of the film. Layering pleural fluid on the right may indicate an increase in volume. Persistent extensive air space opacities.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with history of chronic cough, shortness of breath and previous MAI infection. LUNGS AND PLEURA: Centrilobular nodular opacities with focal areas of solid, dense opacity along with bronchiectasis, most severe in the right lung but affecting the left lung as well. Some component of chronic lung disease may be present, likely MAI, but presence of air bronchograms suggests a superimposed acute pneumonia.No pleural effusions.MEDIASTINUM AND HILA: Cardiac size normal. No pericardial effusion. Calcified hilar and mediastinal lymph nodes likely reflect prior granulomatous disease. Coronary and atherosclerotic calcifications noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Findings as above compatible with MAI, possibly with superimposed acute pneumonia. A preliminary interpretation of this exam was provided to the clinical service by the radiology resident on call. No significant discrepancy exists between the preliminary and final interpretation.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with stage II colorectal cancer. Status post 12 cycles of adjuvant chemotherapy. Please evaluate and compare. CHEST:LUNGS AND PLEURA: Small right middle lobe nodule appears stable and measures 4.3 mm (image 30/107, series 5), compared to 4.6 mm on the previous exam. There is compressive atelectasis of the lingula.MEDIASTINUM AND HILA: Cardiomegaly with calcifications of the coronary arteries, aortic root and mitral annulus.A catheter is noted in the left and right brachiocephalic veins.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips are noted. Multiple hyperdense lesions in the liver, likely represent granulomata however, without IV contrast, these lesions cannot be further characterized. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Two hyperdense lesions are seen within the lower pole of the right kidney and the lower pole of the left kidney, which appear stable but cannot be optimally evaluated due to lack of IV contrast the likely complex cyst. There are also multiple bilateral hypodense lesions, which also cannot be adequately characterized without IV contrast.RETROPERITONEUM, LYMPH NODES: Multiple subcentimeter retroperitoneal lymph nodes. A reference left aortic lymph node is mildly decreased in size and measures are 0.9 cm x 1.3 cm (image 121/216, series 4), compared to 1.5 cm x 1.2 cm on the prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Improvement of anasarca.OTHER: Resolution of perihepatic ascites is noted.Atherosclerosis of the aorta and its branches.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted..BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitisBONES, SOFT TISSUES: Interval resolution of the ubcutaneous abdominal fluid collection..OTHER: No significant abnormality noted..

Output: Limited evaluation of the solid organs due to lack of IV contrast.1.Slight decrease in size of subcentimeter retroperitoneal lymph nodes2.Interval resolution of the previously seen subcutaneous abdominal fluid collection.3.Resolution of perihepatic ascites and decreased anasarca4.Hyperdense lesions in the lower pole of the right kidney and lower pole of the left kidney appear stable and likely represent complex cysts; however, without IV contrast these lesions cannot be further characterized. Multiple bilateral hypodense lesions are again seen and appear stable.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: 52yr old male with history of MM; pre-auto sct evaluation History: evaluate The lungs and pleural spaces are clear. The heart size is normal.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: Post chest tube placement History: PTX s/p chest tube Moderate right pneumothorax which appears smaller although the difference may be due to position.ET tube within 1 cm of the carina.Other findings unchanged.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.COPD with right-sided chest tube for pneumothorax. Tachypnea. Right pigtail catheter projects over the upper thorax near the apex. Moderate right apical, anterior and subpulmonic pneumothorax with pleural separation from the chest wall at the apex of approximately 10 mm but probably larger elsewhere.Architectural distortion and hypovascularity consistent with COPD/emphysema. Scarlike abnormality in the right upper lobe near the hilum could represent scarring or atelectasis but should be followed. Extensive right chest wall subcutaneous emphysema.Small volume of pleural fluid on the right. Blunting of the diaphragm consistent with emphysema/COPD.

Output: Moderate right pneumothorax. Right upper lobe scarlike abnormality for which a follow-up film is suggested to determine etiology/stability.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: patient with fever, concern for aspiration pneumonia History: above No change in left basilar consolidation.Stable cardiomediastinal silhouette.Stable position of support devices.

Output: No change in left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: ETT check Interval intubation with ETT tip terminating 4 cm above the carina. In addition, complete opacification of the left lung is also observed, of uncertain underlying cause given associated visualized major bronchi excluding occlusion. Suspected interval development of a large effusion.Right lung continues to demonstrate nodular opacities greater in the bases with associated mixed interstitial and airspace changes. Metastatic disease with lymphangitic spread of tumor is again suspected and best observed and described on recent CT.

Output: ETT placed however given the marked interval change in the left hemithorax with an associated residual air bronchogram, short term serial imaging is requested to confirm.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old. New ECMO cannula from the IVC extending to the SVC. Balloon catheter tip at the level of the aortic arch. ICD lead unchanged.ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the left descending pulmonary artery.Cardiomegaly and bilateral opacity compatible with edema with moderate pleural effusions, unchanged.

Output: New ECMO cannula as described with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiomegaly, widened mediastinum History: substernal chest pain Severe cardiomegaly with a mitral valve ring in place.Unremarkable mediastinal contours with evidence of previous median sternotomy and disruption of the lowermost sternal suture, unchanged from previous.Large lung volumes with no evidence of edema or infection.Calcified cyst in the right upper quadrant of the abdomen, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of thrombocytopenia and left inguinal mass. CHEST:LUNGS AND PLEURA: There is a 4-mm nodular opacity in the right upper lobe, which is nonspecific, but is new from previous examination.MEDIASTINUM AND HILA: There is an anterior mediastinal lymph node (series 3, image 24) which measures 2.9 x 1.7 cm, previously measured 2.8 x 1.5 cm. This lymph node is equivocally larger compared to previous examination.The heart size is normal. No pericardial effusion.CHEST WALL: Bilateral axillary lymphadenopathy appears similar to previous examination, but an enlarged left axillary lymph node measures 2.6 x 1.7 cm (series 3, image 11), previously measuring 2.0 x 1.3 cm .ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No intra-or intrahepatic biliary ductal dilatation. The liver otherwise appears normal.SPLEEN: No spleen is present.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No enlarged mesenteric or retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral external iliac, femoral, and inguinal lymphadenopathy appears similar to previous examination. A reference left inguinal lymph node measures 2.2 x 1.4 cm (series 3, image 192), previously measuring 2.1 x 1.5 cm. A left femoral lymph node (series 3, image 204) measures 3.3 x 2.2 cm, previously measuring 2.8 x 1.9 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is a 1.6 x 0.9 cm lytic focus in the right iliac wing (series 3, image 168), unchanged from previous examination.OTHER: No significant abnormality noted

Output: Stable and enlarging adenopathy with reference measurements above. Unchanged right iliac wing lytic lesion. New right upper lobe nodular opacity, which is nonspecific.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Cough. Evaluate for pneumonia. Right PICC in place, unchanged in position. Interval increase in moderate size right pleural effusion with underlying atelectasis/consolidation. Persistent right perihilar opacity. No evidence of pneumothorax. Stable cardiomediastinal silhouette.

Output: Persistent right perihilar consolidation with interval increase in size of a moderate sized right pleural effusion.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: 58-year-old female with metastatic breast cancer, new shortness of breath. Evaluate for PE. Technically adequate exam.PULMONARY ARTERIES: No filling defects to suggest presence of PE.LUNGS AND PLEURA: 2 subcentimeter poorly defined opacities are nonspecific (left upper lobe image 30, right upper lobe image 54). These could be post inflammatory or metastatic.MEDIASTINUM AND HILA: No pericardial effusion. No mediastinal or hilar adenopathy.CHEST WALL: Bilateral mastectomies with surgical clips in the right axilla. Multiple mixed sclerotic/lucent expansile lesions of the axial skeleton, compatible with diffuse metastatic disease. Compression fracture and diffuse sclerosis of T10 vertebral body, of indeterminate age, however, not apparent in 2006. Evidence of healing pathologic fracture right sixth rib posteriorly.UPPER ABDOMEN: Arterial phase contrasted images are suboptimal for evaluation of solid organs. Multiple hypo-attenuating hepatic lesions poorly seen, some of which were present previously and are unchanged. Cholelithiasis. Adrenal lesions seen on PET are not clearly seen on current CT; there is a small nodule in the lateral limb of the left adrenal gland on image 245 which is new.

Output: 1) No PE or other acute cardiopulmonary abnormalities. 2) Diffuse osseous metastatic disease with T10 compression fracture of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o opacity History: hypoxia Severe cardiomegaly.Small lung volumes with borderline edema.No specific evidence of infection.

Output: Severe cardiomegaly and possible edema, but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Evaluate for fluid overload vs. PNA History: Pt with cough, shortness of breath x1 day, crackles over left lung base Gradually worsening pulmonary opacities consistent with edema with pleural effusions.Heart size at least upper normal.Right jugular catheter at cavoatrial junction, prior left jugular catheter removed.

Output: Lower lung zone opacities and pleural effusions consistent with CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of metastatic prostate cancer CHEST:LUNGS AND PLEURA: Again noted bilateral lung nodules consistent with metastatic disease. Index nodule in the right middle lobe is unchanged measuring 8 mm on image number 44, series number 5. Left upper lobe nodule is also unchanged measuring 10 x 7 mm on image number 53, series number 5.There is new peripheral air space opacity in the right upper lobe suspicious for pneumonia.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney. Percutaneous nephrostomy catheter and double-J stent on the left side.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy is redemonstrated. Index retroperitoneal lymph node is unchanged measuring 4.1 x 2.4 cm on image number 122, series number 3. A second more caudal left parrot-beak lymph node measures 3 x 3.1 cm on image number 134, series number 3, slightly smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of sclerotic lesions in thoracic vertebral bodies.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Small common iliac lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval development of new sclerotic lesions in bilateral iliac bones and vertebral bodies suspicious for metastatic disease.OTHER: Unremarkable.

Output: Interval development of bone metastases.Right upper lobe air space opacity suspicious for pneumonia.Interval slight decrease in size of the some of the retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: CHF? PNA? History: SOB Cardiomediastinal silhouette is within normal limits.Scattered areas of subsegmental atelectasis and nonspecific basilar reticular opacities. No pleural effusions.Degenerative disease of the shoulders bilaterally. Possible loose body in the right glenohumeral joint.

Output: No acute cardiopulmonary abnormality. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: assess for pna History: sob Left-sided pacemaker electrodes are unchanged in position.Bilateral progression of airspace and interstitial opacities with right greater than left small pleural effusions. The heart size remains normal. No pneumothorax.

Output: Low progressive airspace interstitial opacities with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.PICC placement. Scarlike opacity in the left upper lobe about the same. Retrocardiac hazy opacity and pleural fluid on the left. Minimal patchy retrocardiac opacity at the right lung base.The right PICC projects over the right subclavian vasculature in the mid clavicular line and is not central in location.

Output: Right PICC projects over the midright subclavian vein region, not in a central vein. Pulmonary opacities and pleural fluid suspicious for aspiration and possible infection.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: cp History: cp Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old with cough and shortness of breath. Evaluate for edema or infection. Left subclavian pacemaker leads are unchanged in position.Marked cardiomegaly and tortuous aorta, unchanged.No new pulmonary opacities or pleural effusion.

Output: No evidence of edema or pneumonia. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: sob History: sob The AICD wires in the right atrial appendage and right ventricle, unchanged in position. Moderate to severe cardiomegaly with left atrial enlargement and a tortuous calcified thoracic aorta. Low lung volumes with increased left greater than right basilar atelectasis. Pulmonary vascular redistribution and interstitial opacities, consistent with pulmonary edema. Sequela of granulomatous disease. Probable small pleural effusions.

Output: CHF and mild pulmonary edema.Mild bibasilar atelectasis.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: 72-year-old female with history of NG tube placement. NG tube tip in the stomach with sidehole at the EG junction.Cardiomediastinal silhouette is unchanged. There are bibasilar pulmonary opacities and small bilateral pleural effusions. Calcified and tortuous thoracic aorta. No pneumothorax.There is free air in the abdomen, likely postoperative in etiology.

Output: Stable cardiopulmonary appearance with NG tube tip in the stomach with sidehole at the EG junction.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Reference right axillary adenopathy is smaller measuring 13 x 12 mm image number 21, series number 6. Other lymph nodes are also smaller.ABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged. Cholelithiasis is unchanged.SPLEEN: Spleen is again enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes and decrease in size and number. Reference left para-aortic lymph node measures 2.1 x 1.4 cm. there is no significant decrease in the periportal, peripancreatic, mesenteric and splenic hilar adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymph nodes are also decreased in size and number. Reference left external iliac lymph node now measures 10 x 14 mm image number 191, series number 6.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left-sided fat-containing inguinal hernia is unchanged.OTHER: No significant abnormality noted

Output: Interval decrease in the size and number of the extensive adenopathy in the chest abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with a history of metastatic synovial sarcoma. Evaluate for disease progression LUNGS AND PLEURA: Interval increase in the size of the numerous pulmonary and pleural-based nodules as well as occurrence of new nodules compatible with progression of metastatic disease.Left paraspinal pleural based reference nodule in the left upper lobe (image 32 series 5) now measures 15 mm x 27 mm previously measuring 8 mm x 8 mm.Post surgical changes as previously identified in the right upper lobe and left lower lobe.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Port-A-Cath with its tip in the SVC.CHEST WALL: Right chest port.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval progression of metastatic disease within the lung.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female presents with shortness of breath. Evaluate for pneumonia. The cardiomediastinal silhouette is normal. Bibasilar atelectasis. No focal pulmonary opacity suggestive of pneumonia, no pneumothorax, no pleural effusion.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history shortness of breath. Evaluate for edema or infection. Severe cardiomegaly, unchanged. There are basilar predominant interstitial opacities compatible with edema. Probable bibasilar atelectasis. No significant pleural effusions.

Output: Moderate CHF without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: chest pain and SOB, h/o DVT/PE, r/o PTX or pneumonia History: as above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No evidence of a pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Pleural effusion follow-up. Dyspnea. Chronic elevation of the left hemidiaphragm. Moderate loculated appearing left pleural fluid collection increased in volume with associated compressive atelectasis. Cardiothoracic ratio appears increased compared to prior. Hazy interstitial and airspace opacities at the right lung base. High-riding aortic arch. Surgical clips left axilla. Bilateral breast prostheses. Tracheostomy tube tip at the level of the clavicular heads. Right jugular chest port tip at the superior cavoatrial junction.

Output: Moderate loculated left pleural fluid collection increased in volume. Nonspecific interstitial and airspace opacities at the right base which may reflect atypical edema and/or infection and should be followed by serial radiographs until complete resolution to exclude alternate etiology such as lymphangitic tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Cough evaluate for pulmonary edema/pleural effusion. Moderate right and small left pleural fluid collections.Mild cardiomegaly.Coarse basal interstitial opacities unchangedRight basal opacity suggestive of atelectasis slightly disproportionate to the volume of pleural fluid.

Output: Mild hypervolemia. Right basal opacity most likely reflects atelectasis but is slightly disproportionate to the volume of pleural fluid; if patient remains symptomatic short-term follow-up plain films suggested to exclude possibility of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: NG tube placement History: As above Chronic appearing interstitial opacities with left upper lobe emphysema are unchanged.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: ET tube tip approximately 3 cm above the carina. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: pRE-KIDNEY TRANSPLANT EVAL The cardiomediastinal silhouette is unremarkable.The lungs are clear.Blunting left costophrenic angle compatible with pleural thickening/small effusion.

Output: Left basilar pleural thickening/small effusion. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: r/o infection/edema/wide mediastinum History: chest pain 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, 52 years old.Reason: 52 yo with IABP and swan, check placement History: swan IABP marker in proximal descending thoracic aorta. Femoral Swan-Ganz catheter with tip in upper IVC. Other findings stable.

Output: IABP marker in proximal descending thoracic aorta. Femoral Swan-Ganz catheter with tip in upper IVC.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Chest pain. Alcohol abuse. Persistent contour abnormality of the posterior mediastinum along the projection of the descending thoracic aorta on the left. There is an additional contralateral contour abnormality at a slightly higher level. Although the patient does have mediastinal fat deposition, small lymph nodes were seen in this area on a prior CT and this finding is now suspicious for lymphadenopathy given the change in appearance.

Output: Contour abnormality of the lower posterior mediastinum bilaterally appearing more pronounced than on exams of earlier this year. This is now suspicious for development of lymphadenopathy. Recommend thoracic CT to exclude lymphadenopathy/lymphoma. No acute parenchymal lung abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.TB surveillance. Mild/moderate cardiomegaly with a tortuous aorta.Pulmonary vascular redistribution is present but no evidence of edema or infection.No active TB.

Output: Mild/moderate cardiomegaly, but no active disease, and no evidence of active TB.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: FemaleReason for Study: Reason: chest pain History: pain 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: Male, 27 years old.Reason: r/o infiltrate and evaluate mediastinum History: chest pain with vomiting No significant cardiopulmonary abnormality.Mediastinum unremarkable, although bullet fragments are projected over the midline.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Lung cancer. Chest pain with shortness of breath. Small to medium-sized bilateral pleural effusions with underlying consolidation, significantly progressed from prior. Cardiomegaly is progressed. Known right hilar mass is somewhat obscured. No pneumothorax.

Output: Cardiomegaly with bibasilar pleural effusions and consolidation significantly progressed from prior may reflect aspiration, CHF, or infection


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Hepatic encephalopathy rule out pneumonia Atelectasis and scarring at the lung bases, but no specific evidence of pneumonia. Lung volumes remain low. Right rib fracture deformities with bony bridging. Incompletely visualized cervical spine fixation hardware.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Fever of unknown source. Possible retrocardiac opacity on PA film evaluate for pneumonia. Mild cough. Unchanged left lower lobe paramediastinal opacity, most suggestive of atelectasis or scarring, though not specific. Mild atelectasis or scarring medially in the right. Blunting of the posterior costophrenic angles.Normal heart size. No pneumothorax.

Output: Left lower lobe retrocardiac opacity has an appearance most suggestive of atelectasis or scarring. As this may be bilateral consider chronic aspiration.In an adult patient, follow-up PA and lateral chest radiographs are suggested unless the referring clinical service is able to obtain and submit remote outside prior films to prove stability of the finding and exclude alternate etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: SBO, constipation History: abd pain Cardiomediastinal silhouette is unremarkable. Right basilar scarring/atelectasis.No evidence of intraperitoneal free air. There is gas in normal caliber transverse colon with air-fluid levels. Stool filled rectum noted. Paucity of small bowel gas. Bilateral hip orthopedic fixation device. Severe degenerative changes of bilateral hips, left greater than right.

Output: No evidence of intraperitoneal free air. Paucity of small bowel gas but gas is noted in the normal caliber transverse colon. Stool-filled rectum noted.


Instruction: Generate impression based on medical findings.

Input: Asthma question infection. Motion artifact degrades image quality. Lung volumes are low normal, slightly decreased from prior. Bronchial wall thickening and scattered areas of scarring are unchanged. No focal airspace opacities to suggest pneumonia.

Output: Bronchial wall thickening compatible with asthma but no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Patient c/o Chest pain seat belted front seat passenger of a car got rear ended History: Chest Pain on inspiration post mva eat belted front seat passenger of a car got rear ended The cardiomediastinal silhouette is unremarkable. No displaced rib fracture or pneumothorax is identified. The lungs and pleural spaces are clear.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: assess parenchymal disease History: sob Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: daily CXR History: n/a Left-sided ICD and IVC Swan-Ganz catheter are unchanged.Decreased lung volumes with cardiac enlargement.Perihilar/basilar opacities compatible with edema.Pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices and CHF unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: 38 y/o wo swan and IABP History: swan Swan-Ganz catheter now terminates within the left pulmonary artery. IABP appears to be slightly inferiorly repositioned just below the level of the aortic arch. Right IJ sheath is unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax.

Output: Lines and tubes, as above. Unchanged cardiomegaly. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: SOB History: s/p vomiting Known pulmonary nodules consistent with metastases, unchanged.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.Gastrostomy tube.

Output: Known metastases, with no acute findings.