Instruction: Generate impression based on medical findings.

Input: Female, 33 years old. Left PICC line with its tip in the left innominate.Cardiomediastinal silhouettes unremarkable.The lungs are clear.No pleural effusions.

Output: Placement of left PICC line. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with hypoxia. Moderate to marked cardiomegaly, unchanged.Persistent, diffuse interstitial opacities compatible with edema.No focal areas of consolidation.

Output: Persistent, diffuse interstitial opacities compatible with CHF, without any definite interval change allowing for differences in technique.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: r/o diaphragmatic injury History: chest tightness Right chest wall port tip and left central venous line tip in cavoatrial junction. Stable bilateral basilar atelectasis. Lucency of the inferior right heart border, which may be redistributed intraperitoneal gas. Improving pneumoperitoneum.

Output: Stable bibasilar atelectasis. Improving pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Reason: post-thora History: post-thora Marked interval decrease in the right pleural effusion following thoracocentesis.No pneumothorax or other complications.Other findings unchanged.

Output: Decreased right pleural effusion with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Chronic kidney disease. Atherosclerotic disease of native coronaries with angina Interval small left effusion with basilar streaky densities suggesting atelectasis versus aspiration or even mild edema. Cardiac and mediastinal contours remain within normal limits

Output: Suspected basilar atelectasis with small left nonspecific effusion. Mild CHF cannot be excluded


Instruction: Generate impression based on medical findings.

Input: 61-year-old male metastatic breast seen. Evaluate disease status CHEST:LUNGS AND PLEURA: Area of scarring right lower lobe unchanged. No lung nodules or pleural effusion.MEDIASTINUM AND HILA: No pathologic size nodes.CHEST WALL: Port-A-Cath right chest. Diffuse bone metastases.ABDOMEN:LIVER, BILIARY TRACT: The liver is ill-defined and enhances heterogeneously. There is a new metastasis inferiorly in the right lobe (image 117; series 3) which measures 2.4 x 1.9 cm. Several additional ill-defined regions are also noted (image 108, 87, 97, 119) which could represent metastases but are difficult to characterize currently. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse blastic metastases again noted. Correlate with bone scan. OTHER: No significant abnormality notedPELVIS: Limited by streak artifact from a left hip prosthesis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse blastic metastases. Unchanged. Left hip prosthesis.OTHER: No significant abnormality noted

Output: New liver metastases. Stable diffuse metastatic disease in the bone.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: chest tube History: chest tube Right apically directed chest tube is in stable position.Trace right hydropneumothorax. Right upper lobe surgical staples and surrounding opacities of edema or hemorrhage not significantly changed. Mild interstitial edema remains. Heart size is normal.

Output: Residual trace right hydropneumothorax in the setting of a chest tube.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: chest pain cause History: chest pain Small lung volumes.No acute abnormality.

Output: Small lung volumes, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with history of uterine cancer, status post chemotherapy CHEST:LUNGS AND PLEURA: Trace right-sided pleural effusion, new from previous study. Subsegmental atelectasis in the right lower lobe, new from previous study. right apical fibrosis, unchanged from previous study.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New, trace right-sided pleural effusion and subsegmental atelectasis in the right lower lobe, otherwise no significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: atelectasis vs pneumonia History: Fever 39 Poor inspiratory effort. Borderline cardiomegaly with vascular congestion and basilar opacities. The basilar opacities can represent mild edema and/or atelectasis. Follow-up recommended.No pleural effusion. No pneumothorax.

Output: Borderline cardiomegaly with basilar opacities which could represent edema and/or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Confirm TLC placement. Left jugular catheter tip low in the right atrium, suggest repositioning.No visible pneumothorax.Minimal retrocardiac opacity, improved from prior, with resolution of pleural fluid.

Output: Low position of left jugular catheter in the right atrium, suggest repositioning. No visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: CTICU History: dailyAortic valve stenosis. ET tube tip 3 cm from the carina.IABP marker is not evident on this exam.New Dobbhoff tube coiled in the stomach, with tip at the GE junction.Right IJ sheath again noted, with interval removal of Swan-Ganz catheter.No substantial interval change in basilar edema, effusions, and atelectasis.Moderate cardiomegaly again noted.

Output: No substantial interval change in basilar edema, effusions, and 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: Female, 61 years old.Reason: s/p lung transplant, prednisone, evaluate for pna. History: cough Right hemithorax volume loss and fibrosis, and the native lung.Stable nonspecific lower lung zone opacities on the left possibly scarring.No significant change.Right jugular catheter, tip at SVC/RA junction level.

Output: No change in nonspecific left lung opacities, with a stable fibrotic right native lung.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: ptx History: ptx Stable left basilar air space opacity. No evidence of pneumothorax. Other findings stable.

Output: Stable left basilar air space opacity. No evidence of pneumothorax. Other findings stable.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: 45 y/o w/ AML s/p SCT and recently completed chemo, now with suspected neutropenic fever. Please eval for infection. History: neutropenic fever Left arm PICC, tip in the SVC.Stable cardiomediastinal silhouette.No focal air space abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Hx of metastatic prostate cancer with recurrent strep pneumonia and fluid overload History: SOB Patchy left basilar opacity again noted. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Patchy left basilar opacity again noted consistent with atelectasis, aspiration, and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: Eval for increase in pulmonary opacity History: Hypoxia Unchanged pulmonary opacities and pleural effusions..Stable chest tube with no pneumothorax.Status post sternotomy and aortic valve repair.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: No significant pneumothorax. Stable pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Tb screening for prior exposure/treatment, +ppd patient History: Screening The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormalities. No evidence of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.History of pneumonia. Motion artifact.Endotracheal tube tip approximately 3.5 cm above the carina. Dobbhoff tube tip beyond the field of imaging. Cardiomegaly is unchanged. Bilateral basilar edema like opacities are not significantly changed. No pneumothorax.Partially visualized contrast material within the colon.

Output: No interval change in edema-like basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.History: Heart failure. Symptoms: Shortness of breath. Query: Pulmonary edema Status post median sternotomy.Coronary stent, mitral valve prosthesis, and left subclavian ICD with 3 electrodes, unchanged from prior radiograph.Persistent cardiomegaly. Persistent elevation of the right hemidiaphragm, compatible with eventration.No focal pulmonary consolidation.No pleural effusions. No pneumothorax.

Output: No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Chest pain. No focal pulmonary opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: acute chest; lung infiltrate History: chest pain; VOC Port catheter, unchanged. Mild basilar reticulation again noted. No new focal lung consolidation. No large pleural effusion or pneumothorax. Heart size, normal. Surgical clip noted in the right upper quadrant of the abdomen.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: S/P cardiac surgery History: S/P cardiac surgery 2 right-sided venous catheters are unchanged in position. Enteric tube tip in stomach. Dual-lead pacemaker stable.Stable cardiomegaly with bilateral pleural effusions and mild edema.

Output: Stable cardiomegaly with bilateral pleural effusions and mild edema.


Instruction: Generate impression based on medical findings.

Input: Dyspnea ETT remains 3 to 4 cm above the carina. Right jugular catheter in enteric tube again projected over the left upper quadrant essentially unchanged. Left chest tube represent by pigtail catheter also similar without alteration.Cardiopulmonary appearance is also similar with diffuse patchy mixed interstitial and airspace changes with large layered pleural effusions greater on the right. See subsequent report

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: miliary tb, desaturation History: desaturation Endotracheal tube terminates approximately 4 cm from the carina. Other lines and tubes, unchanged. Improvement in right basilar opacity with worsening in left basilar opacity. No substantial change in diffuse pulmonary opacities given differences in inspiration. Pleural effusions noted. Unchanged heart size. No pneumothorax.

Output: Endotracheal tube, as above. Shifting basilar opacities, likely atelectasis. No substantial change in diffuse pulmonary opacities given differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: 57yo F w/ recent IR line placement, e/f pneumothorax History: as above Stable bilateral pleural effusions with left basilar atelectasis.Second right jugular catheter placed, along with the existing one, both terminating at the RA level.A Dobbhoff tube extends below the lower margin of the image.

Output: Stable pleural effusions and basilar atelectasis. Second right jugular catheter placed. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Hypoxia. Evaluate pulmonary opacities Right central venous catheter with tip in the SVC. Stable cardiac mediastinal silhouette. Mild interval improvement in the dense perihilar airspace opacities. No new pulmonary opacities identified. Stable moderate sized right pleural effusion. Small left pleural effusion is better noted on the recent CT examination.

Output: 1.Mildly improved bilateral dense perihilar opacities compatible with edema. 2.Unchanged right pleural effusion.3.Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: New central line History: Eval for new central line Right internal jugular central venous catheter tip terminates in the proximal SVC. Sternal cerclage wires and sternal fixation device unchanged. There are streaky basilar opacities, left greater than right, consistent with atelectasis/scarring. Possible small pleural effusions versus pleural thickening.The cardiac and mediastinal contours are within normal limits for size. Postoperative predominantly retroperitoneal gas.

Output: 1.Right internal jugular central venous catheter tip in the proximal SVC. 2.Mild basilar atelectasis/scarring and possible small pleural effusions versus pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection History: ams, poor exam Mild left ventricular cardiomegaly with a tortuous aorta, unchanged.No significant pulmonary abnormalities.Healed rib fractures on the left.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.ET tube removed. ETT tip at the carina. NGT has been retracted with sidehole now at the GE junction.Minimal improvement in acute edema pattern in the right lung, but no significant change on the left.

Output: ETT tip at the carina, recommend repositioning. Suggest slight advancement of NGT. Extensive airspace opacities with slight improvement in the right lung, favored to represent acute pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with history of renal cell cancer CHEST:LUNGS AND PLEURA: Subcentimeter nodule in image number 22, series number 6 is unchanged from previous chest CT dated 12/2008.MEDIASTINUM AND HILA: An enlarged pericardiophrenic index node is unchanged measuring 11 x 11 mm on image number 63, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant change in the size and number of retroperitoneal scattered borderline enlarged lymph nodes.BOWEL, MESENTERY: Right-sided hernia containing nonobstructive colonic and small bowel segments is unchanged.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Check ETT ETT remains 3 cm above the carina. Underlying cardiopulmonary appearance persists with left lower lobe partial consolidation, diminished volumes and layered moderate effusions greater on the right. Scattered ablation coils are otherwise observed overlying the right and left upper quadrants

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: s/p transplant History: none Status post bilateral lung transplant.Cardiomediastinal silhouette is unremarkable.Airspace opacity primarily in the right middle lobe somewhat more intense compared to the prior exam.Pleural effusions unchanged.

Output: Right middle lobe airspace opacity compatible with consolidation/atelectasis and may represent infection. Persistent small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female; 74 years old. Reason: Intubated, ARDS History: Vent failure ET tube tip 3 cm above the carina. Right and left -sided jugular catheters with tips in the SVC. NG tube and Dobbhoff tube tips project off the inferior margin of the image.Persistent cardiomegaly and bilateral pleural effusions compatible with edema, effusions, atelectasis.No pneumothorax.

Output: No significant change in bilateral pulmonary opacities. Stable lines and tubes.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: r/o PNA History: L-sided CP The cardiomediastinal silhouette is within normal limits. The lungs are clear of airspace and interstitial opacities. There is no pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: eval for aspiration History: new fever in stroke pt with dysphaga Normal heart size with a tortuous aorta.Large lung volumes with no sign of aspiration or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: eval for worsening of pleural effusions History: known R pleural effusion with pleurX catheter, SOB, weakness Right pleural drain unchanged, with loculated right pleural effusion, stable.Patchy consolidation right perihilar region unchanged.Left upper lung zone ill-defined nodules, stable.Right jugular catheter, tip in SVC.

Output: Unchanged right pleural effusion with a Pleurx catheter in place.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: r/o edema/infection History: cough, CHF Increasing interstitial and airspace opacities with very small pleural effusions.Mild cardiomegaly.

Output: Increasing pulmonary opacities suggestive of edema although atypical infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Reason: post op, eval ETT, lung fields History: s/p CABG No sign of an ET tube.Right jugular catheter with its tip in the right innominate vein. Chest tubes extending towards both apices with no visible pneumothorax.Cardiomegaly with patchy bilateral opacities compatible with edema and atelectasis.A more recent radiograph has been interpreted.

Output: Postoperative edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: iABP History: as above Lines and tubes are unchanged. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Lines and tubes, as above. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male her with brain lesions. Evaluate for primary tumor source CHEST:LUNGS AND PLEURA: Right upper lobe air space opacity measuring 2.7 x 2.3 cm on image number 27, series number 3 suspicious for a bronchogenic neoplasm. There is air space opacity extends to the right hilum.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: Left lower pole stone. Right upper pole subcentimeter cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is mildly enlarged.BLADDER: 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: Right upper lobe soft tissue density lesion suspicious for primary bronchogenic carcinoma.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: edema? PNA? History: SOB, chest pain Mild cardiomegaly.Linear scarring or subsegmental atelectasis left lower lung zone, but no reliable evidence of edema or pneumonia.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Hypotension status post upper GI bleed. Aspiration, pneumonia. ETT tip 2 cm above the level of the carina. Right jugular catheter unchanged in position. Lung volumes remain low. Small left pleural fluid collection, probably unchanged. Mild retrocardiac and dependent atelectasis has worsened. No pneumothorax.

Output: Small left pleural effusion with atelectasis. No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with melanoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Double collecting system involving the right kidney with a stone in the right ureter obstructing both collecting systems and proximal ureter causing hydronephrosis on the right side.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus with 4.2-cm fibroid and dilated endometrial cavity. Pelvic ultrasound may be helpful for further evaluation.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right nephrolithiasis causing right-sided hydronephrosis.Pelvic ultrasound may be helpful for further evaluation of the uterine fibroid indicted an immature cavity.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: r/o infection History: sob, fevers No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Scattered calcified granulomas.Unremarkable cardiomediastinal silhouette.Dense atherosclerotic calcifications of the aortic arch.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: s/p esophagectomy History: see above Unchanged basilar opacities and pleural effusion suggestive of aspiration.Heart size normal.NG tube removed from the gastric pull-up which contains an air-fluid level.IVC filter.

Output: Unchanged basilar opacities suggestive of aspiration with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Chest pain question widened mediastinum. Known aortic dissection. Mediastinal widening and differential density of the aorta at the level of the arch compatible with known aortic dissection. No specific signs of mediastinal hematoma. A subsequent CT has been performed.Subsegmental atelectasis at the lung bases.

Output: Abnormal mediastinal contour compatible with known aortic dissection.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Moderate COPD and scarring without evidence of metastatic disease or new superimposed acute abnormality

Output: Moderate COPD and scarring without new acute abnormality


Instruction: Generate impression based on medical findings.

Input: Cough, sickle cell disease No acute cardiopulmonary abnormality, specifically no findings to suggest pneumonia or infarctUnchanged right jugular single port. Partially visualized right shoulder hemiarthroplasty

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: weight loss History: weight loss, smoking The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No suspicious nodules or masses.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with abdominal pain and nausea CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral axillary adenopathy. Reference left axillary lymph node measuring 14 x 12 mm image number 24, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with distended gallbladder, mild gallbladder wall thickening and small amount of pericholecystic fluid suggestive of acute cholecystitis. No biliary dilatation. No focal liver lesions. Mild hepatomegaly.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large right ovarian cystic lesion measuring 6.2 x 2.5 cm. Further evaluation with pelvic ultrasound is recommended. Enlarged uterus. A fibroid may be present near the lower body measuring 6 x 4.7 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Shotty bilateral inguinal lymph nodes.

Output: Cholelithiasis with acute cholecystitis.Bilateral axillary adenopathy of uncertain etiology.Pelvic ultrasound is recommended to evaluate the right ovarian cystic lesion enlarged uterus.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: assess IABP placement position History: cardiogenic shock Lungs are unremarkable except for minimal left base subsegmental atelectasis.Heart mildly enlarged.IABP proximal marker 2 cm below the top of the aortic arch. Left subclavian ICD, leads unchanged in position.Left PICC, tip in axillary region.

Output: Mild left base subsegmental atelectasis. IABP proximal marker 2 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.History of renal neoplasm. The heart is normal in size.Calcified right lower lobe and right middle lobe granulomas again noted. No new abnormal lung parenchymal opacities.Calcified right hilar lymph nodes, otherwise mediastinal contours are within normal limits.The pleural spaces are normal.Mild degenerative changes of the thoracic spine.

Output: Sequela of prior granulomatous infection.Of note, conventional radiographs are limited for the detection of noncalcified pulmonary nodules. If there is clinical concern for pulmonary metastatic disease, further assessment with chest CT should be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: s/P EcMO History: above Chest tubes with no pneumothorax following median sternotomy and ventricular repair.Patchy dense pulmonary opacities are stable with no findings.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular Swan-Ganz catheter tip directed towards the right main pulmonary artery.Right PICC, tip in the SVC.

Output: No significant pneumothorax. Unchanged pulmonary opacities, tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old. ET tube with its tip at the carina.There are decreased lung volumes with borderline cardiac enlargement.The lungs are clear.No pleural effusions.

Output: ET tube tip in low position with its tip at the carina.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female (ex-smoker) with history of rheumatoid arthritis, hypertension, CAD. Evaluate/characterize left lower lobe nodule seen on chest x-ray. Cannot receive contrast due to renal insufficiency. CHEST:LUNGS AND PLEURA: Stable left apical bulla. Left upper lobe calcified granuloma, also unchanged. No suspicious nodules, masses, or pleural effusion.Specifically, no nodule correlating with the recent chest radiograph findings. Linear scarring at the left base is noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Severe calcifications affect the right coronary, left circumflex, and LAD arteries. Atherosclerotic calcifications of the aorta also seen.Probable left thyroid nodules with calcifications.CHEST WALL: Median sternotomy wires. UPPER ABDOMEN: Atherosclerotic calcifications are seen at the origin of the celiac artery as well as in the splenic artery.

Output: Linear scarring at the left base without evidence of a nodule.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate/edema History: sob Unremarkable cardiac and mediastinal silhouette. Large lung volumes consistent with COPD.New airspace opacity at the left base, compatible with pneumonia.Calcification in the right lower lung and calcified lymph nodes consistent with previous infection.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: assess respiratory support apparatus History: intubated The heart is normal in size.Stable position of ET and enteric tube. The right IJ vascular sheath overlies the proximal SVC.Basilar opacities likely atelectasis or aspiration of secretions.No pneumothorax or pleural effusion, concerning the limitations of technique.

Output: Basilar opacities likely atelectasis or aspiration secretions. No other change.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with metastatic pancreatic cancer CHEST:LUNGS AND PLEURA: Again noted multiple metastatic nodules in the lungs. Referenced nodule in the lingula measures 11 x 11 mm image number 56, series number 4, not significantly changed. Other spiculated bilateral nodular densities and air space opacities have also not significantly changed.MEDIASTINUM AND HILA: Mediastinal and bilateral hilar adenopathy. Reference precarinal lymph node measures 16 x 14 millimeter on image number 47, series number 4.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Large mass in the pancreatic body and tail measures 9.8 x 5.4 cm in image number 113, series number 4.ADRENAL GLANDS: Left adrenal gland is invaded by the mass. Right adrenal gland is unremarkable.KIDNEYS, URETERS: Bilateral simple appearing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference omental implant is not well visualized on today's study, therefore cannot be measured. Other peritoneal implants are grossly unchanged. Small amount of ascites is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. Left common femoral lymph node measures 19 x 17 mm image number 187, series number 4. Not significantly changed from previous study. This may also represent a slightly thickened spermatic cord.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: History of lymphoma submandibular area. Now mass in pharynx. Biopsy pending. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Subcentimeter right thyroid nodule, unchanged.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: CP History: as above Streaky left basilar subsegmental atelectasis, possibly from aspirated secretions or edema.Heart size normal.No specific evidence of infection.

Output: Nonspecific left basilar opacity suggestive of aspirated secretions or localized edema.


Instruction: Generate impression based on medical findings.

Input: 40 years old Male. Reason: fever, cough, hypoxia History: cough. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is interval increase of the left pleural effusion. Interval worsening of the interstitial opacities in the left lung. Airspace consolidation of the left lower lobe in the retrocardiac area is noted. There is a questionable nodule in the right middle lung field. Stable calcified density is seen in the left superior mediastinal region. Sternotomy changes are noted.

Output: The above findings are consistent with the CHF, with interval worsening of the interstitial and airspace opacity in the left lung and left pleural effusion. Retrocardiac opacity, which can be due to infection or atelectasis. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: evaluate for pneumothorax History: chest pain Mild scarring or atelectasis at the left lung base. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild spinal curvature.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains 3 cm above the carina. NG tube well positioned, however distal tip obscured and beyond the distal edge of the imageUnderlying cardiopulmonary appearance limited by motion yet mixed interstitial and patchy airspace opacities greater in the left lower lobe with moderate effusions appears mildly progressed. Suspected edema, however superimposed process including infection cannot be excludedUnchanged left subclavian catheter

Output: Increasing pulmonary edema and stable positioned ETT


Instruction: Generate impression based on medical findings.

Input: 50 years old Female. Reason: SOB, cp History: above. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Stable streaky opacity in the right upper lung, which is consistent with a scar. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with with history of hepatic mass, assess for hemoptysis LUNGS AND PLEURA: Motion degrades sensitivity however groundglass opacities noted on the exam earlier this date are still present and in upper lobe in a subpleural distribution.A calcified granuloma in the left upper lobe.Scattered micronodules.MEDIASTINUM AND HILA: Calcified hilar mediastinal lymph nodes compatible with prior granulomatous disease. No evidence of hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Large mass involving much of the right lobe of the liver with scattered foci of air within the mass most likely procedure related. Small amount of ascites with a cirrhotic contour to the liver.

Output: Respiratory motion limits evaluation. However there are predominantly upper zone groundglass opacities similar to the exam performed earlier this date. Differential diagnosis would include infection, aspiration, or possibly foci of hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: 74 yo F with new oxygen requirement, eval for pulmonary infiltrates Circumflex opacity noted at the right lung base. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. Mild blunting of the left costophrenic angle again noted. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: H/o aspiration PNA, crackles on exam, evaluate for PNA History: as above Pleural and parenchymal scarring with volume loss.No specific evidence of infection or edema.Heart size normal.Healed left rib fractures.Tracheostomy tube, the tip at the level of the thoracic inlet.Right jugular catheter, tip in SVC.Gastrostomy tube.Upper abdominal surgical clips unchanged.

Output: Parenchymal and pleural scarring, but no active infection or edema. No significant pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Reason: left sided PPM placement with subclavian access History: left PPM Pacemaker generator in the left chest wall with leads projected in the area of the left atrial appendage and right ventricular apex.No pneumothorax or other complications.No significant cardiopulmonary abnormalities.

Output: New pacemaker with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: evaluate for cardiomegaly History: dizziness, abnormal cardiac stress test No acute cardiopulmonary abnormality with no evidence of cardiomegaly.

Output: Normal heart size.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for changes in ETT position, recently advanced again History: s/p intubation ET tube tip approximately 3 cm above the carina.Feeding tube tip in the stomach.Bilateral nonspecific airspace opacities with areas of atelectasis, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: atypical chest pain r/o lung infiltrates History: COPD on meds. Afeb Redemonstration of cardiomegaly and pulmonary vascular redistribution.Persistent but improved small bilateral pleural effusions and basilar edema.Basilar subsegmental atelectasis.

Output: Improved but persistent CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p lvad, chest tube removal, please assess for pneumo History: sob Interval removal of left inferior chest tube. Minimal left pleural effusion. No new focal pulmonary opacities. Unchanged cardiomegaly. Other support devices are unchanged. Sternotomy hardware is intact.

Output: Left chest tube removal without pneumothorax. Otherwise, no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVAD History: intubated ET tube tip approximately 5 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.LVAD and ICD leads in place.Small lung volumes with left lower zone retrocardiac opacity compatible with compressive atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Evaluate for pneumonia pulmonary edema History: shortness of breath Cardiomediastinal silhouette is unremarkable. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities, with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for HF vs asthma History: SOB, PND, ORthopnea Unremarkable cardiac and mediastinal silhouette. Calcified right hilar lymph nodes compatible with previous infection.No sign of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Again noted multiple hepatic metastases. Reference lesion high in the liver now measures 4.9 x 2.2-cm on image number 75, series number 3, increased in size. Other metastatic lesions in the liver are also increased in size. Mass in the inferior right lobe now measures 3.3 x 2.8 cm image number 107, series number 3, increased in size..SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged. Left hydronephrosis and dilated hydroureter up to the level of the metastatic adenopathy in the pelvis is unchanged.RETROPERITONEUM, LYMPH NODES: New left peri-aortic adenopathy measuring 19 x 13 mm image number 120, series number 3.BOWEL, MESENTERY: Ostomy in the left lower quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incompletely distended but diffuse the thickened wall.LYMPH NODES: Extensive adenopathy at the level of the aortic bifurcation encasing bilateral common iliac arteries, more prominent on the left than on the right. At the level of the left common iliac artery the ill-defined adenopathy causing left sided hydronephrosis measures 6.4 x 2.7 cm image number 135, series number 3. The adenopathy has significantly increased in size.BOWEL, MESENTERY: The patient has had a rectal resection of presumed post operative changes in the surgical bed.BONES, SOFT TISSUES: Previous identified fluid collection in the anterior abdominal wall is unchanged measuring 5.2 x 1.3 cm.OTHER: No significant abnormality noted

Output: Interval progression of increase in the size of the hepatic metastases and increase in the extent and size of the metastatic retroperitoneal and pelvic adenopathy.Left-sided hydronephrosis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male 12 months old Reason: check ett placement, left sided chest tube and known pneumothorax History: intubated, pneumothoraxVIEW: Chest AP (one view) 3/11/2016 at 0645 hours. ET tube tip is below thoracic inlet. Left upper extremity PICC terminates at the confluence of both innominate veins. Left lower extremity central line terminates at the right atrium. NG tube tip is at the stomach. Left-sided chest tube unchangedCardiac silhouette size is normal. Multifocal streaky opacities of the right upper, left upper lobes and both lung bases. Small loculated left-sided subpulmonic pneumothorax is unchanged.

Output: Unchanged multifocal opacities and loculated left-sided subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Infection/cardiac syncope History: syncope Moderate cardiomegaly.Small lung volumes with mild basilar opacity compatible with atelectasis and blunting of the left costophrenic angle compatible with a small effusion or scarring.Surgical clips in the left axilla.

Output: Possible small left effusion but no specific evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o rib fracture History: CP/rib pain Deformities of the posterior left seventh and eighth, possibly ninth, and posterior right ninth ribs suggestive of subacute fractures. These were noted on 5/15/2015 radiograph. Loss of vertebral body height and superior thoracic spine stable. Basilar reticular opacities of subsegmental atelectasis. Persistent blunting of the right costophrenic angle from scarring and or effusion.

Output: Deformities of bilateral ribs unchanged. No new displaced rib fractures identified.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Please eval for increasing pulm edema History: Pt getting fluid back today Moderate to severe interstitial lung disease, with a slight increase in opacity suggesting superimposed edema versus acute exacerbation.Minimal right pleural effusion.Moderate cardiomegaly unchanged.Right jugular catheter and NG tube have been removed.

Output: Chronic interstitial lung disease, with a slight increase in markings which could indicate increased fluid status.


Instruction: Generate impression based on medical findings.

Input: 32 years old Female. Reason: cause of SOB History: sob. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Reason: PICC line placement History: PICC line placed PICC from the left arm with the tip doubled back in the area of the left subclavian vein.Swan-Ganz catheter tip in the right main pulmonary artery.ICD leads unchanged.Improved pulmonary inflation.

Output: PICC looped back upon itself in the left subclavian vein.


Instruction: Generate impression based on medical findings.

Input: Reason: evidence infection History: sputum, fever Tracheostomy tube and right jugular catheter in place.Small lung volumes with basilar opacity consistent with consolidation and atelectasis which may be related to aspirated secretions.Feeding tube tip in the stomach.

Output: Basilar consolidation and atelectasis compatible with aspirated secretions and possibly infection.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of shortness of breath. Evaluate for infection. 2 left internal jugular central venous catheters are present with tips at the cavoatrial junction.Worsening of right basilar airspace opacities and pleural effusion. Stable cardiomediastinal silhouette.

Output: Worsening right basilar opacities with pleural effusion concerning for infection.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval for infection or fluid overload History: transient sob at dialysis center today, not dialyzed. Asymptomatic upon arrival Small lung volumes.Mild cardiomegaly.Very small pleural effusions seen on the lateral view.No specific evidence of infection or edema.Left jugular catheter, tip in SVC.

Output: Mild cardiomegaly without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Eval for Pneumo History: S/P R Chest Tube removal Right chest tube removed with no pneumothorax.Left chest tubes still in place with a minimal left apical pneumothorax.The lungs are clearer than on the prior study.Moderate cardiomegaly stable.Right jugular catheter, tip in SVC.

Output: Right chest tube removed with no pneumothorax. Minimal left apical pneumothorax is present.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: pna (aspiration?) History: chest pain Median sternotomy.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: history positive PPD History: none Lungs and pleural spaces are clear. The heart size is normal.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval device placement History: IABP, swan Support devices stable in position.No evidence of infection or edema.No pneumothorax.

Output: Support devices stable.No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Prekidney transplant check No cardiopulmonary abnormality.

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: sob, r/o PNA History: sob 1 of the right IJ sheath has been removed. Cardiac leads, unchanged. Diffuse pulmonary opacities again noted. Unchanged mild cardiomegaly. Very small pleural effusions. No pneumothorax.

Output: Diffuse pulmonary opacities again noted, consistent with edema. Unchanged mild cardiomegaly. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: swan placement History: see above Swan-Ganz catheter tip in the right main pulmonary artery.ICD leads and LVAD unchanged.Marked cardiomegaly with no sign of pulmonary edema.Mild blunting of the right costophrenic angle consistent with a small effusion, unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: s/p open heart surgery, s/p chest closure, s/p VA ecmo reinitiation at bedside History: s/p open heart surgery, s/p chest closure, s/p VA ecmo reinitiation at bedside Unchanged upper lung zone predominant interstitial and airspace opacities with minimal pleural effusions.Moderate cardiomegaly.Unchanged chest tubes with no pneumothorax.ECMO cannulae unchanged.ET tube tip approximately 3 cm above the carina.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Right jugular catheter tip at cavoatrial junction.Upper abdominal calcification unchanged.

Output: Unchanged dense opacification as sometimes seen with ECMO, with no new findings. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: infection? History: AMS, falls Unremarkable cardiac and mediastinal silhouette. Interstitial opacities and bronchial thickening at the right base, likely chronic.No specific evidence of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Left lower lobe pneumonia productive cough Persistent left lower lobe consolidation with volume loss and associated moderate effusion. Appearance is essentially unchanged. Underlying mass must also be considered. Small right effusion and decreased lung volumes similar to prior exam.Moderate nonspecific cardiomegalyLeft jugular dialysis catheter unchanged

Output: Persistent left lower lobe consolidation concerning for pneumonia, essentially unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.s/p AVR Unchanged left lower lobe opacities, probably atelectasis. Small left pleural effusion, unchanged. No new focal opacity. Unchanged moderate cardiomegaly.Unchanged Swan-Ganz, IABP and mediastinal drainage catheters.

Output: No interval change from 2/27/16.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Infiltrates History: Fever The heart is normal in size.Right lower pulmonary nodules and left upper lobe primary mediastinal mass, unchanged from recent comparisons, in keeping with history of metastatic primary lung carcinoma.The left apical pneumothorax projecting noted is nonvisualized, and has resolved. No pleural effusion.Interval resolution of left anterior chest wall subcutaneous emphysema previously noted.

Output: Interval resolution of left apical pneumothorax and associated left chest wall subcutaneous emphysema.Multifocal metastatic pulmonary nodules involving both lungs are again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: acute change in o2 requirement History: hypoxia Increase in right basilar opacity. Multifocal/diffuse opacities noted on previous study are not substantially different. Unchanged cardiomegaly. No pneumothorax.

Output: New right basilar opacity which may represent atelectasis, aspiration, and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 66-year-old man with lung cancer, endobronchial lesion. CHEST:LUNGS AND PLEURA: Complete collapse of the right upper lobe. Calcified granuloma in the anterior aspect left upper lobe. A nodular opacity in the left major fissure likely represents a lymph node seen on image 50. Mild scarring in the anterior aspect of the right middle lobe. MEDIASTINUM AND HILA: Large, heterogeneously enhancing endobronchial mass in the region of the carina which invades the distal trachea, left main bronchus, and right main bronchus. Complete collapse of the right upper lobe which is suggestive of occlusion of the right upper lobe bronchus. This mass measures 4.4 x 3.6 cm in maximal transaxial diameter as seen on image 41/142. Precarinal lymph node measures 1.6 x 1.2 cm as seen on image 35/142. Pericardial effusion is noted anteriorly.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple simple cysts are noted in the left kidney.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Endobronchial mass in the region of the carina with invasion of the distal trachea, left main bronchus, and right main bronchus. 2. Complete right upper lobe collapse suggestive of occlusion of right upper lobe bronchus.3. Mediastinal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: anterior chest wall injury History: pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of traumatic injury.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with diffuse large B-cell lymphoma CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. New subtle ground glass opacity in the lingula medially, nonspecific. Right middle lobe scarring and ground glass opacities are unchanged.MEDIASTINUM AND HILA: Small thyroid nodules are unchanged. Index subcarinal lymph node is unchanged measuring 16 x 9 mm image number 38, series number 3. Other smaller lymph nodes are also unchanged.CHEST WALL: TheABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenectomy. Accessory spleen is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign-appearing renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: pneumonia History: productive cough Small pleural effusions with diffuse granular opacities and marked cardiomegaly consistent with congestive heart failure. No pneumothorax.

Output: Probable congestive heart failure, less likely atypical infection.


Instruction: Generate impression based on medical findings.

Input: Productive cough and SOB question pneumonia. Interval removal of right jugular temporary pacemaker. No visible pneumothorax. Improved lung volumes with near complete resolution of basal atelectasis. No evidence of pulmonary edema. Cardiothoracic ratio mildly enlarged, similar to prior. No specific signs of pneumonia.

Output: Cardiomegaly, unchanged, but no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: chest tube, ptx History: chest tube, ptx Right chest tube with a minimal right apical pneumothorax.Improved inflation but residual basilar atelectasis is present.Right jugular catheter, tip at SVC/RA junction level.

Output: Improved inflation, but residual basilar atelectasis is present as well is a minimal right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Fevers, assess for pneumonia. Motion artifact is present. Basal opacity on the right nonspecific. No focal airspace opacities or visible pleural fluid.

Output: Nonspecific right costophrenic angle opacity poorly visualized; infection is not excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: hypoxemia History: see above Left hemithorax complete opacification, unchanged.Nonspecific right interstitial and nodular opacities suggestive of edema and metastases, unchanged. Small right pleural effusion, unchanged

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: 55-year-old female history cervical of esophageal cancer status post chemoradiation and renal ca status post surgery check response. CHEST:LUNGS AND PLEURA: In addition to fibrotic changes in both apices, a cluster of nodules in the anterior aspect of the right apex are increasing in size. The largest individual nodule measures 7.1 x 5 mm series 5 image 16 previously measured 3.7 x 2.4 mm. No other new nodules. No effusions.MEDIASTINUM AND HILA: Scattered small mediastinal nodes redemonstrated unchanged. Atherosclerotic changes aortic arch and root.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made: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: Right kidney is surgically absent. Mild fat stranding around the left kidney is unchanged in the contour the left kidney is unchanged. There is some scarring along the posterior aspect of the upper pole and a probable cyst measuring 17 Hounsfield units standard deviation 19 Hounsfield units, in the anterior aspect of the lower pole.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal nodes redemonstrated. Individually none are pathologic in size.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small shotty nodes unchanged.BOWEL, MESENTERY: Diverticulosis. No ascites.BONES, SOFT TISSUES: Postsurgical changes left hip.OTHER: No significant abnormality noted.

Output: Increase in size and right apical lung nodules. Other measurements as above.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Chest pain, shortness of breath, evaluate for effusion or consolidation No specific evidence of infection or edema. Calcified mediastinal lymph nodes and left mid lung granuloma are noted. The cardiomediastinal contour is within normal limits.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of bladder cancer. Status post cystectomy. CHEST:LUNGS AND PLEURA: Interval increase in the referral increased density, more prominent in the lower lobe bilaterally which may be an early sign of interstitial fibrosis.MEDIASTINUM AND HILA: No change in the size of the previous mentioned mediastinal nodes. Again the largest short axis diameter measures 10-mm image number 40, series number 3CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Gallstones, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal atrophy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: As above with ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Limited study due to lack of IV contrast. No significant change other than interval increase in the peripheral densities in the lung bases which likely represents fibrosis. This may be a sign of usual interstitial fibrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Delirium. Evaluate for infection. Bilateral chest wall generators and skin staples obscure the lower lungs. An enteric tube tip is within the stomach.Low lung volumes with persistent left basal consolidation and probable small pleural effusion. Increasing right basilar atelectasis.Healed fractures of the posterior right fifth and sixth ribs.

Output: Persistent left basal opacity may be related to atelectasis/aspiration . No new pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: PICC line placement PICC line demonstrates repositioning with retraction, however now a redundant loop is observed in the mid subclavian. Pager 1874 contacted. no additional underlying cardiopulmonary changes

Output: PICC line repositioned with new redundant loop, see detail provided


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, hx sarcoidosis History: above Unremarkable cardiac and mediastinal silhouette. Lower zone streaky opacities compatible with scarring, not significantly changed.No acute findings.

Output: Lower zone scarring and no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: ? pna History: green sputum Minimal bronchial wall thickening but no new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 68 years old Female. Reason: s/p stem cell transplant, rule out PNA History: see above. Right-sided central venous catheter tip in the superior vena cava. Cardiomediastinal silhouette is unchanged. Large calcific opacity in the left breast and multiple surgical clips again noted. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Mild emphysema. Right middle lobe nodule measuring 5-mm image number 43, series number 3 is unchanged.MEDIASTINUM AND HILA: Index lymph node in the anterior/superior mediastinum is smaller measuring 12 by 8mm image number 22, series number 3. Small right-sided thyroid nodule is unchanged.CHEST WALL: Index right axillary node is not included in the current study. A new axillary index node medial to the previous index node now measures 23 x 15 mm image number 30, series number 3. Previously it was no significant change in the size of the other right axillary lymph nodes. measuring 26 by 16-mm image number 33, series number 4.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenomegaly again noted. Again noted multiple hypodense lesions in the spleen which are smaller in size compared to previous study. Index lesion now measures 8-mm in diameter on image number 86, series number 3.PANCREAS: No significant abnormality notedADRENAL GLANDS: Small left adrenal nodule is unchanged.KIDNEYS, URETERS: Bilateral benign appearing cystic lesions are unchanged. Solid enhancing mass in the lower pole of the right kidney measures 20 x 19 mm image number 110, series number 3. This is suspicious for renal cell carcinoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: Left external iliac lymph node is stable measuring 15 by 7-mm image number 159, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Left renal mass suspicious for renal cell carcinoma is unchanged.Right axillary adenopathy, right middle lobe nodule are unchanged. Mediastinal index lymph node and splenic hypodense lesions are slightly smaller.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 4 cm above the carina.ICD lead and LVAD unchanged.Mild basilar atelectasis and small effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: concern for infection as etiology of DKA trigger History: ?infection Bronchial wall thickening and chronic appearing interstitial opacities versus aspiration or atypical infection.No significant sized pleural effusions.Heart size normal.

Output: Bronchial wall thickening and interstitial opacities which could be chronic although atypical infection including viral etiologies are in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: sob Asymmetric pulmonary volumes and perfusion secondary to previous right lung transplant with emphysema in the left native lung.No sign of pneumonia or other significant interval change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Cough, shortness of breath and chest pain No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: severe asthma exacerbation History: severe asthma exacerbation Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with blurring of vision. Staging prior to treatment for melanoma. CHEST:LUNGS AND PLEURA: Several scattered subcentimeter micronodules are seen throughout the lungs, specifically on images 31, 36, and 39 of series 80385. These are nonspecific and should be followed radiographically.MEDIASTINUM AND HILA: Mediastinal lymph nodes of normal size are noted and are nonspecific.CHEST WALL: A right axillary soft tissue spiculated mass is seen, measuring 3.0 cm x 2.1 cm (image number 25, series 4). This may be secondary to prior surgical intervention, however this cannot be determined without prior imaging. Clinical correlation is recommended.ABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesion in the right hepatic lobe near the fissure of ligamentum teres is likely third inflow artifact versus focal fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 1.7 cm x 1.3 cm right adrenal mass is seen on image number 86, series number 4). Two left adrenal masses are also noted, with the larger mass measuring 1.3cm x 1.6cm (image number 96, series number 4). These most likely represent benign adrenal adenomas, however the larger of the two left adrenal masses is indeterminant by its Hounsfield unit density. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: A right inguinal lymph node measures 2.8 cm x 1.0 cm (image number 193, series number 4).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Spiculated right axillary soft tissue mass as described above. This may be secondary to prior surgical intervention, however this cannot be determined without previous imaging for comparison. Clinical correlation is recommended.2. Several micronodules in the lungs as described above. These are nonspecific and should be followed.3. Bilateral adrenal masses, favor benign adrenal adenomas over metastatic disease. However, dedicated adrenal imaging is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female status post Whipple with bilious vomiting. Evaluate for SBO. CHEST:LUNG BASES: Bibasilar atelectasis/scarring with patchy areas of consolidation which may represent aspiration. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneously enhancing liver with abnormal lesions. Pneumobilia is unchanged from prior study.SPLEEN: Hypoattenuating area in the spleen (series 4, image 34) is compatible with a splenic infarct.PANCREAS: Postoperative changes status post Whipple.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval occlusion of the SMA (series 4, image 53).Atherosclerotic disease of the aorta.BOWEL, MESENTERY: Nonobstructing incisional hernia (series 4, image 89) containing transverse colon. Foci of air in the mesentery appear to be intravascular in location. However, no abnormal bowel loops are identified. No evidence of obstruction or wall thickening.G-tube in expected location.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Bladder is decompressed around a Foley catheter.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Occlusion of the right femoral artery is also identified (series 4, image 120).

Output: 1. Bibasilar atelectasis/consolidation; consider aspiration.2. Interval occlusion of the SMA as above, likely secondary to embolus. No abnormal bowel loops identified.3. Right femoral artery occlusion as above.4. Incisional hernia in the midabdomen.5. Splenic infarctFindings were communicated to the ordering service by the overnight radiology resident on call via telephone and stat consult.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: s/p chest tube, now with desat History: desat Interval placement of external defibrillator pads. Endotracheal tube is high with the cuff likely close to the cords. The remaining support devices are unchanged in position.Extensive air space and interstitial opacities not significantly changed. Slight improved aeration left lower lobe with persistent small left pleural effusion. Heart size remains stable. Persistent small right pneumothorax. Subcutaneous emphysema the right lateral chest wall is extensive, stable since 0159 hrs.

Output: Stable right pneumothorax in the setting of a chest tube. Interval placement of external defibrillator pads. Advancement of endotracheal tube recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: rule out infection History: rule out infection, pt with suspected MS exacerbation Multiple bilateral calcified granulomas. No interval edema or evidence of infection. Heart size is normal. Surgical clips in the right upper abdominal quadrant consistent with prior cholecystectomy.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: recurrent emesis No significant cardiopulmonary abnormalities.Cyst gastrostomy device in the left upper quadrant of the abdomen.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out tension PTX History: hypotension ET tube tip approximately 4 cm above the carina. Swan-Ganz catheter tip in the right main pulmonary artery.NG tube coiled in the stomach.Mild opacity and volume loss in the right transplanted lung compatible with edema and atelectasis. No significant pneumothorax.

Output: Mild edema and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: effusion, History: resp distress Support devices are unchanged in position.Cardiomegaly unchanged. Diffuse pulmonary opacities, retrocardiac consolidation and pleural effusions stable. No pneumothorax.

Output: No significant change in the pulmonary opacities with pleural effusions. Cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Evaluate for cause of chest pain. Upper normal heart size for age. No focal airspace opacity, pleural fluid or pneumothorax.

Output: Upper normal heart size, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with non-Hodgkin's lymphoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: Stable 13 x 7 mm partially calcified oblong opacity in the right upper lobe (series 5; image 33). Calcified right upper lobe granuloma.MEDIASTINUM AND HILA: 26 x 21 millimeter anterior mediastinal soft tissue density, not significantly changed when remeasured (series 3; image 41). Calcified mediastinal and right hilar lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the left lobe of the liver is unchanged, too small to characterize, but likely in the periodSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensities in the kidneys, compatible with cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Newborn female with increasing respiratory distress.VIEWS: Chest and abdomen AP (two views) 3/14/15, 10:55 Chest: The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No pulmonary opacities. No pleural effusion or pneumothorax. Abdomen: Normal bowel gas pattern. No pneumatosis, free air, or portal venous gas.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

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

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.SOB. Status post aortic dissection. Rule out pneumonia. Moderate left pleural fluid collection, increased from previous. Mediastinal widening about the same. Sternotomy hardware appears in alignment. No pneumothorax or convincing evidence of pulmonary edema.

Output: Increase in volume of nonspecific pleural fluid on the left and associated compressive basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: pulm edema improvement? History: pulm edema s/p diuresis Tracheostomy tube and left central venous catheter unchanged.Stable cardiac enlargement.Diffuse pulmonary opacities similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with diffuse pulmonary opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Postsurgical changes of right middle lobe wedge resection. Basilar and lingular extensive fibrosis and bronchiectasis appears similar to previous examination. Left pleural calcifications are again seen in the fissure. MEDIASTINUM AND HILA: Small mediastinal lymph nodes appear similar to previous examination. A left prevascular lymph node (series 3, image 47) measures 1.2 x 0 .5 cm, previously 1.2 x 0.5 cm.Atherosclerotic calcifications of the cornary artery and thoracic aorta are again noted.CHEST WALL: Median sternotomy wires in place.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: A reference left periaortic lymph node measures 1.2 x 0.7 cm (series 3, image 136), previously measured 1.2 x 0.7 cm. Atherosclerotic ossifications of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracic spine degenerative changes.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: Lumbar spine degenerative changes.OTHER: No significant abnormality noted

Output: 1. Stable reference mediastinal and retroperitoneal lymphadenopathy.2. No new sites of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Possible pneumonia. Decreased breath sounds on right with cough and sputum production. Minimal bibasal patchy opacity likely atelectasis. No specific findings of pneumonia.

Output: Minimal bibasal patchy opacity is likely atelectasis. No specific findings of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old. Slight SOB. Cold-like symptoms x 1 month. Interval resolution of right lower lung opacity. No evidence of infection or edema.Stable cardiomediastinal silhouette. Clamshell sternotomy for bilateral lung transplantation.Stable vertebral compression deformities in the mid thoracic spine.

Output: Interval resolution of right lower lobe opacity. No evidence of active infection.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p RUL for abscess History: as above Right-sided chest tubes unchanged. Dense opacity in the right apex consistent with pleural and extrapleural fluid is unchanged. Cardiomediastinal silhouette is unchanged. Aeration in the right lung is unchanged. Left lower lobe atelectasis/consolidation is unchanged.

Output: No significant change in the appearance of the right hemithorax. Left lower lobe atelectasis/consolidation is unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection within pocket where battery is implanted History: infection Fluid collection is identified within the left chest wall, measuring 7.1 x 6.1 x 1.7 cm. There is no evidence of internal complexity or vascularity.

Output: Simple fluid collection identified within the left chest wall.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.CHF exacerbation concern for worsening volume overload. Worsening hypoxia. Evaluation of the lung parenchyma limited by overlying soft tissues. Patient is rotated. Cardiomegaly is present. Unable to exclude left lower lobe retrocardiac opacity due to significant overlapping soft tissues. There is linear opacity at the right base which is new, most consistent with atelectasis. No specific evidence of edema. Possible small right pleural effusion.

Output: Limited exam. No visible signs of pulmonary edema. Subsegmental atelectasis at the right base and possibly a small right pleural effusion. Unable to effectively exclude an abnormality in the medial left base due to soft tissue obscuration of the area.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: post-op chest tube placement History: asymptomatic Left peripheral chest tube directed apically in the setting of a small left hydropneumothorax. Patchy lower zone opacities. Elevation right hemidiaphragm. Heart size is normal.

Output: Small left hydropneumothorax in the setting of a chest tube. Left greater than right basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: ptx? History: h/o ptx Tracheostomy tube, LVAD, AICD in unchanged position right IJ central venous catheter, tip in right atrium. No significant pneumothorax. Nasogastric tube extends below the lower margin of the image. Mid chest wall staple line.Stable cardiomegaly. Nonspecific basilar opacity, compatible with atelectasis and effusions, appearing similar to the prior exam.

Output: Cardiomegaly, atelectasis and effusions, without significant change. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old. Interval increase in the right lower lobe opacity.Stable small effusions.Cardiomegaly with vascular congestion is unchanged.Support devices stable.No pneumothorax.

Output: 1. Interval increase in the right lower lobe opacity.Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for focal process History: sob COPD and mild cardiomegaly.No specific evidence of infection or edema.

Output: COPD and mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 52 year-old female with history of melanoma, now in remission. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small amount of residual/rebound thymic tissue, decreased in size. Trace pericardial effusion, unchanged.CHEST WALL: Bilateral breast implants.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Atrophic spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Surgical clips in the ventral subcutaneous tissuesOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small external iliac lymph nodes, not pathologically enlarged, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral inguinal clips.OTHER: No significant abnormality noted.

Output: Stable examination without evidence of disease.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath, cough. Evaluate for pneumonia. Increased lung volumes, extensive bullae formation, and flattening of diaphragm consistent with severe emphysema. Superimposed largely interstitial sclerotic foci, most notable in left hilum. Nonspecific, likely represents calcified lymphadenopathy, but follow-up imaging is recommended to ensure stability.Cardiac and mediastinal contours are grossly within limits.

Output: Severe emphysema with superimposed interstitial sclerotic foci, which may represent calcified lymphadenopathy. In the absence of prior imaging, serial imaging is needed to confirm stability. These findings were relayed to an Emergency Department physician at 11:10 AM on 7/13/2016.


Instruction: Generate impression based on medical findings.

Input: Reason: CP 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: Nonrheumatic mitral valve insufficiency status post MVR. Evaluate lung fields. Prosthesis in the mitral position. Right jugular introducer projects over the right brachiocephalic vein. Endotracheal tube tip about 4 cm above the expected level of the carina. Mediastinal drain and a right chest vent are in place. Epicardial pacing lead.No significant sized pneumothorax. Minimal right chest wall subcutaneous emphysema. No evidence of pulmonary edema or aspiration.

Output: No acute pulmonary abnormality. ETT terminates at the level of the clavicular heads.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: as above ET tube tip approximately cm above the carina. NG tube tip projected over the lower mediastinum presumably in the gastric interposition.Bilateral opacity compatible with edema, atelectasis and pleural effusions.No pneumothorax or other acute change.

Output: Edema, atelectasis and effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with history of larynx cancer status post chemoradiation. Check response. CHEST:LUNGS AND PLEURA: Calcified granulomatous nodules, unchanged. Apical scarring also unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Thyroid nodules.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged renal cysts bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Push-type gastrostomy tube in appropriate position.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of metastatic disease


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: r/o pneumothorax History: r/o pneumothorax Support devices are unchanged in position.Persistent small left hydropneumothorax. Nonspecific opacities throughout the entire left lung and right base unchanged. Retrocardiac atelectasis is the same.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: r/o pneumonia History: syncope, hyperglycemia The heart size is normal.Large lung volumes with flattening of the hemidiaphragms. Perihilar bronchial wall thickening, unchanged. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: Large lung volumes and bronchial wall thickening, suggestive of COPD/reactive airways disease. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: sp chest tube for ptx. eval PTX. Unclear on portable AP. Tracheostomy tube in place. Right-sided chest wall port tip in the SVC/right atrium. Right chest tube unchanged in position.Cardiomediastinal silhouette is unchanged. Emphysema and basilar patchy opacities appear similar to prior examination. Left lung base scarring or small pleural effusion. No pneumothorax.

Output: No significant interval change. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 38 years old Reason: r/o pna, edema, effusion History: chest pain Left-sided architectural distortion and volume loss suggestive of scarring/atelectasis.Small/moderate left pleural effusion with associated compressive atelectasis.The right lung is normal.The heart size is normal.

Output: Left-sided architectural distortion and volume loss suggestive of scarring/atelectasis. Small left pleural effusion/thickening.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: Male, 22 years old.Reason: Trialysis catheter position, pneumothorax History: status post trialysis catheter placement New venous catheter tip in SVC. No evidence of pneumothorax.NG tube tip in stomach. ET tube tip 4 cm above carina. Esophageal probe tip in mid esophagus.Cardiomegaly with pulmonary edema and pleural effusions.

Output: New venous catheter tip in SVC. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.History of multiple myeloma. Fever. There is a new left perihilar consolidative opacity with central distribution.No new additional abnormal lung parenchymal opacities are noted.No pleural effusion or pneumothorax.Diffuse osteopenia. Lytic and expansile lesions involving multiple bilateral ribs and the distal left clavicle represent healed pathologic fractures in the setting of known multiple myeloma. Limited assessment of the thoracic spine although there is mild wedge deformity of multiple thoracic vertebral bodies.The left subclavian port catheter overlies to the superior cavoatrial junction.

Output: New left perihilar consolidative opacity may represent infectious or inflammatory pneumonia in the setting of fever. Correlate with laboratory workup. Radiographic follow-up to ensure complete resolution is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: chest tube placement History: s/p RLL lobectomy Right chest tube, tip in apex with no pneumothorax following right lower lobectomy.No other significant abnormality.

Output: Right chest tube with no pneumothorax following right lower lobectomy.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with colon cancer status post resection CHEST:LUNGS AND PLEURA: Emphysematous lungs are unchanged. Subcentimeter nodule image number 28, series number 5 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter, scattered low-density lesions in the liver are unchanged. Status post left hepatectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is unchanged measuring 14 x 11 mm number 97, series number 3.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph nodes is unchanged measuring 17 x 13 mm image number 108, series number 3.BOWEL, MESENTERY: Portacaval and other retroperitoneal lymph nodes are also stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Brachytherapy seeds in the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: cough, chest pain History: cough, chest pain Status post median sternotomy, with the fourth most superior wire suture fracture, unchanged.Heart size normal.No specific evidence of infection or failure.

Output: No significant abnormality. Status post median sternotomy.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: r/o ACS History: epigastric pain No significant pulmonary or pleural abnormality.Heart size normal.Fullness of the lower right peritracheal region has been stable for several years, and may be chronically enlarged lymph nodes or vascular distention.No evidence of acute infection or infarction.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: Atypical PNA? History: 2 wks progressive cough productive of yellow sputum, subjective fevers, malaise Clear lungs. Mild bronchial wall thickening. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Mild bronchial wall thickening consistent with asthma or bronchitis. No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Weakness, evaluate effusion. Accessed right chest port with tip at SVC atrial junction. Normal heart size.Chronic right basilar scarring not significantly changed compared to 11/16/2015 CT. No significant pleural effusions. Pulmonary nodules, pleural nodules, and osseous metastatic disease more fully assessed on recent CT. No new focal pulmonary opacities.

Output: Chronic right basilar scarring and small effusion not significantly changed compared to 11/16/2015 CT.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: chest pain, sickle cell Unchanged port catheter. No new focal pleural parenchymal opacity. Bony changes consistent with sickle cell disease. Rightward deviation of the mediastinum, as before. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.With desaturations and pancreatic cough. Chest tubes are unchanged. Persistent right apical pneumothorax and right subcutaneous emphysema. Bilateral right greater than left basilar atelectasis. Small right pleural effusion. Number

Output: Chest tubes unchanged with persistent small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 55 yo female with history of metastatic breast cancer on Capecitabine. Please evaluate disease. CHEST:LUNGS AND PLEURA: Fibrotic changes re-demonstrated in the right lung apex is unchanged and stable when compared to prior study. No other significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The surface of the liver has a pseudo-cirrhotic appearance with dramatic nodularity.No evidence of hypervascular tumor on arterial phase scanning of the liver. There is extreme heterogeneity of the peripheral zones of the liver parenchyma; best appreciated on venous phase and delayed phase scanning. However, there are no discrete lesions appreciated on today's study.The previously seen hypo-attenuating lesion in Segment IV of the left liver lobe is not appreciated on today's study. There is no evidence of hepatic or portal vein thrombosis. No evidence of biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerosis of several lumbo-vertebral bodies. This is stable in size and appearance when compared to prior study. OTHER: Small hiatal hernia. Peri-hepatic ascites.

Output: 1) Pseudo-cirrhosis of liver surface; otherwise stable appearance of liver parenchyma2) Peri-hepatic ascites


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Nonrheumatic mitral valve insufficiency Interval removal of right jugular sheath without postprocedural complication. The remainder of the cardiopulmonary appearance is otherwise similar with diffuse pulmonary opacities, mild cardiomegaly and suspected small effusions. ICD unchanged

Output: Diffuse multiquadrant changes suggesting persistent edema