Instruction: Generate impression based on medical findings.

Input: Left ovarian borderline tumor evaluate for hepatic and splenic lesions. 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: 4.2 x 5 cm hyperdense lesion near the dome of the liver. Another hyperdense lesion measures 9 x 9 mm image number 68. Liver demonstrates diffuse fatty infiltration. A third hypodense lesion is again in the left lobe measures 2.4 x 2.4 cm image number 81/215.SPLEEN: Small amount of parasplenic fluid is present. Subcentimeter hypodense lesion in the spleen, nonspecific.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 1.6 x 1.3 cm left adrenal nodule on image number 87/215.KIDNEYS, URETERS: Left renal angiomyolipoma measuring less than 1 cm. Bilateral simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 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: Small amount of free fluid in the pelvis.

Output: Multiple hyperdense lesions in the liver, their etiology is unknown but they are most likely benign lesions such as hemangiomas or FNH. If further characterization is clinically indicated, MR of the liver can be helpful.Left adrenal nodule.Small amount of perisplenic fluid and free intra-abdominal fluid. Subcentimeter splenic lesion, nonspecific.Fatty infiltration of liver.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p MVR ET tube, venous catheters and pleural drain unchanged.Cardiomegaly with pulmonary edema and small pleural effusions.No pneumothorax or other acute change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: TEF repair increased PEEPVIEW: Chest AP 1/17/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right chest tube and left central line again noted. The sidehole of the right chest tube appear to be within the subcutaneous tissue. Cardiothymic silhouette normal. Diffuse opacities involving the right lung not significantly changed. No definite pneumothorax.

Output: Diffuse opacities right lung not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: acute chest pain, concern for fluid overload vs pneumonia History: acute chest pain Small lung volumes with mild basilar opacity compatible with small effusions and atelectasis, slightly improved.Interval removal of a right jugular catheter.

Output: Resolving basilar atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Moderate cardiomegaly, unchanged.Moderate left pleural effusion with adjacent compressive atelectasis, stable to slightly decreased from prior. Persistent right pleural effusion, unchanged. Interstitial opacities septal lines consistent with pulmonary edema, some nodularity suggest lymphangitic tumor spread. No pneumothorax.Right chest Port-A-Cath with tip at the level of the SVC.

Output: Moderate left pleural effusion with adjacent compressive atelectasis, stable to slightly decreased from prior. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Chest pain. Shortness of breath. Lungs are clear. Heart size within normal limits. No pneumothorax. Right chest port tip in the SVC.

Output: No significant cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: pneumothorax History: Post right sided central line Unchanged interstitial and airspace opacities suggestive of edema and/or aspiration.Heart size normal.No significant pneumothorax.Right jugular catheter tip at cavoatrial junction level.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: No pneumothorax following right jugular catheter placement.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: positive TB test History: positive TB test Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: r/o pneumothorax, significant bleeding at site of chest tube removal, airtight bandage undone History: recent chest tube removal on left Persistent basilar consolidation left greater than right with cardiomegaly.Unchanged support devices.

Output: Stable support devices. No pneumothorax following recent chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Eval IABP placement History: as above IABP marker at level of aortic arch.Swan-Ganz catheter via femoral approach in main pulmonary artery, it is partially looped in the right atrium.Stable cardiomegaly. Edema may be slightly improved. Other support hardware stable.

Output: IABP marker at level of aortic arch.Swan-Ganz catheter via femoral approach in main pulmonary artery, it is partially looped in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old. Reason: ETT placement confirmation History: intuabted ET tube tip approximately 4 cm above the carina. Dobbhoff tube tip within the stomach.Persistent cardiomegaly. Low lung volumes. Nonspecific basilar opacities may reflect atelectasis. No new focal airspace opacities. No large pleural effusions.

Output: ET tube tip 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Status post CABG evaluate lung fields. Right jugular SGC has been retracted with tip now at the level of the distal right main PA. A right lower chest tube has been repositioned, now terminating laterally near the costophrenic angle. Other hardware and devices unchanged; the IABP marker is horizontally oriented near the top of the aortic arch.Moderate left pleural fluid collection slightly increased, with associated atelectasis. Small volume of pleural fluid on the right. Mild dependent atelectasis and patchy opacity which may be the result of aspirated secretions.No pneumothorax.

Output: IABP marker near the top of the aortic arch. Repositioning of Swan-Ganz catheter which now terminates at the distal right main PA level. Enlarging left pleural fluid collection with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: rule out pneumonia History: short of breath No acute abnormality.Left subclavian pacemaker, leads unchanged in position.

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


Instruction: Generate impression based on medical findings.

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

Output: No sign of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Recent right VATS wedge resection. Right chest tube noted.Calcified mediastinal lymph nodes. Otherwise unremarkable cardiomediastinal silhouette.Low lung volumes. Mild diffuse left lung opacity like represents atelectasis.

Output: Mild diffuse left lung opacity, compatible with atelectasis and possibly aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: endotracheal tube position, pneumonia History: intubated Support devices are unchanged with the endotracheal tube terminating 4 cm above the carina.Multifocal patchy airspace opacities with basilar subsegmental atelectasis stable.

Output: Pulmonary opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with bladder cancer, needs baseline CT exam prior to chemotherapy. LUNGS AND PLEURA: Left upper lobe and right upper lobe micronodules, the largest measuring 4 mm, on axial images 25/97 and 47/97.Very mild emphysema.No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Cardiac size is normal. Coronary artery and aortic atherosclerotic disease. Small pericardial effusion. Calcified hilar lymph nodes likely reflect prior granulomatous disease. Multiple small paraesophageal lymph nodes of uncertain clinical significance (axial image 35/97). Additional small pretracheal nodes, none of which is pathologically enlarged by CT criteria.Small cystic lesion in the right thyroid lobe and large, cystic and calcified lesion in the left thyroid lobe are most likely benign.CHEST WALL: Left breast nodules of uncertain clinical significance. Consider further evaluation with mammography or ultrasound.UPPER ABDOMEN: Limited examination given the lack of IV contrast. Splenic calcifications noted. No other gross abnormality.

Output: 1.Nonspecific micronodules.2.Small pericardial effusion.3.Small mediastinal and paraesophageal lymph nodes.4.Cystic thyroid lesions.5.Left breast nodules. Recommend further evaluation with mammography or ultrasound.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female known breast cancer status post chemotherapy follow-up CHEST:LUNGS AND PLEURA: Volume loss with fibrotic changes and retraction right apex and radiation changes along the right anterior chest wall redemonstrated. No focal lung nodules or effusions. Pleural thickening, unchanged. Emphysematous changes.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Postsurgical changes right mastectomyABDOMEN:LIVER, BILIARY TRACT: Pseudocirrhosis appearance of liver with multifocal areas of retraction. The heterogeneous bandlike hypodensity is redemonstrated in the posterior segment of the right lobe and a few small hypodensities consistent with metastases in the anterior and posterior segments of the right lobe. Index lesion seen on series 3 image 83/192 proximally unchanged measuring 1.2 x 1.1 cm. There are at least 4 additional small lesions in the right lobe also unchanged. Elsewhere in the dome of the liver a simple cyst is seen. There is no 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: Small amount perihepatic ascites, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified leiomyoma, unchanged.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 interval change. The pseudocirrhosis appearance of liver with several small tumors, unchanged. Small amount of ascites. Fibrotic changes are and volume loss right lung.


Instruction: Generate impression based on medical findings.

Input: Reason: et History: resp failure Decreased lung volumes with mild basilar atelectasis.Tracheostomy tube in place.No other significant change.

Output: Decreased lung volumes and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: better demonstration of opacity of R lung apex History: cough, opacity seen on port cxr Ill-defined left basilar opacity suggestive of atelectasis and possibly secondary to aspiration.Stable cardiac mediastinal silhouette.Right apical pleural thickening. No definite abnormal right apical opacity.No large pleural effusions.

Output: New left peripheral basilar opacity suggestive of aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with prostate cancer CHEST:LUNGS AND PLEURA: Minimal new pleural thickening involving the right upper lobes. Thickening is nodular, towards the lobes.MEDIASTINUM AND HILA: Left supraclavicular lymph node is slightly smaller, measuring 9 x 7 mm image number 6, series number 3. Reference posterior mediastinal lymph node on the right side of the aorta is also slightly smaller, measuring 9 x 9 mm image number 40, series number 3. Reference left para-aortic lymph node is stable, measuring 13 x 11 mm image number 58, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral ureteral stents. Bilateral hydronephrosis persists.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 10 x 7 mm image number 146, series number 3, smaller compared to previous study. Other retroperitoneal lymph nodes are also slightly smaller.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: Reference right external iliac lymph node is also slightly smaller, measuring 15 x 11 mm number Waterstone to 4, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal interval decrease in the size of the mediastinal, retroperitoneal, and pelvic lymph nodes.New right-sided pleural thickening of unknown clinical etiology and significance.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of Burkitt's lymphoma/leukemia now with mesenteric node involvement. Presents with abdominal cramping. CHEST:LUNGS AND PLEURA: Few subcentimeter cavitary lesions in both lungs are new/more prominent than prior. Likely etiology would be infectious and clinical correlation is recommended.MEDIASTINUM AND HILA: Left hilar calcifications, similar to prior. Aorto-esophageal soft tissue mass identified on outside CT scan in 9/3/10 with continued decrease in size, currently nonmeasurable due to small size.CHEST WALL: Right-sided PICC terminates at the superior caval atrial junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Tiny anterior splenule, similar to prior. Focal hypodense lesion is nonspecific and incompletely visualized on prior. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Parapelvic cyst in the midpole of the left kidney.RETROPERITONEUM, LYMPH NODES: Few prominent retroperitoneal lymph nodes. Retrocrural node (series 3, image 96) measures 1.1 x 1.5 cm. Aortocaval node (series 3, image 122) measures 1.5 x 0.8 x 3.8 cm. No prior abdominal scans for comparison measurements.BOWEL, MESENTERY: Few mesenteric enlarged lymph nodes seen. The largest node (series 3 image 130) measures 2.3 x 1.0 cm. Confluent/infiltrating higher attenuation almost linear in nature within the mesentery surrounding this node is compatible with evolving lymphoma involvement --- without prior scans it cannot be determined whether resolving or increasing.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate atherosclerotic disease of the thoracic and abdominal aorta with significant stenosis below the level of the renal arteries.PELVIS:PROSTATE, SEMINAL VESICLES: Post operative appearance of prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pelvic lymphadenopathy with prominence of left common iliac lymph node chain. Bilateral external iliac lymphadenopathy, measuring 2.0 x 0.9 cm on the right (series 3 image 183) and 1.5 x 0.9cm on the left (series 3, image 177).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1) Few subcentimeter lung cavitations, new/increased from prior. Correlate for infectious etiology.2) Interval resolution of aortoesophageal lymphadenopathy compared to outside exam 9/3/10.3) Retroperitoneal/pelvic lymphadenopathy and mesenteric soft tissue masses, compatible with lymphoma.3) Moderate atherosclerotic disease with significant infrarenal aortic stenosis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Patient with production cough, please evaluate for infection, etc History: as above Small lung volumes.No specific evidence of infection or edema.

Output: Small lung volumes, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of laryngeal cancer, status post radiation and resection; lung cancer status post surgery/RT/chemo. CHEST:LUNGS AND PLEURA: Status post right upper lobe resection. Micronodule in left major fissure is unchanged, likely representing an intrapulmonary lymph node. No pleural effusion.MEDIASTINUM AND HILA: Stable postoperative findings of right hilum. Left hilar calcifications, unchanged. Multiple small mediastinal lymph nodes are similar in size. No cardiomegaly or pleural effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Irregular dilatation of the pancreatic duct in the body/tail is unchanged. No discrete mass identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of metastatic disease. Postoperative findings unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Evaluate signs of infection/weakness History: weakness Question mild pulmonary edema, as before. Slight increase in peribronchial cuffing. Moderate cardiomegaly, unchanged. No large pleural effusion or pneumothorax. No acute bony abnormality.

Output: Question mild pulmonary edema.Peribronchial cuffing may be representative of edema versus bronchitis or asthma. Moderate cardiomegaly again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: interval changes History: as above Cardiomegaly with mild basilar edema unchanged.IABP catheter tip 3 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.IVC Swan-Ganz catheter tip in right interlobar pulmonary artery.

Output: Stable cardiomegaly pulmonary edema, tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: stage IV lung cancer, 4 months s/p pericardial bx and right pleurX catheter placement for malignant pleural effusion History: increasing drainage from pleurx catheter Right Pleurx catheter remains looped at the right inferior hemithorax.Now complete opacification of the right hemithorax with the right upper lobe no longer aerated. Innumerable pulmonary nodules noted on the left. Multifocal expansile lesions of bilateral ribs compatible with osseous metastases. Mediastinum is shifted to the right.

Output: Complete opacification of the right hemithorax in the setting of a Pleurx catheter. Multifocal rib metastases with innumerable pulmonary metastases on the left.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: eval for free air History: hematemesis Probable small right pleural effusion and streaky right basilar opacity consistent with atelectasis.Multiple calcified mediastinal and hilar lymph nodes.The heart size is normal.No evidence of pneumoperitoneum.IVC filter in place.Multiple surgical screws are evident within the humeral head and humeral diaphysis.

Output: Stable small right pleural effusion with associated basilar atelectasis. No evidence of pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: r/o pna History: cough No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with metastatic rectal carcinoma. Evaluate response to treatment. CHEST:LUNGS AND PLEURA: Interval resolution of bilateral groundglass opacities. Right lower lobe calcified granuloma remains unchanged. MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy. Reference right paratracheal node (series 3, axial image 41/230) measures 1 cm x 1.8 cm, which has decreased in size on comparison to previous exam.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Previously referenced hypoattenuating lesion within the dome of the liver has increased in size, now measuring 8 cm x 8.7 cm on series 3, axial image 71/230.Multiple new, confluent lesions in both hepatic lobes:One lesion is seen in the left lobe of the liver (segment 3) on series 3, axial image 86/230 and measures 2.5 cm x 2.8 cm.The lesion in the right hepatic lobe (segment 5) on series 3 axial image 88/230 measures 2.1 cm x 1.9 cm.Another new lesion is identified in segment 6 of the liver on series 3, axial image 100/230.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule unchanged.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 notedBLADDER: No significant abnormality noted.LYMPH NODES: Previously noted lymph node in left pelvis remain stable in size (series 3, axial image 176/230), measuring 2.6 cm x 1.7 cm. A smaller lymph node adjacent to the rectosigmoid colon also remains unchanged (series 3, axial image 179/230).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.New bilobar, confluent hepatic lesions representing metastases as detailed above.2.Interval decrease in mediastinal lymphadenopathy.3.Stable pelvic lymphadenopathy


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: chest pain History: chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male neonate with meconium aspiration. VIEWS: Chest and abdomen AP, abdomen cross table lateral (3 views) 7/28/2016, 1844 ET tube tip is below the thoracic inlet and above the carina. Umbilical venous catheter coils towards itself and terminates in the umbilical vein similar to prior exam. Umbilical arterial catheter tip is at T7. Enteric tube tip is in the stomach. Urinary bladder catheter tip is in the pelvis.Cardiothymic silhouette is normal. Persistent pneumomediastinum not significantly changed from prior exam. Persistent right lung multifocal streaky opacities in the background of diffuse lung haziness. There is a paucity of bowel gas. No pneumoperitoneum, pneumatosis or portal venous gas.

Output: Persistent pneumomediastinum concerning for meconium aspiration. Malpositioned UVC.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ? pna History: productive cough and cp, dysphagia w/ hx hiatal hernia Heart size normal.Bibasilar subsegmental atelectasis or scarring, stable compared to prior.No pleural effusion. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: swan in place History: swan in place Evaluation is limited by overlying hardware. Swan-Ganz catheter tip in right interlobar pulmonary artery. Other support hardware stable. Cardiomegaly with pleural effusions and basilar opacity unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: as above Cardiomegaly with bilateral airspace and interstitial opacities suggestive of edema and possibly aspiration with small pleural effusions, not significantly changed.Catheter projected over the lower mediastinum, unchanged.No new findings.

Output: Extensive pulmonary opacity compatible with edema and aspiration.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old with history of respiratory failure Support devices unchanged in position.Small lung volumes. Stable cardiomediastinal silhouette with cardiomegaly and underlying pericardial effusion. Diffuse airspace and interstitial opacities with left greater than right pleural effusions appearing similar to prior exam.

Output: Stable cardiopulmonary appearance with diffuse opacities suggestive of pulmonary edema, not significantly changed from prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: neck pain Multiple bilateral pulmonary nodules compatible with metastases, increased from previous.Interstitial opacity on the right confirmed on CT scan, compatible with lymphangitic spread of tumor and with intravenous and lymphatic hilar obstruction.Right perihilar opacity compatible with lymphadenopathy with right middle lobe atelectasis. Elevated right hemidiaphragm.

Output: Interval progression of metastatic disease. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: needed prior to VQ scan per Tamika History: SOB/DOE Mild to moderate cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT remains 3 cm above the carina. NG coiled in the proximal stomach. Left jugular catheter terminates in the proximal SVCUnderlying cardiopulmonary appearance is otherwise unremarkable and without new focal abnormality

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Mitral valve replacement Unchanged right basilar nonspecific opacity, preventing exclusion of a right lower lobe infection or aspiration given only short-term visualization and absence of prior comparisons. Serial imaging is again needed to ensure clearance and stability of what also may represent scarring. Upper lungs are clearBorderline cardiomegaly. Prosthetic mitral valve.

Output: Nonspecific right lower lobe focal opacity, concerning for aspiration versus infection in the appropriate clinical setting. See recommendations and description above


Instruction: Generate impression based on medical findings.

Input: Six to 7-year-old female with hyperparathyroidism and significant weight loss CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes, nonspecific. An index precarinal lymph node measures 14 x 11 mm on image number 32, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst near the dome of the liver.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: 3.7 x 2.2 cm cystic lesion anterior to the left psoas muscle likely represents a left ovarian cyst. Right ovary is unremarkable. Uterus is 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: Nonspecific borderline enlarged mediastinal lymph nodes. Left ovarian cystic lesion. Follow-up imaging in 3 months with pelvic ultrasound is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old. Reason: lung infiltrate History: chest pressure Cardiomediastinal silhouette is unremarkable.No focal airspace opacity and pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality. No significant interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Fever assess for infiltrate. Pulse generator obscures a portion of the left midlung which cannot be assessed. Stimulator leads extend to the left lower neck region.Low lung volumes. Patchy nodular opacity at the left base visible on one of the 2 films is suspicious for aspiration or infection.

Output: Left basal opacity suspicious for aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of breast cancer, status post radiation CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Status post right mastectomy. Post surgical changes.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific 7-mm hypodensity in the right lobe liver image number 116, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrolithiasis. No evidence of hydronephrosis.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: 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: Nonspecific subcentimeter hypodense in the right lower liver, too small to accurately characterize.


Instruction: Generate impression based on medical findings.

Input: Pacemaker leads. Rotation artifact.Interval removal of right jugular catheter.New single lead right subclavian pacemaker with tip projecting over the right ventricle directed towards the apex.No pneumothorax.Low lung volumes with basal atelectasis or scarring on the right.Tortuous thoracic aorta unchanged.

Output: Single lead pacemaker tip projects over the right ventricle directed towards the apex, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Chest tube placement. Acute respiratory failure. 24 mm left apical pneumothorax. Small caliber chest tube is incompletely included on the image but projects only 22-25 mm within the bony thorax boundary; the radiopaque marker is not visualized and the sidehole of the tube could be external to the bony thorax.Multiple nodules in the lower lung zones. Mild edema. Bronchial wall thickening and atelectasis consistent with aspiration. Dobbhoff tube tip off the caudal margin of the film. Upper normal heart size. Emphysema in the upper lobes.

Output: 1. 24 mm left apical pneumothorax; the chest tube marker is not included on the image and the sidehole is likely external to the bony thorax.2. Extensive lower lobe findings bilaterally highly suspicious for aspiration pneumonia. Focal areas of consolidation should be followed to complete resolution.3. Mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: ECMo History: ECMO Bilateral chest tubes with further opacification of the left hemithorax, unchanged airspace opacity on the right.Unchanged support devices.

Output: Further opacification of the left hemithorax, which may in part be due to atelectasis as well as underlying edema.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o PNa History: Febrile, tachycardic Cardiomegaly is unchanged. Mild fissural and peribronchial thickening as well as mild interstitial opacities at the bases suggests mild edema. No specific evidence of infection. No pneumothorax or large pleural effusion.

Output: Mild fissural and peribronchial thickening suggesting mild edema, not significantly changed from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval acute process History: AMS Extensive lobulated right pleural thickening and fluid compressing right lung with a known right lower lung zone mass, unchanged except for decreased in the size of the pleural effusion.Left hemithorax relatively unremarkable.

Output: Decreased volume right pleural effusion, but still extensive tumor involvement.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: ETT advanced 2 cm because was 6 cm from carina History: ARDS Support devices unchanged with ET tube tip 4 cm above the carina.Stable cardiopulmonary appearance with diffuse pulmonary opacities compatible with ARDS.No new pulmonary opacities identified.

Output: ET tube in satisfactory position. Extensive pulmonary opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP Balloon catheter marker in the proximal descending aorta, projected 3 cm below the top of the aortic arch,ICD leads and PICC line unchanged.Cardiomegaly with interstitial pulmonary edema and mild basilar atelectasis.

Output: Balloon catheter in the descending aorta, slightly further distally than on the previous radiograph.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with locally advanced bladder cancer CHEST:LUNGS AND PLEURA: Stable apical bulla. Emphysema. Right lower lobe. Calcified granuloma.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable cholelithiasis without cholecystitis.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: Status post cystoprostatectomyBLADDER: Status post cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval for fluid overload History: rales, dialysis pt Mild scarring or atelectasis at the lung bases. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Heart size at the upper limit of normal, improved from last study. Aortic atherosclerosis, as before. Bony changes consistent with chronic renal osteodystrophy.

Output: Mild scarring or atelectasis at the lung bases. No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.History of sickle cell disease. The previously seen subsegmental right middle lobe consolidation is obscured. Persistent findings suggestive of bilateral lower lobe scarring. No new abnormal focal lung parenchymal opacities.Cardiomegaly.Diffuse of sclerosis scleroses and sequela of prior bone infarctions, in keeping with history of sickle cell disease.

Output: The recently seen right middle lobe subsegmental consolidation is obscured in this single AP projection. No new abnormal lung parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: evaluate for edema, tube position History: s/p robotic valve replacement The patient is intubated with the endotracheal tube 6 cm above the carina. 2 right IJ sheaths terminate at the medial right posterior fourth rib. Interval placement of 2 right-sided chest tubes that are coiled at the right mid and lower zones. Interval replacement of a bioprosthetic mitral valve.Moderate to large layering right pleural effusion with associated subsegmental atelectasis of the right middle lobe and possible mild edema. No significant pneumothorax.

Output: Postoperative radiograph status post mitral valve replacement with the endotracheal tube cuff at the cords. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: assess pleural effusion History: assess pleural effusion Loculated right pleural fluid within the fissures, stable in volume from 4/8/2016, but increased from previous. Similarly, loculated pleural fluid on the left is unchanged from the most recent prior plain film but enlarged compared to earlier studies. Severe interstitial edema pattern, unchanged. No pneumothorax.Interval removal of left PICC. Sternotomy hardware appears intact. Aortic and mitral valve replacements again noted.

Output: Stable appearance of severe interstitial edema and loculated bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: OSH transfer for PNA, r/o focal infiltrate History: See above New right hemithorax volume loss of the right pleural effusion.Patchy consolidation suggestive of infection.Findings could be the result of mucoid impaction given extensive bronchial impaction seen on the prior CT study.Left lung unremarkable except for subsegmental atelectasis.Left subclavian ICD, leads unchanged in position.

Output: The right hemithorax volume loss with patchy consolidation and pleural effusions. A thoracic CT is recommended for follow-up given known underlying bronchiectasis and bronchial impaction.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: sob History: sob No change in upper lobe opacities nor is lower opacities.The tip of the left-sided PICC line is seen in the projection of the right internal jugular vein.

Output: Tip of the PICC line now seen within the right internal jugular vein. No change in the basilar and right upper lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: Hx of bacteremia Normal heart size and mediastinum with a mitral valve prosthesis in place. Small lung volumes with no significant abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab ICD leads in the expected locations, with no pneumothorax or other complications. Cardiomegaly with left atrial enlargement and vascular redistribution.Mild basilar scarring but no sign of edema or infection.

Output: ICD leads in expected locations with no pneumothorax or other complications.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Seizure. Evaluate for aspiration/pneumonia. Interval removal of enteric feeding tube. Left approximately PICC tip projects over the axilla. Low lung volumes with interval improvement in the left basal opacity. No new focal airspace opacity, pleural effusion, or pneumothorax.

Output: Improved, yet persistent left basal opacity compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with cough. Evaluate for fungal pneumonia and evaluate status of abdominal lymphoma. Examination is limited by lack of IV contrastCHEST:LUNGS AND PLEURA: Since the prior examination, the multifocal small areas of airspace opacities have become less dense and are now ground glass in nature. Cavitation has resolved. The right perihilar consolidation is unchanged.MEDIASTINUM AND HILA: Small mediastinal nodes remainMitral and aortic valve prostheses. Visualization of the cardiac chambers suggests anemia. Minimal pericardial effusion, decreased in size.CHEST WALL: The right port terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy.SPLEEN: Calcified splenic granulomas. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A right ureteral stent has been placed with resultant resolution of right-sided hydronephrosis. The left ureteral stent remains.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: See belowBLADDER: The large pelvic mass which involves the urinary bladder has greatly decreased in size, measuring approximately 7.8 x 5.2 cm, previously 12.6 x 7.9 cm. The mass is difficult to separate from the prostate gland and seminal vesicles. The mass encases the distal right ureter.Diffuse bladder wall thickening again noted.LYMPH NODES: The enlarged pelvic lymph nodes bilaterally have decreased in size. The reference left external iliac lymph node measures 10 x 8 mm (series 3; image 105, previously 21 x 18 mm). The reference right external iliac lymph node approximately 14 x 10 mm (series 3; image 186), previously 21 x 16 mm.BOWEL, MESENTERY: The mass continues to abut the anterior aspect of the distal sigmoid colon without evidence of obstructionBONES, SOFT TISSUES: The presacral soft tissue mass measures approximately 1.5 x 1.5 cm (series 3; image 185), previously 3.2 x 2.8 cm.OTHER: No significant abnormality noted

Output: Significant decrease in size of the pelvic mass and pelvic lymphadenopathy.Stable right hilar mass like consolidation with mild improvement residual patchy pulmonary infiltrates. Interval placement of a right ureteral stent.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female. Diarrhea. Assess for colitis, infection, bowel wall thickening. Based on prior requisition also a history of lymphoma and stem cell transplant. Exam is not sensitive for detecting lesions in the bowel solid organs due to lack of oral or intravenous contrast. Given those limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Small left-sided pleural effusion decreased compared to the prior exam. No evidence of pleural effusion on the right. No lung nodules.MEDIASTINUM AND HILA: Port-A-Cath unchanged in position. Scattered calcified mediastinal and left hilar nodes unchanged. No new nodes. CHEST WALL: Small bilateral axillary nodes. Left axillary/pectoral lymph node is poorly defined borders but is probably unchanged or slightly smaller, as seen on series 2 image 29 it measures 1.5 x 1.1 cm. (I believe the earlier measurements on 4/19/11 included surrounding muscle.) No new nodes. Skin thickening of the left breast, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips. Previously described small hypodensity at the dome of the liver is not apparent to the lack of IV contrast.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule 2.1 x 1.7 cm series 3 image 106, unchanged. Small left adrenal nodule unchanged measures 1.1 x 1.1 cm, series 3 image 96. KIDNEYS, URETERS: Persistent minimal left hydronephrosis and bilateral renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Small shotty nodes not pathologic by size criteria, unchanged. IVC filter unchanged.BOWEL, MESENTERY: There is a nodular thickening of the descending colon. This was not seen on the contrast enhanced CT scan of 4/19/11 is probably more marked than on the CT of 5/10/11. This could represent a focal colitis. No evidence of intramural air free air or focal peritoneal fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: This and fat stranding around the rectum rectosigmoid which is a nonspecific and unchanged from the prior exam. No evidence of intramural air, free air or focal peritoneal fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Concern for nodular thickening of the ascending colon which could represent a focal colitis or lymphoma. This is new or progressive compared to the prior exam. Focal fat stranding around the rectum rectosigmoid is probably present previously and is a nonspecific. Decrease in size of left pleural effusion. Stable adenopathy and adrenal nodules.


Instruction: Generate impression based on medical findings.

Input: Reason: cough with sputum - lactic acid History: as above Right jugular catheter tip in the right atrium in the area of the tricuspid valve.No significant pulmonary abnormalities.

Output: Catheter tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: SOB Large lung volumes consistent with COPD with focal scarring or subsegmental atelectasis at the left base, unchanged.No sign of pneumonia or other acute change.

Output: COPD with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Altered mental status evaluate for pulmonary edema or pneumonia. Cardiothoracic ratio appears similar to previous. Sternotomy hardware unchanged in position. Trace right pleural fluid collection. No specific signs of pulmonary edema. Spinal osteophytes limit assessment of the retrocardiac region. No specific signs of pneumonia or pulmonary edema.

Output: Trace pleural fluid on the right, but no specific signs of pneumonia or interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.PICC line placement. Left-sided PICC terminates 1 to 2 cm below the cavoatrial junction. Port catheter is unchanged terminating at the cavoatrial junction. No substantial change in right greater than left nodular and masslike pulmonary lesions. Right paratracheal lymphadenopathy again noted. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: Left sided PICC terminates 1 to 2 cm below the cavoatrial junction. No substantial change in right greater than left nodular and masslike pulmonary lesions or right paratracheal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt no medical history initially with URI sx but now with SOB, pleuritic chest pain. R/o infection History: SOB, chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with long history of tobacco use with chronic cough and abnormal PFTs consistent with sarcoid. Evaluate for emphysematous change, lymphadenopathy. LUNGS AND PLEURA: Moderate to severe, diffuse centrilobular emphysema is noted. Micro-nodule within the right major fissure probably represents an intrapulmonary lymph node (axial image 66/111). No evidence of air trapping on the expiration views. No pleural fluid.MEDIASTINUM AND HILA: Mild aortic and coronary artery atherosclerotic calcification. No suspicious mediastinal or hilar lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Hyperdense foci in the superior poles of both kidneys are unchanged and may represent hemorrhagic or proteinaceous cysts.

Output: 1.Moderate to severe emphysema.2.No evidence of sarcoid or any other interstitial abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: sepsis, hypotensive History: hypotensive Low lung volumes makes detailed pulmonary evaluation difficult. No new focal lung consolidation. Probable mild basilar atelectasis or scarring. Normal heart size given low lung volumes. No large pleural effusion or pneumothorax.

Output: Low lung volumes makes detailed pulmonary evaluation difficult. No new focal lung consolidation. Repeat chest radiographic study, preferably PA and lateral, is suggested in full inspiration.


Instruction: Generate impression based on medical findings.

Input: Chest pain patient fell Persistent shunt tubing projected over the right chest wall. Trajectory suggest interval exchange for new tubing, however no evidence of distinct discontinuation or kinkingUnderlying mild scarring and possible small right effusion with COPD changes. No superimposed acute cardiopulmonary abnormality

Output: Questionable intervally replaced or revised right chest wall shunt with a small right effusion and/or scarring


Instruction: Generate impression based on medical findings.

Input: Age: 88 yearsGender: FemaleReason for Study: Reason: chest pain with negative cardiac biomarkers History: as above Stable cardiac enlargement.Small bilateral pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: lung cancer History: s/p lingula-sparing LUL lobectomy for Stage I NSCLC Left upper lobe postsurgical volume loss.No evidence of new or recurrent tumor or other significant abnormality.

Output: Status post left upper lobe resection, without other abnormal findings.


Instruction: Generate impression based on medical findings.

Input: Male; 82 years. Reason: gastric cancer s/p resection, eval EOD, compare to previous CHEST:LUNGS AND PLEURA: Pulmonary nodules along the right minor fissure (series 4 image 70), left major fissure (series 4 image 67), and left upper lobe (series 4 image 62) are stable to multiple priors, likely represent intrapulmonary lymph nodes. Previously noted right middle and right lower lobe ground glass opacities are less conspicuous, suggesting probable resolving infectious etiologies. However, right upper lobe ground glass opacities (series 4 image 38) persist.Peripheral and basilar fibrosis are not significantly changed.MEDIASTINUM AND HILA: Moderate/severe coronary calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable appearance of indeterminant inferior pole left renal low-attenuation lesion (series 3 image 123) measuring 1.4 cm (previously 1.3 cm).Other simple appearing cysts are similar in size.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable postsurgical appearance of gastric surgery.BONES, SOFT TISSUES: Stable appearance of left T11 paravertebral soft tissue mass encroaching upon the thecal sac (series 3 image 86) measuring 4.1 x 2.9 cm (previously 4.2 x 3.2 cm).OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate, measuring 6.5 cm in diameter.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Vascular calcifications.

Output: 1. No evidence of metastatic disease.2. Stable indeterminant left renal lesion.3. Stable T11 paravertebral lesion.


Instruction: Generate impression based on medical findings.

Input: Reason: new oxygen requirement History: requiring oxygen Small lung volumes with basilar opacities consistent with atelectasis and possibly small effusions.Port catheter with its tip in the SVC.

Output: Basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.History of shortness of breath. Cardiomegaly unchanged.There are new, bilateral pleural effusions with adjacent bibasilar consolidation. Right upper lobe scarring unchanged.

Output: New bilateral pleural effusions with adjacent consolidation and cardiomegaly suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: interval change s/p chest tube History: interval change s/p chest tube, PTX Right chest tube unchanged with improvement in a right basilar pneumothorax.No new findings.

Output: Interval improvement in right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: post cardiac surgery History: MVR Interval extubation. The remaining support devices are unchanged in position.Several left-sided rib deformities again noted. Persistent left lower lobe subsegmental atelectasis and small pleural effusions. Increasing right basilar opacity possibly from aspiration following extubation. Skin fold projects over the right apex; no pneumothorax is present.

Output: Persistent retrocardiac atelectasis following extubation.


Instruction: Generate impression based on medical findings.

Input: Female 39 years old Reason: evaluate for source of fever and cough History: cough, fever, immunocompromised patient. Moderate cardiomegaly with pulmonary vascular redistribution, not substantially changed from prior examination.Low lung volumes.Diffuse bilateral airspace opacities/bronchial wall thickening without discrete superimposed focal airspace process.Midline sternotomy and mild scoliosis again noted.No evidence of pulmonary edema or pleural effusions.

Output: Stable cardiomegaly and unchanged diffuse bilateral airspace opacities/bronchial wall thickening with no evidence of acute pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: volume overload? History: phtn with sepsis, bnp up Mild increase in pulmonary interstitial markings suggesting mild edema.Interval removal of Swan-Ganz catheter.No change in position of tip of central venous catheter at SVC.No pneumothorax.Stable cardiomegaly. No pleural effusion.

Output: 1. Suggestion of mild pulmonary edema2. Interval removal of Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma. CHEST:LUNGS AND PLEURA: Biapical scarring. Subcentimeter right middle lobe nodule on image number 40/213 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference segment 5 metastases in the liver measures 11 x 10 mm image number 122/213. Other, multiple bilobar hypodense lesions suspicious for metastatic disease are small and ill-defined but unchanged from previous CT.SPLEEN: Multiple hypodense metastatic lesions in the spleen. Reference nodule measures 14 x 13 mm on image number 101, unchanged. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal stone, unchanged.RETROPERITONEUM, LYMPH NODES: Index left para-aortic adenopathy is unchanged measuring 15 x 14 mm image number 107. Second reference mass in the mesentery measures 22 x 23 mm and is slightly enlarged on image number 143.Multiple other retroperitoneal and peritoneal nodules consistent with metastatic disease are again noted. Some of the more slightly enlarged. In reference nodule in the left retroperitoneum, image number 133 measures 14 x 10 mm. Previously it was measuring 11 x 9 mm..BOWEL, MESENTERY: Ileal small bowel metastatic lesion causing intussusception is unchanged in the right lower quadrant and measures 3.5 by 2.1-cm. ileal loops at the pelvis demonstrate mild wall thickening and are slightly dilated measuring up to 3 cm. Oral contrast passes beyond this lesion into the colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right obturator adenopathy is slightly enlarged measuring 17 x 2.1 cm. Left inguinal adenopathy or measures 14 x 13 mm on image number 138.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable chest findings. Liver and spleen metastases are unchanged. Retroperitoneal adenopathy and pelvic adenopathy has slightly increased in size.Ileal mass causing intussusception is unchanged. Ileal loops are slightly dilated measuring 3 cm however oral contrast extends to the colon.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: chest pain and sob History: hx of htn Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Question pulmonary artery catheter placement. Right jugular Swan-Ganz catheter with tip in the right pulmonary artery.Left subclavian ICD leads are unchanged in position.Status post median sternotomy for valve replacement.Unchanged cardiomediastinal silhouette.Persistent small left pleural effusion.No significant pneumothorax.

Output: Persistent small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: is there an infiltrate History: chest pain Cardiac silhouette is normal in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.No acute osseous abnormality.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: is there pneumonia? History: neutropenic fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Catheter tip in the SVC.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: serial eval pulm pathology History: intubated, type I RF Support devices unchanged.And mediastinal silhouette is unremarkable.Decreased lung volumes.Diffuse interstitial and patchy airspace opacities similar to the prior exam compatible with edema.

Output: Support devices unchanged. Stable cardiopulmonary appearance with interstitial and airspace opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Device placement Anterior ICD with lead tip projected anteriorly up to the level of the mid sternum no definite interval change however mild retraction is suspected despite differences in lordosis.Lungs remain clear. Cardiac and mediastinal contours are grossly within limits of technique and motion

Output: Anterior ICD repositioned


Instruction: Generate impression based on medical findings.

Input: 69 years old Male. Reason: iabp in place? History: iabp. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Increased densities in the several right ribs, unchanged, which may be due to prior trauma. The cardiac pacemaker/defibrillator electrodes are stable in position. The intra-aortic balloon pump tip is stable in position. A lucency line in the mediastinal adjacent to the aortic arch is likely related to the intra-aortic balloon pump placement.

Output: The above findings are consistent with mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Age: 84 yearsGender: FemaleReason for Study: Reason: altered mental status History: altered mental status Stable cardiomediastinal silhouette with evidence of an LAD stent grafts.Lungs are clear.No pleural effusions.Median sternotomy is intact.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Chest pain The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified. 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: 68-year-old male with history of metastatic prostate cancer. Evaluate for progression. CHEST:LUNGS AND PLEURA: Moderately severe centrilobular emphysema.Bibasilar subsegmental atelectasis. Calcified left upper lobe micronodule likely represents prior granulomatous disease.No suspicious nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Small mediastinal lymph nodes. Calcified prevascular and left hilar nodes again likely represent prior granulomatous disease.Cardiac size is normal. No pericardial effusion.CHEST WALL: A destructive lesion in the posterior right fourth rib with involvement of the adjacent vertebral body and pedicle and associated pleural soft tissue component noted on axial image 21/221. This lesion has progressed when compared to the examination of 9/11/06. A sclerotic lesion in the vertebral body of T4 on coronal image 36/109 is new when compared to the examination of 9/11/06. A sclerotic lesion in the vertebral body of T12 is unchanged.Small axillary lymph nodes are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion in segment 6 is unchanged and probably represents a cyst.SPLEEN: Punctate splenic calcification, likely the residua of prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hyper attenuating lesions in both kidneys probably represent cysts although some interval increase in size is noted when compared to the study of 9/11/06. Calculus in the lower pole of the right kidney unchanged.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications in the distal aorta. An IVC filter is in place.Pelvic soft tissue mass adjacent to the right sacroiliac joint measures 3.4 x 3.8 cm on axial image 159/221 and is slightly increased in size from the prior exam of 10/15/07 where it measured 3.2 x 3.4 cm. An additional soft tissue mass inferior to the above-mentioned measures 2.5 x 3.2 cm on axial image 171/221 and is also slightly increased in size from the prior exam of 10/15/07 where it measured 2.3 x 2.6 cm. Right external iliac lymph node measures 1.2 x 1.5 cm on axial image 178/221 and is unchanged.BOWEL, MESENTERY: Postsurgical changes status post total colectomy with ileostomy in the right lower quadrant.BONES, SOFT TISSUES: Sclerotic foci in the vertebral body of L2 and the right ilium are unchanged. Sclerotic focus in the left ischium on coronal image 55/109 is new when compared to the prior exam of 10/15/07OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Postsurgical changes status post prostatectomy. Within the surgical bed, a soft tissue mass measures 4.3 x 6.6 cm on axial image 188/221 and is grossly unchanged when compared to the prior exam of 10/15/07.BLADDER: No significant abnormality notedLYMPH NODES: As above.BOWEL, MESENTERY: Postsurgical changes as above.BONES, SOFT TISSUES: Multiple foci of bony metastatic disease as described above.OTHER: No significant abnormality noted

Output: Progression of bony and soft tissue metastatic disease and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: evaluate for etiology of shortness of breath, setting of known CHF poorly controlled History: shortness of breath Cardiomegaly with low lung volumes.No specific evidence of infection or edema.

Output: Cardiomegaly, without specific evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: picc line insertion History: picc line insertion Left-sided PICC terminates in the SVC. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Left-sided PICC terminates in the SVC.


Instruction: Generate impression based on medical findings.

Input: ECMO Bilateral chest tubes, tracheostomy and Dobbhoff coiled in the proximal stomach are all unchanged. No progression of the appreciable pneumothoraces, again mildly larger on the right. Support vascular cannula are otherwise unchangedUnderlying cardiopulmonary appearance is otherwise unchanged with advanced fibrotic changes more pronounced on the right. No discrete new superimposed focal airspace process

Output: Chest tubes unchanged


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: Female, 70 years old.Reason: swan placement History: swan, asthma, concern for ILD Femoral Swan-Ganz catheter tip in proximal left pulmonary artery. Other findings stable.

Output: Femoral Swan-Ganz catheter tip in proximal left pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: pna? r/o ptx History: asthma exacerbation, left sided pleuritic chest pain, sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female status post transplant. Cough, rhinorrhea. CHEST:LUNGS AND PLEURA: Scattered tree-and-bud and confluent areas of ground glass opacities are seen bilaterally with more nodular areas of focal consolidation in the lingula and lung bases as well. Moderate bronchial wall thickening and mild bronchiectasis, especially in the lower lobes.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild pericardial thickening.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Subcentimeter hepatic hypodensities remain too small to characterize.

Output: Bronchiolitis pattern compatible with viral or bacterial infection.


Instruction: Generate impression based on medical findings.

Input: Reason: pna, line placement History: intubated ET tube tip approximately 3 cm above the carina.Bilateral venous catheters unchanged.Diffuse nonspecific airspace and interstitial opacity, slightly improved since the previous day.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Bacteremia Motion degrades sensitivity. Decreased lung volumes accentuates appearance and suggests atelectasis without definite superimposed focal abnormality, however serial imaging would be indicated if suspicion remains high. Aspiration or even infection cannot entirely be excluded in either lung base.Extensive atherosclerotic changes and mild tortuosity of the aorta.

Output: Nonspecific basilar pulmonary changes, likely atelectasis, however aspiration or infection cannot be excluded given patient history.


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of infection History: GVHD flare Small calcified nodule in the right lower lung and calcified hilar and subcarinal lymph nodes, compatible with previous granulomatous infection.No sign of active infection.Unremarkable cardiac and mediastinal silhouette.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: hemoptysis endotracheal mass bleed, eval repositioning of ETT History: as above Endotracheal tube has been repositioned, now 3 cm above the carina. The left port catheter terminates in the right atrium. Several embolization coils are noted in the left mid thorax.Opacification of the left lung with leftward mediastinal shift. Right perihilar and upper lobe airspace opacities have not significantly changed compared to immediate prior. No interval pneumothorax.

Output: Stable right-sided airspace opacities and complete left lung collapse. Endotracheal tube tip now 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: sarcoid, PTX, recent endobronchial valve, check for placement of chest tubes and interval change of PTX History: PTX, chest tubes in place Right chest tube side port is at the level of the chest wall. Pigtail pleural drain again noted in the upper aspect of the right hemithorax. Endobronchial valves again noted in the right upper lobe. Small right apical pneumothorax, unchanged. Moderate to severe fibrosis in the upper aspect of the lungs consistent with given history of sarcoidosis. Unchanged heart size. No large pleural effusion.

Output: Unchanged right apical pneumothorax, small. Again, side port of the right sided chest tube is at the level of the chest wall.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Chest pain rule out pneumonia. History of recent aortic dissection 3/16. Severe multichamber cardiomegaly. Interval enlargement of loculated appearing moderate to large pleural fluid collection on the left. Immediately above the pleural fluid in the posterior aspect of the lower lobe in the superior segment of the lower lobe, there is some hazy airspace opacity which is not conclusively atelectatic lung.Small volume of pleural fluid on the right, not significantly changed. Mild pulmonary vascular redistribution and thickening of the fissures consistent with hypervolemia, but only minimal, if any, edema.

Output: Hazy left upper lung opacity with enlarging left pleural fluid collection nonspecific but could reflect infection in the appropriate clinical context. Mild hypervolemia/edema.Please note that vascular pathology cannot be excluded by plain film technique.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with history of uterine leiomyosarcoma now presenting with small bowel obstruction. CHEST:LUNGS AND PLEURA: Right lower lobe mass measuring 4.4 x 2.8 cm image number 46, series number 3. Scattered other smaller nodules in both lungs. These are highly suspicious for metastatic disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right axillary adenopathy measuring 15 x 9 mm image number 27, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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: Lateral inguinal adenopathy is unchanged. A reference, left inguinal lymph node measures 17 x 13-mm on image number 201, series number 3.OTHER: No significant abnormality noted.

Output: Bilateral lung metastases. Right axillary lymph nodes.Pelvic adenopathy, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Myasthenia Gravis, Check Pulmonary Status History: Myasthenia Gravis, Check Pulmonary Status Increased interstitial opacities suggestive of edema.No specific evidence of infection.Mild cardiomegaly.Prior right jugular catheter removed.

Output: Increase interstitial markings suggestive of edema, alternatively aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Shortness of breath. Sternotomy hardware is unremarkable. Mitral valvuloplasty.Stable cardiomediastinal silhouette with mild cardiac silhouette enlargement.Increasing right pleural effusion with right greater than left basilar opacities suggestive of edema and atelectasis.

Output: Increasing right pleural effusion with right greater left basilar opacity suggestive of edema 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: Male, 61 years old.Epicardial LV lead placement with robot. Left subclavian ICD leads are unchanged. New epicardial pacing leads project over the left heart.Left pleural or mediastinal drain extends cranially up to the level of the azygos arch.No pneumothorax.Small pleural effusions. Minimal dependent and basal atelectasis.

Output: No significant pneumothorax post epicardial lead placement.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Yes History: SOB with wheeze Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 69M with history of bladder cancer s/p cystectomy with Indiana Pouch, surveillance imaging History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Eval IABP, swan History: s/p IABP and swan Swan-Ganz catheter has been pulled back and now terminates within the pulmonary artery. Intra-aortic balloon pump, not substantially changed terminating approximately 2.8 cm from the top of the aortic arch. Mild pulmonary edema and dense left lower lobe opacity again noted. Question small left pleural effusion. No pneumothorax.

Output: Lines and tubes, as above. Mild pulmonary edema and dense left lower lobe opacity again noted.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: eval IABP placement History: IABP in place Left-sided ICD unchanged.Left IJ Swan-Ganz catheter tip in the right pulmonary artery.IABP marker in the proximal descending aorta.Decreased lung volumes with stable cardiac enlargement.Nonspecific basilar opacities compatible with atelectasis/edema.

Output: New left IJ Swan-Ganz with its tip in the right pulmonary artery. IABP marker in the proximal descending aorta. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Redo R thoracotomy: repair of esophageal leak and+ pleural patch (GRILLO PATCH) assess for acute process, CT in place History: Redo R thoracotomy: repair of esophageal leak and+ pleural patch (GRILLO PATCH), CT in place assess for acute process Iatrogenic devices are unchanged. Very small right-sided pneumothorax is less apparent on this study. Bibasilar opacities and pleural effusions, unchanged. Unchanged heart size.

Output: Decreased size of very small right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Daily CXR History: Delirium and hypotension Developing left small pleural effusion. Unchanged pneumoperitoneum and persistent right pneumothorax. Bibasilar atelectasis. Cardiomediastinal silhouette is within normal limits. Redemonstration of right posterior rib fracture. Enteric tube sidehole is at the GE junction.

Output: Persistent right pneumothorax and pneumoperitoneum. New small left pleural effusion. Enteric tube sidehole is at the GE junction.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: cough/wheezing History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Status post median sternotomy.Healed left rib fracture.

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


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval pulm edema History: sob Cardiomegaly with pulmonary vascular redistribution and improving perihilar edema.No specific evidence of infection.Spinal stabilization hardware are identified.

Output: Cardiomegaly but improving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: 46yo F with recently adjusted L IJ catheter, re-assess placement. History: catheter adjustment Left jugular catheter pulled back to the SVC.Unchanged left hemithorax opacification.Unremarkable right lung.

Output: Left jugular catheter repositioned.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Systemic sclerosis. Cough and sputum. Basal predominant peripheral fibrosis. Scarlike opacity at the right apex unchanged on CT. Lung volumes minimally decreased compared to the prior study of 2014. Suture line from prior wedge biopsy on the left. No visible signs of a superimposed pneumonia. Heart size remains normal.

Output: Slight worsening of pulmonary fibrosis since 2014, but no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: s/p cabg History: s/p cabg Endotracheal tube terminates 4 cm from the carina. Intra-aortic balloon pump terminates 6 cm from the top the aortic arch. Other lines and tubes, not substantially different. Diffuse pulmonary opacities, unchanged. Slight increase in left basilar opacities. Probable small pleural effusions. Unchanged heart size. No significant pneumothorax.

Output: Pulmonary edema again noted. Slight increase in left basilar opacity. Probable small pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: assess for infiltrate History: desaturation Cardiomediastinal silhouette is unchanged.Low lung volumes.No focal airspace opacities.No pleural effusions or pneumothorax.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: L. IJ line repositioned, please eval placement, rule out pneumothorax History: As above Left jugular catheter pulled back but still crosses the midline and is directed cephalad towards the right brachiocephalic vein.No change in pleural effusions and basilar opacities.

Output: Left jugular catheter still directed cephalad towards the right brachiocephalic vein, slightly pulled back.


Instruction: Generate impression based on medical findings.

Input: Postbiopsy check Decreased lung volumes since prior study without additional new cardiopulmonary abnormality. Significantly no evidence for a left-sided pneumothorax

Output: Decreased lung volumes and persistent scattered pulmonary nodules without postprocedural biopsy complication


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.End-stage renal disease. ETT position. ETT tip 4.5 cm above the level of the carina. Right jugular catheter projects low within the right atrium, near the suprahepatic IVC, consider repositioning. Enteric tube tip off the caudal margin of the film.Small to moderate pleural effusions about the same. Increasing basal atelectasis/consolidation on the left.

Output: ETT 4.5 cm above carina. Increasing left basal opacity. Low position of right jugular catheter, suggest repositioning.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with fever and immunosuppression. Evaluate for pneumonia. Cardiomediastinal silhouette is unremarkable.No focal lung opacity or pleural effusion. Bilateral humeral prostheses are noted.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.ET tube placement. ET tube tip is approximately 4 cm above the carina. Enteric feeding tube tip projects over the distal stomach. Low lung volumes with unchanged left basilar consolidation and small left pleural effusion.

Output: ET tube tip is approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Confirm tracheostomy. Tracheostomy tube appears about 6 cm above the level of the carina. NG tube continues beyond radiograph. Unchanged cardiomegaly. Bibasilar dependent opacities, including retrocardiac opacity.

Output: No significant change in cardiopulmonary appearance including persistent retrocardiac opacity, suspicious for aspiration. Interval placement of tracheostomy terminates about 6 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female. Evaluate for PE. PULMONARY VASCULATURE: No PE. Technically adequate study.LUNGS AND PLEURA: Motion artifact. Large left pleural effusion with associated compressive atelectasis. Pleural metastases (series 8040, images 65 and 76) and right-sided nodules along the fissure.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy.CHEST WALL: Right breast lesion with punctate calcification (series 8040, image 29). Normal-appearing axillary lymph nodes. No osseous lesions noted.UPPER ABDOMEN: Several hypodense lesions in the liver. Splenic calcification.

Output: 1.No PE.2.Right breast mass. Enhancing pleural metastases.3.Hypoattenuating lesions in the liver compatible with multiple cysts versus metastatic disease. Recommend follow-up CT abdomen/pelvis with dedicated liver protocol for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of bladder cancer, status post chemoradiotherapy Limited study due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Kidney atelectasis at the lung bases.MEDIASTINUM AND HILA: Small nonenlarged mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, unchanged.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: Right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy.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: Limited study due to lack of IV contrast. No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: s/p PICC line placement History: s/p PICC line placement Extensive interstitial lung disease, with residual pleural air on the left over the apex and along the chest tube tract, unchanged.Large stable pneumoperitoneum.Right PICC, tip in right subclavian.

Output: No change in interstitial lung disease, a small amount of pleural air and a pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: fever, HIV with low CD4, eval for pneumonia History: see above Right jugular dialysis catheter tip in high right.Stable cardiomegaly but no new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p CIED upgrade to CRT-D --> r/o pneumothorax and evaluate lead positions History: as above Moderate cardiomegaly.Large lung volumes consistent with COPD.6 mm right apical pneumothorax, further evaluated on a follow-up study was larger.Coronary stent identified.Left subclavian biventricular ICD, upgraded from a dual-chamber.

Output: Small left pneumothorax following ICD upgrade, larger on a follow-up study.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval IABP History: IABP repositioned Intra-aortic balloon pump has been repositioned more superiorly. The metallic portion terminates approximately 3 cm from the top of the aortic arch. Other lines and tubes, unchanged. Slight worsening of diffuse pulmonary opacities. Increase in right pleural effusion. Unchanged heart size. No pneumothorax.

Output: Lines and tubes, as above. Worsening diffuse pulmonary opacities and right pleural effusion, presumably congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Wheezing and shortness of breath Motion degrades sensitivity, however within this limitation moderate improvement in the mixed interstitial and patchy opacities are otherwise observed representing diminishing edema. Persistent small effusions and some changes are again observed in all 4 quadrants. Greater both bases with mild cardiomegaly

Output: Partially resolving CHF


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Chest pain. There is marked cardiomegaly with vascular redistribution. No pulmonary edema. No focal opacity, pleural effusion or pneumothorax.

Output: Marked cardiomegaly with vascular redistribution, which may be due to cardiomyopathy or multivalvular disease.


Instruction: Generate impression based on medical findings.

Input: Male 82 years old Reason: s/p thora r/o PTX History: s/p thora, pleural effusion. Low lung volumes.Small right greater than left pleural effusions with bibasilar opacities are noted, no suspicious change from prior examination.Heart size again difficult to assess, but not likely significantly changed.No significant pneumothorax.

Output: No significant pneumothorax. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: productive cough, eval for PNA History: productive cough Focal nodular opacity in the left upper lobe approximately 2 cm in diameter, best seen on the energy subtraction view.No other significant findings.

Output: Focal nodular opacity in the left upper lobe, most likely secondary to infection in this age group. However a follow-up chest radiograph is recommended after appropriate treatment to confirm resolution.The findings were discussed with Dr. Weiss in the ED at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: PICC line placed Right PICC line extends into the mid SVC. Minimal basilar scarring and/or atelectasis without additional acute cardiopulmonary abnormality. Mildly decreased lung volumes

Output: Right PICC line placed


Instruction: Generate impression based on medical findings.

Input: Chest pain A solitary chest radiograph without priors limits sensitivity. Next interstitial and airspace opacities are observed with increased density, specifically involving the right lung base representing either contrast or calcifications. Comparison would be helpful. Upper lungs are grossly clear, however patchy to nodular changes in both lung bases cannot entirely be excluded. No definite effusions.The cardiac and mediastinal contours are grossly significant for mild tortuosity of the aorta

Output: Nonspecific bilateral basilar changes greater on the right representing possible old pleural plaques and/or even possibly prior surgery. Comparison with prior studies and/or history would be helpful. Possible superimposed nodular abnormality also cannot entirely be excluded. Continued imaging is needed


Instruction: Generate impression based on medical findings.

Input: Images are slightly limited by patient motion. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is mild disc narrowing at C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C5-C6, there is a small central disc extrusion which migrates caudally by approximately 4 mm, with central annular fissure. There is indentation the ventral thecal sac although without significant stenosis there is also very minimal uncovertebral hypertrophy bilaterally.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine.

Output: Focal spondylotic changes at C5-C6 where there is a small central disc extrusion with annular fissure indenting the ventral thecal sac, although without significant stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: pre OLT eval History: cirrhosis, ESRD, coronary Ca Central venous catheter terminates in the RA. Clear lungs. No large pleural effusion or pneumothorax. Healed right lateral rib fracture. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female diffuse large B-cell non-Hodgkin's lymphoma status post 4 pedicles cycles of chemotherapy. Restaging. 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: The prominent in size measuring 23 cm cephalocaudad is seen on coronal image 44/104. There are no focal lesions in the liver the biliary tract is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 2.2 x 1.4 cm and sixth image 85. This is a likely unchanged. Right adrenal gland is normal.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, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen soft tissue masses in the right sacrosciatic notch, abutting the right iliac bone, in the by back and in the iliac fossa are all decreased to the point that they are not visible and not measurable.Patchy sclerotic changes seen in the right iliac bone, unchanged. No new sites of disease.OTHER: No significant abnormality noted.

Output: Stable sclerotic changes right iliac bone. All soft tissue mass is of decreased to the point of then not measurable. The left adrenal nodule is unchanged. Nonspecific hepatomegaly (new).


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Cough and fever. Evaluate for pneumonia. Cardiomediastinal silhouette is normal. No focal pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59 yo F new dx AML with new O2 requirement 2-4L History: hypoxia Cardiac size is upper limits normal, although appears somewhat globular. Perihilar and basilar predominant interstitial and airspace opacities, compatible with pulmonary edema.

Output: Moderate to severe pulmonary edema. Correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.With history of altered mental status, please rule out infection. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable. 2 tunneled right subclavian central venous catheters with tips in the atriocaval junction. No focal lung opacities visualized.

Output: No focal lung opacity suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.ET tube placement. ET tube is 6 cm above the carina. Large bilateral pleural effusions with underlying atelectasis is unchanged. Contrast material again present over the left upper quadrant. Right jugular lines tip over the right atrium. Left jugular line tip over the SVC.

Output: ET tube 6 cm above the carina. Bilateral large pleural effusions, stable.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No pneumothorax.Large right lower lobe mass, better characterized on the recent outside PET/CT scan.Mild elevation of the left hemidiaphragm with gaseous distention of the stomach.

Output: Right lower lobe mass and no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath The cardiomediastinal silhouette is normal.Persistent right lower airspace opacity with minimal focal consolidation appears similar to the prior study.No pneumothorax or pleural effusion.

Output: No pneumothorax. Persistent right lower lobe airspace opacity.


Instruction: Generate impression based on medical findings.

Input: 51-year-old man with history of pleural mesothelioma status post chemotherapy. Please review and compare to previous scans. CHEST:LUNGS AND PLEURA: Pleural thickening in the right hemithorax with reference measurements as follows:1. At the level of the AP window (series #3, 38/143), 12 mm at one o'clock, previously 13 mm; 7 mm at 7 o'clock, previously 7 mm.2. At the level of the right main pulmonary tree (series #3, 49/143), 14 mm at 8 o'clock, previously 14 mm.3. At the level of the coronary sinus (series #3, 68/143), 8 mm at 7 o'clock, previously 7 mm; 7 mm at 8 o'clock, previously 7 mm.Interval increase in size of pleural based nodules on the right; the largest nodule is seen on image 34/108 of series 5.MEDIASTINUM AND HILA: Subcarinal mass measures 7 x 3.5 cm (series #3, 52/143), previously 7 x 4 cm. Bulky tumor that is contiguous with the esophagus and causes mass effect on the IVC, displacing it anteriorly. It measures 7.3 x 4.7 cm (series #3, 75/143), previously 7.2 x 4.8 cm. Unchanged extension of the tumor into the paravertebral fat, down the retrocrural space, displacing the suprarenal abdominal aorta anteriorly (series #3, 92/143). Interval increase in size of left hilar mass (non-target lesion) which measures 2.8 x 2.3 cm as seen on image 52/143 of series 3.CHEST WALL: Pleural tumor appears to be extending through the chest wall (series #3, 75/143) unchanged since 12/26/07 but does not show any adjacent rib destruction. Sternotomy wires. Dumbbell-shaped fluid-density collection that extends from the spinal canal to the left costophrenic recess is consistent with lateral meningocele as confirmed on prior MR (series #3 87/143).ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodensities in the posterior and lateral aspect of the liver that are too small to characterize. In retrospect, these lesions were present on prior scans.SPLEEN: No significant abnormality notedADRENAL GLANDS, KIDNEYS: Unchanged nonspecific hypodense lesion in the left kidney.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mildly enlarged lymph nodes in the retroperitoneum.

Output: 1. Mesothelioma of the right hemithorax and retrocrural extension with measurements as above. Reference lesions are stable, however, increase in size of non-reference lesions as noted above. 2. No evidence of intraperitoneal extension of mesothelioma.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: SOB History: SOB Severe cardiomegaly with mild to moderate pulmonary edema and pleural effusions, not significantly changed.Support devices are stable.

Output: No change in CHF and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old. Reason: assess for fluid overload History: Shortness of breath Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly again noted.

Output: No acute cardiopulmonary process on radiography. Stable mild cardiomegaly.