Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Status post fall. Decreased mentation. Question aspiration. Small left pleural fluid and basilar opacity, not significantly changed. Improved interstitial pattern suggesting improved edema. No pneumothorax. Right jugular line tip over the SVC. Dobbhoff at least in the stomach.

Output: Improved edema pattern. Stable left basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: assess for infiltrate History: tachycardia, hypothermia, hypotension Right jugular venous catheter in SVC.Stable pulmonary edema and pleural effusions, left greater than right

Output: Stable pulmonary edema and pleural effusions, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: SOB tahcypnea evalute for pathology History: SOB Focal consolidation within the right lung base with hazy opacity in the upper aspect of the right lung. Question of mild hazy groundglass opacity in the upper aspect of the left lung which may be partially related to leftward patient rotation. Mild cardiomegaly again noted. No pneumothorax. No large pleural effusion. Endotracheal tube terminates approximately 6.5 cm from the carina.

Output: Air space disease consistent with pneumonia, aspiration, or hemorrhage. Differential diagnosis would include asymmetric pulmonary edema and/or diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female with history of syringomyelia status post spinal cord stimulation. Superior radiopaque portion of the stimulator device is seen adjacent the posterior spinal canal at the lower of what appears to be T11.Cardiomediastinal silhouette is within normal limits.No acute focal airspace opacity. No pneumothorax or pleural effusion.

Output: Superior portion of spinal cord stimulator adjacent to the posterior spinal canal in what appears to be T11. No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated, sepsis ARDS History: Intubated, sepsis ARDS ET tube tip approximately 6 cm above the carina.Bilateral pleural effusions with underlying pulmonary opacity compatible with atelectasis and consolidation, not significantly changed.Free intraperitoneal air, dilated loops of bowel, unchanged since the previous day.

Output: ET tube in acceptable position. Free intraperitoneal air and dilated loops of bowel, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Pulmonary edema? History: SOB Interval increase in interstitial opacity which is likely due to mild pulmonary edema. Other findings stable.

Output: Interval increase in interstitial opacity which is likely due to mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Hypoxia and acute pancreatitis NG tube placed, side port observed above the GE junction. Please see subsequent reportLungs and mediastinal contours are within limits

Output: NG tube placed


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: assess for acute process - syncope x2 History: assess for acute process - syncope x2 Left IJ catheter terminates in the RA, as before. Unchanged cardiac leads. The right atrial lead again is more inferiorly oriented than typical for right atrial appendage placement of this not substantially changed compared to multiple other studies. Small pleural effusions. Presumed patchy bibasilar atelectasis. Unchanged cardiomegaly. No pneumothorax.

Output: Small pleural effusions with probable basilar atelectasis. No focal lung consolidation or evidence of overt left-sided heart failure.The right atrial lead again is more inferiorly oriented than typical for right atrial appendage placement of this not substantially changed compared to multiple other studies.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: assess for resolution of PTX History: s/p recurrent L PTX with chest tube placement overnight Left-sided chest tube with mild improvement in moderate left pneumothorax.Subcutaneous emphysema in the left chest wall, axilla, and neck.Bilateral interstitial opacities and cysts unchanged.Normal cardiac silhouette size.Tracheostomy, left IJ, and right IJ catheters are unchanged.

Output: Left pneumothorax mildly improved from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: history of L empyema, decortication. Followup xray History: none Focal scarlike opacities noted in the mid and lower aspects of the left lung. Probable left-sided pleural thickening is noted. Right lung is clear. Normal heart size. No pneumothorax. Bilateral breast implants.

Output: Left-sided pleural parenchymal scarring. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Evaluate for causes of chest pain in pt with ischemic cardiomyopathy History: Chest pain Sternal wires and clips are noted. Most inferior sternal wire is fractured. Mitral valve annuloplasty present.Heart size is enlarged. Pulmonary arteries are enlarged. Low lung volumes. No focal airspace opacities, pleural effusion, or pneumothorax identified.

Output: Moderate cardiomegaly and low lung volumes without focal airspace opacities, pleural effusion, or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: eval for aspirated tooth v tooth in gi tract History: s/p EGD for dysphagia, front, lower incisor missing after procedure There is no evidence of radiopaque foreign body from the level of the hypopharynx to the level of L3. Linear densities of the soft tissue in the left neck have been visualized over multiple examinations, dating back to 2014. There is evidence of prior lumbar surgery with radiopaque surgical hardware in place.Persistent tortuosity of the descending thoracic aorta adjacent to a slightly leftward deviated esophagus. The appearance is stable over multiple examinations. The lungs and pleural spaces remain clear. The heart size is normal.

Output: No evidence of aspirated tooth in the GI tract from the level of the hypopharynx to the level of L3.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Subarachnoid hemorrhage, evaluate endotracheal tube. Low endotracheal tube with tip 1.5-cm above the level of the carina. Blunting of the left lateral costophrenic angle with left lower lobe air space opacity and a small pleural effusion. Nasogastric tube projects over the stomach.

Output: Low endotracheal tube. Lower lobe consolidation may be secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Stage IIIc ovarian cancer status post chemotherapy. CHEST:LUNGS AND PLEURA: Stable emphysematous findings with scarring in the left apex. No new lung nodules suspicious for metastatic disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Stable numerous low attenuation foci.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic cluster of lymph nodes measures 13 by 16mm. Overall no significant change in the size and extent of the retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: New subcutaneous soft tissue nodule measuring 7-mm in the anterior abdominal wall on the right side on image number 143, series number 3.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the retroperitoneal lymph nodes. New subcutaneous subcentimeter soft tissue nodule. Metastatic disease cannot be excluded. Multiple splenic lesions are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: 83M with cough. History: productive cough Clear lungs. No pleural effusion or pneumothorax. Normal heart size. Patient status post sternotomy and CABG.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: repeat, ETT placement History: ETT moved 2cm Cardiomegaly with new basilar opacities suggestive of atelectasis with pleural effusions.An NG tube extends below the lower margin of the image.ET tube tip approximately 5 cm above the carina. Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly, with new basilar opacities suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: chf History: chf Interval placement of right IJ cordis and left IJ central venous line with tip in projection of brachiocephalic vein. No pneumothoraces. Support devices otherwise stable in appearance.No interval change in the dense left lower lobe opacity.

Output: Displaced as above. No change in left lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Hemoptysis Motion severely interferes with sensitivity.No gross significant interval change in the previously described cardiomegaly with left lower lung nonspecific opacification. Suspected partial consolidation with an associated moderate effusion. Less pronounced changes observed on the rightRight jugular catheter continues to extend into the right proximal SVC

Output: Stable mixed changes most pronounced in the left lower lobe and again concerning for superimposed infection


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and sickle cell crisis Motion degrades sensitivity.Persistent moderate nonspecific cardiomegaly with suspected pulmonary hypertension. Patchy opacities are again observed although mildly increased with enlarging effusions. Suspected mild superimposed edema upon more extensive chronic changes. Right jugular port prosthetic valve unchanged.

Output: Suspected new mild edema superimposed upon extensive chronic changes


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: pna? Weakness, AMS History: AMS Interval removal of right IJ line. Cardiac leads are not substantially different. No focal lung consolidation or evidence of overt left-sided heart failure. Unchanged mild cardiomegaly. Stigmata of previous granulomatous disease in noted.

Output: No large pleural effusion or pneumothorax. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 51 years, Male. Reason: evaluate for post op distention History: as above Markedly distended stomach and small and large bowel dilatation, suspicious of severe ileus in the postoperative setting. Please see same day chest radiograph report for thoracic findings.

Output: Severe postoperative ileus.Findings were discussed with Dr. Fintel on 12/13/2016 at 10:30 a.m.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male status post laryngectomy and free flap neck reconstruction. Evaluate for anastomotic leak. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Surgical clips were present in the neck.Volume-controlled test swallow showed no evidence of aspiration in the hypopharynx on AP and lateral views (series 3 and 4). Limited single contrast evaluation of the esophagus showed no mural contour abnormality or abnormal contrast extravasation to indicate an anastomotic leak. Small hiatal hernia was observed. Limited views of the gastric cardia/fundus were grossly unremarkable. TOTAL FLUOROSCOPY TIME: 5:57 mm:ssAIR KERMA: 73.1 mGy

Output: 1.No fluoroscopic evidence of anastomotic leak on this limited study.2.Small hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Reason: f/u pna, pneumothorax History: sob, desaturation Extensive bilateral patchy nonspecific airspace opacities, consistent with the clinical diagnosis of pneumonia, not significantly changed.Moderate left pleural effusion.No visible pneumothorax, although there may be a small residual anterior pneumothorax on the left.

Output: Extensive airspace opacity compatible with pneumonia with no visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Maze with CT. Interval removal of left apical chest tube without significant pneumothorax. Pericardial drain and left atrial appendage occlusion clip similar in position. Moderate volume of pleural fluid on the left, increasing over the last few days. Worsening retrocardiac opacity in the left lower lobe. Atelectasis at the right base is unchanged. Smaller pleural fluid collection on the right. Central venous distention but no evidence of pulmonary edema.

Output: Worsening left lower lobe retrocardiac opacity which may reflect atelectatic lung and possible aspirate. No specific evidence of pulmonary edema. Enlarging left pleural fluid collection. Signs of hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: Aspiration, infectoin History: AMS, ?seizure, anion-gap There appears to be a masslike opacity overlying the right hilum. While it is possible that this represents an enlarged pulmonary artery, more pronounced as the patient is rotated, CT the chest should be obtained for complete evaluation.Right upper lobe scarring as well as thickening of the paratracheal stripe with calcified hilar and mediastinal of stones are noted.Nasal scarring and bronchial wall thickening are likely chronic findings.No specific evidence of acute edema or infection.

Output: 1. Masslike opacity overlying the right hilum. This may represent enlarged pulmonary artery however CT of the chest can be obtained for complete evaluation.2. No specific evidence of infection or edema.3. Chronic findings as above.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with dyspnea and fever. Concern for pulmonary embolus in setting of malignancy presumed to lung. CHEST:PULMONARY VASCULATURE: No PE. The study is diagnostic to the level of the segmental pulmonary arteries.LUNGS AND PLEURA: Bilateral pulmonary micronodules appearing similar to prior study from 12/20/2008 with the largest nodule in the right middle lobe again measuring approximately 7 mm (series 6, image 47). No new suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Moderate to severe coronary calcifications in the LAD.Stable enlargement of the thyroid gland.Hiatal hernia.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No other significant abnormality noted.

Output: 1. No PE.2. Stable micronodules bilaterally. No new suspicious nodules or masses.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: eval PNA History: URI sx, DKA No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: 3 days of intermittent CP, occasional SOB, no prior cardiac hx History: chest pain, SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: eval for infection History: basic infectious w/u Two right internal jugular central venous catheter tips terminate in the SVC. The left internal jugular central venous catheter has been removed. Presternal AICD lead again noted.Possible small right pleural effusion. No focal consolidation or pneumothorax is evident. Cardiomegaly unchanged.

Output: Cardiomegaly and possible small right pleural effusion, without reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64M with cough, subjective fever, myalgias History: 64M with cough, subjective fever, myalgias No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pulmonary edema History: REspiratory distress Small bilateral pleural effusions, not significantly changed.Mild basilar opacity compatible with atelectasis.Chronic abnormalities in the right hemithorax with a hilar mass and fibrosis.Port catheter tip in the SVC.Tracheal deviation at the thoracic inlet compatible with a goiter.

Output: Small pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: IABP History: As above Left-sided ICD and IABP marker unchanged.Stable cardiac mediastinal silhouette.The lungs are clear.No pleural effusions.

Output: Sports device is unchanged with IABP marker in the proximal descending aorta. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: Intubated History: as above Endotracheal tube terminates 3 cm above the carina. Interval placement of a right IJ central catheter that terminates at the inferior right atrium. The right subclavian catheter is unchanged in position.Confluent left perihilar and more patchy diffuse opacities on the right have not significantly changed. No pneumothorax. Mild cardiomegaly. Small bilateral layering pleural effusions.

Output: Stable dense left perihilar and patchy right-sided opacities with small pleural effusions have not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Status post AVR. Left subclavian pacemaker, valve prosthesis and sternotomy hardware. Interval resolution of pleural fluid and left basal atelectasis. Minimal scarring or atelectasis remains at the left base. No pneumothorax.

Output: Resolution of pleural fluid. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: 60yoM intubated on vent with pleural effusions, assess effusions and ETT History: intubated on vent ET tube with its tip approximately 6 cm above the carina.NG tube with its tip in the stomach.Right IJ venous catheter with its tip in the RA.Stable cardiac enlargement.Perihilar interstitial and airspace opacities , more marked on the right, and associated right pleural effusion similar in appearance to the prior exam.No new pulmonary opacities identified.Redemonstration of multiple bullet fragments the upper abdomen.

Output: Support devices unchanged with ET tube tip in a somewhat high position. Stable cardiopulmonary appearance with air space/interstitial opacities and pleural effusions more marked on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: AM cxr - s/p lung resection History: s/p lung resection Persistent small right pneumothorax with associated volume loss. Right perihilar and left lower lobe opacity slightly increased, possibly aspirated secretions. Atherosclerotic disease involves the distal transverse arch. Heart size stable.

Output: Persistent small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: Eval for pneumonia. History: Hypoxia and known ABPA history. Extensive perihilar predominant opacities which could be related to known ABPA, but the extent raises a question of superimposed pneumonia.Heart size normal.Suboptimal study in part due to the patient's size.

Output: Extensive perihilar opacities suggestive of known ABPA with possible superimposed infection. A thoracic CT would better visualize these findings.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: r/o infection, edema, effusion History: shortness of breath, wheezing The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: check pulmonary status History: check pulmonary status ET tube and NG tube unchanged.Right perihilar and upper lobe mass and accompanying atelectasis similar to the prior exam.No new pulmonary opacities identified.Stable cardiomediastinal silhouette.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: follow up on prior image given persistent chronic cough, r/o infection or aspiration History: chronic cough Left neck surgical clips again noted.Suture line and volume loss in the left hemithorax again compatible with lung resection.No new focal airspace opacity, pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No specific evidence of infection


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: r/o PNA, effusion History: Recent URI, cough x1 week, chest pain No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: assess RA and RV lead placement History: noise on both leads The heart is normal in size. Dual lead pacemaker in place, unchanged in position. The position of the left pacer leads is unchanged, terminating in the right atrium and apex of the right ventricle.Abandoned pacer leads again noted.Lung volumes are normal. No signs of fluid overload or pulmonary edema.The pleural spaces are within normal limits.Surgical plates in the right axilla again noted.

Output: Stable position of left pacer leads. No signs of pulmonary edema.Abandoned pacer leads again noted.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable cardiac and mediastinal silhouette. Small focal scar like opacities in the right lung no active disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: LVAD History: LVAD Left subclavian single lead AICD in the right ventricle.LVAD in place.Mitral valve annuloplasty.Median sternotomy wires.Stable cardiomediastinal silhouette. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: eval for pna History: generalized weakness, hx of tb and pna Right basilar consolidation has slightly improved. Increased left basilar opacity may be due to atelectasis, aspiration, or consolidation. Loss of height of multiple vertebral bodies consistent with compression fractures.

Output: Right basilar consolidation has slightly improved. Increased left basilar opacity may be due to atelectasis, aspiration, or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: r/o infection, edema, effusion History: shortness of breath Decreased lung volumes.Widening of the mediastinum compatible with mediastinal lipomatosis identified in prior CT.Stable cardiomegaly. Mild basilar atelectasis. No focal consolidation. No pleural effusion.

Output: Stable exam with no acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Right middle lobectomy Continued mild improved aeration with postsurgical changes and volume loss observed in the right lower lung. Minimal fluid again tracks in the remaining fissure.Left lung is clearCardiac and mediastinal contours are within limits

Output: No acute changes


Instruction: Generate impression based on medical findings.

Input: 64 years, Female, Reason: hypoxia History: desats. Stable cardiomediastinal silhouette.Retrocardiac consolidation/atelectasis is slightly improved. Additional diffuse multifocal air space opacities are unchanged. Small effusions are unchanged.ICD is unchanged. Endotracheal tube tip terminates 4 cm from the carina. Right internal jugular catheter tip in SVC. NG tube tip projects beyond the inferior margin of the radiograph.

Output: Slightly improved retrocardiac consolidation/atelectasis with persistent diffuse multifocal opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: 57F with shortness of breath and hypoxia. History: dyspnea Severe cardiomegaly is unchanged. Small pleural effusions without frank edema. Improved aeration of the lung bases. No interval pneumothorax.

Output: Cardiomegaly with small pleural effusions. Resolving edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: evidence of fluid in lungs History: acute onset of SOB following transfusion c/f trali Chronic appearing elevation left hemidiaphragm with overlying scarring or subsegmental atelectasis.Small lung volumes with no reliable evidence of edema or pneumonia.Heart size normal.

Output: Chronic elevation left hemidiaphragm, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: infection History: SOB No significant cardiopulmonary abnormality.Mild apical scarring unchanged.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Pneumonia and empyema.VIEW: Chest AP (one view) 02/28/15, 0530 Left upper extremity PICC has its tip in right atrium. Left chest tube is present.A small to moderate left pneumothorax has developed. Opacity in the left base has decreased and the left hemidiaphragm is now sharply defined (in part this may also be related to the pneumothorax). Right base opacity persists. There appears to be a small right pleural effusion. Cardiac silhouette size is upper limits of normal.

Output: Left pneumothorax. Decrease in left base opacity.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with chest pain and cough. Stable cardiomegaly with single ICD lead extending to the area of the apex of the right ventricle.Interval improvement of bibasilar opacities and small bilateral pleural effusions. No pneumothorax.Partially visualized spinal fixation hardware in the lumbar spine.

Output: Interval improvement of bibasilar opacities and small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: r/o infection History: cough, SOB Sign detail is limited by patient habitus. There is a new opacity at the right base, suspicious for pneumonia. Recommend follow-up imaging following treatment dimension resolution. Heart size is normal.

Output: Right basilar opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: short of breath and cough x 5 days History: sob cough Severe volume loss in the right hemithorax with shift of the mediastinum to the left side, unchanged from previous. Pleural calcification in the left lower hemithorax, previously confirmed by CT scan.Compensatory hyperinflation in the right lung with no acute findings.

Output: Extensive chronic abnormalities in the left hemithorax with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: R/o PTX in patient with hypoxia s/p chest tube placement History: R/o PTX in patient with hypoxia s/p chest tube placement New perihilar opacities left greater than right suggestive of aspiration or infection.Severe bullous emphysema especially affecting the right lung base unchanged.Small left pleural effusion.Left pleural pigtail catheter with no left pneumothorax.Endobronchial valves are unchanged in position.

Output: No significant pneumothorax. Increasing perihilar opacities suggestive of aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Is ETT in correct position? History: Intubated Lines and tubes are unchanged. Diffuse pulmonary opacities again noted. Heart size difficult to assess.

Output: Diffuse pulmonary opacities again noted consistent with diffuse alveolar damage and/or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.IABP placement. Motion artifact.IABP marker about 5.5 cm below the top of the aortic arch at the T6/T7 level.Mild cardiomegaly and edema-like opacities, left greater than right, about the same.Right jugular Swan-Ganz catheter tip in the proximal right main pulmonary artery projection.Left subclavian ICD unchanged.

Output: IABP marker about 5.5 cm below the top of the aortic arch. No acute change in pulmonary opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: MaleReason for Study: Reason: Pateint with concern for bleeding AAA admitted to SICU on transfer History: as above Cardiac size is normal.Widening of the mediastinum is nonspecific.There are decreased lung volumes with mild basilar scarring/discoid atelectasis .No focal areas of consolidation.No large pleural effusions.

Output: Widening of the mediastinum is nonspecific. CT of the chest with IV contrast may be of value.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o ptx History: s/p ct pull, currently w/ another ct Cardiac size unchanged. Interval removal of one of the 2 right chest tube with tip extending towards the lung apex. Resolving right pneumothorax. Bibasilar and bilateral hilar patchy opacities unchanged. Bilateral pleural effusions without significant change. Minimal chest wall and shoulder subcutaneous emphysema.

Output: Interval removal of one of the 2 right-sided chest tubes. Resolving right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: et tube History: et tube advancement ET2 with tip now approximately 4 to 5 cm above the carina.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette with nonspecific pulmonary opacities improved from the prior exam.

Output: Interval advancement of the ET tube with its tip now 4 to 5 cm above the carina. Mild interval improvement in the nonspecific pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Hypoxia. Persistent bilateral pleural effusions with underlying atelectasis/consolidation, diffuse bilateral opacities, right greater than left consistent with pulmonary edema. NG tube is coiled within the stomach with the tip projecting towards the fundus. Right chest tube tip projects towards the right apex. There is support lines and devices are unchanged in position. No significant interval change in size of the cardiac silhouette.

Output: Persistent pulmonary edema and pleural effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: eval for volume status History: 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: Male, 60 years old.Reason: SOB, want to eval for edema History: SOB Stable cardiomediastinal silhouette in size and configuration.An element of perihilar congestion is again seen without frank edema. Bilateral pleural effusions, left greater than right, are slightly larger than on prior study and demonstrate a new localized component along the left major fissure. There are associated atelectasis with suggestion of retrocardiac consolidation. No evidence of pneumothorax.No acute osseous abnormality.

Output: 1.Bilateral pleural effusions, left greater than right, are slightly larger than on prior study and demonstrate a new localized component along the left major fissure. No other significant interval changes.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval ETt, lung fields History: s/p LVAD exchange Right jugular Swan-Ganz catheter tip in right proximal pulmonary artery. ET tube tip 6 cm above carina. LVAD partially visualized.Lungs hypoinflated with no significant pulmonary metastases, pleural effusions, or pneumothorax.

Output: ET tube tip 6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old. History of intermittent wheezing. Normal heart size. No airspace opacities, effusions, or pneumothorax.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung History: eval lung Status post right pneumonectomy with complete opacification of the right hemithorax and increased in volume compared to the left.Tracheostomy tube and venous catheters unchanged.Left lower lobe airspace opacity compatible with atelectasis and consolidation, unchanged.No new findings.

Output: Status post right pneumonectomy with left lower lobe consolidation and no acute change.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer status post surgery and I-131 ablation There is mild activity consistent with functioning thyroid tissue in the midline neck.There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. Probe uptake of the neck was not measured.

Output: Functioning thyroid tissue detected in the neck.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval swan position History: as above Newly apparent catheter tip overlies the left superior aspect of the hemithorax. Iatrogenic devices are unchanged, otherwise. Diffuse prominent opacities, unchanged. Small pleural effusions. Unchanged cardiomegaly. No pneumothorax.

Output: Newly apparent catheter tip overlies the left superior aspect of the hemithorax.Diffuse prominent opacities, unchanged. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Rule-out pneumonia. Cough. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary gas which are also within normal limits. No airspace disease pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: History of thyroid cancer status post thyroidectomy and radioactive thyroid ablation. Two foci of activity is seen within the thyroid surgical bed, compatible with residual functioning thyroid tissue. There is expected I-131 activity in the liver.

Output: Two small foci of residual functioning thyroid tissue in the surgical bed.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: sp CEA History: continued O2 requirement Median sternotomy with mild cardiomegaly and mild lower lung zone edema with pleural effusions.Left subclavian biventricular dual-chamber pacemaker, multiple leads in the right ventricle.

Output: CHF with mild edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old. Reason: sepsis, CHF History: sepsis Mild cardiomegaly with a tortuous aorta.Low lung volumes with bibasilar opacities likely representing subsegmental atelectasis and/or scarring.No specific evidence of infection or edema.No pleural effusion or pneumothorax.

Output: Cardiomegaly without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 18 yearsGender: MaleReason for Study: Reason: follow-up on nodular RUL infiltrate one month after antibiotics History: nodular infiltrate in context of clinical pneumonia Interval resolution of the right upper lobe nodular opacity identified on the prior exam.No new pulmonary opacities identified.The cardiomediastinal silhouette is unremarkable.No pleural effusions.

Output: Interval clearing of the previously noted right upper lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices ET tube relatively high with its tip about 8 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Perihilar and basilar opacities suggestive of edema, atelectasis and small effusions.

Output: High position of ET tube.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is minimal disc narrowing at C5-C6, with interval increased disc signal posteriorly extending along the inferior endplate of C5. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a stable trace disc bulge with minimal right uncovertebral hypertrophy. There is mild right foraminal narrowing. There is mild developmental narrowing of the central spinal canal. There is trace flattening of the right ventral cord.At C4-C5, there is a stable trace disc bulge with right uncovertebral hypertrophy resulting in minimal right foraminal narrowing. There is mild developmental narrowing of the central spinal canal and trace flattening of the right ventral cord.At C5-C6, the previous left paracentral disc protrusion is no longer appreciated, with at most a trace residual disc bulge and minimal right uncovertebral hypertrophy. There is mild narrowing of the central spinal canal with mild ligamentum flavum thickening. There is also right facet arthropathy contributing to overall moderate right and mild left foraminal narrowing.At C6-C7, previously seen small left paramedian central disc protrusion has resolved. There is minimal right foraminal narrowing secondary to uncovertebral hypertrophy and facet arthropathy.At C7-T1, there is minimal uncovering of the disc and bilateral uncovertebral hypertrophy. There is no significant stenosis.At T1-T2, there is again a prominent left-sided nerve roots sleeve cyst which is partially visualized.

Output: Interval improvement in previously noted cervical spondylotic changes, with focal disc pathology at C5-C6 and C6-C7 no longer appreciated. Mild developmental narrowing of the cervical spinal canal at several levels with up to moderate right foraminal narrowing at C5-C6.


Instruction: Generate impression based on medical findings.

Input: Reason: 60F pw CP SOB History: CP SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.ARDS monitoring. ET tube tip is about 2 to 3 cm above the carina. Leftward rotation makes right central jugular venous catheter positioning hard to determine, likely tip in the SVC. Persistent bilateral diffuse reticulonodular opacity consistent with clinical history of diffuse alveolar damage. Pleural effusions are difficult to assess given patient rotation.New pneumomediastinum.

Output: New pneumomediastinum. ET tube tip about to 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: eval pulmonary edema/pleural effusion History: s/p hepatectomy, now w/ fluid overload getting diuresis Right IJ venous catheter has been removed.Stable cardiomediastinal silhouette with decreased lung volumes.Perihilar/basilar opacities compatible with edema and atelectasis.Pleural effusions, right greater than left.Drainage catheter and multiple surgical clips in the upper abdomen.

Output: Stable cardiopulmonary appearance with pleural effusions, basilar atelectasis, and edema.


Instruction: Generate impression based on medical findings.

Input: Reason: febrile History: same Unremarkable cardiac and mediastinal silhouette. No sign of pneumonia or pulmonary edema.Mild blunting of the posterior costophrenic angles, suggestive of small pleural effusions or possibly scarring, which could be better evaluated with erect PA and lateral views of the chest.

Output: Possible small pleural effusions but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: s/p AVR/MVR; ?Pulm Edema History: SOB Cardiomegaly with bilateral pleural effusions, left greater than right, not significantly changed. Some fluid tracks into the fissure on the right.Postop change with mild basilar pulmonary edema. Retrocardiac consolidation/atelectasis unchanged.

Output: Mild basilar pulmonary edema with stable bilateral pleural effusions. Retrocardiac consolidation/atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: PICC line repositioned PICC line mildly retracted, tip projects into the mid SVC. No additional cardiopulmonary change

Output: Right PICC line repositioned


Instruction: Generate impression based on medical findings.

Input: Cerebral infarction, endocarditis Staphylococcus infection check for CHF ETT remains 4 7-m above the carina. Dobbhoff well advanced, tip extends coiled in the proximal stomach.Essentially unchanged mixed interstitial patchy opacities greater perihilar and basilar distribution with moderate cardiomegaly. Appearance suggests edema and moderate CHF, however superimposed process such as aspiration or even infection, specifically the left lower lobe cannot be excluded.

Output: ETT remains well-positioned. Moderate CHF


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Eval lungs for effusion and atelectasis History: SOB Median sternotomy with cardiomegaly.Status post valve repair.Small pleural effusions and basilar atelectasis unchanged.

Output: Cardiomegaly and pulmonary opacities with pleural effusions are unchanged. No new findings.


Instruction: Generate impression based on medical findings.

Input: Evaluate connectivity The exam is limited secondary to inability to optimally position the patient.SHUNT DEVICE: There is an intracranial shunt that exits the skull via a right frontal burr hole. A second shunt tube extends from the right posterior cranial fossa superiorly to the top of the skull and these 2 shunts appear to connect via a radiolucent T type connector before coursing down the right scalp, neck, and thoracic cavity, terminating posteriorly in the pleural space. Portions of the shunt tubing overlying the skull are radiolucent which limit evaluation but there are no specific findings of shunt complication. Additional shunt tubing is noted overlying the skull and skull base not seen on the prior shunt study but present on the comparison CT. This additional tubing does not appear to connect to the aforementioned shunt device.SKULL: No significant abnormality noted. Note is made of unerupted molars.CERVICAL SPINE: Evaluation of the cervical spine is limited on the lateral view secondary to overlying anatomy. There is no gross abnormality identified on the AP view.CHEST: The lungs are hypoinflated but we see no focal pulmonary opacities.

Output: Shunt tubing as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: shortness of breath History: see above Mild nodular opacities are noted at the lung bases with minimal superimposed reticular abnormality. Normal heart size given the AP projection. Coronary stent is noted. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: No focal lung consolidation. Mild nodular opacities at the lung bases with minimal superimposed reticulation suggests mild interstitial lung disease possibly dendriform pulmonary ossification given morphology. Consider further evaluation with interstitial lung disease protocol chest CT.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: cough History: cough New right pleural effusion, possible left.Heart size normal.Healed granulomatous disease.An NG tube extends below the lower margin of the image.

Output: New pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female. Evaluate for progression of metastatic disease. Prior records indicate history of chondrosarcoma. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No new suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Hypoattenuating lesion near hepatic dome (series 3, image 84) has been present since study from 7/11/2006 without significant change and likely representing a benign hemangioma.Hypoattenuating lesion in segment 7 (series 3, image 90) correlates with the flash filling lesion seen in this location on study from 7/11/2006 and also likely represents a benign hemangioma, not significant changed since most recent prior study.The additional flash filling lesion seen on study from 7/11/2006 is not present on the study, likely due to phase of contrast.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.

Output: 1. No evidence of metastatic disease.2. Probable benign hemangiomas in the liver without significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval swan History: see above Swan-Ganz catheter tip in the right main pulmonary artery.Feeding tube tip in the stomach.No significant pulmonary abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: ETT placement ET tube tip about 7 cm above the carina.Right jugular catheter tip in the right atrium and ICD leads unchanged.Marked cardiomegaly with a few septal lines at the lung bases and no other evidence of pulmonary edema or infection.

Output: Slightly high position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: postop p, eval ETT, lung fields History: s/p aortic dissection Chest and pleural drains with no pneumothorax.Cardiomegaly, with some postop widening of the mediastinum. Basilar opacities consistent with edema and pleural effusions are now present postoperatively.ET tube tip approximately 5 cm above the carina.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.

Output: ET tube tip approximately 5 cm above the carina. Postop basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: 53 y M with IABP ?placement History: 53 y M with IABP ?placement No significant cardiopulmonary abnormality.IABP catheter proximal marker 4 cm below the top of the aortic arch.Left PICC, tip in the SVC.

Output: IABP catheter unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, evaluation for pulmonary edema History: SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: is there pul edema. History: chest pain. +substance abuse Unremarkable cardiac and mediastinal silhouette. Perihilar bronchial thickening compatible with chronic bronchitis or asthma.No sign of pulmonary edema or pneumonia.

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


Instruction: Generate impression based on medical findings.

Input: Reason: left chest tube placement History: pneumothorax Tracheostomy tube, venous catheter and left chest tube unchanged.Diffuse interstitial opacity with a large left perihilar lung cyst and a smaller cyst at the right base.No pneumothorax or other acute change.

Output: No pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of metastatic melanoma CHEST:LUNGS AND PLEURA: Linear atelectasis and scarring at the lung bases, unchanged.MEDIASTINUM AND HILA: Calcified mediastinal adenopathy, unchanged.CHEST WALL: New left axillary adenopathy. Index lesion on image number 33, series number 3 measures two .1 x 1.9 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral numerous renal cysts, stable. Bilateral kidneys are enlarged. These findings can be compatible with adult-onset poses the kidney disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: Hypodense right inguinal lymph node measuring one .1 x 1.1 cm on image number 240, series number 3, new from previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New left axillary adenopathy there suspicious for metastases. Small right inguinal lymph node, new from previous study. Although its size is small, its diffuse hypodense nature make it suspicious for metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.History: Status post heart transplant (2009). Symptoms: Cough Status post median sternotomy. Stable cardiomediastinal silhouette.No pulmonary or pleural abnormality.

Output: No acute cardiopulmonary abnormalities.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, 65 years old.Reason: r/o new infiltrate History: fever Study limited by leftward patient rotation. Slight increase in left basilar opacity. No new focal pleural parenchymal opacity in the right hemithorax. Unchanged heart size. No pneumothorax.

Output: Increased left basilar opacity which may represent aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: post op cardiac surgery History: post op cardiac surgery Support devices unchanged. Stable cardiac enlargement.Basilar opacities compatible with atelectasis and pleural effusions.No new pulmonary opacities identified.No evidence of pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 9-year-old male status post chest tube removal. Evaluate for pneumothorax.VIEW: Chest AP (one view) 2/26/2015 11:35 Interval removal of right chest tube. Left chest tube and right pigtail catheter in stable position. Left upper extremity PICC tip in right atrium.Cardiothymic silhouette size cannot be evaluated. Slightly improved aeration of the bilateral lower lobes however opacities persist. Small left subpulmonic pneumothorax. No pneumothorax on the right.

Output: Interval removal of right chest tube. Small left sided subpulmonic pneumothorax. No pneumothorax on the right. Slightly improved aeration of the bilateral lower lobes.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Shortness of breath question pulmonary edema. Severe multichamber cardiomegaly and/or pericardial effusion, about the same. Large layering pleural effusions may be slightly decreased, though difficult to compare due to differences in patient positioning. Associated atelectasis also appears improved. Previously seen opacity on the right has resolved, with pulmonary vascular redistribution and bronchial wall thickening consistent with hypervolemia.

Output: Signs of hypervolemia/edema with large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: s/p IR lung biopsy, now w/ bleeding at site, drop in hemoglobin, eval for hemothorax History: bleeding Left PICC tip at the left subclavian vein.Cardiomediastinal silhouette is not significantly changed.Low lung volumes. Focal pulmonary opacity in the left midlung is unchanged. Layering right pleural effusion and right lower lobe atelectasis comparable to pre-biopsy studies. No evidence of hemothorax.

Output: Layering right pleural effusion and right lower lobe atelectasis comparable to pre-biopsy studies. No evidence of hemothorax.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with new onset right upper quadrant pain any shortness of breath. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Specifically, no perihepatic or peridiaphragmatic fluid collections.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild submucosal fat deposition is seen the terminal ileum, which can be seen with chronic inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of hepatic mass. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Left rib pain History: Left rib pain in a patient being managed for stage III breast cancer Port catheter tip is in the SVC. Left axillary surgical staples seen.The cardiomediastinal silhouette is normal.No focal pulmonary opacity or pleural effusions.There is no gross osseous abnormality seen involving the ribs.

Output: No findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esophagectomy with jejunal conduit with leak History: - Bilateral airspace and interstitial opacities, greater in the upper lung zones and pleural effusions are thickening, unchanged.Mediastinal drain and esophageal stent also unchanged.Drainage catheter in the left lower pleural space.

Output: Devices and pulmonary opacities without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Hemoptysis, upper respiratory infection The cardiomediastinal silhouette is unremarkable. No pleural effusion or pneumothorax. Mild bibasilar atelectasis/scarring. The lungs are clear.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Aspiration and worsening fevers. Stable cardiomediastinal silhouette. There is a persistent layering right pleural effusion with overlying atelectasis, appearing similar compared to prior. There is retrocardiac opacity is not significantly changed. Enteric feeding tube tip extends beyond the inferior margin of the image.

Output: Stable layering right pleural effusion with overlying atelectasis. Retrocardiac opacity may represent atelectasis and is not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: cough, N/V Unremarkable cardiac and mediastinal silhouette.Mild streaky opacity at the left base suggestive of subsegmental atelectasis.No specific evidence of pneumonia.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 47 year-old female with metastatic breast cancer status post Taxol. Evaluate for changes in tumor prior to next cycle. CHEST:LUNGS AND PLEURA: Postradiation changes in the anterior aspect of the left upper lobe are stable. The previously identified right lower lobe nodular opacity is reidentified and appears stable in size. Basilar, pleural-based right lower lobe opacity seen on image 74/86 which was present in the study on 3/18/2008 appears slightly larger.MEDIASTINUM AND HILA: The reference left anterior mediastinal mass now measures 27 x 12 mm on image 30 (previously 27 x 12 mm). The reference prevascular lymph node measures 19 x 12 mm as seen on image 32/144 (previously 19 x 12 mm). The reference right infrahilar lymph node measures 9.8 x 6.9 mm as seen on image 46 (previously 10 x 8 mm). The pericardial lymph nodes as seen on image 59 are stable in size.CHEST WALL: Decrease in axillary lymphadenopathy. Left axillary surgical clips.ABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic metastases are identified. The reference lesion in the hepatic dome has slightly decreased in size measuring 12 x 14 mm as seen on image 75/144 (previously 16 x 15 mm).SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scarring adjacent to the left paramedian abdominal wall defect is reidentified. Unchanged osseous metastasis in the mid thoracic and thoracolumbar vertebral bodies.OTHER: No significant abnormality noted

Output: Slight increase in size of basilar pleural based right lower lobe opacity. Otherwise, no new focus of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Status post extubation, evaluate left lower lobe infiltrate. Pneumonia. Interval extubation. Nasogastric tube tip projects over the projection of the proximal duodenum.Lung volumes remain low with subsegmental atelectasis at the bases.

Output: No acute change in left lower lobe opacity, most suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: hypoxemia. Checking for pathology History: hypoxemia Left lower lobe consolidation and left pleural effusion, new, consistent with infection or aspiration.Right lung unremarkable.An NG tube terminates in the stomach.Left jugular catheter tip in SVC.

Output: New left lower lobe consolidation and left pleural effusion, consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Chest pain after blunt trauma. The cardiomediastinal silhouette is within normal limits. Subsegmental left basilar atelectasis. No focal airspace opacity, significant pleural effusion, rib fracture, or pneumothorax. Mild leftward bowing of the proximal trachea is suggestive of a thyroid goiter.

Output: No acute cardiopulmonary abnormality or visible rib fracture.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: r/o PE, PNA, dilated cardiomyopathy, pleural effusion, cardiac effusion, pulm fibrosis History: increasing SOB x 4 days and tachycardia, pt on chemo for breast ca with h/o radiation Diffuse nodular and masslike pulmonary opacities with interval increase in the right lower lung zone.Left pleural effusion redemonstrated.Previously noted left apical pneumothorax has been resolved.Stable cardiomediastinal silhouette.Spinal stabilization hardware again noted.

Output: Extensive pulmonary nodular and masslike opacities increased in the right lower lung zone compared to the prior exam. Persistent left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: pulmonary edema, widened mediastinum History: shortness of breath Median sternotomy with mild to moderate cardiomegaly.Deep systemic veins are slightly distended but there is no evidence of a mediastinal hematoma.Worsening lower lung zone edema with pleural effusions and pleural thickening.

Output: Worsening CHF/hypervolemia with underlying chronic pleural and parenchymal lung disease.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Lung Status/Pneumo Extremely limited exam secondary to a portable machine malfunction. Exam will be repeated. No large pleural effusion or pneumothorax. Subsegmental atelectasis. Endotracheal tube tip appears about 2 cm above the carina with esophageal temperature probe in place. Enteric tube tip appears in the mid thorax. Subtle nephrograms.

Output: Endotracheal tube tip about 2 cm above the carina. Enteric tube tip appears in the mid thorax consistent with esophageal placement. Subtle nephrograms, if patient has received recent contrast these may indicate renal insufficiency.Exam will be repeated.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: volume status assessment History: volume status Support devices are unchanged in position.Stable cardiopulmonary appearance. No pneumothorax.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Female; 18 years old. Reason: recent pneumonia History: cough/sob Interval improvement in right basilar consolidation since prior radiograph. No new airspace opacity or pleural effusion. Normal cardiomediastinal silhouette.

Output: Interval improvement in right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of neuroendocrine tumor. Status post chemotherapy CHEST:LUNGS AND PLEURA: Mild emphysema is unchanged. No new nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference lesion near the gallbladder in the right lobe of the liver is not well seen and measures 9-mm in diameter on image number 109, series number 3. However, other larger metastatic lesions in the liver are slightly smaller. A bilobed lesion near the dome on image number 95, series number 3 now measures 6.1 x 2.7 cm. Previously it was measuring 7.3 x 4.8 cm. No new hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is unchanged measuring 17 x 21 cm. Right adrenal nodule is also unchanged measuring 2.7 x 1.6-cm.KIDNEYS, URETERS: Complex cystic lesion in the upper pole of the right kidney is unchanged measuring 2.5 x 1.7 cm. there is suggestion of enhancement posteriorly within this mass.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ill-defined soft tissue nodule in the right lower anterior abdominal wall is smaller measuring 8mm image number 145, series number 3.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic and stenotic lesions throughout the vertebral bodies, ribs and pelvic bones are unchanged. Again noted compression fracture of the L1 vertebral body.OTHER: No significant abnormality noted

Output: Interval decrease in the size of most of the liver metastases and the right anterior abdominal wall nodule.Bone metastases are unchanged.Complex cystic right renal mass demonstrates possible enhancement posteriorly. A cystic renal cell carcinoma cannot be excluded. Further evaluation with dedicated renal mass protocol is recommended.


Instruction: Generate impression based on medical findings.

Input: Left upper lobe VATS Basilar and left apical scarring and/or atelectasis without additional cardiopulmonary acute abnormality and consistent with left upper lobectomy. The cardiac and mediastinal contours are within limits

Output: Postsurgical left upper lobectomy changes


Instruction: Generate impression based on medical findings.

Input: Carcinoid tumor. Postoperative volume loss from right middle and lower lobectomies. Right upper lobe hyperexpanded with slight interval decrease in moderate right pleural fluid collection. Left lung is clear. Surgical staples right chest wall unchanged.

Output: Moderate right pleural fluid collection slightly decreased in volume.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p VATS LUL wedge History: s/p chest tube pull Interval removal of a left chest tube with no significant residual pneumothorax, though there may be a small amount of residual air inferolaterally.Basilar opacities compatible with atelectasis.Moderate subcutaneous emphysema left chest wall.

Output: Interval left chest tube removal with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: right lower lobe crackles History: right lower lobe crackles Heart size about upper normal or mildly enlarged.Small lung volumes with lower zone interstitial opacity and septal lines suggestive of edema with atelectasis and small pleural effusions.

Output: Basilar edema with small pleural effusions suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Stent placement Interval right bronchial mainstem stent placed essentially within the bronchus intermedius.A moderate and poorly defined right hilar mass with extension into the right middle lobe is otherwise observed. Mild volume loss and small effusion. Right upper lung and left lung are otherwise grossly clear other than minimal atelectasisThe cardiac and mediastinal contours are otherwise unremarkable

Output: Right bronchial stent placed and underlying right hilar mass


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 52 year old female on methotrexate for 7 years and has lung toxicity. Now on the IV steroids. Evaluate for response. CHEST:LUNGS AND PLEURA: Marked interval improvement in bilateral upper lobe ground glass opacities, though some of the apparent improvement is due to increased pulmonary inflation.Multiple biopsies sites in the right lung, unchanged.MEDIASTINUM AND HILA: Mildly enlarged lymph nodes with no significant change.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Marked interval improvement in bilateral upper lobe groundglass opacities consistent with drug toxicity.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Neutropenic, hypotensive, syncopal episode. Right jugular catheter tip at the SVC.Diffuse interstitial abnormality new from previous..No pneumothorax.

Output: Mild interstitial abnormality suggestive of edema. Please note that viral pneumonia could have a similar radiographic appearance and a CT may be considered if this abnormality persists after fluid management.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: ETT placement ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Diffuse interstitial opacity and probable small pleural effusions, with no acute change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: 57M with h/o nonischemic heart failure here with worsening edema and orthopnea, eval for effusions/pulm edema History: SOB, LE edema, weight gain Cardiomegaly, with an enlarging right pleural effusion.No specific evidence of edema, and a sign of infection.

Output: Cardiomegaly and right pleural effusion, likely CHF in nature.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: intubation History: intubation The patient is intubated with endotracheal tube 5 cm above the carina.Large lung volumes compatible with COPD. Mild diffuse bronchial wall thickening suspicious for active bronchitis. Blunting bilateral costophrenic angle suggests trace effusions. Heart size remains within limits of normal. No pneumothorax.

Output: The patient is intubated with diffuse bronchial wall thickening, superimposed on COPD, suspicious for bronchitis. Trace pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Postsurgical changes without superimposed acute new abnormalities. Minimal left basilar atelectasis and scattered granuloma unchanged

Output: Unchanged postsurgical changes without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: 23 years old Male. Reason: h/o chest pain and untreated PE, refusing iv for contrast. Evaluate for acute and chronic PE. The comparison chest radiograph performed on today demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images show decreased ventilation in the left lower lung on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show decreased pulmonary perfusion in the left lower lung, which matches with ventilation decrease.

Output: Low probability for pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: 86 years old Male. Reason: eval for pathology History: chest pain. Basilar linear atelectasis/scarring. No new focal lung opacities or suggest infection. No pneumothorax or large pleural effusion. The cardiomediastinal silhouette is similar to the prior study. The bullet is noted within the left chest unchanged in position.

Output: Basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of malignant melanoma in the posterior neck CHEST:LUNGS AND PLEURA: Moderate centrilobular emphysematous changes. Left upper lobe 4-mm nodule is unchanged on image number 45, series number 5. A second left upper lobe subpleural density measures 5-mm image number 29, series number 5. Its etiology is unknown.2 x 1.6 cm nodule in the left lower lobe on image number 54, series number 5, new from previous study. A third new nodule is in the right lower lobe as seen on image number 49, series number 5. It measures 5 mm.MEDIASTINUM AND HILA: Retrosternal goiter. Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Peripancreatic adenopathy is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval developed in the new lung nodules in both lungs suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of non-Hodgkin's lymphoma and pulmonary nodules CHEST:LUNGS AND PLEURA: Severe emphysematous changes remain. Nodule in the left upper lobe has decreased in size, measuring 5 x 4 mm, previously 10 x 7 mm (series 5; image 28). No significant change in the oblong 10 x 7 mm density adjacent to the left oblique fissure (series 5; image 31). No significant change in the previously noted left apical nodule (series 5; image 17) or the spiculated nodule adjacent to the oblique fissure in the left upper lobe (series 5; image 37). Another left upper lobe pulmonary nodule (series 5; image 32) continues to decrease in size, measuring 5 x 4 mm, previously 7 x 6 mm.MEDIASTINUM AND HILA: 9 x 6 mm AP window lymph node, unchanged (series 4; image 34).Aberrant right subclavian artery.Coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild ductal dilatation, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts.RETROPERITONEUM, LYMPH NODES: Ill-defined periaortic soft tissue which extends to the bifurcation is stable.BOWEL, MESENTERY: Aneurysm clips in the midabdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic disease.PELVIS:UTERUS, ADNEXA: A tubular hypodensity in the right adnexa, possibly related to a dilated fallopian tube, is stable. Calcifications projecting over the uterus are compatible with fibroids. BLADDER: No significant abnormality noted.LYMPH NODES: Borderline prominent inguinal lymph nodes lymph nodes remain.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Questionable small filling defect in the common, superficial and deep femoral veins, not significant changed in appearance when compared to 11/08.

Output: Decrease in size of two of the pulmonary nodules. The remainder of the nodules are unchanged in size. No new sites of disease.Stable abdominal/pelvic findings.Questionable partial chronic thrombus affecting the left common, deep and superficial femoral veins.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of retroperitoneal sarcoma CHEST:LUNGS AND PLEURA: Multiple scattered pulmonary nodules are again noted. Index nodule in the right lower lobe measures 6 by 6-mm image number 47, series number 5. Linear atelectasis in the lung bases are also unchanged. Slightly larger left lower lobe nodule is also unchanged.MEDIASTINUM AND HILA: Nonspecific mediastinal and hilar lymph nodes and diffuse wall thickening of the esophagus are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy without evidence of recurrence in the surgical bed. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastric band at the GE junction and access port in the left lower abdomen are unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large fibroid, 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 significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: Right lower base crackles History: generalized weakness Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: s/p MVR \T\ AVR History: s/p valve surgery Status post median sternotomy for mitral valve repair.A small amount of loculated pleural fluid is seen laterally on the left, and the lungs are underinflated with basilar subsegmental atelectasis.Prior right jugular introducer removed.

Output: Loculated left pleural fluid collection and basilar atelectasis noted.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.History of chest pain. The cardiomediastinal silhouette is normal. No focal pulmonary opacities or large pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Abdominal pain and tachycardia. Question free air, pneumonia or acute pathology. Semierect portable chest radiograph. No free air is appreciated however please refer to subsequent abdominal CT which is much more sensitive for its detection.Mild elevation of the right hemidiaphragm. Nonspecific mild superior mediastinal widening. The lungs are clear.

Output: No evidence of acute pulmonary abnormality. Mediastinal widening is nonspecific and may be the result of mediastinal lipomatosis. This could be confirmed by CT if the patient is having chest pain or as otherwise clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: IABP placement History: HF Moderate to severe cardiomegaly.No specific evidence of infection or edema.IABP catheter proximal marker 3 cm below the top of the aortic arch.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Unchanged devices. Moderate to severe cardiomegaly without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: R chest tube History: hypoxia Venous catheters and right chest tube unchanged.Large pleural effusions with underlying atelectasis.Embolization coil projected over the right base.No new findings.

Output: Large pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: 100 years old Female. Reason: eval for PNA History: weakness. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Multiple calcified nodules are noted in both lungs, which are consistent with granulomatous disease. The cardiac silhouette is normal. The aorta is tortuous with extensive calcifications.

Output: Tortuous thoracic aorta with extensive atherosclerosis.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Mild cardiomegaly.No significant pulmonary or pleural abnormality.No significant pneumothorax.Left subclavian ICD, leads unchanged in position.

Output: No pneumothorax following recent ICD placement.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: ETT placement History: ARDS New left IJ venous catheter with its tip in the SVC.No evidence of pneumothorax.Right IJ venous catheter removed.ET tube tip approximately 4 cm above the carina.Extensive bilateral airspace opacities similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: New left IJ venous catheter placed without complication. ET tube in satisfactory position. Extensive pulmonary opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: 79F with PMHx COPD with cough, SOB, eval for infiltrate History: Cough, SOB Bilateral pleural effusions, right larger than left, accompanied by marked elevation of the right hemidiaphragm.Lower lung zone opacities are suggestive of edema and atelectasis.Heart is at least mildly enlarged.

Output: Pleural effusions and basilar opacities suggestive of edema, likely from CHF, with elevation of the right hemidiaphragm. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with lower extremity pitting edema. Assess heart size, lung fields. Redemonstration of severe cardiomegaly, unchanged.Chronic bibasilar opacities, likely representing atelectasis/scarring.No focal pulmonary consolidation or pleural effusion.Large hiatal hernia is again noted. IVC filter is noted. Redemonstration of T12 and L1 collapsed vertebra.

Output: Severe cardiomegaly. Chronic bibasilar subsegmental atelectasis and scarring. No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: wheezing on exam History: wheezing on exam Dense left perihilar airspace opacity with a moderately large pleural effusion.Partial clearing of right basilar airspace opacity.A more recent radiograph has been interpreted.

Output: Dense left airspace opacity suggestive of infection but partial clearing of right lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Shortness of breath. Unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema.No pleural effusions evident.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 98 years old.Reason: Verify History: SOB Improvement in left pleural effusion, although still moderate in size with atelectasis of the adjacent lung base.Heart size upper normal.No obvious edema.Marked degenerative abnormalities affect the shoulders.

Output: Improving left pleural effusion, with no new findings. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: assess for pna - fever History: assess for pna - fever The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Spinal stimulator unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: routine admission chest xray ; s/p lvad History: subjective chills and fever Iatrogenic devices are unchanged. Mild pulmonary edema again noted. Left lower lobe retrocardiac opacity, unchanged. No pneumothorax. Unchanged cardiomegaly.

Output: Mild pulmonary edema and cardiomegaly, unchanged. Left lower lobe atelectasis and/or consolidated lung again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Preop aortic valve replacement, recent cold with nonproductive cough. Normal heart size. Tortuous thoracic aorta. Left lower lobe scarring is chronic.Hazy opacity in the right lower lobe new from previous.

Output: Faint hazy right lower lobe opacity suspicious for early or resolving pneumonia. Follow-up chest radiographs recommended in 7-10 days to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: IABP placement History: IABP placement The IABP marker overlies the proximal descending thoracic aorta.Cardiopulmonary monitoring and support devices are unchanged.No significant change of cardiomediastinal silhouette or streaky basilar opacities suggestive of atelectasis.Surgical clips project in the left hemithorax.No significant pneumothorax.

Output: Stable exam without significant change in position of balloon pump.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.History of recent D&C procedure. Concern for pneumoperitoneum. The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces are within normal limits.There is no evidence of free intra-abdominal air, considering the limitations of a single semierect projection.

Output: No evidence of pneumoperitoneum in this single semierect projection.


Instruction: Generate impression based on medical findings.

Input: Male, 92 years old.Reason: transferred from OSH with pneumonia, evaluate for pneumonia History: as above Lower lung zone opacities worse than before consistent with edema and/or aspiration, with pleural effusions.Mild cardiomegaly.

Output: Worsening basilar opacities consistent with edema or aspiration, with pleural effusions. Infection is also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Shortness of breath. Family history of mesothelioma and lung cancer. Shortness of breath and cough. History of beryllium exposure. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: rhonchi on exam History: rhonchi on exam Support hardware unchanged in position.Lungs hypoinflated with nonspecific basilar opacities, not significantly changed.

Output: Lungs hypoinflated with nonspecific basilar opacities, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab No new focal lung consolidation. Stable subsegmental scarring or atelectasis at the left lung base. No pleural effusion or pneumothorax. Moderate cardiomegaly again noted. Cardiac leads, unchanged.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic cholangiocarcinoma CHEST:LUNGS AND PLEURA: Bilateral numerous metastatic nodules, some of which demonstrate cavitation. These are highly suspicious for metastatic tumor. Paragraph. This lesion in the right lower lobe measures 15 x 13 mm image number 51, series number 3.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Pneumobilia secondary to the metallic stent. Gallbladder is still distended. There is a focal outpouching of the gallbladder anteriorly. This may be a sign of impending perforation.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic duct is diffusely dilated. There is an infiltrative ill-defined soft tissue in the region of the pancreatic head that cannot be adequately differentiated from the surrounding duodenum and the pancreatic head. This likely represents patient's mass, but cannot be reliably measured.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. There referenced retroperitoneal lymph node, image number 119, series number 3 measures 17 x 10 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Extensive lung metastases. Distended gallbladder with a focal area of bulging anteriorly despite the metallic stent. This may be a sign of impending gallbladder perforation.Ill-defined mass in the region of the pancreatic head consistent with patient's known history of cholangiocarcinoma. Retroperitoneal metastatic adenopathy.Dr. Polite was contacted and these findings were discussed acknowledged by him at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: sob History: sob No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of lymphoma CHEST:LUNGS AND PLEURA: This is Krabbe subcentimeter nodule in the left upper lobe on image number 67, series number 6 has been resolved. The second left upper lobe is unchanged on image number 27, series number 5. Multiple new subcentimeter nodules are noted in both lungs. The referenced nodule measures 4-mm in image number 51, series number 5 in the right middle lobe.MEDIASTINUM AND HILA: Nonenlarged mediastinal lymph nodes are stable.CHEST WALL: Bilateral enlarged axillary lymph nodes have slightly increased in size. An index right axillary length. No now measures 22 by 8mm image number 18, series number 3. Previously present measuring 11 by 5 minutes on image number 23, series number 4..ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter focus in the right lobe of the liver is unchanged. No new focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule is unchanged, measuring 13 x 9 mm image number 96, series number 3.KIDNEYS, URETERS: bilateral small renal cysts and punctate stones are unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Pelvic adenopathy. Reference left obturator lymph node measures 28 x 19 mm image number 176, series number 3. Bilateral inguinal, peri-iliac adenopathy is also present.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval developing of new subcentimeter lung nodules.Minimal interval increase in the size of the axillary lymph nodes.Pelvic adenopathy.Nephrolithiasis


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Status post right IJ placement. The endotracheal tube tip is about 3 cm above the carina. Interval placement of right jugular venous catheter with tip in the SVC. No pneumothorax. Small right pleural effusion. Diffuse reticulonodular airspace opacities are consistent with prior exam. Mild cardiomegaly.

Output: Interval placement of right jugular venous catheter without pneumothorax. The endotracheal tube tip is about 3 cm above the carina. Continued diffuse reticulonodular airspace opacities.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with chest pain and elevated d-dimer; evaluate for pulmonary embolus CHEST:PULMONARY VASCULATURE: No evidence of pulmonary embolus. Technically adequate study.LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.Note is made of a hiatal hernia.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No pulmonary embolus


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.With history of lung cancer. Redemonstration of right hilar opacities consistent with history of known tumor. Previously described left midlung opacity is slightly improved from prior. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is consistent with prior exam, normal. Redemonstration of right bronchus intermedius stent.

Output: Redemonstration of right hilar mass consistent with prior history of malignancy. Left midlung opacity appears slightly improved from prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: fever, tachycardia History: above No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval for interval line/tube placement History: intubated, laryngeal edema Basilar opacities suggestive of aspiration with small pleural effusions.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 3 cm above the carina. Basilar opacities are suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Renal cell carcinoma status post partial nephrectomy. Rule out chest metastasis. Normal heart size. No suspicious pulmonary nodules or masses. No pleural fluid. No visible lymphadenopathy.

Output: No acute cardiopulmonary abnormality and no signs of pulmonary metastases by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Preop subclavian bypass History: Preop subclavian bypass Cardiac silhouette is normal in size and configuration.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: Male, 54 years old.Reason: ett History: ett Endotracheal tube terminates 4 cm above the carina. A loop recorder projects over the left hemithorax. Nasogastric tube sidehole projects over the gastric fundus.The lungs and pleural spaces are clear. No pneumothorax. Heart size is normal.

Output: Endotracheal tube terminates 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: intubated, eval ETT and infiltrates History: hypoxia Lines and tubes are unchanged. Diffuse opacities, not substantially changed. Unchanged heart size. No pneumothorax.

Output: Diffuse pulmonary opacities again noted consistent with edema, multifocal pneumonia, and/or diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: 60 y/o with IABP History: heart failure Right IJ Swan-Ganz has been removed with introducer in place.Left IJ Swan-Ganz has been placed with its tip in the right pulmonary artery.IABP marker in the mid descending aorta.Stable cardiac enlargement.Left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.No evidence of pneumothorax.

Output: Placement of a new left IJ Swan-Ganz with its tip in the right pulmonary artery. Removal of a right IJ Swan-Ganz. IVP marker repositioned with the tip now in the mid descending aorta. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with pancreas cancer CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules. An index right upper lobe nodule measures 4 mm on image number 34, series number 14. Mild scarring in the anterior right lower lobe.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous hypodense lesions in the liver. The larger ones most likely represent cysts but some are too small to accurately characterize. Proximal common bile duct is mildly dilated, however, no evidence of intrahepatic biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: Ill-defined pancreatic head mass extending to the uncinate process measuring 4 x 4.6-cm image number 45, series number 15. Pancreatic mass encases the main portal vein at the level of the confluence. Common hepatic artery and SMA are invaded by the mass. SMV is also invaded by the mass. The mass also extends to the level of the diaphragm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left parapelvic cysts.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: Significantly enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Locally invasive pancreatic head mass as described above.Numerous hypodense lesions in the liver. Larger ones represent cysts, or, some of the lesions are too small to accurate characterize.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: r/o pneumothorax History: Chest tube removal Interval removal of right chest tube. No right pneumothorax. Stable left pneumothorax. Mitral valve annuloplasty, sternal wires and clips noted. Cardiomediastinal silhouette is unchanged. Patchy bibasilar opacities unchanged. Bilateral pleural effusions stable.

Output: Stable left pneumothorax. No right-sided pneumothorax. No significant interval change in bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: trach, s/p biVADs History: sob Complete white out of the left hemithorax again noted. Tracheostomy remains in place. Diffuse pulmonary opacities in the right lung again noted. No pneumothorax. Unchanged hepatomegaly.

Output: Unchanged diffuse opacities in the right lung. Near-complete whiteout of the left hemithorax again noted.