Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: fever w/up Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Remote bilateral rib fractures. Mild cardiomegaly.

Output: No acute cardiopulmonary process on radiography. Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: pna History: pna Bilateral diffuse predominantly airspace opacities, left much greater than right.Left basilar atelectasis.Probable small left pleural effusion.Unremarkable cardiomediastinal silhouette.

Output: Diffuse bilateral airspace opacities, suggestive of ARDS, multifocal pneumonia, or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old. Tracheostomy tube unchanged.A looped catheter projected over the right apex as partially visualized and may be external to the patient.Bilateral pulmonary bnormalities with severe bullous emphysema and areas of atelectasis, not significantly changed.No new findings.

Output: Emphysema and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: post intubation History: post intubation Pleural effusions now appear to be more in the lung bases, but may have not significantly changed.Patchy lower lung zone opacities left greater than right are consistent with aspiration or infection.ET tube tip approximately 5 cm above the carina.Right subclavian catheter, tip in SVC.

Output: ET tube tip approximately 5 cm above the carina. Pleural effusions now more inferior than before but probably little changed.


Instruction: Generate impression based on medical findings.

Input: 56 year-old man with a parasellar carcinoma status post chemoembolization. Evaluate response pleural effusions and retroperitoneal disease. CHEST:LUNGS AND PLEURA: Large right pleural effusion is unchanged. Deep tendon atelectasis is unchanged. Minimal scarring and cystic changes in the left apex is unchanged. Scattered micronodules bilaterally are unchanged.MEDIASTINUM AND HILA: Borderline enlarged left supraclavicular lymph nodes and small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large mass in the liver demonstrate post chemoembolization changes. Most of the mass, more prominent in its inferior aspect demonstrates enhancement suggestive of recurrent disease.A new round lesion (from 1/19/2010) in the right lobe of the liver measuring 21 x 18 mm image number 75, series number 11 is close but separate from the large mass and washes out on the portal venous phase images consistent with a new foci of parasellar carcinoma. Liver is enlarged. Subcentimeter hypodense lesions in the left lobe are nonspecific and unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node measures 6 x 4.5 cm in image number 121, series number 14, slightly enlarged. More superior lymph node has significantly enlarged and now measures 4.3 x 4.8 cm image number 110, series number 14. On 1/19/2000 typos measuring two .BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis.

Output: Large right-sided pleural effusion is unchanged. Supraclavicular, mediastinal nodes and lung nodules are unchanged.Significant residual enhancement involving the right lobe of a sellar carcinoma consistent with recurrent disease. New round hepatocellular carcinoma in the right lobe.Interval increase in the size of the retroperitoneal adenopathy


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: cough x 3 weeks History: cough x 3 weeks Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old. S/p colonic stent plcmt. pls assess position. Colonic stent overlying the left pelvis. Multiple surgical clips in the pelvis. Residual contrast in the pelvis, likely within the rectum.Nonobstructive bowel gas pattern. Gaseous distention of the colon proximal to the stent. Gas within some loops of small bowel. No free air seen on upright imaging.Basilar pulmonary opacities compatible with bilateral pleural effusions as well as scattered nodular opacities compatible with pulmonary metastases.

Output: Colonic stent in expected location, with colonic dilatation proximal to the stent. No free air.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Stable cardiomegaly and low lung volumes. Unchanged perihilar and upper lobe opacities.Unchanged atelectasis at the lung bases.No new opacities or large effusion is noted.

Output: Stable exam with no significant interval change in the findings.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, 18 years old.Reason: ett distance? History: ett ET tube tip 5-6 cm above carina. Dobbhoff tube tip in stomach. Other findings stable.

Output: ET tube tip 5-6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Evaluate Swan-Ganz catheter positioning. Right jugular Swan-Ganz catheter projects over the level of the interlobar artery. Peripheral catheter from the right can be followed to the subclavian vein.LVAD partially visualized.Right subclavian ICD unchanged in position.Sternotomy hardware appears in alignment.Lung volumes remain low. Nodular opacity adjacent to a suture line in the left lower lung persists, please refer to recent CT.Dependent atelectasis. Small volume of pleural fluid on the left about the same. Unchanged mediastinal widening consistent with previously documented lipomatosis.No pneumothorax.

Output: Right jugular Swan-Ganz catheter tip in the projection of the right interlobar artery. No acute change in pleural fluid or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Rib pain? Rib fracture. Breast cancer. Right chest wall port tip in the SVC.Left apical reticular opacities consistent with prior radiation, unchanged from recent CT.No evidence of infection or edema. No significant pneumothorax.Left axillary surgical clips.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for effusion, edema, consolidation History: SOB Unremarkable cardiac and mediastinal silhouette. Cardiopulmonary monitoring and support devices, unchanged.Bronchial thickening compatible with bronchitis, with mild lower zone scarring.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for pneumonia History: cough, new leukocytosis Interval removal right Swan-Ganz catheter. Left ventricular electrodes are unchanged.Asymmetric right apical thickening. The lungs and pleural spaces are otherwise clear. Mild pectus excavatum deformity. Heart size is normal.

Output: No evidence of pneumonia. Mild apical nodular pleural thickening which can be followed on subsequent radiographs.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: fever, hx of cardiac transplant History: fever Status post median sternotomy.Cardiac silhouette is normal in size.Lungs are clear.No acute osseous abnormalities. Remote right second rib fracture deformity anteriorly.

Output: No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: S/P LVAD. eval for internal drive line fracture History: Abnormal alarm Median sternotomy with pleural effusions and basilar atelectasis, unchanged.LVAD, the drive line only partially imaged on this chest radiograph, appearing intact however. Reference should be made to a separate abdomen radiograph.Left subclavian ICD, leads unchanged in position.

Output: LVAD and stable pulmonary opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: intubation History: intubation Marked cardiomegaly. Deviation of the trachea at the thoracic inlet suggestive of goiter.Bilateral basilar opacities consistent with pleural effusions and underlying consolidation/atelectasis.No sign of an endotracheal tube.Biliary stent partially visualized.

Output: Cardiomegaly with pleural effusions and possible CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? ptx? R chest pain, SOB 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: Reason: right side effusion/consolidation History: fever, leukocytosis Cardiopulmonary monitoring and support devices, unchanged.Small lung volumes with mild opacity compatible with edema and atelectasis, increased in the left lower lobe.Small pleural effusions.No specific evidence of pneumonia.

Output: Increased left lower lobe atelectasis and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: check for ptx s/p biopsy on left History: check for ptx s/p biopsy leiomyosarcoma mets Multiple large pulmonary metastases.No pneumothorax following biopsy.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Status post esophagectomy. Interval removal of NGT.Basilar opacities suggestive of atelectasis and/or aspiration, unchanged.Stable cardiomegaly with a left subclavian ICD.

Output: Unchanged basilar opacities suggestive of atelectasis and aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.ET tube ET tube tip is 5 cm above the carina. Right IJ tip is in the superior vena cava. Dobbhoff tube tip projects over the gastric fundus. Large right and small left pleural effusions again noted with diffuse interstitial opacities and basilar atelectasis, right greater the left.

Output: ET tube tip is 5 cm above the carina. Unchanged pulmonary opacities 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: Reason: r/o rib fracture History: difficulty breathing and rib pain Fracture deformity of the left eighth and ninth ribs laterally with associated soft tissue opacity compatible with acute rib fractures. Chronic appearing fracture deformities of the left fifth and sixth, and right ninth ribs.Prominent bilateral costochondral cartilages and mild apical opacity compatible with scarring.The findings were discussed with Dr.Checkett in the ED at the time of reporting.

Output: Recent fractures of the left eighth and ninth ribs.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: 59M with metastatic gastric ca, lung met, pleural effusion on OSH imaging, please eval History: as above Moderate pleural effusions right larger than left, and basilar opacities suggestive of compression atelectasis. No obvious metastases. Heart size normal.Right jugular catheter, tip in SVC.

Output: Large pleural effusions, with overlying compression atelectasis. No obvious metastases, although these could easily be obscured by the effusions.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath The cardiomediastinal silhouette is within normal limits. Basilar atelectasis. No pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.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, 44 years old.Elevated WBC question pneumonia. Elevation of the right hemidiaphragm. Right upper lobe paramediastinal masslike opacity is partially obscured. Septal thickening and nodularity appears worse, which may be the result of edema superimposed upon lymphangitic tumor spread. Nonspecific retrocardiac opacity on the left appears worse and correlates to progressively increasing left medial basal consolidation seen on the few CT scans. It is possible that this could reflect an element of superimposed postobstructive pneumonia.

Output: Worsening edema superimposed upon probable lymphangitic tumor spread. Worsening left lower lobe basal opacity, previously not evident by plain film technique, and could potentially reflect a superimposed component of postobstructive pneumonia.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with altered mental status. For pneumonia or pulmonary edema. Cardiomediastinal silhouette is within normal limits. Tortuous aorta.No acute cardiopulmonary abnormality given semierect portable technique.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old. Crackles on RLL. Evaluate for pneumonia. New moderately large left pleural effusion with overlying atelectasis and nonspecific consolidation.Stable cardiomediastinal silhouette.

Output: New moderately large left pleural effusion with overlying atelectasis and consolidation, which may represent infection; follow-up to resolution recommended in a patient of this age to exclude malignancy.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: edema vs pna History: sob Mild cardiomegaly with lower lung zone edema and a right pleural effusion, both slightly worse than on the prior study.Right jugular catheter tip in or at level.

Output: CHF with pulmonary edema and pleural fluid, but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: assess hardware, LVAD, intubated, persistent fever History: above Hardware and cardiopulmonary monitoring/support devices similar in position. Probable left pleural effusion. No specific evidence of pulmonary edema.

Output: Stable appearance of support devices. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval R IJ line placement History: as above Basilar opacities suggestive of subsegmental atelectasis or scarring.Heart size normal.Right jugular catheter, tip in SVC.ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.

Output: Right jugular catheter, tip in SVC. Basilar opacities suggestive of atelectasis from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Shortness of breath rule out pneumonia. Normal heart size, though the cardiothoracic ratio has increased since the prior study. Unsharpness of the bronchovascular markings especially in the right lung.No airspace opacity or pleural fluid. No pneumothorax. Minimal subsegmental atelectasis at the lung bases.

Output: Although the heart size is within normal limits, the cardiothoracic ratio has increased since the prior study. Reticular opacities suspicious for diffuse bronchiolitis from etiology such as viral infection or diffuse aspiration. Suggest follow-up PA and lateral chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Reason: ICM History: Weakness. ICD leads and LVAD unchanged.Left jugular catheter tip in the area of the SVC.Cardiomegaly with interstitial opacity suggestive of edema and small pleural effusions.Nodular opacity in the right lower lung probably due to pleural fluid loculated in the fissures.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval for pneumothorax History: s/p robotic right partial nephrectomy Numerous surgical clips project over the lower neck. Right upper quadrant surgical drain in place. There is subcutaneous emphysema of the right chest wall and neck.There is no pneumothorax or large pleural effusion. Streaky left basilar opacity consistent with atelectasis. The cardiac and mediastinal contours are within normal limits for size.

Output: No pneumothorax. Mild left basilar atelectasis and subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: pna? Cancer, pain History: pain No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: persisten RLL pneumonia, symptomatic today History: productive cough, fatigue Right lower lobe airspace opacity, decreased since the previous radiographs, consistent with resolving infection.No new findings.

Output: Decreased right lower lobe airspace opacity with residual focal consolidation. A CT scan has been performed and provides more detailed evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: pulm edema History: pulm edema Extra cardia with situs inversus.Moderate interstitial and airspace opacities suggestive of edema, unchanged since yesterday evening but worse compared to the day before.ET tube tip approximately 4 cm above the carina.Left PICC, tip in the SVC.An NG tube extends below the lower margin of the image.

Output: Pulmonary edema pattern consistent with CHF, unchanged since yesterday evening but worse compared to the day before.


Instruction: Generate impression based on medical findings.

Input: Male; 62 years old. Reason: respiratory failure s/p trach History: respiratory failure s/p trach Stable left chest tube with no pneumothorax. Other tubes and devices are stable.Stable cardiopulmonary appearance with low lung volumes and nonspecific interstitial opacities suggestive of edema or aspiration. Stable small pleural effusions.

Output: Stable cardiopulmonary appearance and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval pna History: sob Cardiomediastinal silhouette is unremarkable. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: 51 years old Female. Reason: pleural effusion History: previous x-ray. There is interval increase of the bilateral pleural effusions. Diffuse pulmonary opacities, unchanged. The support devices are unchanged.

Output: Interval worsening of bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 36 or old male status post resection of pleomorphic leiomyosarcoma. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable subcentimeter gastrohepatic lymph node. No pathologically enlarged lymph nodes identified.BOWEL, MESENTERY: Status post right hemicolectomy.BONES, SOFT TISSUES: Postoperative changes in the anterior abdominal wall soft tissues, similar to prior.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: as aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 90 yearsGender: MaleReason for Study: Reason: Rule out lung pathology contributing to symptoms History: SOB increasing over few weeks There is moderate cardiac enlargement.Basilar interstitial opacities compatible with edema and atelectasis.No focal areas consolidation.Small pleural effusions bilaterally.Kyphosis and degenerative changes in the thoracic spine.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval lung fields History: s/p BiVAD Open sternotomy with surgical drains and sponges projected over the mediastinum and heart.Stable basilar interstitial and airspace opacities consistent with edema and possible aspiration/pneumonia.Cardiac assist catheters unchanged.ET tube tip approximately 6 cm above the carina.Right jugular Swan-Ganz catheter, tip in main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Eval s/p bilateral lung transplant History: - Small to moderate right pneumothorax especially evident the right lung base.Left chest tube with no left pneumothorax.Abundant chest wall soft tissue emphysema is stable.

Output: Enlarging right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: cough, pneumonia? pulmonary edema? History: cough Sternal wires remain well aligned.Multilevel degenerative changes of the thoracic spine with large osteophytes again noted.The lungs and pleural spaces are clear. The heart size is normal. Atherosclerotic disease of the thoracic aorta.

Output: No evidence of pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Possible artifact versus focal opacity in the right lower lung zone. End-stage renal disease. Prekidney transplant. Focal opacity in the right lower lung zone has cleared. Mild-to-moderate cardiomegaly again noted. Dual-lumen IJ catheter again terminating near the cavoatrial junction. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: Focal opacity in the right lower lung zone has cleared. No acute cardiopulmonary process. Stable moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: Lung cancer patient Day 7 chemotherapy with productive cough r/o pneumonia or aspiration History: Lung cancer patient Day 7 chemotherapy with productive cough r/o pneumonia or aspiration Opacification of the right hemithorax compatible with known pneumonectomy.The left lung is clear.Stable cardiac mediastinal silhouette.

Output: Status post right pneumonectomy. No acute abnormalities can be identified. Specifically, there is no evidence of infection in the left lung.


Instruction: Generate impression based on medical findings.

Input: Lung cancer Scattered calcified granuloma with minimal scarring also unchanged. No superimposed acute abnormalities.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Preparing for VQ scan to R/O PE HIT POS History: Persistent 02 requirements Left greater than right pleural effusions. Probable basilar atelectasis. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No pneumothorax.

Output: Left greater than right pleural effusions. Probable basilar atelectasis. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: 67 year old male with history of laryngeal cancer; rule out recurrence. LUNGS AND PLEURA: Punctate calcification within the right upper lobe likely represents prior healed granulomatous disease.MEDIASTINUM AND HILA: Trace pericardial effusion. Calcified mediastinal and right hilar lymph nodes; likely represent prior healed granulomatous disease.CHEST WALL: Unchanged low neck lymph nodes; the reference lymph node measures 0.9 x 1.1 cm (image 12 of 101).UPPER ABDOMEN: Severe pancreatic atrophy with multiple punctate calcifications throughout the remainder of the body and massive pancreatic duct dilatation. In addition, there is a large calcification within the pancreatic head that measures 1.5 x 1.2 cm (image 101 of 101); however, this calcification is incompletely evaluated on this examination.

Output: 1. Stable cervical lymph nodes.2. Large calcification within the pancreatic head noted; however, pancreatic atrophy with punctate calcifications and ductal dilatation are unchanged.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, 26 years old.Sudden onset left-sided pleuritic chest pain for 3 days. Evaluate for pneumothorax. No focal pulmonary opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61 yo M s/p intubation History: intubated Interval development of the complete opacification of left hemithorax with shift of mediastinal silhouette to the left. However, which is similar as compared with the study 12/2/2016. Stable diffuse right lung opacities. The ET tube is stable in position. No evidence of pneumothorax.

Output: New complete opacification of left lung, which can be due to mucous plug.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: swan line History: n/a Support devices are unchanged in position.Cardiomegaly is unchanged. Lungs and pleural spaces remain clear.

Output: Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Cardiac pacemaker with chest pain rule out cardiopulmonary abnormality. Low lung volumes. Thoracic kyphosis with degenerative changes and bridging osteophytes.Left subclavian dual-chamber pacemaker unchanged in position. The pulse generator obscures a portion of the left upper lobe which cannot be assessed.No specific signs of pulmonary edema or visible focal pulmonary opacities.Right upper quadrant surgical clips.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: pt intubated with asthma exac, check ett as well as hyperinflation History: History: intubated Endotracheal tube terminates 4 cm above the carina. Interval placement of an enteric tube terminates inferior to the caudal margin of the image.Interval decreased lung volumes. No evidence of edema or infection.

Output: Interval placement of enteric tube terminates inferior to the caudal margin of the image.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female with line pain. Evaluate PICC line placement. Right-sided PICC catheter with tip unchanged in the distal SVC.No focal airspace opacities. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: Right-sided PICC catheter tip in appropriate position with no acute complication.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Intubation. ETT tip 2 cm above the carina.Dobbhoff tube tip just beyond the GE junction.Right jugular Swan-Ganz catheter unchanged in position.Motion artifact.Unchanged pleural effusions, edema and atelectasis.

Output: ETT tip 2 cm above carina. No acute change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Status post TAC/EI with increased WOB. Motion artifact. Right jugular catheter unchanged in position. Enteric tube extends off the caudal margin of the radiograph.Persistent left basal airspace opacity suspicious for aspiration or infection. Scarring in the left lung base and right upper lobe. Patchy atelectasis elsewhere without acute change. No conclusive pneumothorax although the left apex appears somewhat lucent and a follow-up radiograph is suggested.

Output: Exam limited by motion. Persistent left basal opacity suspicious for aspiration or infection. Suggest short-term follow-up portable chest radiograph to exclude possibility of pneumothorax at the left apex.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT remains 3 cm above the carina. NG and right jugular catheters are also similar with essentially unchanged cardiopulmonary appearance. See subsequent reports and concern for possible ARDS

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Patient with right sided wheeze/rales r/o aspiration or pulmonary edema History: abnormal lung sounds Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Unchanged port catheter.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia, increased O2 requirement History: hypoxia on 15 L nonrebreather Decreased left pneumothorax with minimal residual.Basilar subsegmental atelectasis.Chest tubes in place without significant change.Displaced fracture of the left seventh rib laterally.

Output: Basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval lung fields, LVAD History: L chest pain Improvement in basilar opacities with no new findings.Heart size relatively normal.LVAD and ICD unchanged.

Output: Stable support devices. No new findings.


Instruction: Generate impression based on medical findings.

Input: 95 years old Female. Reason: improvement of pulmonary edema History: previously hypoxic. The study is very limited due to patient positioning and body habitus. Within the limitation, the right pleural effusion is again noted. There is a prominence of the right lung hilum.

Output: Prominence of the right hilum and right pleural effusion. If clinically indicated, CT examination can be obtained.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: chest pain, cough, eval for PNA History: chest pain, cough, eval for PNA Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.History of HIV, now with shortness of breath. The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: Normal examination, specifically no infection.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p left single lung txp History: sob Status post left lung transplant. Surgical clips noted.Stable cardiomediastinal silhouette.Right basilar atelectasis unchanged.Reticulonodular interstitial opacities and left pleural thickening appears slightly improved.No new pulmonary opacities identified.

Output: Interval improvement in reticulonodular interstitial opacities and left pleural thickening. No other new cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Right central catheter with tip in SVC. Mild cardiomegaly. No pleural effusion or pneumothorax. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: s/p esophagectomy with chest tube History: same Support devices unchanged. Stable cardiomediastinal silhouette with right paramediastinal postoperative changes related to recent esophagectomy.Perihilar and basilar opacities similar in appearance the prior exam.No significant pneumothorax identified.

Output: Stable postoperative cardiopulmonary appearance without evidence of a significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Placement of enteric tube Enteric tube seen with side-port in gastric fundus. Scattered surgical clips. Catheter seen in pelvis, additional line seen overlying right abdomen, correlate clinically. Mildly dilated small bowel with small amount of gas seen in colon.

Output: Enteric tube and additional lines/catheters as above.Mildly dilated small bowel with only small amount of gas seen in colon, while findings may reflect postoperative ileus, a developing small bowel obstruction is a consideration and continued follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: s/p left sided BIV ICD placement History: BIV-ICD The left-sided ICD is identified with lead wires in the right ventricle and coronary sinus.The cardiomediastinal silhouette is unremarkable.Decreased lung volumes.New perihilar/basilar opacities suggestive of edema and atelectasis.No pleural effusions.

Output: New left-sided ICD placed with lead wires in the right ventricle and coronary sinus. Increasing perihilar/basilar opacities suggestive of edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Chest tube check 3 left and 2 right chest tubes appear similar in position without evidence of new underlying abnormality or change in position. Supportive vascular cannula and right PICC line are also unchangedMarked cardiomegaly with large right pleural effusion with underlying compression is associated with improved mild aeration of the noncollapsed right lung. Changes are minimal. Left lung remains grossly clear

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Shortness of breath ETT, NG and bilateral jugular catheters are unchanged.Persistent decreased lung volumes with mixed interstitial and airspace opacities greater on the right with pleural effusions. Cardiac silhouette remains borderline in size. Mediastinal contours are within limits

Output: Nonspecific changes suggesting pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Reason: acute on chronic lung disease History: shortness of breath. Mild cardiomegaly with a tortuous aorta. Prominent hila, unchanged, consistent with vascular structures and bronchial thickening.Large lung volumes compatible with COPD with mild basilar scarring.Focal subsegmental atelectasis in the right middle lobe and lingula, unchanged from previous. Expansile lesion in the right distal clavicle, unchanged and likely benign. No sign of CHF or pneumonia.

Output: Cardiomegaly and COPD with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: severe GERD; assess for pulmonary changes of chronic aspiration History: Severe GERD; possible chronic aspiration Moderate size hiatal hernia.The cardiomediastinal silhouette is otherwise unremarkable.No significant pulmonary or pleural abnormality.

Output: Moderate size hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with metastatic melanoma CHEST:LUNGS AND PLEURA: Reference subpleural mass in the left lobe measures 7.6 x 7.5 cm on image number 51, series number 5, slight increase in size compared to previous study. Patchy ground glass opacity within the posterior aspect of the left upper lobe has almost completely resolved. Nodular air space densities in the left lower lobe superior to the patient's known mass may represent infection. Air bronchograms associated with the patient's known large left lower lobe mass. Small amount of left-sided pleural effusion.Right lung is normal.MEDIASTINUM AND HILA: Index aortopulmonary lymph node measures 1.8 by 1.8 cm on image number 28, series number 3, not significantly changed from previous study. Non-reference adenopathy appears subjectively similar.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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal increase in the size of the patient's known left lower lobe mass, otherwise stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: ETT adjustment History: intubated Support devices appear unchanged.Again, no visualized pneumothorax.No change in lung opacities.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: IABP check The IABP marker remains within the aortic arch without additional new cardiopulmonary abnormality. Specifically Swan-Ganz again extends into the right pulmonary outflow tract, possibly the right lower lobe

Output: IABP marker unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: Central line placement History: Central line placement Upper abdominal drains following recent liver transplant, with elevation of the right hemidiaphragm and/or a right subpulmonic effusion.Minimal basilar atelectasis.Status post extubation.Left jugular catheter tip at cavoatrial junction.Unchanged left subclavian catheter with its tip probably in the subclavian.

Output: Left jugular catheter place, the tip at the cavoatrial junction level.


Instruction: Generate impression based on medical findings.

Input: 58 year old female with metastatic cervical cancer CHEST:LUNGS AND PLEURA: Subpleural nodular opacity right lung base has resolved.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference lesion in the right lobe is no longer visualized, possibly due to decreased fatty infiltration of the liver. Other previously noted hyperdense foci within the liver are also not well visualized likely due to the above.Hypodense foci in the liver (series 3; images 91, 80) are unchanged and compatible with focal fatty infiltration. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Horseshoe kidney with bilateral nephroureteral stents. Subcentimeter angiomyolipoma in the right moiety, unchanged. 1 cm hypodensity in the right moiety inferiorly is also unchanged but does not represent a simple cyst. Scarring affects the left moiety.Mild hydronephrosis bilaterally, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine fibroid is seen in theBLADDER: No significant abnormality noted.LYMPH NODES: Stable right iliac nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged sclerotic lesions in bilateral iliac wings.OTHER: No significant abnormality noted.

Output: Decrease in fatty infiltration of the liver, obscuring the prior reference lesion.Resolution of the nodular opacity in the right lung base.Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Shortness of breath, rule out effusion. Nonspecific basilar interstitial opacities suggestive of pulmonary edema.There are trace bilateral pleural effusions.The heart is enlarged.

Output: Cardiomegaly, trace bilateral pleural effusions and nonspecific basilar opacities are suggestive of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Status post cardiac surgery.VIEW: Chest AP (one view) 6/7/2016 at 2219 hours. Cervical ribs, central line, cardiac pacer leads and bilateral chest tubes are again noted.Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax.

Output: No focal lung opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: R/o pulmonary edema in patient with cardiogenic shock History: pulmonary edema, resp distress Moderate to severe cardiomegaly status post mitral valve repair and median sternotomy.Moderate lower lung zone edema and pleural effusions are accompanied by left lower lobe consolidation, new since the prior study.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC.Left jugular catheter, tip in SVC.

Output: New pleural effusions and pulmonary opacities suggestive of edema, consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: ett placement History: intubated Interval intubation with tip of endotracheal tube approximately 3 cm above the carina.NG tube seen with tip coiled within the gastric fundus.Streaky opacities lung bases likely scarring versus atelectasis.Heart size within normal limits.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: pna History: sob Nonspecific retrocardiac opacity likely atelectasis although infection is possible.Elsewhere, the lungs are unremarkable.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Left retrocardiac opacity possible infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: intubated. Pls assess ETT placement History: intubated Right chest wall soft tissue emphysema and right chest tube, but no pneumothorax.Left pleural effusion unchanged with retrocardiac consolidation.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.Left jugular catheter, tip in SVC.A Dobbhoff tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: s/p MVR/AVR History: SOB The patient is rotated to the left. The sternotomy hardware remains well aligned.No significant change in severe pulmonary edema with retrocardiac atelectasis and consolidation. Left greater than right moderate pleural effusions. No pneumothorax.

Output: Pulmonary edema unchanged.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with history of recurrent papillary thyroid cancer. Now with increasing thyroglobulin. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: New right upper lobe mass (series 6, image 25) measures 13 mm in short axis with adjacent groundglass opacities and architectural distortion.Mild bronchial wall thickening bilaterally with patchy mosaic attenuation of the lungs, possibly representing small airways disease.Scattered micronodules bilaterally, including a calcified left lower lobe granuloma, are unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Calcified left hilar lymph nodes, unchanged. Heart size normal without pericardial effusion. Mild coronary calcifications.Postsurgical changes in the superior mediastinum on the left, appearing similar to prior study. However, please refer to report for PET/CT performed on the same date.CHEST WALL: Few sclerotic foci in the right ribs and mid thoracic spine, unchanged and likely represent bone islands. ABDOMEN: LIVER, BILIARY TRACT: Probable benign hepatic cyst, unchanged. Cholelithiasis and layering sludge.SPLEEN: Scattered, punctate calcifications.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: New right upper lobe mass suspicious for malignancy. Its appearance is most consistent with a primary lung cancer; however metastasis from patient's known thyroid cancer is also a consideration.


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 which have progressed compared to prior examination. Reference lesion lesion in the right lower lobe measures 15 x 17 mm on image 52 of series 6, previously measured 15 x 13 mm image.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Pneumobilia secondary to the metallic stent. The gallbladder is decompressed. 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, unchanged from prior. This likely represents patient's mass, but cannot be reliably measured.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. The reference retroperitoneal lymph node has not significantly changed in size measuring 16 x 11 mm on image 117 of series 4, previously measured 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: 1- Extensive lung metastases which have significantly increased in number compared to prior. 2- Ill-defined mass in the region of the pancreatic head consistent with patient's known history of cholangiocarcinoma. 3- Retroperitoneal adenopathy is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: air under diaphragm History: epigastric pain post-procedure Stable minimal atelectasis left base. Heart size unchanged. Lungs remain otherwise clear.No pleural effusion. No pneumothorax.

Output: No change in left basilar atelectasis. Otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Cardiac arrest. ETT. Endotracheal tube tip 3.5 cm above the level of the carina. Normal heart size. Bilateral upper lobe predominant airspace opacities may be consistent with neurogenic pulmonary edema or pulmonary hemorrhage.

Output: ETT tip 3.5 cm above carina. Bilateral upper lobe predominant airspace opacities suggestive of noncardiogenic (neurogenic) edema or possibly pulmonary hemorrhage. A subsequent CT has been performed.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: infiltrate History: tachycardia Left lung nodule, consistent with known lung cancer.No evidence of superimposed edema or pneumonia.Heart size normal.

Output: Known lung nodule consistent with cancer, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p bronchoscopy History: s/p bronchoscopy Unchanged basilar opacities suggestive of atelectasis from aspirated secretions or mucous plugging.New NG tube, the tip of the hemidiaphragm level.Left jugular catheter, tip in SVC.ET tube tip approximately 5 cm above the carina.

Output: Unchanged basilar opacities. High NG tube.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: Hypertension History: Hypertension Cardiomediastinal silhouette is unremarkable.No focal opacity or pleural effusion.Mild degenerative changes of the thoracic spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: 62yo M w/ fever, abdominal pain, assess for PNA History: as above Small lung volumes with mild interstitial abnormality with septal lines suggestive of edema, as well as areas of linear atelectasis. Unchanged superior mediastinal widening which likely is due to tortuous vessels and mediastinal fat deposition is seen on prior CT.Distended gas-filled loops of bowel are present in the upper abdomen.

Output: Interstitial edema with areas of atelectasis, consistent with CHF and possible aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Resolution of hemopneumothorax status post chest tube insertion. No chest tube is identified.Right subclavian catheter tip low in the right atrium.LVAD and left subclavian ICD unchanged.Loculated right air and fluid collection consistent with provided diagnosis of hemopneumothorax. There is significant compressive atelectasis of the right lung due to pleural fluid and elevation of the right hemidiaphragm. Retrocardiac atelectasis on the left also noted.

Output: No chest tube is identified. Right hemopneumothorax. Low position of right jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Heart failure Moderate nonspecific cardiomegaly with underlying perihilar enlarged basilar mixed interstitial and patchy airspace opacities with moderate layered effusions. Pulmonary edema and CHF2-lead left subclavian ICD with lead tips in the expected locations

Output: Mild-to-moderate CHF


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Subclavian central line placement. Interval placement of a left-sided central line with tip in the distribution of the SVC. No pneumothorax. The endotracheal tube has been removed. An enteric tube is present with the tip in the distribution of the stomach. Additional catheters and tubing are projected over the upper abdomen.Low lung volumes with persistent elevation of the right hemidiaphragm. Persistent mild basilar opacities and small left pleural effusion.

Output: Placement of left subclavian central venous catheter without evidence of complication. Interval extubation. Persistent mild basilar opacities and small left pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube clamp History: hypoxia Large bilateral pneumothoraces, markedly increased since the previous radiograph with partial atelectasis of both lungs and bilateral chest tubes projected over the lower lungs.Left subclavian catheter tip in the area of the junction of the subclavian and jugular veins.NG tube coiled in the stomach.A text page was sent to Dr. Martin at the time of reporting.

Output: Markedly increased bilateral pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Positive blood cultures No cardiopulmonary abnormality.

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old. Baseline pre kidney transplant evaluation. Right jugular catheter tip at the cavoatrial junction.Interval resolution of basilar opacities. No evidence of infection or edema. Right pleural effusion has resolved.Stable cardiomegaly.

Output: Interval resolution of pulmonary opacities. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: R Rib trauma History: Pain Minimally displaced fractures of the right 10th and 11th ribs, better shown on a previous rib series.No significant cardiopulmonary abnormalities.

Output: Minimally displaced fractures of the right 10th and 11th ribs, better shown on a previous rib series.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: cause of chest pain History: chest pain Cardiomegaly with mild basilar interstitial opacities.No specific evidence of infection or infarction.

Output: Cardiomegaly with chronic appearing basilar interstitial opacities consistent with known sickle cell disease, without acute infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Reason: Confirm ETT placement History: arrest ET tube tip approximately 4 cm above the carina.Possible mild cardiomegaly.Small lung volumes with no gross pulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval for free air under diaphragm History: eval for free air under diaphragm Pneumoperitoneum noted. Low lung volume. Bibasilar opacities. Mild to moderate cardiomegaly. Question of hiatal hernia. Left PICC terminates in the superior aspect of the SVC.

Output: Pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: ETT History: ETT ET tube and NG tube unchanged.Stable cardiomediastinal silhouette.Increasing left retrocardiac opacity compatible with consolidation/atelectasis and may be related aspirated secretions.

Output: Support devices unchanged. Increasing left retrocardiac consolidation/atelectasis compatible with aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: ECMO cannulas placed for pulmonary hypertension in patient with diaphragmatic hernia.VIEW: Chest AP (one view) 03/19/15, 2302 Endotracheal tube tip is at thoracic inlet. Feeding tube tip is in stomach in left chest. Esophageal temperature probe tip is in the midesophagus. Two umbilical venous lines are present. One has its tip in the right atrium. The other is coiled upon itself in the portal veins. ECMO cannulas have been placed.Less bowel gas is present and right mediastinal shift is slightly decreased however the mediastinum remains in the right chest. Aeration of right lung has increased. Cardiac silhouette size cannot be evaluated.

Output: ECMO cannulas in place without evidence of complication. Decrease in amount of gas within bowel loops in the left thorax.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: eval edema History: palpitations, LE edema Cardiomegaly is unchanged. Small bilateral pleural effusions without edema. Vascular redistribution is stable.

Output: No pneumothorax. Cardiomegaly with vascular redistribution. No associated edema.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: productive cough History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 74 years, Female. Reason: ? obstruction vs ileus History: vomiting No focal airspace opacity, pleural effusion or pneumothorax. Above average stool burden with multiple air-fluid levels identified within the colon. There is nonspecific paucity of air distended small bowel loops. No evidence bowel obstruction. No pneumoperitoneum.Degenerative changes of the lower lumbar spine and bilateral hips.

Output: Above average stool burden with few air-fluid levels in the colon, likely representing ileus.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: r/o pna. 1 wk productive cough. h/o asthma History: productive cough No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: check placement of L IJ central line History: check placement of L IJ central line Left jugular catheter tip projected over superior mediastinum just right of midline, presumably in the central aspect of the brachiocephalic vein though the terminal portion assumes a superior course. No pneumothorax. Other findings stable.

Output: Left jugular catheter tip projected over mediastinum just right of midline, presumably in the central aspect of the brachiocephalic vein though the terminal portion assumes a superior course. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: AMS, SOB. Small to moderate right pleural fluid collection. Dependent opacity in the right lung base may reflect atelectasis or infection, follow-up suggested. Unchanged cardiomegaly.

Output: Right pleural effusion and nonspecific dependent opacity near the right base.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with history of rectal cancer status post rectal resection and ileostomy CHEST:LUNGS AND PLEURA: Small calcified granulomas are seen in both lungs.MEDIASTINUM AND HILA: Status post CABG. Coronary and aortic calcifications are identified.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without inflammatory changes.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal aortobiiliac stent/graft has been placed. Diffuse atherosclerosis affects the major aortic branches.BOWEL, MESENTERY: Right lower quadrant double barrel ileostomy without evidence of obstruction. Diverticulosis. BONES, SOFT TISSUES: Osteoporosis.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder wall thickening can be due to prior radiation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sutures are seen in the rectum. Fat stranding in the presacral space to the prior surgery or radiation. Diverticulosis is identified, but mostly affecting the ascending colon.BONES, SOFT TISSUES: Osteoporosis with bilateral spondylolysis of L5.OTHER: No significant abnormality noted

Output: Limited examination due to lack of IV contrast. No gross metastatic disease on this noncontrast study.Cholelithiasis.Extensive atherosclerotic disease with aortobiiliac stent/graft.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: known pleural effusions, eval for interval change History: shortness of breath Stable mild cardiac enlargement.Bilateral pleural effusions and basilar atelectasis similar in appearance to the prior exam.No new pulmonary opacities identified.

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


Instruction: Generate impression based on medical findings.

Input: Chest pain Borderline cardiomegaly without additional cardiopulmonary abnormality

Output: Borderline cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Confirm right subclavian central line placement History: septic shock Right basilar consolidation and small pleural effusions unchanged.Right subclavian catheter tip in SVC/atrial junction level.Bilateral jugular catheters terminate in the SVC. Tracheostomy tube tip approximately 4 cm above the carina.An enteric tube extends below the lower margin of the image.

Output: Right subclavian catheter, tip at SVC/right atrial junction level.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.NICMP, history of LAA and A. fib status post maze. Recurrent A. fib with RVR while not taking diuretics regularly, slightly wheezing on exam. Question volume overload. Metallic foreign body projecting over the hypopharynx is most likely a hair comb at the base of the scalp, as artifact from artificial hair is present nearby.Cardiomegaly and right midlung scarring about the same. No specific signs of pulmonary edema. No pleural fluid.

Output: No acute pulmonary abnormality. Unchanged cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: tachypnea History: as above Severe cardiomegaly with a mitral valve ring in place.Bilateral mainly lower zone pulmonary opacity suggestive of edema with underlying atelectasis and probable small pleural effusions.No significant change allowing for differences in positioning and technique.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: 57-year-old man with history of CHF status post ICD, ESRD status post renal transplant (2015) A right subclavian ICD is seen with two transvenous and one epicardial leads, one projected over the right atrial appendage, one directed toward the apex and one projected over the mass of the left ventricle. Cardiomediastinal silhouette is within normal limits. No pulmonary or pleural abnormalities.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: increased oxygen requirement s/p chest tube removal History: increased o2 requirements The left chest tube has been removed. Interval decreased lung volumes. The basilar opacities of atelectasis. No pneumothorax. The heart size remains stable.

Output: Interval removal of left chest tube without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval lung fields History: cough, cp Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Unchanged mediastinum.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Essentially unchanged appearing bilateral mixed interstitial and patchy opacities greater both bases and on the right with small effusions. Mild cardiomegaly, suspected left ventricular.New catheter projected over the right lung base are upper abdomen, possible surgical drain incompletely visualizedRight jugular catheter extends into the right atrium or junction with the SVC. Calcified pleural plaques.

Output: Suspected left pleural chest tube placed over lower lung


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection/edema History: SOB Unremarkable cardiac and mediastinal silhouette. The posterior costophrenic angles are indistinct which could be due to scarring, mild atelectasis or very small pleural effusions.No specific evidence of pneumonia or pulmonary edema.

Output: Possible small effusions or atelectasis in the posterior costophrenic angles, but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: COPD exacerbation Persistent and grossly unchanged severe emphysematous disease with more pronounced scarring in both bases and a small to moderate right pleural effusion versus scarring.No discrete new superimposed focal airspace process within these limitations.

Output: No interval change from underlying severe emphysema and pleural thickening


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: s/p fall Marked cardiomegaly with a tortuous aorta.Large hiatal hernia with adjacent atelectasis.Right supraclavicular calcification compatible with previous infection.No displaced fractures or pneumothorax.

Output: Marked cardiomegaly and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: lung cancer left lung History: lung resection, thoracotomy Feb 2016 Left hemithorax postsurgical volume loss.Left chest tube removed with no pneumothorax.Right lung unremarkable.

Output: Left chest tube removal with no pneumothorax. Left hemithorax postsurgical volume loss.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p iabp removal History: n IABP has been removed. Lungs clear. No significant pleural effusion. No pneumothorax. Heart size within normal limits.

Output: Interval removal of IABP. Lungs clear.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Septic shock evaluate lung fields. Hardware and devices unchanged, including a total artificial heart. Right pleural fluid collection about the same and remains loculated laterally which could be the result of blood products or infection the pleural space. Diffuse pulmonary opacities are also without significant change, most consistent with infection.

Output: Diffuse airspace opacities, left greater than right, most compatible with pneumonia. Loculation of the right pleural fluid collection is also suspicious for either infection or blood products within the pleural space.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: COPD, signs of infection. The cardiomediastinal silhouette is normal. Prominent hila consistent with lymphadenopathy. No new focal opacity.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate progression of ptx History: PTX Moderately large right pneumothorax with the apex of the lung 2.5 cm from the chest wall.ET tube tip within 1 cm of the carina. Bilateral nonspecific airspace opacities and small pleural effusions, not significantly changed.

Output: Persistent moderately large right pneumothorax. Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Left pneumothorax check Persistent left apical small and suspected loculated hydropneumothorax, air fluid level currently is not well appreciated likely due to semiupright positioning.Underlying cardiopulmonary appearance otherwise unchanged with a well-positioned tracheostomy tube.

Output: Small left apical pneumothorax unchanged please correlate with subsequent studies


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: eval ETT, lung fields History: s/p CABG Interval median sternotomy.ET tube with its tip approximately 3 cm above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.IABP marker in the proximal and mid descending aorta.Right chest and mediastinal tubes in place without evidence of a pneumothorax or pneumomediastinum.Mild basilar atelectasis and possible small effusions.

Output: Postoperative chest without complications. ET tube in satisfactory position.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: FemaleReason for Study: Reason: post extubation, eval pulmonary edema History: as above ET tube has been removed.There are decreased lung volumes with stable cardiomediastinal silhouette.  Perihilar/basilar opacities slightly improved.Left retrocardiac consolidation/atelectasis and probable effusions.

Output: Interval extubation. Diffuse pulmonary opacities mildly improved.


Instruction: Generate impression based on medical findings.

Input: Cough with yellow sputum Line cardiomegaly without additional acute cardiopulmonary abnormality. Mild COPD changes with minimal reticular changes suggesting probable chronic scarring. Comparison with prior outside images would be helpful to confirm. Scattered calcified granuloma

Output: Mild COPD with old healed granulomatous disease exposure. No discrete superimposed acute changes, however serial imaging can increase sensitivity if concern remains high


Instruction: Generate impression based on medical findings.

Input: Reason: L IJ cordis in R subclavian; please compare to previous History: Displaced dilaysis line Right jugular catheter tip in the area of the SVC with its tip directed laterally.Persistent nonspecific basilar opacity compatible with atelectasis and effusions.

Output: Catheter tip in the area of the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.PICC pulled back, evaluate position. Right PICC tip at the superior cavoatrial junction. Left subclavian ICD unchanged. Cardiomegaly. Near complete resolution of pulmonary edema.

Output: PICC tip at the superior cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Chest pain rule out infection. Upper normal heart size. Atherosclerotic calcifications of the thoracic aorta at the level of the arch. No convincing evidence of pneumonia. No pleural fluid.

Output: No focal airspace opacities to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with fever and cough. Unchanged cardiomediastinal silhouette.Previously described retrocardiac opacity is no longer seen. No focal consolidation, pleural effusion, or pneumothorax.Right chest port with tip in the SVC. Unchanged tracheostomy.

Output: No acute cardiopulmonary abnormality. Previously described retrocardiac opacity is no longer seen.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: eval for pneumonia History: abdominal pain Decreased lung volumes with stable cardiomediastinal silhouette.The lungs are clear without focal areas of consolidation.No large pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: recent fever - sign of infection? History: fevers Right Port-A-Cath its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Nonspecific right basilar opacity similar to the prior exam.No new pulmonary opacities noted.

Output: Nonspecific right basilar opacity suggestive of atelectasis/aspiration similar to the prior exam. No new pulmonary opacities noted.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval for pneumonia History: syncope, hypotension. Normal heart size. Tortuous thoracic aorta.Nonspecific left lower lobe opacity. No dense consolidation, pleural effusion or pneumothorax.Multiple healed rib fractures.

Output: Nonspecific left lower lobe opacity likely reflects subsegmental atelectasis given resolution follow-up radiograph.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: 71-year-old female with history of metastatic thyroid cancer. Compare previous measurements. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules bilaterally and right infrahilar mass compatible metastatic disease are reidentified, many of which continue to decrease in size. Reference measurements as follows:1] left upper lobe nodule (series 5, image 20) measures 9 x 5 mm; fusion measuring 11 x 6 mm.2] second left upper lobe nodule (series 5, image 24) measures 4 mm (stable)3] left lower lobe nodule (series 5, image 32) measures 11 x 9 mm; previously measuring 14 x 11 mm.4] right infrahilar mass (series 5, image 51) measures 38 x 16 mm; previously measuring 42 x 20 mm.No new or enlarging nodules identified.No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Lytic lesion in the inferior aspect of the sternum (series 3, image 50) is unchanged from prior study. Left chest pacemaker as seen previously.ABDOMEN: LIVER, BILIARY TRACT: Diffuse fatty infiltration. No focal hepatic lesions identified. The portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass (series 3, image 84) measures 28 x 24 mm; previously measuring 29 x 25 mm (overall stable accounting for differences in technique).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. Continued decrease in size in pulmonary metastases. No new sites of disease identified.2. Stable left adrenal mass.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: increased work of breathing History: see above Right IJ venous catheter and pleural catheters unchanged. Dobbhoff tube has been removed.Pleural effusions and pulmonary opacities similar to the prior exam.No pneumothorax identified.

Output: Interval removal of Dobbhoff tube. Remaining support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: swan placement, pleural effusion, assess for interval changes History: as above Cardiopulmonary monitoring and support devices, unchanged.Moderately large layered out right pleural effusion.No pneumothorax or other acute change.

Output: Moderately large right pleural effusion, slightly increased compared to previous, and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Right pleural effusion status post IR drain placement and fluid removal. Right inferolateral pigtail catheter unchanged.Moderate volume of pleural fluid on the right, slightly improved compared to yesterday's exam and significantly smaller than the study of 7/11/2016.Compressive atelectasis and mild reexpansion edema on the right. Improving mild atelectasis on the left.Scoliosis.

Output: Continued slight improvement in right pleural fluid volume.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: ETT History: intubation Lower lung zone edema-like opacities gradually worsening consistent with CHF/hypervolemia.ET tube tip 4 cm above the carina.An NG tube terminates in the stomach.Unchanged ICD and LVAD.Left subclavian catheter tip in SVC.

Output: Gradually worsening pulmonary edema consistent with CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: History of TEF fistulaVIEW: Abdomen ap NG tube tip in the stomach. Gastrostomy tube in place. Right chest tube again noted. There is contrast within the dilated distal esophagus. Absent bowel gas within the abdomen. No pneumatosis or pneumoperitoneum.

Output: Contrast within the dilated distal esophagus.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: 67M transferred for outside hospital with post-op abdominal distention; please evaluate gas pattern and presence of air in colon. History: obstipation Right middle lobe subsegmental atelectasis of indeterminate etiology and chronicity. Mild cardiomegaly. There is extensive gaseous distention of small bowel loops and colon segments. These findings are most likely suggestive of ileus, or, a colonic obstruction cannot be excluded. No free air.

Output: Significant gaseous distention of bowel loops in the abdomen most likely representing ileus. However serial x-ray imaging and/or abdominal CT is recommended to clarify the etiology of bowel distention.


Instruction: Generate impression based on medical findings.

Input: Reason: concerns for chf History: dyspnea on exertion, leg swelling times 2 weeks The heart size and mediastinal contours within normal limits.Perihilar and lower zone bronchial thickening suggestive of bronchitis, possibly with a component of interstitial edema.

Output: Bronchial thickening suggestive of bronchitis or asthma, and possible mild CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for cardiomegaly, pulm edema; hx of CHF History: orthopnea, DOE Moderate cardiomegaly with large central pulmonary arteries suggestive of pulmonary hypertension.No evidence of pulmonary edema or pleural effusions.Thin curvilinear calcific opacity in the anterior mediastinum, best seen on the lateral view, and faintly visible in retrospect on the previous radiograph from 2002.This may represent a calcified anterior mediastinal mass such as thymoma, but its etiology and significance is uncertain. Avascular etiology is possible but less likely. Given its large size and uncertain etiology a CT scan is recommended for further evaluation.

Output: 1.Moderate cardiomegaly with probable pulmonary hypertension.2. Anterior mediastinal mass with thin curvilinear calcification, of uncertain etiology for which a CT scan is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Status post right IJ trialysis placement, assess position. Sepsis. Right jugular catheter tip projects over the right brachiocephalic vein approximately 1 cm above the level of the azygos arch.Dense opacity in the left hemithorax, probably a combination of fluid layering within the major fissure and adjacent consolidation/atelectasis about the same. Left greater than right basal bronchial wall thickening and peribronchial airspace opacities. Left subclavian stent.Quadrant cholecystectomy clips. Sternotomy wires. No pneumothorax.

Output: Right jugular catheter tip projects over a central vein near the SVC. No pneumothorax. No acute change in pleural and pulmonary abnormalities consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: 70F with leukocytosis and pulmonary congestion History: pulmonary congestion and leukocytosis Median sternotomy.Small lung volumes.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with diffuse large B-cell non-Hodgkin's lymphoma status post autologous stem cell transplant in 7/23/2007. Restaging. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small to moderate amount of pericardial fluid redemonstrated. No adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Few small hypodense lesions too small to characterize one in the lateral segment of the left lobe image 78 one in the posterior segment of the right lobe image 91, unchanged. Remainder the liver is normal.SPLEEN: Normal size no focal lesions.PANCREAS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No pathologic size nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered diverticulosis. No evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No pathologic-sized adenopathy. Few hypodense lesions in the liver, unchanged. Small amount of pericardial fluid, unchanged. Diverticulosis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: chest tube History: chest tube Right chest tube removed, left still in place with a small left apical pneumothorax, unchanged.Gastric pull-up with basilar atelectasis stable.An NG tube traverses a gastric pull-up.

Output: Unchanged small left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: Evaluate for cardiopulmonary disease. History: Abd pain, nausea The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: ? Infection/volume status History: rising WBC. Congestion Median sternotomy status post cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: FemaleReason for Study: Reason: evaluate for RLL infiltrate History: R CVA tenderness, pain with inspiration The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p trach, PNA History: PNA, secretions The Dobbhoff tube tip is no longer visualized the gastric fundus; it terminates inferior to the caudal margin of the image. The remaining support devices are unchanged in position.Increasing right infrahilar opacities suspicious for aspiration or atelectasis. Left-sided opacities are stable. Left greater than right pleural effusions unchanged. Cardiomegaly with evidence of prior coronary artery revascularization stable. No interval pneumothorax.

Output: Increasing right infrahilar opacity suspicious for aspiration. Diffuse left-sided opacities and bilateral pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Cardiomegaly, end-stage renal disease Small and questionably loculated right pleural effusion without additional underlying cardiopulmonary abnormality

Output: Small right effusion


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval lung fields History: s/p MVR Diffuse opacity throughout the right lung again noted. Resolution of small right-sided pneumothorax with increase in right-sided pleural fluid. Slight increase in left basilar opacity. Iatrogenic devices are unchanged. Unchanged cardiomegaly.

Output: Resolution of pneumothorax. Diffuse pulmonary opacity again noted in the right lung which may represent asymmetric edema, pulmonary hemorrhage, and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: Dyspnea on exertion History: Dyspnea on exertion Mild interstitial pulmonary edema. Moderate cardiomegaly again noted. Extensive aortic atherosclerosis, unchanged. No focal lung consolidation. No large pleural effusions or pneumothorax. No acute bony abnormality.

Output: Mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: r/o ptx History: gsw Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No pneumothorax or evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of right subclavian dialysis catheter malfunction. Cardiomediastinal silhouette is unremarkable. There is a faint nodular opacity projecting in the area of the catheter hub. There is no evidence of edema or infection.

Output: Faint nodular opacity projecting in the area of the catheter hub. Recommend repeat PA/lateral chest radiograph with repositioned catheter. If the catheter cannot be repositioned, a CT should be considered. No evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: 41 years old Female. Reason: eval new hypoxia History: hypoxia. Stable bilateral pleural effusions, airspace and interstitial opacities. Cardiac silhouette appears enlarged. The double-lumen catheter is stable in position. There is no evidence of pneumothorax.

Output: Extensive bilateral airspace and interstitial opacities and bilateral pleural effusions, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: chronic cough History: chronic cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: evaluate for infection History: cough, HIV not on treatment, smoker Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality. If symptoms persist a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with metastatic melanoma. Neck pain. CHEST:LUNGS AND PLEURA: Calcified right lower lobe granuloma.MEDIASTINUM AND HILA: Calcified right hilar and mediastinal lymph nodesCHEST WALL: The left-sided port terminates in the SVC.Right axillary node dissection. Small right axillary fluid collection remains. Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liverSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts.Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: 14 by 8mm morphologically normal lymph node (series 3; image 1.9), previously 15 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: Mild diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination..


Instruction: Generate impression based on medical findings.

Input: Reason: Hx of renal cell carcinoma. Surveillance for metastatic disease History: As above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Status post cardiac surgery. Enteric tube tip above the level of the GE junction and may be advanced. Tracheostomy tube tip 6 cm above the level of the carina. Sternotomy hardware appears in alignment. A peripheral catheter from the right terminates in the projection of the right subclavian vein.No acute change in diffuse nonspecific opacities suggestive of edema and atelectasis. Right pleural effusion similar in volume. Small pleural effusion on the left.

Output: No acute change in pulmonary opacities. Enteric tube may be advanced.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: 34yo M with SC-beta thal with new productive cough and leukocytosis. History: cough. Volume loss in the left lung is again noted with chronic left basilar scarring.No new focal pulmonary opacity, pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval pna History: leukocytosis, cough Worsening retrocardiac opacity and small pleural effusion. No pneumothorax. Cardiomediastinal silhouette is unchanged.

Output: Worsening retrocardiac opacity and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old Reason: free air? also NGT placement History: n/v s/p NGT placement Lungs are clear. Heart size is normal. The tip of the NG tube is in the proximal stomach. There is significant distention of the small bowel loops consistent with obstruction. No free air.

Output: Distal small bowel obstruction without evidence of free air.


Instruction: Generate impression based on medical findings.

Input: Hemoptysis No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 40 year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: Reason: lung fields History: lung ET tube tip approximately 5 cm above the carina.Right jugular catheter is extending to the area of the right innominate vein. Chest tubes in place with no significant pneumothorax.Diffuse opacity compatible with edema, atelectasis and small effusions.A more recent radiograph has been interpreted.

Output: Edema, atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Evaluate for ileus, history of transplanted kidney Relative paucity of bowel gas particularly in small bowel, small amount of air seen distally in colon. Partially imaged right nephroureteral stent and pelvic drain. Right upper quadrant surgical clips related to prior cholecystectomy.

Output: Paucity of bowel gas, amount of intraluminal air in small bowel decreased from prior study, may be seen in setting of fluid containing bowel.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old Reason: SOB History: above Low lung volumes.Persistent mild elevation of the right hemidiaphragm.Minimal left basilar atelectasis.Mild cardiomegaly unchanged.

Output: Mild cardiomegaly and minimal basilar atelectasis without reliable evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: Pt with cad and today presents with chest pain. eval for edema or widened mediastimum History: Pt with cad and today presents with chest pain. eval for edema or widened mediastimum The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Infiltrates History: Fever Cardiomediastinal silhouette and vasculature are normal.Dual-lumen chest port with tip in the projection of right atrium.No airspace or interstitial opacities. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Status post left-sided pacemaker implantation, please rule out pneumothorax. Interval placement of left-sided pacemaker with leads in acceptable position. Low lung volumes. No pneumothorax or pleural effusion. Moderate cardiomegaly.

Output: Interval placement of left-sided pacemaker with leads in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with history of asthma and fever. Question pneumonia. Cardiomediastinal silhouette is within normal limits.No focal pulmonary consolidation or pleural effusion.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with stridor and dyspnea. Unchanged position of tracheostomy. Visualized intrathoracic trachea is patent. Left upper extremity PICC overlying the left subclavian vein, unchanged. Stable cardiomediastinal silhouette. Persistent basilar pleural-parenchymal opacities likely due to chronic aspiration.

Output: Persistent basilar pleural-parenchymal opacities likely due to chronic aspiration.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, 76 years old.Mild persistent asthma and SOB. Low lung volumes with basal atelectasis and underinflation artifact. No pleural fluid, pneumothorax or pneumomediastinum is visualized. No conclusive airspace opacities.Degenerative changes of the spine.

Output: No specific evidence of pneumonia or CHF within the limitations of underinflation artifact.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: sob, ronchi, productive cough Thin-walled cyst containing an air-fluid level in the right lung, not significantly changed from previous, compatible with infection.Chronic interstitial abnormalities at the right base.Underlying emphysema.

Output: COPD with right midlung cyst with an air-fluid level consistent with infection, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: infection History: sob desats Large lung volumes consistent with COPD, with mild basilar scarring.Heart size normal, the aorta is very tortuous, and a stable saccular aneurysm involving the aortic arch.Status post several kyphoplasty.

Output: COPD and a thoracic aneurysm, unchanged, with no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Leukocytosis and tachycardia rule out infection and acute chest syndrome. Upper normal heart size. No focal airspace opacities. A device, presumably an iPhone, projects over the right upper quadrant on the frontal image, obscuring the costophrenic angle and right upper quadrant which cannot be evaluated.Extrapleural opacity on the left laterally just below the level of the scapular tip may reflect artifact however please correlate for symptoms referable to this area. This is approximately at the level of the seventh and eighth ribs.No pleural fluid or pneumothorax.Osseous tip amount of sickle cell disease.

Output: Right costophrenic angle obscured on frontal radiograph and cannot be assessed. Otherwise, no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 71 years old Male. Reason: r/o infection History: high aspiration risk, tachypnea, leukocytosis. Multiple scattered lung nodules are noted. There is a prominence of the left lung hilum and mediastinal AP window regions. Cardiac silhouette is normal.

Output: Multiple lung nodules and prominence of the left lung hilar and mediastinal AP window. Suggest further evaluation with CT if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: rule out acute chest History: sickle cell crisis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: abnormality? History: sob, cancer with mets Normal heart size.Left paraesophageal nodular opacity corresponding to lymphadenopathy on recent CT scan, new from previous. No significant pulmonary abnormalities.

Output: Mediastinal lymphadenopathy and no acute pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Evaluate position of DHT Dobbhoff tube seen either curled in gastric body or in third portion of duodenum, extending towards the ligament of Treitz. Partially imaged left-sided skin staples. Incompletely imaged paucity of bowel gas. Small amount of gas and stool seen in left colon.Please see same day chest radiography for additional findings.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumonia v. Plumonary Edema History: SOB, CHF, LVAD Unremarkable cardiac and mediastinal silhouette. Status post median sternotomy with complete withdrawal of at least one screw and partial withdrawal of another screw from sternotomy plates.Abandoned ICD leads and LVAD, unchanged. No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: pneumo vs rib fracture History: right sided cp Cardiomediastinal silhouette is normal in size.No focal airspace opacity, pleural effusion or pneumothorax.No displaced rib fracture.

Output: No acute cardiopulmonary findings. Acute rib fracture may not be visible by chest radiograph technique.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, 50 years old.Reason: pna History: fever Heart size is normal. The lungs are clear. No pneumothorax or pleural effusion. Lung volumes are low normal.

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