Instruction: Generate impression based on medical findings.

Input: Patient without bowel movement in awhile, evaluate stool burden Suboptimal study secondary to patient's body habitus, per technologist's notes, patient morbidly obese and bed was broken, acquired images were best possible.Enteric tube seen in satisfactory position with tip extending to level of gastric antrum. Distended stomach. Relative paucity of small bowel gas, gas seen in portions of colon. No definitive evidence of bowel obstruction. Minimal to no formed stool visualized, within limitations of study.Please see same day chest radiographic study for additional findings.

Output: Within limitations of the exam, minimal to no formed stool visualized.Enteric tube in satisfactory position. Distended stomach.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is mild multilevel disc narrowing, most conspicuous at C6-C7. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C2-C3, there is bilateral uncovertebral hypertrophy and left facet arthropathy. There is a very minimal central disc protrusion which indents the ventral thecal sac without stenosis.At C3-C4, there is a trace posterior osteophyte disk complex with right greater than left uncovertebral hypertrophy and moderate bilateral facet arthropathy. There is mild-moderate right foraminal narrowing and minimal left foraminal stenosis.At C4-C5, there is a trace disc bulge with minimal bilateral facet arthropathy and uncovertebral hypertrophy with mild bilateral foraminal narrowing.At C5-C6, there is a mild diffuse posterior osteophyte disk complex with slight left paramedian prominence, which flattens the left ventral cord. There is minimal central spinal canal stenosis and mild right foraminal narrowing.At C6-C7, there is a trace posterior osteophyte disk complex with right paracentral prominence. There is minimal flattening of the ventral cord. There is mild right greater than left uncovertebral hypertrophy without significant stenosis.At C7-T1, there is a trace disc bulge without stenosis.Incidental note is made of a nodular appearance of the visualized parotid glands which is nonspecific but may relate to autoimmune disease. In addition, the coronal T2-weighted images through the upper spine suggest enlargement of the parotid glands bilaterally.THORACIC SPINE

Output: 1. Redemonstration of significant rotatory scoliosis of the thoracolumbar spine without evidence of segmentation anomaly. No evidence of cord abnormality, with mild scattered degenerative changes as detailed above.2. Prominent bilateral parotid glands partially visualized with nodular appearance. This is nonspecific but could relate to underlying autoimmune disease. Please correlate clinically.3. Suggestion of slightly prominent craniocaudal dimension of the liver although incompletely assessed as images may be somewhat obliqued through the organ. Please correlate with physical exam.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer Right basilar focal scarring with hilar calcified lymph nodes compatible old granulomatous disease exposure. No distinct superimposed focal acute cardiopulmonary abnormalities.Mildly asymmetric apical opacities, possible scarring greater on the right, correlating with the prior January chest CT. please correlate given greater sensitivity.

Output: No new superimposed focal acute pulmonary abnormalities. Persistent questionable scarring and/or possibly post infectious or treatment related changes in the right apex.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: ? aspiration History: ? aspiration No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: s/p line exchange History: eval position of central line s/p line exchange R IJ Mild lower lung zone opacities with pleural effusions and retrocardiac consolidation are unchanged.Right jugular catheter, tip in SVC, replaced.

Output: Unchanged pulmonary opacities and pleural effusions. Right jugular catheter exchange, the tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: s/p RV ICD lead extraction and reimplantation --> r/o pneumothorax and evaluate lead positions History: as above Left-sided ICD with new lead wire in the ri right ventricle.Stable cardiac mediastinal silhouette.The lungs are clear.No pleural effusions.

Output: New right ventricular ICD lead placed without complication.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: cough Unremarkable cardiac and mediastinal silhouette.Moderate perihilar bronchial thickening compatible with bronchitis.No acute pulmonary or pleural disease.

Output: Probable bronchitis with no sign of pneumonia or other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: r/o infection History: crackles on exam Support devices are unchanged.Streaky mid to lower zone opacities of subsegmental atelectasis. No interval edema or pneumonia. Heart size remains normal.

Output: Basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Heart transplant check Swan-Ganz again projects into the pulmonary flow tract at the bifurcation. IABP has been removedLungs otherwise remain essentially clear given mild decrease in volume. Cardiac and medius on contours are within limits

Output: Unchanged Swan-Ganz position


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: assess for interval changes in r ptx History: r ptx Right chest tube with no pneumothorax.Nonspecific pulmonary opacities unchanged.Known metastases.Right subclavian catheter, tip in SVC.

Output: No significant pneumothorax. Stable right chest tube.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: FemaleReason for Study: Reason: advanced ET tube History: respiratory failure ET tube with its tip approximately 2 cm above the carina.NG tube with its tip in the region imaged.Markedly decreased lung lines are stable cardiomediastinal silhouette.Basilar opacities and small left pleural effusion similar to the prior exam.

Output: Interval advancement of the ET tube with its tip now 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: respiratory failure History: respiratory failure Patchy bibasilar subsegmental atelectasis or scarring again noted. No new focal lung consolidation. No definite pleural effusion. No pneumothorax. Marked cardiomegaly again noted. Dense atherosclerosis again noted within the aorta and coronary arteries.

Output: No substantial difference compared to last study in patchy bibasilar atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: 69 years old Male. Reason: NGT placement History: stroke`. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Streaky opacities are seen in the lower lungs, which are consistent with atelectasis. The tip of the feeding tube is below the lower margin of the image. The right PICC line is stable in position. There is no evidence of pneumothorax.

Output: Streaky opacities in the lower lungs, which are consistent with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: pna? History: ams Cardiomediastinal silhouette is unremarkable. Mild bibasilar atelectasis. No pleural effusion or pneumothorax.

Output: Mild bibasilar atelectasis with no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: history of NSCLC stage IIB, evaluation of Pleurx History: follow up Volume loss in the right hemithorax with diffuse airspace and interstitial opacity and right pleural effusion or pleural thickening.A pleural catheter is visible on the lateral view with its tip directed posteriorly. However it is not visible on the PA view, possibly obscured by overlying lung and pleural disease.Healed fracture deformities of the right fourth and fifth ribs laterally.

Output: Extensive abnormalities in the right hemithorax with a Pleurx catheter faintly visible on the lateral view.


Instruction: Generate impression based on medical findings.

Input: Metastatic renal cell carcinoma for reevaluation. CHEST:LUNGS AND PLEURA: Previously described patchy groundglass opacities throughout the right lung have regressed but are still present.MEDIASTINUM AND HILA: Index right paratracheal node measures 17 x 9 mm (image 39; series 4), unchanged. Other smaller mediastinal lymph nodes are also stable. Coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver is again noted. Several punctate enhancing lesions are stable compared to prior. Of note, the previously described 9 x 7 mm lesion in the right lobe is not clearly evident on today's examination. This may be due to differences in scan timing. Fatty infiltration of the liver severely limits the ability of CT to detect focal liver lesions. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left upper pole renal mass is stable to equivocally enlarged measuring 4.2 x 4.2 cm (image 103; series 4). Subcentimeter left renal lesions are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Regression of patchy ground glass opacities in the right lung. Otherwise, no substantial interval change compared to previous with reference measurements given above.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: R/o worsening pulm edema History: sepsis with volume administration Chest port tip in the SVC. Cardiomediastinal silhouette is unremarkable. Nonspecific basilar opacities likely representing edema, atelectasis and effusions, unchanged.

Output: Basilar opacities likely representing edema, atelectasis and effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Swan placement History: Swan placement Moderate cardiomegaly.Small pleural effusions without edema.Left jugular Swan-Ganz catheter tip in right pulmonary artery.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: Unchanged Swan-Ganz catheter, cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: r/o PNA, CAT P History: fever, cough No significant cardiopulmonary abnormality.Left subclavian pacemaker, leads unchanged in position.Spinal stabilization hardware.

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


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.ARDS/pneumonia, follow-up trach. Visualized tubes and lines unchanged. Mediastinal widening about the same, likely due to mediastinal lipomatosis and prominent lymph nodes seen on a recent CT. Extensive pulmonary opacities consistent with provided history of ARDS without appreciable change.

Output: No acute change in diffuse pulmonary opacities or mediastinal widening.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: intubation History: intubation No significant cardiopulmonary abnormality.ET tube tip approximately 2 cm above the carina.

Output: ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Cough and intermittent shortness of breath for 4 days. Evaluate for infection. The cardiomediastinal silhouette is normal.Calcified mediastinal lymph nodes are unchanged.There is no pleural effusion, pneumothorax, or abnormal pulmonary opacity.

Output: No reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for acute pulmonary changes History: recently extubated after respiratory failure at OSH, dyspneic Moderate cardiomegaly.Right jugular catheter extending to the SVC.Moderate bilateral pleural effusions with underlying atelectasis.

Output: Cardiomegaly with bilateral pleural effusions. No specific evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: 8-year-old female presents with decreased breathing. Evaluate for pneumonia or pulmonary edema. The cardiomediastinal silhouette is stable with cephalization of the pulmonary veins. Interval increase of diffuse interstitial opacities, right greater than left. Interval development of bilateral pleural effusions, right greater left. Deviation of the trachea to the right due to thyromegaly (as previously demonstrated on prior CT neck).

Output: 1.Asymmetric, right greater than left, pulmonary edema.2.Bilateral, right greater than left, pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: intubated, s/p pericardial drain, assess interval change History: see above New IVC cardiac assist catheter extending as high as the right jugular in the supraclavicular region.Cardiomegaly with pericardial drains.Pleural effusions and mild edema are unchanged.Right jugular catheter tip at right atrial level. ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: New device placement, with severe cardiomegaly or pericardial effusion, mild edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Small lung volumes with mild basilar atelectasis.No specific evidence of infection.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC. New basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: resp insuf History: same There is a small increase in size of the left pneumothorax but a significant increase in the degree of left chest wall and body wall subcutaneous emphysema.Line position stable.Pulmonary opacities are otherwise unchanged.

Output: Slight increase in the sizable left pneumothorax but significant increase in the degree of left chest wall and body wall subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: intubated History: intubated Bilateral pleural effusions slightly improved with persistent retrocardiac atelectasis and mild/moderate cardiomegaly.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.Right PICC, tip in right subclavian.

Output: Persistent pleural effusions and basilar atelectasis. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: coughing History: coughing Stable cardiac mediastinal silhouette.Bilateral pleural effusions increased from the prior exam.Spinal stabilization hardware unchanged.

Output: Increasing pleural effusions compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: central line insertion History: central line insertion Unchanged airspace opacity left lower lung zone, and dense fibrotic native right lung.ET tube tip approximately 5 cm above the carina.Left jugular catheter tip in left brachiocephalic vein at the midline.

Output: Unchanged pulmonary opacities. New left jugular catheter emanates in the left brachiocephalic vein at the midline. Follow-up study showed a large left pneumothorax developed.


Instruction: Generate impression based on medical findings.

Input: Left chest mass resection Unchanged 2 left chest tube projecting to the apex with small residual pneumothorax. Overlying mild chest wall at this edema also similarPersistent decreased lung volumes mildly diminished as compared to 12/13, however this may be partially due to semiupright portable technique. Underlying mild basilar atelectasis and mild edema are again observed, possibly increased on the left. Serial imaging will be helpful to confirm.

Output: Chest tubes unchanged with questionable mild increasing pulmonary edema on the left


Instruction: Generate impression based on medical findings.

Input: 90 years old Male. Reason: Chest pain History: As above. The cardiac silhouette is normal. There are mild interstitial changes in both lungs especially in the left lower lung. The cardiac pacemaker/defibrillator electrodes project over the right atrium and the right ventricle. There is no evidence of pneumothorax. There is blunting of the right costophrenic angle, suggesting small right pleural effusion.

Output: Mild interstitial changes in both the lungs and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o pulm edema vs. new infiltrate History: hypoxia Mild cardiomegaly. Patchy air space opacities, slightly increased compared to prior. No new pulmonary findings. Right jugular and left subclavian catheters, unchanged in positions.

Output: Increasing patchy air space opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: evaluate ETT History: see above Improving basilar opacities, but persistent in the right lower lobe.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Bilateral jugular catheters terminate in the SVC.Bullet fragments are projected over the upper chest.

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


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: asthma History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: unilateral right sided wheezes, evaluate History: as above COPD.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: r/o tb History: weight loss, night sweats 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, 72 years old.Reason: ards History: ards Tracheostomy and left subclavian central line unchanged.Diffuse bilateral interstitial and airspace opacities with medium-sized effusions not substantially changed.Cardiomediastinal silhouette not well assessed.

Output: Effusions and extensive opacities which may reflect edema and chronic fibrosis.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: FemaleReason for Study: Reason: ETT repositioned History: above ET tube with its tip 3 cm above the carina.NG tube with its tip beyond the margin of the image.Stable cardiomediastinal silhouette.Bilateral pulmonary opacities and pleural effusions similar appearance to prior exam.

Output: ET tube tip in satisfactory position. Stable cardiopulmonary appearance with bilateral pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: 58 yo male with history of AML; post-allo sex-mismatched SCT evaluation History: evaluate No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: resp insufficiency History: as above ET tube has been removed.Bilateral central venous catheters unchanged.Dobbhoff tube looped within the stomach and its tip beyond the margin of the image.Increasing right pleural effusion with atelectasis and edema on the right. Patchy areas of atelectasis in the left lung.

Output: Interval extubation. Increasing right pleural effusion right basilar consolidation/atelectasis and right lung opacities may represent infection.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: better assess for cardiomegaly, pulmonary edema History: shortness of breath Decreased size of left pleural effusion. Left lower lobe atelectasis and consolidation. Resolving pulmonary edema. Left nodular pleural thickening or loculated pleural fluid at the left mid zone. Small right pleural effusion.

Output: Resolving pulmonary edema with decreased size of left pleural effusion and retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with colorectal metastatic cancer CHEST:LUNGS AND PLEURA: Nonspecific 6-mm nodule in the right lower lobe on image number 46, series number 3. Subsegmental atelectasis in the right lung base.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous large metastatic lesions in the liver. A reference lesion in the right lobe measures 4.8 x 3.3 cm image number 111, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant amount of ascites. Thickening of the mesenteric root and soft tissue density in the omentum and surrounding small bowel loops is suspicious for peritoneal carcinomatosis. No evidence of bowel obstruction. Multiple borderline enlarged mesenteric lymph nodes.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: Significant amount of ascites.

Output: Nonspecific right lung nodule.Extensive hepatic metastatic disease.Significant ascites. Possible peritoneal carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Intubation. Low endotracheal tube, with tip less than 1 cm above the level of the carina. Linear areas of atelectasis bilaterally. Low lung volumes.

Output: Low endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: ?left pleural effusion History: DOE up stairs; decreased breath sounds at left base, mid field Moderate to severe globular cardiomegaly.New left pleural effusion and/or left hemidiaphragm elevation with left basilar consolidation.Small right pleural effusion and basilar atelectasis.

Output: New left pleural effusion and basilar opacities. Findings are suggestive of CHF although left lower lobe pneumonia may also be present.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: AMS Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Fever and tachycardic Persistent decreased lung volumes with atelectasis in left lung base. Tracheostomy tube unchanged, tip projects 5 cm above the carina. No superimposed new acute abnormality

Output: Mild atelectasis without additional new airspace focal abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Cough and fever evaluate for pneumonia. Small right pleural fluid collection unchanged. Faint opacity at the left lung base. Normal heart size.Chronic metallic density foreign body projecting over the right paratracheal region, possibly intravascular, unchanged over multiple studies.

Output: Small right pleural effusion, and minimal faint opacity at the left base, nonspecific but could be signs of early infection.


Instruction: Generate impression based on medical findings.

Input: Dyspnea and IABP Unchanged IABP marker, tip projects 3 cm from the arch. Swan-Ganz again extends into the right pulmonary outflow tract unchangedLungs remain significant for decreased volumes, moderate effusions and edema greater both bases with cardiomegaly

Output: Mild to moderate CHF with unchanged IABP marker


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Infiltrates History: fever The cardiomediastinal silhouette is normal. Lungs are clear of airspace and interstitial opacities. There is no pneumothorax. No pleural effusion. Stable calcified granuloma in the right lower lobe.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#2 Status post lung transplant, one of the right-sided chest tubes crossing the midline to the left.Small left apical pneumothorax.Patchy consolidation and pleural effusions.Left chest wall soft tissue emphysema.Left jugular introducer remains in place.

Output: Unchanged pulmonary opacities with only a small left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male; 66 years. Reason: mets lung ca, on crizotinib, pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Postop appearance of left upper lobectomy with surgical clips, soft tissue, and loculated pleural gas superior to the left heart border again noted. The soft tissue mass with surrounding gas foci in the surgical bed is less masslike on current exam with a smaller amount of soft tissue debris, making recurrent neoplasm less likely. Infection, including fungus ball remains a possibility.Referenced right upper lobe mass (series 5 image 25) now measures 1.8 x 1.9 cm (previously 1.4 x 2 cm), now with small cavitation, highly likely metastatic. Other and scattered micronodules are not significantly changed. No new lesions.Branching right middle lobe opacities (series 5 image 57) are unchanged from recent priors. While this finding is common with acute infections, given the chronicity, lymphovascular spread of tumor is likely.MEDIASTINUM AND HILA: Index pretracheal lymph node (series 3 image 30) measures 1 x 0.8 cm (previously 1 x 0.6 cm). Index AP window lymph node (series 3 image 32) measures 2 x 1.3 centimeters (previously 1.7 x 1.1 cm). Other non-referenced subcarinal and hilar adenopathy are increased from prior. No pericardial effusion.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: Hypoattenuating renal lesions bilaterally, are incompletely characterized, but similar in appearance to multiple priors, suggestive of simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic interposition anterior to the liver again noted, normal variant.BONES, SOFT TISSUES: Expansile, sclerotic lesion in the left ninth rib posteriorly, unchanged.OTHER: No significant abnormality notedPELVIS: Metallic streak artifact from right hip prosthesis limits evaluation of this.PROSTATE, SEMINAL VESICLES: Heterogeneously enlarged.BLADDER: Not well evaluated secondary to streak artifact. Questionable soft tissue density (series 3 image 196) within the bladder lumen as noted on priors. LYMPH NODES: Reference right external iliac lymph node (series 3 image 28) measures 0.9 x 0.6 cm, essentially unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic bony pelvis lesions, unchanged.OTHER: No significant abnormality noted

Output: 1. Progression of metastatic disease in the chest.2. Stable osseous metastasis.3. Post-surgical appearance of left hemithorax with decreased size of soft-tissue component in the surgical bed making recurrent neoplasm at this site less likely. Infection including fungal still a possibility. 4. Bladder/Pelvis not well evaluated due to streak artifact.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: 3 months non-productive cough History: 3 months non-productive cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.VP shunt tubing again noted overlying the right hemithorax.

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


Instruction: Generate impression based on medical findings.

Input: 72-year-old female history of ovarian carcinoma. Reevaluate disease post 8 cycles of chemotherapy and compared provide bidimensional measurements. Please measure left internal iliac lymph node and right lobe liver. CHEST:LUNGS AND PLEURA: A new moderately large left pleural effusion.There is suggestion of nodules at the border of the lung and pleural effusion probably representing pleural based lesions for example at the left lung base series 6 image 52. These are not amenable to measurement.The right lung is normal.MEDIASTINUM AND HILA: Small non-pathologically enlarged mediastinal nodes including prevascular nodes, unchanged from the prior exam.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Peritoneal implant on the surface of the left lobe of the liver is measured on series 4 image 80/209, 13.8 x 8.3 mm. Implant along the lateral surface of the right lobe of the liver is redemonstrated unchanged on series 4 image 101.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal nodes are unchanged. OneBOWEL, MESENTERY: Scattered stranding and implants in the distribution of the omentum and mesentery particularly in the right abdomen are grossly unchanged. There is no evidence of ascites. The bowel is normal.BONES, SOFT TISSUES: Several vertebral hemangiomas, unchanged. No definite lytic or blastic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Proximal left external iliac nodes series 4 image 157 measures 7.9 x 5.9 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New large left pleural effusion and suggestion of new pleural-based nodules on the left although there not amenable to measurement. Lymph nodes stable. Carcinomatosis stable.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: interval eval for swan placement History: as above Mild cardiomegaly status post sternotomy.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter, tip in proximal right main pulmonary artery.Right jugular catheter, tip in SVC.Remnants of a left subclavian ICD remain in the chest wall.

Output: Mild cardiomegaly, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: Infiltrates History: Fever Mildly decreased lung volumes with scattered areas of scarring/discoid atelectasis.The cardiomediastinal silhouette is unremarkable.No focal areas of consolidation. No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: R/O pneumothorax History: Chest tube removal Status post median sternotomy, the heart size upper normal.Minimal left apical pneumothorax following chest tube removal.Residual basilar subsegmental atelectasis noted.

Output: Minimal left apical pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Shortness of breath rule out pneumothorax. History of lung cancer. Portable semierect film taken in the CCD the recovery room. 4.5 cm lobulated masslike opacity in the right upper lobe with adjacent pleural retraction.No pneumothorax.No additional nodules are visible by this technique, but CT is much more sensitive.

Output: 4.5 cm right upper lobe mass. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.IABP placement Severe cardiomegaly again noted. However, no convincing interstitial edema. No airspace consolidation. Previous questioned left upper lobe nodularity and right perihilar opacities are not as well seen currently. Right jugular catheter tip over the SVC. No pneumothorax. IABP marker faintly seen over the proximal descending aorta, stable.

Output: Severe cardiomegaly but no interstitial edema or other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: L posterior Stab wound History: above No significant cardiopulmonary abnormality.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: assess of intrapulmonary process History: SOB Mild diffuse pulmonary edema. No large pleural effusion. No pneumothorax. Moderate cardiomegaly again noted.

Output: Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: chest tube placement History: s/p major lung resection Right-sided chest tubes unchanged.Volume loss and postsurgical changes in the right upper lobe.Basilar predominant interstitial opacities similar to the prior exam.No significant pneumothorax identified.

Output: Stable cardiopulmonary appearance with postoperative changes in the right upper lobe. No significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: rule out infection vs sarcoid History: cough Mild upper lobe nodular fibrotic changes as noted on prior CT dated 4/15/11 and compatible with history sarcoidosis.No focal areas of consolidation.The cardiomediastinal silhouette is unremarkable.No pleural effusions.

Output: Upper lobe fibrotic changes compatible with tissue sarcoidosis. No acute abnormalities identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: please assess et tube position after manipulation History: above ET tube at least 12 cm above the carina, the tip well above the level of the clavicles.Unchanged pulmonary opacities, soft tissue emphysema and a pneumomediastinum.Unchanged pneumothoraces.An NG tube terminates in the stomach.

Output: ET tube tip at least 12 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Status post thoracentesis 1.5-cm pneumothorax is seen at the lateral left apex, new from previous. Retrocardiac opacity is slightly improved. Lungs otherwise clear. NG tube below the diaphragm.

Output: New left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Cough. No focal pulmonary opacities to suggest infection. Small right pleural effusion and basilar scarring. No pneumothorax.Cardiac silhouette is at the upper end of normal.

Output: Small right pleural effusion and basilar scarring, new since the previous chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: evaluate for etiology of asthma exacerbation c/f pna History: wheezing, sob Calcified nodes consistent with healed granulomatous disease. No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male presents with vomiting and dysphagia. The cardiomediastinal silhouette is stable. Low lung volumes. No focal pulmonary opacity, large pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: ETT check Interval ETT placed, tip projects 2 cm above the carina. The remaining lungs are otherwise grossly clear with mild cardiomegaly exaggerated due to technique and motion. Consider serial imaging if needed

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: eval for PNA History: chills Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter tip at right atrial level.

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


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: icu History: icu Severe cardiomegaly, status post sternotomy.Stable mild basilar edema and small pleural effusions.Unchanged support devices.

Output: Stable cardiomegaly and mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.History of testicular cancer. The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.40-year-old female intubated. Evaluate ETT placement. ETT with tip approximately 4 cm above the carina. Left IJ central venous catheter with tip in the right atrium. Interval placement of an enteric tube which courses below the diaphragm but terminates off the field of view.Unchanged interstitial pulmonary edema, bibasilar subsegmental atelectasis, and layering pleural effusions. No pneumothorax.Cardiac silhouette is within normal limits.

Output: ETT tip approximately 4 cm above the carina. Interval placement of enteric tube which courses below the diaphragm, tip not visualized.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Cough and evaluate for pneumonia Normal cardiomediastinal silhouette. No pleural fluid or pneumothorax. The lungs are clear. Mild bronchial wall thickening.

Output: No signs of pneumonia. Mild bronchial wall thickening may be secondary to bronchitis or reactive airways disease, nonspecific..


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval lung fields History: eval lung fields Bioprosthetic valve occupies the aortic position. Support devices are unchanged.Bilateral pleural effusions and diffuse linear opacities not significantly changed. Cardiomediastinal silhouette is stable, unremarkable. No pneumothorax.

Output: Extensive bilateral pulmonary opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: hypoxemic respiratory failure History: hypoxia, sickle cell, trach s/p anoxic brain injury Interval placement of a tracheostomy cannula.Lung volumes. Streaky and patchy bibasilar opacities suggestive of atelectasis/aspiration. There is no pneumothorax or pleural effusion.The cardiac and mediastinal contours are within normal limits for size.Osseous sequelae of sickle cell disease.

Output: Streaky and patchy bibasilar opacities are suggestive of atelectasis/aspiration, although superimposed infection is not excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: desaturation History: desaturation ET tube its tip 2 cm above the carina.NG tube with its tip beyond the margin of the image.Stable cardiomediastinal silhouette.Right perihilar consolidation and diffuse interstitial opacities similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with right perihilar consolidation and diffuse interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: pneumonia? History: crackles Unchanged pulmonary nodules.No specific evidence of infection or edema.Heart size upper normal.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary nodules. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Shortness of breath, pneumothorax, hemothorax. Status post mesh placement near diaphragm. No focal pulmonary opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.Surgical clips and spinal fixation screws and rods are visualized projecting over the abdomen.

Output: No acute cardiopulmonary abnormalities. No evidence of pneumothorax or hemothorax.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with history of Hodgkin disease status post chemotherapy. Restage. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Patent right internal jugular vein containing central venous catheter from right-sided port. Reference anterior mass currently measures 5.4 cm x 2.8 cm (series 3, axial image 49/216), stable to slightly smaller on comparison to previous exam.Stable mediastinal and left hilar adenopathy.CHEST WALL: Unenlarged axillary lymph nodes. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly.SPLEEN: Stable heterogeneous enhancement with trace perisplenic fluid.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previously measured infrarenal retroperitoneal adenopathy measures 8 cm x 2.8 cm (series 3, axial image 111/216) and remains stable on comparison to previous exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Stable pelvic lymphadenopathy. Reference left femoral lymph node (series 3, axial image 176/216) measures 2 cm x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously noted foci of mixed sclerotic and lytic bone lesions remain stable.OTHER: No other significant abnormality noted.

Output: 1.Stable to slightly improved intrathoracic, retroperitoneal, and pelvic lymphadenopathy as detailed above.2.Interval resolution of axillary lymphadenopathy.3.Stable bone lesions.4.5.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: eval for edema/infiltrate History: sob, recent cardiac surgery Stable cardiomediastinal silhouette.Loculated left pleural effusion unchanged from the prior exam.Small right pleural effusion and basilar subsegmental atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with loculated left pleural effusion and basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Check ETT ETT repositioned, tip currently terminates 4 cm above the carina. NG, ICD and right jugular catheter are unchanged. The Swan-Ganz demonstrates minimal repositioning with mild retraction, however tip again projects in the right pulmonary outflow tract.Marked cardiomegaly with underlying left lower lobe opacification, possible atelectasis versus consolidation. Small effusions. Vascular redistribution similar to prior exam

Output: Mild edema with interval ETT repositioning


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for fluid overload/effusions History: hx CHF, not taking meds, now with BLE edema and SOB/orthopnea No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: cough x2-3d` History: cough No significant cardiopulmonary abnormality.Left PICC, tip in the SVC.Spinal stabilization hardware unchanged.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVRS History: chest tube A small left apical pneumothorax with clear margin of the upper lobe about 10 mm from the chest wall. Left chest tubes in place with the lower chest tube extending across the midline, unchanged.Focal consolidation and atelectasis medially in the left upper lobe area, compatible with post operative contusion unchanged.Extensive bilateral nonspecific opacity elsewhere as previously described without significant interval change.

Output: Small left apical pneumothorax, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: assess for pneumothorax History: s/p thoracentesis Moderate size right pleural effusion with underlying consolidation/atelectasis..No evidence of pneumothorax postthoracentesis.Cardiac size cannot be adequately assessed due to the above-noted pleural effusion.The left lung is clear.

Output: Moderate size right pleural effusion. No evidence of a pneumothorax post thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: Rule out pneumonia History: Productive cough x2 weeks in immunocompromised patient Median sternotomy.Heart size normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, sob History: sob Moderate cardiomegaly with small lung volumes.Bilateral interstitial opacities suggestive of edema withprobable small pleural effusions. Fixation device in the thoracolumbar spine.

Output: Findings suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with fallopian tube cancer CHEST:LUNGS AND PLEURA: A few micronodules are seen in the lungs, some which are definitively calcified.MEDIASTINUM AND HILA: Multiple small thyroid nodules are seen.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Serosal lesions along the dome of the liver are identified.SPLEEN: Absent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 11 x 10 mm nodule, possibly lymph node, posterior to the pancreatic tail (series 3; image 84).BOWEL, MESENTERY: Marked improvement of disease. As stated, serosal lesions along the dome of the liver are still present. A few small nodules are seen in the mesentery (series 3; image 114). Ascites has resolved. Omentectomy.Nodular thickening along the right inferior peritoneum is seen (series 3; image 136).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Supracervical hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Erosions are seen along the pubic symphysis with a small amount of fluid in the joint, not significantly changedSclerosis is seen in both SI joints.OTHER: No significant abnormality noted.

Output: Marked decrease in disease burden. Scattered peritoneal lesions remain, most prominent along the hepatic dome.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: assess for infection or edema History: SOB, chest tightness Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Aortic arch calcifications.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o pneumonia History: uterine cancer pt currently in remission, productive cough Heart size normal. Lungs clear. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: EVAL FOR PNEUMONIA, BRONCHITIS History: CHILLS, COUGH X 2 WEEKS, sob 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, 50 years old.Reason: pleuritic ches pain, chills, hx heart transplant History: chest pain Patchy bibasilar subsegmental atelectasis or scarring. No focal lung consolidation or evidence of overt left-sided heart failure. Moderate cardiomegaly again noted. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Post transplant line placement Right jugular catheter injects into the upper SVC without additional cardiopulmonary abnormality, specifically no postprocedural acute abnormality

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Patient arrived with PICC from outside hospital. Right PICC tip projects over the right subclavian vein near the mid clavicular line.Low lung volumes with patchy basilar atelectasis, left greater than right. The presence of infection or other abnormality cannot be excluded without follow-up.No pneumothorax.Right upper quadrant surgical clips.

Output: Right PICC tip projects over the right subclavian vein near the mid clavicular line.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: sob History: sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: new cough in 76F with multiple comorbidities and unable to get out of bed without assistance; rule out PNA History: cough Unremarkable cardiac and mediastinal silhouette.Catheter from the right arm extending to the area of the SVC.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: evaluate for pulmonary edema History: planning for valve surgery Tracheostomy remains in place. Improvement in lung volumes. Interstitial pulmonary edema, as before. New focal opacity in the right apex. Improvement in pleural effusions. Unchanged cardiomegaly. No significant pneumothorax.

Output: New focal opacity in the right apex which may represent developing pneumonia/aspiration.Improvement in pleural effusions.Interstitial pulmonary edema, as before.


Instruction: Generate impression based on medical findings.

Input: Reason: 21yo F with HgbSS in VOC with hypoxia History: hypoxia, coughVIEW: Chest AP (one view) 9/14/2016, 10:46 Mildly enlarged cardiac silhouette. No pleural effusion or pneumothorax. Development of right upper lobe pulmonary opacity, which can represent acute chest syndrome or pneumonia.

Output: Right upper lobe pulmonary opacity, which can represent acute chest syndrome or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: PNA History: cough Small lung volumes with mild interstitial abnormality suggestive of edema.Focal opacity in the left mid lung periphery may correlate with subpleural radiation fibrosis seen on the follow-up CT.No specific evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.

Output: Interstitial opacities suggestive of edema, with underlying left upper lung zone radiation fibrosis. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: assess cardiomegaly History: multiple cardiac surgeries, congenital heart disease, s/p AVR and MVR Cardiomegaly with valve prostheses and a PDA closure device. No specific evidence of infection or failure.No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: pneumothorax History: shortness of breath, chest pain Left hemithorax volume loss unchanged.Marked upper lobe emphysema.No significant pneumothorax.No specific evidence of infection or edema.

Output: Emphysema, but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Scarring and subsegmental atelectasis involving the left lower lobe is stable. Right lower lobe subpleural scarring is also unchanged.MEDIASTINUM AND HILA: Nonenlarged mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the left lobe is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Small cystic lesions in the body and tail of the pancreas are unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous uterus is unchanged. This may be due to fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes are also unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: daily History: icu Cardiomegaly with moderate to severe diffuse bilateral interstitial and airspace opacities not significantly changed, suggesting pulmonary edema. Dobbhoff tube over the stomach. ET tube is 2.5 cm above the carina. Right jugular catheter tip over the SVC. Right chest drainage catheters without possible pneumothorax.

Output: Moderate pulmonary edema pattern, stable.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with metastatic colorectal cancer CHEST:LUNGS AND PLEURA: Bilateral multiple numerous metastases. Index lesion in the right upper lobe measures 1.7 x 1.8 cm on image number 46, series number 4, smaller compared to previous study.Second index lesion in the left lower lobe measures 2.3 by 1.9 cm on image number 66 on series number 4, smaller compared to previous study.MEDIASTINUM AND HILA: Multiple enlarged mediastinal and hilar nodes are again noted. Index right hilar node measures 1.1 x 1 cm image number 48, slightly smaller compared to previous study. Index subcarinal node measures 2.2 x 1 cm on image number 53, smaller compared to previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large mass in the right lobe of the liver consistent with metastatic disease is smaller measuring 17.2 x 10.2 cm on image number 93.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Again noted multiple retroperitoneal lymph nodes, some of them calcified. Index left para-aortic lymph node measures 8mm in diameter on image number 149, smaller compared to previous study.BOWEL, MESENTERY: Nodularity in the sigmoid colon mesentery and in the small bowel mesentery likely indicating metastatic disease is stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple calcified and noncalcified lymph nodes are again noted.BOWEL, MESENTERY: Again noted circumferential thickening of the sigmoid colon consistent with patient's known cancer.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the lung metastases, hilar and mediastinal lymph nodes, liver metastasis and retroperitoneal lymph nodes. Mesenteric spread of disease is unchanged. Patient's known mass in the sigmoid colon is again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: concern for aspiration History: cough, dysphagia Lungs clear of airspace opacities. Small right effusion remains. Heart size normal.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.CHF, Swan position question pneumonia or pulmonary edema. Hardware and devices unchanged in position with Swan-Ganz catheter at the level of the right main pulmonary artery.Cardiomegaly, unchanged.Worsening atelectasis at the right lung base, at least partially the result of decreased lung volumes. Indistinct vascular markings suggestive of edema, about the same. Signs of pulmonary hypertension. A portion of the left lung is obscured by the pulse generator and cannot be assessed.

Output: Mild CHF. Decreased lung volumes and worsening right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: assess ETT positioning History: s/p intubation Lower lung zone interstitial and airspace opacities with an enlarging right pleural effusion.Tracheostomy tube tip approximately 6 cm above the carina.Left jugular catheter tip in left brachiocephalic vein at the midline.

Output: Unchanged pulmonary opacities and enlarging right pleural effusion. Tracheostomy tube tip approximately 6 above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Reason: cough with eating, ? aspiration History: cough Cardiomegaly with streaky left lower lung zone opacities suggestive of scarring or subsegmental atelectasis, unchanged.

Output: Left basilar subsegmental atelectasis or scarring, not new, but could be the result of chronic aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: cardiopulmonary issues? History: SOB, chest pain Moderate cardiomegaly is not significantly changed compared to the prior exam.No specific evidence of infection or edema. No pleural effusion or pneumothorax. Enlarged pulmonary arteries consistent with PA hypertension.

Output: Moderate cardiomegaly without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 88 years old Male. Reason: serial eval s/p TAVR History: serial eval s/p TAVR. Central venous catheter has been removed. Stable basilar pleural parenchymal opacities. There are small bilateral pleural effusions. Unchanged heart size. No pneumothorax.

Output: Stable lower lung pleural-parenchymal opacities, consistent with the edema, atelectasis with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: sob, CF patient s/p BSL now relisted due to decreasing function, evaluate for progression of pneumomediastinum History: sob Right chest port catheter projects over the coronary sinus, unchanged. Postsurgical changes of bilateral lung transplant.Continued improvement in pneumomediastinum and subcutaneous emphysema. Resolution of left extrapleural air collection.Diffuse interstitial opacities are unchanged.Bilateral blunting of the costophrenic angles compatible with scarring, unchanged.

Output: Near complete resolution of pneumomediastinum. No new findings.


Instruction: Generate impression based on medical findings.

Input: septic shockVIEW: Chest AP Feeding tube with tip in the stomach. The UVC tip in the right atrium. The UAC tip at T8. There are two chest tubes on the right with the superior chest tube sidehole in the subcutaneous tissue. There is a small right basal pneumothorax. Diffuse pulmonary opacities are unchanged. Cardiothymic silhouette normal.

Output: Right small basal pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.History of productive cough. The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 52 years old Male. Reason: hx of CAD, OSA; eval for pulmonary edema/infiltrate History: SOB, cough. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Unchanged cardiac size.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: lung eval History: lung eval History of CHF Esophageal stent right of midline appears in stable position. Right pleural pigtail catheter and right PICC also unchanged.No significant change in the right-sided opacities suggestive of aspiration. Small right pleural effusion.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Myocardial infarction. History of CABG Improving bibasilar opacities which may reflect resolving atelectasis. Lungs hyperlucent suggesting emphysema but otherwise clear. Right jugular Swan-Ganz catheter tip in the proximal right main pulmonary artery. ET tube is 5 cm above the carina. Left chest drainage catheter is again noted. No pneumothorax.

Output: Improving bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: 53M with neutropenic fever. History: neutropenic fever Right port tip in SVC. No focal opacity to suggest pneumonia. Linear scarring or atelectasis at the lung bases.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Heart transplant Persistent and questionable mildly improving moderate right effusion with loculation. Borderline cardiomegaly. Lungs otherwise clear

Output: Loculated moderate right effusion unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Right lung cancer with worsening hypoxia and hypercarbia. Improved expansion of the right lung. Elevation of the right hemidiaphragm with moderate volume of pleural fluid remaining. Dense opacities throughout the aerated right lung are now visible, similar to earlier previous studies and most pronounced in the right upper lobe.

Output: Improved inflation of the right lung; interstitial abnormality superimposed upon metastatic disease within the right upper lobe could reflect lymphangitic tumor and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with tachycardia. History of cancer with new atrial flutter/atrial fibrillation. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the subsegmental level.LUNGS AND PLEURA: Mild linear scarring in the left upper lobe. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary artery stents and calcifications.CHEST WALL: Right mastectomy. Multiple surgical clips in right axilla. Degenerative changes of the spine. UPPER ABDOMEN: Hypoattenuating lesion near the hepatic dome, measuring approximately 3.5 x 2.7 cm, compatible with known hepatic metastasis seen on prior CT from April 2011.

Output: 1. No PE and no other acute cardiopulmonary abnormality.2. Partially visualized liver metastasis near the hepatic dome.


Instruction: Generate impression based on medical findings.

Input: Female, 96 years old.Reason: eval for pneumonia History: mild hypoxia on room air Minimal basilar atelectasis but no evidence of pneumonia. Stable heart size with aortic calcification.

Output: Minimal basilar atelectasis but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: r/o mets History: renal mass Lungs hypoinflated. Well-circumscribed roughly 1 cm right upper lung pulmonary nodule for which CT is recommended.

Output: Nonspecific right upper lung pulmonary nodule for which chest CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p AVR Right jugular catheter extending to the SVC and right chest tube in place.Small lung volumes with bilateral opacities compatible with edema, atelectasis and small effusions.

Output: Mild edema, atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Male; 63 years old. Reason: eval for PNA History: cough Improved lung volumes. No abnormal pulmonary opacities. No pleural effusions or pneumothorax.Borderline cardiac enlargement.No rib fractures evident.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Device placement Diffuse mild edema-like changes of moderate nonspecific cardiomegaly. Right jugular catheter extends into the mid SVC unchanged. Anterior ICD is also similar position, tip projects over the level of the aortic arch anteriorly

Output: ICD unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: epigastric pain, eval for perf History: see above Port catheter with its tip in the SVC.New tracheostomy tube in place.Large lung volumes with diffuse bronchial thickening and mild focal air space opacity in the right midlung that may be due to infection or aspiration.No sign of free air in the abdomen.

Output: No free air.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with breast cancer and lung metastasis. Evaluate disease status. CHEST:LUNGS AND PLEURA: Reference right upper lobe lesion measures 21 x 13 mm image number 28, series number 4. Reference is right middle lobe lesion measures 24 x 16 mm on image number 49, series number 4. No new nodules. Scarring in the left apex is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Status post left mastectomy. There is a right sided venous access device in the expected position. ABDOMEN:LIVER, BILIARY TRACT: Few scattered hypodense lesions in the liver are unchanged. 1 cm left lobe lesion is also unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval enlargement in the size of the lung nodules, as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p LVAD. Post-op study History: s/p LVAD Support hardware unchanged in position. Stable cardiomegaly with no new opacity.

Output: Support hardware unchanged in position. Stable cardiomegaly with no new opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: h/o TB; annual surveillance due; pt asymptomatic History: see above Extensive pleural calcification and thickening consistent with healed tuberculosis in the remote past.Small lung volumes.Heart size normal.No active TB, or other acute abnormality.

Output: Healed tuberculosis with extensive pleural calcification, but no active disease.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male. RFO trigger: multiple surgical teams. Counts correct. Post surgical changes from median sternotomy. Clips and a surgical drain projects over the left neck. A second surgical drain projects over the right aspect of the mediastinum. ET tube tip at the level of the carina. There is mild basilar opacities which may represent atelectasis or small postoperative contusions.

Output: No evidence of unexpected retained radiopaque foreign object. Findings discussed with Dr. Grogan at 1700 on 3/25/15.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: r/o infiltrate History: chest pain Cardiomediastinal silhouette is unremarkable.No specific evidence of infection or edema.No pleural effusion or pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval ET placement History: Above ET tube tip approximately 2 cm above the carina. Catheter tip in the SVC.Small lung volumes with nonspecific diffuse predominantly upper zone opacity and moderately large pleural effusions.No pneumothorax or other acute change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 49 years, Female. Reason: ulcerative colitis with increased abd pain. please check stool burden as h/o constipation History: abd pain No pulmonary airspace opacities or pleural effusions. Normal heart size.The bowel gas pattern is nonobstructive. Average stool burden.

Output: Nonobstructive bowel gas pattern. Average stool burden.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Cough with fever treated for pneumonia 7/22. Still not feeling well. Question resolution of right upper lobe consolidation. Improvement in the right upper lobe consolidation, though it has not completely resolved. No new pulmonary opacities. Posterior costophrenic angle blunting which may be due to small pleural effusions or scarring is unchanged. No large pleural effusions. Normal heart size. Mild pectus excavatum deformity.

Output: Although the right upper lobe consolidation has not completely resolved, it has improved, and pneumonia may take up to 6 weeks to fully clear on chest radiograph. Follow-up chest radiographs recommended 6 weeks from the time of initial study (on or slightly after September 2, 2016).


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Sarcoidosis with dyspnea, monitor effusions. Low normal lung volumes unchanged. No conclusive pleural fluid. Mild atelectasis at the lung bases has improved in the interim. Normal heart size.

Output: Low normal lung volumes but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Heart disease, angina. Chest tubes removed Mediastinal and left basilar chest tubes have been removed without apparent associated complication. Small persistent small effusions with decreased lung volumes and borderline cardiomegaly persists with atelectasis. No suspicious new focal acute airspace process.Sternotomy

Output: Chest tubes removed without complication


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval for chf History: doe, lee 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: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: chest pain, eval for PTX/PNA/fluid overload History: chest pain, eval for PTX/PNA/fluid overload The heart is normal in size.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces and visualized bones are within normal limits.

Output: No abnormal radiographic findings to suggest pneumonia, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Shortness of breath Cardiac mediastinal silhouette is unremarkable.Mildly increased lung volumes compatible with COPD.No focal airspace opacities.No pleural effusions.Degenerative changes of the thoracic spine with stable anterior wedging of several mid thoracic vertebrae.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: shortness of breath History: Shortness of breath Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: port repositioned History: same No significant cardiopulmonary abnormality.Right subclavian catheter, tip in SVC.Left subclavian pacemaker, leads unchanged in position.

Output: No significant abnormality. Port catheter tip repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: interval change History: interval chagne Stable cardiac enlargement with upper lobe predominant interstitial opacities unchanged.No focal areas of consolidation.No large pleural effusions.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old with acute congestive heart failure. Interstitial and airspace opacities are stable. Unchanged right greater than left bilateral pleural effusions. No pneumothorax.ECMO cannulae are unchanged in position.Tip of the feeding tube tip was retracted near the GE junction.Bilateral IJ catheter terminates in the SVC.

Output: Feeding tube tip retracted near the gastroesophageal junction. No other significant interval change from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: VATS, right upper lobectomy History: s/p VATS right upper lobectomy Postsurgical volume loss on the right with residual pleural effusion and atelectasis.No significant residual pneumothorax.

Output: Pleural effusion and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Confirm R IJ Line placement History: NA Cardiomegaly is unchanged. Basilar edema, atelectasis and layering pleural effusions are not significantly changed.Right IJ catheter tip in SVC. ICD is unchanged. Median sternotomy wires with small fracture of superior and inferior most wires. Swan-Ganz catheter tip slightly retracted in right main pulmonary artery. IABP marker 4 cm from top of aortic arch. Endotracheal tube tip 6 cm from the carina. NG tube tip projects beyond the inferior margins of the radiograph.

Output: Right IJ catheter tip in SVC.


Instruction: Generate impression based on medical findings.

Input: 87 year-old female colon cancer status post resection. Follow-up. CHEST:LUNGS AND PLEURA: Micronodules right middle lobe series 4 image 52, unchanged. Scarring lung bases.MEDIASTINUM AND HILA: Small mediastinal nodes unchanged. Cluster of index nodes in the AP window measured on series 2 image 32, 11.2 x 8.2 mm. No new nodes.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis unchanged. No focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement and portions of the pancreas. Focal small calcification some of which may be in the head of the pancreas, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small probable cysts bilaterally unchanged.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes stable. Index portacaval node measured on series 2 image 9213.2 x 9.7 mm.Atherosclerotic changes aorta and tortuosity.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: Limited due to streak artifact from hip prosthesis.UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis. Incisional hernia nonobstructive containing omentum and colon.BONES, SOFT TISSUES: Bilateral hip prostheses. Degenerative changes and discogenic disease lumbosacral spine.OTHER: Laxity pelvic floor.

Output: No interval change. Stable small nodes questionable significance. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 94 year-old female with stage IIIB non-small cell lung cancer. Please evaluate for disease status. CHEST:LUNGS AND PLEURA: The previously identified spiculated mass in the left upper lobe is larger and measures 3.4 x 2.4 cm in size as seen on image 86/283 of series 4. There is slight increase in pleural nodularity.MEDIASTINUM AND HILA: There is increase in mediastinal and hilar lymphadenopathy with a new right hilar lymph node measuring 1.9 x 1 cm as seen on image 121/283 of series 4. Furthermore, there is a multinodular goiter which appears stable from prior exam.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The hypodense lesion in the dome of the liver is unchanged. Furthermore, the previously described area of enhancement in the posterior aspect of the right lobe of the liver is also stable in appearance. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a omental hernia along the left lower abdominal wall containing fat without any signs of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: There are multiple calcified fibroids in the uterus..BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in size of the left upper lobe spiculated mass, increase in pleural nodularity, and increased mediastinal and hilar lymphadenopathy consistent with progressive disease.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with history of BAC status post right-sided resection with recurrent right upper lobe nodules and right middle lobe infiltrate. Please evaluate progression of nodules and infiltrate. CHEST:LUNGS AND PLEURA: Part-solid nodule in the right upper lobe (series 4, image 27) measures 10 x 12 mm (unchanged). The two additional foci of nodular consolidation in the right upper lobe (series 4, images 35 and 37) appear more solid on comparison to prior study. For example, the more posterior lesion (series 4, image 35) now extends to the pleura. The adjacent nodular pleural thickening appears similar to prior study.Area of consolidation abutting the right heart border and the right middle lobe (series 4, image 54) also appears more organized than on prior study.Multiple other nodules are unchanged.No new suspicious nodules or masses identified. No pleural effusions. Right-sided pleural nodularity, unchanged. Status post right lower lobectomy with mediastinal surgical clips.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: Multiple pulmonary nodules and areas of consolidation, some of which are more organized and solid than on prior study; findings continue to be suspicious for metastatic bronchioloalveolar cancer.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: abnormality? History: hypoxia Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of stage 4 lung CA, transfered from OSH with PNA History: sob, pna Focal masslike opacity in the superior segment of the left lower lobe and dense atelectasis and consolidation in both lower lobes, generally similar to a CT scan of 11/6/2014 though right lower lobe atelectasis has increased. Findings are consistent with a history of known lung cancer, possibly with superimposed infection.A CT scan is recommended for further evaluation of one has not been performed recently.

Output: Extensive bilateral opacity consistent with known lung cancer, possibly with superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Known pulmonary fibrosis.Decreased lung volumes and increased fibrosis since the prior study consistent with disease progression.Heart size normal.

Output: Worsening interstitial lung disease previously suggested to be UIP.


Instruction: Generate impression based on medical findings.

Input: Patient with malignant mesothelioma for follow up after 4 cycles chemo. LUNGS AND PLEURA: Extensive opacity in the right hemithorax, consistent with atelectasis and consolidation, has worsened since the last study. Loculated fluid in the right apex and loculated right subpulmonic effusion are not significantly changed.3 mm thickening at the 10 o'clock position and 11 mm thickening at the two o'clock position at the level of the right pulmonary artery (series 3, image 49), previously measuring 3 mm and 10 mm.12 mm thickening at the 10 o'clock position at the level of the aortic arch (series 3, image 35), previously 12 mm.5 mm thickening at the 5 o'clock position at the level of the carina (series 3, image 38), previously measuring 7 mm.MEDIASTINUM AND HILA: Lower right paratracheal lymphadenopathy, measuring 13 mm in short axis, unchanged. Subcarinal lymphadenopathy appears unchanged.Extensive coronary artery calcification.CHEST WALL: No findings suggestive of chest wall invasion. Degenerative disease in the thoracic spine.LIVER, BILIARY TRACT: Nonspecific hypodense lesion again noted in segment 4, now measuring 21 x 16 mm (previously 20 x 13 mm), not significantly changed. A few other smaller hypodense lesions in the liver, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonobstructing renal calculi.LYMPH NODES: No significant abnormality noted.VASCULATURE: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted.BONES: Degenerative disk disease.

Output: 1.Atelectasis and consolidation in the right lung, worse compared to previous. Loculated right pleural effusion, unchanged. 2.Pleural thickening consistent with mesothelioma with measurements as above.3.Mediastinal lymphadenopathy, not significantly unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: Post-Op History: S/p right bilobectomy 2 right-sided apical chest tubes are noted. Question of small right apical pneumothorax. Right-sided subcutaneous emphysema. Left lung is clear. Normal heart size.

Output: 2 right-sided apical chest tubes are noted. Small right-sided pneumothorax, not unexpected.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: acute pathology History: chest pain, nausea, sob, wheezing--r/o acs although likely asthma exacerbation Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 64 year-old man with metastatic melanoma. Please evaluate current disease. CHEST:LUNGS AND PLEURA:Bilateral multiple pulmonary nodules are appreciated in the lungs. The largest lesion is located in the posterior aspect of the left superior lobe and measures 2.7 x 2.7 cm in size. Small right pleural effusion is noted.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy or pericardial effusion is appreciated.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and is without any intraparenchymal lesions. There is a calcified gallstone in the neck of the gallbladder. There is no wall thickening or fat stranding.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a simple cyst at the superior aspect of the right kidney. There is also a high attenuation cyst in the left kidney which requires a non-contrast study for further evaluation. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a right inguinal hernia without any evidence of bowel wall thickening or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Multiple bilateral metastatic pulmonary nodules.2. Indeterminate high attenuation cyst in the left kidney which requires a noncontrast study for further evaluation.3. Cholelithiasis.4. Right inguinal hernia.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Status post lung transplant with shortness of breath. The cardiomediastinal silhouette is unchanged. Persistent elevation of the right hemidiaphragm with corresponding rightward mediastinal shift. Diffuse reticulation of the right lung is again visualized, consistent with history of interstitial lung disease. Left pleural effusion and adjacent atelectasis are unchanged. No pneumothorax.

Output: Left pleural effusion with adjacent atelectasis is unchanged.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic colorectal cancer, follow up scan CHEST:LUNGS AND PLEURA: Diffuse bilateral pulmonary metastasis are again noted. Emphysematous changes most pronounced in the upper lung fields are stable. Reference right apical mass measuring 2.2 x 1 .9 cm (series 5 image 24), asymmetric 2 x 2 centimeters.Right middle lobe mass measuring 3.5 x 3 .5 cm (series 5 image 53), previously measured 3.7 x 3.4 cm. Right lower lobe mass measuring 11 x 6 mm (series 5 image 45), previously measured 13 x 7 mm.No significant change in multiple non-reference lung lesions. MEDIASTINUM AND HILA: Reference right hilar adenopathy measuring 4.6 x 2.4 cm (series 3 image 43), previously measured 4.4 x 2 .2 cm. Coronary artery calcifications is again noted. Right-sided port with its tip terminating in the SVC. CHEST WALL: Status post median sternotomy. Right-sided port in unchanged position. Status post coronary artery bypass graft.Right clavicular expansile bone mass adjacent to the sternum measuring 2.5 x 2 .3 cm (series 3 image 14), previously measured 2.4 x 2 .2 cm. This lesion is now associated with posterior cortical break.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with no evidence of cholecystitis. Minimal Intrahepatic biliary dilatation is unchanged. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left upper adrenal nodule measuring 2.5 x 1.1 cm (series 3 image 11), previously measured 2.6 x 1 .1 cm.Left lower adrenal nodule measuring 1.8 x 1.7 cm (series 3 image 106), previously measured 1.7 x 1 .7 cm.Right adrenal nodularity is not significantly changed.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Right retrocrural lymph node measuring 1.5 x 1.5 cm (series 3 image 94), previously measured 1.7 x 1.4 cm.Reference retrocaval confluent lymphadenopathy measuring 2.5 x 1.6 (series 3 image 118), retrospectively previously measured 2.5 x 1.5.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Punctate scattered lesions in the thoracic and lumbar vertebral bodies, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant change in the sigmoid colon wall thickening and adjacent fat stranding.Soft tissue density mass measuring 1.2 x 1.1 cm (series 3 image 172), previously measured 1.1 x 1 cm.BONES, SOFT TISSUES: Punctate sclerotic lesions in the pelvic bones and vertebral bodies are unchanged.Bilateral fat containing inguinal hernia again noted.OTHER: No significant abnormality noted

Output: 1.No significant change in size of lung nodules and adenopathy.2.Stable adrenal lesions.3.Stable retrocrural and retroperitoneal lymphadenopathy.4.Interval increase in right expansile clavicular bone lesion, otherwise small sclerotic bone lesion are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval lung field History: eval lung fields History of cardiac arrest Tracheostomy tube and right subclavian catheter unchanged. Enteric tube tip in stomach.Hazy lower zone opacity compatible with pleural effusions and atelectasis.No new findings.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: SOB History: above No change in cardiomegaly and basilar consolidation.Small pleural effusions unchanged.

Output: No change in basilar consolidation and pleural effusions, with no new findings.


Instruction: Generate impression based on medical findings.

Input: 74 year-old female with end stage renal disease and history of stage II colon cancer 4/06. CHEST:LUNGS AND PLEURA: Calcified granulomataMEDIASTINUM AND HILA: Calcified mediastinal and right hilar nodes. 18 x 12 mm paratracheal lymph node (series 3; image 30), not significantly changed.The heart size is mildly enlarged.The esophagus is dilated with an air fluid level.CHEST WALL: The right-sided port terminates in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Borderline cortical thinning.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subtotal colectomy with ileostomy without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic disease.PELVIS:UTERUS, ADNEXA: Tubal ligation bilaterally. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subtotal colectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subtotal colectomy with ileostomy. No evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: size of ptx History: known ptx, sob Significant interval increase in moderate left pneumothorax. Other findings stable.

Output: Significant interval increase in moderate left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Follicular non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Multiple, round, well-defined cysts in both lungs are unchanged. The well defined and round appearance of these cysts is somewhat atypical for centrilobular emphysema. Lymphoid interstitial pneumonia can be considered in differential diagnosis. Scattered multiple nodules in both lungs are unchanged. Reference right middle lobe nodule is unchanged measuring 6 x 6 mm number 59, series number 4.MEDIASTINUM AND HILA: Reference prevascular conglomeration of lymph nodes is unchanged measuring 22 x 11 mm image number 29, series number 3. Other smaller mediastinal lymph nodes are also unchanged.CHEST WALL: Nonenlarged subpectoral and axillary lymph nodes are unchanged.ABDOMEN: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: Multiple mesentery lymph nodes and stranding in the mesentery are unchanged. The reference mesentery node measures 15 x 20 mm number 111, series number 3.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of pelvic free fluid is unchanged.

Output: No significant change from previous study. Multiple cystic lesions in the lungs may represent lymphoid interstitial pneumonia.


Instruction: Generate impression based on medical findings.

Input: 32 year old female requesting second opinion regarding ILD diagnosed by outside physician. History of cough and shortness of breath. Evaluate lungs. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.Specifically, no evidence of air trapping, honeycombing, or bronchiectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Cholecystectomy clips.

Output: No significant abnormalities. Specifically, no findings of interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: 90 year-old female with 3-mm nodule in left upper lobe on chest x-ray. CHEST:LUNGS AND PLEURA: Scattered micronodules. No nodule corresponding to opacity seen on recent chest radiograph identified. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Severe coronary artery calcifications. Low density of the blood suggests anemia.CHEST WALL: Right breast calcifications (series 4, image 61). No abnormal rib lesions identified.UPPER ABDOMEN: Benign-appearing hypoattenuating foci in the liver are incompletely characterized on this noncontrast examination. Atherosclerotic calcifications of the aorta and great vessels.

Output: Scattered micronodules. No nodule or rib abnormality identified that corresponds with opacity seen on recent chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Confirm ETT placement. Cutaneous abscess. ETT tip about 1.5 cm above the level of the carina. Left jugular catheter and visualized portion of the Dobbhoff tube unchanged. Lung volumes remain low with diffuse pulmonary opacities, layering pleural fluid and atelectasis. No significant sized pneumothorax.

Output: Low endotracheal tube, tip is about 1.5 cm above the level of the carina. Large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: s/p Esophagectomy History: s/p Esophagectomy Increased pulmonary edema and basilar subsegmental atelectasis.Bilateral chest tubes are unchanged with a small left apical pneumothorax not seen previously.An NG tube still traverses a gastric pull-up.

Output: Increased edema and a small left apical pneumothorax now visible.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: r/o pna History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection.